Rationale: Necrotizing fasciitis is an aggressive infection of subcutaneous tissues, which tends to spread rapidly through the fascial planes. Colonic diverticulosis is a common disease in advanced age, although it ra...Rationale: Necrotizing fasciitis is an aggressive infection of subcutaneous tissues, which tends to spread rapidly through the fascial planes. Colonic diverticulosis is a common disease in advanced age, although it rarely causes a lethal necrotizing soft-tissue infection. Patient concerns: A 58-year-old woman complained of left leg pain for 15 d without abdominal pain. Diagnosis: Diverticulitis perforation presented as necrotizing fasciitis of the left thigh. Interventions: Extensive debridement. Outcomes: The patient died due to sepsis-induced multiple organ failure and severe metabolic acidosis. Lessons: Clinicians should be aware of presentations of diverticulitis in patients who have a soft-tissue infection in lower extremity even though patients may not have had a history of diverticulosis or abdominal pain.展开更多
Objective: To prevent unnecessary laparotomies by evaluating the effectiveness of conservative approach in abdominal trauma cases due to drilling-cutting instruments.Methods: Demographic data, effected region of the b...Objective: To prevent unnecessary laparotomies by evaluating the effectiveness of conservative approach in abdominal trauma cases due to drilling-cutting instruments.Methods: Demographic data, effected region of the body, additional findings of trauma, hemodynamic parameters, duration of admission, diagnostic methods and treatment modalities were retrospectively evaluated in 217 cases with abdominal injury (lower thoracic region, abdominal wall and back) among 1128 victims with drilling-cutting instrument injuries between January 1, 2012 and December 31, 2017. The conservative approach was based on physical examination, hemogram follow-up and hemodynamic evaluation.Results: Totally 177 (81.6%) cases of 217 patients were followed conservatively while 25 cases were operated at early (1-8 hours) and 15 were operated at late (9-48 hours) periods. Two patients who underwent surgery in the early period and two patients who underwent surgery in the late period were accepted as negative laparotomy while 1 patient in the late operated group was regarded as non-therapeutic laparotomy. Diagnostic laparoscopy was performed in 81 cases. Complications developed in 7 patients who were operated in the early period and 10 patients who were operated in the late period. The mean hospital stay period was 5.3 days (1-33) in all cases, 4.5 days (2-20) in conservative treatment group and 8.4 days (3-33) in the operated patients;and the difference was statistically significant.Conclusions: Detailed physical examination, accurate assessment and effective use of different diagnostic methods reduce the frequency of negative and non-therapeutic laparotomies in abdominal stab wound injuries.展开更多
Objective:To investigate the effect of the use of color codes for patient triage on physicians’clinical decision.Methods:This prospective study was conducted among female patients aged 18-65 years who visited the eme...Objective:To investigate the effect of the use of color codes for patient triage on physicians’clinical decision.Methods:This prospective study was conducted among female patients aged 18-65 years who visited the emergency department(ED)with complaints of acute abdominal pain.A 3-level of triage system[red(very urgent),yellow(urgent)and green(less urgent)]was used in our ED.All patients were green level.Half of these patients remained at the green level(the green group),and the remaining patients were re-labeled as false yellow(the false yellow group)in the order of ED visits.Ordering tests,consultation requests,intravenous treatment,length of hospital stay,and cost were compared between the two groups of patients.Results:In total 393 patients were included with 198 patients in the green group and 195 in the false yellow group.There was no statistically significant difference between the two groups in age,temperature,systolic blood pressure,diastolic blood pressure,pulse and oxygen saturation(P>0.05).It was observed that more tests(P=0.001),consultations(P<0.001),and intravenous treatment were requested(P<0.001),and the duration of stay in the ED was longer(P<0.001)and cost(P<0.001)was higher in the false yellow group.Conclusions:Triage do affect the decisions of physicians on female patients with acute abdominal pain.展开更多
文摘Rationale: Necrotizing fasciitis is an aggressive infection of subcutaneous tissues, which tends to spread rapidly through the fascial planes. Colonic diverticulosis is a common disease in advanced age, although it rarely causes a lethal necrotizing soft-tissue infection. Patient concerns: A 58-year-old woman complained of left leg pain for 15 d without abdominal pain. Diagnosis: Diverticulitis perforation presented as necrotizing fasciitis of the left thigh. Interventions: Extensive debridement. Outcomes: The patient died due to sepsis-induced multiple organ failure and severe metabolic acidosis. Lessons: Clinicians should be aware of presentations of diverticulitis in patients who have a soft-tissue infection in lower extremity even though patients may not have had a history of diverticulosis or abdominal pain.
文摘Objective: To prevent unnecessary laparotomies by evaluating the effectiveness of conservative approach in abdominal trauma cases due to drilling-cutting instruments.Methods: Demographic data, effected region of the body, additional findings of trauma, hemodynamic parameters, duration of admission, diagnostic methods and treatment modalities were retrospectively evaluated in 217 cases with abdominal injury (lower thoracic region, abdominal wall and back) among 1128 victims with drilling-cutting instrument injuries between January 1, 2012 and December 31, 2017. The conservative approach was based on physical examination, hemogram follow-up and hemodynamic evaluation.Results: Totally 177 (81.6%) cases of 217 patients were followed conservatively while 25 cases were operated at early (1-8 hours) and 15 were operated at late (9-48 hours) periods. Two patients who underwent surgery in the early period and two patients who underwent surgery in the late period were accepted as negative laparotomy while 1 patient in the late operated group was regarded as non-therapeutic laparotomy. Diagnostic laparoscopy was performed in 81 cases. Complications developed in 7 patients who were operated in the early period and 10 patients who were operated in the late period. The mean hospital stay period was 5.3 days (1-33) in all cases, 4.5 days (2-20) in conservative treatment group and 8.4 days (3-33) in the operated patients;and the difference was statistically significant.Conclusions: Detailed physical examination, accurate assessment and effective use of different diagnostic methods reduce the frequency of negative and non-therapeutic laparotomies in abdominal stab wound injuries.
文摘Objective:To investigate the effect of the use of color codes for patient triage on physicians’clinical decision.Methods:This prospective study was conducted among female patients aged 18-65 years who visited the emergency department(ED)with complaints of acute abdominal pain.A 3-level of triage system[red(very urgent),yellow(urgent)and green(less urgent)]was used in our ED.All patients were green level.Half of these patients remained at the green level(the green group),and the remaining patients were re-labeled as false yellow(the false yellow group)in the order of ED visits.Ordering tests,consultation requests,intravenous treatment,length of hospital stay,and cost were compared between the two groups of patients.Results:In total 393 patients were included with 198 patients in the green group and 195 in the false yellow group.There was no statistically significant difference between the two groups in age,temperature,systolic blood pressure,diastolic blood pressure,pulse and oxygen saturation(P>0.05).It was observed that more tests(P=0.001),consultations(P<0.001),and intravenous treatment were requested(P<0.001),and the duration of stay in the ED was longer(P<0.001)and cost(P<0.001)was higher in the false yellow group.Conclusions:Triage do affect the decisions of physicians on female patients with acute abdominal pain.
