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Patient Ch., 24 years old, was operated on for acute gangrenous appendicitis. On the third day after the operation, oozing between the sutures of serous and then serous-purulent fluid was noted with the impregnation of subcutaneous fat. On the fifth day, pronounced hyperemia of the wound edges, dense edema of the skin and subcutaneous tissue proximally to the hypochondrium and distally to the upper third of the right thigh were found without a clear limitation of the process.
The stitches were removed, the edges of the wound were parted. A brownish exudate with a pungent unpleasant odor is released from the wound. Subcutaneous fatty tissue in the wound, fascia of gray-dirty color.
What is your presumptive diagnosis? What methods can be used to verify it?
The patient can assume extensive anaerobic non-clostridial phlegmon of the anterior abdominal wall and the upper third of the right thigh. The diagnosis is confirmed by bacteriological data.
But since the isolation and identification of non-clostridial microflora during bacteriological examination requires special equipment and a long period (3-5 days), in practice you can focus on the results of microscopy of a smear stained according to Gram, and the results of gas-liquid chromatography of phlegmon punctates and abscesses, pathologically altered tissues from different areas of the wound, surgical material after surgical treatment. The fact is that anaerobic microorganisms in the process of metabolism produce volatile fatty acids into the growth medium or into pathologically altered tissues: propionic, butyric, isobutyric, valeric, isovaleric and others, while aerobes do not form such compounds. These metabolites can be detected by gas-liquid chromatography.
A 25-year-old patient was transferred to the clinic from the regional hospital, due to phlegmon of the right thigh, which developed after an injury 7 days ago. Before admission, the skin and subcutaneous tissue were repeatedly dissected in the form of small incisions along the inner surface of the lower third of the thigh, leaving in the wounds of graduates from the glove rubber. On the antero-inner surface of the right thigh in the lower third of it there is a purulent-necrotic wound 15x18x9 cm in size. Necrosis of the skin and subcutaneous fat is noted, which is abundantly saturated with serous-purulent exudate with a pungent unpleasant odor. Expressed edema and hyperemia of the skin up to the level of the middle third of the thigh and the upper third of the lower leg.
What is your presumptive diagnosis and treatment tactics?
The patient should assume anaerobic non-clostridial phlegmon of the right thigh.
An urgent surgical intervention is shown, the essence of which consists in a wide dissection of the skin, starting from the border with healthy tissues, as well as tissues of the entire affected area with complete removal of pathologically altered subcutaneous tissue, fascia and muscles, without fear of the appearance of an extensive wound surface. Skin flaps along the edges of the surgical wound must be widened, laid on sterile gauze rolls, and sutured with separate sutures to the nearby unaffected skin. This technique allows you to improve aeration of the wound and visually monitor the course of the wound process.
Antibiotic therapy is a necessary component of treatment for non-clostridial infection. The drugs of choice are clindamycin, chloramphenicol (levomycetin), lycomycin, drugs with a targeted effect on ieclostridial anaerobes – metronidazole (trichopol) and its derivatives: tinidazole, tricanix, etc.
For 5 days after receiving a small wound on the right hand, the patient’s body temperature rose to 38 C when processing the land plot, muscle pains, difficulty swallowing, inability to close his mouth, and a sardonic smile appeared.
What complication did the patient have? Your actions?
The patient has tetanus. Surgical treatment of the wound should be performed immediately in order to remove pathogens and create unfavorable conditions for the development of anaerobic infection. After that, the patient is transferred to the intensive care unit, where he is given general tetanus treatment.
Serotherapy is performed under general anesthesia.
Anti-tetanus serum is administered intravenously for two days in a row, 200 000 IU per 250 ml of isotonic sodium chloride solution (this can completely neutralize the toxin circulating in the blood).
On the third day, the dose of tetanus toxoid is reduced by one third. In the acute period of the disease, triple adsorbed tetanus toxoid is injected, 1 ml each.
In order to relieve seizures, chlorpromazine is administered, which is prescribed in combination with sedatives, hypnotics, desensitizing, analgesics, antibiotics. In severe cases, muscle relaxants are recommended in combination with mechanical ventilation. To turn off consciousness, anesthesia with nitrous oxide, sedatives, antipsychotics is used.
A young woman was delivered to the emergency room by an ambulance on the 3rd day after an out-of-hospital abortion. Complains of pain in the lower abdomen. The condition is serious. The skin is pale. Pulse-112 beats per minute. The abdomen is soft, painful in the lower parts. Symptom Shchetkin-Blumberg questionable. Does the patient need emergency tetanus prophylaxis?
According to the “Instructions for the use of purified adsorbed liquid tetanus toxoid (AC-ana-toxin)” dated 07/14/89, a patient who has undergone an out-of-hospital abortion is subject to urgent specific prophylaxis of tetanus.
An ambulance car delivered a woman in labor with a newborn to the admission department of the district hospital. The birth took place at home about 6 hours ago. The condition of the newborn and the mother is satisfactory.
As a gynecologist, will you carry out emergency specific prophylaxis of tetanus in a woman in labor and a newborn?
Undoubtedly, during childbirth outside medical institutions, both the woman in labor and the newborn are subject to urgent specific prevention of tetanus.
A 30-year-old patient has undergone an appendectomy for emergency indications. Macroscopically removed gangrenous altered appendix. The abdominal cavity and the pelvic cavity are drained from the effusion. The latter was taken for bacterial culture and the sensitivity of microflora to antibiotics. A polyvinyl chloride microirrigator is connected to the bed of the vermiform appendix through the wound. The wound was sutured in layers. The patient was prescribed cold to the wound, pain reliever and antibiotics intramuscularly and into the abdominal cavity.
What else should the doctor prescribe in this situation?
In the given situation (the patient has gangrenous appendicitis), as with gangrene or tissue necrosis of any other type, the surgeon who operated should carry out urgent specific prophylaxis of tetanus.
A kitchen worker turned to the surgeon at the polyclinic, who, by negligence, 4 hours. she knocked over a pot of hot water over herself. On the antero-outer surface of the right thigh in an area of up to 4-5 / body there is tissue edema, bright redness of the skin, there is severe pain when touched. There are no bubbles. The patient was injected intramuscularly with an analgin solution with diphenhydramine, a bandage with a furacilin solution was applied to the burn surface. Emergency specific prophylaxis of tetanus was not carried out.
Did the surgeon do the right thing in this case and why?
Indeed, in this case, the surgeon’s actions in relation to emergency specific prophylaxis of tetanus were correct.
With superficial burns of the 1st degree, as well as with frostbites of the 1st degree, there are no indications for urgent specific prophylaxis of tetanus, since with such lesions the protective skin barrier against the penetration of microbes is generally not broken.
A teenager came to see the surgeon with a stab wound on the plantar surface of his right foot. Two hours ago I stepped on a board with a nail. The polyclinic has documentary evidence that the boy received a full course of routine vaccinations in accordance with age.
The wound was cleaned on the foot, and an aseptic bandage was applied.
How can specific tetanus prophylaxis be carried out?
In the given case, a teenager who has received all routine vaccinations in accordance with age, for which there is documentary evidence, urgent specific prophylaxis of tetanus is not carried out regardless of the period since the last vaccination.
For wounds prone to infection (infected wounds), if more than 5 years have passed after the previous revaccination, 0.5 ml of tetanus toxoid is injected subcutaneously into the subscapularis.
A 76-year-old patient was admitted to the surgical department with complaints of abdominal pain. Acutely fell ill 16 hours ago. The condition is serious. Pulse – 116 beats per minute. The tongue is coated, dry. The abdomen is somewhat swollen, does not participate in the act of breathing, is tense boardlike, painful most of all in the left iliac region, above the bosom and along the left lateral canal. Shchetkin’s symptom – Blumberg positive. On the general X-ray, pneumatization of the intestine is noted, there is no free gas under the domes of the diaphragm. Digital examination of the rectum revealed no pathology.
An emergency laparotomy revealed perforation of the sigmoid colon with a fish bone, moderately swollen intestinal loops, and fibrinous-purulent effusion in the abdominal cavity. An unnatural anus is imposed. The abdominal cavity is drained, drained.
Vaccination history is unknown, although there were no contraindications to vaccination.
Is an emergency specific prophylaxis of tetanus necessary in this case? If necessary, how will you carry it out?
In the given case, as in other situations associated with the opening of the intestine, it is necessary to carry out urgent specific prophylaxis of tetanus.
After an intradermal test, the patient needs to inject 1 ml of tetanus toxoid and 3000 IU of tetanus toxoid (or 250 IU of human tetanus immunoglobulin) subcutaneously from different syringes. After 30-40 days and after 6-12 months, 0.5 ml of tetanus toxoid is injected again.
A woman came to your appointment with complaints of headache, weakness. She has been ill for two days.
On the dorsum of the right hand, against the background of pronounced edema, there is a necrotic ulcer with abundant serous discharge and a depressed dark center. An inflammatory rim and a corolla of vesicles filled with serous exudate are observed around the ulcer.
You suspect an anthrax carbuncle. What will be your actions?
It is necessary to apply a bandage with an antiseptic on the hand and hospitalize the patient in the infectious diseases department. In addition, it is necessary to inform by phone and send a written emergency notification of the detected case of the disease to the sanitary and epidemiological station.
On a day off, a 19-year-old patient came to the emergency room of the hospital with a request to bandage the wound he received 1.5 weeks ago. He did not seek medical help.
From the anamnesis it is known that a month ago he suffered from pharyngeal diphtheria.
On the palmar surface of the middle third of the right forearm, there is a cut-lacerated wound 5×3 cm in size, covered with a purulent bloom and a gray-yellow film, which is difficult to remove with tweezers. In places where the film is removed, the wound bleeds. The edges of the wound are infiltrated, red. Moderately enlarged axillary lymph nodes on the right are palpated.
You suspect wound diphtheria.
How do you confirm the diagnosis? What should you do with the patient? What is your treatment strategy?
To verify the diagnosis, it is necessary to perform a microscopic examination of smears from the wound, stained according to Gram, Neisser, Leffler. After applying a bandage with an antiseptic solution to the wound, the patient should be sent to the infectious diseases hospital by special sanitary transport. Complete isolation of the patient is required. Treatment consists in subcutaneous or intramuscular administration of antidiphtheria serum at a dose of 2000-4000 AE with preliminary desensitization by subcutaneous administration of 0.1 ml first, 0.2 ml after 30 minutes and the rest of the dose after 1-2 hours. Topically applied dressings impregnated with specific serum, as well as antiseptic solutions.
CHRONIC SPECIFIC SURGICAL INFECTION
A 39-year-old patient was admitted to the surgical department with suspicion of a strangulated right-sided femoral hernia.
The patient has a history of pulmonary tuberculosis. When viewed under the right groin fold on the anterior-inner surface of the thigh, a tumor-like formation measuring 3×6 cm of dense elastic consistency, fixed, painless, is determined. The skin above it is not changed.
The duration of the disease is about four days.
What is your presumptive diagnosis? What research will you conduct to clarify it?
With such a clinical picture, the patient should be expected to have tuberculous spondylitis of the lumbar-thoracic spine, complicated by a loose abscess on the right thigh.
In order to clarify the diagnosis, first of all, it is necessary to perform an X-ray of the lumbar-thoracic spine.
A patient was taken to the emergency room 40 minutes after a minor injury (fell out of bed) with complaints of pain in the thoracic spine.
The patient has a history of pulmonary tuberculosis. An X-ray of the spine suggests a compression fracture of the 8th and 9th thoracic vertebrae. What pathological process can a patient have?
Given the history of the disease, the nature of the injury, one should first of all think about a pathological compression fracture of the thoracic vertebrae due to tuberculous spondylitis.
An 80-year-old woman came to the local doctor with complaints of neck pain on the left. Has been ill for about two weeks. She suffered a stroke 30 years ago. There is right-sided hemiparesis. About a year ago, I first discovered in my left submandibular region, and then on the neck, dense nodes, which gradually increased. Two weeks ago, a fistula opened in the left submandibular region, from which a meager amount of liquid pus with yellowish-gray grains was released. The skin around is not changed.
What is your diagnosis? What additional studies will you assign to confirm it?
The patient should assume tuberculosis of the cervical lymph nodes with their decay.
To confirm the diagnosis, it is necessary to sow the discharge from the fistula on the tuberculous flora, perform a chest fluoroscopy, and appoint an ENT doctor’s consultation.
A patient came to the clinic for an appointment with the surgeon with complaints of pain in the right hip joint, the presence of a tumor-like formation in the right popliteal fossa. Examination revealed a pronounced atrophy of the muscles of the right thigh, a positive symptom of Aleksandrov, fluctuation in the area of a tumor-like formation in the right popliteal fossa.
The surgeon performed a puncture of the tumor-like formation, received pus.
What mistake was made by the surgeon? What additional research methods were needed?
The surgeon decided on a puncture without a specified diagnosis, which, of course, will not bring success in stopping the process. First of all, it was necessary to make X-rays of the right hip joint and fluoroscopy of the lungs, and when clarifying the diagnosis, send the patient to hospital treatment (possibly tuberculosis of the right hip joint with cold congestion in the popliteal fossa!).
A patient admitted to the emergency room of the hospital with complaints of pain in the right thigh area has a sharp pain on palpation of the latter.
The patient has a history of pulmonary tuberculosis. On examination, there is atrophy of the thigh muscles, a positive symptom of Aleksandrov, and limited mobility in the right hip joint. On the roentgenogram, the phenomena of osteoporosis and a fracture of the upper third of the thigh with displacement of bone fragments along the length with their overlap up to 3-4 cm are determined.
What is your diagnosis? What help will you render to the patient?
A patient has pulmonary tuberculosis, right thigh, pathological fracture of the upper third of the latter with displacement of bone fragments along the length. He needs to inject painkillers, apply an immobilizing bandage and be hospitalized in the trauma department.
A patient who consulted a doctor with complaints of pain during swallowing, during examination, revealed a lumpy, dense, 10×15 cm infiltrate in the submandibular region on the left. The skin above it is bluish-purple in color. Body temperature 36.7 ° C.
What is your presumptive diagnosis? What will you do with the patient?
The patient apparently has actinomycosis of the left submandibular region.
He should be referred for inpatient treatment at the dental department.
A patient admitted to a surgical hospital with complaints of abdominal pain, when examined in the right iliac region, revealed a lumpy, immobile infiltrate with a size of 10×12 cm in the right iliac region.Fluctuation in the projection of the tumor is not detected, the skin over it is not changed. Peritoneal symptoms are negative. Body temperature 36.6 ° C. Sick for 14-16 days.
What disease do you suspect in the patient? What additional research would you assign?
The patient may have actinomycosis of the cecum. But this disease should be differentiated primarily with appendicular infiltration, cecum tuberculosis, its tumor, Crohn’s disease, a pathological process on the part of the right uterine appendages.
To do this, it is necessary to do a general blood test, consult a gynecologist, perform a fibrocolonos copy, irrigoscopy, a reaction with actinolysate (filtrate of lysing actinomycete cultures) and serological complement binding reactions.
A 26-year-old woman came to the clinic for an appointment with the surgeon complaining of pain in the right lower leg, especially at night. Single. Leads a hectic life. Shin injury is excluded.
The patient considers himself about 2.5-3 months. On examination, a painful soft swelling of the anterior surface of the right tibia is determined.
What is your presumptive diagnosis? What additional research will you assign? What should you do with the patient?
The patient may have syphilis (secondary period) with periostitis of the right tibia. To confirm the diagnosis, it is necessary to use the results of serological research methods (Wasserman reactions, sedimentary reactions of Kahn, Sachs-Vitebsky).
The patient should be referred to a venereal hospital for specific treatment.
Necrosis, Gangrens, Ulcers, Fistulas, BED.
A 40-year-old patient suffering from atrial fibrillation suddenly developed severe pain in the left foot and lower leg. The patient groans with pain. The foot and lower third of the lower leg are pale, cold to the touch. Palpation of the lower leg is sharply painful, active movements in the ankle joint are absent, tactile sensitivity on the foot is reduced. The pulse on the femoral artery is satisfactory, on the other arteries of the limb is not determined.
What is your diagnosis and treatment tactics?
A patient has thromboembolism of the femoral artery. She should immediately inject 5000 IU of heparin intravenously, 2 ml of a 2% solution of papaverine hydrochloride and 1 ml of a 2% solution of promedol or another anesthetic. The patient, according to urgent indications, should be hospitalized in the vascular or general surgical department, where, by a specialized team, she urgently needs to perform thromboembolectomy.
In a patient located at a gynecological distance, on the 11th day after extirpation of the uterus, there were bursting pains in the left lower extremity, pronounced swelling of the foot, lower leg and thigh. The toes are warm, movement and sensitivity are preserved.
What happened? Where and how should the patient be treated?
A patient has a clinical picture of acute thrombosis (phlebothrombosis) of the left common iliac vein. She should be immediately transferred to the vascular or general surgery department for thromboectomy with restoration of blood flow in the iliac vein.
A 36-year-old patient, about 1 year ago, developed intermittent claudication: every 400-500m of the way he had to stop due to pain in the calf muscles. Before hospitalization, this distance was reduced to 100 m, pain appeared in the first toe, and a deep necrotic ulcer developed on the toe. The skin on the legs is marbled, the distal parts of the feet are bluish-purple. Cold to the touch. The nail plates are dull, brittle. Pulse on the dorsal arteries of the feet is absent, on the popliteal arteries it is weakened.
What disease does the patient have? How will you treat it?
The patient has obliterating endarteritis. Since the disease progresses rapidly, the patient is shown bilateral lumbar sympathectomy and necrectomy of the first finger. At the same time it is necessary to carry out conservative treatment (complex of vitamins C, B, B6, vasodilators), physiotherapy and hyperbaric oxygenation.
The patient, 60 years old, within 1.5-2 years began to notice intermittent claudication, and in the last 2-3 months. pain in the right gastrocnemius muscle appears every 50m way. The right foot began to freeze even in summer and get tired after a short stay on his feet. On examination, the right foot and lower third of the lower leg are paler and colder to the touch than the left. Pulse on the dorsal artery of the right foot, posterior tibial and popliteal arteries is not detected, on the right femoral artery is weakened. Above the latter, with the help of a phonendoscope, a systolic murmur (a symptom of a “top”) is clearly heard. The general condition of the patient is satisfactory.
What is your diagnosis and treatment tactics?
The patient suffers from obliterating atherosclerosis with a clear lesion of the aorto-femoral segment on the right. To clarify the diagnosis, it is necessary to perform angiography. In the case of damage to only the aorto-iliac segment, aorto-femoral shunting is indicated, and in case of vascular lesions over a short distance, endarterectomy. If the femoral artery is damaged, bypass grafting is performed with an autovenous graft.
To perform these operations, the patient must be referred to the vascular surgery department.
The mother decided, using concentrated nitric acid, to remove the wart on the palmar surface of her finger for her young daughter. After that, a long-term non-healing ulcer with a diameter of about 1 cm formed on it. What method of treatment is indicated for the patient?
After a course of conservative treatment (dressings with proteolytic enzymes, antiseptics, UHF currents), when the ulcerative surface is completely cleared, the child is shown skin plastic surgery.
A patient 2 years ago underwent resection of the stomach with the imposition of anastomosis m / u of the stumps of the stomach and the jejunum. For about a year, the patient is worried about epigastric pain, sour eructations, nausea, sometimes vomiting, notes weight loss.
What is your presumptive diagnosis? What specials. research methods should be used to confirm the diagnosis?
The patient should assume a peptic ulcer of the anastomosis.
To confirm the diagnosis, it is necessary to carry out fluoroscopy (X-ray) of the stomach or fibro-esophagogastroscopy, as well as examine the acidity of gastric juice.
A patient suffering from varicose veins of the lower extremities developed an ulcer on the inner surface of the lower third of the right leg 2 years ago. On examination, the ulcer is rounded, up to 5 cm in diameter, with gently sloping edges. Its bottom is covered with flaccid granulations with serous bloom. Around the circumference of the ulcer, brown-brown pigmentation is determined. What is your treatment strategy?
A patient has varicose veins of the lower extremities with circulatory disorders. This was the reason for the formation of a trophic ulcer of the right leg.
To improve blood circulation, the patient should be advised to lie down with a raised right leg or to bandage the limb with an elastic bandage. It is necessary with the help of proteolytic enzymes, hypertonic solutions, antiseptics, ointment dressings, physiotherapeutic procedures to achieve complete cleansing of the ulcer, to perform it with granulation tissue and to recommend the patient surgical treatment: removal of varicose saphenous veins (subject to deep veins patency) and skin grafting of the ulcer defect.
A 40-year-old patient with fractures of the pelvic bones and the right thigh developed shortness of breath, tachycardia, cyanosis, and a disorder of consciousness 1.5 days after the injury. The body temperature rose to 40 ° C. X-ray studies in the lungs revealed small eclipses, similar to snow patches.
What complication should you think about? What are the necessary treatment measures? What is the prevention of such a complication?
The patient should assume a fatty embolism of the capillaries of the lungs and brain.
The complex of therapeutic measures should include tracheal intubation with artificial lung ventilation, parenteral and tube feeding, infusion therapy aimed at replenishing the circulating plasma volume, restoring microcirculation and rheological properties of blood.
Prevention of fatty embolism consists in the correct transport immobilization of the limb and the implementation of anti-shock measures.
In severe fat embolism, hyperbaric oxygenation is performed, drugs that improve tissue metabolism are prescribed, lipospadil is administered intravenously for three days, 40-60 ml and heparin, 5 000 ED.
A 76-year-old patient was admitted to the hospital with complaints of severe pain in the right foot. Has been ill for about 10 days. She did not seek medical help. The condition is serious. Inhibited. Pulse-116 beats per minute, weak filling. Blood pressure – 100/60 mm Hg. Oliguria. Body temperature – 39.2 ° C. The left side and lower leg are edematous, pale, narrow stripes of hyperemia are noted in the longitudinal directions. Toes and distal part of the foot are dirty gray in color. On the back of the foot, a flitten-weeping surface with a fetid odor is determined.
What is your diagnosis and treatment tactics?
The patient has wet gangrene of the left foot. Given the severity of the patient’s condition caused by intoxication, it is necessary to parenterally inject a sufficient amount of fluid (hemodez, glucose solutions, electrolytes), heart drugs, vitamins, diuretics, antibiotics, make a blood transfusion, hyperimmune plasma, and enter staphylococcal toxoid. Emergency prophylaxis of tetanus is indicated. An early necrotomy is performed locally, low-temperature dry air baths are prescribed, dead tissues are treated with an alcohol solution of tannin or iodine, and ultraviolet irradiation is performed. If the condition does not improve, for health reasons the limb is amputated within the healthy tissues.
A 70-year-old patient has an artificial colonic fistula due to peritonitis caused by perforation of the swollen sigmoid colon. After 4 days, the patient began to complain of moderate local pain in the coccyx area. Operated with excess nutrition, adynamic, all the time lies in bed, motionless on his back. When viewed in the projection of the coccyx base, local venous hyperemia is noted without clear boundaries.
What kind of complication is possible? What preventive measures should be taken?
You should think about the danger of bedsores in the patient. Along with adequate general treatment, in order to prevent the formation of pressure ulcers, it is necessary that the sheets under the patient and underwear are not gathered into folds, they are clean. Service personnel are obliged to turn it 8-10 times a day. A slightly inflated rubber circle (water cushion, foam pad) should be placed under the sacrum. Particular attention should be paid to the cleanliness of the skin, for this it is washed 2-3 times a day in the most vulnerable areas of the body with cold water and soap and wiped with napkins moistened with camphor alcohol, vodka, cologne, and then wiped dry. It is advisable to carry out UV irradiation (suberythemal doses), UHF therapy.
A woman came to your appointment with a 4-year-old child. From the moment of birth, on the left neck of the boy there is a pink mass up to 2.5 cm in diameter, slightly protruding on the surface of the skin, soft, painless, changing color when pressed. What is your presumptive diagnosis and treatment recommendations?
A patient has a benign vascular tumor – he-mangioma. The child can be recommended radiation therapy, cryotherapy on the tumor, or its surgical excision.
A 21-year-old patient was admitted to the hospital with complaints of the presence of a mass in the lumbar region on the right (up to 7 cm in diameter), which appeared about 4 years ago and is slowly increasing. On palpation, it is of a soft consistency, painless, with clear boundaries, limited displacement, not adhered to the skin. What is your diagnosis and treatment tactics?
A patient has a benign tumor of the right lumbar region – a lipoma. Surgical treatment is indicated: removal of the tumor along with the capsule.
Since the tumor (lipoma) has reached a significant size and causes inconvenience to the patient, surgical treatment is indicated: its removal.
A 35-year-old patient turned to a surgeon complaining of a mass (10×5 cm) in the area of the left gluteofemoral fold. The tumor interferes with sitting, slightly displaceable on palpation, painless, soft consistency. Is surgical treatment indicated for the patient?
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A 42-year-old patient turned to you for help in connection with the presence of a dense mass up to 2 cm in diameter in the region of the cranial vault on the left. The tumor grows relatively quickly. On palpation, the density of the formation is stony, the skin above it is displaceable, the outlines are clear, the tumor is motionless, painless. On the roentgenogram, a homogeneous tissue with clear edges in the outer bone plate is determined. What is your presumptive diagnosis and action?
Clinically, it is impossible to exclude periosteal osteosarcoma of the cranial vault in the patient. Therefore, she should be referred to an oncological dispensary for treatment.
A 65-year-old patient turned to a surgeon complaining of the presence of three rounded formations from 1 to 2 cm in diameter in the scalp region, which he discovered 3-4 years ago. They slowly increase, have smooth, clear contours, are painless, of a densely elastic consistency, the skin above them is not displaceable. What is your diagnosis and treatment tactics?
The patient has atheroma of the scalp. They are retention cysts that develop from stretching of the sebaceous gland capsule by its contents (fat) due to blockage of the excretory duct.
The patient should be recommended surgical treatment: exfoliation of atheroma. Otherwise, with inflammation, their suppuration occurs: the skin above them turns red, becomes thinner and breaks through. In addition, if during the operation part of the cyst wall remains unremoved (which is often observed with suppuration), then a relapse is possible.