Biomedical subjects

T B Purcell

Publications and source records attributed to T B Purcell.

5 recordsLinked to original sources

PubMed1991

The somatic patient.

A significant proportion of patients seen in the Emergency Department will present with somatic complaints for which there is no apparent physiologic cause. Such patients may be divided into two broad categories: (1) those with symptoms and signs consciously synthesized by the patient, either for obvious secondary gain (malingering) or as a result of more subtle and complex motivations (factitious disorders); and (2) those patients with symptoms that are the unconscious expression of psychological stress (somatoform disorders). The somatoform disorders include (1) somatization disorder (characterized by a chronic history of numerous and widely divergent somatic complaints), (2) psychogenic pain disorder (somatization expressed in terms of persistent pain), (3) hypochondriasis (a conviction that one is diseased and disabled in conjunction with a well-focused constellation of supporting symptoms), and (4) conversion disorder (a single, usually nonpainful neurologic symptom, often with identifiable coping value for the patient). The first three disorders have been aggregately termed the "common somatization syndrome." Management of the somatically focused patient includes the communication of a caring attitude to the patient in conjunction with a cautious and diligent search for treatable medical or psychiatric illness. Resocialization and development of patient links with ongoing, nurturing nonmedical as well as medical support systems is of benefit.

Emergency Service, Hospital↗

PubMed1989

Nonsurgical and extraperitoneal causes of abdominal pain.

Most patients presenting to the emergency department with acute abdominal pain suffer from disorders requiring other than surgical intervention. Unnecessary morbidity may be avoided through understanding the anatomic and physiologic variables involved in producing abdominal pain. Table 1 lists conditions that may simulate an acute surgical abdomen. Selected disorders were discussed.

Abdomen↗

PubMed1983

Emergency autotransfusion.

Autotransfusion, a technique with more than 160 years of experience behind it, has become a subject of renewed interest in the emergency setting. The technique itself is not much more difficult than the tube thoracostomy or the peritoneal lavage that otherwise might be indicated in the multiple trauma victim and that would be required to start collection of autologous blood. The previously feared complications of hematologic or metabolic embarrassment and of sepsis have not proved to be of clinical significance when appropriate patient selection and careful technique are followed. In addition the use of autologous blood has a number of advantages over the transfusion of stored homologous blood in the emergency patient, including ready availability of compatible blood, homeostasis of core temperature, higher levels of red blood cell 2,3-DPG, and cost effectiveness. A review of the literature reveals that, while it is not totally free of complications, the benefits to be gained from autotransfusing the selected trauma patient outweigh the relatively limited risks of the procedure.

Blood Transfusion, Autologous↗

PubMedDate not supplied

Necrotizing fasciitis in the pediatric age group: report of a case.

Necrotizing fasciitis is a rapidly progressive invasive soft tissue infection that is rarely seen in the pediatric population. In the majority of cases described in the medical literature, there has been an identifiable initiating event such as instrumentation or other trauma to the skin. Because of the rapid progression of the infection, the key to a successful outcome is early recognition and rapid initiation of definitive surgical management. A case is presented in which necrotizing fasciitis was seen in a child with no precipitating skin trauma.

Emergencies↗

PubMedDate not supplied

Accuracy of the tongue blade test in patients with suspected mandibular fracture.

The inter-observer reliability and accuracy of the tongue blade test (TBT) for the identification of patients with mandibular fracture was prospectively evaluated using radiographic diagnosis as the gold standard. A consecutive sample of 110 patients presenting to the emergency department of a teaching county hospital was studied. Patients with uninterpretable x-rays, known diagnosis of mandibular fracture, or inability to cooperate for the test were excluded. Bilateral ability to crack a wooden tongue blade held between the teeth was scored as a negative test. Fifty-three patients had mandibular fractures. In the study group, the TBT had a sensitivity of 95.7%; a specificity of 63.5%; a positive predictive value of 66.2%; a negative predictive value of 95.2%; and an accuracy of 77.3%. The TBT provided contributory evidence useful in screening patients for mandibular fracture.

Adolescent↗