Skip to Main Content

++

Umbilical discharge

++

In adults usually infected (fungal or bacterial) dermatitis, often with offensive discharge.

++

Precautions: consider umbilical fistula, carcinoma, umbilical calculus.

++ Management:
++

  • Swab for micro and culture.

  • Toilet—remove all debris and clean.

  • Keep dry and clean—daily dressings.

  • Consider Kenacomb ointment.

++

Umbilical granuloma in infants

++

Apply a caustic pencil gently daily for about 5 d.

++

Undescended testes

++

A testis that is not in the scrotum may be ectopic, absent, retractile or truly undescended.

++
The problem of non-descent
++

  • Testicular dysplasia

  • Susceptible to direct violence (if in inguinal region)

  • Risk of malignant change (seminoma) is 5–10 times greater than normal

++
Optimal time for assessment
++

Between 3 and 6 mths (before development of cremasteric reflex and thus confusion with a retractile testis)

++

Review 2½–3 yrs—?acquired maldescent

++
Refer
++

  • All undescended testes by 6 mths

  • Acquired maldescent

  • Concerned parents

  • Doubtful position of testis

++
Optimal time for surgery
++

The optimal time for orchidopexy is 6–12 mths. Production of spermatozoa is adversely affected in undescended testes from 2 yrs onwards. Exploration for the uncommon impalpable testis is worthwhile.

++
Hormone injections
++

Injections of chorionic gonadotrophic hormones are generally not recommended. They are ineffective except for borderline retractile testes.

++

Unemployment

++

Leads to increased cardiovascular disease, death rate and psychiatric illness.

++

Objective is to prevent resignation, hopelessness and deterioration of health. Encourage positive outlook with readiness to re-enter labour force.

++
Vulnerable groups
++

  • School leavers, esp. non-achievers (beware of impulsive overdoses)

  • History of psychosomatic or physical disability

  • Children of the unemployed

  • Previous problematic marriages

  • Men with many dependants

  • Those >50 yrs with good job records

++ Role of GP
++

  • Diagnostic awareness

  • Foreshadow problems

  • Caring, supportive counselling (very powerful)

  • Liaison with social services

++

Urethritis

++

The important STIs that cause urethritis which may be asymptomatic (esp.♀s) are gonorrhoea and Chlamydia trachomatis.

++ Collection of specimens
++

Check with your laboratory. The conventional method is as follows.

++

  • The NAAT (PCR) Chlamydia urine test (95% specific) is the preferred test (in both sexes), traditionally on the first catch urine specimen (don't urinate for 4 hrs) then first 10 mL passed in an ordinary MCU jar. However, now the specimen can be collected at any time—there is no minimum time since the last urination.

  • New approaches are to collect a random sample by passing urine through a UriSWAB or self-collection from a tampon in females.

++

These tests ...

Want remote access to your institution's subscription?

Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.

Ok

About MyAccess

If your institution subscribes to this resource, and you don't have a MyAccess profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus.

Subscription Options

Murtagh Collection Full Site: One-Year Subscription

Connect to a suite of general practice resources from one of the most influential authors in the field. Learn the breadth of general practice, including up-to-date information on diagnosis and treatment, as well as key clinical skills like communication.

$145 USD
Buy Now

Pay Per View: Timed Access to all of Murtagh Collection

48 Hour Subscription $34.95

Buy Now

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.