41-year-Old Man with Penis Pain

Summary: Venous thrombosis is a common reason for medical consultations in family medicine. This article describes the case of a man in his twenties, presenting an indolent, restiform swelling of the left chest wall. Based on the patient´s history the differential diagnosis of mondor’s disease, a rare case of superficial vein thrombosis, is presented. Based on national and international guidelines for SVT therapeutic pathways are discussed.

Prevention of Venous Thromboembolism in Case of Arthroplasty of the Hip or Knee, Injury of the Leg and Long Traveling: a Case for Shared Decision MakingSummary: Family practitioners are faced with increasingly complex and sometimes contradictory guidelines concerning the prevention of thrombosis. Effectiveness levels and recommendations from international guidelines are extracted and a patient-information that is suitable for daily use is presented. The article provides information which helps to be a competent patient adviser during shared decision-making processes.

Background: The symptom uni- or bilateral leg oedema represents a broad range of possible underlying aetiologies. The background of leg oedema is multifactorial and usually the GP is the first contact point for patients presenting with this symptom. We aimed to identify GPs’ diagnostic approaches in patients presenting with leg oedema.Method: Interviews with 15 GPs (20–30 minutes) using a semi-structured interview-guideline were conducted. GPs described their individual diagnostic strategies concerning all patients presenting with leg oedema they had prospectively identified during the previous four weeks. Interviews were taped and transcribed verbatim. Qualitative analysis was conducted by two independent raters.Results: First impression of the patient together with knowledge of the past history plays an important role in the workup of patients with leg oedema. Individualised approaches to history taking and clinical examination are the cornerstones of diagnosis, the value und contribution of further technical examinations are judged differently by GPs. Collegial feedback and patient referral are the main strategies used by GPs to reduce diagnostic uncertainty.Conclusion: Further research in regard to diagnostic accuracy of symptoms and signs for patients with leg oedema is necessary. Results of this research should be incorporated in future guidelines.