Biomedical subjects
Publications and source records attributed to Morton L Kasdan.
High-pressure injection injuries of the hand represent one of the most serious surgical emergencies of the upper extremity. It is imperative to understand the mechanism of injury and the parts that take place for this injury to occur (material, pressure, site of injury). Prompt recognition and treatment may alter the final outcome.
Patient selection is the process by which an evaluating surgeon decides whether to accept responsibility for the care and treatment of a potential patient. It is assumed the physician has the requisite knowledge to assess the anatomic disorder and the technical ability to render appropriate care if needed. The aim of this article is to help the less experienced health care professional sort out which patients, either by true psychological disorder or personality and behavioral traits, pose the highest risk of a poor outcome. An unsatisfactory outcome can be measured not only by failure to resolve the disorder but also by expenditure of a disproportionate amount of practice resources in achieving resolution of the problem.
The deliberate production or feigning of signs or symptoms in a child by a caretaker is well recognized as factitious disorder by proxy, a psychiatric condition commonly reported in the pediatric literature. However, it is not as well recognized that the false illness portrayal may also be the result of a parent instructing the child to malinger. A case report of a 13-year-old patient who feigned an immobile upper extremity for the purpose of obtaining a legal settlement is presented. Physicians are encouraged to make protecting the child from parental or iatrogenic harm a priority. Recommendations for careful confrontation and expedient resolution are made.
CTS, which has been determined to be caused or aggravated by work, can be a complex challenge. The proper diagnosis is often elusive, as a patient may have other conditions that mimic CTS. The patient's job may be a factor in the development of symptoms, but there are a host of other risk factors that should be considered in establishing the cause of the problem. While the medical and surgical treatment of CTS is not always straightforward, dealing with the social and economic aspects of this problem can be even more complex and frustrating. Trying to coordinate vocational and psychological aspects of treatment while helping the patient to stay motivated can be far more stressful than the most difficult surgical procedure. The physician may be tempted to diagnose CTS without objective evidence or to define a problem as work related without performing the necessary investigation. Labeling a patient inappropriately may cause far more harm than good [8,17,25,27]. Do not give patients with CTS the impression that they will be "crippled for life" or totally disabled.