[Factitious disorder--an iatrogenic disease?].
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One hundred and fifteen cases of iatrogenic disorders were observed in 106 patients during a one-year prospective study. Each case was included after informed agreement of two investigators. Each case was classified into 4 groups, according to duration time between iatrogenic disorder and hospitalization, and into 3 sections according to responsibility of causative agent. A control group of 200 patients matched for age and sex was studied. Patients represented 8% of the hospitalisations. Mean age (69.2 years) was higher than other patients hospitalized during the same period (61.6 years). Principal causative agents were diuretics (30), physchotrops (13) and technic examinations (12). Main pathologies were electrolytes disorders (28), orthostatic hypotension (19), confusion and/or alteration of mental functions (13), and cutaneous or allergic disorders (12). Mean induced hospitalization duration time was of 8 days. Mean estimate cost was 18,808 francs per patient. Associated factors were elderly, and an elevated number of drugs. A negligency could participate to iatrogenic disorders in 50% of cases. Half part of iatrogenic disorders could be avoided by using simple precautions: respect of contra-indications, restriction on self-therapy and of number of associated drugs.
Sixteen cases of myospherulosis, a disease of unknown etiology previously reported only from East Africa, were found in the St. Louis metropolitan area. Although the disease in Africa occurred in the peripheral deep and superficial soft tissues, in St. Louis it involved the paranasal sinuses, nose, and middle ear. All patients had previously had surgical procedures involving the regions subsequently shown to contain the structures of myospherulosis. A common denominator in these cases was the operative use of hemostatic packing containing petrolatum-based ointments and gauze. These ointments, usually containing an antibiotic, were nonsterile. This raised the possibility that the as yet unidentified structures of myospherulosis may be introduced via these petrolatum-based substances.
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