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PubMed2004

[Physical urticaria].

The different types of physical urticaria are triggered by mechanical and thermal stimuli, as well as electromagnetic waves. Localized forms restricted to the skin and mucous membranes are most common, but generalized urticaria with variable extracutaneous manifestations can also occur. Physical urticaria is usually sporadic but may rarely have a familial form; it is often associated with chronic urticaria. In most instances, the short time interval between the physical stimulus and reaction points to a causal relationship, but in delayed types the exact diagnosis may be missed without provocation tests. The clinical implication of physical urticaria is demonstrated by investigations showing a greater degree of disability in affected patients as compared to other types of urticaria. There is still an incomplete understanding of the crucial pathophysiological aspects; most likely inflammatory reactions involving leukocytes, endothelial cells and nerves stimulated by various mediators play an important role in this form of urticaria.

Chronic Disease↗
PubMed2001

["Folie a deux" in the age of lasers].

We report on a 59-year-old teacher suffering for approximately 5 years from multiple dermatological changes, some of which are artificially induced and some of which are imaginary. The patient believes these manifestations are the result of neighbors shooting at her with lasers. Her husband is also convinced of the veracity of these impressions. We interpret her notion of almost daily laser attacks to a skin-related paranoid/hallucinatory psychosis with the involvement of her husband in a "folie à deux".

Delusions↗
PubMed1996

[Self-induced illness in ENT medical practice. Artefacts as a contribution to differential diagnosis of unusual illness courses].

Until now reports of factitious disease have not been found in the ENT literature. In contrast, the dermatologic literature estimates an incidence from 0.01 to 0.26%. In order to achieve effective treatment for these patients, knowledge of the characteristic symptoms is fundamental. The present paper describes the variety of disease possible, using three cases treated between 1992 and 1994 in the ENT Department of Cologne. According to the literature, females are involved in a ratio of 9:1, with the majority working in medically related professions. Depression and anorexia are typical symptoms. When a factitious disease is suspected, psychiatric consultation is essential. Confrontation of a suspect patient by the otolaryngologist is not often considered because several reports quote suicidal behavior in up to 25% of self-manipulating patients and tendencies to refuse to follow psychiatric treatment are considerable.

Adult↗
PubMed1999

[Therapy refractory unilateral chronic blepharokeratoconjunctivitis as the chief manifestation of auto-aggression syndrome. Clinico-histopathologic findings].

UNLABELLED: Autoaggressive syndromes as causes of diseases underlying chronic blepharitis and keratoconjunctivitis that are refractory to treatment are often difficult to recognize. PATIENTS: Three female patients (age 21, 25, 41 years) and one male patient (age 42 years) had suffered from a right-(4x) or left-(1x) handed treatment-refractory blepharokeratoconjunctivitis for 1, 2, 11 and 30 months prior to admission. In each case more than 5 ophthalmologists and 2-6 eye hospitals had been consulted, and extraocular surgery had been performed 1-4 times. RESULTS: Patients presented with a visual acuity of 0.3 p (1x), 0.1 (1x), FC (1x), HM (1x). In three patients contact eczema of the facial skin and lids and a corneal pannus were observed; in two patients we saw purulent pseudomembranous and in two patients chronic cicatrizing keratoconjunctivitis. Conjunctival smears grew P. aeruginosa, and S. aureus; impression cytology showed infiltration with neutrophils and epithelial keratinization; histopathology indicated chronic inflammatory, partly purulent subepithelial and stromal conjunctival infiltrate with hyper- and parakeratosis fibrous strands and epithelial cell loss; the lower lids showed parakeratosis, focal necrosis, intercellular edema and a lymphohistiocytic round-cell infiltrate. Furthermore, multiple allergies to antibiotics and preservatives (4x), lacerations of the arms and legs (2x) and an irritative-toxic dermatitis (1x) were substantiated. In the patients who agreed to a psychiatric consultation, somatized-agitated longing for care combined with a dependent and infantile personality (1x) and reactive depression (2x) were verified. CONCLUSIONS: In patients suffering from treatment-refractory unilateral chronic blepharokeratoconjunctivitis correlated with the hand, one must take into consideration the fact that other factors may be involved: possible exacerbation prior to examinations; multiple inpatient diagnostic and surgical procedures in different locations; histopathological mixed inflammatory patterns; and psychiatric syndromes.

Adult↗
PubMed2004

Segmental vertebral motion in the assessment of neck range of motion in whiplash patients.

The purpose of this study was to obtain comparative data concerning the relative contribution of segmental cervical vertebral motion to the cervical range of motion (ROM) in whiplash and healthy subjects in an effort to evaluate the usefulness of X-ray analysis in future forensic and research efforts. Each subject's neck ROM was measured with an optoelectronic system and also by X-ray measurements of the angular rotation in flexion and extension. The X-rays were examined to calculate the angular movement in the sagittal plane of each of the functional units C2-C3 to C6-C7. The chronic whiplash subjects showed reduced total neck range in all directions as compared to healthy subjects (p<0.001). There was a reduced total angular rotation from flexion to extension between these two groups (p<0.01), but no significant difference, however, between chronic whiplash subjects and controls in the percentage contribution of each of the functional units C2-C3 to C6-C7 to this rotation. This data will now allow a design of trials where healthy subjects are asked to simulate restricted neck ROM while undergoing optokinetic and X-ray evaluation of segmental vertebral motion. We will be able to determine if simulators produce a similar pattern to chronic whiplash and healthy, non-simulating subjects, and thus determine if, at least for forensic and research purposes, this technique is useful in validating reported restricted neck range.

Adolescent↗
PubMed2006

Cervical spine segmental vertebral motion in healthy volunteers feigning restriction of neck flexion and extension.

The purpose of this study was to obtain comparative data concerning the percentage contribution of segmental cervical vertebral motion to the cervical range of motion (ROM) in healthy volunteers under two conditions: (1) normal, voluntary neck flexion and extension and (2) feigned restriction of neck flexion and extension. Each healthy subject's angular motion over forward cervical flexion and extension was measured first by X-ray analysis during normal, voluntary motion. Then the subjects were asked to pretend that they had a 50% restricted neck range due to pain or stiffness and thus to move in both flexion and extension only as far as about 50% of their normal range. A total of 26 healthy subjects (ten males and sixteen females, age 28.7+/-7.7 years) participated. The total angular motion from C2 to C7 was normal in the unrestricted condition and was significantly reduced in the feigned restriction condition (p<0.001). The percentage contribution of each of the functional units C2-C3 to C6-C7 to this rotation was different between the normal unrestricted and the feigned restricted conditions. In the feigned restricted neck flexion and extension, a shift occurred in the pattern of how each segment contributes to the total angular range. A greater percentage contribution was made by C2-C3 and C3-C4 than under normal conditions (P<0.01), and the percentage contribution to total rotation made by C6-C7 became much less under the feigned restricted movements than under normal, unrestricted neck range (p<0.001). Thus, simulated or feigned restricted neck ROM affects the percentage contribution of the functional units C2-C3 to C6-C7 by showing a higher percentage contribution of the upper cervical segments and less contribution to the angular rotation by the lowest cervical segment. Feigners of restricted neck range thus produce a pattern different from nonfeigning subjects.

Adult↗
PubMed1998

Diagnosis of "non-organic" limb paresis by a novel objective motor assessment: the quantitative Hoover's test.

The differentiation of "non-organic" limb weakness from genuine paralysis is sometimes difficult in neurological practice. To address this problem, we developed a computerized quantitative method, based on the Hoover's test principle, that determines the extent of involuntary limb activation when contralateral movement is performed. Measurements of hip or arm extension isometric force are performed during direct maximal voluntary effort and during contralateral hip flexion. Maximal involuntary/voluntary force ratio (IVVR) is calculated. IVVR of the lower limbs in ten healthy subjects was 0.614, 0.044 (mean, SEM). Similar results were obtained from seven patients with genuine weakness and in the non-affected limbs of nine patients with "non-organic" mono- or hemiparesis. In contrast, IVVR in the affected limbs in the "non-organic" group was markedly increased (2.48, 0.61; P < 0.001). The same pattern was elicited in the upper limbs (2.27, 0.46 vs 0.406, 0.06; P < 0,001). We conclude that Hoover's sign in "nonorganic" paralysis is a preservation or increase of a normal synkinetic phenomenon. Quantitative measurement of the IVVR can serve as a useful ancillary test in diagnosing non-organic weakness in either lower or upper limbs.

Adult↗
PubMed2006

[When health care professionals become unwillingly involved in child abuse: the Munchhausen-by-proxy syndrome].

Reports on seemingly caring mothers, who at the same time fabricate or provoke clinical symptoms in their children and subsequently expose them to potentially harmful medical procedures, are hardly believable at first sight. Nevertheless the steadily growing number of reports on this kind of child abuse, known as Munchausen-by-proxy syndrome, points to a significant number of undetected cases. The interactional involvement of health care professionals in the abuse tends to impede diagnosis, and, as a consequence of the syndrome, usually leads to violent emotional reactions, which require careful analysis and professional handling.

Child↗
PubMed1985

Factitious brittle diabetes mellitus.

Five patients are described in whom factitious disease was the cause of brittle type I diabetes mellitus. The patients were referred from throughout the United States because their physicians had been unable to establish the reason for recurrent hospitalizations for diabetic ketoacidosis or coma. In three of the patients, unexplainable signs, symptoms, and/or laboratory results lead to the diagnosis of factitious disease. In the two remaining patients, long-term follow-up was necessary before a factitious cause was established. These five patients exemplify the extraordinary measures that some patients will utilize to continue as a "patient" rather than return to a normal lifestyle.

Adult↗
PubMed1988

Factitious dermatosis masquerading as recurrent herpes zoster.

A 35-year-old nurse's aide presented with monthly episodes, during her menses, of self-induced cutaneous lesions intended to simulate recurrent herpes zoster. Features of the clinical presentation that prompted the correct diagnosis are discussed.

Adult↗
PubMedDate not supplied

Ganser syndrome: a review of 15 cases.

Using the diagnostic criteria found in the literature, 15 new cases of Ganser syndrome were examined. A relationship was found between specific premorbid personality traits and severity of the syndrome; a high percentage of the sample belonged to an ethnic minority and was suspected of having symptoms of premorbid neurological pathology.

Adult↗
PubMed1985

Factitious sneezing.

We report a case of hysterical, intractable paroxysmal sneezing in an adolescent girl. The patient had been observed by two pediatricians, an allergist, an emergency room physician, and a chiropractor. She had been treated with antihistamines, epinephrine, corticosteroid nasal spray, and a 1-week course of an oral corticosteroid without improvement. She was referred for evaluation of an allergic etiology before continuing her workup with a computed tomographic head scan. The patient had been sneezing almost daily for 3 mo up to 2000 times a day. The patient did not sneeze at night. She had nasal congestion but no rhinorrhea or eye symptoms. She did not sneeze during the interview. The results of a physical examination were normal except for mild obesity. No organic cause was found. Most cases of intractable paroxysmal sneezing reported in the literature occur in adolescents and appear to have a psychogenic etiology. The problem was discussed with the child and parents, and psychologic therapy was recommended. Considerable decrease in sneezing subsequently occurred, but the parents credited this is further chiropractic therapy.

Adolescent↗
PubMed1990

Munchausen syndrome by proxy: a family affair.

Munchausen syndrome by proxy is an unusual form of child abuse: a child presents with an illness that has been factitiously produced by a parent, typically the mother. A case of chronic illicit insulin administration to a one-year-old girl is described. Despite temporary separation of the child from the mother and long-term psychiatric intervention, factitious illnesses continued, including urine specimen contamination, laxative-induced diarrhea, suspected bladder catheterization, and suspected poisoning. Retrospective review of the medical records of the mother and two siblings demonstrated previously unrecognized evidence of factitious illnesses. The medical records contained evidence of 30 separate episodes of suspected or documented factitious illness in these four members of the same family. This unique family illustrates the significant morbidity of Munchausen syndrome by proxy and a poor response to psychiatric treatment.

Child Abuse↗