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At least 703 records · Page 39Linked to original sources
PubMed1983

Digitalis poisoning: historical and forensic aspects.

Since the introduction of digitalis into therapy approximately 200 years ago, there have been continuing admonitions concerning its toxicity. Over 400 years ago, herbalists listed the plant as being poisonous. In fiction, the homicidal use of digitalis has appeared in the writings of Mary Webb, Dorothy Sayers and Agatha Christie. Ten instances in real life of alleged homicide by digitalis and trials of the accused are listed. The drug has been used with suicidal intent rather infrequently, compared with other medications. Possibly, it is more commonly used for such a purpose in France than in England or the United States. The fraudulent use of digitalis in the support of claims for disability because of heart disease has occurred, and one large conspiracy of physicians and lawyers in the swindle of insurance companies during the 1930s is a shameful episode in the record of these professions. Although innocent, one professor of medicine who was involved committed suicide. Two pharmaceutical (manufacturing) blunders that occurred in Belgium and Holland with mislabeling are mentioned. These resulted in numerous deaths and the profession seemed rather slow to recognize the nature of these small epidemics of poisoning. Instances of psychiatric illness with digitalis seem well documented. The story of digitalis toxicity continues into the present and physicians should be vigilant regarding the drug's potential for poisoning that can result from prescribing digitalis with ignorance of proper dosage, pharmacodynamics or drug interactions, as well as from accidental overdose as in children and use with self-destructive or homicidal intent.

Cardiology↗
PubMedDate not supplied

Extortion in the emergency department.

We present the case of a 33-yr-old female patient who, along with members of her family, attempted to extort approximately $6000.00 from our institution and her insurance company. This attempted extortion was done under the guise of a missed retained foreign body. The patient initially presented to our emergency department with a laceration to her right forearm; X-ray studies obtained after the wound had been sutured revealed no foreign body. Several days later, the patient and family members approached our administrative staff demanding recompense for metal fragments discovered in the patient's wound at another facility. Comparison of radiographs revealed that the metallic fragments were placed in the wound after she was treated and released from our emergency department, and monetary compensation was denied.

Adult↗
PubMedDate not supplied

Vocal cord dysfunction mimicking a severe asthma attack.

Vocal cord dysfunction is a rare type of airway obstruction that may mimic an acute asthma attack. We present a case of a patient who arrived in the Emergency Department (ED) in acute respiratory distress, with a history of severe asthma requiring previous intubation, who was diagnosed with vocal cord dysfunction by bronchoscopy in the ED.

Adult↗
PubMed1989

Factitious illness and the ENT surgeon.

Factitious illness' is a recently classified group of diseases characterized by repeated purposeful simulation of physical or mental illness in order to obtain medical or psychiatric treatment. 'Münchausen Syndrome' is a classical example of this group. The case reported is a 26-year-old Caucasian male who presented with recurrent facial swelling between December 1978 and November 1987. His true condition eluded diagnosis for so long because he presented repeatedly with overt clinical signs which appeared severe enough to justify the symptoms claimed.

Adult↗
PubMed1988

Lycanthropy: alive and well in the twentieth century.

Lycanthropy, the belief that one has been transformed into an animal (or behaviour suggestive of such a belief), has been described by physicians and clerics since antiquity, but has received scant attention in the modern literature. Some have even thought the syndrome extinct. However, in a review of patients admitted to our centre since 1974, we identified twelve cases of lycanthropy, ranging in duration from one day to 13 years. The syndrome was generally associated with severe psychosis, but not with any specific psychiatric diagnosis or neurological findings, or with any particular outcome. As a rare but colourful presentation of psychosis, lycanthropy appears to have survived into modern times.

Adolescent↗
PubMed2004

The secret of the phantom stone: a case report.

A 50-year old man, who has a history of allergies to i.v. contrast and NSAID, was presented with right renal colic. He was treated with regular opiate injections. Plain abdominal X ray showed a 1 cm opacity at the level of L2 but spiral CT failed to locate the urinary calculus. Abdominal examination revealed a small piece of metal implanted in the subcutaneous anterior abdominal wall which was also subsequently identified on CT scanning. When the opiate treatment was withdrawn, the patient absconded.

Analgesics, Opioid↗
PubMed2003

Corneal toxicity: the epithelium and stroma in iatrogenic and factitious disease.

Corneal toxicity is caused by chemical trauma and by iatrogenic and factitious disease, which are often overlooked, and which are reviewed here. The clinical signs of iatrogenic disease are usually nonspecific and identical to those resulting from other causes of surface disease. Factitious disease is either the result of mechanical trauma or the abuse of toxic eye drops. One epidemiological study, in a tertiary setting, identified 13% of keratoconjunctivitis cases as iatrogenic. Healing was prolonged taking 7-93 (median 28.5) days. Pathogenic mechanisms vary widely with different drugs and include subclinical scarring, pseudopemphigoid, drug-induced ocular cicatricial pemphigoid, and toxic follicular reactions. There is little readily available data either on the probability of the development of adverse reactions or for the comparison of different drugs. The assessment of the toxicity of topical drugs is currently by the Draize test in rabbits. New in vitro tests on human corneal epithelial cell cultures include ATP assays for cell viability, scanning EM of epithelial microvilli, and vital staining to assess cell membrane permeability and intracellular esterase. Despite their simplicity, these test systems can correlate well with clinical toxicity and provide a toxicity index for drug comparisons. Treatment requires drug withdrawal or substitution by non-preserved and less toxic preparations. Factitious injury is rare, difficult to diagnose, and should only be considered when all other diagnoses have been excluded. Prevention requires a high level of awareness of the potential for iatrogenic disease, particularly in the high-risk setting of chronic ocular surface disease.

Corneal Diseases↗
PubMed1998

Dermatitis simulata.

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Factitious Disorders↗
PubMed2001

Artefactual skin disease in children and adolescents.

As in adults, artefactual skin disease in children and adolescents has heterogenous presentations with multifactorial aetiology. We report a series of 32 young patients aged 8-16 years. There were 24 females and 8 males. In over half of the cases the lesions were on the head and neck. The types of lesions encountered included physical injury producing grazing, erosions and deep ulcers, chemical and thermal burns, hair cutting and shaving and skin painting. We discuss the approach that we believe should be taken with these patients, emphasizing the role of dermatology-psychiatry liaison in their management. Of great importance is the avoidance of confrontation of the patient but the clear exposition of the nature of the problem to the parents. The major aim should be to have the family accept the need for expert psychiatric assistance.

Adolescent↗