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At least 955 records · Page 53Linked to original sources
PubMed2002

Suicide by blunt force trauma.

Suicide by self-inflicted blunt force injury is rare. The authors report a case of a 48-year-old man who initially appeared to have died of a homicidal beating. The pertinent autopsy findings consisted of blunt force closed head injury combined with numerous cutaneous abrasions and contusions of the entire body. Further inquiries confirmed a medical history of paranoid schizophrenia and a previous attempt at suicide. This case represents an extreme example of severe blunt trauma sustained during fatal self-mutilation and masquerading as a homicide. It also underscores the importance of correlating a thorough background investigation with autopsy findings in determining the appropriate manner of death.

Head Injuries, Closed↗
PubMed1991

Injury prior to neurectomy alters the pattern of autotomy in rats. Behavioral evidence of central neural plasticity.

A common property of phantom limb pain is that a preamputation lesion continues to be felt in the same location of the phantom limb after amputation. A model of the phantom limb in the rat is provided by sectioning the sciatic and saphenous nerves. This procedure leads to self-mutilation of the denervated hindpaw, a behavior known as autotomy. There is strong evidence that autotomy is a response to painful or dysesthetic sensations referred to the anesthetic limb. The present study examined the hypothesis that the site of autotomy behavior can be altered by an injury given prior to denervation. Experiment 1 evaluated the effects of a thermal injury applied (under sodium pentobarbital anesthesia) to the medial or lateral hindpaw and digits before or after sciatic and saphenous nerve transections in order to determine whether autotomy is directed specifically to a previously injured site. The results revealed that autotomy onset occurred in the injured region of the paw in a significantly greater proportion of rats, compared to an uninjured control group, if the thermal injury had been induced before denervation: 100% of the rats with medial paw injury induced prior to neurectomy initiated autotomy in the medial digits, and 55.6% of rats with lateral paw injury initiated autotomy in the lateral digits. Rats injured after autotomy showed no such preference (medial, 33.3% and lateral, 37.5%) relative to the uninjured controls (medial, 33.3% and lateral, 17%). These results suggest that central cells, sensitized by the thermal injury, contribute to enhanced autotomy in the absence of further inputs from the injured paw.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed2006

Anesthesia and patients with congenital hyposensitivity to pain.

BACKGROUND: Congenital hyposensitivity to pain or hereditary sensory and autonomic neuropathy represents a variety of disorders characterized by decreased perception of nociception, loss of other modalities of sensation, and variable expression of autonomic dysfunction. Sensory loss, especially that of pain, is associated with self-mutilations that may require frequent operations. Little is known about the safety of anesthesia for these patients. METHODS: The authors performed a computerized search of the Mayo Clinic medical records database between January 1996 and November 2005 for patients with congenital hyposensitivity to pain and related disorders who underwent general anesthesia. Medical records were reviewed for demographics, anesthetic techniques and agents, use of opioids, and perioperative complications. In addition, the authors conducted a comprehensive review of the literature to summarize the current knowledge regarding anesthesia for patients with congenital hyposensitivity to pain, and compared it with the patients with hyposensitivity to pain identified at the Mayo Clinic. RESULTS: The authors identified seven patients with hereditary sensory and autonomic neuropathy II, IV, or V and undefined variants of congenital pain hyposensitivity who generated 17 anesthesia records: 12 for orthopedic operations, 3 for sural nerve biopsies, and 2 for ophthalmologic procedures. In all patients, standard doses of volatile agents were used during anesthesia. Small amounts of opioids were used during the course of eight operations. Most patients experienced mild hypothermia (lowest temperature 34.7 degrees C), and none experienced hyperthermia. All patients were hemodynamically stable during otherwise uneventful anesthesia. During recovery from anesthesia, opioids were given to only one patient, a single dose of 1 mg morphine. Even after major orthopedic operations, the patient did not require additional analgesia. CONCLUSIONS: The patients with profound congenital hyposensitivity to pain underwent anesthesia without any adverse events. The authors found that despite reduced pain perception, the requirements for volatile anesthetics were within the expected range for population with normal pain perception, but they did not require opioids postoperatively. Intraoperative mild hypothermia was easily managed by adjustment of environmental temperature.

Adolescent↗
PubMed1999

Auto-amputation of the tongue associated with flupenthixol induced extrapyramidal symptoms.

We report a case of tongue auto-amputation in a mentally retarded patient after a flupenthixol injection. Four days after flupenthixol administration, the patient developed orolingual dyskinetic movements involving mainly tongue biting and protrusion. Self-mutilation in this case may be secondary to flupenthixol induced acute atypical orolingual dyskinesia in the face of mental retardation.

Adult↗
PubMed2000

Nasal alar necrosis.

OBJECTIVE: To describe an unrecognized clinical entity, nasal alar necrosis, and propose recommendations regarding the diagnosis, pathophysiology, and management of these cases. STUDY DESIGN: Retrospective review of four patients with this condition. METHODS: Histories, treatments, and outcomes were evaluated using office and hospital chart data. RESULTS: We noted that three patients had prior trauma or surgery, other than to the nose, in the head and neck region. All four patients had comorbidities such as diabetes, hypothyroidism, depression, or tobacco abuse. Three patients had sensory deficits over the distribution of the maxillary nerve, and three volunteered that they had a habit of picking the crusted wound. Two patients improved over several months with aggressive wound care. One patient refused treatment and another underwent successful reconstruction. CONCLUSIONS: After malignant and granulomatous diseases were ruled out, our evaluations suggested that the pathogenesis was multifactorial including several factors alone or in combination, such as, hypoesthesia, self-mutilation, and an inadequate blood supply. Deficits in vascularity and sensory innervation must be considered as potential obstacles in reconstruction. Psychological problems causing factitious wounding may complicate therapeutic interventions.

Adult↗
PubMed1992

Profile of trauma due to violence in a statewide prison population.

Acts of violence within a statewide prison population were reviewed to determine the incidence, types of injuries, surgical procedures required, persons involved in the trauma, and weapons used to inflict the injuries. The objective was to identify trends to aid in developing methods of prevention. Over a 3-year period, 1600 prisoners from the state of Tennessee were hospitalized at our institution. The majority were from the maximum security unit. There were 133 episodes of trauma. Our study focused on the first admission of 94 inmates. Fourteen (15%) of the injuries were self-inflicted, including seven self-inflicted penetrating wounds. Nineteen different weapons were used to inflict trauma. Prison cafeteria utensils and workshop utility and office devices may need to be redesigned because these items are frequently used in acts of violence. Victims subjected to repeated episodes of violence should be relocated. Lastly, self-mutilators may need to be transferred to an institution for the mentally impaired for their own protection.

Adult↗
PubMed1999

Relationship of dopamine to serotonin in the neonatal 6-OHDA rat model of Lesch-Nyhan syndrome.

Rats were treated as neonates with either 6-hydroxydopamine (6-OHDA) 100 micrograms or vehicle intracisternally. Upon maturation, animals receiving 6-OHDA were assigned to four groups, with two of the four groups receiving intraventricular 5,7-dihydroxytryptamine (5,7-DHT) 75 micrograms bilaterally. At 94 days of age, animals were injected with either SKF-38393 (3.0 mg/kg, intraperitoneally (i.p.)), a dopamine D1 agonist, or m-chlorophenylpiperazine (m-CPP) (3.0 mg/kg, i.p.), a 5-HT2C agonist, in an attempt to evoke behaviors such as stereotypical chewing, head-nodding, self-biting and self-mutilation. Both SKF-38393 and m-CPP induced the target behaviors in animals receiving 6-OHDA alone. Animals receiving additional 5,7-DHT treatment did not show any of the target behaviors in response to SKF-38393, but exhibited a much higher sensitivity to m-CPP. Pre-treatment with SCH-23390 in animals receiving 6-OHDA alone was effective in preventing SKF-38393-induced target behaviors, but not those induced by m-CPP. Pre-treatment with mianserin partially antagonized the effects of both SKF-38393 and m-CPP in these same animals. In groups receiving both neonatal 6-OHDA and adult 5,7-DHT, mianserin was effective in reducing m-CPP-induced behaviors, while SCH-23390 was largely ineffective. These data provide evidence of a serial relationship between the D1 and 5-HT2C receptor systems in the neostriatum of animals receiving neonatal 6-OHDA lesions.

Adrenergic Agents↗
PubMedDate not supplied

Prader-Willi Syndrome: clinical concerns for the orthopaedic surgeon.

BACKGROUND: Prader-Willi Syndrome (PWS) is a chromosome 15 disorder characterized by hypotonia, hypogonadism, hyperphagia, and obesity. Musculoskeletal manifestations, including scoliosis, hip dysplasia, and lower limb alignment abnormalities, are well described in the orthopaedic literature. However, care of this patient population from the orthopaedic surgeon's perspective is complicated by other clinical manifestations of PWS. Osteopenia, psychiatric disorders, and diminished pain sensitivity are frequently noted in PWS but are not discussed in the orthopaedic literature. The authors present a clinical review of an 8-year experience of caring for 31 patients with PWS to highlight all clinical concerns that influence orthopaedic management. METHODS: Thirty-one institutionalized patients diagnosed with PWS were examined and all past medical records were reviewed. Patient demographics, genetic testing, musculoskeletal diagnoses, psychiatric diagnoses, and clinical behaviors were recorded. Radiological studies performed in the course of routine clinical care were evaluated. RESULTS: Twenty-three men and 8 women, with an average age of 22 years (range, 8-39 years), were studied. A chromosome 15q abnormality was confirmed in 18 patients. Scoliosis was clinically detected in 21 of 30 patients and confirmed by radiographs in 14 of these 24 patients (overall with scoliosis, 45%) with an average primary curve of 27 degrees; 3 were braced, and 2 underwent spinal fusion. Radiographs also revealed diminished cervical lordosis and increased cervicothoracic kyphosis in 16 patients, a previously undescribed finding. Hip radiographs of 26 patients revealed dysplasia in 2 patients (13%); no slipped capital femoral epiphysis were identified. Fourteen patients had sustained a total of 58 fractures, with 6 patients sustaining multiple fractures (range, 2-7). Six patients have undergone orthopaedic surgical procedures with one major complication (spinal infection). Fracture management was associated with frequent minor complications. Bone densitometry was performed on 14 patients; 8 patients had osteopenia, and 4 had osteoporosis based on lumbar spine z scores. Twenty-six patients had Axis I psychiatric diagnoses including impulse control disorder (7), organic personality disorder (6), oppositional defiant disorder (5), dysthymic disorder (4), depressive disorder not otherwise specified (3), attention-deficit/hyperactivity disorder (2), and obsessive-compulsive disorder (2). Nine patients exhibited self-mutilating behaviors. CONCLUSIONS: Osteopenia, poor impulse control and defiant behaviors, and diminished pain sensitivity are aspects of PWS that may complicate all facets of orthopaedic nonsurgical and surgical management in this patient population. The treating orthopaedic surgeon must plan carefully and proceed with caution when treating children and adults with PWS.

Adolescent↗
PubMed2005

Practice parameter for the assessment and treatment of youth in juvenile detention and correctional facilities.

This practice parameter presents recommendations for the mental health assessment and treatment of youths in juvenile detention and correctional facilities. Mental and substance-related disorders are significant public health problems affecting youths in juvenile justice settings. Sufficient time is necessary to conduct a comprehensive diagnostic assessment, interview collateral historians, and review pertinent records to identify primary and comorbid conditions. Potential role conflicts (i.e., forensic evaluator versus clinical care provider) need to be clarified before beginning any evaluation or treatment program, and particular attention must be paid to the issue of patient confidentiality. Issues of special concern in correctional health care, such as self-mutilative behaviors, suicide attempts, malingering, mandated reporting, ethical issues, cultural competency, institutional policies affecting clinical care, and the role of the clinician, are reviewed.

Adolescent↗
PubMedDate not supplied

Hypothesized deficiency of guanine-based purines may contribute to abnormalities of neurodevelopment, neuromodulation, and neurotransmission in Lesch-Nyhan syndrome.

The Lesch-Nyhan syndrome is a devastating sex-linked recessive disorder resulting from almost complete deficiency of the activity of hypoxanthine phosphoribosyltransferase (HPRT). The enzyme deficiency results in an inability to synthesize the nucleotides guanosine monophosphate and inosine monophosphate from the purine bases guanine and hypoxanthine, respectively, via the "salvage" pathway and an accelerated biosynthesis of these purines via the de novo pathway. The syndrome is characterized by neurologic manifestations, including the very dramatic symptom of compulsive self-mutilation. The neurologic manifestations may result, at least in part, from a mixture of neurodevelopmental (eg, a failure to "arborize" dopaminergic synaptic terminals) and neurotransmitter (eg, disruption of GABA and glutamate receptor-mediated neurotransmission) consequences. HPRT deficiency results in elevated extracellular levels of hypoxanthine, which can bind to the benzodiazepine agonist recognition site on the GABA(A) receptor complex, and the possibility of diminished levels of guanine-based purines in discrete "pools" involved in synaptic transmission. In addition to their critical roles in metabolism, gene replication and expression, and signal transduction, guanine-based purines may be important regulators of the synaptic availability of L-glutamate. Guanine-based purines may also have important trophic functions in the CNS. The investigation of the Lesch-Nyhan syndrome may serve to clarify these and other important neurotransmitter, neuromodulatory, and neurotrophic roles that guanine-based purines play in the central nervous system, especially the developing brain. A widespread and general deficiency of guanine-based purines would lead to impaired transduction of a variety of signals that depend on GTP-protein-coupled second messenger systems. This is less likely in view of a prominent localized pathologic effect of HPRT deficiency on presynaptic dopaminergic projections to the striatum. A possible more circumscribed effect of a deficiency of guanine-based purines could be interference with modulation of glutamatergic neurotransmission. Guanosine has been shown to be an important modulator of glutamatergic neurotransmission, promoting glial reuptake of L-glutamate. A deficiency of guanosine could lead to dysregulated glutamatergic neurotransmission, including possible excitotoxic damage. Unfortunately, although the biochemical lesion has been known for quite some time (ie, HPRT deficiency), therapeutically beneficial interventions for these affected children and adults have not yet emerged based on this elucidation. Conceivably, guanosine or its analogues and excitatory amino acid receptor antagonists could participate in the pharmacotherapy of this devastating disorder.

Animals↗
PubMed1992

Congenital sensory neuropathy with anhidrosis (hereditary sensory neuropathy type IV).

Hereditary sensory neuropathies comprise a group of rare childhood diseases which are classified into four types. We present a Greek boy 11 years old with hereditary sensory neuropathy type IV (congenital sensory neuropathy with anhidrosis) whom we have followed up and studied during the last seven years. Our patient presented for the first time with recurrent hyperthermic episodes without sweating, and lack of pain sensation from the first months of life. Insensitivity to pain and thermal stimuli had resulted in burns on the extremities and self-mutilation of the tongue, lips and fingertips. When he was five and seven years old respectively he had two painless fractures of the ankles which led to insoluble orthopedic problems. He also suffered from mental retardation, which was obvious from his first years of life. Sweat gland investigations showed significant hypohidrosis or anhidrosis although the sweat glands were normal microscopically. Hereditary sensory neuropathy type IV, although rare, is important for dermatologists because it must be differentiated from other anhidrotic syndromes, and in view of the poor prognosis of the condition.

Child, Preschool↗
PubMed2006

Development and verification of saphenous, tibial and common peroneal nerve block techniques for analgesia below the thigh in the nonchondrodystrophoid dog.

OBJECTIVE: To document simple and reliable local, infiltrating nerve blocks for the saphenous, tibial and common peroneal nerves in the dog. STUDY DESIGN: Laboratory technique development; in vivo blind, controlled, prospective study. ANIMALS: Twenty canine cadavers and 18 clinically normal, client-owned dogs. METHODS: A peripheral nerve blockade technique of the tibial, common peroneal, and saphenous nerves was perfected through anatomic dissection. Injections were planned in the caudal thigh for the tibial and common peroneal nerves, and in the medial thigh for the saphenous nerve. Cadaver limbs were injected with methylene blue dye and subsequently dissected to confirm successful dye placement. Clinically normal dogs undergoing general anesthesia for unrelated, elective procedures were randomly assigned to treatment (bupivacaine; n = 8) or control (saline; n = 8) nerve blocks of the nerves under study. Upon recovery from general anesthesia, skin sensation in selected dermatomes was evaluated for 24 hours. RESULTS: Cadaver tibial, common peroneal, and saphenous perineural infiltrations were successful in nonchondrodystrophoid dogs (100, 100, and 97%, respectively.) Intraneural injection was rare (1%; 1/105; tibial nerve) in cadaver dogs. In the treatment group of normal dogs, duration of loss of cutaneous sensation in some dermatomes (saphenous, superficial and deep peroneal nerve) was significantly different than control dogs; the range of desensitization occurred for 1-20 hours. No clinical morbidity was detected. CONCLUSIONS: This technique for local blockade of the tibial, common peroneal, and saphenous nerves just proximal to the stifle is easy to perform, requires minimal supplies and results in significant desensitization of the associated dermatomes in clinically normal, nonchondrodystrophoid dogs. CLINICAL RELEVANCE: This technique may be an effective tool for post-operative analgesia to the femoro-tibial joint and distal pelvic limb. Other applications, using sustained-release drugs or methods, may include anesthesia/analgesia in high-risk patients or as a treatment for chronic pelvic limb pain or self-mutilation.

Anesthetics, Local↗
PubMed1990

Hereditary sensory neuropathy type II without trophic changes.

Three cases with sensory peripheral neuropathies are reported. Case 1 presented with scoliosis, and cases 2 and 3 presented with abnormal gait. None had trophic limb changes, evidence of weakness, or a tendency to self-mutilation and each had normal motor studies on neurophysiological testing. Sural nerve biopsies showed a severe loss of myelinated fibres and case 3 had evidence of denervation on muscle biopsy. These cases are presented as examples of hereditary sensory neuropathy type II. They are unusual in that they do not have trophic changes.

Adolescent↗
PubMed1984

Lesch-Nyhan syndrome, caffeine model: increase of purine and pyrimidine enzymes in rat brain.

Rats ingesting high doses of caffeine reproduce the self-destructive behaviour observed in the Lesch-Nyhan syndrome. This syndrome includes a deficit in hypoxanthine-guanine phosphoribosyltransferase. We have observed, however, that the activity of hypoxanthine-guanine phosphoribosyltransferase increases in direct proportion to the concentration of caffeine found in rat brain. It appears, therefore, that the caffeine model is not a true model for the Lesch-Nyhan syndrome, or alternatively, that the deficit in hypoxanthine-guanine phosphoribosyltransferase is coincidental and not a main key to the multifarious aspects of the syndrome, particularly the self-mutilation. The possibility that levels of dopamine are increased in the caffeine model are discussed as a basis for the destructive behaviour. We have found also that ingestion of large amounts of caffeine increases the activities in rat brain of adenosine deaminase, purine nucleoside phosphorylase, aspartate carbamoyl-transferase, dihydroorotase, and dihydroorotate oxidase.

Adenosine Deaminase↗
PubMed1986

Dopamine metabolism in hypoxanthine-guanine phosphoribosyltransferase-deficient variants of PC12 cells.

Lesch-Nyhan syndrome results from a deficiency of hypoxanthine-guanine phosphoribosyltransferase (HPRT). It is manifest by behavioral abnormalities, including self-mutilation, and evidence of abnormal 3,4-dihydroxyphenylethylamine (dopamine) metabolism. To assess whether an HPRT deficiency in a dopaminergic cell can adversely affect dopamine metabolism in that cell, dopamine metabolism was examined in HPRT-deficient variants of PC12 pheochromocytoma cells and in cells that had regained HPRT activity by virtue of transformation with a recombinant retrovirus containing the human gene for HPRT. There was no correlation between HPRT activity and endogenous dopamine levels, dopamine uptake, dopamine release, or monoamine oxidase activity. Transformation with the HPRT retrovirus did not adversely affect dopamine metabolism.

Adrenal Gland Neoplasms↗
PubMed1996

Glioblastoma multiforme arising in the irradiated spinal cord of a rhesus monkey (Macaca mulatta).

An adult female rhesus monkey that had received 44.0 Gy of cobalt 60 radiation to 8 cm of the cervical and upper thoracic spinal cord approximately 2.8 years postirradiation developed a sudden onset of self-mutilation and loss of function of the right arm followed progressively by loss of function of the left arm and terminally bilateral paresis of the legs. Histopathologic examination of the cervical spinal cord revealed a glioblastoma multiforme that extended from the cervical medullary junction to the sixth cervical vertebrae. Because of the infrequent occurrence of spontaneous neoplasia in rhesus monkeys and the location in the radiation field, the glioblastoma is believed to be radiation induced.

Animals↗
PubMed2005

Construction of neoglans penis: a new sculpturing technique from rectus abdominis myofascial flap.

INTRODUCTION: Construction of a neoglans penis may be required following glans amputation at circumcision, strangulation by a hair coil, or self-mutilation, among other indications. It may also be combined with phalloplasty to imitate the natural appearance and to support a penile prosthesis. AIM: This is a report on a novel technique of neoglans construction for a patient with an amputated glans penis as a result of circumcision injury. METHODS: A rectus abdominis myofascial flap was used. The flap was designed to be a 12 x 4 cm segment of the infraumbilical portion of the muscle, based on the inferior epigastric vessels. The flap was harvested through a paramedian incision. The penis was partially degloved through a circumferential incision 1 cm below its summit. The distal penile skin was utilized to elongate the urethra, so that the urethral meatus would be at the tip of the neoglans. The flap was reflected and tunneled underneath the mons veneris and alongside the penis, to emerge distal to the summit of the penis. The flap was fashioned into the shape of a glans and secured in place around the neourethra. The impression of a corona was achieved by tucking the proximal edge of the flap to its undersurface. RESULT: Six months following surgery, the patient had a neoglans penis, a corona, and a urethral meatus at the very tip. The neoglans had similar consistency, color, and shape to the normal glans. CONCLUSION: Construction of a neoglans penis is possible using the described sculpturing techniques, with satisfactory cosmetic results.

Adult↗
PubMedDate not supplied

The challenge of ritualistic child abuse.

Survivors of ritual abuse have endured physical and psychosexual trauma typically compounded by mind-altering drugs. Some abused children have never known a trustworthy adult to protect them from harm. Children often cope with the anxiety and terror of abuse through psychological defenses such as denial, self-hypnosis, and dissociation, but more extreme responses such as self-mutilation or multiple personalities may occur. Reports of ritual abuse of children are so shocking and bizarre that professionals initially respond with confusion and disbelief (Cozolino, 1989). Nurses need to assess clues and detect symbols of abuse in drawings or flashbacks, to build trust, and to monitor their attitudes and countertransference. Nurses are in a critical position to detect and begin healing wounds of ritual abuse.

Adolescent↗