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At least 1,117 records · Page 62Linked to original sources
PubMed1995

The factitious wound: plastic surgeon beware.

Plastic surgeons are frequently consulted for the management of chronic problem wounds, usually after other physicians' efforts have failed. This makes them vulnerable to those patients who feign, produce, or perpetuate their wounds because of underlying psychopathology or attempts at secondary gain. Three cases of factitious wounds, all seen in a plastic surgery practice, are presented. These cases are analyzed in the context of the literature published on this subject. They exemplify this condition and clearly demonstrate the common features of this type of patient. Despite the relevance of this problem and its economic, social, and possible legal implications, very little is published about it in the surgical literature.

Adult↗
PubMed1994

Litigation and chronic facial pain.

Clinical studies have suggested that the presence of litigation in chronic pain syndromes may complicate diagnostic and treatment strategies. In addition, psychosocial factors may be prevalent in such cases. The present study explored the possible correlation in the facial pain population between patients in litigation and psychological disturbance as measured by the Minnesota Multiphasic Personality Inventory. Beck Depression Inventory and Wahler Symptom Checklist scores also were compared. One hundred eleven patients diagnosed with chronic facial pain were asked if they currently were involved in litigation related to their medical complaints. The result revealed that 18% of the 111 patients were in litigation at the time of their initial visit. The Minnesota Multiphasic Personality Inventory profiles showed that 45% of the litigation patients had four or more clinical scales above 70 (significantly elevated) on the Minnesota Multiphasic Personality Inventory. In contrast, only 18% of the patients who were not in litigation had four or more scales above the 70 criteria. Beck and Wahler scores also were more elevated for the litigation group. The results of the study indicate that chronic facial pain patients in litigation may present with more psychological disturbance as compared to those patients not in litigation.

Chronic Disease↗
PubMed1994

[Diagnosis of factitious diarrhea (Munchausen syndrome) by colon biopsy].

The differential diagnosis of chronic diarrhea is broad. Most of the illnesses causing diarrhea can be diagnosed through a carefully taken medical history, stool examination, few complementary laboratory tests as well as an endoscopy and, if needed, a radiological examination. However, a few causes could still remain undiagnosed and special diagnostic techniques must then be implemented. The diagnosis of self-induced diarrhea by concealed laxative abuse is a special challenge and should be considered in every case of diarrhea where the cause remains unclear. This paper reports such a case where the diagnosis of the habitual laxative abuse with Bisacodyl was made with the help of the pathologist on the basis of stepwise taken colonic biopsies. The most important histological criteria are a champagne glass-like ectasia of the deep curved crypts, combined with increased goblet cell content and increased mucus production in the presence of an intact surface-epithelium.

Biopsy↗
PubMed1993

Pseudodementia and competency.

An increase in the number of challenges to competency determinations in probate cases parallels an increasingly aging population. In the literature on competency determination, there is little if any discussion of the implications of pseudodementing conditions, which can quite readily be misdiagnosed as true dementias, especially in the elderly. This case report describes a patient thought to have had a stroke with dementia and paresis who turned out to have had a pseudodementia. She later made a dramatic and somewhat surprising recovery. It subsequently came to light that a nearly successful attempt had been made to defraud her of her estate during her presumed dementia, which was thought to have been irreversible. The case underscores issues in competency determination, including matters of diagnosis, prognosis, and undue influence.

Aged↗
PubMedDate not supplied

[Factitious fever in childhood].

Factitious fever is a heterogeneous pathology based on the simulation, obtained by the patient himself (self-induced fever) or by fraudulent state (feigned fever). Diagnosis must be suspected according to several criteria: long-lasting fever, "belle indifférence" of children and their family, normal clinical and haematological data. The authors report, in the light of the personal experience, two cases of factitious fever.

Adolescent↗
PubMed1993

[Psychogenic paraplegia/quadriplegia].

In eight patients psychogenic para- or quadriparesis was clinically diagnosed. The following features were identified as positive criteria for psychogenic etiology: (1.) contradictory clinical findings (normal muscle tone, normal reflexes, no pyramidal signs, alternating muscle power at varying situations of clinical examination etc.), (2.) paradoxical behavior ("belle indifférence"), (3.) normal electrophysiologic, neuroradiologic and cerebrospinal fluid findings. Overemphasizing technical versus clinical diagnosis involves the risk of expensive diagnostic and therapeutic procedures and favors fixation on the symptoms.

Adult↗
PubMed1993

Child stealing by cesarean section: a psychiatric case report and review of the child stealing literature.

A highly unusual case of child stealing by cesarean section resulting in the death of the mother is presented. The judicial proceedings are summarized. The literature on the psychiatric status of perpetrators committing child stealing is presented. Two methods of psychiatrically categorizing these perpetrators are reviewed. The relevance of the literature to this and possible future cases is discussed.

Adult↗
PubMed1993

The molar ratio of insulin to C-peptide. An aid to the diagnosis of hypoglycemia due to surreptitious (or inadvertent) insulin administration.

After beta-cell stimulation by carbohydrate or other secretagogues, insulin and C-peptide are secreted into the portal vein in a 1:1 molar ratio. A large fraction of endogenous insulin is cleared by the liver, whereas C-peptide, which is cleared primarily by the kidney and has a lower metabolic clearance rate than insulin, traverses the liver with essentially no extraction by hepatocytes. Hence, the molar ratio of insulin to C-peptide in peripheral venous blood (ICPR) should be less than 1.0 during fasting and feeding, unless exogenous insulin is introduced into the systemic circulation. Consequently, an ICPR in excess of 1.0 in a hypoglycemic patient argues persuasively for surreptitious or inadvertent insulin administration and against insulinoma (or sulfonylurea ingestion) as the cause of the hypoglycemia. This conclusion is supported by personal experience and by the literature.

Adult↗