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Dental transfigurement, formerly termed dental mutilation, has been practised by many societies worldwide. This article gives many of the forms that have been attributed to the indigenes of the island of Borneo. The method has been performed by review of anthropological books, sparse dental references, Borneo research literature, and popular writing.
Mean plasma metenkephalin concentration was significantly higher in ten patients who habitually mutilated themselves than in matched, healthy controls. No differences were found in corticotropin, N-lipotropin or C-lipotropin (beta-endorphin). Plasma metenkephalin was raised only in the five patients receiving hospital treatment because of their behaviour disorder. It was not raised in those patients sufficiently well to have been discharged from hospital.
Reflex sympathetic dystrophy (RSD) is a poorly understood posttraumatic pain syndrome associated with dysfunction of the sympathetic nervous system. Pain is often out of proportion to the extent of injury. Progression of the disease may lead to dystrophic and atrophic changes resulting in total disability of an affected limb. Skin findings are highly variable and nonspecific and may rarely include bullae and ulcerations. We describe a mutilating case of RSD with unusual and severely disfiguring ulcerations that necessitated amputation of the right arm. Shortly after the amputation, ulcerations began appearing on the left arm. We suspect a factitial component but have been unable to prove or disprove it. We propose that some ulcerations in patients with RSD may be factitial in origin.
A case of factitial gingival traumatism and trichotillomania in a hysteric 28-year-old female patient is reported. During a period of 31 months the patient presented with gingival necrosis which involved the lingual aspects of all four quadrants respectively. A wide range of diagnostical aids failed to enlighten the nature of the lesions until the patient developed an alopecia capitis which was typical for hysteric trichotillomania. The diagnostical and therapeutical aspects of selfmutilation in hysteria are discussed.
The rat sciatic nerve serves as a good model of nerve regeneration and, as such, is often used in investigations of nerve repair. After transection of the sciatic nerve, rodents frequently scratch and bite their anesthetic foot, resulting in amputation of one or more toes. This is termed autotomy or autophagy. When these rats are part of a study using the sciatic functional index (SFI), autotomy results in unusable data, since necessary foot landmarks have been removed. It would be helpful, therefore, to be familiar with the phenomenon of autotomy and to know which rats are least likely to mutilate themselves. In our experiment involving 64 rats in which the sciatic nerve was transected and repaired, we found that female Sprague-Dawley rats were significantly less likely to perform autotomy than males (33% vs. 65%, P = .04). In addition, we noted that two-thirds of the autotomies that occurred did so by postoperative week 4 and that tabasco sauce did not decrease this activity. We present our experience and a survey of the literature on autotomy and the SFI.
The aim of this study is to determine the prevalence of extraction of 'nylon' teeth and its long term adverse effects on the permanent dentition of Tanzanians. A total of 1890 subjects, aged between 3 and 5 years, and 1377 subjects aged between 12 and 19 years, in different parts of the country were examined. The prevalence of missing teeth in the primary dentition due to 'nylon' teeth practice ranged from 0% to 16.9%, with a weighted mean of 9.5%. Canines were the most involved teeth, accounting for 95% of all missing teeth. Mutilated permanent teeth, a result of traditional extraction of deciduous tooth germs, were observed only in Singida district in 8% of the examined subjects. 22.8% of these mutilations presented as malformations, while the remaining 77.2% presented as missing teeth. Most missing teeth and all the malformed teeth were seen in the mandible. The mandibular canines were the most affected, followed by the mandibular lateral incisors. It is suggested that 'nylon' teeth practice in Tanzania may be a recent invention rather than a traditional tribe related custom. The precariously high prevalence of 'nylon' teeth practice in Tanzania, and the people's perception of this malpractice, requires that particular attention be paid to this issue during oral health educational programmes in the affected communities.
This study presents five cases of completed suicides in which injures were situated in parts of the body changed by illness or in areas related to medical treatment. Following early research, physical illness has been identified as an important risk factor for suicide and for suicidal behavior. It is an unusual and rare problem when opposition to somatic disease is signified by the localization and character of suicidal injures. These cases illustrate such a phenomenon, where the body--in a symbolic way is engaged in expression of human stress and frustration. This is caused by the loss of the possibility to control one's own life. The authors also discussed this problem in the view of the literature.
A 10-year-old mixed-breed dog was examined because of lameness and mutilation of the left hind limb. Neurologic examination revealed ataxia, conscious proprioceptive deficit, muscle atrophy, lack of withdrawal reflex, and hyperreflexia of the patella of the left hind limb. Epidurography revealed right-sided deviation of the dye column at the sixth to seventh lumbar vertebrae. Laminectomy with cytoreduction was performed, and histologic examination revealed ganglioneuroma. Twelve months after surgery, clinical signs recurred and surgery was repeated. The dog's clinical signs were again palliated. The specific type of ganglioneuroma identified in this dog is amenable to surgical resection, unlike many types of spinal cord neoplasia.
The behavior and injuries of raccoons held for 12 and 24 hr in the Soft Catch and the EGG traps were studied in simulated natural environments. Nine raccoons held for 12 hr in the Soft Catch received minor injuries. However, one of nine raccoons held for 24 hr in this trap mutilated itself. The EGG trap caused only minor injuries to nine raccoons held for 12 hr, and nine others held for 24 hr. Thus the EGG trap can be expected, at a 95% level of confidence, to hold > or = 70% of the raccoons on traplines for 24 hr without serious injury. Raccoons captured in the Soft Catch fought their surroundings more than the trap. Those captured in the EGG trap fought the trap more than their surroundings. During the 24-hr capture study, escape behavior was more intense during the first 12 hr of capture, during both day and night.
Social insect colonies are not the harmonious entities they were once considered. Considerable conflicts exist between colony members, as has been shown for Hymenoptera. For termites, similar studies are lacking, but aggressive manipulations have been claimed to regulate sexual development, and even to account for the evolution of workers. This study on a basal termite, Cryptotermes secundus (Kalotermitidae), suggests that the importance of aggressive manipulations in termites has been overemphasized. Wing-bud mutilations, a means proposed to regulate the development of dispersing sexuals (alates), seem to be artifacts of handling conditions that cause disturbance. Aggressive behaviors never occurred unless colonies were disturbed. Theoretical considerations further showed that the potential for intense conflict among termite nestmates is low compared to hymenopteran societies. Strong conflicts are only expected to occur over the replacement of natal reproductives that died, while less intense conflicts should exist over the development into alates when food in the colony becomes limiting. Accordingly, intracolonial aggressive interactions over replacement are common, whereas nestmates seem to manipulate alate development via proctodeal feeding when food resources decline. However, the latter is rather an honest signal than a manipulation because only the most competent prospective dispersers can impede the development of nestmates.
Southern Africa has a long history of dental mutilation in the form of dental chipping and of intentional removal of anterior teeth. The first evidence is found in the skeletons of Early Iron Age populations (ca. 1500 years before present), but the incidence decreases in archaeological sites of more recent origin. In modern times, dental mutilation appears to have been limited to the people of the countries further north in Africa, but the one exception is the presence of deliberate incisor removal amongst the communities of the Western Cape. It is hypothesised in this paper that the modern practice in the Cape is associated with youthful gangs in the poorer communities, and acts as part of a rite of passage into adulthood. The "socio-sexual" theory, as reflected in such names as the "passion gap", is shown to be both wrong and insulting. The name "Cape Flats Smile" is recommended as a more appropriate and respectful term for the phenomenon.
Hereditary sensory neuropathies (HSNs) are rare disorders characterized by progressive distal sensory loss, predominantly affecting the lower limbs. Foot ulcers, severe skin and bone infections, arthropathy, and amputations are frequent and feared complications. Occasionally, patients complain of spontaneous shooting or lancinating pain. Autonomic fibers can be affected to a variable degree. Patients with HSN can also have severe distal weakness, and some HSN variants have therefore been classified among the hereditary motor and sensory neuropathies (HMSNs). Molecular genetic studies of autosomal dominant inherited neuropathies with prominent sensory loss and ulceromutilating features have assigned the genetic loci for HMSN type 2B (Charcot-Marie-Tooth syndrome type 2B) and HSN type 1 to chromosomes 3q13-22 and 9q22.1-22.3, respectively. However, some families with HSN have been excluded for linkage to these loci, suggesting further genetic heterogeneity. Recently, disease-causing mutations in the SPTLC1 gene have been identified in patients with HSN type 1. In this review, we discuss the hallmark features associated with the distinct genetic subtypes of autosomal dominant inherited HSN and provide genotype-phenotype correlations.
QUESTION UNDER STUDY: To evaluate the situation of Female Genital Mutilation (FGM) in Switzerland. METHODS: Through a questionnaire, Swiss gynaecologists were asked if they have been confronted to FGMs, if they have been asked to perform infibulations and FGMs. The health representatives (Kantonsärzte/médecins cantonaux) were interviewed on FGM activity at the Canton level. Swiss Medical Schools were asked if FGM was included in the pregraduate curriculum, and an estimated prevalence rate for FGMs in Switzerland was gathered. RESULTS: Among Swiss gynaecologists, 20% reported having been confronted with patients presenting with FGM and among them 40% had been asked about reinfibulation. Gynaecologists are occasionally asked about the possibility of performing FGMs in Switzerland. No activity concerning FGM is reported by health authorities in the Cantons. Teaching about FGM is not included in the curriculum of any of the Swiss medical schools. Approximately 6,700 girls at risk and women who have undergone FGM live in Switzerland. CONCLUSION: The extent to which gynaecologists are confronted to women with FGM may justify further action to try to better understand the situation in Switzerland. Improvement of care by better education of health care providers (guidelines) and prevention of new cases by women's education should also be considered.
Despite high suicide rates all over the world, complete decapitation as a consequence of violent suicide methods is exceptionally rare and there is always a potential for confusion with homicide as well as with body dismemberment or mutilation. We analyzed the phenomenology and morphology of 10 cases (six male, four female; individual age 18-60 years) of suicidal complete decapitation that were subjected to medico-legal autopsies at the Institute of Legal Medicine, University of Hamburg, Germany, between 1995 and 2002. All decapitations occurred while the person was alive as proven by signs of vitality. Blood alcohol levels were positive in five cases and ranged between 28 and 202 mg/dl. The applied methods of suicide were running over by a train in eight cases and hanging in two cases. In suicidal hanging resulting in complete decapitation the wound margins were clear-cut with an adjacent sharply demarcated circumferential band-like abrasion zone showing a homogenous width, the latter determined by the thickness of the rope. In decapitations due to railway interference a broad spectrum of pathologic alterations such as the co-existence of irregular, ragged and sharp-edged wound margins, vascular and nervous pathways forming bridges in the depth of the wound and bruising could be observed. In such cases skin abrasion zones were generally not circumferential and showed a heterogenous width. Concerning hanging-related complete decapitations, our findings are well in line with those of other authors, namely that heavy body weight of the suicidal, fall from a great height and in some cases inelastic and/or thin rope material used for the noose are the determining factors decisive for complete decapitation.
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BACKGROUND: Nasal ulcerations have many causes. Ulcerations that are self-induced are difficult to diagnose and treat. Two rare conditions with self-induced nasal ulceration are trigeminal trophic syndrome (TTS) and factitious disorder (FD). Trigeminal trophic syndrome is characterized by trigeminal anesthesia, nasal alar ulceration, and facial paresthesia. Appearance of the nasal ulcer after trigeminal ablation for neuralgia is diagnostic. Self-induced nasal lesions that occur in FD are primarily distinguished from those in TTS by the presence of normal trigeminal nerve function and frequent patient denial of lesion manipulation. OBJECTIVES: To increase physician awareness of the disorders leading to self-induced nasal ulceration and to discuss management issues in our patient series. DESIGN: A retrospective review of 7 cases in which the patients presented for reconstructive consultation between March 1985 and October 1997 and were found to have self-induced nasal ulcerations. SETTING: Tertiary university medical center. RESULTS: Five patients were identified with TTS and underwent nasal reconstruction an average of 43 months (range, 4-72 months) after nasal ulcer presentation. Four of the 5 patients developed ulcer recurrence between 1 and 58 months after reconstruction; secondary reconstruction resulted in recurrence in 2 of these patients. Two patients were identified with FD and self-induced nasal ulceration. One of these 2 patients underwent total nasal reconstruction 15 months after ulcer occurrence and developed recurrence 2 weeks after surgery. CONCLUSIONS: Self-induced nasal ulceration remains a difficult condition to diagnose and treat. Readily treatable conditions should be excluded, and diagnostic workup should include tissue biopsy and laboratory studies. Patients with TTS may have associated ocular findings, and those who do should be referred for ophthalmologic consultation. Surgical reconstruction can be considered in the highly motivated patient with TTS; however, delayed ulcer recurrence is common. Patients with FD should be treated primarily with local wound care and referred for psychiatric intervention. We strongly recommend nasal prosthetic devices as the primary means of aesthetic correction and discourage surgical repair in the patient with FD.
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