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PubMed1991

Morsicatio buccarum et labiorum (excessive cheek and lip biting).

In some individuals habitual cheek and lip biting becomes a fixed neurosis. Pieces of oral mucosa are actually torn free from the surface, producing a distinctive clinical appearance termed morsicatio buccarum et labiorum. Sometimes it may be confused with other dermatological disorders involving the oral mucosa, and can lead to misdiagnosis. Most patients with this condition are unaware of their habit and will not aid in the diagnosis. We suggest that the histopathological features of this condition are distinctive, if not pathognomonic, and that an accurate diagnosis should be rendered if a biopsy sample is taken. Two cases are reported herein that were originally misdiagnosed as pemphigus, one of which resulted in complications of improper oral corticosteroid use.

Adult↗
PubMed1986

Head injury associated with barbiturate suicide.

Two cases of self-inflicted injury, associated with suicide by ingestion of barbiturates, are presented. The head injury was so severe in one of the deceased that the death was at first thought to be due to homicide. It is postulated that barbiturate poisoning may induce a phase of excitation, with headache, prior to induction of coma.

Adult↗
PubMed1987

An alleged assault by police.

A case is presented of self-inflicted injuries alleged to have been sustained during an assault by police. A summary is given of the factors in this case differentiating between self-inflicted injuries and those due to an assault. The desirability of taking photographs of injuries in cases of alleged assault and the importance of keeping an open mind when assessing injuries are emphasised. The need for greater awareness in the medical and legal professions of the advantages of a forensic medical opinion in the assessment of injuries is mentioned.

Adult↗
PubMed1988

Autoamputation of the left arm--a bizarre suicide.

A 24-year-old woman committed suicide by amputating her left arm immediately below the shoulder joint with a small kitchen knife. No references to such a suicide were found in an extensive literature search.

Adult↗
PubMed1999

False rape: a case report.

A 16-year-old girl was admitted to the emergency department for sexual assault. The forensic examination revealed genital lesions of an age that were incompatible with her statements. She also presented extragenital lesions that resembled self-inflicted lesions. The reports of false rape allegations in the literature have all dealt with the motivations of the false victims. This case report is a reminder that an allegation of rape can be considered only on the basis of proof and not on speculation.

Abdominal Injuries↗
PubMed1998

Intrathecal administration of excitatory amino acid receptor antagonists or nitric oxide synthase inhibitor reduced autotomy behavior in rats.

UNLABELLED: Peripheral nerve injury may produce neuropathic pain. At the spinal cord level, excitatory amino acid receptors play a role in nociceptive signal modulation. N-methyl-D-aspartate (NMDA) receptor activation initiates the NO-cGMP pathway and further modulates nociceptive signal. Using the autotomy model, we examined the effect of an NMDA and a non-NMDA receptor antagonist, and nitric oxide synthase inhibitor in the treatment of autotomy behavior in rats. A right-side brachial plexus (C5-T1) transection was performed in all rats. In the treatment groups, MK-801, 1-(4-chlorobenzoyl)-piperazine-2,3-dicarboxylic acid (a non-NMDA antagonist), and L-NG-nitro arginine methyl ester (L-NAME) were infused intrathecally via an osmotic pump for 7 days at doses of 10, 4, and 400 microg/h, respectively. Saline was infused to control animals. Autotomy behavior was observed daily for 8 wk. The incidence of autotomy was 85% in the control group. MK-801, the non-NMDA antagonist, and L-NAME reduced the autotomy incidence to 10%, 20%, and 10% (P < 0.0001), respectively. All treatments delayed the onset of the autotomy behavior from 15+/-4.5 days in the control group to 52+/-3.8, 43+/-5.6, and 54+/-2.9 (P < 0.001) days in the treatment groups, respectively. The average autotomy scores were also attenuated significantly by these treatments. We conclude that the excitatory amino acid receptors and their intracellular signal messenger NO play a role in deafferentation behavior development. Inhibition of this signaling pathway may be of use for neuropathic pain relief. IMPLICATIONS: The excitatory amino acid receptors and their intracellular signal messenger NO play a role in deafferentation behavior development. Inhibition of this signaling pathway may be of use for neuropathic pain relief.

Animals↗
PubMed1988

Self-inflicted hand injuries: diagnostic challenge and treatment.

Self-inflicted injuries are probably more common than is generally appreciated. Three patients with self-inflicted hand injuries are described. A delay in making the correct diagnosis resulted in severe hand disability in 2 of the patients. Early diagnosis of this entity, combined with prompt psychotherapy, prevented disability in the third. The pertinent literature is reviewed and the importance of early diagnosis and psychotherapy is stressed.

Adolescent↗
PubMed1992

Self-inflicted midline facial gunshot wounds: the case for a combined craniofacial and microvascular team approach.

Self-inflicted gunshot wounds to the face are extremely complex and difficult to manage. In the past, these patients have been treated by debridement, hemostasis, and soft tissue closure with reconstruction deferred to a later time. This approach consigned the patient to significant facial contracture and scarring, which is impossible to adequately correct secondarily. As a result of this traditional approach, patients had substantial disfigurement as well as dysfunction. At the Medical College of Wisconsin, we have begun an aggressive multispecialty team approach in which the maximum possible reconstruction is performed acutely. This has resulted in superior aesthetic and functional results, and in a substantially lower number of hospitalizations, surgical procedures, and hospital days. This approach includes the spectrum of current plastic surgical techniques including the craniofacial approach using open reduction with accurate miniplate reconstruction and acute bone grafting as well as soft tissue reconstruction and replacement using composite multiple-stacked free tissue transfer. We believe the overall approach provides a superior result and we will continue a program of aggressive and acute intervention.

Adult↗
PubMed1999

SHAFT syndrome revisited.

Wallace aptly described patients with overriding psychological problems and upper extremity complaints as possessing the Shaft syndrome. SHAFT patients studied fell into two categories. The first group inflicted physical harm on themselves, creating factitious injuries. The second group postured their limbs in attitudes that are not explainable anatomically. This latter group is described by Simmons as the clenched fist syndrome. Although patients who had factitious injuries invariably healed with protective casting, 4 patients relapsed. Eight of 14 patients who were employed at the onset of their complaints returned to gainful employment. Some patients received psychological counseling but most lacked sufficient insight to make gainful progress. Reaching a diagnoses was often difficult. At least 5 patients had unwarranted operations. The surgeon needs a high index of suspicion when the history and findings do not match for patients harboring complaints of pain, numbness, stiffness, or inability to use their limb.

Adult↗
PubMed2001

Munchausen syndrome.

Munchausen syndrome is a rare condition in which the patient repeatedly seeks medical care for factitious illnesses. With this self-inflicted disease, the patients characteristically travel from one hospital to another, feigning acute, usually spectacular illnesses. The patients willingly submit themselves to extensive as well as invasive diagnostic and therapeutic procedures. Munchausen syndrome is a psychiatric disorder that requires psychiatric treatment. Reconstructive surgical procedures may be required to correct the acquired deformities. The difficulty in Munchausen syndrome lies essentially in early recognition of the psychiatric syndrome. Two exceptional cases are reported, and diagnosis and treatment are presented in the light of the current literature.

Adult↗
PubMed1983

Care of the psychotic self-amputee undergoing replantation.

The acutely psychotic self-amputee may be brought to the emergency room out of control, refusing treatment. Although these conditions make it difficult for the surgeon to provide restorative surgery, these patients may be quite grateful when resolution of psychosis restores realistic thinking and better judgment. This article describes the treatment of two such patients and provides practical guidelines for general behavioral management. The focal point of the approach is the formation of a surgeon/psychiatrist team that actively and consistently confronts and manages the disturbed behavior from the time the patient arrives in the emergency room until after discharge. Responsibility for deciding to operate when the patient is verbally refusing must be shared by surgeon and psychiatrist. Both surgeon and psychiatrist must be active in the treatment, each contributing his particular expertise to the collaborative effort.

Adult↗
PubMed1998

Dietary supplementation with the inhibitory amino acid taurine suppresses autotomy in HA rats.

Taurine is an inhibitory amino acid in the CNS. When supplied to rats it produces analgesia in some acute pain tests. Here we examined the effect of taurine supplementation on sensitivity to pain in intact rats, and whether perioperative dietary supplementation with taurine in rats would suppress autotomy, a behavior produced by peripheral neurectomy and related to neuropathic pain. Thermal pain sensitivity of intact rats consuming 1% taurine in the drinking solution for 2 weeks was not significantly different from that of control rats. Autotomy levels, determined in rats consuming taurine pre-, post- or perioperatively were significantly lower than in matching control groups. We conclude that taurine plays an important role in the autotomy model, presumably by protecting inhibitory neurons in the CNS against an excitotoxic damage triggered by injury discharge and ectopic input from the severed nerves.

Administration, Oral↗
PubMed1989

Lithium carbonate for aggressive behavior or affective instability in ten brain-injured patients.

Lithium carbonate (LiCO3) was used to treat 10 brain-injured patients with severe, unremitting, aggressive, combative, or self destructive behavior or severe affective instability. Five patients had a dramatic response that resulted in significant improvement in their participation in a rehabilitative program. One other patient had a moderate response. A seventh patient improved dramatically, but regressed after 7 wk. Three other patients had neurotoxic side effects that precluded continued use of the medication. Two of them were simultaneously taking neuroleptic agents. These case reports provide further evidence that LiCO3 can be a useful medication in the treatment of aggressive behavior and affective instability after brain injury, but that it has significant potential for neurotoxicity in this population, particularly when used in conjunction with neuroleptic agents.

Adult↗
PubMed1989

Antibiotics and morphinomimetic injections prevent automutilation behavior in rats after dorsal rhizotomy.

Unilateral section of dorsal roots C5 to T1 were performed in rats, and the automutilation behavior was measured by the extent of the limb lesions expressed in arbitrary units. Changes in the scores of automutilation were studied after the injection of four substances: a morphinomimetic (pethidine) and three antibiotics, chloramphenicol, amoxicillin, and doxycycline. Effects were tested on groups of at least eight rats that were compared with another group of eight animals operated on in the same way but injected with distilled water. The animals of the group treated with pethidine performed significantly less autotomy than did the animals in the control group. The same effect was found when the animals were injected with chloramphenicol and amoxicillin. On the contrary, doxycycline was found less efficacious. These results are discussed using the hypothesis of autotomy caused by an abnormal painful sensation felt in the deafferented forelimb.

Amoxicillin↗