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Psychogenic epidemics cover various forms of collective behavior and include mass hysteria, mass psychogenic illness, and hysterical contagion for which no physical explanation can be found. The typical course of a psychogenic epidemic at a workplace progresses from sudden onset, often with dramatic symptoms, to a rapidly attained peak that draws much publicity and is followed by quick disappearance of the symptoms. Over 90% of the affected persons are women, and the symptoms range from dizziness, vomiting, nausea, and fainting to epileptic-type seizures, hyperventilation, and skin disorders. The background mechanisms are thought to be generalized beliefs and triggering events which create a sense of threat that leads to a physiological state of arousal. This state, in turn, creates new beliefs which give meaning to the sense of arousal. The new belief spreads through sociometric channels. Predisposing factors include boredom, pressure to produce, physical stressors, poor labor-management relations, and impaired interpersonal communications, and lack of social support. It is important that a thorough investigation be carried out in all instances. Investigation is not only necessary for diagnosis, but it also reassures the management, the employees, and the press that physical factors are unlikely to be responsible for the disease.
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PMID:Psychogenic epidemics and work. 653 52

Because nonepileptic disorders may cause episodic and paroxysmal symptoms that resemble epilepsy, these conditions and syndromes must be considered in the differential diagnosis or when antiepileptic drugs are ineffective. Gastroesophageal reflux usually presents as recurrent vomiting in infants and young children. A small subgroup of infants develop apnea and cyanosis accompanied by posturing of the limbs, deviation of the eyes, or opisthotonos, which leads to the incorrect diagnosis of epilepsy. Breathholding spells and pallid infantile syncope, common in infants and young children, may also be mistaken for epileptic attacks. The parasomnias, including pavor nocturnus and somnambulism, are frequently mistaken for epilepsy, since these nocturnal episodes are paroxysmal in nature, may be associated with automatic behavioral mannerisms, and tend to be recurrent. Migraine is especially difficult to differentiate from epilepsy because its manifestations, particularly in children, are so diverse. Other disorders that may superficially mimic epilepsy include transient ischemic attacks, syncope, and transient global amnesia.
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PMID:Differential diagnosis of episodic symptoms. 661 95

A case is presented of a 29-year old woman who developed sudden onset of abdominal pain, vomiting, near syncope, abdominal tenderness, profound hypotension, and a late menstrual period. The patient was in good health and her only medication was zomepirac for musculoskeletal discomfort. An exploratory mini-laparotomy was performed for the suspicion of a ruptured ectopic pregnancy, but no evidence of hemoperitoneum or of ectopic pregnancy was found. A subsequent pregnancy test was negative, and the episode was attributed to a zomepirac reaction. A review of zomepirac and zomepirac reactions is included.
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PMID:A zomepirac reaction mimicking ectopic pregnancy. 673 36

A case report is presented of toxic shock syndrome associated with the use of a contraceptive diaphragm and recent removal of an IUD. A 23 year old woman was admitted to St. Paul's Hospital in Vancouver, British Columbia because of frequent watery diarrhea and vomiting that had begun suddenly 2 days earlier, as well as generalized abdominal and muscular pain, fever and sweating of 1 day's duration. The patient's last menstrual period had ended 3 weeks earlier. Oral contraceptive (OC) therapy had been stopped 9 months earlier, and 2 weeks before admission an IUD had been removed because of dyspareunia. A diaphragm had been inserted 24 hours before the onset of symptoms and was in place at the time of admission. Removal of the diaphragm revealed about 10 ml of greenish yellow pus. Laboratory tests showed multiorgan involvement. The blood urea nitrogen level was 35 mg/dl and the serum creatinine level 2.9 mg/dl. The serum amylase level was 125 IU/l at the time of admission but rose to 1021 IU/l by day 6. The prothrombin time was 16 seconds. Arterial blood gas studies while the patient was breathing room air showed the following: pH 7.36, carbon dioxide tension 20 mm Hg and oxygen tension 84 mm Hg. Urinalysis showed pus and a small amount of glucose. Treatment consisted of blood volume expansion and electrolyte replacement. The patient showed improvement within 48 hours. 6 days after admission an exfoliative desquamating rash developed on the volar surfaces of the fingers and feet, and a slight scaling rash was noted on the face. These cleared spontaneously, without residual scarring. 6 criteria for the diagnosis of toxic shock syndrome have been defined: an increased body temperature; skin manifestations; shock, frequently with orthostatic hypotension and syncope; involvement of multiple organs; diarrhea; and myalgia. Clinicians need to appreciate that tampons are not the only cause of toxic shock syndrome and that the syndrome can occur at times other than during menstruation. Diaphragms may only rarely be associated, but their relation to toxic shock syndrome must be recognized. Counseling on the use of diaphragms should stress the avoidance of prolonged use.
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PMID:Toxic shock syndrome associated with a contraceptive diaphragm. 712 32

In a double-blind clinical trial with 20 patients suffering from endogenous depression statistically significant changes (improvement) were present in the scores of all assessment instruments. Although no statistically significant differences occurred between the groups, significant improvement on the HAM-D occurred earlier for amitriptyline and significant improvement occurred earlier on HAM-A for viloxazine. 2 patients were discontinued due to adverse reactions; one for nausea and vomiting while receiving viloxazine and one for paroxysmal atrial tachycardia while receiving amitriptyline. The same number of TES occurred for each group with seven unique to viloxazine (numbness, tingling, palpitation, ejaculation difficulty, nausea/vomiting, diarrhea, epigastric pain and gustatory disturbances) and seven unique to amitriptyline (insomnia, irritability, syncope, tremor, nasal congestion, orthostatic hypertension and paroxysmal atrial tachycardia). Other than for 1 patient who developed syncope and orthostatic hypotension and the patient who developed paroxysmal atrial tachycardia, there were no clinically significant changes in pulse rate, blood pressure and weight. There were no clinical laboratory findings with either drug that were judged to be pathological.
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PMID:Viloxazine in the treatment of endogenous depression. A standard (amitriptyline) controlled clinical study. 718 72

This study analyzes the clinicopathologic findings in patients with ectopic pregnancy (EP), and deals with the differential diagnosis of the EP, intrauterine pregnancy (IUP), and pelvic inflammatory disease (PID). We evaluated 346 patients with suspected EP. Among those, 119 patients had EP, 82 had IUP, and 55 had PID without pregnancy. The incidence of EP was 1/32.9 live births. Comparing with the other groups, the patients with EP were slightly older, gave a history of previous pregnancies, had acute abdominal pain, nausea, vomiting, dizziness, and fainting, and had direct and rebound abdominal tenderness, pain on motion of the cervix, absence of a pelvic mass, and bilateral adnexal or cul de sac fullness. Culdocentesis was accurate in 95.1% of EP cases. Salpingectomy was performed in 89.9% of the patients with EP. The patients with EP had gross evidence of PID at the surgery in 31% and microscopic evidence of tubal inflammation in 19.4% of cases.
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PMID:Ectopic pregnancy. A prospective study on differential diagnosis. 726 61

A young, diabetic woman suffering from fainting spells, vomiting, and diarrhea is described. Extensive investigations showed total cardiac denervation, orthostatic hypotension, and disturbances in the the pupillary and sudomotor functions, as well as impairment of glucagon secretion during hypoglycemia. These disturbances were found to be caused by autonomic neuropathy. No signs of peripheral neuropathy could be detected. To the best of our knowledge this is the second case of total cardiac denervation due to diabetic neuropathy described in the literature.
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PMID:Cardiac denervation and other multisystem manifestations caused by isolated autonomic neuropathy in a young diabetic patient. 743 22

The effect of carmoxirole, a presynaptic dopamine (DA2) receptor agonist, on blood pressure, plasma catecholamines, renin-aldosterone and atrial natriuretic peptide and the intracellular concentration and transmembrane fluxes of Na+ and K+, in erythrocytes and platelets was studied in 24 normal men, using a double-blind, parallel study design. After a run-in period of 1 week, the subjects were treated with either placebo (n = 8) or 0.5 mg carmoxirole (n = 16) once daily for 1 week. Blood pressure and heart rate were not changed during carmoxirole administration in these normal men. Surprisingly, no significant effect of carmoxirole was found on the circulating plasma concentration of noradrenaline, adrenaline or dopamine. Other hormones such as renin, aldosterone and atrial natriuretic peptide were also not changed during carmoxirole administration. No significant effect of carmoxirole could be demonstrated on the intracellular concentration of Na+, K+, Mg2+ and Ca2+ and on the transmembrane fluxes of Na+ and K+ in erythrocytes and platelets. In the carmoxirole-treated subjects (n = 16), 6 subjects reported spontaneously adverse events such as syncope, dizziness and vomiting tendencies and/or fatigue.
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PMID:Erythrocyte and platelet cationic concentrations and transport systems in normal volunteers treated with carmoxirole. 790 90

A 32-year-old man developed a rash on his body and extremities following acute fever of a few days duration, and also noticed pain and spontaneous tingling sensations in his lower extremities. Because severe pneumonia with dyspnea and low arterial blood oxygen concentration were found on examination, he was admitted and treated. After recovering from pneumonia in two months, he complained of abdominal symptoms, such as constipation, nausea and vomiting, spontaneous tingling sensations in the lower extremities, and orthostatic dizziness and fainting. On neurological examination, a mild to moderate muscle weakness was found in the distal muscles of both extremities. The ankle jerk was absent. Both superficial and deep sensations were moderately to severely decreased in the feet with positive Romberg's sign. Constipation and vomiting with nausea were noted. Clinical and laboratory examinations revealed marked orthostatic hypotension and hypohidrosis. Motor and sensory conduction studies indicated the presence of axonal degeneration and segmental demyelination and remyelination in the limbs nerves. CSF examination indicated that protein was 150 mg/dl and the cell count to be 18/mm3. Titer of antibody to rubella virus was significantly elevated. There were no other abnormalities to indicate the cause of motor, sensory and autonomic neuropathies. Therefore, the diagnosis of acute polyradiculoneuropathy with autonomic disturbances after rubella infection, which is rare in the literature, was made.
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PMID:[A case of acute polyradiculoneuropathy with autonomic disturbances following rubella infection]. 826 90

Clinical data on the first 100 patients who underwent dipyridamole-thallium stress testing in our hospital were reviewed in order to re-evaluate safety guidelines and diagnostic utility in patients with coronary artery disease. Forty patients developed symptoms, including three major ones. One patient had significant bronchospasm, and two others developed significant hypotension with near syncope. The rest had nonspecific chest, shoulder, arm or throat pain, dyspnea, nausea, vomiting, and paresthesia. Most symptoms occurred within the first 10 minutes of dipyridamole infusion. Twenty-eight patients required treatment with intravenous (IV) aminophylline. Of the remaining 60 patients, 30 became hypotensive but remained asymptomatic. Fourteen of 20 patients who underwent coronary angiography had coronary disease. Thirteen were correctly identified by thallium imaging, and only one was identified by electrocardiogram (EKG). Six patients' angiographies showed no evidence of coronary disease. Five of these patients developed perfusion abnormalities during thallium scintigraphy. These results suggest that dipyridamole is a relatively safe drug for pharmacologic stress testing even though the incidence of side effects is relatively high. The high incidence of thallium perfusion abnormalities in patients without coronary disease probably reflects bias in patient selection for coronary angiography, resulting in a relatively small sample of catheterized patients. However, this requires further investigation.
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PMID:Dipyridamole-thallium stress testing: a local community hospital experience. 841 26


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