Physical symptom reporting is associated with a tendency to experience somatosensory distortion.

OBJECTIVE: Theory suggests that a tendency to experience distortions in somatosensory awareness is associated with physical symptom reporting (i.e., somatization) but empirical evidence for this is lacking. This article describes research designed to test this hypothesis. METHODS: Somatosensory distortion was operationalized as the frequency of illusory touch experiences (i.e., false alarm rate) on the Somatic Signal Detection Task. Two studies correlated false alarms on this task with physical symptom reporting on the 15-item Patient Health Questionnaire, the first using a nonclinical sample (n = 35), the second using a clinical sample of endoscopy patients who were identified as having either medically explained (n = 25) or medically unexplained symptoms (n = 30). RESULTS: Scores on the 15-item Patient Health Questionnaire were positively correlated with false alarm rate in both studies (r = 0.288-0.506), even after controlling for trait anxiety, depression, anxiety (standardized ß range = 0.793-0.932, all p < .0001) and (in Study 2) somatosensory amplification and hypochondriacal worry (standardized ß range = 0.345-0.375, both p < .05). There was no difference in false alarm rate between patients with medically explained and medically unexplained symptoms (medically explained median range = 6.8 [3.7] to 6.8 [4.0] versus medically unexplained median range = 4.3 [3.9] to 5.6 [3.1], both p > .1). CONCLUSIONS: There seems to be a robust link between physical symptom reporting and the tendency to experience somatosensory distortion, consistent with recent cognitive theories. It may be possible to reduce the impact of somatization by developing treatments that target this tendency.

Percutaneous endoscopic gastrostomy and ventriculoperitoneal shunts: a dangerous combination?

BACKGROUND: We report the largest European series of patients in whom both ventriculoperitoneal shunts (VPS) and percutaneous endoscopic gastrostomies (PEG) have been inserted with the aim of determining if this combination is safe or if there is an increased risk of VPS infection. PATIENTS AND METHODS: The paper and electronic records of 302 patients who had a ventriculoperitoneal (VP) shunt inserted in the regional Neurosciences unit at Salford Royal NHS Foundation Trust between 2002 and 2007 were reviewed. RESULTS: A total of 24 patients with VP shunts had 26 PEG inserted. Thirteen PEG were inserted in 11 patients with a pre-existing VP shunt. The median age was 58 years (21-77 Yrs) with seven male and 17 female patients. In total, five patients developed a shunt infection (20.8%) compared to the overall rate of VP shunt infection for Salford Royal NHS Foundation Trust of 7% (P = 0.017). The increase in number of VP shunt infections when the procedures were done more than 10 days apart (2/14) was not significant (P = 0.25). CONCLUSION: In patients who need long-term enteral feeding following a VP shunt insertion it may be prudent to delay insertion of a PEG for at least 10 days to reduce VPS infection. In stable patients who have had a VP shunt inserted on previous hospital admissions PEG insertion need not be avoided because of concern regarding cerebrospinal fluid or shunt infection.

Challenges in diagnosing acute pancreatitis in renal transplant patients.

Acute pancreatitis is a recognized occurrence in patients with end-stage renal disease, those on dialysis and those who have undergone renal transplantation. The incidence is significantly increased in comparison to the general population and carries significant mortality. We report two cases of acute pancreatitis that occurred in stable renal transplant recipients, and in which there was diagnostic difficulty. The etiology of the acute pancreatitis is not always identifiable in these patients. Classical symptoms and laboratory findings are often absent, which may cause diagnostic difficulty. Our experience suggests that in immunosuppressed patients with unexplained abdominal pain or abnormal liver function tests, acute pancreatitis should be considered at an early stage in order to initiate appropriate treatment and therefore minimize mortality and morbidity.

Small bowel angiodysplasia in a patient on haemodialysis: difficulties in diagnosis and management.

Angiodysplasia is a common cause of gastrointestinal blood loss in patients with end stage renal disease. Diagnosis is especially difficult when the angiodysplastic lesions are concentrated in the small bowel. This report describes a case of a patient on haemodialysis who had transfusion-dependent anaemia from small bowel angiodysplasia. Endoscopic treatment was unsuccessful, tranexamic acid caused complications with thrombosis, and thalidomide showed no benefit. This case report highlights the problems in the diagnosis and management of this condition in patients on haemodialysis. Early diagnosis and optimisation of the patient for treatment is key to the successful outcomes of such patients.

Topiramate-induced psychosis in two members of the one family: a case report.

INTRODUCTION: The use of topiramate has increased in recent years. It is now used by various specialties to treat a wide range of medical conditions. A small number of case reports describe psychosis as an adverse event of topiramate but most are in patients being treated for epilepsy and none describe a family history of this side effect. CASE PRESENTATION: We present a case report of topiramate-induced psychosis in a patient with familial essential tremor, whose sister also developed this same adverse effect. CONCLUSION: Physicians need to be aware of psychosis as a rare but debilitating side effect of this drug. Several predictors have been identified and a careful history, including family history, needs to be obtained prior to initiation of therapy to stratify the risk.