Postsurgical psychosis: case report and review of literature.

A wide range of behavioral symptoms may occur following surgery, including depression, hallucinations, true psychosis, mania, and impulsivity. Psychoses, including those that occur postoperatively, are among the most frequent indications for hospitalization in the United States and are associated with a substantially increased rate of morbidity. The exact cause of postoperative psychosis has not been identified. A 59-year-old woman who developed acute psychosis after cholecystectomy is described here. The patient was brought to Mount Vernon Hospital in New York because she exhibited acute disruptive behavior following endoscopic retrograde cholangiopancreatography and laparoscopic cholecystectomy performed on 2 consecutive days. The patient was psychotic and was unable to be managed; she was disorganized, confused, and perplexed. Findings of computed tomography of the head, electroencephalography, and chemical and hematologic tests were normal. The patient was treated with lorazepam 1 mg every 6 h, olanzapine 5 mg at bedtime, and clonazepam 1 mg at bedtime. She experienced a mixture of auditory and visual hallucinations with a paranoid perspective and was then treated with haloperidol 5 mg, diphenhydramine chloride 25 mg, and divalproex sodium 500 mg. After 1 wk, the patient was described as acutely psychotic; antipsychotic medication dosages were readjusted and the patient's condition stabilized. The association between surgical procedures and psychosis is thoroughly reviewed here. Awareness, ability to diagnose, and an understanding of the cause of psychotic symptoms that emerge following surgery must be established if physicians are to provide better care and more effective treatment.

Hyperbaric oxygen as an adjunctive therapy for bilateral compartment syndrome, rhabdomyolysis and acute renal failure after heroin intake.

Heroin abuse causes various medical and surgical complications. We report a case of heroin-induced severe bilateral compartment syndrome complicated by rhabdomyolysis, acute renal failure and extremely elevated creatinine kinase. A 30-year-old male heroin addict presented to the emergency department of Mount Vernon Hospital, Mount Vernon, New York complaining of severe pain and burning sensation in both legs and feet 1 day after abusing intravenous heroin. He had severe swelling and tenderness of both legs and feet. Laboratory data revealed tremendous elevation of creatine kinase (236,000 IU/L) consistent with rhabdomyolysis. Acute renal failure developed over subsequent days. Treatment consisted of fasciotomy, hyperbaric oxygen therapy (HBO2) and supportive therapy. The condition gradually improved over 4 weeks and the patient did not require dialysis or amputation.

Neonatal footdrop.

This study included 50 newborns; it was conducted in the Department of Orthopedics in Azady Hospital in Duhok, Kurdistan, Iraq, from June 1998-June 2000. The patients were 26 males (52 percent) and 24 females (48 percent). The loss of movement of the affected foot was detected in the first day after delivery in 15 cases (30 percent), later within the first week in 20 cases (40 percent) and the remaining 15 cases (30 percent) from the second to the fourth week after delivery. The condition was unilateral in 46 cases (92 percent) and bilateral in four cases (eight percent). All the patients were treated conservatively by either immobilization by a back slab of the affected limb or immobilization and physical therapy. Recovery was faster when physiotherapy was implied. All the mothers were educated to avoid two traditional methods of nursing their babies. They were advised not to wrap the newborns tightly and to avoid using the traditional crib (Landek).