Physical and sexual abuse in female patients with fibromyalgia.

Sexual and physical abuse during childhood seem to be common. The purpose of this study was to determine the prevalence of sexual and physical abuse reported by female fibromyalgia (FM) patients in a referral-based rheumatology practice, and whether patients with FM report greater frequencies of abuse than do patients with rheumatoid arthritis (RA).Patients from two tertiary care centers, 205 with FM and 84 with RA, were mailed a self-administered questionnaire requesting information about demographics, mental health care use, and history of sexual and/ or physical abuse. There were responses from 105 FM and 44 RA patients.A history of sexual or physical abuse was reported by 54% of the sample. Any type of abuse was significantly more prevalent among patients with FM (62%) compared with those with RA (34%, p = 0.02). FM patients had a significantly increased prevalence of both sexual abuse (51% vs. 32%, p = 0.028) and physical abuse (39 vs. 16%, p = 0.006) compared with RA patients. FM patients were more likely than RA patients to report a history of multiple sexual abusers, increased duration of sexual abuse, and more violent physical abuse. Irritable bowel syndrome was more common in FM (44%) than RA patients (9%, p < 0.001), and 57% of FM patients had seen a mental health professional compared with 30% of RA patients (p = 0.002).

Transtracheal oxygen catheterization with pneumomediastinum and sudden death.

A 69-year-old man with hypoxemic COPD underwent placement of a transtracheal oxygen (TTO) catheter. At 3 months, the catheter tract appeared mature with minimal erythema and no evidence of infection at the catheter site. The patient and his spouse were taught to remove and reinsert the catheter but were told to delay beginning the procedure due to erythema at the stoma site. Despite instructions not to remove the catheter for cleaning, the spouse removed the TTO catheter and attempted to reinsert it using the flexible metal cleaning rod. Subsequently, the patient suffered an acute episode of subcutaneous air and hemodynamic collapse resulting in death. Necropsy revealed a false catheter tract occluded by clotted blood and a defect in the platysma muscle where oxygen had dissected into the mediastinum. The patient died due to pneumomediastinum and cardiac tamponade.