Pituitary-testicular axis dysfunction in burned men.

Plasma total testosterone, free testosterone, LH, and sex hormone-binding globulin (testosterone-estradiol-binding globulin) were measured in adult men hospitalized for treatment of burns. Total testosterone was below the normal range in 37 of 41 patients. Free and total testosterone levels declined very rapidly after the burn, remained low for weeks, and rose toward the end of hospitalization, but usually had not reached normal levels at discharge. The more severe the burns, the lower were the testosterone levels. LH levels were below normal during the first 4 days after the burn and remained in the low or mid normal range thereafter. Sex hormone-binding globulin levels were normal or slightly low. The data suggest the presence of a central defect in the release of LH. Large doses of opiate analgesics or an increase in endogenous opiate peptides related to severe persistent pain might be contributing factors to the pituitary-testicular hypofunction found in burned men.

The therapeutics of placebo.

The use of placebo is not old-fashioned, ineffective or unethical. It requires an ongoing, trusting relationship between the physician and the patient. Deception of the patient and self-deception must be avoided. Under these conditions, there are specific situations in which placebo is the treatment of choice.

Self-inflicted gunshot wounds to the face: a review of 18 cases.

A 9-year experience at the University of New Mexico affiliated hospitals involving 18 patients with self-inflicted gunshot wounds to the face is reviewed. Almost all were young males, averaging 27.9 years of age. Fourteen patients were Native American, six from the same pueblo. Four shootings were 'accidental' and the rest suicidal. Sixteen patients were intoxicated at the time of injury. Interpersonal conflict with an important female and acculturation difficulties were thought to play major roles. Rifles were most commonly used, and injuries tended to be severe. High muzzle velocity (greater than or equal to 2,000 ft/sec), high muzzle energy (greater than or equal to 2,000 ft-lbs) weapons tended to be the most injurious, and low muzzle energy (less than or equal to 1,000 ft-lbs) guns were related to a lesser extent of injury regardless of muzzle velocity. Patient compliance during reconstruction has been excellent, and functional return to society with gainful employment and a stable marriage has been the rule. Subsequent suicide attempts have been uncommon.

Knowledge and use of placebos by house officers and nurses.

Sixty house officers and 39 registered nurses in a university teaching hospital were surveyed to ascertain their knowledge of placebo action and their patterns of placebo use. The majority of physicians and nurses greatly underestimated the percentage of patients who experience pain relief when given placebo. Placebos typically were given to disliked patients who were suspected of exaggerating their pain or had failed to respond to usual medical regimens, or both. Positive responses to placebo medication were then interpreted by the physicians as evidence that the pain had no physiologic basis. Many studies have shown that overdemanding and complaining patients are, if anything, less likely to respond to placebo than patients well liked by the hospital staff. Nevertheless the results of our survey suggest that this is precisely the type of patient "at risk" for placebo treatment.

Telltale mouth flora: a clue to the diagnosis of factitious recurrent thigh abscesses.

A 27-year-old man had recurrent abscesses of the thigh caused by organisms typical of mouth flora. The unusual identity of these organisms from a thigh abscess led to the recognition that the illness was induced by self-injection with saliva, and that the patient had many of the characteristics of Münchausen's syndrome.