Iatrogenic depression: the case of Frederic Chopin

Author(s):  
V. I. Berezutskyi ◽  
M. S. Berezutska

Psychological disorders caused by the doctor’s rash words are as common as the side effects of drug. Iatrogenic depression caused by ethical and psychological mistakes of doctors will never go away. Their frequency can be reduced only by improving the physicians’ skills in the fields of medical ethics and psychology. A clinical case analysis based on a famous person’s history of the disease is an effective pedagogical tool. The study aims to present the case of the famous Polish composer Frederic Chopin. The A comparative analysis of doctors’ objective actions and patients’ subjective evaluations of their actions were made based on a study of Chopin’s and Sand’s letters as well as the works of composer’s biographers. This approach provides a valuable opportunity to see doctors through the patient’s eyes. In the fall of 1838, during his rest in Majorca, the local doctors diagnosed pulmonary tuberculosis in Chopin. The Majorcan doctors made a serious ethical mistake. They ignored the patient’s anamnesis vitae indicating his phthisiophobia and informed Chopin about the diagnosis of pulmonary tuberculosis and a poor prognosis in a very cynical manner. Chopin wrote: ‘One (doctor) said I had died the second that I am dying, the 3rd that I shall die’. Chopin perceived the diagnosis of tuberculosis as a ‘death sentence’, as a result of which he developed iatrogenic depression. All previous and subsequent Chopin’s doctors used other tactics: they prescribed the correct treatment, but the diagnosis was not voiced. The analysis shows the effectiveness of this tactic: Chopin lived another 10 years after the Majorcan episode. Chopin’s case shows typical doctors’ ethical and psychological issues in informing the patient about the dangerous diagnosis and poor prognosis as well as tactics for building a good physician‑patient relationship.

2021 ◽  
Vol 19 (3) ◽  
pp. 344-355
Author(s):  
V. I. Berezutsky ◽  
◽  
M. S. Berezutskaya ◽  

The narratives based on history of the disease of famous people are an effective pedagogical tool for future physicians’ preparation in medical ethics and psychology. The objective of this study was to analyze the methods that doctors used to inform Frederic Chopin about his disease. Frederic Chopin's and Georges Sand's letters, the works of the composer's biographers as well as scientific publications devoted to Chopin's illness were analysed. The analysis showed that most of Frederic Chopin's physicians hid from him an incurable and fatal diagnosis for ethical reasons. This tactic proved to be effective: Chopin lived for more than 10 years with severe symptoms of pulmonary tuberculosis.


2011 ◽  
Vol 70 (1) ◽  
pp. 7-39
Author(s):  
Jos Monballyu

Indien men de geschiedenis van de strafrechtelijke repressie van het Vlaamse activisme na de Eerste Wereldoorlog ten gronde wil bestuderen, moet men niet alleen de parlementaire verklaringen, de gerechtelijke statistieken en de kranten omrent die repressie raadplegen, maar vooral de gerechtelijke archieven uitpluizen die deze repressie heeft nagelaten. In dit artikel wordt dit voor de eerste keer gedaan voor de Vlaamse activisten die door de krijgsraad van het Groot Hoofdkwartier van het Leger werden veroordeeld. Die krijgsraad te velde kreeg tussen 19 november 1918 en 13 mei 1919 het monopolie van de bestraffing van zowel burgeractivisten als militaire activisten en behield dit monopolie tussen 14 mei 1919 en 30 september 1919 voor de militaire activisten. Na deze laatste datum werden de Vlaamse burgeractivisten vervolgd voor de provinciale Assisenhoven en de militaire activisten voor de provinciale krijgsraden.Het krijgsauditoraat van het Groot Hoofdkwartier vervolgde uiteindelijk 689 gewone burgers en 105 militairen voor (Vlaams en Waals) activisme (inbreuk op artikel 104, 115, lid 5 en 118bis van het Belgische strafwetboek). Hiervan moesten er zich uiteindelijk slechts drieëndertig Vlamingen (26 burgers en 7 militairen) verantwoorden voor de krijgsraad van het Groot Hoofdkwartier. Vier van hen werden vrijgesproken en negenentwintig tot een straf veroordeeld. De hoogste straf was een doodstraf, die in hoger beroep werd omgezet in een buitengewone hechtenis van twintig jaar. De laagste straf bestond uit een gevangenisstraf van twee jaar. Onder de veroordeelde burgers waren er twee die deel hadden uitgemaakt van de tweede Raad van Vlaanderen en twee die de Duitsers hadden benoemd in de door hen opgerichte Vlaamse administratie. Alle andere waren plaatselijke propagandisten van het Vlaamse activisme. De zeven militairen waren allen verdacht van activisme in het bezette België tijdens de zes laatste maanden van de oorlog. Drie van hen waren vanuit het Frontgebied naar het bezette gebied overgelopen en drie andere genoten van een vervroegde terugkeer uit een krijgsgevangenenkamp in Duitsland waar ze zich ook al maanden voor de Vlaamse zaak hadden ingezet.________The day of reckoning. Flemish activists court-martialled at the Main Headquarters of the Army (23 January until 30 June 1919)In order to carry out a thorough study of the history of the criminal repression of Flemish activism after the First World War, you need to consult not only the parliamentary declarations, the legal statistics and the newspapers on the subject, but more in particular research the court records reporting on that repression. This article is the first to study the Flemish activists who were sentenced by the court-martial at the Main Headquarters of the Army. From 19 November 1918 until 13 May 1919 that field court-martial was given the monopoly of prosecuting both civilian and military activists and it retained this monopoly for the prosecution of military activists between 14 May 1919 and 30 September 1919. After the latter date the Flemish civilian activists were prosecuted by the provincial Assize Courts and the military activists by the provincial court-martials.  Eventually the military tribunal of the Main Headquarters prosecuted 689 civilians and 105 military on the basis of (Flemish and Walloon) activism (infringement of article 104, 115 paragraph 5 and 118bis of the Belgian Criminal Code). Finally only 33 Flemish (26 civilians and 7 military) had to account for their actions in front of the court-martial of the Main Headquarters. Four of them were acquitted and twenty-nine were sentenced. The most severe penalty was a death sentence, which was converted on appeal to an exceptional imprisonment of twenty years. The most lenient penalty was two years imprisonment. Two of the convicted civilians had been part of the Second Council of Flanders and two of them had been appointed by the Germans to be part of the Flemish administration they had established. All the others had been local propagandists of Flemish activism. The seven military had all been suspected of activism in occupied Belgium during the last six months of the war. Three of them had deserted from the Frontline to the occupied territory and three others had been granted an early return from a prisoner of war camp in Germany where they also had dedicated themselves for months to the Flemish cause. 


Infection ◽  
2021 ◽  
Author(s):  
Lisa C. Ruby ◽  
Rajagopal Kadavigere ◽  
Shubha Sheshadri ◽  
Kavitha Saravu ◽  
Sabine Bélard

Abstract Purpose Pulmonary aspergilloma affects immunocompromised patients but is also a recurrent condition in patients previously treated for pulmonary tuberculosis. Methods and Results We report the case of a 45-year-old patient with a history of cured pulmonary tuberculosis 15 years earlier in whom we visualized pulmonary aspergilloma by transthoracic lung sonography. Sonography of pulmonary aspergilloma demonstrated an oval cavity with hypoechoic contents and an irregular border, measuring a diameter of 4.7 cm; inside the lesion, a roundish structure with an anechoic rim was discernable. Conclusions The sonographic findings corresponded to chest X-ray and computed tomography imaging in this patient and to previously reported sonographic characteristics of mycotic abscesses in other organs. Lung ultrasound may be a tool to identify pulmonary aspergilloma, especially as a point-of-care imaging tool and where other imaging modalities are inaccessible.


2021 ◽  
Vol 10 (4) ◽  
pp. 860
Author(s):  
Shiang-Jin Chen ◽  
Chun-Yu Lin ◽  
Tzu-Ling Huang ◽  
Ying-Chi Hsu ◽  
Kuan-Ting Liu

Objective: To investigate factors associated with recognition and delayed isolation of pulmonary tuberculosis (PTB). Background: Precise identification of PTB in the emergency department (ED) remains challenging. Methods: Retrospectively reviewed PTB suspects admitted via the ED were divided into three groups based on the acid-fast bacilli culture report and whether they were isolated initially in the ED or general ward. Factors related to recognition and delayed isolation were statistically compared. Results: Only 24.94% (100/401) of PTB suspects were truly active PTB and 33.77% (51/151) of active PTB were unrecognized in the ED. Weight loss (p = 0.022), absence of dyspnea (p = 0.021), and left upper lobe field (p = 0.024) lesions on chest radiographs were related to truly active PTB. Malignancy (p = 0.015), chronic kidney disease (p = 0.047), absence of a history of PTB (p = 0.013), and lack of right upper lung (p ≤ 0.001) and left upper lung (p = 0.020) lesions were associated with PTB being missed in the ED. Conclusions: Weight loss, absence of dyspnea, and left upper lobe field lesions on chest radiographs were related to truly active PTB. Malignancy, chronic kidney disease, absence of a history of PTB, and absence of right and/or left upper lung lesions on chest radiography were associated with isolation delay.


2018 ◽  
Vol 5 (2) ◽  
pp. 1
Author(s):  
Sylvester Luu ◽  
Brian C. Benson ◽  
Kelly A. Haeusler ◽  
Robert O. Brady ◽  
Katherine M. Cebe ◽  
...  

A 60-year-old male with prior history of laryngeal carcinoma and active smoking presented with six months of solid food dysphagia. Endoscopy showed a large, friable gastroesophageal junction mass. Biopsies revealed a high-grade, poorlydifferentiated neuroendocrine carcinoma. He was subsequently started on platinum based chemotherapy and radiation therapy and his tumor decreased dramatically in size. This case is unique as neuroendocrine carcinomas (NECs) are rarely found in the esophagus and usually have a poor prognosis at time of diagnosis.


2014 ◽  
Vol 58 (8) ◽  
pp. 812-816 ◽  
Author(s):  
Pedro Weslley Rosario ◽  
Maria Regina Calsolari

Objective To determine whether the currently recommended therapy for papillary thyroid carcinoma (PTC) that show no classical factors indicating a poor prognosis is also effective in cases with a family history of this tumor. Subjects and methods: Forty-two patients were studied; 10 were submitted to lobectomy and 32 to total thyroidectomy, including 23 without lymph node dissection and 9 with lymph node dissection. None of the patients received radioiodine or was maintained under TSH suppression. Results No case of recurrence was detected by imaging methods and there was no increase in thyroglobulin or antithyroglobulin antibodies during follow-up (24 to 72 months). Conclusion The treatment usually recommended for patients with PTC does not need to be modified in the presence of a family history of this tumor if no factors indicating a poor prognosis are present (tumor ≤2 cm, non-aggressive histology, no extensive extrathyroid invasion or important lymph node involvement, complete tumor resection, no evidence of persistent disease after surgery).


2020 ◽  
Vol 89 (5) ◽  
pp. 279-283
Author(s):  
K. Rosiers ◽  
M. Strubbe ◽  
T. Flahou ◽  
H. Versnaeyen ◽  
R. Ducatelle ◽  
...  

A twenty-year-old, male, intact alpaca with a history of anorexia, progressive weakness and recumbency was euthanized because of a poor prognosis and clinical deterioration. The animal was submitted for necropsy at the pathology department of Dierengezondheidszorg Vlaanderen (DGZ) diagnostic lab. A full necropsy was performed and showed a large firm white mass measuring 18x8x10 cm attached to the dorsal wall of gastric compartment 1 (C1) and expanding to the abdominal aorta. Miliary small white metastatic nodules were present on the pleura and peritoneum (carcinomatosis). Multiple small white metastatic nodules were also present in the parenchyma of the liver. On histological investigation, this neoplasia was characterized as squamous cell carcinoma (SCC).


2021 ◽  
Vol 4 (1) ◽  
pp. 33-37
Author(s):  
John Ogunkoya ◽  
Oluwatosin Yetunde Adesuyi

Background: The diaphragm is one of the most important muscles of respiration in the body separating the abdomen from the thorax. Abnormalities of the diaphragm could be congenital or acquired, morphological or functional while pulmonary infection e.g. pulmonary tuberculosis, is implicated in its etiology. Case presentation: A 63-year- old man with six weeks history of cough productive of yellowish sputum. Chest X-ray showed a uniform well-circumscribed opacity in the right lower lobe abutting on or in continuum with the right diaphragm consistent with a diaphragmatic hump. Sputum Gene Xpert was positive for Mycobacterium tuberculosis. Chest CT scan revealed bilateral lymph node enlargement with hyperdense lesions in the anterior basal segment of the right lower lobe and medial bronchopulmonary segments of the right middle lobe. He was treated for 6 months with first-line anti-tuberculosis drugs. Discussion: The incidence of the diaphragmatic hump on chest radiograph worldwide and among Nigerians is unknown. The association of diaphragmatic hump with chest infection has been well document. The association of diaphragmatic hump with pulmonary tuberculosis is uncommon. Conclusion: A high index of suspicion is needed to diagnose pulmonary tuberculosis with atypical clinical and radiological presentations. Such prompt diagnosis will aid the treatment of the disease.


Thorax ◽  
2021 ◽  
pp. thoraxjnl-2021-217190
Author(s):  
Rebecca Nightingale ◽  
Beatrice Chinoko ◽  
Maia Lesosky ◽  
Sarah J Rylance ◽  
Bright Mnesa ◽  
...  

RationalePulmonary tuberculosis (PTB) can cause post-TB lung disease (PTLD) associated with respiratory symptoms, spirometric and radiological abnormalities. Understanding of the predictors and natural history of PTLD is limited.ObjectivesTo describe the symptoms and lung function of Malawian adults up to 3 years following PTB-treatment completion, and to determine the evolution of PTLD over this period.MethodsAdults successfully completing PTB treatment in Blantyre, Malawi were followed up for 3 years and assessed using questionnaires, post-bronchodilator spirometry, 6 min walk tests, chest X-ray and high-resolution CT. Predictors of lung function at 3 years were identified by mixed effects regression modelling.Measurement and main resultsWe recruited 405 participants of whom 301 completed 3 years follow-up (mean (SD) age 35 years (10.2); 66.6% males; 60.4% HIV-positive). At 3 years, 59/301 (19.6%) reported respiratory symptoms and 76/272 (27.9%) had abnormal spirometry. The proportions with low FVC fell from 57/285 (20.0%) at TB treatment completion to 33/272 (12.1%), while obstruction increased from and 41/285 (14.4%) to 43/272 (15.8%) at 3 years. Absolute FEV1 and FVC increased by mean 0.03 L and 0.1 L over this period, but FEV1 decline of more than 0.1 L was seen in 73/246 (29.7%). Higher spirometry values at 3 years were associated with higher body mass index and HIV coinfection at TB-treatment completion.ConclusionSpirometric measures improved over the 3 years following treatment, mostly in the first year. However, a third of PTB survivors experienced ongoing respiratory symptoms and abnormal spirometry (with accelerated FEV1 decline). Effective interventions are needed to improve the care of this group of patients.


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