Effects of Cleft Lip and/or Palate Surgery on Acid-Base Balance

A 62-year-old female patient developed a hypochondriacal state, which seemed to be in close correlation with ”zirkumskripte Hypochondrien” (Schwarz) or ”prasenile Dermatozohenwahn” (Ekbom). The patient had previously received two major abdominal surgical operations, and had an unfortunate marital history. She developed symptoms of a distressing ”infestation by numerous tiny worms”, creping on the skin everywhere in the body. Creeping worms were also felt in the abdomen and she stated that her abdominal distension was due to an infestation of worms. She felt itching on the skin by worm-bite. She became irritable, sleepless, and at last she attempted suicide from her depressive mood. Beside the chief complaint concerning her skin, she also had a bizarre cenesthetic hypocondriacal symptoms in her abdomen. She stated that the suture ligature of the intestine from her previous operation had been cut off by the injection of sedatives to subside her irratability, and therefore ingested foods were accumulating in her abdomen, causing distressing abdominal distension. These symptoms persisted and resisted pharmacotherapy. This case is thought to be a chronic tactile hallucinosis, combined with ”cenesthopathia”. The problem of nosology was discussed, including latent syphilis infection, late schizophrenia, presenile depression, chronic organic cerebral disease, and neurotic state.