Self-inflicted Chronic Bacterial Keratoconjunctivitis Using Self Semen

This case report describes a case of self-inflicted chronic bacterial keratoconjunctivitis involving the patient's own semen. A 20-year-old male soldier was referred to our clinic for the evaluation of refractory chronic bacterial conjunctivitis. Over the previous 4 months, he had been treated for copious mucous discharge, conjunctival injection, and superficial punctate keratitis in both eyes at an army hospital and a local eye clinic. Despite the use of topical and systemic antibiotics according to the results of conjunctival swab culture, there was no improvement. During the repeated smear and culture of conjunctival swabs, surprisingly, a few sperm were detected on Gram staining, revealing that the condition was self-inflicted bacterial keratoconjunctivitis involving the patient's own semen. Thus, in cases of chronic keratoconjunctivitis that do not respond to appropriate antibiotic treatment, self-inflicted disease or malingering should be considered.

Traumatismo encefalocraneano fetal por vía penetrante transvaginal / Transvaginal penetrating fetal head injury

Los traumatismos encefalocraneanos in útero son extremadamente raros y suelen ser consecuencia de lesiones penetrantes a través de la pared torácica o abdominal, que alcanzan la cavidad uterina. Los originados a través de la vagina se han comunicado excepcionalmente. Se presenta el caso de un feto que padeció traumatismo encefalocraneano penetrante, con fractura de la bóveda craneal y hemorragia intraventricular tras la introducción violenta de un objeto contundente a través de la vagina por parte de su madre. La ruptura traumática de las membranas ovulares desencadenó el trabajo de parto pretérmino. Tras el nacimiento, se realizó tratamiento quirúrgico de la fractura deprimida y desbridamiento de la herida; sin embargo, el paciente falleció cuatro semanas más tarde a causa de sepsis neonatal. El tratamiento de estos casos no solo deber ser dirigido a la corrección de las lesiones traumáticas primarias sino también a la prevención de las complicaciones infecciosas.

In utero head traumas are extremely rare and are usually caused by penetrating injuries in the thoracic or abdominal wall that affect the uterine cavity. Transvaginal fetal head injuries have been reported in exceptional cases. This is a case-report of a fetus affected by penetrating head trauma with skull fracture and intra-ventricular hemorrhage after his mother's self-insertion of a blunt object, violently through the vagina. Trauma disrupted the integrity of intrauterine membranes and precipitated preterm labor. After birth, there was a debridement of the scalp and surgical management of the fracture was performed; nevertheless, the patient died four weeks later, due to neonatal sepsis. Management of these wounds must not only be focused on repairing the primary wound, but on preventing the infectious complications.

Morbid obesity in an adolescent with Prader-Willi syndrome / Obesidad mórbida en una adolescente con síndrome de Prader-Willi

Prader- Willi syndrome is an uncommon multisystem genetic disorder caused by defects of chromosome 15 (15qll-ql3), often due to deletions or uniparental disomy The syndrome is characterized by neonatal hypotonia, dysmorphic facial features, short stature, motor and mental disabilities, behavioral changes, hyperphagia, precocious obesity and hypogonadotropic hypogonadism. We present a 17 year-old woman, with a previous genetic diagnosis of Prader-Willi syndrome and BMI of 74 Kg/m², that was admitted in anasarca, with marked cyanosis, dyspnea and oliguria. She presented high levels ofblood urea, creatinine and aminotransferases, in addition to hyperkalemia and hyperuricemia. She had been in regular use of fluoxetine during the last six months, and evolved with severe high bloodpressure and respiratory failure, which needed intensive care support. Moreover, sequéis and clear signs of recent selfinjuries were observed in her trunk, forearms and hands. The findings of morbid obesity, anasarca, self-injury, hyperuricemia and hypoxemia in Prader- Willi syndrome are emphasized.

El síndrome de Prader-Willi es un desorden multisistémico infrecuente causado por defectos genéticos del cromosoma 15 (15qll-ql3), debido a deleciones o disomía uniparental. Se caracteriza por hipotonía neonatal, dismorfias faciales, baja estatura, incapacidades motoras y mentales, problemas conductuales, hiperfagia, obesidad precoz e hipogonadismo hipogonadotrófico. Presentamos una mujer de 17 años, con IMC de 74 Kg/m² con diagnóstico genético previo del síndrome que ingresó con anasarca, intensa cianosis, disnea y oliguria. Presentaba elevación plasmática de urea, creatinina y aminotransferasas, asociadas con hiperkalemia e hiperuricemia. Había utilizado regularmente ñuoxetina durante los seis meses precedentes y evolucionó con hipertensión arterial severa e insuficiencia respiratoria, que requirieron de cuidados intensivos. Además, se constataron cicatrices y claras señales de automutilación reciente en su tronco, antebrazos y manos. Se destacan los hallazgos de obesidad mórbida, anasarca, automutilación, hiperuricemia e hipoxemia en el síndrome de Prader-Willi.

Bipolar disorder complicated by selfmutilation: neurofunctional changes demonstrated by Tc99mHMPAO Neuro SPECT

We report neurofunctional changes in patients with selfmutilation and bipolar disorder. We compared a sample of 29 patients with selfmutilation and bipolar disorder with a group of 20 patients with bipolar disorder without selfmutilation. Furthermore we had an additional control of 22 patients with Major Depression without selfmutilation. Among the findings in selfmutilation, increased anterior dorsal-ventral thalamic perfusion stands out, this is associated with decreased perfusion in the perilimbic area (areas 24, 32 and 23 of Brodmann). There are multiple reports relating in animals and humans selfmutilation with hypoalgesia, anesthesia and disestesias; an hypothesis can be formulated relating self mutilation phenomena with a dysfunction of thalamus and perilimbic circuits associated with nosoceptive circuits and somato-psychic conscience.

Coreoatetosis hereditaria con automutilaciones e hiperuricemia: síndrome de Lesch-Nyhan / Hereditary coreoathetotic disease with self-mutilations and hyperuricaemia: Lesch-Nyhan syndrome

Esta curiosa enfermedad, descrita en 1964, tiene una baja incidencia (1 en 100.000 a 1 en 380.000 personas-año). No tiene prevalencia geográfica ni étnica. Aunque al nacer el niño parece normal, la sintomatología aparece en los primeros meses de vida. Se produce un retardo del desarrollo psicomotor con una sorprendente compulsión a automutilarse especialmente los labios, lengua y mejillas. Puede también golpearse los dedos, manos o la cabeza con una conducta autoagresiva. Además hay habitualmente movimientos coreoatetósicos y espasticidad. La mayoría logra caminar pero, con el avance de la enfermedad, quedan inválidos. Se retrasa la adquisición del lenguaje y hay disartria permanente

Automutilaçäo ocular / Ocular self-mutilation

Os autores fazem uma revisäo bibliográfica do assunto e algumas características desta forma bizarra de automutilacäo ocular, raramente encontrada por oftalmologistas. Descrevem quatro casos documentados no instituto Penido Burnier