[Male genital self-mutilation: A case series]. / Automutilation des organes génitaux externes chez l'homme.

INTRODUCTION: Genital self-mutilation is a rare phenomenon that often occurs on a psychotic ground. Its diagnosis is clinical and its management involves a coordinated action of urologists and psychiatrists. MATERIALS AND METHOD: We report a retrospective monocentric series of 14 cases of genital self-mutilation (penis and testicles), collected from January 2000 to May 2019. In addition to psychiatric care and according to the type of lesions, we performed implantations of penis, cutaneous urethrostomies, hemostatic ligature of spermatic cord, ablation of rings. The implantations of the penis were done without microscope or magnifying glass and on the basis only of an end-to-end anastomosis of the erectile bodies and the urethra. Sexual abstinence was indicated for 6weeks. RESULTS: The average age of our patients was 31.5years. We have identified ten cases of penis section including two incomplete, two cases of strangulation of penis by a metal ring, an isolated wound of the glans and three cases of testicular ablation, two of which were associated with a section of penis. We performed as first line: 5 penis reimplantation, 5 cutaneous urethrostomy, 2 ablation of strangulation rings and 3 hemostatic ligature of the spermatic cord. Three reimplanted patients had fairly satisfactory immediate operating suites: 2 patients healed well with good penile sensitivities, while one patient presented with a loss of penile skin sensitivity. The other two patients, on the other hand, presented on D1 a necrosis of the reimplanted stump, requiring an amputation and cutaneous urethrostomy. Also, necrosis of the strangulated penis was observed in one case and also required a second operating time with an amputation of the necrotic penis and a cutaneous urethrostomy. One patient died on D7 by autolysis. From a distance, the sexual and urinary function of reimplanted patients could not be assessed because they were lost to follow-up. Only a few patients who received a skin urethrostomy were seen at follow-up consultations. And with an average follow-up of 3years, no functional urinary disorder was found in them. CONCLUSION: The management of genital self-harm requires coordination between urologist and psychiatrist. With our conditions the results are mixed and penile reimplantation should ideally be done under a microscope with an experienced surgeon. However, it can be attempted as long as possible, with the possibility of making an urethrostomy in the second time in case of failure. The pillar of care for these patients, however, lies in a good psychiatric balance because they are not immune to recurrence or autolysis. LEVEL OF EVIDENCE: 3.

[Subarachnoid hemorrhage resulting from a ruptured aneurysm : management in an emergency department]. / L'hémorragie méningée sur rupture d'anévrisme Prise en charge dans un service d'Urgences.

Subarachnoid hemorrhage is a neurovascular emergency affecting relatively young adults. A ruptured cerebral aneurysm is the main non-traumatic cause. Except for the non-specific symptom of headache, which frequently occurs in subarachnoid hemorrhage, the clinical presentation is atypical, making the diagnosis difficult with possible dramatic consequences. The diagnosis is based on the CT scan without contrast, which, when negative, will be followed by a lumbar puncture. The etiologic analysis is based on an urgent arteriography, revealing the characteristics of the aneurysm such as the anatomy of the intracerebral vessels, the identification of the bleeding site and the size and location of the aneurysm. The main complications are bleeding relapse, hydrocephaly and vasospasm. Early treatment is based on the final repair of the aneurysm through two possible approaches: microvascular neurosurgical clipping or coiling via endovascular access. This article discusses the diagnostic and therapeutic aspects of subarachnoid hemorrhage.

L'hémorragie méningée représente une urgence neuro-vasculaire grave affectant l'adulte relativement jeune. La rupture d'anévrisme cérébral en est la principale cause non traumatique. Hormis la présence fréquente de céphalées, son mode de présentation clinique est variable, ce qui rend le diagnostic difficile et peut entraîner des conséquences dramatiques. La mise au point diagnostique repose sur le scanner cérébral sans injection de produit de contraste qui, s'il est négatif, est suivi d'une ponction lombaire. Le bilan étiologique repose sur l'artériographie, laquelle renseigne sur les caractéristiques de l'anévrisme : anatomie des vaisseaux intracérébraux, identification du site de saignement, taille et localisation de l'anévrisme. Les principales complications sont la récidive de saignement, l'hydrocéphalie et le vasospasme. Le traitement, précoce, repose sur la réparation définitive de l'anévrisme par deux principaux abords : la voie neurochirurgicale (clippage microvasculaire) ou le traitement endovasculaire par pose de spires métalliques (ou coiling). Cet article aborde les aspects diagnostiques et thérapeutiques de la prise en charge de l'hémorragie méningée.

Application of magnetic resonance imaging to the investigation of the diffusivity of 1,1,1,2-tetrafluorethane in two polymers.

In order to evaluate the suitability of a polymer as a sealing material for certain working fluids used in process plants, information about the fluid diffusivity into the polymer or the polymer permeability to the fluid is a prerequisite. The fluid of interest in the present work is 1,1,1,2-tetrafluorethane, CH(2)FCF(3), a partly fluorinated hydrocarbon (HFC) commonly known as refrigerant R134a. HFCs are increasingly used in refrigeration, air conditioning, and heat pump applications as substitutes for the chlorofluorocarbons (CFCs) or hydrochlorofluorocarbons (HCFCs) that are believed to be responsible for ozone depletion in the stratosphere. The polymers studied were FPM, a perfluoroelastomer, and EPDM, an ethylene-propylene-diene rubber. The study was carried out using magnetic resonance imaging (MRI). The contact time dependence of diffusion of the fluid into the polymer, as well as the spatial distributions of spin-lattice, T(1), and spin-spin, T(2), relaxation times, were used as indicators of the influence of the EPDM matrix on the mobility of R134a molecules.