[The Figurative Language Test: An instrument for the assessment of concretism in schizophrenic patients]. / El test de lenguaje figurado: un instrumento para medir el concretismo en pacientes esquizofrénicos.

BACKGROUND: Concretism is a recognized formal thought disorder of schizophrenia, which has been studied clinically by proverb interpretation. To avoid the shortcomings of oral proverbs, there have been developed tests with multiple choice format, which have the advantage of avoiding the disparity of criteria and simplifying its application. In the absence of an equivalent test in Spanish, it is of interest to elaborate a test of this type to be used for clinical and research purposes. METHOD: the test consists of ten idioms and ten proverbs, each with four possible answers (one correct, abstract). Thirty schizophrenics and thirty depressive controls were evaluated. The premorbid intelligence level was measured by the Word Accentuation Test. The reliability of the instrument was estimated using Cronbach's alpha coefficient. The differential diagnostic utility of the test was measured by logistic regression. RESULTS: the number of correct answers was significantly higher in the depressive group. Logistic regression correctly classified more than 80% of patients from the correct answers. Cronbach's alpha index was 0.89. CONCLUSIONS: The Figurative Language Test is a reliable and useful scale.

The Evolution and Utility of the Small-Carrion Prosthesis, Its Impact, and Progression to the Modern-Day Malleable Penile Prosthesis.

INTRODUCTION: Erectile dysfunction has plagued humanity for millennia. For years, treatment had been in the hands of mental health professionals. It was not until the 1970s that urologists created a modality that was marketable, reproducible, and consistently successful at treating impotence, the Small-Carrion Penile Prosthesis. AIM: We present the evolution of the malleable/semi-rigid penile prosthesis, concentrating our efforts reviewing and critiquing the pivotal article published by Drs. Michael P. Small, Hernan M. Carrion, and Julian A. Gordon. We then discuss its continued advancement, current-day utilization, and the future of the malleable prosthesis. METHODS: From the early 1900s, surgeons have been toying with the idea of creating a penile implant. These initial attempts utilized rib cartilage, and eventually synthetic materials, including acrylic, silicone, and polyethylene. RESULTS: In 1975, Drs. Carrion and Small presented their initial experience of 31 patients utilizing their silicone implant. In their manuscript titled, "The Small-Carrion Penile Prosthesis: New Implant for the Management of Impotence," they discuss their technique, perioperative management of complications, and results. CONCLUSIONS: The malleable penile prosthesis continued to evolve throughout the years to the current day Genesis and Spectra. Although the current market is dominated by the inflatable penile prosthesis, there are specific situations where the malleable is ideally utilized. The pivotal article by Drs. Carrion and Small helped pave the way for the "New Era" of penile prosthetics and still remains one of the most impactful contributions to the management of erectile dysfunction.

The reduction corporoplasty: the answer to the improbable urologic question "can you make my penis smaller?".

INTRODUCTION: Aneurysmal dilatation of the corpora cavernosa can occur because of recurrent priapism in the setting of sickle cell disease. AIM: We present the first case of a successful implementation of the reduction corporoplasty technique for treatment of a phallus that was "too large for intercourse." METHODS: We describe the presentation of a 17-year-old male with a history of sickle cell disease with a phallus "too large for intercourse." Patient reported normal erectile function and response with masturbation but also reported inability to penetrate his partner due to the enlarged and disfigured morphology. He had three priapismic episodes since the age of 10 that progressively led to an aneurysmal morphologic deformity of his phallus. Evaluation included a magnetic resonance imaging, which revealed true aneurysmal dilatation of bilateral corpora cavernosa in the middle and distal portions, and diffusely hyperplastic tunica. MAIN OUTCOME MEASURE: The main outcome measure is the successful management of phallic disfiguration. RESULTS: Reduction corporoplasty was performed, and the patient reported intact erectile function without aneurysmal recurrence. CONCLUSIONS: Patients with significant corporal aneurysmal defects secondary to recurrent priapism can be successfully managed with reduction corporoplasty.

[On the concept of lucidity]. / Sobre el concepto de lucidez.

Kraepelin's concept of clarity of awareness (lucidity) had a stable signification during more than hundred years. It is the basis of most of current theories of disturbed consciousness. However, two alternative definitions that arise in Buenos Aires produce confusion due to their conceptual overlap. We discuss these definitions and propose a classification of disorders of consciousness that rely on traditional point of view.

A preliminary report on the usage of an intracorporal antibiotic cast with synthetic high purity CaSO4 for the treatment of infected penile implant.

INTRODUCTION: Currently, the surgical treatment of infected penile prostheses is complete removal and either immediate salvage procedure, which carries a significant infection risk, or delayed implantation. With delayed implantation the risk of infection is lower, but the patient loses penile length and width due to corporal fibrosis. AIM: We present our experience with the use of a novel temporary synthetic high purity calcium sulfate (SHPCaSO4) component that acts as a "spacer" at the time of removal of an infected prosthesis while providing constant delivery of local antibiotic elution to the infected area. MAIN OUTCOME MEASURES: Demonstrate that the use of a novel material, SHPCaSO4, can be an innovative way to bridge the gap between removal of an infected penile implant and delayed reimplantation. METHODS: Two patients (Patient A and B) presented with pain and erythema and were found to have infected malleable penile prosthesis. Both underwent removal of all infected components, and sent for tissue culture. The SHPCaSO4 was mixed with vancomycin and tobramycin, allowed to set up for 5 minutes, and then injected into the corporal space followed by closure with 2-0 Vicryl sutures. The injected SHPCaSO4 was palpable in the penile shaft both proximally and distally, as an "intracorporal casts." RESULTS: Patients denied pain postoperatively. Delayed implantation occurred at 6 weeks for patient A. This went uneventful and a new three-piece inflatable implant was inserted. Patient B underwent salvage placement of right malleable implant at 15 weeks, and here significant corporal fibrosis was encountered. Patients have had no infection since their delayed implantation (mean follow-up 4 months). CONCLUSIONS: Data in reference to SHPCaSO4 shows that this product dissolves in approximately 4-6 weeks. This may account for the difference in the ease of delayed implantation between the two patients. Further investigation is warranted.

One hundred and fifty years of hebephrenia. A review.

INTRODUCTION: The publication of Hecker's article on hebephrenia in 1871 was a fundamental milestone for clinical psychiatry. Despite the initial recognition, many voices were raised against this diagnostic category and its limits were attenuated throughout the 20th century until its disappearance at the beginning of this century (along with the other subtypes of schizophrenia) in the DSM and ICD. DISCUSSION: However, given the consistency of the clinical picture, there is the possibility of other criteria emerging that would lead its systematic study to continue or recommence. In this sense, the concepts of deficit schizophrenia, hebephrenia as a replacement for schizophrenia as a whole, and Leonhard's hebephrenias as systematic schizophrenias stand out. This article discusses the main diagnostic conflicts of the category of hebephrenia over time, with emphasis on the problems of recent decades. CONCLUSIONS: The concept of hebephrenia has begun to be revalued in recent years, and the concepts of deficit schizophrenia, of hebephrenia as a major category, and of systematic hebephrenias allow further investigation of this foundational picture of clinical psychiatry.

Erectile function significant enough for penetration during sexual intercourse after removal of inflatable penile prosthesis.

INTRODUCTION: Fifty-two-year-old male with history of multiple insults to his erectile tissue, including insertion and removal of penile implant, presents with significant partial erectile function, substantial enough for anal penetration during sexual intercourse. AIM: Erectile function rigid enough for anal penetration, let alone any erectile function after removal of an inflatable penile prosthesis (IPP), is rare. This article, to our knowledge, is the first case of a patient who has undergone multiple insults to his erectile tissue, including an episode of ischemic priapism followed by implantation and removal of an IPP, who presents with erectile function sufficient enough for coitus. MAIN OUTCOME MEASURES: Outcome measured via standardized patient questionnaires and penile Doppler following injection of Trimix. METHOD: An objective measure of the patient's erectile function was performed via penile Doppler. RESULTS: Penile Doppler after 10-mcg injection of Trimix revealed numerous perforating vessels from the corpora spongiosum providing blood flow to the corpora cavernosa. The patient obtained approximately 60-70% rigid erection. CONCLUSIONS: To our knowledge, and after thorough review of the literature, we could not find any reports of erectile function significant enough to take part in sexual intercourse and penetration after removal of a three-piece IPP. The implant usually disrupts the normal anatomy which allows for cavernosal arterial vasodilation and increased blood flow into the corpora. Following dilation of the corpora the cylinders are inserted and inflated, and the smooth muscle that makes up the corpora cavernosum is compressed against the wall of the tunica albuginea. Theoretically, the remaining smooth muscle tissue may retain some of its physiologic function, adding some additional girth to the penis with an already activated IPP during sexual intercourse.

One Hundred and Fifty Years of Hebephrenia. A Review. / Ciento cincuenta años de hebefrenia. Una revisión.

INTRODUCTION: The publication of Hecker's article on hebephrenia in 1871 was a fundamental milestone for clinical psychiatry. Despite the initial recognition, many voices were raised against this diagnostic category and its limits were attenuated throughout the 20th century until its disappearance at the beginning of this century (along with the other subtypes of schizophrenia) in the DSM and ICD. DISCUSSION: However, given the consistency of the clinical picture, there is the possibility of other criteria emerging that would lead its systematic study to continue or recommence. In this sense, the concepts of deficit schizophrenia, hebephrenia as a replacement for schizophrenia as a whole, and Leonhard's hebephrenias as systematic schizophrenias stand out. This article discusses the main diagnostic conflicts of the category of hebephrenia over time, with emphasis on the problems of recent decades. CONCLUSIONS: The concept of hebephrenia has begun to be revalued in recent years, and the concepts of deficit schizophrenia, of hebephrenia as a major category, and of systematic hebephrenias allow further investigation of this foundational picture of clinical psychiatry.

Ciento cincuenta años de hebefrenia. Una revisión

Introducción: La publicación del artículo de Hecker sobre la hebefrenia en 1871 fue un hito fundamental para la psiquiatría clínica. A pesar del reconocimiento inicial, se alzaron muchas voces en contra de esta categoría diagnóstica y sus límites se fueron diluyendo a lo largo del siglo XX hasta su desaparición a comienzos de este siglo -con el resto de los subtipos de esquizofrenia- del DSM y la CIE. Discusión: Contrariamente a su disolución conceptual, la consistencia del cuadro clínico hace posible que surjan otros criterios para continuar o reiniciar su estudio sistemático. Sobresalen en este sentido los conceptos de esquizofrenia deficitaria, de hebefrenia como sustitución de la esquizofrenia en su conjunto y las hebefrenias como esquizofrenias sistemáticas de Leonhard. En el presente artículo se discuten los principales conflictos diagnósticos de la categoría de hebefrenia a lo largo del tiempo, haciendo hincapié en la problemática de las últimas décadas. Conclusiones: El concepto de hebefrenia comenzó a revalorizarse en los últimos arios y los conceptos de esquizofrenia deficitaria, de hebefrenia como categoría mayor y de hebefrenias sistemáticas permiten profundizar en nuevas investigaciones sobre este cuadro fundacional de la psiquiatría clínica.

Introduction: The publication of Hecker's article on hebephrenia in 1871 was a fundamental milestone for clinical psychiatry. Despite the initial recognition, many voices were raised against this diagnostic category and its limits were attenuated throughout the 20th century until its disappearance at the beginning of this century (along with the other subtypes of schizophrenia) in the DSM and ICD. Discussion: However, given the consistency of the clinical picture, there is the possibility of other criteria emerging that would lead its systematic study to continue or recommence. In this sense, the concepts of deficit schizophrenia, hebephrenia as a replacement for schizophrenia as a whole, and Leonhard's hebephrenias as systematic schizophrenias stand out. This article discusses the main diagnostic conflicts of the category of hebephrenia over time, with emphasis on the problems of recent decades. Conclusions: The concept of hebephrenia has begun to be revalued in recent years, and the concepts of deficit schizophrenia, of hebephrenia as a major category, and of systematic hebephrenias allow further investigation of this foundational picture of clinical psychiatry.

Excision and Patch Grafting of a Lateral Peyronie's Plaque-Utilizing a Longitudinal "Window" Approach.

INTRODUCTION: Peyronie's disease (PD) is a debilitating disorder in which collagen deposition, fibrosis, and plaques in the tunica albuginea result in penile curvature, shortening, and pain. For severe curvatures requiring plaque incision or excision with grafting (PIEG), a subcoronal circumcising incision with penile degloving has historically been used. AIMS: The aim of this study was to report our unique approach to PIEG via a longitudinal "window" incision for the correction of PD, minimizing the surgical manipulation and dissection accompanying the traditional circumcising incisional approach that may lead to increased postoperative edema, pain, and prolonged healing time. METHODS: A patient presented with a stable, painless, 90-degree midshaft leftward curvature causing penetration difficulties and painful intercourse for his partner. His Sexual Health Inventory for Men (SHIM) score was 23. The patient opted for surgical correction with plaque excision and grafting via a 4-cm longitudinal incision overlying the point of maximal curvature along the left lateral penile shaft. This direct access to the left corpus cavernosum and plaque, along with dissecting skin, dartos, and Buck's fascia, created a window with sufficient exposure for excision and patch grafting. MAIN OUTCOME MEASURES: The main outcome measures were objective data and subjective data in men undergoing PIEG via lateral longitudinal "window" incision for PD repair. RESULTS: The plaque was excised and a porcine small intestinal submucosa graft was sewn in. Intraoperative artificial tumescence at the end of surgery revealed complete correction of the curvature. The patient experienced painless rigid erections by postoperative day three with minimal penile edema. By postoperative week four, he could successfully partake in coitus. His SHIM score remained unchanged. At maximum follow-up 6 months postoperatively, he still endorsed excellent cosmetic and functional outcomes with spontaneous unassisted erections and no recurrence of his curvature. CONCLUSION: A lateral longitudinal incision for PIEG is a feasible technique and may reduce the postoperative morbidity and dissection required with traditional circumcising incision with penile degloving. Larger comparative studies are necessary for further evaluation.

La clasificación de los trastornos de la conciencia / Classification of disorders of consciousness

Tradicionalmente ha existido una incongruencia entre la definición de conciencia y la caracterización de su patología, que se restringe a aquellos cuadros que afectan la vida consciente en su conjunto, ya sea por un descenso del nivel o por una desorganización de sus contenidos. Los avances en neurociencia cognitiva han demostrado que existen otras perturbaciones de la conciencia que no implican su afectación total. Con el fin de presentar una clasificación integral de estos trastornos, partiremos de las teorías de Edelman y Damasio, quienes diferencian una forma elemental de conciencia (conciencia primaria, para el primero, o central, para el segundo) de una forma compleja (conciencia de orden superior o ampliada, respectivamente). Las enfermedades que afectan a la conciencia primaria producen trastornos globales, pues afectan a la conciencia en su conjunto. Los trastornos de la conciencia superior producen perturbaciones parciales, que involucran mayormente a la autoconciencia, aunque también incluyen las distorsiones y engaños perceptivos

Traditionally, there has been an incongruity between the definition of consciousness and the characterization of its pathology, which is restricted to those disorders that affect consciousness as a whole, either by a decrease in its level or by a disorganization of its contents. Developments in cognitive neuroscience have shown that there are other disturbances of consciousness that do not imply its total involvement. In order to present a comprehensive classification of these disorders, we will build our classification on the theories of Edelman and Damasio, who differentiate an elementary form of consciousness (primary or core consciousness, respectively) from a complex one (higher order or extended consciousness, respectively). Diseases that affect primary consciousness cause global disorders, because they affect consciousness as a whole. Disorders of higher-order consciousness cause partial disturbances, which mostly involve self-consciousness. Perceptual distortions and deceptions are also included here

Sobre el concepto de lucidez / [On the concept of lucidity].

Kraepelin’s concept of clarity of awareness (lucidity) had a stable signification during more than hundred years. It is the basis of most of current theories of disturbed consciousness. However, two alternative definitions that arise in Buenos Aires produce confusion due to their conceptual overlap. We discuss these definitions and propose a classification of disorders of consciousness that rely on traditional point of view.

Las clasificaciones en la psiquiatría actual / The classification in actual psychiatry

La importancia del diagnóstico psiquiátrico excede los límites de la terapéutica para extenderse al terreno de la investigación y la elaboración de planes de salud. En la década de 1970/80 surgieron los primeros sistemas diagnósticos operativos con el fin de mejorar Ia confiabilidad interjuicios y darle una base más sólida a la validación de los diversos trastornos. Paradójicamente, la proliferación de sistemas operativos ha puesto en duda su objetivo de servir como lenguaje psiquiátrico común. A pesar de su innegable utilidad, se observa una tendência reduccionista en la aplicación de estos sistemas diagnósticos, la cual podría generar efectos negativos en el ámbito de la psicopatología y de la enseñanza de la psiquiatría.