[Apotemnophilia as a contemporary frame for psychological suffering]. / Apotemnophilie: une mise en forme contemporaine de la souffrance psychique?

UNLABELLED: The word <> was created in 1977. It was first used to describe an extreme paraphilia concerning both the search for amputees as sexual partners, and the fantasies and wishes to be amputated linked to a sexual arousal. CLINICAL FINDINGS: More recently, the number of self-demand amputations appears to have raised. Some amputations of healthy legs have even been performed in hospital settings, raising important ethical issues. A new category of trouble has been described: the Body Integrity Identity Disorder (BIID). Criterias for its diagnosis have been developed and submitted to DSM V task force. According to clinicians who support the existence of BIID, this disorder is not a paraphilia, don't overlap with other psychiatric disorders and could be in some ways compared to transexualism. The patient's health would therefore require the amputation of healthy limbs in order to <> themselves and to help them to become <> according to their <>. Still according to those clinicians, psychiatric symptoms would be either a consequence of the shame resulting from this condition, or a consequence of the doctor's refusal to perform these amputations. An ever growing <> litterature on the web support this opinion, but the scientific litterature is still very scarce. LITERATURE FINDINGS: In this paper, we analyse available scientific datas. This review does not support the existence of BIID as a discrete nor a specific condition. CASE-REPORT: In a second part of this paper, we describe the case of a young woman who started asking for above-the-knee leg amputation after a minor knee trauma, while complaining for pain and leg rigidity. Her medical state worsened, probably because of repeated self-inflicted lesions and food restriction, leading to a severe undernutrition and life-threatening hypokaliemia. After some time, her medical state required amputation. This surgery did not resolve her psychological suffering. She never talked about amputation as a way to achieve herself. She did not meet the criterias for BIID. We consider her trouble as an association of a factitious disorder with a borderline personality disorder. DISCUSSION: In the last part of this paper, we discuss the <> scientific litterature about apotemnophilia and BIID. We support the idea that BIID can be considered as a culture-bound syndrome, a contemporary frame for psychological suffering. We think that BIID does not have neither intrinsic nor unequivocal psychopathological meaning. It is a <> (Elliott), a common pathway for the expression of very different kinds of psychological suffering. CONCLUSION: Apotemnophilia and BIID are raising important ethical and practical issues for psychiatrists: their opinion will probably be requested by patients and surgical teams having to deal with patient asking for healthy limbs amputation.

[Pain perioperative in surgery of the hand]. / La douleur périopératoire en chirurgie de la main.

Pain has to be treated during the perioperative period. The recent improvement in pain treatment results from a better understanding of pain mechanisms, strict evaluations and appropriate protocols for pain management. Mainly nociceptive, postoperative pain looks more and more like neuropathic pain when it persists or increases. Therefore, analgesics are no more effective and antihyperalgesiant drugs must use. Preventive treatments have to be considered first as the best pain treatment. Basically, perioperative pain has to be understood as a standard quality management by the medical and surgical team.

[Neurophysiology of perineal pain]. / Neurophysiologie des douleurs périnéales.

Perineal pains are based on two principal mechanisms: excess of nociception and desafferentation. The pain is psychogenic when none these mechanisms is found. Chronicization depends on first primary and secondary hyperalgesia and is sustained by sympathic and motor reflexs, and second nevrotic characters and even psychiatric pathology which give a painful experience of life.

[Treatment of neuralgia after surgical repair of inguinal hernia. Apropos of 47 cases]. / Traitement des névralgies après cure de hernie inguinale. A propos de 47 observations.

A semiologic study is performed and therapeutic proposals are made on the basis of the anatomical and physiopathological data relating to residual neuralgia after the cure of a hernia. A series of 47 patients, 41 of whom were treated at the Multidisciplinary Pain Treatment Center of Avicenne Hospital (Bobigny) is analysed. The results are the following: 16 cures, 22 improvements, 6 failures, 3 patients lost to follow-up. The authors emphasize the difficulties of treatment, the poor effectiveness of second surgery as a rule, and the necessity of a general management.

[Histological study of livers conserved for long periods (author's transl)]. / Etude histologique des conservations hépatiques de lognue durée.

33 pig livers were preserved using two comparative methods: extra-corporeal perfusion and immersion in hypothermia. The duration of conservation varied between 2 and 24 hours. A macroscopic and microscopic study carried out in all cases permitted us to define four cytological stages for the lesions, completed by an ultrastructural study showing the cyto-pathological course of the hepatocytes in two distinct cell series. The interest of this study is to better appreciate the degree of aggression of the lobule in relation to the metabolic gradient and that of the hepatic parenchyma. Analysis of the results is in favour of conservation of the liver by immersion.

[Necrotising enterocolitis. Report of 3 cases (author's transl)]. / Entérocolites aiguës nécrosantes. A propos de trois observations.

A review of clinical, pathological findings in 3 cases of necrotising enterocolitis is presented, as well as considerations about pathogenesis. The authors stress the benefits of hyperbarie oxygen in the treatment of the disease.

[Post-operative necrotising enterocolitis. One case cured by hyperbaric oxygenotherapy (author's transl)]. / Entérite aiguë nécrosante post-opératoire traitement par oxygénothérapie hyperbare. A propos d'un cas suivi de guérison.

About one case of necrotising enterocolitis following an extra-peritoneal and aseptic operation, it seems that a post-operative ileus, by the ischemia of mucous membrane and the swarming of anerobics that it involves, seems to be responsable of this dreadful complication. The macroscopic and deceiver aspect of intestine to an early re-operation can impeed this diagnosis. The hyperbaric oxygenotherapy seems to be a perceptible adjuvant treatment.