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A 26-year-old female patient, from La Paz-Bolivia. She came with a disease period of 15 months characterized by progressive dysphagia. One month before the onset of the symptomatology she ingested bleach with autolytic intentions. In the study of diagnostic upper gastrointestinal endoscopy at 25 centimeters of the dental arch was evidenced a stenosis of about 3 mm in diameter, central and with adjacent esophageal epithelium of a preserved appearance. In the x-ray of contrasted esophagus at the level of the middle third of the esophagus was evidenced a stenosis, short tubular, with a smooth border, of approximately 2 cm in length. Treatment was initiated using axial mechanical dilatations with Savary Guilliard bougies with an interval between sessions of 2 to 3 weeks and with 8 sessions in total. In the last session the largest bougie used was 12.8 mm. It is then that taking into account the diagnostic criteria of Kochman, the diagnosis of refractory caustic esophageal stenosis was made. During the period of realization of the dilations with bougies the patient became pregnant, which made difficult the accomplishment of the procedures for the routine use of fluoroscopic control. At 14 weeks of pregnancy, a SX-ELLA uncovered biodegradable esophageal stent of 10 cm length was implanted. We present the case as an alternative and novel management for this type of pathology.

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Paciente mujer de 26 años de edad, natural y procedente de La Paz-Bolivia. Acudió con un tiempo de enfermedad de 15 meses caracterizado por disfagia progresiva. Un mes antes del comienzo de la sintomatología ingirió lejía con intenciones autolíticas. En el estudio de endoscopia digestiva alta diagnóstica se evidenció a los 25 centímetros de la arcada dentaria una estenosis, de unos 3 mm de diámetro, central y con el epitelio esofágico adyacente de aspecto conservado. En la radiografía de esófago contrastada se evidenció a nivel de tercio medio de esófago una estenosis tubular corta, de bordes lisos, de aproximadamente 2 cm de longitud. Se inició tratamiento mediante dilataciones mecánicas axiales con bujías Savary Guilliard con un intervalo entre sesiones de 2 a 3 semanas y con 8 sesiones en total. En la última sesión la bujía de mayor calibre usada fue 12,8 mm. Es entonces que tomando en consideración los criterios diagnósticos de Kochman, se hizo el diagnóstico de estenosis esofágica cáustica refractaria. Durante el periodo de realización de las dilataciones con bujías la paciente quedo embarazada, lo que dificultaba la realización de los procedimientos por el rutinario uso de control fluoroscópico. Con 14 semanas de gestación se implantó un Stent esofágico biodegradable no cubierto SX-ELLA de 10 cm de longitud. Presentamos el caso por ser un manejo alternativo y novedoso para este tipo de patología.

A 26-year-old female patient, from La Paz-Bolivia. She came with a disease period of 15 months characterized by progressive dysphagia. One month before the onset of the symptomatology she ingested bleach with autolytic intentions. In the study of diagnostic upper gastrointestinal endoscopy at 25 centimeters of the dental arch was evidenced a stenosis of about 3 mm in diameter, central and with adjacent esophageal epithelium of a preserved appearance. In the x-ray of contrasted esophagus at the level of the middle third of the esophagus was evidenced a stenosis, short tubular, with a smooth border, of approximately 2 cm in length. Treatment was initiated using axial mechanical dilatations with Savary Guilliard bougies with an interval between sessions of 2 to 3 weeks and with 8 sessions in total. In the last session the largest bougie used was 12.8 mm. It is then that taking into account the diagnostic criteria of Kochman, the diagnosis of refractory caustic esophageal stenosis was made. During the period of realization of the dilations with bougies the patient became pregnant, which made difficult the accomplishment of the procedures for the routine use of fluoroscopic control. At 14 weeks of pregnancy, a SX-ELLA uncovered biodegradable esophageal stent of 10 cm length was implanted. We present the case as an alternative and novel management for this type of pathology.

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ABSTRACT Purpose: To study the effect of penile constriction devices used on a large series of patients who presented at our emergency facility. We explored treatment options to prevent a wide range of vascular and mechanical injuries occurring due to penile entrapment. Materials and Methods: Between January 2001 and March 2016, 26 patients with penile entrapment were admitted to our facility and prospectively evaluated. Results: The time that elapsed from penile constrictor application to hospital admission varied from 10 hours to 6 weeks (mean: 22.8 hours). Non-metallic devices were used by 18 patients (66.6%) while the other nine (33.4%) had used metallic objects. Acute urinary retention was present in six (23%) patients, of whom four (66.6%) underwent percutaneous surgical cystotomy and two (33.4%) underwent simple bladder catheterization. The main reason for penile constrictor placement was erectile dysfunction, accounting for 15 (55.5%) cases. Autoerotic intention, psychiatric disorders, and sexual violence were responsible in five (18.5%), five (18.5%), and two (7.4%) cases, respectively. The mean hospital stay was 18 hours (range, 6 hours to 3 weeks). Conclusion: Penile strangulation treatment must be immediate through the extraction of the foreign body, avoiding vascular impairments that can lead to serious complications. Most patients present with low-grade injuries and use penile constrictors due to erectile dysfunction. Removal of constrictor device can be challenging. The use of specific tools for achieving penile release from constrictors is a fast, safe and effective method. Patients with urinary retention may require urinary diversion.

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Las conductas auto estimulatorias y auto lesivas son muy frecuentes en los trastornos del neurodesarrollo, siendo una fuente de ansiedad y sufrimiento importante tanto para las personas que las presentan como para sus familias. En ocasiones estas conductas son tan intensas y frecuentes que llegan a ser un peligro para la salud del sujeto. Se realiza una revisión bibliográfica sobre las diferentes vías de atención de estas conductas desarrolladas hasta el momento, y se expone la metodología aplicada en nuestra clínica, presentando datos recopilados sobre el efecto de la terapia sobre las conductas auto lesivas y auto estimulatorias en 20 casos, como punto de partida para próximas investigaciones. Se destaca el modelo de integración sensorial que complementa el tratamiento farmacológico y el cognitivo conductual, ya que considera relevante las necesidades sensoriales y entrena la capacidad de auto regulación funcional.

Self-stimulatory and self-injurious behaviors are very frequent in neurodevelopmental disorders, being a source of anxiety and suffering for persons who have that behavior and their families. Sometimes these behaviors are so intense and frequent that it becomes a self-integrity risk. A bibliographic review was conducted on the different approaches that have been developed until today; in addition, this article explains the methodology applied in our clinic, with a data collection on the effect of therapy on self-injurious and self-stimulatory behaviors in 20 cases, as a starting point for future research. The sensory integration model that complements pharmacological and behavioral cognitive treatment is highlighted, since it considers sensory needs relevant and trains the capacity for functional self-regulation.

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Self-stimulatory and self-injurious behaviors are very frequent in neurodevelopmental disorders, being a source of anxiety and suffering for persons who have that behavior and their families. Sometimes these behaviors are so intense and frequent that it becomes a selfintegrity risk. A bibliographic review was conducted on the different approaches that have been developed until today; in addition, this article explains the methodology applied in our clinic, with a data collection on the effect of therapy on self-injurious and self-stimulatory behaviors in 20 cases, as a starting point for future research. The sensory integration model that complements pharmacological and behavioral cognitive treatment is highlighted, since it considers sensory needs relevant and trains the capacity for functional self-regulation.

Las conductas auto estimulatorias y auto lesivas son muy frecuentes en los trastornos del neurodesarrollo, siendo una fuente de ansiedad y sufrimiento importante tanto para las personas que las presentan como para sus familias. En ocasiones estas conductas son tan intensas y frecuentes que llegan a ser un peligro para la salud del sujeto. Se realiza una revisión bibliográfica sobre las diferentes vías de atención de estas conductas desarrolladas hasta el momento, y se expone la metodología aplicada en nuestra clínica, presentando datos recopilados sobre el efecto de la terapia sobre las conductas auto lesivas y auto estimulatorias en 20 casos, como punto de partida para próximas investigaciones. Se destaca el modelo de integración sensorial que complementa el tratamiento farmacológico y el cognitivo conductual, ya que considera relevante las necesidades sensoriales y entrena la capacidad de auto regulación funcional.

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PURPOSE: To study the effect of penile constriction devices used on a large series of patients who presented at our emergency facility. We explored treatment options to prevent a wide range of vascular and mechanical injuries occurring due to penile entrapment. MATERIALS AND METHODS: Between January 2001 and March 2016, 26 patients with penile entrapment were admitted to our facility and prospectively evaluated. RESULTS: The time that elapsed from penile constrictor application to hospital admission varied from 10 hours to 6 weeks (mean: 22.8 hours). Non-metallic devices were used by 18 patients (66.6%) while the other nine (33.4%) had used metallic objects. Acute urinary retention was present in six (23%) patients, of whom four (66.6%) underwent percutaneous surgical cystotomy and two (33.4%) underwent simple bladder catheterization. The main reason for penile constrictor placement was erectile dysfunction, accounting for 15 (55.5%) cases. Autoerotic intention, psychiatric disorders, and sexual violence were responsible in five (18.5%), five (18.5%), and two (7.4%) cases, respectively. The mean hospital stay was 18 hours (range, 6 hours to 3 weeks). CONCLUSION: Penile strangulation treatment must be immediate through the extraction of the foreign body, avoiding vascular impairments that can lead to serious complications. Most patients present with low-grade injuries and use penile constrictors due to erectile dysfunction. Removal of constrictor device can be challenging. The use of specific tools for achieving penile release from constrictors is a fast, safe and effective method. Patients with urinary retention may require urinary diversion.

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Penetrating cardiac trauma has been increasing in clinical experience and is joined to important morbidity and mortality. A case of a 38-year-old female with history of postpartum depression was reported, admitted to our department for cardiac tamponade due to penetrating self-inflicted multiple stab wound of the chest complicated by rupture of anterior left ventricular wall and traumatic ventricular septal defect. Following the unstable hemodynamic instability, a combined therapeutic strategy was chosen: surgery and transcatheter implantation to correct free wall ventricle damage and traumatic ventricular septal defect, respectively.

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Abstract Penetrating cardiac trauma has been increasing in clinical experience and is joined to important morbidity and mortality. A case of a 38-year-old female with history of postpartum depression was reported, admitted to our department for cardiac tamponade due to penetrating self-inflicted multiple stab wound of the chest complicated by rupture of anterior left ventricular wall and traumatic ventricular septal defect. Following the unstable hemodynamic instability, a combined therapeutic strategy was chosen: surgery and transcatheter implantation to correct free wall ventricle damage and traumatic ventricular septal defect, respectively.

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Obsessive-compulsive-related cutaneous disease most often includes trichotillomania, neurotic excoriations and nail biting. In this report, we present two cases of self-inflicted severe wounds that were diagnosed as secondary to obsessive-compulsive behaviour. Patients were middle-aged females who presented with deep cutaneous ulcers that were acknowledgedly maintained through repetitive manipulation. Obsessive-compulsive-related cutaneous disease is better treated with serotonin reuptake inhibitor antidepressants in higher dosages than those used to treat depression. Both patients were treated with fluoxetine 60-80 mg that resulted in adequate healing of the ulcers; relapses were observed during attempts to taper fluoxetine dosage. An adequate psychic diagnosis is required if an effective therapeutic response to self-inflicted cutaneous lesions is desired, because clinically identical lesions can also be caused as a result of distinct mental mechanisms: anxiety, depression, psychosis, obsessive-compulsive disorder and classic dermatitis artefacta.

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Pyogenic granuloma (PG) is a rare, benign, vascular, hyperplasic, soft tissue lesion caused by diverse factors, including traumatic injuries. This article presents a case involving the surgical removal of PG on the tongue of a 4-year-old boy who had difficulty with speech and eating because of the tongue lesion. The parents reported that the child had the habit of nibbling on and sucking his tongue. The lesion was excised and histopathological analysis confirmed the diagnosis of PG; however, because the child continued to nibble and suck on his tongue, the lesion recurred. A second surgery was performed with the same histopathological diagnosis. At a one-year follow-up, the child had ceased his tongue habits, and no recurrence was seen.

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OBJECTIVE: This study investigated the association between alcohol and violence among Argentine youth. METHODS: Data from the 2007 Argentina Global School-based Student Health Survey (GSHS), a nationally representative survey of middle school students, were examined using age-adjusted logistic regression models. RESULTS: Of the 1,328 participating students aged 13 to 15 years old, 51.9% reported drinking alcohol in the previous month, with higher rates among males (p=0.04) and older students (p<0.01). Both male and female drinkers were nearly twice as likely as non-drinkers to report being physically attacked, being in a physical fight, and having thoughts about self-directed violence. Among drinkers, those who reported poor mental health, were victims of bullying, used tobacco or drugs, or skipped school without permission were approximately twice as likely as other drinkers to have engaged in violent activities. CONCLUSION: Public health interventions targeting violence among young adolescents should be developed in combination with alcohol education programs.

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OBJETIVO: Este estudo investigou a associação entre álcool e violência na população de jovens argentinos. MÉTODOS: Dados da Global School-based Student Health Survey (GSHS) de 2007, uma pesquisa representativa em termos nacionais com alunos do ensino médio, foram examinados utilizando-se modelos de regressão logística ajustados por idade. RESULTADOS: Dos 1328 alunos participantes entre 13 e 15 anos de idade, 51,9% declararam ter consumido álcool no último mês, com taxas mais elevadas entre meninos (p = 0,04) e alunos mais velhos (p < 0,01). Homens e mulheres que bebem demonstraram estar quase duas vezes mais propensos a relatar agressão física, quando em uma briga física, e pensamentos sobre violência autoinfligida do que aqueles que não bebem. Entre as pessoas que bebem, aquelas que reportaram saúde mental precária, haviam sido vítimas de bullying, fumavam, faziam uso de drogas ou abandonaram a escola sem permissão se mostraram duas vezes mais propensas ao envolvimento em atividades violentas do que outras pessoas que também bebem. CONCLUSÃO: Intervenções de saúde pública quanto à violência entre jovens adolescentes devem ser desenvolvidas em combinação com programas de educação sobre álcool.

OBJECTIVE: This study investigated the association between alcohol and violence among Argentine youth. METHODS: Data from the 2007 Argentina Global School-based Student Health Survey (GSHS), a nationally representative survey of middle school students, were examined using age-adjusted logistic regression models. RESULTS: Of the 1,328 participating students aged 13 to 15 years old, 51.9% reported drinking alcohol in the previous month, with higher rates among males (p = 0.04) and older students (p < 0.01). Both male and female drinkers were nearly twice as likely as non-drinkers to report being physically attacked, being in a physical fight, and having thoughts about self-directed violence. Among drinkers, those who reported poor mental health, were victims of bullying, used tobacco or drugs, or skipped school without permission were approximately twice as likely as other drinkers to have engaged in violent activities. CONCLUSION: Public health interventions targeting violence among young adolescents should be developed in combination with alcohol education programs.

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OBJECTIVE: To report a rare case of self-inflicted eye injury secondary to obsessive-compulsive disorder (OCD). METHOD: Case report. RESULTS: A 41 year-old patient had significant bilateral visual loss and blunt trauma through touching his ocular cavities due to recurrent doubts regarding their shape and urges to check the format of bones and cartilages. Differential diagnosis with tic disorders is discussed, and the patient's treatment approach is described. CONCLUSION: Although rare, severe clinical complications can occur in OCD.

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Adolescentes que manifestam seus problemas de modo autodestrutivo geralmente têm histórias pessoais caracterizadas por séria disfunção parental e uma experiência familiar instável. Nestes casos, os analistas vêem-se forçados a trabalhar num clima de risco iminente, o que cria problemas contratransferenciais específicos. Estes são explorados neste artigo através do relato de uma seqüência clínica a respeito de uma adolescente, a qual, depois de ter sido completamente abandonada aos quatorze anos pelo pai, passou a apresentar actings sexuais cada vez mais perigosos e compulsivos, com o objetivo de evacuar uma intolerável dor mental, antes mesmo de ser capaz de senti-la. O material clínico apresentado mostra um momento de transformação de uma ação repetitiva a um esboço de elaboração(AU)

Adolescents who manifest their problems in a self-destructive way generally have personal histories characterized by serious parental dysfunction and an unstable family background. In such cases, analysts find themselves forced to work in a climate of imminent risk, which creates specific counter-transference problems. These are explored through an account of a clinical sequence relating to an adolescent who, after being completely abandoned by the father at the age of 14, carried out increasingly dangerous and compulsive sexual acting out, designed to expel intolerable mental pain before being able to feel it. The clinical material presented describes a moment of transformation, from a repetitive action to an outline of elaboration(AU)

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Self Injurious Behaviour (SIB) is a deliberate harm to the body that may lead to factitial injuries. Its origin may be functional or biological and it has a higher prevalence in females and in psychologically impaired individuals. Seventy per cent of autistic patients have SIB. Seventy-five per cent of factitial injuries are located in the head and neck region. A paediatric case report concerning a 4-year-old autistic female is presented. Detailed medical history, physical examination, clinical intraoral and radiographic examination, incisional biopsy, neuropaediatrical, psychological and speech evaluation were undertaken. Diagnosis included hypochromic macrocytic anaemia, caries, coronal fracture, factitial ulcer, factitial periodontitis, self-extraction of primary teeth and permanent teeth buds, non-specific oral ulcer with inflammatory reaction, mild mental retardation, speech impairment, autistic syndrome and self injurious behaviour consisting of putting fingers and foreign objects in the gingiva, fingernail biting and hair pulling. Differential diagnosis included hystiocitosis X, prepuberal periodontitis and leukocyte adhesion deficiency. Dental preventive and restorative treatment was performed. Non-contingent reinforcement therapy was successfully used to diminish SIB. Treatment of factitial oral injuries must be interdisciplinary and requires cooperation of the patient, the parents, health care providers, and medical team.

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