Problématique des anéjaculations psychogènes au Sénégal : à propos de quatre cas

In Senegal, sexual disorders are a real diagnosis and support problem, which is due to the lack of information of patients, sexual taboos and the little number of these affections. Patients with an anejaculation without organic or iatrogenic etiology were sent to psychiatry in psychological support consultation. The individual sessions have identified common psychosocial factors over the circumstances leading up to and sustaining the psychogenic anejaculation. The first common factor is early sexual intercourse prior to puberty for all patients. In addition, we have noted the fear of a potential incest with guilt feelings, and a sort of over-appraisal of the anejaculation by partners, all these factors may contribute to the strengthening of the disorder Provision of a listening space associated with adjustments based on the behavioral cognitive approach could bring relief to patients.     

Les tumeurs testiculaires à cellules de Leydig: à propos de quatre cas et revue de la littérature

Introduction

Leydig cell tumors of the testis are uncommon, and represent 1 to 3% of all testicular tumors, it’s the most common of sex cord stromal tumors. They can be found in all age groups, but they mainly occur in subjects aged 15 to 50 years (50%), 25% occurring in older men and a little less than 20% in children aged 5 to 9 years. The most common revealing symptom is gynecomastia in adults, whereas in children it is isosexual pseudo-precocious puberty. They pose a problem during diagnosis, nonpalpable tumors, and during the choice of surgical treatment, because it is difficult to make a clear distinction between benign and malignant tumors.

Material and methods

We describe four different presentations of this disease. The parameters studied were: age, revealing symptom, hormonal profile, type of treatment, and mode of evolution.

Results

The average age of our patients was 37.5 years. The first revealing symptom was a unilateral increasing size of purse in two cases, a bilateral increasing size of purse in one case, and gynecomastia in the last one. In all cases testosterone was normal or low, and oestradiol was normal or elevated. Our four patients underwent an orchidectomy, associated with an enucleation of the contralateral testis in only one case. A favorable evolution was observed in every case for a mean follow-up of 15 months.

Conclusion

On the basis of four different clinical observations and the analysis of the literature, the aim of this review is to present the various clinical, biological, radiological, pathological and therapeutic aspects of Leydig cell tumors of the testis.     

Scintigraphie myocardique et séquelles de myocardite : présentation d’un cas clinique

Acute and subacute myocarditis are well-defined pathological entities but it is often difficult to identify them because their clinical expression is variable and the diagnosis is histological showing myocardial inflammation associated with degeneration and/or necrosis. Often symptoms are similar to those of acute pericarditis with “chest-crushing” pain that mimics myocardial infarction and prompts practitioners to request angiography, especially when there are cardiovascular risk factors. We report the case of a 61-year-old patient with neither cardiac history nor cardiovascular risk factor who consulted for a long and self-limited atypical chest pain with normal clinical examination and electrocardiogram. Myocardial perfusion scintigraphy showed a non-reversible photopenic area suspected of being a nontransmural necrosis or an artifact. The discovery of inferolateral hypokinesis of left ventricle on echocardiography led to perform a coronary angiography which was finally normal. Cardiac MRI allowed to diagnose scars of a previous episode of myocarditis.     

Espaces de représentation et psychopathologie

A subjective world can be conceptualized as a “representational space” — that is, as a universe displayed from memory, in which the subject “is sailing”. Recent cognitive theory provides some conceptual tools for describing such a space in a relevant way for clinical purposes. The construction of a representational space is based on mental representations: (a) analogical representations, which display a content in working memory; (b) symbolic representations, which code and link up analogical representations to form a represented world. The dynamics of representations and affects is ruled by a principle of unification of representational space. The topology of a representational space depends on objective and subjective constraints which cause some “folds” and limit the display of such a space. The interaction between an event and a subjective memory can be analyzed within this framework, so that the concepts of trauma and defence processes can be defined. Clinical syndromes are defensive configurations that tend to close the representational space.     

Arrachement du scrotum par morsure humaine: présentation d’un cas et revue de la littérature

Human bites of male external genitalia are rare. We report a case of scrotal wound caused by human bite during a sexual dispute. Lesion was recent wound caused by tearing off the summit of scrotal skin without any testicular injury. The wound was successfully treated by antibiotics, surgical debridement and suture. The patient was immunized against tetanus.     

Analogues et dosages d’insuline : le cas général et le cas particulier de la glargine

Since 1996, genetic engineering has allowed modifications of insulin yielding to multiple modified insulins with different pharmacokinetic and/or pharmacodynamic properties. Molecules with maintained pharmacodynamic and modified pharmacokinetic profiles have been selected. Currently available rapid-acting analogues (lispro, aspart and glulisine) achieve plasma peak concentrations about twice as high and within approximately half the time compared with regular human insulin thus closely mimicking the physiological insulin response to a meal. Long-acting analogues (glargine and detemir) ensure the steady supplement of basal insulin plasma levels, with a plateau type of profile. Main analytical pitfalls of commercially human insulin immunoassays include crossreactivity with analogues and their metabolites. These crossreactivities are of great concern for interpreting insulin levels in patients treated with analogues. The development of more specific analytical methods to quantify separately the concentrations of endogenous insulin, rapid-acting and long-acting analogues and metabolites would be of utmost importance: (1) to further understand long-acting analogue variability in terms of efficiency; (2) to perform analogue kinetic studies; (3) to measure analogues in routine toxicology (forensic medicine) and (4) to assess intact glargine or glargine metabolite in vivo toxicity: recent debates about glargine safety have highlighted the lack of data about metabolite status (proportion of metabolized glargine and bioactivity of its metabolite). This goal could be achieved by specific immunoassay development or/and mass spectrometry analysis.     

A propos de l'intervention des aéroions dans les processus de régulation de la lipémie et de la cholestérolémie

Resume Les expériences ont porté sur des lapins repartis en deux groupes parallèles — un groupe étant traité avec des aéroions négatifs en concentrations moderées (n^– = 10 – 40.000; n⁺ = 1.000) et l'autre sans aéroionothérapie (témoins). Par rapport aux animaux témoins (pas exposés aux aéroions),on a enregistré,sous l'influence de l'aéroionothérapie, que: (1)il y a une tendence de normalisation de la motilité spontanée, deprimée par une alimentation contenant un excès de cholestérol(0,3 g/kg/jour); (2) la lipémie et la cholestérolémie sont restées à un niveau plus bas chez les animaux alimentés au cholestérol; (3) la lipémie et la cholestérolémie, de même que l'iode thyroïdien, sont restées aux valeurs voisines de celles normales,chez les animaux nourris avec un excès (20 mg/kg/jour), de substances antithyroïdiennes naturelles (provenant du chou).

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Groups of rabbits were exposed to negative air ions of moderate concentrations (n^– = 10 – 40,000; n⁺ = 1,000) while others served as controls. (1) When rabbits were fed a cholesterol-rich diet (0.3 g/kg/day)causing reduction of motility in the control animals, their motility was normalized under air ion treatment. (2) The blood cholesterol and lipid levels of rabbits on a cholesterol-rich diet were lower with air ion treatment than in controls.(3) When rabbits were fed a diet with thyroid blocking agents from cabbage the blood cholesterol and lipid levels and the thyroid iodine content remained unchanged with air ion treatment.

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Zusammenfassung Gruppen Kaninchen wurden mit negativen Luftionen in mässigen Konzentrationen (n^– = 100 000 – 40 000; n⁺ = 1 000) behandelt, während andere als Kontrollen dienten. (1) Die durch Fütterung von cholesterinreicher Diät (0,3 g/kg/Tag) verminderte Motilität der Tiere wurde unter der Luftionenbehandlung normalisiert. (2) Der durch Fütterung von cholesterinreicher Diät erhöhte Blutcholesterin- und-fettspiegel fiel durch Luftionenbehandlung ab. (3) Der durch Fütterung von strumipriven Substanzen aus Kohl erhöhte Cholesterin- und Fettspiegel im Blut und verminderte Jodgehalt der Schilddrüse wurde durch Luftionenbehandlung nicht beeinflusst.

     

Epidémie de dysentérie bacillaire.

An outbreak of bacillary dysentery in 1978 affecting 928 persons, most of whom were living in the village of St-Jacques, PQ, is described. An epidemiologic study suggested the water supply as the source of the infection, and it was established that the water carried by the municipal aqueduct was contaminated by feces containing the causal agent, Shigella sonnei. This epidemic, the largest mentioned in he Canadian medical literature, demonstrates how contagious this infection is.     

Dépistage de l’hypothyroïdie congénitale à l’hôpital de la Mère et de l’Enfant Lagune de Cotonou

Congenital hypothyroidism is a preventable cause of mental retardation in children. Systematically detected and treated in Western countries, this condition remains neglected in Africa. This study was conducted from March through July 2011 in the Gynecology-Obstetrics Department and the Paediatrics Department of Hôpital de la Mère et de l’Enfant Lagune (HOMEL) and in the Radioimmunoassays laboratory (SeRiD) of Cotonou. Authors’ objective was to screen newborns for congenital hypothyroidism. Five hundred and forty-nine newborns were enrolled in the study and 35 (6.4%) had abnormal levels of thyroid markers in the first assay on umbilical cord blood. Controls that were performed in 27 children between the third and 15th days disclosed no abnormality. Maternal fever and birth asphyxia appeared to influence hyperthyrotropinemia while low birth weight, birth asphyxia and non-cephalic presentations were associated with hypothyroxinemia.