Giacomo Gualtieri

Sexual Masochism Disorder with Asphyxiophilia: A Deadly yet Underrecognized Disease

DSM-5 distinguishes between paraphilias and paraphilic disorders. Paraphilias are defined as atypical, yet not necessarily disordered, sexual practices. Paraphilic disorders are instead diseases, which include distress, impairment in functioning, or entail risk of harm ones self or others. Hence, DSM-5 new approach to paraphilias demedicalizes and destigmatizes unusual sexual behaviors, provided they are not distressing or detrimental to self or others. Asphyxiophilia, a dangerous and potentially deadly form of sexual masochism involving sexual arousal by oxygen deprivation, are clearly described as disorders. Although autoerotic asphyxia has been associated with estimated mortality rates ranging from 250 to 1000 deaths per year in the United States, in Italy, knowledge on this condition is very poor. Episodes of death caused by autoerotic asphyxia seem to be underestimated because it often can be confounded with suicide cases, particularly in the Italian context where family members of the victim often try to disguise autoerotic behaviors of the victims. The current paper provides a review on sexual masochism disorder with asphyxiophilia and discusses one specific case as an example to examine those conditions that may or may not influence the likelihood that death from autoerotic asphyxia be erroneously reported as suicide or accidental injury.

Drinking wine to "get high": the influence of awareness of the negative effects among young adults.

Introduction In a group of university students, the current study investigated the relationship between drinking wine to get high and the awareness about its characteristics, composition, positive and negative effects on health. Methods Through a web-based survey, 1685 students at the University of Siena completed a self-report questionnaire to assess consumption behaviours, knowledge about wine and the awareness about its effects. Results Seventy-three percent reported drinking wine. Males were more frequently wine consumers (p = 0.037). Among the students who reported drinking, 69.3% engaged this habit during the weekend. Almost 12% reported drinking wine to get high. Drinking wine to get high correlated with the consideration of its consumption: using this beverage to get high was strongly associated with considering wine like other spirits (p = 0.033). Conclusions Older age, female gender, and considering wine as a part of the diet were found to be protective factors against wine drinking-to get high. In contrast with some literature, awareness of the negative effects correlated with higher propensity to use wine to get high. Potential interpretations and limitations are addressed.

A case of fatal Clostridium perfringens bacteremia and sepsis following CT-guided liver biopsy of a rare neuroendocrine hepatic tumor

Clostridium perfringens, formerly known as Clostridium welchii, is an anaerobic, Gram-positive, spore-forming bacillus [1–3]. Clostridia are ubiquitous organisms found in soil and water, as well as in the gastro-intestinal and urogenital tract of healthy humans [1, 4]. Some Clostridia, like Clostridium botulinum, Clostridium tetani and Clostridium difficile are pathogenic to humans and animals [3, 5–7]. Clostridium perfringens has the ability to cause disease in humans and animals, because of its rapid growth, spore formation, and toxin production. The clinical presentation of C. perfringens infection includes a variety of manifestations, such as gas gangrene, emphysematous cholecystitis, crepitant cellulitis, fasciitis and myositis [4, 8–10]. The main toxin is theα-toxin, an enzyme that splits lecithin into phosphocholine and diglyceride, causing damage to red blood cell membranes, leading to spherocytosis and subsequent intravascular hemolysis [3, 11, 12] Once inside the body, this organism can also perform anaerobic fermentation, producing large amounts of gaseous waste products [13–15]. The mortality rate of patients with Clostridium perfringens bacteremia is 27–44%; in 7%–15% of cases, hemolysis complicates the sepsis, raising the mortality to 70%–100% [7, 16–18]. The early clinical symptoms ofC. perfringens infection are non-specific, which leads to considerable difficulty with diagnosis [19–22]. Early recognition and initiation of appropriate antibiotic treatment and surgical intervention or drainage is essential [18, 19]. In some instances, the initial presenting symptom is anemia, with a raised mean cell hemoglobin concentration and a reduced mean cell volume, in conjunction with hemoglobinemia and hemoglobinuria [10, 23, 24]. Gram-positive rods on a peripheral blood smear and positive blood or tissue culture confirm the diagnosis. A plain radiograph of the abdomen may reveal the presence of abscesses or gas in tissues [2].