Conséquences de la chimiothérapie anticancéreuse sur la fertilité de la femme

Sterility is a potential toxic effect of chemotherapy. This risk is well established for alkylating agents, but is less clearly defined for anthracyclines, methotrexate and fluorouracil and poorly defined for alkaloids, platinum, etoposide and taxanes. The main predictive factors for ovarian toxicity are the additive effect of cytotoxic drugs, the cumulative dose of each drug and the patient’s age. This effect of chemotherapy is evaluated on menstrual cycles, hormonal assays and the number of pregnancies observed in patient cohorts. Chemotherapy induces destruction of oocytes and granulosa cells. In mice, it has been shown that adriamycin may induce oocyte apoptosis, which can be prevented by modulation of cycle cell signalling (dysregulation of Bax gene or, on the contrary, expression of its antagonist gene Bcl-2 or inhibition of apoptosis with sphingosine-1-phosphate or caspase inhibitors). Clinical data in the literature are usually based on retrospective studies and are somewhat confused: global fertility after MOPP chemotherapy for Hodgkin’s disease is about 20%, adjuvant chemotherapy with CMF, F(A)C or TAC for breast cancer induces amenorrhea in 50% to 70% of cases, PVB or BEP chemotherapy for ovarian germ cell tumors has little effect on fertility when the uterus and one ovary can be preserved, and the majority of women treated with methotrexate, actinomycin D or various combinations for persistent trophoblastic disease remain fertile. Preservation of fertility is a major goal for cancer patients receiving chemotherapy: in vitro fertilization could preserve the couple’s fertility, but is usually not feasible as it would delay initiation of chemotherapy until after stimulation of ovulation; oocyte or ovarian tissue cryopreservation is at the stage of research; oral contraceptives have not been demonstrated to be effective to preserve ovarian function; gonadotropin releasing hormone (GnRH) agonists prevent cyclophosphamide toxicity in rat and monkey ovaries, and a few pilot clinical studies suggest that chemotherapy-induced amenorrhea could be prevented by administration of GnRH analogues simultaneously to chemotherapy, but randomised studies are necessary.     

Surveillance de la santé à l'école maternelle.

In contrast to the traditional program of health assessment of schoolchildren based on periodic physical examination, the program described in this paper is based on the integration of information and data obtained by observation through the school year from parents, teachers and the school nurse, who coordinates the program. The numbers and the types of problems and the date on which they were identified are compared in an experimental group of 557 kindergarten children and a matched control group of 498 children in whom the traditional program was maintained. For problems of hearing, enuresis, learning and behaviour the number of cases detected was significantly greater in the experimental group than in the control group. Each element of the proposed program is analysed and the advantages of an integrated approach to health assessment of schoolchildren are underlined.     

Testostérone circulante et cancer de la prostate. Revue de données récentes

In vitro andin vivo studies show that androgens stimulate prostate cancer. However, evidence from epidemiological studies of an association between circulating levels of androgens and prostate cancer risk has been inconsistent, but most studies have likely been undersized given that the association may be relatively weak. We review prospective studies on the association of serum levels of free and total testosterone, the principal androgen in circulation with risk of prostate cancer. No significant association between total or free testosterone and risk of prostate cancer was found in studies that together included 1,525 cases of prostate cancer and 4,349 controls. No support was found for the hypothesis that high levels of circulating testosterone within a physiological range stimulate development and growth of prostate cancer. Intraprostatic androgen metabolism may still be of importance for prostate cancer development.     

Étude de l'effet de la température sur la division des cellules séparées de feuilles deCalystegia sepium (L.) R.Br.

Cells mechanically isolated from homogenized leaves ofC. sepium dividein vitro. The rate of cell division is strongly influenced by temperature with the optimum between 31 and 34 °C. The rate of cell division increases proportionally with a rise in temperature up to 31 °C and is accompanied by a reduction in the length of the preparatory phase of the division. A supraoptimal temperature (40 °C) inhibits or stops the cell division which can be restored provided that the cells are transferred to 31 °C. If the preparatory phase to the commencement of cell division is accomplished at 17 °C the cells then exposed to 31 °C divide more rapidly than if they are exposed directly to 31 °C.     

Étude de la variabilité de la clairance hépatique de la mébrofénine-99mTc en scintigraphie hépatobiliaire

AimThe purpose of this study was to investigate some of the parameters likely to influence mebrofenin-^99mTc hepatic clearance calculation and inter-and intra-observers reproducibility.Materials and methodsHepatic clearance (%/min m²) of 30 scintigraphies was calculated from the values of hepatic, cardiac, and total activities, according to the method recommended in the literature. We studied: 1) impact of injection–acquisition delay variations; 2) acquisition type: anterior face only (FA) or geometric mean (GM); 3) clearances calculated according to four different body surface area (BSA) formulas; 4) intra-and inter-observers reproducibility for three observers (two evaluations for each observer).Results1) Clearance differences between different studied intervals were statistically significant, more important if the studied interval was far from reference interval (150–350 secondes) and even more when the interval studied was too early (110–310 secondes). 2) There was a statistically significant difference between clearance calculated using either FA or GM datasets (0.85 %/min m²). 3) There were small but statistically significant differences for four of the clearance comparisons using different BSA formulas. 4) Despite differences in size of cardiac and hepatic regions of interest (ROI), intra-observer reproducibility of hepatic clearance was excellent for each observer. Inter-observers reproducibility was also excellent (r = 0.982).ConclusionHepatic clearance of mebrofenin-^99mTc appears to be a highly reproducible method provided that acquisition and clearance calculation are standardized. It provides additionnal functional information to morphological and biological data usually performed before major hepatectomy. Thereby, the definition of a standardized protocol would enable realization of multicentric studies.     

Production primaire dans les eaux de surface de la Méditerranée occidentale. Calcul de la production journalière

We have found a relationship between the net absorption of carbon at time t divided by the net absorption of carbon in 24 h (A_N(t)/A_N(24)) and the incubation duration after sunrise, in surface waters of the western Mediterranean sea. This ratio is quite similar whatever the sample location, the sample depth and the 24-h net-absorption level. Considering this result, we have established a correction factor which may be used to convert primary production rates obtained from incubation durations ≤ 24 h to daily rates (24 h dawn-to-dawn).     

Variations de quelques aclivités enzymatiques (peroxydase, catalase, AIA-oxydase) et de la teneur en polyphénols au cours de la germination de I'Orge. Influence de la kinétine

Peroxidase catalase, IAA-oxidase and polyphenol content of growing barley coleoptile. Effect of kinetin. - Kinetin strongly inhibits root and coleoptile growth of germinating barley in the dark. Treated coleoptiles become senescent before the untreated ones. Soluble proteins content, peroxidase, catalase and IAA-oxidase activity were greatly increased in treated coleoptiles while the level of polyphenols was reduced. These biochemical effects joined with the other property of kinetin to diminish α-amylase synthesis in the endosperm are discussed in relation to growth and in connection with the classic view of a cytokinin retarded senescence.     

Influence de la densité de population larvaire sur la taille des adultes,la durée de développement et la fréquence de la diapause chezPteromalus puparum L. [Hym., Chalcidien]

Summary The parasitoid waspPteromalus puparum was reared for many generations under controlled laboratory conditions: larval development in diapausing pupae ofPieris brassicae, 14 hours photoperiod, temperature of 21 °C or 25 °C. The fluctuations in the density of population appear to be the main source of variation for larval development. An increase in the number of larvae living in the same host pupa results in a decrease of adult size, a reduction of developmental time and a diminution of incidence of larval diapause. According to these results, it appears that a high population density hastens the occurrence of metamorphosis and makes it easier. It is suggested that various nervous stimulations, such as food shortage and interactions between larvae, may induce the onset of neurosecretion by the brain.      

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.

     

Quelques considérations sur l'enseignement de la médecine physique et de la réhabilitation

Particularly since World War II physical medicine and rehabilitation have assumed a growing importance. The efforts of the Canadian Association of Physical Medicine and Rehabilitation, following a survey of Canadian universities, to increase the theoretical and practical teaching of physiatrics are emphasized. It is considered important that the teaching of physical medicine and rehabilitation should be carried out concurrently with other medical and surgical teaching programs. Paramedical and auxiliary rehabilitation personnel should participate in the teaching program. The number of hours devoted to physiatrics should be increased, and the medical student should be permitted to choose physical medicine and rehabilitation as a part of his internship program.     

Les résidents et l'enseignement: revue de la littérature.

We reviewed the available data on residents'' teaching role in the clinical setting to develop programs to improve their teaching skills. Articles published from 1966 to 1989 were identified through a computerized search of MEDLINE, and the bibliographies of identified papers were reviewed. Articles directly related to the topic were included and analysed. Taking into account their quality, we extracted data relevant to specific issues. Approximately 15% to 25% of an average work week was spent by residents in different teaching activities. Students acknowledged the importance of their contribution to clinical teaching. Residents benefitted from teaching by increasing their medical knowledge and promoting the development of important attitudes. Insufficient preparation for this task and the numerous practical problems faced by residents may explain their modest performance as teachers. Nevertheless, programs directed to residents might improve the quality of their teaching. We suggest some guidelines for the development of programs to improve their teaching skills and for future research.     

Principes de la lecture critique de la littérature médicale: Illustration urologique

There has been an enormous expansion in scientific literature, especially in the area of health and medicine. At the same time the complexity of the research has increased. Through the reading of medical literature of his field of interest, the physician is in search of useful information. However, reading medical papers is very time consuming and most physicians, for their usual literature review, content themselves with the titles and the abstracts. Moreover, quality and relevancy of the publications vary greatly and the reader must be able to “separate the wheat from the chaff”. Thus the reading of literature needs selection and evaluation. As a result, physicians require critical appraisal skills. The principle of appraisal of medical literature is to assess the value of publications which will influence the medical practice of the reader. The reader has a double objective: to assess the credibility of the publications, and to define the applicability of the publication information. By following eight steps the reader is able to quickly rule out from his reading what is not valid and have an objective look at the quality of the results which are proposed to him. These eight steps comprise the assessment of the study objectives, the study design, the study factor(s), the outcome factor(s), the study population and sample, the confounding factor(s) and bias, the results with their statistical and clinical significance and the power of the study, and, lastly, the synthesis of the reader's judgment. The last word belongs to the clinician facing his patient.     

Utilisation des spermatozoïdes testiculaires en ICSI. Intérêt de la culture in vitro. Revue de la littérature

The number of ICSI cycles performed with testicular spermatozoa has increased dramatically over recent years. However, one of the technical limitations of this approach concerns the extremely reduced motility of testicular spermatozoa. However, increased sperm motility was observed after incubating testicular samples for several hours. Therefore, in order to improve ICSI success rates, several authors have tested the effect of previous in vitro culture. We present a review of the literature on this subject. In vitro culture does not appear to be very useful in cases of obstructive azoospermia, as, apart from possible sperm “maturation” during this culture phase, a high proportion of motile spermatozoa is usually already observed prior to in vitro culture. The benefits of in vitro culture appear to be greater in the case of non-obstructive azoospermia, as when spermatozoa are present on the biopsy, they are usually immobile. However, discordant results have been published: after in vitro culture, spermatozoa have been reported to be either motile or mostly dead. Regardless of the type of azoospermia, the best results are obtained after 3–4 days of in vitro culture. Addition of recombinant FSH to the culture medium also appears to be effective. Cryopreservation of testicular biopsies may also be associated with in vitro culture and the in vitro culture/freezing sequence appears to give better results than the freezing/in vitro culture sequence. Very few studies have reported the results of ICSI using frozen in vitro cultured spermatozoa, as most published studies concern fresh spermatozoa, used after 1–2 days of in vitro culture with satisfactory fertilization and pregnancy rates. In vitro culture of testicular spermatozoa may therefore constitute an interesting research approach to improve the results of ICSI when the number of spermatozoa and/or motility are very low. In addition, in vitro culture of testicular spermatozoa appears to be a good tool to study the mechanisms of acquisition of motility, which are still poorly understood.