Le test post coïtal à l’heure de l’AMP

The recent development of assisted reproductive technologies has greatly modified treatment and evaluation of infertility. In view of the high pregnancy rates obtained, the value of conventional diagnostic tests, especially the post-coital test, has become controversial. Apart from differences in terms of standardization, the confusion concerning the diagnostic and prognostic value is largely due to the interpretation and the purpose of the test. According to the World Health Organization guidelines, the post-coital test remains a reliable tool for the diagnosis of cervical infertility and sperm dysfunction, which is a possible cause of unexplained infertility. Over the last two cases, most other conventional tests have become inoperative and the results of the post-coital test may indicate the need for further investigations and may positively influence the treatment strategy.     

Syndrome de Klinefelter et diagnostic prénatal

Because of the widespread use of amniocentesis and chorionic villus sampling, antenatal diagnosis of sex chromosome anomalies, particularly 47,XXY, has become increasingly common. The clinical and laboratory features of Klinefelter syndromes are well documented. On the contrary, the intelligence and achievement outcome of patients with Klinefelter syndrome are less well documented. Early reports suggested an increased frequency of psychological disturbances, subnormal intelligence, and sociopathy; however, because this information was obtained from inmates/patients of various institutions and clinics, it is considered to be biased. Most males born with the 47,XXY pattern will go through life without being karyotyped, while the commonest indication for karyotyping of a Klinefelter male is hypogonadism and/or infertility. Parents are very anxious when they are told that their fetus is 47,XXY. The couple should be allowed to continue the pregnancy in view of the absence of developmental delay and/or behavioural problems and congenital malformations. The abortion rate is higher when the fetal abnormality is announced by an obstetrician rather than a geneticist. The current tendency is to no longer propose termination of pregnancy, as most 47,XXY males only present with infertility.     

Les théories de l’économie animale et l’émergence de la psychiatrie de l’Encyclopédie à l’aliénisme

The author analysesEncyclopédie’s articles devoted to nervous and mental functioning and disorders, showing that a new approach to lunacy as a mental illness, which is defined in some articles as a “general trouble of the animal economy”, progressively emerged. The term,animal economy, unified physical and moral aspects of the study of man. It was elaborated by XVIIIth century physiologists and was widely accepted by French physicians. This idea is based on the vitalistic thought of the Montpellier school, which equated life with sensibility, and on English medical conceptions of a nervous-centred organism. Later on Philippe Pinel’s work displayed the legacy of these conceptions. On one hand, the comprehensive view of physical and moral dimensions in theanimal economy neutralized the question of an organic or psychogenetic origin of madness. This enabled him to consider it as a determinate field of sensibility interactions and as a medical matter, and to legitimize the group of therapeutic practices that he namedtraitement moral. On the other hand, Pinel departed from the classical conception ofanimal economy by developing his concept of aprinciple of mania, which underlies the manifold symptoms and forms of madness, and which are only perceptible to a trained specialist (aliéniste). The historical development analysed in this article show how alienists were enabled to claim both the wholly medical nature of insanity as disease, and their specific competence as apart from the other medical disciplines. To this extent, Esquirol achieved Pinel’s scientific work.     

Évaluation de la perfusion et de la fonction contractile du myocarde à l’aide de l’analyse de Karhunen-Loeve en tomographie d’émission monophotonique myocardique synchronisée à l’ECG

GoalWe evaluated the diagnostic performance of the Karhunen–Loeve transform applied to myocardial gated SPECT. The previous studies showed that KLT images characterize myocardial perfusion (KL0) and contractile function (KL1).Method and material99mTc-gSPECT studies were performed in 101 patients (121 acquisitions) with suspected or known coronary artery disease. The images were evaluated using a five-point scoring system dividing the left ventricle into 11 segments. We compared the scores obtained by this semi-quantitative visual analysis of gSPECT and KLT images.Results and discussionThe agreement for perfusion and thickening scores was 94 and 95% respectively. Quantitative evaluation of KL0 and KL1 images by univariate and multivariate analysis was performed in the left ventricular ROI. Discriminant analysis characterized the acquisitions as normal or pathologic with a sensitivity of 95% and a specificity of 96% and positive and negative predictive values of 96 and 95%. These selection criteria were tested prospectively in 52 patients with similar results. KLT generates a synthesis of left ventricular perfusion and kinetics. It facilitates discrimination between normal and pathological acquisitions with high predictive values.     

Sénescence de segments de coleoptiles d’avoine et élongation due à l’auxine

Five mm sections excised from 20, 30 and 40 mm long coleoptiles were transferred into a indole-3-acetic acid (IAA) solution after an incubation in a medium containing buffer and sucrose without IAA. The ability of sections to elongate in dependence on IAA treatment was rapidly decreased at a temperature of 23 °C within a period of time depending both on the duration of incubation and on the age of coleoptiles from which sections were obtained. Under the same conditions of incubation and age the same decrease of the ability of sections to elongate at 4 °C was, however, observed only after a period fourfold longer than at 23 °C. Incubation of sections in the presence of benzimidazole did not extend their reactivity to IAA. This phenomenon may be therefore considered as a senescence reaction which is more effective at 23 °C than at 4 °C.     

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.     

Pollution de l’eau souterraine et risques sanitaires à Yaoundé au Cameroun

The aim of this article consists of developing an ecosystemic approach to collect information about groundwater pollution in order to determine its origin and infer the health risks in Mingoa's watershed through the study of 12 spontaneous settlements. From an environmental point of view, family interviews and direct observations allowed us to inventory springs, wells and latrines, and to collect information. So, we have selected, on the basis of predefined criteria, 21 wells and springs for physico-chemical and bacteriological laboratory analyses. Two hundred children aged less than 5 years were subjected to KOAP examination. A number of 1224 latrines were inventoried, for an average use of 15 people per latrine, producing 913.3 kg/year of excreta. Most of 91% of people use these latrines. The superficial aquifers, connected to the wells and springs, present high values of nitrogen, phosphorous pollutant and fecal contamination indicators (coliforms and fecal streptococcus), which make water inappropriate to human consumption. PCA analysis establishes that water pollution comes mainly from traditional pit latrines. The overall prevalence of diarrhea and parasite infestation was important (= 40%). The presence of cysts of Entamoeba histolytica, Ascaris limbricoides, and Entamoeba coli confirms this high prevalence and testify to very approximate hygiene and environment conditions.     

Techniques d’AMP et leurs indications dans l’hypofertilité masculine

In spite of several trials, medical treatment of male sterility is still deceiving. Only few indications are likely to gain from antibiotherapy, anti-inflammatory molecules or hormonotherapy. Most of the time, ART techniques remain the last issue in male sterility. In 1992, the WHO defined the threshold sperm criteria’s in order to obtain natural fertilization: sperm concentration ≥ 20 millions per ml., progressive motility ≥ 50% after liquefaction, and normal forms ≥ 30%. In vitro techniques used for sperm preparation before ART, are necessary for multiple reasons: selection of motile spermatozoa’s with normal morphology, suppression of dead spermatozoa’s and cellular fragments, elimination of seminal plasma, and induction of sperm capacitating process. Several ART techniques are now available and the result of in vitro sperm selection will help to choose the best technique in each indication.     

Traitement psychopharmacologique du trouble obsessionnel compulsif de l’enfant et de l’adolescent

The present report review available literature on psychopharmacological treatment of obsessive compulsive disorder (OCD) in children and adolescents. There is now clear evidence that drugs that are potent serotonin reuptake inhibitors (clomipramine and SSRIs) induce a clinically substantial reduction of OC symptoms for most children and adolescents with the disorder. However, improvement is often incomplete, few patients become asymptomatic, and long-term maintenance treatment may be required. Cognitive behavioural treatment, based on graded exposure with response prevention, might have more durable benefits, and is considered as the first line treatment in mild non comorbid OCD. Because OCD frequently occurs in the context of other psychopathology and adaptative difficulties, additional individual and family psychotherapy, pharmacological associations and educational interventions are often necessary.     

Syndrome de Klinefelter et microinjections intraovocytaires de spermatozoïdes (revue de la littérature)

Historically, Klinefelter’s is the typical clinical form of secretory azoospermia with no hope of achieving biological paternity. However, ICSI, either from ejaculated sperm or following testicular sperm extraction, have been recently applied to patients with Klinefelter’s syndrome. Papers published until June 2002 have reported microinjections with ejaculated sperm in 9 cases of Klinefelter’s syndrome with extreme oligospermia with the following overall results: 79 mature oocytes, 52 fertilized oocytes, 31 embryos, 18 transferred embryos, 6 pregnancies, 5 births, or from testicular spermatozoa, in 93 cases, with the following results: 347 oocytes, 193 fertilized oocytes, 149 embryos, 78 embryos transferred out of 37 cycles, 24 clinical pregnancies and 2 positive pregnancy tests, and 32 births. Although a publication bias was very likely (successful attempts were published, failed attempts were probably not published), these results were unexpected based on the traditional view on Klinefelter’s syndrome. The rate of aneuploid spermatozoa also appeared to be lower than expected. The real proportion of Klinefelter patients in whom spermatozoa with a good potential for embryonic development can be retrieved and the means of identifying these patients remain to be established.     

Oldowayen archaïque et Oldowayen classique de l’Afrique à l’Europe méditerranéenne

Analyzing lithic industries of Lower Pleistocene and beginning of Middle Pleistocene times allows to define three groups not clearly chronological but which reflect the cognitive evolution of prehistoric Men who knapped them and the constraints of the environment: - “Archaic Oldowan” industries in which raw flakes are dominant and no small tools retouched on flakes or debris are present; - “Classical Oldowan” industries in which raw flakes are dominant and small tools retouched on flakes and debris – especially scrapers – are present; - “Acheulean industries”, in which bifaces are present – generally in small proportions – and small retouched tools are increasingly standardized.