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.     

Application de la technique de PCR en temps réel à l’étude de l’ADN ancien

Real-time Polymerase Chain Reaction (PCR) for the study of ancient DNA. The properties of ancient DNA (aDNA) make difficult the retrieval of DNA sequence. The advantage of Real-Time PCR was exploited, for the first time, in the study of aDNA. We determined the optimal condition to amplify, in one round of PCR, aDNA, which should be directly sequenced. Beside the verification of aDNA authenticity, we compared two cleaning bone methods: scalpel and ethanol. The ethanol specimens showed the best DNA yield. The aDNA was extracted and amplified (mitochondrial hypervariable region I) from five skeletons exhumed from the archaeological site of Notre-Dame-du-Bourg (France), dated from 3rd to 17th century. To cite this article: R. Kefi et al., C. R. Palevol 2 (2003) 125–132.     

Rôle de la TEP FDG dans l’évaluation de l’extension locorégionale et à distance du mélanome

FDG PET/CT is a relevant examination for patients with high-risk melanoma. For early stages with thickness ≥ 1 mm, lymph node ultrasound, and when negative, lymphoscintigraphy for determination of sentinel lymph node, remain necessary. For more advanced stages, FDG PET can map the lesions and guide the therapeutic strategy, either with surgical management, or systemic therapy (or sometimes both). In patients with high-risk melanoma, it allows to detect relapses early, including in asymptomatic patients, with a potential impact on therapeutic decisions. Beside the detection of classical secondary localizations, FDG PET has the advantage of allowing whole-body imaging, the identification of soft tissue lesions, frequent in melanomas, as well as rarer sites of involvement, such as those of the gastro-intestinal tract. For the assessment of cerebral and leptomeningeal involvement, MRI remains mandatory. Evolutions in the therapeutic management of advanced melanomas, and the search for biomarkers to guide the therapeutic strategy, ask for more refined analyses of PET, with metabolic tumour volume analysis and radiomics. The combination of metabolic imaging data with biological and molecular data, and the development of new PET tracers may improve the assessment of prognosis and the prediction of response to therapies, in order to tailor the therapeutic strategy to each patient. Further studies are needed to consolidate the role of PET/CT in this disease for which numerous therapeutic innovations are emerging.     

Effets d’une exposition à la Vinclozoline et à la Génistéine de la gestation à l’âge adulte sur la fonction de reproduction du ratWistar mâle: protocole et résultats préliminaires

Current evidence indicates that endocrine disrupters (EDs) can induce adverse effects on the male reproductive tract in various mammalian species. Recent reports indicate deterioration in male reproductive health in several human populations, but the evidence for a causal link with endocrine disruption is still weak. In addition, the experimental conditions of most of the reportedin vivo studies are not representative of environmental exposures (for example, high doses, short-term exposure, a single ED) and the mechanisms by which EDs disrupt the reproductive system are poorly understood. The objective of the present study is to develop an animal model to assess the reproductive effects and study the putative cellular and molecular mechanisms involved after exposure to genistein (phytoestrogen) and vinclozolin (fungicide with a known antiandrogenic potential) alone or in combination. The study will be performed in male Wistar rats, with administration of low and high doses of the compounds from conception to adulthood and a subset of the males in each treatment group will be mated with unexposed females. We plan to assess the level of sperm production, histology of the reproductive organs, motility and morphometry of spermatozoa and hormone levels, as well as DNA fragmentation of spermatozoa and determination of the number of germ cells, Sertoli cells and the diameters of seminiferous tubules. Estrogen, androgen, progesterone and FSH receptors will be detected and quantified and the level of testicular apoptosis and several apoptosis pathways will be studied to determine the putative cellular and molecular mechanisms involved. The preliminary results confirmed the developmental effects previously reported for high doses of vinclozolin. More interestingly, they indicated a number of deleterious effects for male rats exposed to low dosages alone or mixtures of low and high dosages compared to controls and rats exposed to high dosages alone. For example, a number of developmental anomalies of the genitalia were observed and a significant decrease of sperm motility and motion and fertilizing ability were observed. These preliminary results provide evidence that chronic exposure to environmental levels of EDs or mixtures of EDs have a detrimental impact on the male reproductive tract. The next step involves assessment of the anatomical disorders and the study of some of the cellular and molecular mechanisms possibly involved.     

Syndrome de Klinefelter et AMP à l’aube de l’an 2000

Material and Methods

The patient is a 33 year old male, with a 47, XXY karyotype (cytogenetical investigation of 16 metaphases). Semen analysis revealed a severe oligozoospermia. (spermatozoa ?1×106/mL) and asthenozoospermia (60% of decreased motiliy), for an ejaculate volume of 1.8mL. Three-colourIn Situ Hybridization was performed on spermatozoa recovered from his cryopreserved semen, in order to simultaneously detect the chromosome X, Y and one with specific appropriate probes. Semen from two 23 year old men were also analyzed as controls.

Results

502 spermatozoa were analyzed from the patient and about 10,000 from the controls. There was an increase of about ten times of the percentage of hyperhaploïd (24XY) spermatozoa in the semen of the Klinefelter patient compared to the controls.

Discussion and conlustion

In a general view of IVF-ICSI practice in Klinefelter patients, we also discuss here several practical points such as (i) is there any morphological criteria which may prevent from injecting an aneuploid spermatozoa, (ii) is the risk of aneuploidy higher when using testicular spermatozoa than when using ejaculated spermatozoa, (iii) what do we know about the offspring obtained by IVF-ICSI in Klinefelter patients and (iv) when should prenatal and/or preimplantatory genetical diagnosisbe proposed in this particular context.     

Les inhibiteurs spécifiques de la recapture de la sérotonine dans la dépression de l’enfant et de l’adolescent: revue des controverses récentes

European and US drug regulatory authorities have recently warned against the use of selective serotonin reuptake inhibitors (SSRIs) in childhood and adolescent depression. Through an extensive literature review on the use of SSRIs to treat depression in children and adolescents — including psychiatric clinical trials, pharmacology, and drug safety data — we will: i) describe the main arguments justifying various regulatory decisions; ii) present published data and subsequent meta-analyses; iii) discuss how to integrate the recommendations into daily clinical practice, freeing professionals from a Manichean approach. We reach the limits of evidence-based medicine, which provide the basis of the scientific work of the regulatory authorities.     

Intérêt de l’interprétation collégiale de l’échographie cervicale,de la scintigraphie 99mTc-MIBI et de la TEP-TDM à la 18-Fluorocholine dans l’hyperparathyroïdie primaire : expérience du service de médecine nucléaire de l’hôpital Cochin

ObjectivesThis study aims to assess performances of preoperative conventional imaging (99mTc-MIBI scintigraphy, cervical Ultrasonography) and 18F-fluorocholine PET/CT (FCH PET/CT) exams in the detection of hyperfunctioning parathyroid gland(s) in patients operated from primary hyperparathyroidism (pHPT).MethodsBefore surgery, 51 consecutive patients with biochemically confirmed pHPT had successively cervical ultrasonography (cUS), 99mTc-MIBI scintigraphy and FCH PET/CT, all performed in the same Nuclear Medicine Department. 99mTc-MIBI scintigraphy were performed immediatly after cUS and interpreted by same operators. FCH PET/CT exam were interpreted independently by two nuclear medicine physicians. An additional interpretation session integrating the three imaging modalities read in consensus as a combined imaging set was performed.ResultsAt surgery, 69 lesions were removed: 32 parathyroid adenoma and 37 parathyroid hyperplasia. 70% of patients had single-gland disease and 30% had multiglandular disease at histopathology analysis. In the patient-based analysis, sensitivity and accuracy in the detection of single gland disease) for FCH PET/CT, cUS and for 99mTc-MIBI scintigraphy were 86% [0.71–0.94] and 86% [0.70–0.95], 69% [0.52–0.81] and 69% [0.51–0.83], 40% [0.26–0.56] and 40% [0.24–0.58], respectively. Sensitivity and accuracy of the combined imaging set for the detection of single gland disease were 94% [0.81–0.99] and 94% [0.81–0.99].ConclusionOur results suggest that cUS/99mTc-MIBI scintigraphy and FCH PET/CT interpreted during a comprehensive session could be the ideal practice to precisely localize parathyroid lesion(s) in patients with pHPT before surgery.     

Application de l’imagerie moléculaire par fluorescence à la clinique

Fluorescence probes and imaging methods have been extensively developed in microscopy to visualize biological pathways, cell trafficking and intracellular interactions, which are the main targets of molecular imaging. The translation of these methods from microscopy to preclinical and clinical applications requires to image through large thickness of live biological tissues, and to ensure the non-toxicity of the probes. We hereafter list the main issues that must be addressed to translate fluorescence techniques to clinic, and we present the main envisioned solutions. As first realistic clinical application, we present work in progress on intraoperative fluorescence guided surgery.     

De l’origine des anthropoïdes à l’émergence de la famille humaine

The human lineage has a very ancient origin, as most of the mammals. Its oldest representatives, anthropoid primates, have been described from Asia some 45 million years ago. During this long evolutionary story, two critical stages have appeared as especially important, their beginning in Asia and the emergence of hominids in Africa, some seven million years ago. These two stages are discussed hereby with new data relative to their Asian origins and their dispersal into Africa between 45 and 40 million years ago. Following this dispersal event, these primates evolved in Africa and gave rise to the early hominids. These appeared around seven million years ago and have three distinct representatives. Among them, Toumaï appears as the oldest and the closest to our ancestry, a point that is evidenced here.     

Apports de la géologie et de la géomorphologie à l’étude du mégalithisme : identifier,interpréter,dater

The contribution of geology and geomorphology to architectural and technological study of the Atlantic coast of France megaliths is important and can be grouped into three main axes: to identify, interpret and dating. Identification refers to the sourcing of the megalithic materiel from 0 to 7 km, sometimes around 10 km, or even exceptionally around 30 km. It is never the entire supply that is affected by such long distances but only a few blocks, some of them are remarkably well staged in the megalithic architecture. Another contribution lies in a fresh look at the management of stone recognized through the modes of acquisition, transformation and use of the raw material. More particularly, the geomorphology associated with technological reading offers tools for recognizing ancient standing stones. In the context of the interpretation of funerary chambers, the two sciences open a large window on the modalities of the internal structuring of monuments. From the entrance to the end of the chamber, the organization and use of the space is documented, sometimes a symbolic coding emerges from the mineral walls. This symbolic coding is based on particular petrography, on surface conditions operating a subdivision of space, on granulometries and homogeneities of differentiated surfaces. The internal organization can also be marked with natural “patterns”, which refer to a completely new aspect of Neolithic thought. Finally, the last axis concerns relative dating, by recognizing forms of postmegalithic fossil erosion, geomorphology makes it possible to identify reused stelae. A very important tool in a current research context where an important episode of reuse of standing stones at the end of the middle Neolithic is anticipated in the construction of dolmens in the south of France.     

Stratégies biologiques à l’heure de l’Assistance Médicale à la Procréation chez le blessé médullaire

Most men with spinal cord injury (SCI) men have fertility problems caused by anejaculation and decreased fertility of the ejaculate. There are two main causes for the impaired reproductive potential in SCI men: ejaculatory dysfunction and poor quality semen. However, current treatment techniques allow a large number of SCI males to achieve ejaculation (rectal electro-stimulation, penile vibrator stimulation). Firstly, masturbation and/or penile vibrator are used at home allowing the couple to perform insemination themselves. The semen of men with spinal cord injuries has commonly been characterised by small volume, abnormal count (low or high), decreased sperm mobility, increased formation of reactive oxygen species, sperm autoimmunity, necrospermia. This impairment is thought to be due to insufficient drainage, genitourinary infections and raised scrotal temperature. Testicular biopsy reveals varying degrees of tubule degeneration and decreased spermatogenetic activity. Semen could be used for various assisted reproductive technologies such as intrauterine insemination,in vitro fertilisation (IVF) and microinsemination (ICSI). The literature reports pregnancy rates by intrauterine insemination of about 15 to 20% per couple. Clinical pregnancy rates after IVF and ICSI techniques are 30% per cycle and these results are comparable to the clinical pregnancy rates when these techniques are performed for female infertility. However, semen must be frozen as soon as possible after the injury and the patient must be informed about the various available assisted reproductive technologies.     

Intérêt de l’utilisation de la scintigraphie osseuse dans le diagnostic et le suivi de l’ostéochondrite primitive de la hanche

Osteochondritis, or Legg-Calvé-Perthes disease (LCP), is a necrosis of the proximal femoral epiphysis. This vascular accident entails on the complex phenomenon of growth of the child's hip and can result in deformations or even a strict destruction of the proximal femoral epiphysis. The aim of this article is to show the interest of the bone scintigraphy (BS) in precocious diagnosis and follow-up of LCP disease. In this aim, we introduced a clinical case of LCP disease where BS allowed a precocious diagnosis and a strigent monitoring. Discussion of case includes a systematic review of literature.     

Évaluation de la faisabilité de la tomoscintigraphie myocardique précoce au sestamibi synchronisée à l’électrocardiogramme

BackgroundOur aim was to assess the feasibility of early acquisition (10 min) gated single photon emission computed tomography (SPECT) by comparison to conventional imaging at one hour.Methods and resultsOne hundred and four patients referred for exercise test and SPECT were included. Sequential imaging was started 10 min (SPECT 10) and 60 min (SPECT 60) after injection of the radiotracer (Tc-99m sestamibi). Stress myocardial perfusion was visually analyzed from 10 to 60 min stress by two experienced nuclear-cardiologists. Six patients were further excluded, because of high digestive accumulation: one patient at 10 min, three at 10 and 60 min, two at rest. The participants were classified as follows: group G1 (normal SPECT 10 and 60, n = 53), group G2 (abnormal SPECT 10 and/or SPECT 60, n = 45). The left ventricle ejection fraction (EF) and volumes (end-systolic and end-diastolic volumes, ESV, EDV) were calculated with the Cedars-Sinai program.ResultsQuality imaging was the same at SPECT 10 min and SPECT 60 min. Perfusion scores: G1 10 min = 0,4 versus G1 60 min = 0,4 (p = NS); G2 10 min = 10,2 versus G2 60 min = 10,1 (p = NS); EFG1 10 min = 71 ± 11% versus EFG1 60 min = 68 ± 10% (p = 4E-04); EFG2 10 min = 56 ± 15% versus EFG2 60 min = 53 ± 15% (p = 0,002); EDV G1 10 min = 72 ± 20 ml versus EDV G1 60 min = 76 ± 19 (p = 0,002); EDV G2 10 min = 98 ± 46 ml versus EDV G2 60 min = 105 ± 38 (p = 0,08); ESVG1 10 min = 22 ± 12 m versus ESV G1 60 min = 25 ± 12 (p = 9E-04); ESVG2 10 min = 47 ± 35 ml versus ESV G2 60 min = 53 ± 36 (p = 3E-04).ConclusionsThis study suggests that early gated Sestamibi SPECT after stress provides same perfusion analysis than classical late imaging.     

L’emploi des méthodes de la théorie des ensembles flous à l’étude biométrique de l’espèce Nummulites millecaput dans la partie occidentale de la Téthys

Application of the fuzzy set theory to the biometric evaluation of the species Nummulites millecaput in the western part of the Tethys. The goal of this paper is to demonstrate the ability of the fuzzy-set theory to contribute to the evaluation of paleontological problems. As an example, the species Nummulites millecaput, Boubée has been chosen. One hundred specimens of this species, collected from four localities (Arrimblar, Adelholzen, Dudar, and Mount-Kotuc) have been prepared (equatorial sections) for the biometric measurement of the external and internal characteristics. First a traditional statistical evaluation was performed, followed by the construction of membership functions, the latter ones expressing in the best way the transitions from one locality to the other. The results of this evaluation confirmed that from Aquitaine (France) to Armenia, the same species – Nummulites millecaput – was distributed during the Eocene. To cite this article: G. Bárdossy et al., C. R. Palevol 2 (2003).     

Biogéographie et spéciation des Odonates de l’île de la Réunion

Du fait de l’histoire géologique des Mascareignes et des trajectoires cycloniques dans le sud-ouest de l’océan Indien, l’affinité de la faune odonatologique de la Réunion est essentiellement mauricienne. L’étude de la distribution des Odonates en fonction des différents écosystèmes aquatiques de l’île montre que: 1. Les espèces indigènes ayant une vaste répartition géographique se rencontrent essentiellement dans les écosystèmes ouverts de basse et moyenne altitude (de 0 à 800 m d’altitude). Ces écosystèmes peuvent héberger jusqu’à 13 espèces et possèdent les plus fortes densités odonatologiques. 2. La faune odonatologique de la Réunion se distingue de celle des autres îles de la sous-région malgache par la présence de deux espèces continentales cantonnées à des altitudes supérieures à 1000 m. 3. Les espèces endémiques fréquentent surtout les écosystèmes forestiers. Ces écosystèmes ne présentent au plus que cinq espèces de la faune odonatologique de l’île. En définitive, il apparaît donc que la spéciation des Odonates à la Réunion ne se fait pas dans les écosystèmes diversifiés comportant des espèces à large répartition géographique, mais dans un ensemble d’écosystèmes marginaux à faible diversité odonatologique.     

Infection génitale à chlamydia chez l’homme et retentissement sur la fécondité

Chlamydia trachomatis is responsible for the most common sexually transmitted disease, up to 40% of the non gonococcal urethritis. It is a compulsary intracellular parasite. Its peculiar metabolism makes the bacteria interfere with the host cell immunity. Infection can become chronic and induce inflammation, if not properly treated, by permanent emission of antigens and heat shock proteins, and stimulation of Tcells. Autoimmunization against sperm can occur and impair fertilization and embryo implantation. Thus, Chlamydial infection can be associated with male infertility because of tissue damage, altered movement and antisperm immunization. PCR and LCR are to date the most sensitive detection techniques for c.trachomatis. Our study aim was to determine the prevalence of Chlamydial infection by PCR in 6 groups of men in andrologic practice. The highest prevalences have been found in the infertile men group and in the symptomatic group. No Chlamydia culture was found positive in any group. The association of PCR with anti C. trachomatis seminal IgA and seric IgG are useful tools for andrologic exploration.     

La cognition dans le trouble obsessionnel compulsif : à l’intersection de la clinique et de la neuro-imagerie

The investigation of neural activity in OCD (Obsessive Compulsive Disorder) has allowed to link obsessive compulsive symptoms and cortico-striatal dysfunction. In the present article, we try to show the significance of cognition in an integrative physiopathologic model of OCD. Clinically, patients are unable to inhibit irrelevant thoughts or actions. In a cognitive way, decision making, planification or organisation are impaired. Those impairments are related to an executive deficit, which depends on frontal structures. Finally, we present a current study which tries to identify executive deficit functions related to cerebral dysfunction in patients presenting different OCD features (washing, checking, hoarding).