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.     

Physiopathologie des troubles de l’érection chez l’homme paraplégique

Peripheral mechanisms responsible for penile erection are dependant upon a complex control by the nervous system, including peripheral nervous pathways, spinally mediated reflex loops and supraspinal nervous structures. Spinal cord injury is accompanied by a partial or a complete modification of these controls. In relation to the reflexogenic or psychogenic origin of penile erection, spinal cord injury does not cause the same effects. Reflexogenic erections sitll occur after spinal cord injury at a suprasacral level. After lesions at a level lower than the thoracolumbar spinal cord, tumescence following psychogenic stimulation has been observed. The hypotheses resulting from clinical and experimental observations and explaining the differences at the origin of these response are detailed. The recent developments in the neurophysiology of penile erection and the role of neurotransmitters allow a more analytical approach of the phenomenous and also bring new insights into possible compensatory pathways following spinal cord injury.     

La part de l’analyse phénoménologique dans l’étude de cas singulier

We argue that clinical psychiatry oscillates between two epistemological poles: inference and perception. The inferential approach categorises illnesses bottom up, from visible symptoms to the pathological category supposedly causing them. In doing so, psychiatry moves away from the possible instantaneous perception of a patient, as well as from illness as a changing, evolving, phenomenon. From a phenomenological point of view, the perceptive approach enables the therapist, within an encounter, to experience the emergence of an impression of a patient’s overall bearing, or attitude. Thanks to épochè, a sense of form, Gestalt will emerge. The clinical case, nevertheless, is always a construction, an intersubjective narrative about illness, recounted by the patient. Creating a library of clinical cases leads to the development of case types, each becoming a reference to which future clinical cases can be compared and categorised as belonging to a clinical family; it is the participant with respect to Plato’s eidos. Phenomenology contributes to clinical experience in that it makes possible the link between perception and inference, between subjective experience and intersubjective narrative, and between person and case type.     

Nouvelles données sur l’évolution paléoclimatique de l’époque magdalénienne,d’après l’étude lithostratigraphique du Roc-aux-Sorciers (Angles-sur-l’Anglin,Vienne, France)

Situated a few kilometres from Angles-sur-Anglin (Vienne, France), the Roc-aux-Sorciers cave has yielded in 1927 and 1950 industry of the Middle and Upper Magdalenian periods. Our analyses of the sedimentary filling, dated from isotope stage 2, demonstrate the existence of two climatic sequences in the six ensembles defined during the excavations. A first sequence, at the base of the cave filling, corresponds to the occupation levels of the Middle Magdalenian and of the early Upper Magdalenian. At that time, the climate was globally cold and particularly humid, a conclusion that does not support Bastin's 1975 hypothesis on the oscillation of Angles-sur-Anglin, which postulates a mild and humid climate. In fact, the climate evolved progressively towards a slight warming from the base to the top of the stratigraphy. During the second sequence, corresponding to the occupation period of the Upper Magdalenian, the relatively stable climate was slightly warmer and quite humid. Stratigraphical and sedimentological data thus provide new information on the conditions under which the filling was deposited and on the palaeoclimatology of the Poitou-Charentes region during Magdalenian occupation.     

Importance de l’étape pré-analytique en spermiologie pour le diagnostic et l’évaluation des thérapeutiques

Semen analysis is subject to great variability, partly due to the mechanism of ejaculation. This variability can be reduced by taking certain precautions, such as interviewing the patient to eliminate any external factor of variability, by imposing a 3- to 5-day period of sexual abstinence, by explaining the procedures to avoid bacterial contamination of the sample, by verifying whether the whole semen sample has been collected, by checking that the temperature of the sample is maintained at 37°C and finally, by carefully homogenising the sample to obtain good quality liquefaction.     

Le Paléolithique supérieur dans l’ouest de l’île principale du Japon

The Kinki, Chugoku and Shikoku regions are located in the western part of the Japanese mainland. This area lacks the Pleistocene volcanic soil except a part of Chugoku Mountains. For this reason, the chronology of the late Paleolithic stone industries has been mainly studied by technology and typology of the fields excavated. However, after the late 1980s, the analysis of volcanic ash that contained the Paleolithic sediments had remarkable development. As a result, the cultural layer between the distant Paleolithic sites is compared by several widespread volcanic ashes such as Aira-Tanzawa (in short AT) as key bed. In this paper, we offered chronological order of the late Paleolithic culture in these regions by comparing cultural layers on the basis of the widespread volcanic ashes, referring to typological analysis of industries. The Sétoüchi technique and Ku industry characterize the late Paleolithic culture in these regions. The Sétoüchi technique is the unique one to produce the Ku type backed knife blunting on only one side, using the particular side-blow flaking technology based on physical characteristics of sanukite stone which is a kind of andesite. However, a hypothesis named the “Sétoüchi concept” was proposed in 2001, and it has been used as a substitute of the “Sétoüchi technique” by a few Japanese researchers. So we point out the mistake of the Sétoüchi concept relying on the fact which yielded stratigraphically two different industries in the Suncheon site.     

Déficit androgénique lié à l’âge. Que faut-il attendre de l’androgénothérapie?

With the exception of disease or drug-induced changes in Leydig cell function, aging is accompanied by specific changes of androgen status in healthy men. The level of testosterone production decreases in contrast with the rise in plasma protein testosterone binding capacity. Free testosterone, considered to be the biologically active fraction, decreases, leading to tissue androgen deficiency. The resulting clinical picture mimics hypogonadism, including physical and psychological asthenia, decreased libido and sexual behaviour, increased fat mass and decreased lean mass, gynaecomastia, osteoporosis and pro-atherogenic metabolic changes. The cut-off value for plasma testosterone below which androgen deficiency can be considered to be responsible for clinical signs is a key point which determines the therapeutic approach. In the absence of clearly validated data in healthy aging males, this cut-off value has been consensually defined as the mean plasma testosterone levels of men between 30 and 50 years of age minus two standard deviations, corresponding to the zone of hypogonadism in adult males. The association of clinical signs compatible with hypogonadism and reduced total (or preferably bioavailable) plasma testosterone level justifies initiation of hormone replacement therapy after excluding any contraindications (especially prostatic). The aim of this treatment is to reverse the consequences of age-related hypogonadism. Some benefits of this treatment have been clearly demonstrated, such as a decrease of fat mass, and an increase of lean mass and muscle strength. Similarly, bone mineral density increases, particularly in men with the lowest pretreatment plasma testosterone levels. It must be stressed that these changes are observed in truly hypogonadal aging men, but not in aging men with normal plasma testosterone levels. Testosterone replacement therapy can promote the development of gynaecomastia, while dihydrotestosterone tends to reduce gynaecomastia. Finally, androgen replacement therapy appears to improve a hypogonadism-related decrease in libido or sexual behaviour, provided other associated non-endocrine factors have been previously treated. Androgen replacement therapy improves well-being, and physical and psychological asthenia in hypogonadal men. However, this treatment has not been demonstrated to be effective in healthy aging men. Although androgen replacement therapy does not have a negative impact on lipid parameters, its possible cardiovascular protective effects have not yet been demonstrated. In conclusion, androgen replacement therapy, respecting the contraindications, is beneficial in patients of all ages with clearly demonstrated hypogonadism, but has no efficacy on symptoms in other cases.     

Déficit Androgénique Lié à l’Age

In contrast with the abrupt cessation of ovarian function at menopause in women, alteration of testicular functions in aging males is partial and progressive. Several cross-sectional studies have demonstrated an age-related decrease of testosterone levels in men. This decrease has also been observed when only men in good health are included in such studies. This age-related decline of testosterone levels has been recently confirmed by a longitudinal study including a large number of subjects. The progressive decline begins early, from the late thirties, and continues at a constant rate throughout the subject’s lifetime. Since SHBG increases with age, free testosterone and non-SHBG-bound testosterone (referred to as bioavailable testosterone) decrease more markedly than total testosterone. As variations of SHBG levels (mainly a decrease in obese and/or insulin-resistant subjects) are often encountered in clinical practice and as it is difficult to reliably measure free testosterone, bioavailable testosterone appears to be the better index to diagnose androgen deficiency in the aging male. Elevation of basal LH levels, decrease of hCG-induced testosterone levels and reduction of Leydig cell number demonstrate the testicular origin of hypogonadism. However, gonadotropic function is also relatively altered with aging. As a result of this alteration of gonadotropic function, LH level is not a reliable index of hypogonadism in the aging male. None of the androgen-dependent functions that are altered with aging, i.e. libido, erectile function, sense of well-being, muscle mass, muscle strength, fat mass, bone mass, etc., are exclusively controlled by androgens. In clinical practice, the indication for androgen replacement therapy must therefore be based on a combination of clinical symptoms and a reduction of bioavailable testosterone below a certain cut-off value, indicating “significant” hypogonadism.     

Validation du logiciel de semi-quantification DaTQUANT® dans l’aide à l’analyse visuelle en TEMP au 123I-FP-CIT dans l’étude des pathologies neurodégénératives

ObjectiveSemi-quantification is a valuable tool increasing the diagnosis accuracy of the single photon emission computer tomography (SPECT) with FP-CIT-¹²³I (DaTSCAN^®), particularly in cases where visual analysis is unclear and especially on the posterior putamen. The DaTQUANT^® software (GE^® Healthcare), allows a quick and simple uptake assessment on several regions of interest. It also provides deviation values compared to a database of healthy subjects obtained in the ENC-DAT project. However, any threshold value is currently validated routinely.Patients and methodsA retrospective study was conducted in 55 patients (33 men, 22 women) referred for a suspicion of neurological disorders and who underwent SPECT imaging with DaTSCAN^® on camera D670 GE^®. Final diagnosis made by neurologist time after the SPECT was established as a reference, reinforced by clinical evolution. Analysis was initially visual without semi-quantitative results, realized by two experimented nuclear physicians, and then semi-quantitative analysis was made by DaTQUANT^® with calculation of Youden indices and ROC curves so as to define threshold values for six regions of interest (caudate, putamen anterior, posterior putamen, bilaterally).ResultsInterobserver match in the blind visual analysis was excellent with kappa coefficient = 0.91, CI at 95% = [0.87–0.95]. The semi-quantitative and statistical analysis by DaTQUANT^® determined pathological threshold values for each region of interest, setting a standard deviation percentage from a database of healthy subjects, worth −16.3% for the right posterior putamen (sensitivity of 100% and specificity of 88%) and −18.3% for the left posterior putamen (sensitivity of 100% and specificity of 97%).ConclusionThe pathological threshold values defined by our study would improve the data analysis obtained from DaTQUANT^® software and would support the DaTSCAN^® visual analysis. Nevertheless, such statistical values are complementary to visual analysis.     

La géométrie fractale pour l’analyse de signaux médicaux : état de l’art

The diagnostic interpretation of medical images is a complex task aiming to detect potential abnormalities. One of the most used features in this process is texture which is a key component in the human understanding of images. Many studies were conducted to develop algorithms for texture quantification. The relevance of fractal geometry in medical image analysis is justified by the proven self-similarity of anatomical objects when imaged with a finite resolution. Over the last years, fractal geometry was applied extensively in many medical signal analysis applications. The use of these geometries relies heavily on estimation of the fractal features. Various methods were proposed to estimate the fractal dimension or multifractal spectrum of a signal. This article presents an overview of these algorithms, the way they work, their benefits and limits, and their application in the field of medical signal analysis.     

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.     

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.     

Place de l’imagerie dans l’évaluation de l’efficacité des traitements dans le cancer du sein

This paper describes, from the current literature, the role of various imaging methods to assess the response to therapy in breast cancer. Two different clinical situations are considered: neoadjuvant chemotherapy of locally advanced breast cancer and the metastastic breast cancer. Significant clinical data are available for three criteria: the volume of the tumour, the uptake of fluorodeoxyglucose using PET and the perfusion of the tumor evaluated either by dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) or by PET using ¹⁵O water. ¹⁸F FDG PET allows prediction of the response after one or two cycles of neoadjuvant chemotherapy. New approaches will offer opportunities to refine the role of imaging in monitoring the response to chemotherapy. PET using thymidine as biomarker is promising in assessing the tissular proliferation. Estrogen analogs could be used to predict hormonally responsive breast cancer. Many other approaches, although less developed, might offer new insights in the response to therapy of breast cancer like magnetic resonance spectroscopy or optical imaging of hemoglobin oxygenation. Imaging also offers potential of monitoring the down-regulation of specialized receptors of the cell membrane in response to treatment: the most studied receptor in preclinical model has been the human epidermal growth factor receptor type 2 (HER2). Integrin, a family of cell adhesion receptor, is also an important target for imaging. Apoptosis, multidrug resistance and hypoxia can also be studied using appropriate biomarkers. To allow reliable multicenter trials of new drugs, these different imaging approaches still require an improved standardization of image acquisition and processing.     

Les enjeux de l’intégration de l’automate d’immunohématologie AutoVue d’Ortho-Clinical Diagnostics au sein du laboratoire

Evaluation des critères de sécurité, productivité et conformité à la réglementation. L’automatisation de la paillasse d’immuno-hématologie au laboratoire est une démarche dont l’objectif est d’optimiser les contraintes organisationnelles et économiques tout en préservant la qualité des résultats par l’utilisation des techniques analytiques de référence dans un cadre sécuritaire et réglementaire de haut niveau.     

Azoospermias au Sénégal: quelle prise en charge à l’heure de l’ICSI?

Objective

to determine the place of azoospermia among the various causes of infertility in Senegal.

Material and methods

141 cases of azoospermia were identified from a series of 492 infertile patients. The clinical profile, laboratory results and outcome after management were studied.

Results

The mean age was 40.6 years. Testicular atrophy was detected in 34.75% of cases. Azoospermia was secretory in 71.69% of cases. A varicocele was associated in 56% of cases. Varicocele repair was performed in 32.62% and allowed an improvement of sperm parameters in 28.3% of cases. Testicular biopsy, performed in 53 cases, demonstrated 2 cases of Sertoli cell syndrome, 3 cases of arrested maturation, 8 cases of hypo spermatogenesis, and 25 cases of seminiferous tubules. Forty nine cases of azoospermia were associated with normal FSH levels. Only one patient was treated by assisted reproductive technologies (ART).     

Contrôle neurologique de l’éjaculation

The brain control of the genital tract and sexual behaviour remains poorly understood. Clinical results and basic research indicate that the neural control of ejaculation depends on three levels of organization. The first level consists of peripheral autonomic and somatic nerves. Leaving the spinal cord, these nerves control the motility, secretions and blood supply of the genital tract, and contractions of perineal striated muscles. Their path in the abdominal cavity and the effects of their neuro-transmitters on peripheral tissues have been established. These nerves also convey sensory information from the genital tract to the spinal cord. The second level is represented by the spinal cord. The thoracolumbar (sympathetic), and sacral (parasympathetic and pudendal) segments of the cord contain the somata of autonomic and somatic motoneurons, whose axons run in the above nerves. These motoneurons are part of a spinal network that likely organizes the activity of the whole genital tract in a given context such as copulation. The role of the different spinal cord segments in the control of ejaculation is mainly inferred from observations of the deleterious effects of spinal cord injury in human patients. A small population of galaninergic positive neurons has recently been identified in the lumbar segments of the rat spinal cord that plays a major role in ejaculation (Truitt and Coolen, 2003). Selective lesion of this population abolishes in copula ejaculations, but spares erection. Finally, the third level of organization is represented by supraspinal nervous structures. The spinal cord receives direct excitatory and inhibitory information from the brainstem, pons and hypothalamus. In turn, these structures receive sensory information from the genital tract. However, their role in the control of ejaculation remains poorly investigated. Again, it is mainly inferred from the observation of the deleterious effects of pharmacological treatments on brain neurotransmission. Positron emission tomography has recently been used to observe brain areas whose activity is enhanced during ejaculation in humans (Holstege et al., 2003). In this study, several areas of the right side of the cortex and the cerebellum were activated. The targets of future clinical and basic research include: the neural basis of the required coordination between spinal autonomic and somatic nuclei that innervate the genital tract, the role of sensory information from the genital tract in the recruitment and coordination of spinal and supraspinal nuclei, and finally the integration of descending excitatory and inhibitory influences onto the spinal cord. Both the organization during development and the activation at puberty of the spinal neural network that controls the genital tract are dependent on androgens. Future research should identify the regulatory factors that, in response to the action of androgens, provide neurons with the possibility of building their connexions and selecting their neurotransmitters and receptors.     

Apport de l’imagerie radioisotopique dans l’artérite inflammatoire des gros vaisseaux

The group of large vessel vasculitis includes giant cell arthritis and Takayasu's disease. If monophotonic nuclear medicine can sometimes show some unusual patterns in these diseases, positron emission tomography with fluorodeoxyglucose seems have a special attract and provide some indications during the monitoring of these patients. However, most of these indications remain to be validated, specially to differentiate weak vascular wall inflammatory activities from physiological and/or atherosclerotic accumulation.