Place du scanner dans l’imagerie de l’hyperparathyroïdie primaire

Primary hyperparathyroidism is a biological diagnosis. The reference treatment is surgery. When minimally invasive surgery is considered, it is recommended to perform a cervical ultrasound and a scintigraphic examination to localize the hypertrophied parathyroid glands. The multiphasic scanner (4D CT) is a very effective examination to detect and locate precisely the parathyroid adenomas. The study of densities makes it possible to differentiate the adenoma from the thyroid and the lymph nodes that are the differential diagnoses. Without injection, the adenoma is more hypodense than the thyroid with a threshold set at 75 UH. On the early phase after injection, the adenoma appears very hypervascularized with a density > 114 UH. The ganglion appears hypovascularized with a density < 114 UH. In the late phase, there is a decrease in the density within the adenoma, while density within the ganglion increases. The parathyroid scan is indicated in case of negativity or discordance of the couple ultrasound scintigraphy. It is also strongly recommended, in case of persistence or recurrence of hyperparathyroidism after surgery, as well as to better study a parathyroid ectopy.     

Place de l’embolisation percutanée de la varicocèle dans le traitement de l’infertilité

Objectives

To describe percutaneous embolization of varicocele and to evaluate the effect on fertility disorders.

Materials and methods

One hundred nineteen patients, aged 11 to 48 years, underwent percutaneous embolization for varicocele indicated by a fertility disorder in 23% of cases. Correction of the varicocele and resolution of associated pain, improvement of testicular trophicity and the effect on fertility were studied and a review of the literature was performed.

Results

Percutaneous embolization was performed using neuroleptanalgesia on an outpatient basis. The technique combined venous sclerotherapy and placement of coils in the gonadal vein. The technique was successful in 95% of cases and one complication was observed. At 3 months, the varicocele and related pain had resolved in 98% of treated patients. According to previous reports in the literature, the relations between varicocele and fertility disorders are still unclear, but improvement of fertility (semen quality and conception rates) after varicocele repair has been established.

Conclusion

Although the consequences of varicocele on fertility have not been fully elucidated, treatment of varicocele appears to be beneficial. Percutaneous embolization of varicocele is a safe and effective alternative to surgery. This technique, based on a urological and radiological consensus, is the first-line treatment for varicocele in our institution.     

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.     

Indications de l’imagerie dans l’infertilité masculine (bourses,testicules)

Imaging modalities in the work up of male infertility are almost resumed to Ultrasound with Color Doppler which is quite performant if its indications are well-balanced:

-To look for abnormalities of the seminal tract.

-To evaluate clinical varicoceles (Testis, associated abnormalities).

-To screen the neoscrotal pouchs of ectopic operatively corrected Testis (occult tumor, epididymal abnormalities).

     

Le BNP dans l’exploration de l’insuffisance cardiaque et le syndrome coronarien aigu

Le BNP, ou “Brain Natriuretic Peptide”, initialement mis en évidence au niveau de l’encéphale de porc, est aujourd’hui renommé “B-type natriuretic peptide” en raison de l’origine myocardique chez l’homme. Sa synthèse, principalement réalisée au niveau du ventricule gauche, à partir d’une pro-hormone, le Pro-BNP, est liée à l’état d’étirement de la paroi ventriculaire.     

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.     

Intérêt de l’imagerie hybride TEMP-TDM dans l’exploration des infections

Single-Photon Emission Computed Tomography-Computerized Tomography (SPECT-CT) is a new hybrid technique which offers new diagnostical capabilities in daily nuclear medicine practice. This technique not only allows to acquire fusioned anatomic and functional images in the same time, but also, it increases sensitivity and accuracy of SPECT thanks to attenuation and scattering corrections got from transmission data. Until now, SPECT-CT data have been mainly obtained in oncology and cardiology, but now, many authors use it in many scan studies and particularly for infectious diseases. In inflammatory bowel diseases, SPECT-CT seems to increase diagnostical performances and to modify management of many patients. In suspected vascular sepsis, SPECT-CT could increase sensitivity of white blood cell scintigraphy but also its specificity thanks to spatial resolution of CT. In osteoarticular sepsis, SPECT-CT has the advantage to distinguish osteomyelitis from soft tissue infection and to guide biopsies. Nevertheless, in the light of PET-CT works, SPECT-CT development will probably modify nuclear medicine practice and many studies have to be conducted to highlight consensual procedure guidelines.     

Apport de l’iode 131 dans le traitement de la maladie de Basedow dans le service de médecine nucléaire de l’hôpital Ibn Sina de Rabat

One hundred and twenty-nine Grave's Basedow diseases in any gender and variable age patients, coming from several cities of Morocco, were randomized in a study of radio-iodine treatment who took place at the nuclear medicine department of Ibn Sina Hospital (Rabat, Morocco) during the period (from January 2001 to December 2008). The radio-iodine treatment was a first, second or third option and radio-iodine activities delivered varied (from 222 to 555 MBq 6 to 15 mCi) according to the age, the thyroid volume, the degree of hyperthyroidism and socio-economical situation. The high amounts of ¹³¹I were reserved especially to the patients who live far and whose socio-economic level is low with an aim of quickly obtaining an easily controllable state of hypothyroidism by a substitute treatment. The results showed that: (1) 57.36% of patients reverted to euthyroïdism (n = 74) with a patient having received two ¹³¹I cures. The second cure was justified by recurrence of hyperthyroidism after the first cure; (2) 34.88% passed in hypothyroidism (n = 45) with three patients having received two cures of ¹³¹I, the second cure was justified by recurrence of hyperthyroidism after the first cure in two patients and by the persistence of the hyperthyroidism after the first cure for the third patient. The average time of passage in hypothyroidism was 4.5 months; (3) 7.76% had remained in hyperthyroidism after the radioactive iodine treatment. Finally, 92.24% of our patients treated by radioactive iodine had passed in euthyroïdism or hypothyroidism against 7.76% whose hyperthyroidism had persisted or occurred.     

Apport de l’iode 131 dans le traitement de l’adénome thyroïdien toxique

IntroductionToxic thyroid adenoma is an evolutive condition requiring radical treatment. The purpose of this study is to evaluate the contribution of 131 in the treatment of toxic thyroid adenoma.Patients and methodsThis is a retrospective study of patients treated with iodine 131 for toxic thyroid adenoma. The diagnosis of toxic adenoma is confirmed by scintigraphy and/or ultrasound. Data collected were age, sex, previous treatments, pre treatment hormonal status, radioiodine activity received and post therapy hormonal status.Results and conclusionWe have 45 women to seven men with a sex ratio of 6.42. Mean age of our patients is 53 years. Mean age for women at time of treatment is 57.33 years and 52.85 years for men. 98.07% of our patients treated with iodine 131 gained euthyroidism or became hypothyroid vs. 1.92% in whom hyperthyroidism persisted. These results are comparable to literature. Moroccan patients socioeconomic status pleads for an expansion of use of radioiodine in toxic thyroid adenoma due to its favourable cost/effectiveness ratio.     

L’intersubjectif et l’intrasubjectif dans l’expérience de souffrance. Un regard psychanalytique

Psychoanalysis characterises subjectivity as a notion based on the “plurality of psychologically troubled persons”, revealed, for instance, in dreams. The author takes a closer look at a number of Freud’s dream analyses and argues that, in working with the dream, subjects often eject one of their psychologically troubled persons (often the “suffering child”) out of themselves, projecting the person into the Other. As a result, an intersubjective space is created, which is required to receive the divisions originating from the intrasubjective space. Freud’s 1895 Project, however, goes farther: the evacuation of the “disparate part” of the child to the Other grants access to logical and rational judgement, guaranteeing a child’s psychological life a fictional stability (the “Thing” or the “ego”). Freud adds that this process is possible if a Nebenmensch — or “fellow creature” — is present and has the quality of a “helping person” capable of receiving the child’s suffering cry. These two lines of thought, together, help clarify the intersubjective position underlying the analytical work: a tentative encounter between the patient’s distress and the analyst’s presence. Free-floating attention will enable the analyst to receive and hear this distress and ease the patient’s recovery of his or her intrasubjective space.     

Place de l’annonce dans la prise en charge des patients souffrant de cancer

Cancer is the leading cause of death in developed countries. About 365,500 new cases have been diagnosed in France in 2012 according to French National Cancer Institute. To break the cancer constitutes a traumatism for the patient. For the clinical oncologist, this is a well-known cause of professional burnout syndrome. Nuclear physicians seem to be often asked for results after an exam by the patient. The delivery of cancer diagnosis will be presented form the perspective of the patient, the clinical oncologist and the nuclear physician.     

Rôle du sens de l’effort dans le syndrome d’influence

Centrally generated signals from premotor areas play a key role in voluntary muscle force perception. Indeed, sensations of effort, rather than sensations of intramuscular tension, make it possible to evaluate the intensity of willed muscle forces. We suggest that the sense of effort is involved in agency, the cognitive process by which one is aware of one’s actions. We argue that effort awareness accompanies each action and is the key component of the feeling of will. In delusions of alien control, patients with schizophrenia do not recognize some of their acts as their own and are convinced that they are under the control of someone else. Some experimental data suggest that delusions of control are related to an altered awareness of effort and an exaggerated awareness of afferent neural information, caused by neurological disorders in the frontal and parietal lobes. This impairment could lead to the inability to identify the author of an action. In this pathological condition, the cerebral state coding for “I intend to act” might move toward the state coding for “someone else intends to act”, even in the absence of another agent.     

Sur quelques hyménoptères intervenant dans la biocoenose de ravageurs de l’Artichaut dans le sud-est de la France

Summary No discovery of any parasite ofSphaeroderma rubidium Graell.,Ceratapion carduorum Kirbi, andDepressaria subpropinquella Stain. has been mentioned for France. However considerable collections ofMymaridae obtained on layings ofS. rubidium, show that parasitism may have a part in the limitation of this species. The few parasites of larvae and pupae ofC. carduorum obtained do not seem to have any considerable regulating influence. Although the parasitism of caterpillars ofD. subpropinquella byAngitia is frequent, the latter do not seem to be the essential factor in the evolution of the population of this species. The caterpillars ofChoreutis bjerkandrella thnb. may be used as a refuge by manyHymenoptera in summer, as a consequence of the scarcety ofMicrolepidoptera at a vulnerable stage.      

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.     

Fertilité de l’homme en fonction de l’âge

The aim of this work was to analyse the evolution of sperm characteristics according to age. To this end we analysed the spermogram of 2,126 men aged 20 to 64 who came for consultation for feminine indications for in vitro fertilization at the Clermont-Ferrand Human Reproduction Unit during the period 1980 to 1994. A search for a link between the age of the patient at the time of the spermogram and 10 sperm parameters, by studying a linear regression, did not reveal any evidence of a significant correlation between the age and the parameters studied. The mean values for volume, concentration of spermatozoa, percentage of mobile forms (normal, diminished), percentage of typical and mobile forms and percentage of abnormal forms were compared for age classes covering 5 years. These values showed no significant difference according to the age classes. Between 20 and 60 years the essential parameters of the spermogram seem generally to be independent of age, from which it can be deduced that ejaculate quality remains the same until 50 years of age. However a bias in the recruitment of the population studied and a very wide spread for the values for a given age mean that we may not have detected fluctuations in sperm characteristics linked with age.     

Anomalies de position des testicules dans l’enfance: conséquences à l’âge adulte

Non descended testes in the low scrotum is a common anomaly at birth, with about 4% of the newborn males affected. Only one quarter of these newborn babies will still have non descended testes when one year old. However, the testes that will descend within the first year of life seem no more to be considered as normally descended testes. Moreover, the retractile testis, which represents a secondary anomaly of testicular position occuring after the babies are older than one year, is no more to be regarded as a physiological variant of the normally descended testis, since several reports indicate histological and clinical modifications in such cases. The testicular non descent can be associated with two consequences in adult life. Firstly, an history of non descended testis is the only known risk factor for the testicular cancer. Secondly, such an history is a risk factor for the male fertility because of spermatogenesis alterations, as indicated by qualitative and quantitative histological analyses of the testicular tissue, and by depressed spermatozoa output and quality (motility, normal forms); moreover, testicular volumes are reduced, and the time to pregnancy as well as the rate of infertility are increased. Time is arrived for a reappraisal of the consequences in adult life of the abnormal testicular location (either congenital or acquired) during childhood.     

Interet diagnostique d’une injection intracaverneuse de 20 μg de Prostaglandine E1 dans l’impuissance

Intracavernous injection of 20 μg of prostaglandin E1 (PGE1) was carried out in 130 impotent patients. The erectile response was compared to the results of arteriological investigations including nocturnal penile tumescence and rigidity monitoring (NPTR) in 59 patients. The response of 60 patients positively categorized as exclusively psychogenic or vasculogenic was also compared to the pattern of the response to 80 mg of papaverine observed in a previous study by the same authors. The PGE1 test may not discriminate psychogenic from wholly organic patients since its results are not correlated to those of NPTR. It helps for the screening of vasculogenic impotence. Lack of response or a partly rigid response is consistent with this actiology but is not specific for it. A fully response makes it unlikely. Compared to papaverine, PGE1 induces less non rigid responses in psychogenic patients (15% versus 35% with papaverine) and more fully rigid responses in vasculogenic patients (respectively 12% and 5 %). Consequently the specificity of the PGE1 test is higher but its sensitivity lower than that of papaverine so that there is no clear difference in the effectiveness of the tests. Nevertheless the PGE1 test should be preferred, because it is safer. Prolonged erections occured in only 5 patients, and all ceased spontaneously. However 4 presented severely painful erections.