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.     

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.     

L'éléphantiasis péno-scrotal. A propos d'un cas

Massive scrotal lymphoedema with gross genital deformation is called penoscrotal elephantiasis. It is a rare syndrome outside of filariasis endemic regions. It is usually idiopathic and rarely congenital or secondary. It is both physically disabling and emotionally distressing for the patient. Surgical treatment is often necessary. The authors report a case of a patient with penoscrotal elephantiasis in whom no aetiology could be found. Complete surgical resection of the diseased tissue and scrotum and penile reconstruction were performed with good cosmetic and functional results.     

Personnages dans l’art saharien : le réel et l’imaginé

In the Sahara, wherever there are naked rock surfaces, engravings and paintings have been found in large numbers. This rock art includes various types of images — the oldest dating about ten millenniums — among which human beings, wild or domesticated animals, therianthrops and non-explicit images can be identified. According to periods and styles, the human being has been represented under extremely varied aspects from particularly realistic — similar to the reality — till very simplified, even caricatural drawings. For some realistic representations of women and men, we can observe anatomical or morphological peculiarities which, without being frequent, show cases of steatopygy and gynoïd or androïd obesity, pathological or not. For certain periods, we also find imaginary, fantastic or caricatural representations. These images characterize particularly styles previous to that called “Round Heads”. So, in the Saharan art, the human being has been represented either in his physical truth, or according to multiple stylistic conventions or graphic stereotypes, which could characterize certain ethnic groups.     

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.     

Expérience de biologie délocalisée,télémaintenance et CQ interlaboratoire...

Dans le cadre de la gestion des analyses urgentes de biologie, le site d’Argenteuil a mis en place une organisation originale (Filière “urgence” mise en place depuis avril 1998) assurant en particulier rapidité et sécurité dans la production des résultats. Nous avons recueilli le témoignage des acteurs principaux à l’origine de cette mise en place.     

Le système neuro-sécrétoire caudal du téléostéen Jenynsia lineata

Résumé On décrit le système neurosécrétoire caudal de Jenynsia lineata. L'urophyse de cette espèce est un organe bien différencié, séparé de la moelle par une membrane méningée discontinue, et formé de fibres qui y arrivent après avoir constitué un pédoncule principal. Les fibres ne pénètrent pas par celui-ci, le font par les orifices de la membrane méningée.Dans l'urophyse comme dans les cellules neurosécrétoires du système, la neurosécrétion se colore à l'aldéhyde fuchsine après oxydation par le KMnO₄/ H₂SO₄; à l'hématoxyline chromique de Gomori elle se colore aussi, mais faiblement, et toujours après mordançage par de l'alun chromique dans le Bouin. On en discute les causes, par rapport aux données obtenues par d'autres auteurs.Il n'y a pas de cellules géantes, si caractéristiques du systéme neurosécréteur caudal d'autres Téléostéens. Les cellules neurosécrétoires du système sont petites et peu remarquables.Nous tenons à remercier le Dr. Juan H. Tramezzani de la lecture du manuscrit de ce travail, et des précieuses suggestions qu'il a bien voulu nous faire parvenir.     

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.     

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.     

Les otolithes des Téléostéens du Plio-Pleistocène belge

The study of approximately twenty three thousand otoliths from Plio-Pleistocene sites in the harbour region of Antwerp, as well as a critical revision of already published material allowed us to identify a teleostean fauna with fourty seven species (including two subspecies and seven species in open nomenclature). Two of these, Ophidion springeri and Uranoscopus septentrionalis are new to science. The fauna is typical for coastal waters slightly warmer than those of the actual North Sea and caracterized by the predominance of Gadidae. Biostratigraphically this fauna is well individualized with respect to preceeding ones (only seven species in common with the Miocene fauna) and those following twenty-three species in common with the extant fauna). The following biostratigraphical subdivision has been recognized in the Upper Miocene and the Plio-Pleistocene of the Antwerp region: (1) an association with «genus? Macrouridarum labiatus, Trisopterus sculptus, Gadiculus benedeni and Trisopterus luscus spectabilis, in the Sands of Deurne (Upper Miocene); (2) an association with Gadiculus benedeni and Merlangius pseudaeglephinus, in the Formation of Kattendijk (Pliocene); (3) an association with Gadiculus verticalis and Merlangius pseudaeglefinus in the Formation of Lillo (Plio-Pleistocene); (4) an association with Gadus morhua and Merlangius pseudaeglefinus in the so called «Icenian deposits not present in Belgium but found in the Netherlands.     

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.     

Cytochrome P450 et activation génétique — de la pharmacologie à l’élimination du cholestérol et à la régression de l’athérosclérose

Background

Lipoproteins are closely associated with the atherosclerotic vascular process. Elevated levels of highdensity lipoprotein cholesterol (HDL-C) and apolipoprotein AI (apo AI) in plasma indicate a low probability of coronary heart disease (CHD) together with enhanced longevity, and elevated levels of low-density lipoproteincholesterol (LDL-C) and apo B indicate an increased risk of CHD and death. Studies linking gene activation and the induction of cytochrome P450 with elevated plasma levels of apo AI and HDL-C and lowered plasma levels of LDL-C presented a new potential approach to prevent and treat atherosclerotic disease.

Objective and methods

This is a review aimed at clarifying the effects of P450-enzymes and gene activation on cholesterol homeostasis, the atherosclerotic vascular process, prevention and regression of atherosclerosis and the manifestation of atherosclerotic disease, particularly CHD, the leading cause of death in the world.

Results

P450-enzymes maintain cellular cholesterol homeostasis. They respond to cholesterol accumulation by enhancing the generation of hydroxycholesterols (oxysterols) and activating cholesterol-eliminating mechanisms. The CYP7A1, CYP27A1, CYP46A1 and CYP3A4 enzymes generate major oxysterols that enter the circulation. The oxysterols activate — via nuclear receptors — ATP-binding cassette (ABC) A1 and other genes, leading to the elimination of excess cholesterol and protecting arteries from atherosclerosis. Several drugs and nonpharmacologic compounds are ligands for the liver X receptor, pregnane X receptor and other receptors, activate P450 and other genes involved in cholesterol elimination, prevent or regress atherosclerosis and reduce cardiovascular events.

Conclusions

P450-enzymes are essential in the physiological maintenance of cholesterol balance. They activate mechanisms which eliminate excess cholesterol and counteract the atherosclerotic process. Several drugs and nonpharmacologic compounds induce P450 and other genes, prevent or regress atherosclerosis and reduce the occurrence of non-fatal and fatal CHD and other atherosclerotic diseases.     

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.