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.     

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.     

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.     

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.     

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.     

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.     

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.     

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.     

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.     

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.      

évaluation des pratiques professionnelles dans le cadre de l’accréditation des établissements psychiatriques

As regards evaluation of professionnal practices (EPP), Formep’s has decided to stay in the limits of psychiatric institutions, for reason of experience. Every medical doctor working in these institutions is concerned by evaluation, but also institutions in the specific framework of V2 44, 45 and 46 references. The EPP is multidisciplinary and involves everybody who takes part of patient caring. Formep’s is adviser, training agent, and partner. Follow-up takes place both on-site and off-site all along the EPP, by a team including psychiatrists, medical practitioners, quality and risk management engineers. They are all experienced to work in psychiatric institutions. Formep’s program includes preliminary and definitive choice of themes, putting methology is place, work of teams, initial analysis of results and deviations, further work of teams, final analysis, which purpose is to improve practices and therefore medical benefit.     

Impact de l’imagerie hybride TEMP/TDM dans le diagnostic et la prise en charge de l’ostéome ostéoïde

IntroductionThe osteoid osteoma is a major bone benign tumors in children. It is more common in boys. The femoral and tibial locations account for 50% of cases. Clinically, it is revealed by nocturnal pain relieved by aspirin. The pain may precede by several months the radiographic abnormality. The purpose of our work is to elucidate the contribution of SPECT/CT in addition to the planar bone scintigraphy in the diagnosis and treatment of osteoid osteoma about two cases.Case reportClinical case No. 1: a 10-year-old child who presented a limp nocturnal pain in the left hip evolving for 4 months. The radiograph of the pelvis showed bone condensation subtrochanteric left femur. SPECT/CT showed an image for an osteoid osteoma. Surgical resection of the home revealed in the histological study an osteoid osteoma of the left femoral neck. The evolution was marked by an immediate pain relief and full recovery of the left lower limb mobility. Clinical case No. 2: an 11-year-old child who had a limp nocturnal pain at the upper end of the left femur evolving for 2 months. The pain was paroxysmal, relieved by salicylates. The X-ray of the pelvis showed a metaphyseal image with peripheral condensation and thickening of the cortex. SPECT/CT showed an image for an osteoid osteoma. The intervention was a tumor excision resection. Histopathological examination revealed a small nidus consistent with an osteoid osteoma. The evolution was marked by an immediate pain relief and normalization of the mobility of the left lower limb.DiscussionThe SPECT/CT can increase the sensitivity and specificity of planar bone scintigraphy. It confirms the location of osteoid osteoma and defines its anatomical relationships in order to optimize surgical management.ConclusionThe SPECT/CT contributes significantly to the diagnosis of osteoid osteoma when radiological images are atypical or unusual clinical expression.     

Apport de l’exploration cytogénétique et ultrastructurale dans le pronostic de fertilité des sujets globozoospermiques

Globozoospermia is a severe form of teratozoospermia characterized by round-headed sperms with absence or presence of a rudimentary acrosome. The objective of this study is to analyze sperm from six patients with globozoospermia syndrome and report the results of 11 intracytoplasmic sperm injection (ICSI) attempts. The investigation of these issues was carried out by studying the sperm aneuploidy rate by fluorescent in situ hybridization (sperm-FISH) for chromosomes X, Yand 18. The rate of DNA fragmentation was studied by using the terminal deoxynucleotidyl transferase dUTP nick end labelling (TUNEL) technique and a detailed ultrastructural morphology study of the sperm using transmission electron microscopy. Eleven ICSI attempts were performed in patients with low fertilization rate, (9.37%) and pregnancy did not occur. This study confirmed the variability of sperm phenotypes observed in this syndrome and the low fertilization rates after IVF-ICSI regardless of the phenotype.     

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.     

Place de la prostaglandine E1 intra urétrale dans le traitement de l’impuissance érectile

Transurethral alprostadil (Muse) is an effective and safe treatment of erectile dysfunction. Nevertheless, the result after its exit on the US market two years ago were not as good as the investigational studies which claimed aroud 60% of sccess rate. In the litterature success rate were between 35% and 40% all together. The Muse had a better acceptance than the intra-cavernous injection despite a lower success rate (40 % v.s 75 %). Since Sildenafil came on the market, it seems that the place of Muse is reduced because comparative studies give better results for Sildenafil than Muse (70 % v.s 40 %) and of course with a better acceptance. Nevertheless there are absolute and relative counter-indications to the Sildenafil which could benefit to the treatment by Muse. All the comparative studies, IIC, v.s Muse and sildenafil v.s Muse will be studied in this article. In conclusion Muse should be used as an alternative and should remain an effective tool that must be available to all physicians dealing with erectile dysfunction, perhaps using new formula with a combination of alprostadil with an alpha-blocker.     

Intérêt du dosage de l’inhibine B et de l’AMH dans le plasma séminal: étude préliminaire

Objectives

The aim of this study was to establish reference values for seminal inhibin B and AMH concentrations in patients with normal and abnormal sperm parameters. Preliminary analysis was performed to evaluate the predictive value of these markers for retrieving testicular sperm in non-obstructive azoospermic men.

Methods

Seminal inhibin B and AMH concentrations were assayed by an enzyme-linked immunoassay in three groups of men: 47 patients with normal sperm parameters, 28 oligospermic men and 68 patients with azoospermia.

Results

Inhibin B and AMH concentrations varied considerably in the three groups, but were significantly higher in normospermic men (inhibin B: 714.36±522.66 ng/l, AMH: 97.08±135.15 pmol/l) than in oligospermic men (inhibin B: 417.5±386.9 ng/l, AMH: 62.02±93.33 pmol/l) and azoospermic men (59.61±2.65 ng/l et 13.12±31.94 pmol/l, respectively) (p<0.001). A significant correlation (p=0.0054) was observed between seminal inhibin B concentration and sperm production. Testicular biopsy allowed sperm retrieval in 11 out of 21 patients (52.3%). The predictive value of seminal inhibin B was analyzed using receiver operating characteristics (ROC) curve analysis. The best discriminating inhibin B concentration was 30 ng/l with an area under the curve (AUC) of 0.63.

Conclusion

This study confirms the correlation between seminal inhibin B and AMH concentrations and spermatogenesis. However, the significance of these two markers as predictors of the presence of testicular sperm in men with non-obstructive azoospermia is limited. This analysis shows that AMH and inhibin B, either alone or in combination with serum FSH, fail to predict the presence of sperm in men with non-obstructive azoospermia undergoing testicular sperm extraction.     

Testostérone et contrôle central de l’érection

Testosterone orchestrates the perinatal organization and activation of cerebral and spinal neuronal structures involved in the expression of male sexual behaviour in adults. The present review briefly describes testosterone effects in the regulation of sexual motivation and erection, as well as the genetic models developed to date in order to unravel its central mechanisms of action.