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.     

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 mammouth dans l’art paléolithique

The mammoth, an emblematic animal of the Prehistory, possesses an important place in the depictions made by prehistoric artists, both in parietal art (cave art) and in mobile art. Its image is known from the Aurignacian, at the beginning of the Upper Palaeolithic, until the end of the Last Ice Age, the Magdalenian. However, its geographical and chronological distribution is dissimilar. Mammoth depictions are generally more frequent during the Aurignacian where this animal is found engraved and painted in the Chauvet cave for example and carved from ivory in several cave sites of the Swabian Jura. The Magdalenian cave of Rouffignac and its 160 representations constitute a notable exception. From a formal point of view, the representations of mammoth are elaborated in a rather constant way, like the characteristic cephalic contour and the typical back of the animal, at least as it could be seen in nature. The representations are often even limited to a cursive line with a double curvature that expresses the pachyderm. On the other hand some drawings show intimate details. Sometimes the tusks of the mammoths are not indicated, but certain stylistic features, such as the ventral arch, are relatively reliable chronological markers. Finally, one cannot ignore the ethological or seasonal expressions that sometimes link the mammoths to each other, in a row or in confrontation. This animal obviously inspired the artists of the prehistory who created various portraits of the mammoth.     

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.     

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.     

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.     

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’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.     

Le Paléolithique supérieur dans l’île d’Hokkaïdo

Since the discovery of the first Paleolithic site in Hokkaido, we consider that the time in the half more than centuries already passed, and float today. However, our research is still a way. By today, we have not discovered the trace about a Pithecantropines (Homo erectus) and a Paleanthropic man (Homo sapiens neanderthalensis) at all in this region. We know that a Neanthropic man (Homo sapiens sapiens) dominated all the continents except Antarctica in the final time of the Pleistocene era. And they passed along the dried shoal which appeared to the north in the same time from the Asian Continent to the Island of Hokkaido, and reached it to this place. The first attainment time is an age which exceeds 20,000-years before a little from the present. We are not checking a fact which exceeds it you to be much. However, the habitants of these beginnings left the trace of the activity of them in large numbers, so that he was wonderful to inside of this island. The studies-of-prehistory research in Hokkaido has little proof of the natural science field concerned on age determination or chronology. This has serious restriction. However, the tephra-chronology of volcanic ashes has played the big role uniquely. The eruption of the Eniwa volcano of the Hokkaido central part is especially a very important index. This volcano blows off ash fall (En-a) in large quantities, and covered all large ranges. This deposited volcanic-ashes layer plays a big role to discernment of an old industry and a recent industry on the cultural chronology. The obsidian from this island and nearby hard shale was used for many industries of this Upper Paleolithic cultures as main materials. Although obsidians in the island where the different four outcrops are known well. This rock was mined in large quantities, and was carried in various places. As well as many examples in the world, we divided this rock, and the human beings of the prehistoric age were demanded for it, and it was often utilized. In it, especially the outcrop of Shirataki was located in the northern part of Hokkaido, and was very important. Large quantities of obsidian from Shirataki outcrop is discovered in a large number of Paleolithic sites within a segment 700 km in diameter at least. It covered the territory in Hokkaido and circulated further also except this island. This fact circulated as important trade materials on stone-tool fabrication among the human-beings groups from whom this island's every place differed. In this time, human beings’ activity in Hokkaido is a clear proof, which was not isolated at all. As for the studies of the prehistorians of Hokkaido distinguish, the exception put the technical process of eight different microblade productions. The technical process of some of them was limited only to the specific narrow area. Or it is proved that other technical processes are widely connected with the human-beings group of the Asian Continent on the contrary. At present, our research grasps the whole second-half Paleolithic culture, and has not yet established the year system edited by locally complete. The oldest industry of this area composed the typical stone tool of second-half Paleolithic culture from the beginning, and was accompanied by the manufacturing technique of a braid and microblade. The feature is the example in which the ruins of Kashiwadai-I were most excellent. These ruins correspond at time older than deposition of the Eniwa volcano tephra. It is located at the chill time in the second half of a Würm glacial period. The second continuing step is an industry of succession newer than this volcano tephra. It is raised as an example with Ôsatsu-16 typical ruins etc. The third phase is an industry of the end term of second-half Paleolithic culture. It is simultaneously located in the dawn of Jōmon culture. The feature of this cultural aspect is a transitional cultural stage which earthenware appears and is called what is called “Sub-Neolithic-Culture”. We can check having passed expansively, while the aspect of this last continues within a short period of time relatively.     

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.     

L’échographie Doppler dans le diagnostic des duplications gastriques chez l’enfant

Gastric duplication is a rare congenital gastrointestinal malformation responsible for abdominal pain and digestive disorders in children. When it is not discovered prenatally, it raises the problem of diagnosis of abdominal cystic mass leading to surgical excision with histological confirmation. We report 4 cases of gastric duplication diagnosed in children aged 11 days, 4 months, 6 years and 13 years of the pediatric imaging unit of the southern Teaching hospital of Rennes (France). Our goal is to emphasize on the role of medical imaging in particular the color Doppler ultrasound in the diagnosis and the monitoring of this uncommon disease of the child.     

Indications d’une étude méiotique dans l’infertilité masculine

Meiotic investigation is rare in male infertility. Now, some mutations affecting spermatogenesis exhibit characteristic cytogenetic figures, whereas testicular histology does not show specific aspects of this pathology. In male infertility with abnormal somatic caryotype, the aim of meiotic survey is to find the mechanisms inducing spermatogenic failure, and thus to lead to a better understanding of normal spermatogenesis. In addition to cytogenetic techniques, meiosis is also investigated by electron microscopy and molecular biology. Also, we think that a larger place must be grant to meiotic study in male infertility evaluation when the indication of testicular histopathology was settled.     

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.     

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.     

L’intégrine α6β1 ovocytaire et spermatique dans l’interaction gamétique

Based on inhibition tests, the α6β1 integrin was suggested to be a sperm receptor, but further experiments using gene deletion techniques have shown that neither oocyte α6, nor β1 integrin subunits were essential for mouse fertilization. Using Western blot analysis and immunofluorescence (flow cytometry and microscopy), we have shown that mouse sperm expresses the α6β1 integrin. As for oocytes, binding of GoH3 anti-alpha6 antibody to sperm induces specific inhibition of sperm fertilizing ability. Comparing zona-intact and zona-free eggs in fusion tests, we have shown that removal of the zona pellucida bypasses the α6β1 integrin role in the adhesion/fusion process of oocyte fertilization. The α6β1 integrin is expressed by both gametes and is functional during their membrane interactions. Our results, previous reports on fertilization of α6 or β1 integrin subunit-deleted oocytes by wild-type sperm and the fusion ability of β1 mutant myoblasts when they were co-cultured with wild-type myoblasts suggest that the presence of α6βl integrin on one of the two gamete membranes can rescue the fertilization process. This hypothesis is further supported by the recently reported exchange of membrane fragments occurring between gametes prior to fusion.     

Nouveaux marqueurs dans l’homéostasie glucidique : physiologie et physiopathologie

The term diabetes mellitus describes a metabolic disorder resulting from defects in insulin secretion, insulin action, or both. People with diabetes are at increased risk of cardiovascular, peripheral and cerebrovascular disease. In consequence, it is important to better understand early step in this disease in order to prevent complications. Incretine hormones are defined as intestinal hormones released in response to nutrient ingestion, which potentiate the glucose-induced insulin response. The incretine effect is mainly caused by two peptide hormones, glucose-dependent insulin releasing polypeptide (GIP) and glucagons-like peptide-1 (GLP-1). Analogs of GLP-1 and dipeptidyl-peptidase IV (DPP-IV) inhibitors are actually used as antidiabetic drugs. Adiponectin is an adipokine, which is expressed in adipose tissue and is thought to play an important role in glucose metabolism. Hypoadiponectinemia was related to obesity, insulin-resistance and as a risk factor of diabetes, cardiovascular events and death. Plasmatic quantification of GLP-1 and adiponectin should improve insulin-resistance diagnosis and diabetes prevention.