Les inhibiteurs spécifiques de la recapture de la sérotonine dans la dépression de l’enfant et de l’adolescent: revue des controverses récentes

European and US drug regulatory authorities have recently warned against the use of selective serotonin reuptake inhibitors (SSRIs) in childhood and adolescent depression. Through an extensive literature review on the use of SSRIs to treat depression in children and adolescents — including psychiatric clinical trials, pharmacology, and drug safety data — we will: i) describe the main arguments justifying various regulatory decisions; ii) present published data and subsequent meta-analyses; iii) discuss how to integrate the recommendations into daily clinical practice, freeing professionals from a Manichean approach. We reach the limits of evidence-based medicine, which provide the basis of the scientific work of the regulatory authorities.     

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.     

Dosage de la testostérone plasmatique chez l’homme

The measurement of testosterone in plasma is the main tool to investigate the endocrine function of the testis. Radioimmunoassay of total testosterone using³H-testosterone as tracer, after steroid extraction and chromatography avoids the interactions of steroids and plasma proteins in the assay. It can be considered as a method of reference. Direct methods, without extraction and chromatography, and using non-radioactive tracers have been developped. They are easier and faster to perform but less accurate because of the aforementioned interactions. In the plasma, testosterone is mainly bound with a high affinity to SBP and with a low affinity to albumin. Non-SBP-bound testosterone is considered to represent the fraction of the testosterone available for target cells. Non-SBP-bound testosterone can be measured after precipitation of SBP by ammonium sulfate. This procedure is usefull to investigate androgenicity when plasma SBP concentrations are altered such as in hyperthyroidism, aging and severe exocrine testicular failure. Plasma free testosterone can be mesured by equilibrium dialysis, a procedure not suitable for routine assay or more easily but less accuratly by direct measurement in the plasma with methods using tracer analogs. The interpretation of testosterone measurement must take into account moment-to-moment and nycthemeral variations. The inter-subject variations of plasma testosterone concentrations are large, the decrease with aging is very progressive. Testosterone has a permisive effect on male sexual function with a threshold level above which no relationship between plasma testosterone concentration and sexual “performances” could be demonstrated. Because of the multifactorial control of human sexual function, the threshold value is difficult to determine for a given patient.     

Traumatisme du testicule chez l’enfant

Introduction

The testicular trauma is uncommon in children and the literature about this topic is very poor. The aim was to investigate the testicular trauma in children from a retrospective study.

Materials and methods

All the French pediatric surgical departments were requested to send their cases of testicular trauma reported between 2000 and 2009. The analysis was performed from the data and the operative report. Isolated scrotal wounds, testicular torsions revealed by trauma, and incomplete files were excluded.

Results

Fifteen departments sent their data and 2 had no cases. From 60 cases, 15 were excluded and 45 selected. The mean age was 12.3 years (2 days–18 years). The circumstances of the trauma were 23 knocks (foot, knee, and fist), 13 falls, 4 motorcycle accidents, 4 unknown traumas, and 1 obstetrical trauma. There were 4 wounds and 41 without wound. A color Doppler sonography was performed in 34 cases (75.5%) with an accurate diagnosis in 30 cases; 2 testicular fractures and 1 intratesticular hematoma were not confirmed at surgery, and 1 epididymal hematoma was not seen on sonography. The lesions were testicular fractures (15), intratesticular hematomas (8), benign testicular blunt traumas (6), spermatic cord hematomas (6), epididymal hematomas (6), isolated hematoceles (3), and avulsion (1). Surgical treatment was done in 33 children and 12 had nonoperative treatment. Among the 15 testicular fractures, 13 were operated (8 sutures and 5 partial orchidectomies) and 2 were only observed. For the intratesticular hematomas, a surgical treatment was performed in 5 children and a nonoperative treatment in 3, with a good evolution. Only 20 children were controlled beyond 4 months, especially the testicular fractures and no secondary testicular atrophy was seen.

Conclusion

The testicular trauma in children is rare and the prognosis is rather good. The color Doppler sonography now allows a good diagnosis in most cases and the surgery can be often avoided in benign blunt trauma. In this situation, it is important to repeat sonography 24 or 48 hours after trauma to ensure there is no fracture or other lesion necessitating a surgical treatment.     

Recherche d'antigènes de groupe chez des rickettsies de la tribu desWolbachiae par la technique d'agglutination des corps élémentaires

Résumé Les relations antigéniques entre einq rickettsies pathogènes aux Invertébrés sont étudiées par agglutination. Cette comparaison met en évidence que le genreRickettsiella ne constitue pas au point de vue immunologique un ensemble homogène. On définit deux groupes sérologiques distincts:R. melolonthae, R. tipulae etR. cetonidarum appartiennent au groupe I; le groupe II est actuellement consitué parR. grylli etR. armadillidii.

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Summary The antigenic relation between five rickettsiae pathogenic to Invertebrates have been studied by agglutination. This comparison shows that the genusRickettsiella does not form and homogeneous group from an immunological point of view. Two separate serological groups are defined:R. melolonthae, R. tipulae andR. cetonidarum belong to the Ist group;grylli andR. armadillidii are forming the IInd group now.

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Ce travail a été réalisé en partie dans le cadre d'une convention D.R.M.E.     

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.     

Les symptômes de premier rang de la schizophrénie: de la clinique à l’approche expérimentale

Theoretical models about action monitoring and action attribution developed over the last ten years have given a new framework in the understanding of first-rank symptoms of schizophrenia, as described by Kurt Schneider. Impaired action attribution has been demonstrated in patients with first-rank symptoms. Moreover, positron emission tomography studies have revealed that the cortical network involved in action attribution processes in normal subjects is not correctly activated in patients with first-rank symptoms. These results demonstrate that these symptoms are related to cognitive and cerebral correlates and they shed new light on the understanding of psychotic symptoms.     

Reactivite thermique de la peau scrotale chez l’homme

Although the existence of heat exchange between the testicular artery and the adjacent veins is well known, it may be insufficient to maintain the lower temperature of the testis. In order to investigate the role of the scrotum in testicular thermoregulation, the dynamics of scrotal and other skin temperatures was studied in relation to thermal stress. The results of this study revealed that the scrotal skin exhibited a greater thermal inertia than did other skin areas. This finding may be due to modifications in scrotal blood flow patterns as temperature increased, as well as changes in the scrotal surface area. Other possible thermoregulatory factors may include the evaporation of sweat from the scrotum. In conclusion, there seems to be a complex collection of mechanisms, rather than a single specific mechanism, regulating testicular temperature.     

Les premiers villages agricoles de l’est du plateau Iranien à la vallée de l’Indus : état de la question

The birth of agriculture east of the Fertile Crescent, between the Iranian plateau, Central Asia and South Asia, is poorly known. This area is vast and the archaeological data relating to this period, the Neolithic, is extremely limited. Most researchers agree that plants and animals’ domestication was introduced in this area from south-west Asia, similarly to what happened in Europe. In this scenario, agriculture emerged in the Fertile Crescent, between the Levant, Anatolia and the Zagros, 12.000 to 11.000 years ago, and then spread to other regions further east, across the Iranian plateau to Central Asia and the north-western part of the Indian subcontinent, beginning between the 8th and 7th millennia BCE. This article summarizes the main available data relating to this topic with a focus on the Indo-Iranian Borderlands, between southeastern Iran and Pakistan. Currently available paleoclimatic, paleogenetic and archaeological records are presented. A synthesis and discussion is then provided in the conclusion as well as reconstructions based on these records. Issues or challenges relating to the research on the earliest farming villages are mentioned while directions for future research are evoked.     

Les marqueurs biologiques de l’hémostase à la phase aiguë de la thrombose artèrielle

Les “bilans” hydro-électrolytiques comportent le dosage de la natrémie, de la kaliémie et de la concentration en bicarbonates. Il est habituel d’y associer le dosage de la chlorémie et de la protidémie. Selon le contexte, un ionogramme urinaire, le dosage de la glycémie, de l’urémie, de la créatinine voire une gazométrie sanguine avec mesure du pH sont prescrits. Les mesures d’osmolarité plasmatique et urinaire peuvent être également utiles dans l’interprétation des résultats.     

Les monuments funéraires en trou de serrure de l’Edjereh et de l’Amadror (Ahaggar,Algérie)

In this work, we will try to illuminate that in the Ahaggar region (Algeria) funerary monuments are very abundant with a various architecture. A series of archaeological field explorations has made it possible to gather the necessary observations and measurements. The most spectacular architecture is the so-called “keyhole architecture”, also identified as “corridor and enclosure”, which has been recognised in the central Ahaggar, with the exception of the Téfedest area, which has not yet produced any examples. The here is to present some keyhole monuments recognised during our various missions in the Edjereh and Amadror regions, some of which have been the subject of archaeological excavations in the past.     

Intérêt de la scintigraphie pulmonaire de perfusion dans les dilatations des bronches de l’enfant

IntroductionBronchiectasis is a chronic disease of the lungs by repeated respiratory infection. An early and adequate diagnosis and management reduce the morbidity and mortality of this disease. The aim of this study is to emphasize the importance of the combination of Computer Tomography (CT) and lung perfusion scan (SPP) in the diagnosis and therapeutic approach.Materials and methodsForty-three children were referred in the nuclear medicine department with a clinical diagnosis of bronchiectasis; they underwent a CT and a SPP.Results and conclusionBy analyzing the results of the SPP and CT separately, we conclude that there is no significant difference between the two investigations. The combination of the two explorations provides a gain in most surgical therapeutic orientation.     

La cryptorchidie chez l’enfant sénégalais en âge scolaire

The aim of this prospective study was to determine the incidence and the particularities of cryptorchidism in senegalese schoolboys. In a serie of 2830 boys, 40 of them had a cryptorchid testes. The incidence was 1.41%. This rate is higher than those previously reported in the litterature. Correlating the incidence to the economic level of the boys, it appears that the incidence was very low in rich group (0.25%). In the opposite it was high in poor groups (2.5%). We conclude that the high incidence rate of cryptorchidism in boys is due to the lack of information of parents issued from poor social groups.     

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.