Apport de l’embolisation de la varicocèle chez 51 patients infertiles

This study evaluated the changes induced on the parameters of the sperm count four months after sclero-embolization of varicocele. From February 1993 to February 2000, 51 infertile patients with testicular hypotrophy or oligospermia were treated by percutaneous sclero-embolization of varicocele. All patients underwent preoperative diagnostic evaluation by semen analysis, Doppler flowmetry or color Doppler ultrasound and venography. Scrotal ultrasound was performed to evaluate the echogenicity of the testes, their volume and funicular vein enlargement during Valsalva manoeuvre. Patients were reviewed four months after sclero-embolization with semen analysis. Clinical follow-up showed complete resolution of the varicocele in 94% of cases (47 patients), while the varicocele persisted in two cases. In 2% of cases (1 patient), selective catheterization of the internal spermatic vein was impossible. Four months later, analysis of semen parameters showed an increased number of spermatozoa. In 69.4% of oligospermic cases, the sperm count was at least tripled. The time-course of the sperm count (average) was as follows: in a total of 50 patients with pre- and post-embolization evaluation, sperm count increased from 19.6 106/ml to 26.7 106/ml. In the population of 36 patients with a sperm count <20 106/ml (i.e. with oligospermia or azoospermia), the sperm count increased from 3 106/ml to 14.6 106/ml. In the subgroup of patients with oligospermia (1–20.106/ml), the sperm count increased (p<0.01) from 5.32 106/ml to 22.32 106/ml; in the subgroup of patients with severe oligospermia (0–1 106/ml), the sperm count increased (p<0.01) from 0.188 106/ml to 3.5 106/ml. Semen analysis was improved in 1 of the 4 patients with azoospermia. In conclusion, sclero-embolization improved sperm count in this population of infertile patients with varicocele and testicular hypotrophy. In vitro fertilization or intra-uterine insemination can therefore be considered in the place of ICSI.     

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.     

Place actuelle de la biologie dans l’exploration et le suivi de l’allergie

The allergy disease requires an early diagnosis which, in addition to the management of the disease at its initial stage, will prevent its development towards potentially more severe symptoms. In primary care, screening tests allow to investigate the underlying cause of the symptoms and to confirm or exclude an allergic condition. They were recently completed by a test specially dedicated to the infant, which takes into account the predominance of the food allergens at this age. Specific IgE tests contribute, by the identification of the offending allergens, to implement a specific treatment (more particularly allergen avoidance) and to follow the development of the disease over time. The last scientific and technological advances allow from now on to refine the exploration at the molecular level and the recent development of tests with allergenic components offers new perspectives to the in vitro diagnostic as well as new indications.     

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.     

Efficacité et innocuité du prélèvement percutané de sperme testiculaire dans la prise en charge de l’infertilité masculine

Objective

To assess the efficacy and safety of percutaneous testicular biopsy to provide sperm cells for ICSI in male patients with azoospermia not amenable to surgical treatment.

Materials and methods

From October 1995 to December 2001, 175 biopsies were performed in men with azoospermia to provide material for intracytoplasmic sperm injection. Azoospermia was obstructive (OA) in 41 cases and non-obstructive (NOA) in 134 cases. Open biopsy was performed in the first 15 patients in the series and percutaneous biopsy was performed on an outpatient basis, under local anesthesia, with a Biopty Gun® (14G needle), in the subsequent patients as the first step in management. Open surgical biopsies were performed in another 15 patients following a sperm cell-negative percutaneous biopsy.

Results

All biopsies performed for OA were positive, but only 51/134 biopsies (38%) were positive in the NOA group. The material provided by percutaneous biopsy, when positive for sperm cells, was always sufficient to perform ICSI. When percutaneous biopsy was negative, open surgical biopsy failed to give better results. Five men developed minor complications (acute hematocele) following percutaneous biopsies requiring reoperation for hemostasis (3.12%). No major complications were observed. Results were comparable in terms of fertilization and pregnancy rates whether fresh or frozen-thawed sperm was used.

Conclusion

Percutaneous testicular sperm extraction is a safe, well-tolerated and cost-effective procedure in the management of male-factor infertility related to azoospermia.     

La nutraceutiques (alicaments) et compléments alimentaires dans le traitement de l’infertilité masculine

Several controlled and well-validated trials provide evidence that food supplementation with particular substances can improve semen quality and function of subfertile men. These include the antioxidants astaxanthin, tocopherols and ubiquinone Q10, essential fatty acids of the omega-3 group, zinc, and folic acid. There is suggestive evidence that certain plant extracts and lignans may equally exert beneficial effects. Supplementation with a nutraceutical (Qualisperm®, Nutriphyt, Oostkamp, Belgium) containing these substances increases the probability of spontaneous conception and successful pregnancy. Although the exact mechanisms of action of these supplements on spermatogenesis and sperm function remain to be unravelled, a direct effect on the cells of Sertoli and via epididymal function seems conceivable. Nutraceutical food supplementation should also be considered beforein vitro fertilization and ICSI, in order to reduce the oxidative damage to sperm DNA.     

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.     

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.      

Place des troubles de la spermatogenèse dans l’hypofertilité masculine

According to Thonneauet al., (1991), 14% of couples are subfertile. In at least 59% of the cases, a male factor was involved. This indicates that 8% (14% × 59%) of men are hypofertile. Since several causes can induce male infertility and because of the heterogeneous criteria and classifications used in the literature, the percentage of each etiologic factor has not been very precisely established. In a population of 2072 consecutive patients we identified an alteration of spermatogenesis in 52% of the cases. This indicates that about 4% of men might have a spermatogenic problem. The spermatogenic insufficiency was isolated in 43% of the cases (i.e. 23% of the total population) or associated with post-testicular causes of male infertility (infectious/inflammatory; autoimmune; obstructive) in 57% of the cases (i.e. 30% of the total population studied). An etiologic factor is clinically identified for 64% of the patients presenting with a spermatogenic insufficiency. The most relevant risk factors linked to spermatogenic alteration were history of mumps orchitis (OR [IC95%]=14,6 [3,4–62,3]), history of radiotherapy-chemotherapy (OR=14,7 [3,4–63,2]). These situations were found with a low frequency (1,4% and 1,3% of the cases respectively) but provoked a spermatogenic alteration in a large majority of cases (92,9% and 92,3% respectively). On the other hand, varicoceles (OR=3,7 [2,9–4,8]) and troubles in testicular descend (OR=2,9 [2,3–3,7]), were more frequent (20,6% and 20,1% of the cases respectively), but less frequently associated with spermatogenic insufficiency (in 73,7 and 69,6% of the cases).     

Place de la rigidimetrie informatisee dans l’evaluation de la fonction erectile

This study reports the results of 1080 rigidometry tests performed as the initial investigations on impotent subjects since 1987, comprising 920 visual stimulation tests and 160 nocturnal erection recordings. Positive tests indicated a psychogenic cause of the problem in 78% of cases and allowed a classification of the subjects according to their responses. Even though this approach does not provide an aetiological diagnosis, it has the advantage of avoiding additional, more invasive, investigations.     

Abus et danger du traitement au citrate de clomiphène dans l’infertilité masculine

Obiective

To describe a case of seminoma occurring in a patient with a past history of cryptorchidism, infertility and clomiphene citrate (CC) treatment. To review the literature of seminoma in association with these risk factors.

Case report

A 33 year old man developed typical seminoma in the right testis. A bilateral cryptorchidism was lately diagnosed and treated by orchidopexy at the age of 17. Primary infertility due to oligoasthenospermia was diagnosed at the age of 29. Treatment was initiated with CC at the dose of 25 mG/day. Semen quality improved gradually. After failure of various assisted reproductive techniques, a spontaneous pregnancy was achieved and a healthy baby delivered. Shortly after delivery the seminoma was diagnosed, after a totla of three years of treatment. Six cases of testicular tumors have been reported in the literature in which patients had been pretreated with fertility drugs for various priods of time before tumors was diagnosed. Cryptorchidism is a well-known risk factor for testicular malignancy, as is the infertil state. Clomiphene citrate may promote malignant transformation by activation of estrogen receptors, by raising gonadotropin and/or testosterone concentrations, or by other mechanisms.

Conclusion

Clomiphene citrate may have a previously unappreciated malignancy-promoting effect in infertile men, especially those with other risk factors. Clinicians treating similar patients should take this into account and the literature monitored for other associated cases.     

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.     

Place des tests d’interaction sperme-mucus dans le bilan masculin de l’infécondité

In infertile couples, it may be necessary to finely analyze the fertilization ability of spermatozoa. The postcoital test (PCT) has long been the only sperm functional assay. It tests the sperm penetration and survival ability in the cervical mucus. These are the first steps of a long cascade of events that spermatozoa have to undergo during their ascension in the female genital tract, on their way to the site of fertilization. However, the PCT may evoke emotional stress and should be done in a simple way to avoid sexual inhibitions. In optimal conditions, the number of motile spermatozoa seen in the upper cervical mucus correlates well with semen analysis and the odds of subsequent pregnancies. Antisperm antibodies may impair the PCT and only few, if at all, or many immobile or shaking spermatozoa, may be seen in cervical mucus, in contrast to the sperm quality in the ejaculate. In vitro Sperm-Mucus tests may be done using Kurzrok or Kremer technique with human or bovine mucus as well as with synthetic media. These in vitro tests do allow a good evaluation of sperm quality but only partially correlate with natural PCT. In an IVF group the PCT correlates with IVF fertilization and pregnancy outcome. It helps detecting the high risk group in which additional tests, antisperm antibody detection, acrosome reaction test, hamster test (SPA), hemizona assay (HZA), are recommended. These tests may sort those couples requiring sperm egg micro-injection. However, the PCT has been criticized for its poor methodology and mainly for its weak validity. In this IVF group, we performed a validity analysis of PCT and all sperm tests against fertilization and pregnancy rate. It confirms the weak validity indices of PCT and of all sperm tests as well. Nevertheless, in the stepwise regression analysis of all these tests against IVF fertilization and pregnancy, F-test value of PCT was almost similar to SPA/HZA and higher than sperm morphology. Thus, PCT is important and the weak validity indices of all sperm tests are probably due to the multifactorial nature of sperm quality. So, no single test may reliably check sperm fertilization potential. Male work-up does require a cascade of examinations including PCT to allow reliable evaluation and rational therapeutic act.