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.     

L’entretien psychologique systématique pour les couples optant pour l’IAD: huit ans d’expérience clinique dans une législation prévoyant la levée de l’anonymat du donneur

A law on medically assisted procreation was implemented in Switzerland in 2001. This law is subordinate to the well-being of the child and stipulates that only married couples can benefit from donor insemination (DI). Furthermore, a child who was conceived with donor sperm may obtain access to information including the identity of the donor on reaching adulthood, at age 18. The law also specifies that psychological assistance must be offered before, during, and after treatment. For the past 12 years, the Unit of Reproductive Medicine and the Center of Medically Assisted Procreation in Lausanne employ a concept of psychological assistance adjusted to each couple’s needs, called “ressource counselling”. In preparation for DI, specific questions are examined, such as “Should the child be informed about the donor insemination, should others be informed, if so, how and when?” These questions may also be discussed in a group setting specific for couples concerned with DI. Our experience shows that systematic counselling helps couples in finding their own path through the delicate subjects of secrecy, attachment, and the rights of a child to be informed of his/her genetic links.     

Apport de l’échographie dans le bilan d’une infécondité masculine

Recent technical progress in ultrasound, particularly with respect to high-frequency linear probes and transrectal probes, now enables a very detailed morphological approach to the scrotal, prostate and surrounding structures, such as the seminal vesicles, the vas deferens and the ejaculatory ducts. For almost 20 years, in close collaboration with Male Sterility Center of Toulouse, we have carried out such examinations as part of infertility testing procedures, and we set out below the results of our experience. After a short anatomical reminder, we shall begin with an echographical study of the scrotum, followed by the prostate and its adjoining structures, pursuant to a transrectal examination. In the course of these two examinations, we shall consider the various pathologies that we have encountered, which have tended to be secretory with respect to the scrotum, and excretory in the prostate area, in order to determine the usefulness and importance of echographical examinations in male infertility.     

La TEP-TDM dans la maladie de Hodgkin : expérience clermontoise

The aim of this study was to evaluate the standardized uptake value (SUV) of ¹⁸FDG in Hodgkin's disease according to various histopathologic parameters as well as the impact of the examination on stadification and follow-up. A total of 37 patients profited from a pretherapeutic PET-CT. Standardized uptake value was calculated a posteriori. This one is higher in mixed cellularity Hodgkin's disease compared to nodular sclerosing Hodgkin's disease. In addition, the examination involved a change of stage in 35% of the cases compared to the injected CT. The specificity of the PET-CT at the end of the treatment was 96% and its exactitude of 93%, both significantly higher than those found in CT.     

La stimulation électrique pallidale dans le traitement des mouvements anormaux : l’expérience montpelliéraine dans l’utilisation de l’imagerie fonctionnelle comme critères de sélection des patients

Magnetic resonance anatomical imaging gives to the practician an important set of criteria for selecting patients with dystonic and dyskinetic syndromes who can get benefice from a treatment by electrical deep brain stimulation. However, anatomical anomalies seen on MRI, whatever their number and morphological extension, do not reflect the effective (residual) functional activity of the corresponding structures. We describe, in this short report, the way how, in our experience, functional imaging techniques used for measuring cerebral perfusion and neurotransmission in Single Photon Emission Computerized Tomography (SPECT), cerebral metabolism in Positron Emission Tomography (PET) and motor neuroactivations in functional Magnetic Resonance Imaging (fMRI) are capable of progressively fulfil this deficiency.     

Méthodologie d’évaluation de l’impact d’une formation sur la qualité de l’utilisation d’une nouvelle technologie

For health care professionals, training is critical to assure the patient safety. This paper is interested in the nurses training when a new technology is introduced in their work environment, and more particularly in the impact of the type of training on the quality of the new device use. This means that both the learned knowledge and their integration in the work environment have to be evaluated. Two types of training were compared through qualitative and quantitative indicators of the device used in the work situation. The results highlight a better satisfaction of learners and more effective results on the practice with one of the two trainings.     

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.     

Etude d’un modèle expérimental d’infection de l’appareil génital mâle

Injection of uropathogenic E. coli into the rat cauda epididymidis results in chronic epididymitis in 74.2% of cases, accompanied by necrotic orchitis (16.1% of cases) or non-infectious testicular lesions (45.2% of cases). Injection of killed bacteria caused the same noninfectious testicular lesions, most probably due to toxic damage. Injection of bacteria into the seminal vesicles caused a vesiculitis which regressed after seven days and disappeared progressively. Simultaneously, the prostate was invaded by polymorphonuclear leucocytes, an infection which persisted for more than three months. E. coli injection in association with bilateral castration gave rise to the formation of chronic vesicular abscesses. Examination of the male genital tract lymphatic system allowed explanation of the spread of infection from the epididymis to the testis, and from the seminal vesicle to the prostate. The epididymis is an organ with poor defense against against infection whereas the seminal vesicle is able, owing to the activity of its epithelium, to fight infection. On the other hand, prostatitis secondary to vesiculitis is immediately chronic.     

La spécificité de l’auto-analyse freudienne: un expérimentalisme sans laboratoire

WithThe Interpretation of Dreams, Freud introduced his readers into the psychoanalytic technique. Freud’s strategy was a reaction to the difficulties produced by the establishment of laboratories of hypnosis, difficulties due to the resistance of patients and to the large diffusion of suggestion in everyday life. The possibility of resistance enables subjects to take an active role. This led to a change of the former configuration of experimental hypnotism where the subjects had to be deceived. In contrast to the doctors of the hypnosis movement, Freud abandoned the project of constructing a laboratory of hypnosis and elaborated reading and writing practices instead. Early psychoanalysis thus develops in the form of an “experimentalism without a laboratory”, a specific articulation of dreaming, reading and writing.     

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).     

Apports de l’imagerie hybride TEMP/TDM dans le descellement aseptique de prothèse de hanche

Hip prosthesis loosening detection is a common indication for bone scan, however, the diagnosis can be difficult to confirm based solely on bone scan information which have a low specificity. The development of bone SPECT/CT hybrid imaging allows the correlation of two complementary modalities to palliate the low sensitivity of CT caused by metallic artefacts and the moderate specificity of bone scan. It becomes a necessity for nuclear medicine physicians to master the bases of pathological hip prosthesis radiological semiology. We propose in this review article to recall the physiopathology of prosthesis loosening then we will describe the radiological and scintigraphic characteristics of hip prosthesis loosening as well as its differential diagnoses and the benefits of other imaging modalities.     

Prothèses orthopédiques et médecine nucléaire : le cas particulier de l’infection. Cas cliniques d’infection chronique sur prothèse de hanche

The diagnosis of chronic orthopedic infections relies on the combination of clinical, laboratory and imaging findings. Although there is no perfect imaging examination, the various nuclear medicine techniques are a useful help for clinicians. Performance and image quality have improved dramatically since the development of hybrid cameras. The choice of the most appropriate examination for underlying infections is sometimes difficult as well as its interpretation. It is often essential to know the patient's history (surgical history, biology, etc.). We have tried to illustrate the sometimes-complex management of chronic infections of hip prostheses through these clinical cases from multidisciplinary staff committee of osteoarticular infections.