Varicocèle et infertilité masculine

Introduction

Male responsibility in couple infertility has been established in several studies. The purpose of this research was to report varicocele clinical and spermatic aspects and assess the outcomes of open retroperitoneal varicocelectomy.

Patients and methods

Our study is a retrospective assessment of the outcomes of open retroperitoneal varicocelectomy at the urology department of Aristide Le Dantec teaching hospital (Senegal). Our focus is on patients with varicocelectomy facing couple infertility (inability for sexually active couples who are not using contraceptive methods to obtain a pregnancy over a year), patients among which no other infertility cause was revealed in their partner or partners in polygamist households. To assess the results, we compared the averages of preoperative and postoperative spermatic parameters by using the Z test (comparison test of two averages on two mated series). A difference was regarded as significant if P ?? 0.05.

Results

Five hundred and fourteen cases were examined over 6 years (January 2005?CDecember 2010). The average age of the patients was 36.5 ± 7.3 years. The infertility was primary in 62.4%. The analysis of the preoperative spermograms revealed that severe oligozoospermia (33.7%) was the most common abnormalities in the sperm cells concentrations. The abnormalities in the sperm cells concentrations were variously connected with an asthenozoospermia and to a theratozoospermia. The patients were monitored with an average hindsight of 22 months (6?C48 months). The improvement of the parameters was more significant on the concentration and the mobility of sperm cells. The natural pregnancy rate obtained in our study was 20.8%. The registered pregnancies were more important in the group IV (48%). No case of natural pregnancy was noted in the group I but an induction of the spermatogenesis was noted in 20.5% of the cases. About two thirds of natural pregnancies (64%) were noted during the first 12 post-operative months.

Conclusion

The surgical treatment of varicocele allows improving the spermatic parameters. Not only do these improvements help obtain natural pregnancies but also simplify the techniques of ART planned with the preoperative spermatic parameters.     

Androgènes et sexualité masculine

Testosteron is known to be critical for the right maintenance of masculin sexuality. It acts on all components of sexuality: libido, erection and ejaculation. As far as erection is concerned, one has to emphasize on the fact that only spontaneous nocturnal erections are androgen-dependent unlike erectile responses to visual erotic stimuliThe T can act, at the level of target organes, either as unchanged or as more often observed after reduction to DHT or aromatisation to E2. It is essencially as DHT that the male hormone seems to act on the sexuality at both the central and peripherical levels. The oestrogens even if now shown to have no peripherical action, are still subject to controversy as far as their central action is concerned. Therefore an action at the cerebral level of the oestrogens produced locally can not be definitively eliminated.The concentrations of T required for the re-establishment of the sexual function in case of hypogonadism are closer to the lower limits of normal values. The upper treshold of the action of T on the sexuality, if any, would be at supra-physiological levels.Androgenotherapy of sexual dysfonctionnalities is wittnissing a constant evolution. New and more performing products, as well as novel and less astreignant ways of administration, are already disponible or under evaluation. Moreover, the improvement of plasmic androgen exploration (dosage of free and non-sex hormone-binding globulin bound testosterone) associated to a better understanding of side effects of the androgenic therapeutics may allow in the near futur to reach a consensus on the androgenotherapy indications. As a matter of fact among the population of patients considered eugonadic (based on normal levels of T) and showing a sexual dysfonctionality, two subgroups might be interested: That of elderly patients displaying either an increase of the hormone-binding globulin (SHBG) or a decrease of the non-sex hormone-binding globulin bound testosterone levels and that of young patients suffering from idiopathic impotence. It should be, however, pointed at that the recent character of the different physiopathologic and therapeutic acquisitions requires a validation through larger series and long term studies.     

Qualité du gamète testiculaire

The combination of testicular sperm extraction (TESE) and ICSI has constituted a breakthrough in the treatment of men with nonobstructive azoospermia. However, impaired spermatogenesis raises the question of the quality of testicular spermatozoa obtained by testicular biopsy, when considering the male gamete as the product of a sequential and programmed spermatogenic process. The aim of this paper is: 1) To briefly recall the successive events of sperm protein synthesis; 2) To define the characteristics of sperm cells retrieved from the testis and 3) To evaluate the effect of nuclear anomalies on the outcome of ICSI.     

Fertilité après cancer du testicule

Objectives

To study the fertility of patients treated for testicular cancer and to identify predictive factors of infertility after treatment.

Material and Methods

314 men with germ cell tumor, followed by the CECOS Midi-Pyrénées center between 1978 and 1998, were included in the study. They were evaluated retrospectively and interviewed by a mailed questionnaire concerning their reproductive history. If they failed to respond to the questionnaire, they were contacted twice by mail, and once by telephone. The response rate was 92%.

Results

The reproductive history of 277 men was known: 138 men had tried to have a child. 91 (66%) succeeded and 47 (34%) failed to achieve a “spontaneous” pregnancy. Age greater than 25 (p<0.004), a history of undescended testis, and a sperm count lower than 10 million per ml were inversely correlated with fertility (p<0.004, p<0.01, p<0.0001, respectively). However, no relationship was found between radiotherapy or chemotherapy and fertility after treatment.

Conclusion

Men treated for testicular cancer are at high risk of infertility. We identified various prognostic factors for fertility after treatment for testicular cancer: radiotherapy and chemotherapy had no significant effect on fertility.     

Spécificité des hyphomycètes entomopathogènes pour les larves de lepidoptèresNoctuidae

Résumé L'étude de la sensibilité des 4 espèces de noctuelles,Mamestra brassicae L.,Spodoptera littoralis Boisduval,Spodoptera frugiperda Smith etScotia ipsilon Hübner, aux hyphomycètes a été conduite avec 10 souches dePaecilomyces fumoro-roseus (Wize) Brown & Smith, 6 deNomuraea rileyi (Farlow) Samson, 1 deBeauveria bassiana (Bals.) Vuill. et 1 deMetarhizium anisopliae (Metsch.) Sor. Les chenilles nouvelles-nées agées de moins de 16 h ont été exposées pendant 24 h sur des rondelles de feuilles contaminées par aspersion des inoculums, puis élevées individuellement à 25±1°C. A la dose de 3.10⁵ conidiospores/cm², l'activité pathogène des germes sur les chenilles varie dans de larges proportions suivant l'espèce-h?te et suivant l'isolat considérés. L'espèce la plus sensible à la plupart des souches estM. brassicae et la plus résistanteS. littoralis. Les germes les plus performants présentent des temps létaux 50% compris entre 2 et 3,5 j (à la dose de 3.10⁵ spores/cm²) et des doses létales 50% de 10³ à 10⁴ conidiospores/cm² (mortalités cumulées le 6e j après traitement); ce sont les isolats:P. fumoso-roseus n^o 13, 32, 39, 40 et 45 pourM. brassicae, N. rileyi n^o 5 pourS. littoralis; P. fumoso-roseus n^o 32 pourS. frugiperda etM. anisopliae n^o 139 pourS. ipsilon. La virulence élevée du pathotypeN. rileyi n^o 5 pourS. littoralis et son agressivité à l'égard des 3 autres noctuelles, confirment l'intérêt de cet hyphomycète en dehors de son aire d'origine (Sud-Est des Etats-Unis). Par ailleurs, les aptitudes des souches européennes deP. fumoso-roseus montrent que cette espèce présente des potentialités pour la lutte biologique contre divers noctuides.

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Summary Bioassays were carried out on 1st instar larvae to determine the relative susceptibility of 4 noctuid species,Mamestra brassicae L.,Spodoptera littoralis Boisduval,Spodoptera exigua Smith andScotia ipsilon Hübner to 10Paecilomyces fumoso-roseus, 6Nomuraea rileyi, 1Metarhizium anisopliae and 1Beauveria bassiana isolates. Neonate larvae, 2 to 16 h old, were exposed for 24 h to leaf pieces treated with conidial suspensions of each fungal strain and then transferred to untreated foliage at 25±1°C. When tested at 3×10⁵ conidia/cm², pathogenic activity of hyphomycetes towards noctuids showed high variability depending on both host-species and fungal isolate.M. brassicae was more susceptible to tested isolates than the other 3 noctuids. In contrast,S. littoralis was the most resistant species. The most active pathotypes had LT 50 values ranging from 2 to 3,5 days at the concentration of 3×10⁵ conidia/cm² and LD 50 values ranging from 10³ to 10⁴ conidia/cm² (mortality recorded at 6 days post exposure). According to these data, there were 5P. fumoso-roseus isolates (nos 13, 32, 39, 40 and 45) highly active againstM. brassicae, oneN. rileyi isolate (n^o 5) againstS. littoralis, oneP. fumoso-roseus isolate (n^o 32) againstS. frugiperda and oneM. anisopliae isolate (n^o 139) againstS. ipsilon. Bioassays establishing the high virulence of the FloridaN. rileyi isolate (n^o 5) to the Egyptian cottonworm and its pathogenic activity against the other tested noctuids, confirmed the interest for this fungal entomopathogen which has been demonstrated on noctuid populations in the southeastern United States. Moreover results of the host range assays of European isolates ofP. fumoso-roseus showed that this species appears to be an other potentially valuable microbial control agent against noctuid pests.

     

Caractères taxinomiques et spécificité dans le genreAsplanchna (Rotifère)

A comparative analysis of eight characters in two clones ofA. brightwelli and a clone ofA. intermedia, fed withParamecium orBrachionus, is made to determine the intraclonal, interclonal and interspecific variations in this complex of species.The trophi morphology appears the most species specific criterium whereas the other features (size of males, diameter and ornamentation of resting eggs, nuclear number in syncytial glands) show variability, either genetic or related to environmental conditions. The variation observed in the ornamentation of resting eggs and in the nuclear number of vitellogen was distributed along a continuous gradient.

     

Effet des androgènes sur l’activité sportive

Androgenic hormones seem to be of beneficial effects on sports performance:

- they increase motivation, will, aggressiveness, resistance to the stress and to the fatigue, leading to an increase of the training quantity,

- they increase bone mineralization and probably mechanical resistance,

- they stimulate the bone marrow and so, with the erythropoietin, the erythropoiesis,

- they increase the tendancy to hyperglycemia, but with a decrease of the tolerance to the glucose,

- they stimulate the fatty acids mobilization from the adipose tissue, for their utilization in the muscle during the exercise,

- they participate, for the trained sportmen, to a better gestion of the muscle glycogen storage: their utilization during exercise is decreased,

- they increase the lean body mass, with an increase of the protein synthesis and a decrease of the protein catabolism, leading also to an increase of the muscle force under training. There is no beneficial effect upon the tendons,

- they have an immunomodulation action.

     

Impuissance sexuelle iatrogène et responsabilité médicale

Medical responsibility means that the Doctor must assume his acts. It enables not only to repair prejudices met but also discourage prejudiciable acts to society by sanctioning them. Its founding is based on the principle of error, of the damage caused and the establishing of a cause link between error and damage. The authors report a clinical case observed during a medical expertise of an iatrogenic accident (priapism) secondary to the treatment of a psychogenic impotence with papaverine injection in intracavernous. It’s a 27 year old patient, single, teacher, without pathological antecedents, who, after a psycho-affective shock (break with his girl-friend), showed a diminished sewal desire and erectile power. These complaints led him to consult an urologist, who prescribed a hormonal check-up and a medical treatment based on Yohimbine^* for two weeks. Seeing no improvement of his state, he consulted another urologist who gave him an intracavernous Papaverine chlorydrate injection (40 mg). The immediate main consequen?s were a priapism necessitating a surgical intervention (caverno-spongious anastomosis), practised one day after the injection. Following the intervention, the patient complains of a persistant impoten?, which led him to sue his Doctor for a professional error having led to a permanent sexual prejudice. The error retained against the Doctor consists in a bad control of his patient, which led to delay in taking the latter in charge, a classical complication resulting from the treatment prescribed. Because of the existence of an error, a damage caused and a cause link, the responsibility of the Doctor is in question. From this case, the authors insist on the necessity of a psychologic evaluation prior to every medicinal treatment of a psychogenic impotence.     

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.     

Sexualité des patients après traitements anti-cancéreux-nécessité d'une prévention

Sex and cancer, pleasure and death are words very difficult and painful to associate and to evoke. The sexuality of patients with cancerous diseases is unrecognized by physicians and very little present in the practice of sexology. the sexual life of cancerous patients must be preserved. The preventions must have aims, means and time. The aims are: to allow, to keep, to find or to rediscover a sexual and relational life. The means are:

? systematic information on the clinical reality and his results,

? directed information on the sexual reality and his capacities,

? thinked information on the sense and the value of the sexuality and of the pleasure.

The time is before, during and after the treatment for cancer. The prevention is also sexological treatments if sexuals symptoms occur.     

Reproductibilité interobservateur d'un tympanomètre portatif,le MicroTymp.

OBJECTIVE: To determine the interobserver reliability of tympanograms obtained with the MicroTymp, a portable tympanometer. SETTING: Family medicine teaching unit in a tertiary care hospital. PATIENTS: Thirty-three patients who presented to the ear, nose and throat clinic in August 1990 for an ear problem. INTERVENTION: Three residents in family medicine independently attempted to record with the MicroTymp one tympanogram for the 66 ears. We excluded the results for seven ears for which tympanograms could not be obtained. MAIN OUTCOME MEASURE: Using objective criteria, two family physicians and two residents in family medicine independently classified the 177 tympanograms into five categories (normal, possible effusion, possible perforation, possible tympano-ossicular dysfunction and unclassifiable). Reliability was estimated by means of the kappa (kappa) coefficient on 161 tympanograms from 59 ears for which the interpretation of the three tympanograms agreed. MAIN RESULTS: The interpretation of the three tympanograms agreed for 34 of the 59 ears (0.58) (kappa = 0.52, 95% confidence limits 0.45 and 0.59). There was no significant difference in interobserver reliability between pairs of observers or between symptomatic and asymptomatic ears. CONCLUSIONS: The interobserver reliability of the MicroTymp is moderate. The tympanograms obtained with the instrument should be interpreted in the context of the clinical findings.     

Toxicité du champignon entomopathogèneCordyceps militaris pour des larves de culicides

Différents métabolites excrétés lors de la croissancein vitro deCordyceps militaris (L.)Link ont un effet toxique marqué sur les larves deCulex pipiens et d'Aedes atropalpus mais plus faible sur celles d'A. aegypti. Ces produits toxiques partiellement thermostables entraînent, suivant leur concentration, la mortalité d'une population entière deC. pipiens pipiens et d'A. atropalpus tandis qu'une proportion élevée deC. pipiens pipiens et d'A. atropalpus tandis qu'une proportion élevée des larves d'A. aegypti semble résistante à leur action. Nous pensons pouvoir utiliser ces résultats dans la recherche d'un synergisme entre ces métabolites toxiques et d'autres microorganismes ou insecticides dans un programme de lutte intégrée contre les larves de moustiques.     

Variabilité de la sensibilité despodoptera littoralis [Lep.: Noctuidae] a l'hyphomycete entomopathogèneNomuraea rileyi

Résumé La variabilité de la sensibilité des larves de la noctuelle égyptienne du coton,Spodoptera littoralis Boisduval à l'hyphomycète entomopathogèneNomuraea rileyi (Farlow) Samson a été abordée en étudiant la variabilité interclonale du champignon et la variabilité de l'insecte-h?te à travers des populations d'origines géographiques différentes. En raison de la polyphagie de l'espèce-cible, l'influence de la plante-h?te sur la sensibilité des larves phytophages a aussi été prise en compte. Les traitements ont consisté à exposer les larves à un inoculum sporal déposé par pulvérisation sur des rondelles de feuille calibrées pendant 24 h. L'activité pathogène, à l'égard des larves du 1^er stade, des 12 clones monosporaux de la soucheN. rileyi 5 varie significativement (TL50 compris entre 4,7 et 6,2 j à la dose de 3.10⁴ spores/cm²). Cette variabilité intraspécifique observée à un moment donné est néanmoins du même ordre que la variabilité de l'activité de la souche-mère polyclonale, relevée sur une période de 4 ans (TL50 compris entre 4,5 et 6,6 j). Les 3 populations originaires d'Isra?l, d'Egypte et du Maroc ont présenté une sensibilité comparable àN. rileyi 5 après contamination des larves nouveau-nées avec des doses croissantes d'inoculum (DL50 comprises entre 0,7.10⁴ et 1,1.10⁴ spores/cm² et TL50 compris entre 5,1 et 5,5 j à la dose de 3.10⁴ spores/cm²). L'alimentation des larves, depuis l'éclosion, sur 4 espèces végétales: chou, coton, féverole ou aubergine, n'a pas modifié significativement la sensibilité des larves du 3^e stade (DL50 comprises entre 0,3.10³ et 0,7.10³ spores/cm² et TL50 compris entre 4,0 et 4,3 j à la dose de 3.10⁴ spores/cm²). La souche polyclonaleN. rileyi 5 para?t bien adaptée à la noctuelle égyptienne du coton en raison de sa stabilité, de son agressivité à l'égard des populations d'origines géographiques différentes et de l'absence d'effet de l'alimentation des larves sur l'infection.      

La découverte de l'anaphylaxie: dix-neuf jours après une note anodine de toxicologie,il est montré que l'immunité peut être pathogène

While studying the toxicology of various coelenteres fishing filament poisons, Charles Richet and Paul Portier observed cases of rapid death which had no correlation with the injected doses. In dogs, death only occurred in those which, more than 15 days beforehand, had withstood well an injection more concentrated or identical to the later fatal one. The authors created the neologism ‘anaphylaxis’ which signifies ‘non-protection’. Thus, it appeared that an immune response could be pathological. This discovery opened the subject area of immunopathology at a period of time when, in contrast, vaccination and serotherapy researches were prominent.     

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).     

L’évolution chez les Phyllocerataceae,la variabilité des paramètres dimensionnels et relatifs. Variabilité de la complexité de la ligne cloisonnaire: Variabilité et paedomorphose

Evolution of the Phyllocerataceae, the variability of the dimensional and relative parameters. Variability of the complexity of the suture line. Variability and paedomorphosis. A recent study has shown the importance of heterochronies in the development of Phyllocerataceae. It was attractive to estimate with precision the variability of some morphological characters of the shell and of the suture line in order to study how this variability changed in the course of time (from Jurassic to terminal Cretaceous). This note gives the averages of the calculations of variability in dimensional and relative variables in the shell of Phylloceratidae and variability in the complexity C of their suture lines. Coefficient of variation V is the statistical parameter used here, because it allows the comparison between the dispersions of different populations. This study shows that the variability of the complexity in the suture line and h₁ + h₂ is more fluctuating among the taxa (usually subfamilies, genera and species) in which heterochrony is evident. On the other hand, the variability of other parameters (V₁, V₂, D) first grows and then slowly decreases till the branch or the lineage is extinct. This schema is mostly acceptable down to the Lower Cretaceous-Upper Cretaceous in the Tethys and in the marine shelf of Gondwana. In the family of Neophylloceratidae, very clearly in the Tethys, less clearly in marine shelf of Gondwana (it is less obvious in the genus Phyllopachyceras), the variability grows as far as the terminal Cretaceous. The extinction of this family may result from a catastrophic event and not from internal causes. In short, the decrease of variability comes before the extinction of the taxa and consequently it agrees with a Darwinian classic schema. On the other hand, the extinction of Neophylloceratidae that occurs when the variability is maximal probably takes place in another perspective, an external « catastrophic » event. To cite this article, B. Joly, C.R. Palevol 2 (2003).