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.     

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.     

Biogéographie et spéciation des Odonates de l’île de la Réunion

Du fait de l’histoire géologique des Mascareignes et des trajectoires cycloniques dans le sud-ouest de l’océan Indien, l’affinité de la faune odonatologique de la Réunion est essentiellement mauricienne. L’étude de la distribution des Odonates en fonction des différents écosystèmes aquatiques de l’île montre que: 1. Les espèces indigènes ayant une vaste répartition géographique se rencontrent essentiellement dans les écosystèmes ouverts de basse et moyenne altitude (de 0 à 800 m d’altitude). Ces écosystèmes peuvent héberger jusqu’à 13 espèces et possèdent les plus fortes densités odonatologiques. 2. La faune odonatologique de la Réunion se distingue de celle des autres îles de la sous-région malgache par la présence de deux espèces continentales cantonnées à des altitudes supérieures à 1000 m. 3. Les espèces endémiques fréquentent surtout les écosystèmes forestiers. Ces écosystèmes ne présentent au plus que cinq espèces de la faune odonatologique de l’île. En définitive, il apparaît donc que la spéciation des Odonates à la Réunion ne se fait pas dans les écosystèmes diversifiés comportant des espèces à large répartition géographique, mais dans un ensemble d’écosystèmes marginaux à faible diversité odonatologique.     

Contrôle neurologique de l’éjaculation

The brain control of the genital tract and sexual behaviour remains poorly understood. Clinical results and basic research indicate that the neural control of ejaculation depends on three levels of organization. The first level consists of peripheral autonomic and somatic nerves. Leaving the spinal cord, these nerves control the motility, secretions and blood supply of the genital tract, and contractions of perineal striated muscles. Their path in the abdominal cavity and the effects of their neuro-transmitters on peripheral tissues have been established. These nerves also convey sensory information from the genital tract to the spinal cord. The second level is represented by the spinal cord. The thoracolumbar (sympathetic), and sacral (parasympathetic and pudendal) segments of the cord contain the somata of autonomic and somatic motoneurons, whose axons run in the above nerves. These motoneurons are part of a spinal network that likely organizes the activity of the whole genital tract in a given context such as copulation. The role of the different spinal cord segments in the control of ejaculation is mainly inferred from observations of the deleterious effects of spinal cord injury in human patients. A small population of galaninergic positive neurons has recently been identified in the lumbar segments of the rat spinal cord that plays a major role in ejaculation (Truitt and Coolen, 2003). Selective lesion of this population abolishes in copula ejaculations, but spares erection. Finally, the third level of organization is represented by supraspinal nervous structures. The spinal cord receives direct excitatory and inhibitory information from the brainstem, pons and hypothalamus. In turn, these structures receive sensory information from the genital tract. However, their role in the control of ejaculation remains poorly investigated. Again, it is mainly inferred from the observation of the deleterious effects of pharmacological treatments on brain neurotransmission. Positron emission tomography has recently been used to observe brain areas whose activity is enhanced during ejaculation in humans (Holstege et al., 2003). In this study, several areas of the right side of the cortex and the cerebellum were activated. The targets of future clinical and basic research include: the neural basis of the required coordination between spinal autonomic and somatic nuclei that innervate the genital tract, the role of sensory information from the genital tract in the recruitment and coordination of spinal and supraspinal nuclei, and finally the integration of descending excitatory and inhibitory influences onto the spinal cord. Both the organization during development and the activation at puberty of the spinal neural network that controls the genital tract are dependent on androgens. Future research should identify the regulatory factors that, in response to the action of androgens, provide neurons with the possibility of building their connexions and selecting their neurotransmitters and receptors.     

Le Paléolithique supérieur de la région centre de l’île de Honshû

Tokai area is situated in the middle of Japan and has various configurations of ground. The eastern area has thick natural layers with volcanic ash which has been supplied from Mt. Fuji. About five chronological stages of Paleolithic culture from trapeze and edge-ground axe culture to microlith culture through backed blade culture have been found in the layers. These stages of Paleolithic culture are indicators of chronological studies in Tokai area. On the other hand, it is difficult to advance chronological studies in the middle east, middle, and west areas, because they have little thickness of layers with volcanic ash. However, different Paleolithic artifacts are found in top and bottom layers which put the AT layer between at Tsubakibora Site in Gifu Prefecture, and they have helped very much chronological studies of Paleolithic culture in the west area. Here is the first result of Paleolithic studies in Tokai area with artifacts which have been found on the forth layer of scoriae at Idemaruyama Site are dated about 35,000 years, one of the oldest Paleolithic culture in Japan. In addition, some lines of pits which were dated 30,000 years were found at Hatsunegahara Site, and they provided valuable data to study Paleolithic hunting. Finally, a holed pendant which had 10 notches on one side was unearthed from Fujiishi Site, and it was dated 19,000 years ago. At Terada and Hino Site, a flat big stone which had carvings was found, though the shape and use were seemed to be different from the pendant at Fujiishi Site.     

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.     

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.     

Impact de l’imagerie hybride TEMP/TDM dans le diagnostic et la prise en charge de l’ostéome ostéoïde

IntroductionThe osteoid osteoma is a major bone benign tumors in children. It is more common in boys. The femoral and tibial locations account for 50% of cases. Clinically, it is revealed by nocturnal pain relieved by aspirin. The pain may precede by several months the radiographic abnormality. The purpose of our work is to elucidate the contribution of SPECT/CT in addition to the planar bone scintigraphy in the diagnosis and treatment of osteoid osteoma about two cases.Case reportClinical case No. 1: a 10-year-old child who presented a limp nocturnal pain in the left hip evolving for 4 months. The radiograph of the pelvis showed bone condensation subtrochanteric left femur. SPECT/CT showed an image for an osteoid osteoma. Surgical resection of the home revealed in the histological study an osteoid osteoma of the left femoral neck. The evolution was marked by an immediate pain relief and full recovery of the left lower limb mobility. Clinical case No. 2: an 11-year-old child who had a limp nocturnal pain at the upper end of the left femur evolving for 2 months. The pain was paroxysmal, relieved by salicylates. The X-ray of the pelvis showed a metaphyseal image with peripheral condensation and thickening of the cortex. SPECT/CT showed an image for an osteoid osteoma. The intervention was a tumor excision resection. Histopathological examination revealed a small nidus consistent with an osteoid osteoma. The evolution was marked by an immediate pain relief and normalization of the mobility of the left lower limb.DiscussionThe SPECT/CT can increase the sensitivity and specificity of planar bone scintigraphy. It confirms the location of osteoid osteoma and defines its anatomical relationships in order to optimize surgical management.ConclusionThe SPECT/CT contributes significantly to the diagnosis of osteoid osteoma when radiological images are atypical or unusual clinical expression.     

Application de la technique de PCR en temps réel à l’étude de l’ADN ancien

Real-time Polymerase Chain Reaction (PCR) for the study of ancient DNA. The properties of ancient DNA (aDNA) make difficult the retrieval of DNA sequence. The advantage of Real-Time PCR was exploited, for the first time, in the study of aDNA. We determined the optimal condition to amplify, in one round of PCR, aDNA, which should be directly sequenced. Beside the verification of aDNA authenticity, we compared two cleaning bone methods: scalpel and ethanol. The ethanol specimens showed the best DNA yield. The aDNA was extracted and amplified (mitochondrial hypervariable region I) from five skeletons exhumed from the archaeological site of Notre-Dame-du-Bourg (France), dated from 3rd to 17th century. To cite this article: R. Kefi et al., C. R. Palevol 2 (2003) 125–132.     

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.     

Développementin vitro de la lignée germinale foetale mâle chez le rat, la souris et l’homme

The key role of the foetal germ cell line in the reproductive capacity of the adult has been known for a long time. More recently, the observed increase in male reproductive disorders such as the decline of sperm count and quality and the increased incidence of testicular cancer has been postulated to be due to alterations of foetal and neonatal testicular development in response to increasing environmental pollution. However, few tools are available to study foetal and neonatal germ cell line development and the effects of physiological or toxic substances on this process. The authors have developed an organ culture system in which foetal or neonatal testis is grown on a filter floating on a synthetic medium free of serum, hormones or biological factors. This study, using rats and mice, first compared the long-term morphological and functional development of Sertoli and germ cells in thisin vivo system. In rats, these cells developed normally over a period of two weeksin vitro. Fewer cells were produced thanin vivo, but a similar level of differentiated function was observed. Germ cells, which are difficult to maintainin vitro, resumed mitosis after a quiescent period, at the same time asin vivo. Similar results were obtained with mouse fetuses, but this model was less efficient. This culture model can be used to study post-natal development of the germ cell lineage in testes derived from foetuses on the last day of foetal life and invalidated for P63, that do not survive after birth. This gene was found to be involved in the regulation of germ apoptosis which resumes after birth in the mouse. Lastly, this model applied to the human species (from 6 to 12 weeks of gestation) showed that testicular architecture and germ cells can be maintained for 4 days with better efficiency at younger stages than at older stages. p]In conclusion, testicular architecture and intercellular communications are sufficiently preserved to sustain gametogenesisin vitro with no added factors. This method is potentially useful to study the effects of various factors, particularly xenobiotics.     

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.      

Stratégies biologiques à l’heure de l’Assistance Médicale à la Procréation chez le blessé médullaire

Most men with spinal cord injury (SCI) men have fertility problems caused by anejaculation and decreased fertility of the ejaculate. There are two main causes for the impaired reproductive potential in SCI men: ejaculatory dysfunction and poor quality semen. However, current treatment techniques allow a large number of SCI males to achieve ejaculation (rectal electro-stimulation, penile vibrator stimulation). Firstly, masturbation and/or penile vibrator are used at home allowing the couple to perform insemination themselves. The semen of men with spinal cord injuries has commonly been characterised by small volume, abnormal count (low or high), decreased sperm mobility, increased formation of reactive oxygen species, sperm autoimmunity, necrospermia. This impairment is thought to be due to insufficient drainage, genitourinary infections and raised scrotal temperature. Testicular biopsy reveals varying degrees of tubule degeneration and decreased spermatogenetic activity. Semen could be used for various assisted reproductive technologies such as intrauterine insemination,in vitro fertilisation (IVF) and microinsemination (ICSI). The literature reports pregnancy rates by intrauterine insemination of about 15 to 20% per couple. Clinical pregnancy rates after IVF and ICSI techniques are 30% per cycle and these results are comparable to the clinical pregnancy rates when these techniques are performed for female infertility. However, semen must be frozen as soon as possible after the injury and the patient must be informed about the various available assisted reproductive technologies.     

Analyse de l’algorithme décisionnel basé sur la testostérone totale et recommandé pour le diagnostic de l’hypogonadisme acquis

Introduction

The diagnosis of acquired hypogonadism is still an important issue for laboratory medicine. Hypogonadism is defined as a sustained decrease of total testosterone confirmed by the biochemistry laboratory and total testosterone measurement is proposed as the initial step in the investigation of hypogonadism. If TT is over 12 nmol/l, the probability of hypogonadism is considered low and it is suggested that patients be referred to others methods of investigation. Only a small percentage of men aged 50 and over are treated for hypogonadism. Seventy percent of men investigated for hypogonadism have a TT of over 12 nmol/l and there is an unpredictable increase of SHBG during this period, reducing the bioavailability of circulating testosterone. The hypothalamic-pituitary gonadal axis is modified with age and contributes to hypogonadism. The efficacy of biochemical investigation of hypogonadism needs to be reassessed.

Materials and methods

Total testosterone and LH were measured on the Centaur immunoanalyser (Siemens) and SHBG was analysed on the Immulite 2000 (Siemens). Bioavailable testosterone was calculated using the formula provided by ISSAM.

Results

Using the algorithm based on TT, only 27.9% of men would have been investigated for hypogonadism. Of the 638 patients considered as normal, 325 showed an index of hypothalamic-pituitary gonadal axis stimulation and possible hypogonadism, revealed by an elevated LH. In these patients with TT superior to 12 nmol/l and a LH superior to 7 UI/l, SHBG level was at the upper limit of or over the reference range. No correlation was observed between calculated BT and the abnormal LH level found in these patients. Calculated BT was not considered a good marker of hypogonadism for these patients.

Conclusion

Elevated LH is a biochemical marker of hypogonadism and should be interpreted in the context of stimulation of the hypothalamic-pituitary gonadal axis. Based on our data, an initial step in the investigation of hypogonadism based only on TT does not seem suitable for the identification of all patients who might experience hypogonadism. A complete investigation should be offered to all patients with clinical evidence of hypogonadism whatever their TT level. In patients who might benefit from hormonal treatment, calculated BT should be interpreted with caution. A definition of hypogonadism based on TT does not seem appropriate and a new definition based on bioavailable testosterone and the hypothalamopituitary gonadal axis should be considered.     

Testostérone et contrôle central de l’érection

Testosterone orchestrates the perinatal organization and activation of cerebral and spinal neuronal structures involved in the expression of male sexual behaviour in adults. The present review briefly describes testosterone effects in the regulation of sexual motivation and erection, as well as the genetic models developed to date in order to unravel its central mechanisms of action.     

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.     

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.