Conséquences de la chimiothérapie anticancéreuse sur la fertilité de la femme

Sterility is a potential toxic effect of chemotherapy. This risk is well established for alkylating agents, but is less clearly defined for anthracyclines, methotrexate and fluorouracil and poorly defined for alkaloids, platinum, etoposide and taxanes. The main predictive factors for ovarian toxicity are the additive effect of cytotoxic drugs, the cumulative dose of each drug and the patient’s age. This effect of chemotherapy is evaluated on menstrual cycles, hormonal assays and the number of pregnancies observed in patient cohorts. Chemotherapy induces destruction of oocytes and granulosa cells. In mice, it has been shown that adriamycin may induce oocyte apoptosis, which can be prevented by modulation of cycle cell signalling (dysregulation of Bax gene or, on the contrary, expression of its antagonist gene Bcl-2 or inhibition of apoptosis with sphingosine-1-phosphate or caspase inhibitors). Clinical data in the literature are usually based on retrospective studies and are somewhat confused: global fertility after MOPP chemotherapy for Hodgkin’s disease is about 20%, adjuvant chemotherapy with CMF, F(A)C or TAC for breast cancer induces amenorrhea in 50% to 70% of cases, PVB or BEP chemotherapy for ovarian germ cell tumors has little effect on fertility when the uterus and one ovary can be preserved, and the majority of women treated with methotrexate, actinomycin D or various combinations for persistent trophoblastic disease remain fertile. Preservation of fertility is a major goal for cancer patients receiving chemotherapy: in vitro fertilization could preserve the couple’s fertility, but is usually not feasible as it would delay initiation of chemotherapy until after stimulation of ovulation; oocyte or ovarian tissue cryopreservation is at the stage of research; oral contraceptives have not been demonstrated to be effective to preserve ovarian function; gonadotropin releasing hormone (GnRH) agonists prevent cyclophosphamide toxicity in rat and monkey ovaries, and a few pilot clinical studies suggest that chemotherapy-induced amenorrhea could be prevented by administration of GnRH analogues simultaneously to chemotherapy, but randomised studies are necessary.     

Étude de la variabilité de la clairance hépatique de la mébrofénine-99mTc en scintigraphie hépatobiliaire

AimThe purpose of this study was to investigate some of the parameters likely to influence mebrofenin-^99mTc hepatic clearance calculation and inter-and intra-observers reproducibility.Materials and methodsHepatic clearance (%/min m²) of 30 scintigraphies was calculated from the values of hepatic, cardiac, and total activities, according to the method recommended in the literature. We studied: 1) impact of injection–acquisition delay variations; 2) acquisition type: anterior face only (FA) or geometric mean (GM); 3) clearances calculated according to four different body surface area (BSA) formulas; 4) intra-and inter-observers reproducibility for three observers (two evaluations for each observer).Results1) Clearance differences between different studied intervals were statistically significant, more important if the studied interval was far from reference interval (150–350 secondes) and even more when the interval studied was too early (110–310 secondes). 2) There was a statistically significant difference between clearance calculated using either FA or GM datasets (0.85 %/min m²). 3) There were small but statistically significant differences for four of the clearance comparisons using different BSA formulas. 4) Despite differences in size of cardiac and hepatic regions of interest (ROI), intra-observer reproducibility of hepatic clearance was excellent for each observer. Inter-observers reproducibility was also excellent (r = 0.982).ConclusionHepatic clearance of mebrofenin-^99mTc appears to be a highly reproducible method provided that acquisition and clearance calculation are standardized. It provides additionnal functional information to morphological and biological data usually performed before major hepatectomy. Thereby, the definition of a standardized protocol would enable realization of multicentric studies.     

A propos de l'intervention des aéroions dans les processus de régulation de la lipémie et de la cholestérolémie

Resume Les expériences ont porté sur des lapins repartis en deux groupes parallèles — un groupe étant traité avec des aéroions négatifs en concentrations moderées (n^– = 10 – 40.000; n⁺ = 1.000) et l'autre sans aéroionothérapie (témoins). Par rapport aux animaux témoins (pas exposés aux aéroions),on a enregistré,sous l'influence de l'aéroionothérapie, que: (1)il y a une tendence de normalisation de la motilité spontanée, deprimée par une alimentation contenant un excès de cholestérol(0,3 g/kg/jour); (2) la lipémie et la cholestérolémie sont restées à un niveau plus bas chez les animaux alimentés au cholestérol; (3) la lipémie et la cholestérolémie, de même que l'iode thyroïdien, sont restées aux valeurs voisines de celles normales,chez les animaux nourris avec un excès (20 mg/kg/jour), de substances antithyroïdiennes naturelles (provenant du chou).

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Groups of rabbits were exposed to negative air ions of moderate concentrations (n^– = 10 – 40,000; n⁺ = 1,000) while others served as controls. (1) When rabbits were fed a cholesterol-rich diet (0.3 g/kg/day)causing reduction of motility in the control animals, their motility was normalized under air ion treatment. (2) The blood cholesterol and lipid levels of rabbits on a cholesterol-rich diet were lower with air ion treatment than in controls.(3) When rabbits were fed a diet with thyroid blocking agents from cabbage the blood cholesterol and lipid levels and the thyroid iodine content remained unchanged with air ion treatment.

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Zusammenfassung Gruppen Kaninchen wurden mit negativen Luftionen in mässigen Konzentrationen (n^– = 100 000 – 40 000; n⁺ = 1 000) behandelt, während andere als Kontrollen dienten. (1) Die durch Fütterung von cholesterinreicher Diät (0,3 g/kg/Tag) verminderte Motilität der Tiere wurde unter der Luftionenbehandlung normalisiert. (2) Der durch Fütterung von cholesterinreicher Diät erhöhte Blutcholesterin- und-fettspiegel fiel durch Luftionenbehandlung ab. (3) Der durch Fütterung von strumipriven Substanzen aus Kohl erhöhte Cholesterin- und Fettspiegel im Blut und verminderte Jodgehalt der Schilddrüse wurde durch Luftionenbehandlung nicht beeinflusst.

     

Quelques considérations sur l'enseignement de la médecine physique et de la réhabilitation

Particularly since World War II physical medicine and rehabilitation have assumed a growing importance. The efforts of the Canadian Association of Physical Medicine and Rehabilitation, following a survey of Canadian universities, to increase the theoretical and practical teaching of physiatrics are emphasized. It is considered important that the teaching of physical medicine and rehabilitation should be carried out concurrently with other medical and surgical teaching programs. Paramedical and auxiliary rehabilitation personnel should participate in the teaching program. The number of hours devoted to physiatrics should be increased, and the medical student should be permitted to choose physical medicine and rehabilitation as a part of his internship program.     

Effets de la radiothérapie sur la fonction testiculaire de l'adulte

Radiation therapy plays a major role in the curative management of numerous neoplasms, such as Hodgkin's disease or testicular cancer. However, the adverse effects of low-dose radiation scattered to radiosensitive normal tissues adjacent to the radiation fields, such as the testes, have been recognized. Experimental studies performed on healthy volunteers showed that no lesion was detectable on sperm counts or testicular biopsies after single doses of less than 10 cGy. Oligospermia has been reported after 15 cGy and 100 cGy result in a 90% incidence of azoospermia. In the radiotherapy of cancer, fractionated regimens are used to increase the differential effect between normal and tumoral tissues. For the same dose, a fractionated radiation regimen results in a higher incidence and a longer period of azoospermia than a single dose irradiation. Fractionated doses of >50 cGy result in a 100% incidence of azoospermia. For doses up to 200 cGy, recovery occurs but normal sperm production remains uncertain. Although the recovery time can be very long (more than 10 years), there is a risk of definitive azoospermia after doses of >200 cGy. Spermatogonia are the most radio-sensitive cell type and their depletion after small irradiation doses explain the effect of radiotherapy on fertility. Clinical hypogonadism is very unfrequent in usual practice, what seems to prove a relative radio-resistance of the Leydig cells. However, functionals studies show that there is a rise in serum LH with increasing dose to the testes. A decrease in testosterone levels has been reported after high testicular doses.     

Principes de la lecture critique de la littérature médicale: Illustration urologique

There has been an enormous expansion in scientific literature, especially in the area of health and medicine. At the same time the complexity of the research has increased. Through the reading of medical literature of his field of interest, the physician is in search of useful information. However, reading medical papers is very time consuming and most physicians, for their usual literature review, content themselves with the titles and the abstracts. Moreover, quality and relevancy of the publications vary greatly and the reader must be able to “separate the wheat from the chaff”. Thus the reading of literature needs selection and evaluation. As a result, physicians require critical appraisal skills. The principle of appraisal of medical literature is to assess the value of publications which will influence the medical practice of the reader. The reader has a double objective: to assess the credibility of the publications, and to define the applicability of the publication information. By following eight steps the reader is able to quickly rule out from his reading what is not valid and have an objective look at the quality of the results which are proposed to him. These eight steps comprise the assessment of the study objectives, the study design, the study factor(s), the outcome factor(s), the study population and sample, the confounding factor(s) and bias, the results with their statistical and clinical significance and the power of the study, and, lastly, the synthesis of the reader's judgment. The last word belongs to the clinician facing his patient.     

Vue d'ensemble sur la végétation de la turquie

Sans résuméReçu par la rédaction le 15.XI.1953.     

Étude de la cohorte nord-finlandaise de 1966: facteurs prédictifs et conséquences de la schizophrénie

Subtle motor, emotional, cognitive and behavioural abnormalities are often present in apparently healthy children and adolescents who later develop schizophrenia. This suggests that some aspects of causation are established long before psychosis becomes manifest. We aim to assess the factors contributing to the development of schizophrenia focusing mainly on genetic factors, pregnancy and delivery complications, early development and scholastic performance, as well as later educational, social and health consequences. This is done by reviewing the Northern Finland 1966 Birth Cohort, its scientific activities, publications and work in progress.     

Fonctions histoenzymatiques lors de l'évolution et de la lutéolyse du corps jaune de la lapine

Résumé Trente cinq enzymes sont recherchées lors de l'étude comparative de la lutéinisation et la lutéolyse. Vingt six sont histochimiquement décelables dans les corps jaunes gestatifs leur permettant de stocker et métaboliser glucides, corps gras, nucléotides, amines, phosphates, sulfates et d'autres métabolites. Les activités importantes des enzymes de la voie des pentoses, des diaphorases et de la stéroïde 3 ol DH témoigneraient d'une stéroïdogenèse active. Les cellules lutéiniques thécales semblent histoenzymatiquement mieux pourvues au début de la luteinisation; les cellules lutéiniques granuleuses le sont pendant les stades ultérieurs.La lutéolyse est marquée par une diminution de la plupart des activités enzymatiques. Les activités tant qu'elles existent, sont topographiquement limitées (ilôts actifs extra lutéaux) et surtout métaboliquement restreintes. L'équipement enzymatique des structures lutéales très involuées suggère plutôt qu'une stéroïdogenèse même résiduelle des processus typiques et une activité des éléments conjonctifs (fibrillogenèse).

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Histoenzymatic functions of the evolution and the luteolysis of the corpus luteum of the rabbit

Summary 35 enzymes were investigated in the course of a comparative study on the luteinisation and luteolysis. 26 of them were found in the corpora lutea during gestation. They were able as a consequence to stock and the metabolize glucides, lipides, nucleotides, amines, phosphates, sulphates as well as other metabolites. The strong activities of the pentose shunt's enzymes, of the tetrazolium reductases and ⁵ 3 OH-steroide DH indicated most probably an active steroidogenesis. The theca-luteinic cells appeared having a stronger histoenzymatic activity in the beginning of the luteinisation; the granuloso-luteinic cells showed a stronger activity in the later stades.The luteolysis is characterized by a decrease of the activity of the preponderant number of the enzymes mainly in the degenerated luteal cells. The enzymes activities as far as such existed were topographically limited (active extraluteal islands) and restricted mainly in their metabolizing possibilities. The author's results suggested as more probable the existence of a process of lysis and an activity of the connective tissue elements (fibrillogenesis) than a steroidogenesis, even though in a residual or terminal form.

     

Influence comparée de l'(±)-acide abscissique,de la coumarine,de l'acide p-coumarique et de certains de leurs dérivés sur la croissance de la première feuille de blé

Summary The activities of (±)-abscisic acid and a number of compounds derived from p-coumaric acid and coumarin and their interaction with gibberellic acid in the control of the elongation of the first wheat leaf are examined. (±)-Abscisic acid strongly inhibits leaf growth in the presence as well as in the absence of gibberellic acid, but the inhibition is greater in the presence of gibberellic acid (3 g/l already have an observable effect). Among other compounds, only ferulic acid and coumarin significantly reduce leaf elongation, and they are effective only at high concentrations (1.44 · 10^-4 M/l).     

Domaine de la biologie théorique

Summary In order to delimit the field of theoretical biology, the author distinguishes in empirical biology a substructure and a superstructure. Empirical biology cannot be constituted without a minimum of reference to philosophical ideas such as the principle of identity (substructure); having regard to its objective, which is explanation by means of physico-chemical models, it does not easily avoid ontological aspirations. Further, experimental research makes great use of scientific theories. Finally, the elaboration of the empirical data of biology may find its fulfilment in an ontological science, philosophical biology, which is a branch of the philosophy of nature. Philosophical biology, superstructure of experimental biology, is a discipline intermediate between the special sciences of life, defined in an empirical sense, and metaphysics.

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Zusammenfassung Um den Bereich der theoretischen Biologie abzugrenzen, unterscheidet der Autor in der positiven Biologie eine “Infrastruktur” und eine “Suprastruktur”. Die positive Biologie kann nicht ohne ein Minimum von Beziehungen zu den philosophischen Begriffen aufgebaut werden, wie z.B. zu dem Prinzip der Identit?t (Infrastruktur); ihrem Ziele nach betrachtet, welches in der Erkl?rung durch physiko-chemische Grundbegriffe besteht, kann sie sich nicht gut den ontologischen Ansprüchen entziehen. Darüber hinaus bedient sich die experimentelle Forschung weitgehend der wissenschaftlichen Theorien. Zum Schluss kann die Bearbeitung der empirischen Erkenntnisse in der Biologie ihre Vollendung in einer ontologischen Wissenschaft, die philosophische Biologie, welche ein Zweig der Philosophie der Natur ist, finden. Die philosophische Biologie, die der experimentellen übergeordnet ist, steht als Disziplin zwischen den besonderen Wissenschaften vom Leben, verstanden im empirischen Sinne, und der Metaphysik.