Fertilité et aneuploïdies spermatiques après traitement par radiothérapie et/ou chimiothérapie pour cancer du testicule ou lymphome

Improvements in cancer therapy have considerably modified patient survival rates over recent years. However, the side effects of these treatments especially the effects on fertility, must be taken into account. Anticancer therapy can transiently inhibit spermatogenesis. Factors such as pretreatment semen parameters and the type of chemotherapy or radiotherapy may influence recovery of spermatogenesis, but it is still impossible to predict the probability of and time to recovery for each patient. Sperm banking remains the only way to prevent the effects of cancer treatment on male fertility. Another possible effect of chemotherapy or radiotherapy is genetic damage to germ cells. For instance, chromosomal abnormalities in viable sperm produced by these patients after recovery of spermatogenesis may result in fetal death or congenital abnormalities in their offspring. It has been fairly well documented that, during the first three months after treatment, DNA breaks and abnormal chromosomal segregation induced by chemotherapy/radiotherapy lead to structural and numerical chromosomal abnormalities in spermatozoa, respectively. However, the long-term effects on genetic sperm content have not been clearly established. The results of published studies are contradictory and are based on limited numbers of patients (maximum of 6). We present the preliminary results of a retrospective study concerning patients treated for testicular cancer or lymphoma between 1995 and 2000. Fluorescence in situ hybridization (FISH) analysis of chromosomes X, Y and 18 was performed on sperm collected one to five years after treatment and compared to the data obtained for non-affected fertile men. For four out of 13 patients, we found a significantly increased frequency of aneuploidy rates (mainly XY disomy and diploidy), and these results did not appear to be correlated with sperm count, sperm morphology or post-treatment duration. In conclusion, increased sperm aneuploidy rates appear to only concern a small number of patients, to varying degrees and without any predictive factors. According to published data and our preliminary results, we recommend waiting at least two years before starting ART (Assisted Reproduction Therapy) for patients treated for testicular cancer or lymphoma. Moreover, FISH analysis could be helpful to choose between ART with post-treatment sperm or cryopreserved sperm.     

Données nouvelles sur le spectre d'hôtes et le parasitisme du nématode entomophageNeoaplectana carpocapsae

Résumé Des essais réalisés au laboratoire en conditions standards et destinés à compléter la connaissance du spectre d'h?tes deNeoaplectana carpocapsae Weiser ont été effectués à Antibes, en Guadeloupe et à Madagascar. 128 espèces d'insectes appartenant aux ordres des Odonates, Dictyoptères, Isoptères, Phasmoptères, Orthoptères, Planipennes, Lépidoptères, Diptères, Coléoptères, Hyménoptères, Homoptères, Hėtéroptères, ont été étudiées ainsi que quelques autres arthropodes (diplopodes et acariens). Les rėsultats ont confirmé le fait que la gamme d'h?tes potentiels deN. carpocapsae est très large malgré quelques cas de résistance chez les Diptères essentiellement. La rapidité d'action deN. carpocapsae, sa capacité à se multiplier dans l'h?te, ainsi que certaines de ses exigences écologiques en vue de son utilisation pratique, ont été examinées.

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Summary Laboratory tests under controlled conditions were carried out in Antibes, Guadeloupe and Madagascar, to investigate the host range ofNeoaplectana carpocapsae Weiser. 128 insect species including members of Odonata, Dictyoptera, Isoptera, Phasmida, Orthoptera, Planipennia, Lepidoptera, Diptera, Coleoptera, Hymenoptera, Homoptera, Heteroptera and a few other arthropods, were tested. Results confirmed that the potential host range ofN. carpocapsae is very broad in spite of some cases of resistance, mainly in Diptera. The effectiveness rapidity of the nematode, its ability to multiply in the host and some other of its ecological requirements for practical use, were also studied.

     

Cancer et Hérédité

Sans résumé     

Psychothérapie des cas difficiles. Perspectives phénoménologiques

The author provides a brief overview of clinical anthropology. To achieve better understanding of clinical anthropology, it is very important to grasp its close relationship with the development of phenomenology, most notably existential analysis. This paper mainly references L. Binswanger, S. Freud, V. von Weizsäcker and J. Schotte, arguing that the anthropological perspective is up to date in the psychotherapy of difficult cases. Four fields of application and a clinical case of a psychotic patient’s replacement of medications by psychotherapy after 30 years of use show how the anthropological perspective can create a new way of looking at pathology, help achieve a better relationship with the patient and revitalise the representation of what we call a clinical fact.