Fragments d’anthropologie clinique en action

The human condition means that both humaneness and inhumanity dwell in human beings, along with light and shadow, madness and reason. This ‘holistic’ conception of human life, which is based on the notion of drive, is under relentless threat from objectifying, psychiatric reductionism. Such impoverishment of the psyche is evident in neuroscience, sociologism and economism; the psyche is the locus of fragility, which constitutes the human condition and flows from the precarious balance between shadow and light in every person’s life. Psychiatry draws on the tendency of today’s society to eradicate evil, or at least make it invisible. This results in a world of hypertransparency, where negativity is obscured. Hence, life is deprived of destiny, of its tragic dimension, and of transcendence; it is under general anaesthesia, with no apparent suffering or pain. An anthropoclinical approach, which views human beings in their totality, offers an alternative to psychiatry’s objectification of the psyche. It goes beyond the alliance of the therapeutic and scientific and is driven by the ethical concern of a genuinely anthropological and clinical approach that allows meeting the Other in an existential union.     

L’anthropologie clinique au carrefour des psychothérapies

Individualism, which characterises modern, democratic society, impacts the social bond and the institutions that protect it. Psychotherapy reflects this change in the social context through the ever-increasing fragmentation of its theories and methods. Within the context of the resulting division of therapeutic approach, the tendency for technical specialisation and mutual dismissal among the various schools sometimes overshadows the very object of psychotherapy, namely, suffering human beings. The future of humane psychotherapy, therefore, requires therapists to increase their awareness of the scope and limits of the approach they pledge allegiance to, relative to other schools. Therapists must epistemologically clarify the implicit presuppositions of the theories and methods they adopt and emotionally distance themselves from their theoretical school. Phenomenology-inspired clinical anthropology provides essential tools to meet this goal.     

Application de l’imagerie moléculaire par fluorescence à la clinique

Fluorescence probes and imaging methods have been extensively developed in microscopy to visualize biological pathways, cell trafficking and intracellular interactions, which are the main targets of molecular imaging. The translation of these methods from microscopy to preclinical and clinical applications requires to image through large thickness of live biological tissues, and to ensure the non-toxicity of the probes. We hereafter list the main issues that must be addressed to translate fluorescence techniques to clinic, and we present the main envisioned solutions. As first realistic clinical application, we present work in progress on intraoperative fluorescence guided surgery.     

Syndrome de Klinefelter et AMP à l’aube de l’an 2000

Material and Methods

The patient is a 33 year old male, with a 47, XXY karyotype (cytogenetical investigation of 16 metaphases). Semen analysis revealed a severe oligozoospermia. (spermatozoa ?1×106/mL) and asthenozoospermia (60% of decreased motiliy), for an ejaculate volume of 1.8mL. Three-colourIn Situ Hybridization was performed on spermatozoa recovered from his cryopreserved semen, in order to simultaneously detect the chromosome X, Y and one with specific appropriate probes. Semen from two 23 year old men were also analyzed as controls.

Results

502 spermatozoa were analyzed from the patient and about 10,000 from the controls. There was an increase of about ten times of the percentage of hyperhaploïd (24XY) spermatozoa in the semen of the Klinefelter patient compared to the controls.

Discussion and conlustion

In a general view of IVF-ICSI practice in Klinefelter patients, we also discuss here several practical points such as (i) is there any morphological criteria which may prevent from injecting an aneuploid spermatozoa, (ii) is the risk of aneuploidy higher when using testicular spermatozoa than when using ejaculated spermatozoa, (iii) what do we know about the offspring obtained by IVF-ICSI in Klinefelter patients and (iv) when should prenatal and/or preimplantatory genetical diagnosisbe proposed in this particular context.     

Le test post coïtal à l’heure de l’AMP

The recent development of assisted reproductive technologies has greatly modified treatment and evaluation of infertility. In view of the high pregnancy rates obtained, the value of conventional diagnostic tests, especially the post-coital test, has become controversial. Apart from differences in terms of standardization, the confusion concerning the diagnostic and prognostic value is largely due to the interpretation and the purpose of the test. According to the World Health Organization guidelines, the post-coital test remains a reliable tool for the diagnosis of cervical infertility and sperm dysfunction, which is a possible cause of unexplained infertility. Over the last two cases, most other conventional tests have become inoperative and the results of the post-coital test may indicate the need for further investigations and may positively influence the treatment strategy.     

La cognition dans le trouble obsessionnel compulsif : à l’intersection de la clinique et de la neuro-imagerie

The investigation of neural activity in OCD (Obsessive Compulsive Disorder) has allowed to link obsessive compulsive symptoms and cortico-striatal dysfunction. In the present article, we try to show the significance of cognition in an integrative physiopathologic model of OCD. Clinically, patients are unable to inhibit irrelevant thoughts or actions. In a cognitive way, decision making, planification or organisation are impaired. Those impairments are related to an executive deficit, which depends on frontal structures. Finally, we present a current study which tries to identify executive deficit functions related to cerebral dysfunction in patients presenting different OCD features (washing, checking, hoarding).     

De l’origine des anthropoïdes à l’émergence de la famille humaine

The human lineage has a very ancient origin, as most of the mammals. Its oldest representatives, anthropoid primates, have been described from Asia some 45 million years ago. During this long evolutionary story, two critical stages have appeared as especially important, their beginning in Asia and the emergence of hominids in Africa, some seven million years ago. These two stages are discussed hereby with new data relative to their Asian origins and their dispersal into Africa between 45 and 40 million years ago. Following this dispersal event, these primates evolved in Africa and gave rise to the early hominids. These appeared around seven million years ago and have three distinct representatives. Among them, Toumaï appears as the oldest and the closest to our ancestry, a point that is evidenced here.     

Quand l’évolution parle à la biologie fondamentale

Like many results in comparative anatomy, the works on bone histology led by Armand de Ricqlès have found their whole sense within the framework of the theory of evolution. It seems to be the same thing in genomics and molecular biology. However, some examples show that the fluidity of genomes is not realized by the same processes in eukaryotes and in prokaryotes. In the first taxon, transposons play a fundamental role, since in the other case horizontal gene transfers are essential. These dynamics seem to be necessary for understanding the bases of genomic evolution both from fundamental and applied points of view.     

Plastie pénoscrotale pour volumineux éléphantiasis des organes génitaux externes : à propos d’un cas à la clinique universitaire d’urologie-andrologie de Cotonou

Although historically an area of lymphatic filariasis endemic, repercussions from this disease are becoming rarer in Benin. We are reporting on an extreme case of penoscrotal elephantiasis, treated at the Urology-Andrology University Clinic in Cotonou. Penoscrotal plastic surgery was performed through the reduction in volume and reconstruction of the scrotum using two lateral flaps. Results after a follow-up at six months are satisfactory.     

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.     

Les symptômes de premier rang de la schizophrénie: de la clinique à l’approche expérimentale

Theoretical models about action monitoring and action attribution developed over the last ten years have given a new framework in the understanding of first-rank symptoms of schizophrenia, as described by Kurt Schneider. Impaired action attribution has been demonstrated in patients with first-rank symptoms. Moreover, positron emission tomography studies have revealed that the cortical network involved in action attribution processes in normal subjects is not correctly activated in patients with first-rank symptoms. These results demonstrate that these symptoms are related to cognitive and cerebral correlates and they shed new light on the understanding of psychotic symptoms.     

Anomalies de position des testicules dans l’enfance: conséquences à l’âge adulte

Non descended testes in the low scrotum is a common anomaly at birth, with about 4% of the newborn males affected. Only one quarter of these newborn babies will still have non descended testes when one year old. However, the testes that will descend within the first year of life seem no more to be considered as normally descended testes. Moreover, the retractile testis, which represents a secondary anomaly of testicular position occuring after the babies are older than one year, is no more to be regarded as a physiological variant of the normally descended testis, since several reports indicate histological and clinical modifications in such cases. The testicular non descent can be associated with two consequences in adult life. Firstly, an history of non descended testis is the only known risk factor for the testicular cancer. Secondly, such an history is a risk factor for the male fertility because of spermatogenesis alterations, as indicated by qualitative and quantitative histological analyses of the testicular tissue, and by depressed spermatozoa output and quality (motility, normal forms); moreover, testicular volumes are reduced, and the time to pregnancy as well as the rate of infertility are increased. Time is arrived for a reappraisal of the consequences in adult life of the abnormal testicular location (either congenital or acquired) during childhood.     

Les aptamères : du concept à l’outil

Aptamers are oligonucleotides, generally DNA or RNA but occasionnally chemically modified nucleic acids, which are identified within randomly synthesized libraries containing up to 10¹⁵ different candidates. They are obtained following a process of in vitro selection termed systematic evolution of ligands by exponantial enrichment (SELEX) that makes use of iterative steps of selection and amplification. Aptamers were successfully raised against a wide range of targets: amino acids, antibiotics, dyes, peptides, proteins, nucleic acids, intact viruses or live cells. They generally display high affinity (Kd in the nanomolar range or lower are frequent for proteins) and high specificity. They are easily obtained by chemical synthesis and can be converted in tools of interest for diagnostic purposes, by conjugation to various pendant groups. They rival antibodies and can be used in vivo in human beings.     

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.     

De la « théorie sexuelle » à l’anthropopsychiatrie

The creation of scientific psychiatry, which was modelled after the medical classification of diseases, was brought into question by the tenets of Sigmund Freud’s theory of psychoanalysis. We draw on Leopold Szondi’s method of developing an analytically inspired psychiatry in our effort to interpret Freud’s work from an anthropological perspective, removing psychiatry from the naturalistic medical model and giving it a genuinely human bearing. Szondi’s drive system ranges from the analysis of constitution (as in the animal biomedical model) to the analysis of destiny (as in Schicksalsanalyse). Within this system, the human is considered a driven being, existing in a psychological dimension from the outset, outside animal, sexual instincts. This distinction between mankind and animals accounts for the specificities of mental disorders and illnesses and paves the way to a purely anthropological psychiatry we can call cultural psychiatry. In this kind of psychiatry, any pathology is considered inherent in the destiny of a human being, a part of a person’s development. Its analysis, called pathoanalysis, deals with the human suffering at the heart of mankind’s place in the world.     

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.     

Azoospermias au Sénégal: quelle prise en charge à l’heure de l’ICSI?

Objective

to determine the place of azoospermia among the various causes of infertility in Senegal.

Material and methods

141 cases of azoospermia were identified from a series of 492 infertile patients. The clinical profile, laboratory results and outcome after management were studied.

Results

The mean age was 40.6 years. Testicular atrophy was detected in 34.75% of cases. Azoospermia was secretory in 71.69% of cases. A varicocele was associated in 56% of cases. Varicocele repair was performed in 32.62% and allowed an improvement of sperm parameters in 28.3% of cases. Testicular biopsy, performed in 53 cases, demonstrated 2 cases of Sertoli cell syndrome, 3 cases of arrested maturation, 8 cases of hypo spermatogenesis, and 25 cases of seminiferous tubules. Forty nine cases of azoospermia were associated with normal FSH levels. Only one patient was treated by assisted reproductive technologies (ART).     

Comment l’externalisation remodèle l’industrie de l’instrumentation

On estime que le marché global de l’externalisation des dispositifs médicaux et de l’instrumentation représente actuellement plus de 6 milliards d’euros. D’après les cadres dirigeants de l’industrie, cette tendance devrait non seulement se poursuivre, mais aussi s’amplifier dans les années à venir.