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.     

Efficacité de la mémoire associative inhérente à la potentiation post-tétanique

An associative memory is modeled in networks of cells that are assumed to have the short-term plasticity of the neuromuscular junction of the frog. The data relating synaptic transmission efficiency and stimulation frequency for post-tetanic potentiation of the neuromuscular junction are represented by polynomial expansions. Simulation of storage and retrieval demonstrates that functional associative memory is feasible based on this particular synaptic plasticity. Retrieval reaches a maximum efficiency at a delay of three minutes after storage and is lost after about 9 min. The signal to noise ratio of the retrieved pattern drops steadily as additional associations are stored in memory but retrieval appears to be possible with up to four stored associations. Although the data are derived from synapses not normally proposed as a basis for memory functions, the results here will generalize to other synaptic junctions located more centrally that have similar characteristics. This simulation technique allows the efficiency of associative memory based on various types of synaptic plasticity to be evaluated.     

Le vécu de la sexualité chez les paraplégiques

In spinal cord injury, sexual reactions have a common dimension with ablebodied mankind, but also particular features corresponding to particular neurological syndromes. The third dimension which has to be taken into account is the singular one, every man, paraplegic or able-bodied, being unique. When the level of the lesion is above T10, genito-sexual responses to stimulations have a reflex functioning. In such cases, erotic tricks must be used to complete psycho-physiological reactions. On the contrary, technical devices are ill-tolerated both by the paraplegic man and by his spouse. Incomplete lesions in T12-L1 have to psychogenic responses to stimulations, i.e. partial erection and/or semen emission due to the neurophysiological mecanisms of desire. In the complete lesions of the conus medullaris or of the cauda equina, men become impotent and can no longer produce semen. In such cases, technical devices and drugs directly injected in the corpus cavernosum are technically efficacious but psychologically ill-tolerated. Facing his new sexual responses, the paraplegic man and his spouse have to adjuste themselves to the new circumstances. The way of adjustment is similar to a mourning process. One has to pay attention to let every paraplegic live every period of adjustment on his own, and at the same time one must be present to help him and answer his questioning.     

Évaluation de la faisabilité de la tomoscintigraphie myocardique précoce au sestamibi synchronisée à l’électrocardiogramme

BackgroundOur aim was to assess the feasibility of early acquisition (10 min) gated single photon emission computed tomography (SPECT) by comparison to conventional imaging at one hour.Methods and resultsOne hundred and four patients referred for exercise test and SPECT were included. Sequential imaging was started 10 min (SPECT 10) and 60 min (SPECT 60) after injection of the radiotracer (Tc-99m sestamibi). Stress myocardial perfusion was visually analyzed from 10 to 60 min stress by two experienced nuclear-cardiologists. Six patients were further excluded, because of high digestive accumulation: one patient at 10 min, three at 10 and 60 min, two at rest. The participants were classified as follows: group G1 (normal SPECT 10 and 60, n = 53), group G2 (abnormal SPECT 10 and/or SPECT 60, n = 45). The left ventricle ejection fraction (EF) and volumes (end-systolic and end-diastolic volumes, ESV, EDV) were calculated with the Cedars-Sinai program.ResultsQuality imaging was the same at SPECT 10 min and SPECT 60 min. Perfusion scores: G1 10 min = 0,4 versus G1 60 min = 0,4 (p = NS); G2 10 min = 10,2 versus G2 60 min = 10,1 (p = NS); EFG1 10 min = 71 ± 11% versus EFG1 60 min = 68 ± 10% (p = 4E-04); EFG2 10 min = 56 ± 15% versus EFG2 60 min = 53 ± 15% (p = 0,002); EDV G1 10 min = 72 ± 20 ml versus EDV G1 60 min = 76 ± 19 (p = 0,002); EDV G2 10 min = 98 ± 46 ml versus EDV G2 60 min = 105 ± 38 (p = 0,08); ESVG1 10 min = 22 ± 12 m versus ESV G1 60 min = 25 ± 12 (p = 9E-04); ESVG2 10 min = 47 ± 35 ml versus ESV G2 60 min = 53 ± 36 (p = 3E-04).ConclusionsThis study suggests that early gated Sestamibi SPECT after stress provides same perfusion analysis than classical late imaging.     

Joseph-Pierre Pétrequin (1809–1876): chirurgien, anatomiste, historien de la médecine, fondateur de la Faculté médicale lyonnaise et son procédé chirurgical original pour la cure de la gangrène de la verge

Pétrequin was an outstanding anatomist, surgeon, medical historian, and founder of the Lyon School of Medicine. This article describes his scientific contribution with particular emphasis on his original surgical procedure for the treatment of penile gangrene.     

Influence de la température sur la cinétique,de croissance et le coefficient de maintenance de Candida lipolytica cultivé sur n-alcane

The effect of growth temperature on the evolution of kinetic parameters and yields was determined for Candida lipolytica cultures with ntetradecane as substrate, in a temperature range of 18°C to 30°C, which is below the critical growth temperature in order to work only in the activation zone of these parameters.In such a culture limited by substrate transfer, growth rate depends on biological rates, related to microorganisms characteristics, and diffusional rates, related to mass transfer. The effect of temperature thus depends on the limiting step. The activation energy, calculated from exponential growth rate determinations is .When the activation energy is calculated from the maximal rate of cell production (determined at the growth curve's inflexion point), it's found to be E _X=71,200 J/mole in the 18°C–24°C range, and E _X=28,000 J/mole in the 24°C–30°C range. The latter one is characteristic of a diffusion-limited process. Above 24°C, growth is controlled by substrate-transfer, as physiological potentialities are preferentially increased with temperature than diffusional ones: 24°C is thus the transition temperature T _t from physiological to diffusional limitation.The apparent yield is almost constant, over the 18°C to 30°C temperature range, although maintenance coefficients are very dependent on temperature. The activation energies related to maintenance coefficients for alkane and oxygen respectively are and .The m _s/m_{O 2} ratio is about 3 (g/g), whereas that, for a strict oxidation reaction of n-tetradecane ought to be 3.47 (g/g). A satisfactory correlation, relating maintenance coefficients to the maximal growth rate of yeast, is given.

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Liste des symboles A constante de saturation de modèle de croissance(1) - B vitesse spécifique considérée - C substrat carboné ou oxygène (g/l) - E energie d'activation (J/mole) - S _m quantité de substrat consommée par maintenance au cours d'une fermentation discontinue (g) - O₂ quantité d'oxygène transférée au milieu de culture (g/l) - R rendement global de la fermentation - R rendement global de la fermentation - constante des gaz parfaits (J/mole K) - S concentration en substrat carboné (g/l) - T température de croissance (°K) - X concentration en biomasse (g/l) - Y rendement limite - m coefficient de maintenance (h^-1) - t duree de fermentation (h) - tømpérature de croissance (^o Celsius) - taux de croissance (h^-1) Indices 1 relatif à la température 1. - 2 relatif à la température 2 - c relatif au substrat carboné ou à l'oxygène - f relatif au temps final - i relatif au point d'inflexion - m maximum - mO₂ relatif au coefficient de maintenance sur l'oxygène - m _s relatif au coefficient de maintenance sur le substrat carboné - o relatif au temps initial - O₂ relatif à l'oxygène - s relatif au substrat carboné - t de transition - T relatif à la température de croissance T - U _m relatif au taux de croissance maximal - X relatif à la productivité maximale en biomasse     

Alcaloïdes de Zanthoxylum decaryi: la decarine,nouvel alcaloide dérivé de la benzophénanthridine

Four alkaloids have been isolated from the stem bark of Zatithoxylum decaryi. Three are known, dictamnine skimmianine, 4-methoxy-1- methyl-2-quinolone. The fourth decarine is new; its structure has been established as 9-methoxy-10-hydroxy-2,3-methylenedioxybenzophenanthridine.¹