Bilan scintigraphique osseux d’une hypercondylie unilatérale

A 10-year-old girl with unilateral condylar hyperplasia was referred to our department for a bone scan. We describe the role of the bone scan in this condition. Unilateral condylar hyperplasia is a rare disease of the mandibular condyle cartilage growth leading to facial deformity. Bone scan demonstrates the active or inactive nature of condylar hyperplasia and orients therapy. A planar bone scan completed by single-photon emission computed tomography (SPECT) combined with CT was performed. Increased uptake of the left mandibular condyle, particularly well demonstrated on SPECT images, was seen. This was confirmed by relative quantification and helped decision making to surgical treatment.     

La consultation psychologique dans l’indication d’une prothèse pénienne : une expérience originale de complémentarité médicopsychologique

In the Center for the Study and Treatment of Male Sexual Dysfunction (CETISM) of our University Department of Urology, a psychological consultation is systematically provided when penile prosthesis implantation is considered by the patient ?? and the urologist ?? as a possible solution to his erectile dysfunction. This consultation has three key objectives: to identify ?? rare ?? cases of psychological contraindication, to complete the information already given to the patient during urologic consultations, and to explore the relational, emotional, cognitive and erotic aspects that could influence the decision-making and the integration of the prosthetic solution. It is also and especially to give to the man a central position, an active position, not only for the decision-making, but also for developing a life project which takes into account the decision (positive or negative), a position he often lost from the time he had become ??powerless??.     

La spécificité de l’auto-analyse freudienne: un expérimentalisme sans laboratoire

WithThe Interpretation of Dreams, Freud introduced his readers into the psychoanalytic technique. Freud’s strategy was a reaction to the difficulties produced by the establishment of laboratories of hypnosis, difficulties due to the resistance of patients and to the large diffusion of suggestion in everyday life. The possibility of resistance enables subjects to take an active role. This led to a change of the former configuration of experimental hypnotism where the subjects had to be deceived. In contrast to the doctors of the hypnosis movement, Freud abandoned the project of constructing a laboratory of hypnosis and elaborated reading and writing practices instead. Early psychoanalysis thus develops in the form of an “experimentalism without a laboratory”, a specific articulation of dreaming, reading and writing.     

Myiase préputiale: à propos d’une observation

We report a case of preputial myiasis in a child who presented with painful penile swelling suggestive of balanoposthitis. Treatment consisted of manual extraction of the worm followed by circumcision. Parasitologic study of the worm revealed a stage-three larva of Cordylobia anthropophaga. Through this case report and a review of the literature, we discuss the epidemiologic, diagnostic and therapeutic features of this disease.     

Spectrométrie de masse au laboratoire d’analyses: validation de méthode. Bilan de 15 mois d’utilisation

Prospective study recently published and carried out at the Clermont-Ferrand Teaching Hospital, has demonstrated the utility of S100 β protein determination in serum, for the management of children with mild traumatic brain injury (mTBI). Determination of S100 β concentrations, with a 100% NPV test (negative predictive value) along with the clinical evaluation, could in the future avoid unnecessary irradiation and hospitalization, in order to optimize management of children with mTBI in pediatric emergency departments. For people with serious traumatic brain injury, another study carried out at the same Teaching Hospital, has shown that relatively high levels of S100 β when determined in the jugular vein, could be a sign of bad prognosis.     

Développement d’un dispositif expérimental ultrasonore pour le largage ciblé et contrôlé d’une chimiothérapie encapsulée

Applying ultrasound on drug-loaded sonosensitive liposomes offers new possibilities for treating cancer. In vitro experiments were performed in the present study to define an index of inertial cavitation which could be used to monitor the delivery of drugs. This index could also be used to assess the sonosensitivity of new formulations of liposomes. Experiments were then carried out in rats bearing subcutaneous abdominal tumors. Based on pharmacokinetic and biodistribution studies, a period of 48 hours was chosen between the injection of the liposomes and the exposure to ultrasound. At the injected doses, liposomes slowed down significantly the tumor development. Ultrasound combined with liposomes seemed to contribute to the tumor control. However, the important efficacy of liposomes alone and the eventual weak interactions with ultrasound prevent to guarantee that the effect of ultrasound is significant.     

Apports de l’acquisition TDM couplée à la scintigraphie pulmonaire dans l’exploration d’une suspicion d’embolie pulmonaire

Pulmonary embolism is a frequent disease difficult to diagnose because of heterogeneous clinical presentation. Pulmonary embolism diagnosis requires additional examinations, which are guided by clinical probability scores. The ventilation/perfusion scintigraphy is a validated technic in pulmonary embolism diagnosis strategies, which represents one of its most important indications. In the past years, the technique of scintigraphy evolved with the appearance of hybrid cameras, allowing the realization of tomoscintigraphy coupled with computerised tomodensitometry (CT). One of the major interests of this technique is the possibility of considering alternative diagnosis in case of negative result of scintigraphy. The purpose of this article is to offer nuclear medicine physicians a review of the alternative diagnoses that can be found during pulmonary ventilation/perfusion tomoscintigraphy according to the underlying scintigraphic and morphological abnormalities. In this review, we will first on diseases responsible for: a mismatch (pathological perfusion and normal ventilation), an inverted mismatch (normal perfusion and pathological ventilation) and for associated disorders in ventilation and in perfusion patterns (identically abnormal perfusion and ventilation). The final part will address some specific CT features that can be encountered on a low dose CT centered on thorax.     

L’intersubjectif et l’intrasubjectif dans l’expérience de souffrance. Un regard psychanalytique

Psychoanalysis characterises subjectivity as a notion based on the “plurality of psychologically troubled persons”, revealed, for instance, in dreams. The author takes a closer look at a number of Freud’s dream analyses and argues that, in working with the dream, subjects often eject one of their psychologically troubled persons (often the “suffering child”) out of themselves, projecting the person into the Other. As a result, an intersubjective space is created, which is required to receive the divisions originating from the intrasubjective space. Freud’s 1895 Project, however, goes farther: the evacuation of the “disparate part” of the child to the Other grants access to logical and rational judgement, guaranteeing a child’s psychological life a fictional stability (the “Thing” or the “ego”). Freud adds that this process is possible if a Nebenmensch — or “fellow creature” — is present and has the quality of a “helping person” capable of receiving the child’s suffering cry. These two lines of thought, together, help clarify the intersubjective position underlying the analytical work: a tentative encounter between the patient’s distress and the analyst’s presence. Free-floating attention will enable the analyst to receive and hear this distress and ease the patient’s recovery of his or her intrasubjective space.     

L’entretien psychologique systématique pour les couples optant pour l’IAD: huit ans d’expérience clinique dans une législation prévoyant la levée de l’anonymat du donneur

A law on medically assisted procreation was implemented in Switzerland in 2001. This law is subordinate to the well-being of the child and stipulates that only married couples can benefit from donor insemination (DI). Furthermore, a child who was conceived with donor sperm may obtain access to information including the identity of the donor on reaching adulthood, at age 18. The law also specifies that psychological assistance must be offered before, during, and after treatment. For the past 12 years, the Unit of Reproductive Medicine and the Center of Medically Assisted Procreation in Lausanne employ a concept of psychological assistance adjusted to each couple’s needs, called “ressource counselling”. In preparation for DI, specific questions are examined, such as “Should the child be informed about the donor insemination, should others be informed, if so, how and when?” These questions may also be discussed in a group setting specific for couples concerned with DI. Our experience shows that systematic counselling helps couples in finding their own path through the delicate subjects of secrecy, attachment, and the rights of a child to be informed of his/her genetic links.     

Ectopie testiculaire croisée: à propos d’un cas

Crossed testicular ectopia, also called transverse testicular ectopia, is an uncommon congenital anomaly in which both testes migrate through a single inguinal canal toward the same hemiscrotum. More than 100 cases have been reported in the literature. This rare syndrome is commonly associated with abnormalities of genitourinary development, especially inguinal hernia and defective Müllerian regression. A conservative approach is recommended, now performed via laparoscopy. Long-term follow-up is required for assessment of fertility and early detection of testicular malignancy. The authors report a new case of crossed testicular ectopia in a 4-year-old boy who presented with right inguinal hernia and impalpable left testis.     

L’ectopie testiculaire pénienne: à propos d’un cas

Penile ectopic testis is a rare congenital abnormality. The aetiopathogenesis is still not well known.We report a case in a two-years-old child. The diagnosis was easy and required no exploration. The orchidopexy in dartos after lowering the testis was easy due to the sufficient length of the spermatic cord. Three years later, the lowered testis appeared normal. We review the other forms of penile ectopic testis reported in the literature and those requiring further exploration.