Over staphylotoxine en -toxoïd

Samenvatting Er wordt een beschrijving gegeven van de bereiding en de standaardisatie van staphylococcen-toxoïd, zooals die door het Rijks Instituut voor de Volksgezondheid geschieden.Voorts worden, aan de hand van proeven, enkele opmerkingen gemaakt over het wezen van de immuniteit tegen besmetting met staphylococcen.     

Chirurgie de l’hyperparathyroïdie primaire en 2008

In recent years, different minimally invasive techniques of parathyroidectomy have been described. The concept of these limited explorations is based on the fact that 85% of patients will have a single-gland disease. Minimally invasive techniques are targeted on one specific parathyroid gland and in most cases the exploration of other glands is not performed. These interventions are today possible for three main reasons: the available imaging techniques permit to localize the diseased gland, the use of rapid intraoperative PTH assay can confirm the successful extirpation, new instrumentation and miniaturized cameras have been adapted for this kind of surgery. Not all patients presenting with primary hyperparathyroidism are candidate for this surgery. Contraindications are mainly due to a large goiter, previous surgery in the parathyroid vicinity, suspicious multiglandular disease and equivocal preoperative localization studies. Currently 60% of patients with primary hyperparathyroidism can benefit of these techniques. Studies comparing conventional parathyroid surgery to minimally-invasive techniques have shown a diminution of postoperative pain and better cosmetic results with minimally-invasive techniques. If early results are similar to those obtained with conventional parathyroidectomies, it is still too soon to evaluate what will be the recurrence rate of these new techniques. One can expect that minimally invasive and conventional parathyroid surgery will probably turn out to be complementary in the near future.     

Validation clinique du module Oncoflash® en scintigraphie planaire thyroïdienne

IntroductionThe Oncoflash® adaptive filtering algorithm is poorly validated in clinical practice. The objective of this study was to evaluate this algorithm efficacity in order to reduce injected activity or acquisition time on thyroid scintigraphy.MethodsOne hundred and five patients who received a thyroid scan have been tested. Three sets of images (conventional acquisition, gross half-time acquisition, post-processed half-time acquisition by Oncoflash®) were interpreted as open ultrasound and biological data without any view on their medical file and the patient's identity by 2 nuclear doctors. The concordance with the diagnosis retained in the medical file, the quality of the images and the inter-observer reproducibility were evaluated.ResultsNo significant differences were found in terms of agreement with the final diagnosis between post-processed Oncoflash® half-time images and conventional images (κ at 0.81 and 0.74 respectively). The quality of Oncoflash® half-time images was rated good or excellent in 90% of cases compared to 88.6% of cases for conventional acquisitions (P = 0.16). No significant difference in inter-observer agreement was found between the 3 sets of images compared two by two.ConclusionThese results suggest the possibility of using the Oncoflash® module in thyroid scintigraphy to reduce acquisition time or injected activity without impacting interpretation.     

Hyperparasitisme facultatif de parasitoïdes en cours de développement par les femelles des ectoparasitoïdes Eupelmus vuilleti et Eupelmus orientalis Craw

In a community of three ectoparasitoids, Dinarmus basalis, Eupelmus vuilleti and E. orientalis, the host Callosobruchus maculatus parasitised 48 h before by D. basalis, is accepted by E. vuilleti females after they have eliminated the eggs and neonatal larvae of D. basalis. This ovicidal and larvicidal behaviour enables E. vuilleti to develop on C. maculatus instead of D. basalis. E. vuilleti females are able to parasitise the L5 larval stage and the pupa of D. basalis: their larvae therefore feed at the expense of the developing parasitoid. This trophic level is that of hyperparasitism. However, E. vuilleti females rarely practise hyperparasitism on their own L5 larvae and on those of E. orientalis. This behaviour reveals a high behavioural plasticity enabled by intra- and interspecific recognition of parasitoids used as hosts. Hyperparasitism activity in E. orientalis females is higher than that in E. vuilleti females since they hyperparasitise host parasitoids more frequently without preferential species choice. However, E. vuilleti seems to be free from competitive pressure with E. orientalis, as the former penetrates deeply into a grain store contaminated with C. maculatus in contrast to E. orientalis females, which remain on the surface from where they escaped.     

Quelle valeur attribuer à l’analyse morphologique des spermatozoïdes en microscopie optique?

The value of sperm morphology to predict the sperm fertilizing capacity is a subject of ongoing debate. However, it is clear that sperm morphological examination is essential to determine sperm quality as part of the assessment of male or couple infertility. Moreover, application of a new high-power magnification method, which allows the choice of spermatozoa with a preferred nuclear morphology, is positively correlated with a dramatic increase in IVF-IMSI pregnancy rates. Several detailed classification systems of sperm abnormalities have been proposed over the last fifty years and each revision of these classifications introduces stricter criteria. Three of these classifications are generally used as reference classifications: the Kruger/Tygerberg classification and the David classification, carefully revised by Auger and Eustache to ensure quality assurance in reproduction biology. However, the results of sperm analyses are very heterogeneous in terms of the overall percentage of morphological abnormalities and the respective frequencies of the various abnormalities. This examination must therefore be performed very carefully based on strictly defined criteria for the assessment of each abnormality with harmonization of these criteria between the various observers in the same laboratory and between laboratories. Various studies have examined the impact of isolated teratozoospermia on the results of IVF and ICSI, but once again with sometimes contradictory results. However, most studies show that the percentage of morphologically normal sperm is positively correlated with the results of ICSI, and many authors agree that a percentage of morphologically normal sperm less than 5% is predictive of low fertilization and pregnancy rates in IVF and ICSI. Over the last ten years, it has been shown that aneuploidy rates in the semen of populations of infertile men with moderate or severe oligospermia were higher than those in fertile men with normal sperm counts, and that sperm disomy rates were about 20-fold higher in ICSI than in IVF. However, the results of these various studies fail to demonstrate an obvious link between polymorphic teratozoospermia and the frequency of disomy and aneuploidy in sperm. Consequently, light microscopy sperm morphological examination, at the magnifications generally used for sperm counts (x 2000), is therefore not a good indicator of chromosomal abnormalities in human semen, except in the rare cases of monomorphic abnormalities. However, this is not the case for the link between sperm morphology and apoptosis, as a growing number of studies establish a positive correlation between male infertility and the presence of apoptotic markers on spermatozoa, and morphological parameters appear to be closely correlated with apoptosis. Finally, standardization of examination procedures and reporting of the results of sperm morphological examination is absolutely essential.     

Variation de l'angle sphénoïdal du crâne humain en fonction du vieillissement

The degree of the cranial base flexion is a major parameter in the study of the evolution of verbal communication in mankind. The variability of this area among modern humans has received little attention. In the present study, a sample of 330 modern human skulls have been used to characterize the changes in the angle of the cranial base flexion with age, and its possible relationships with gender and ethnic origin. Statistical analysis of the results show significant changes with age. Two conclusions emerged: i) the debate regarding Neandertal speech should also consider the effect of age on the cranial base; and ii) the sphenoidal angle can be used as an ageing criterion in forensic and anthropological studies.     

Les spermatozoïdes immobiles frais ou décongelés en fécondation assistée

Contrasting with sperm count or morphology, complete lack of mobile sperm may seriously impair ICSI fertilization and pergnancy rate. In three cases with flagellar skeleton abnormalities [dynein arm absence] only immobile sperm were found in the ejaculate. Following repeated ejaculations, higher rates of viable spermatozoa and even some motile spermatozoa could be found. Some times, in nonobstructive azoospermia, extensive sperm search didn't allow us to find but immobile sperm mostly, with very few motile sperm cells, not enough for the microinjection of all oocytes. The third group of immobile sperm is iatrogenic, following freezing and thawing surgically retrieved, testicular or epididymal spermatozoa in order to avoid repeated surgical retrieval. Following thawing, one find frequently very few motile spermatozoa that may be not enough for all retrieved oocytes and it might be necessary to inject some eggs with immobile spermatozoa. The outcome of ICSI using mobile and immobile sperm was compared in the three above mentioned groups: 1-immobile ejaculated sperm with flagellar defects, 2-immobile sperm discovered in the ejaculate after extensive sperm search and 3- immobile frozen-thawed testicular or epididymal spermatozoa. The results of ICSI in these groups show that fertilizing ability of fresh or frozenthawed immobile spermatozoa is not significantly different from ICSI with mobile sperm from the same origin. More over, in the first group with flagellar abnormalities, repeated ejaculations allowed us significantly increase sperm viability and fertilization ability. Finding only immobile fresh or frozen-thawed sperm the day of egg retrieval should not lead us to ICSI cancellation. Pregnancies may occur with such immobile sperm.     

Estimation du taux d’aneuploïdies des spermatozoïdes épididymaires prélevés en vue d’ICSI chez des hommes à caryotype normal

Over the last ten years, fluorescent in situ hybridization in decondensed sperm nuclei has been used to study the chromosomal constitution of human spermatozoa. Studies have estimated that the disomy rate per chromosomal pairs is between 0.15% and 0.3%. The aim of this study was to evaluate the aneuploidy rate of human epididymal spermatozoa extracted from five men with obstructive azoospermia undergoing IVF. Genetic studies (karyotypes, Y micodeletion syndrome and mutation of the CFTR gene) did not reveal any abnormality. Disomy frequencies were determined by X-Y-8 multicolour fluorescence in situ hybridisation on 18,013 epididymal spermatozoa and 20,000 spermatozoa from healthy donors (control group). No significant difference was found between epididymal and ejaculated samples. However, isolated non-significant differences were observed between one of the patients and the control group. In conclusion, the present findings suggests that there is no increased risk for de novo chromosomal aberrations after IVF therapy with epididymal spermatozoa of men with obstructive azoospermia.     

Nadine Dobrovolskaïa-Zavadskaïa and the dawn of developmental genetics

In one of the first genetic screens aimed at identifying induced developmental mutants, Nadine Dobrovolskaïa‐Zavadskaïa, working at the Pasteur Laboratory in the 1920s, isolated and characterized a mutation affecting Brachyury, a gene that regulates tail and axial development in the mouse. Dobrovolskaïa‐Zavadskaïa's analysis of Brachyury and other mutations affecting tail development were among the earliest attempts to link gene action with a tissue‐specific developmental process in a vertebrate. Her analyses of genes that interacted with Brachyury led to the discovery of the t‐haplotype chromosome of mouse. After 70 years, Brachyury and the multiple genes with which it interacts continue to occupy a prominent focus in developmental biology research. A goal of this review is to identify the contributions that Dobrovolskaïa‐Zavadskaïa made to our current thinking about Brachyury and how she helped to shape the dawn of the field of developmental genetics. BioEssays 23:365–371, 2001. © 2001 John Wiley & Sons, Inc.     

Comparaison de différentes méthodes de segmentation en TEP/TDM pour le ciblage en radiothérapie des carcinomes épidermoïdes des VADS

IntroductionTo assess interobserver variability for biological target volume (BTV) delineation and to compare the reproductibility of different semiautomatic segmentation methods in pretreatment 18-fluorodeoxyglucose positron emission tomography (PET/CT) of head and neck squamous cell carcinoma (HNSCC).Patients and methodsPatients with histologically proved HNSCC referred to the nuclear medicine service in Brest for pretreatment PET/CT were prospectively included from February 2009 to June 2010. Three nuclear medicine physicians (two specialized in oncology) delineated manually and independently BTV on each primary tumor. Four semiautomatic segmentation methods have been studied; three using a fixed threshold and one applying an adaptive threshold based on the signal-to-background ratio (Daisne). The variability between κ observers and/or methods has been assessed. The concordance between the various BTV intersections and unions has been also assessed.ResultsThirty patients (29M; 1F) were included. The primary site location was oropharynx in six patients, oral cavity in 10 patients, hypopharynx in five patients and larynx in nine patients. A statistically significant global interobserver variability (P = 0.01) was showed, but without statistically difference between the two experienced oncologists (P = 0.15). The maximal concordance of the two experienced observers with the semiautomatic methods was found for the Daisne method (CI = 61.5%; κ = 0.68), expressing a good agreement according to the Landis and Koch criteria, better than with the segmentation method using a fixed threshold with 40% of maximal signal intensity (CI = 52.1%; κ = 0.53).ConclusionOur results suggest the feasibility of achieving HNSCC BTV delineation by PET/CT using semiautomatic methods, in particular those which apply an adaptative threshold but under the supervision of an experienced operator.     

Morphologie des spermatozoïdes

Spermatozoa morphology is one of the qualitative characteristics of spermatogenesis. However, because of both the variations in the definition of normal morphology and the existence of different kinds of sperm abnormalities as well as the use of various techniques of morphology assessment, such a parameter is poorly used in usual laboratory work. Morphological sperm anomalies can be from testicular or post-testicular origines, while the latter is still unproved. The causes of such anomalies are either from genetic origines, but in these cases any spermatozoa demonstrate this anomaly, or due to an endogenous factor with varicocele the most usually quoted but unproved pathology, But exogenous factors, either chemical such as drugs and pesticides or physical such as heat, are also responsible for morphological sperm anomalies. Analysis of sperm morphology is indicative of both the testicular health status (in cases of occupational exposure to chemical or physical toxics) and the fertility potential since morphology is correlated to sperm motility and involved in fertilization through the acrosome reaction.     

Intérêt de la scintigraphie parathyroïdienne de soustraction dans la prise en charge de l’hyperparathyroïdie secondaire. À propos de 33 cas

Aim^99mTc-Sestamibi is used in the imaging of hyperparathyroidism in order to guide the surgical procedure and to propose methods of less invasive surgery. The aim of our study was to evaluate the efficiency of preoperative subtraction parathyroid scintigraphy (Sestamibi-^99mTc/Pertechnetate) in the management of secondary hyperparathyroidism.Patients and methodsThe records of 33 patients with renal impairment consecutively operated from 2009 to 2011 for secondary hyperparathyroidism were retrospectively reviewed. We collected data on parathyroid function, results of parathyroid scintigraphy, intraoperative findings and pathological findings.ResultsScintigraphy was positive in 32 patients by disclosing a total of 75 hyperplastic parathyroid glands. The surgical exploration of all parathyroid glands revealed 99 hyperplastic glands confirmed by histological analysis. The sensitivity of parathyroid scintigraphy was 70.7% with a specificity of 85%. Positive predictive value was 93.3%, while negative predictive value was 50%. No correlation was found between the values of parathyroid hormone (PTH) and calcemia measured preoperatively and scintigraphic results.Discussion and conclusionIn our study, the correlation of scintigraphic data with PTH and serum calcium is not statistically significant. However, owing to a high positive predictive value, the parathyroid scan should be indicated. Value of parathyroid scintigraphy extends to searching ectopic or supernumerary glands and especially in cases of persistent or recurrent hyperparathyroidism.