Sexualité des patients après traitements anti-cancéreux-nécessité d'une prévention

Sex and cancer, pleasure and death are words very difficult and painful to associate and to evoke. The sexuality of patients with cancerous diseases is unrecognized by physicians and very little present in the practice of sexology. the sexual life of cancerous patients must be preserved. The preventions must have aims, means and time. The aims are: to allow, to keep, to find or to rediscover a sexual and relational life. The means are:

? systematic information on the clinical reality and his results,

? directed information on the sexual reality and his capacities,

? thinked information on the sense and the value of the sexuality and of the pleasure.

The time is before, during and after the treatment for cancer. The prevention is also sexological treatments if sexuals symptoms occur.     

La puberté surrénalienne

The androgens produced by the adrenal glands are mainly Δ5 steroids, first dehydroepiandrosterone (DHA) and its sulfate (DHAS). Adrenal androgens, very high at birth, decrease rapidly the first few months of life, remaining very low from 1 to 6 years of life. Adrenarche is defined as the changes in the pattern of adrenal secretions which occur several years before the onset of gonadal puberty (gonadarche). Developmental patterns of adrenal androgens differ markedly among species and only the chimpanzee exhibits an adrenarche comparable to that of man. Adrenarche starts in both sexes around age 7. The increase in DHA/DHAS has a rather abrupt onset and is thereafter progressive. Before the onset of gonadarche mean levels of DHA and DHAS have increased by about 10 and 20 fold respectively. The prepubertal rise in plasma Δ⁵-androgens is accompanied by that of Δ4-androstenedione and 11β-hydroxy-Δ⁴-androstenedione occurring likely at about the same time but being very progressive and more modest are only significant after age 8 in both sexes. Adrenal androgens continue to rise during puberty. Plasma levels of DHA and DHAS continue to rise from pubertal stages 1 to 5 and remain similar in both sexes until age 15. At pubertal stage P5, plasma DHA levels are similar to that seen in young adults with no sex difference while that of DHAS continue to rise in boys and become significantly higher than in girls. Developmental changes in adrenal androgen secretions are also observed in the response to ACTH stimulation. Whether estimated as absolute levels or Δ of response, the rise in all unconjugated adrenal androgens to a short or prolonged ACTH stimulation, is greater with increasing age, with no sex difference, and is somewhat correlated to basal levels. Plasma levels of DHAS do not vary significantly the 2 hours following a bolus injection of ACTH (21, 34) but its response to longterm (3-days) ACTH stimulation is also increasing with age. Morphological and functional changes in the adrenal cortex also occur during development. Focal development of aZona reticularis starts at 5 years of age, and progressively becomes continuous. The development of the zona reticularis is parallel to the increase in adrenal androgen secretions, and is completed only by age 15. This is accompanied by a rise in 17-hydroxylase and 17,20-desmolase activity in the adrenals. In a normal timing of physiological events, the onset of adrenarche occurs several years before the onset of gonadarche, 2–3 years in girls and 3–4 years in boys. This relation does not preclude that the processes are independent events. Indeed, the onset of adrenarche and gonadarche are dissociated in a variety of disorders of sexual maturation Adrenal androgen secretions are under the control of ACTH, as shown by a series of observations. However, the specific increase of adrenal androgen secretions during development without any detectable change in ACTH stimulation, the dissociation between adrenarche and gonadarche in several conditions, have led to postulate that the biochemical differentiation of the zona reticularis may require the action of an «adrenal factor» in addition to ACTH. Among the proposed «trophic» factors of adrenal androgen secretion, LH/FSH and estrogens are no longer believed to be involved. The evidences for the existence of a separate and specific pituitary cortical androgen-stimulating hormone (CASH) are not yet convincing. Prolactin, linked to nutritional status, may stimulate the activity of the adrenal hydroxysteroid sulfotransferase. The functional zonal theory» is attractive, but it does not explain why changes in adrenal androgens occur at a given age. Finally, the occurrence of familial cases of premature pubarche, the study of the changes in adrenal androgens in monozygotic or dizygotic twins and the observation that in idiopathic delayed puberty the delay in adrenarche is only one part of a generalized growth and developmental delay, strongly suggests that maturation of the adrenal cortex is regulated, at least in part, by genetic factors. The physiological importance of adrenal androgens remains a matter of controversy. Classical “dogma” dictates that adrenal androgens are responsible for pubic hair development. It has also been suggested that they contribute to somatic growth or epiphyseal advancement in childhood. This is mainly based on the observation that premature adrenarche is accompanied by premature pubarche, tall stature and advanced bone age. However, adequate androgen secretion alone does not ensure normal sexual hair development in many patients with gonadal dysgenesis. Moreover, in children with a lack or delayed adrenarche long-term treatment with DHAS at dosages such as to restore normal levels for age, failed to induce growth of sexual hair or any change in growth rate, bone maturation velocity, or to advance puberty. Although new hypotheses favour the view that Δ5-androgens, particularly Δ⁵-androstenediol, have some characteristic properties of estrogens, the physiological role of adrenal androgens, if any, remains to be established. DHAS may well be only a prohormone. There are ample evidences that all tissues possess active sulfatases which transform it into DHA, a steroid with high turn-over. Administration of DHA to experimental animals has shown beneficial effects on various endocrine-metabolic parameters, enhanced immunoprotective functions and reduced carcinogenesis. DHA prevents diabetes in genetically diabetic and obese mice. The importance ofin vivo andin vitro experimental findings is underscored by epidemiological data showing that low DHA levels are correlated with increased cardiovascular morbidity in men, breast cancer in women and a decline in immune competence. Human studies are at the moment controversial. It remains possible that DHAS influence breast cancer risk earlier in life, and/or that there are more complex interactions with other hormones or the intracellular metabolism of DHA/DHAS. Indeed, the tissue concentrations of DHAS may be important since it may act indirectly via its metabolism into estradiol or other steroids. Further long-term studies are needed to conclude whether DHA/DHAS are a youth fountain.     

Réactivité du plasmalemme végétal Etude cytochimique

Résumé Plusieurs méthodes cytochimiques utilisées convergent pour indiquer l'existence d'une réactivité du plasmalemme, qui le distingue des autres cytomembranes. 1. Des résultats positifs constants ont été obtenus avec deux sortes de méthodes. Certaines sont effectues sur pièces, utilisant la capture de métaux colloïdaux par les groupements électronégatifs. D'autres sont réalisées sur coupes ultrafines: technique dérivant de l'APS et méthode utilisant l'acide phosphotungstique à bas pH, dans différents milieux d'inclusion. 2. D'autres méthodes fournissent des résultats plus sporadiques, en particulier les techniques de détection d'ions inorganiques.Ces données cytochimiques tendent à indiquer l'existence d'une sorte de glycocalyx au niveau du plasmalemme végétal, évoquant celui des cellules animales. Il s'en distingue toutefois par certains caractères (absence d'action de la neuraminidase). La confrontation de ces résultats avec ceux obtenus après les tests d'activité enzymatique ou après des études histoautoradiographiques, confirme l'idée d'une organisation du plasmalemme, liée à son activité.Ces résultats fournissent des précisions sur les modalités de différenciation des membranes et sur leurs relations dans les phénomènes d'échange entre la cellule et le milieu extérieur (pinocytose, émission de vésicules sécrétrices).

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Reactivity of the plasmalemma. Cytochemical study

Summary Several cytochemical methods converge to indicate a reactivity of the plasmalemma, which makes it different from others cytomembranes. 1. Positive and constant results are obtained with two kinds of methods. Some are performed on specimen blocks, using the binding of colloidal metals with electronegative groups; some are performed on ultrathin sections: procedure derivating from PAS reaction, and method using phosphotungstic acid at a low pH in different embedding resins (epon, araldite, methacrylate, glycol-methacrylate). 2. Rather sporadic results are obtained with other procedures, specially those which demonstrate inorganic ions.These cytochemical data tend to indicate the existence, at the level of the plasmalemma, of a kind of glycocalyx similar to that described in animal cells. It is however different in some characteristics (neuraminidase has no effect on its reactivity).After a comparison of the results with those obtained from enzymatic tests or autoradiographic studies, the idea of a special activity of the plasmalemma is enhanced.These results give some informations on the ways the differenciation of cytomembranes occurs, and on their relations during exchanges between the cell and the exterior (pinocytosis and emission of secretory vesicles).

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Abréviations f fossette sécrétrice (anfractuosité du plasmalemme contenant des polysaccharides) - G dictyosome (appareil de Golgi) - ls lomasome - m mitochondrie - mn membrane nucléaire - mt méat - n noyau - P paroi - pe plasmalemme (pellicule ectoplasmique) - pl plaste - ps plasmodesme - re reticulum endoplasmique - sl slime body (corps muqueux de tube criblé) - t tractus polysaccharidique reliant cytoplasme et paroi - v vésicule cytoplasmique - va vacuole - Grossissement sur chaque cliché, le trait représente 0,5 micron     

La religiosité au Paléolithique

During the oldest periods of the Palaeolithic, evidence of distinct behaviours related to technicity, hunting and settlement patterns is difficult to clearly interpret. Yet such evidence increases from the Lower to Middle Palaeolithic, with the appearance of the first incontestable burials and symbolic representations, in the form of collected shells and colorants. With the Upper Palaeolithic, the archaeological record is more abundant. It is then possible to address spiritual aspects, the component of non-technological human behaviour beyond subsistence, lithic reduction or hafting techniques. Figurative art appears, in both mobile and parietal form, the iconography and organisation of which are structured. Painted caves seem to have been places for ritual practices in addition to having been selected for art alone. Evidence of visits and archaeological deposits reflect a space for possible exchanges between the human and spirit worlds in the framework of an animist world view. In the religious domain, such data allow the reconstruction of some elements of mythical thought, analogous to that described by ethnologists and historians of religions in other contexts. Their study does not allow precise recovery of the myths themselves, but rather consideration of their existence and structuring function within these prehistoric societies.     

Café Scientifique--déjà vu

Is the Café Scientifique a fashionable by-product of a comfortable age or an indicator of the changing relationship between science and society?     

Génétique et infertilité masculine: données actuelles

Intracytoplasmic sperm injection (ICSI) and testicular biopsies (TESE) have revolutionized the treatment of male infertility, introducing a risk of an increased frequency of genetic defects in the offspring. These risks and their consequences must therefore be evaluated when proposing ICSI to an infertile man. Karyotype and molecular analysis should be performed to detect any genetic defects responsible for male infertility. Y microdeletion screening is important, not only to define the aetiology of spermatogenic failure, but also to provide information allowing a more appropriate management of both the infertile male and his future male child. Genetic counselling is then advised before deciding to attempt ICSI.     

Le Mésolithique. Continuité et développement métaphysique

The Mesolithic is a fascinating period, where ancient traditions are tilting towards a new paradigm. Many changes can be recognised without being able to establish a real split with the Palaeolithic. Far from being just a bridge towards the Neolithic, the Mesolithic is truly a new and stable metaphysical structure. In our article, we are interested in the structural mechanisms by which Palaeolithic metaphysics slides towards the Mesolithic, where the individual occupies a central role.     

L'évaluation de l'incapacité dermatologique en santé au travail.

This paper presents a simple method for evaluating the extent of impairment in occupational dermatosis based on the portion (P) of the anatomic area involved (A) and the coefficient of physiologic disturbance (C). A percentage value is assigned to each anatomic area on the basis of its functional importance. The coefficient of physiologic disturbance is the average of four factors (stiffness, dehydration, thickening, and pruritus or pain). The formula (P X A). C gives the final percentage of impairment.     

La biologie délocalisée, une activité transversale

A ce jour, aucun texte réglementaire ne permet d’obliger le biologiste à mettre en œuvre un système d’assurance qualité adapté à la gestion de la biologie délocalisée. La SFBC a réuni un groupe d’experts afin de formaliser des recommandations dès 1998 [1]. Actuellement, ce sujet est à l’ordre du jour des organismes internationaux, et il est vraisemblable qu’une normalisation interviendra dans le futur, à terme opposable aux biologistes en relation avec un établissement de soins pratiquant une délocalisation des analyses de biologie médicale: une annexe à la future norme ISO/CEN 15189 concernant les recommandations pour la biologie délocalisée est en cours de validation, faisant suite aux recommandations du groupe européen EC4 [2].     

Sur la spécificité deVagoiavirus melolonthae

Summary The activity ofVagoiavirus melolonthae towards 16 species ofScarabaeidae, 3 Coleoptera, 3 Lepidoptera and 2 Diptera was studied by injection into the hemocoel and contamination of the substratum or of the rearing host plant. Only insects belonging to 3 sub-families ofScarabaeidae: Hopliinae, Melolonthinae, Rutelinae, are susceptible to the disease.      

Fluctuations morphologiques et hétérochronies chez Toxaster (échinides,Crétacé inférieur)

Morphological fluctuations and heterochronies of Toxaster (echinoid, Lower Cretaceous). Several steps of the diversification of the spatangoid Toxaster are described with an analysis of six species distributed over the north-west Tethyan margin, and ranging from the Lower Valanginian to the Barremian. Morphological variation was investigated with the analysis of two parameters (angles), which allowed recognition of three modules on the test. Comparison of ontogenetic trajectories of two reference species (T. granosus kiliani and T. retusus) suggests a peramorphic heterochronic pattern. However, no peramorphocline can be attested when comparisons are extended to adults of the six species. Evolution among these species is partially driven by allometric changes in one module, indicating an important influence of size. On the temporal and spatial scale of the study, the evolution of Toxaster appears globally quite conservative. To cite this article: É. François et al., C. R. Palevol 2 (2003).