Fertilité de l’homme en fonction de l’âge

The aim of this work was to analyse the evolution of sperm characteristics according to age. To this end we analysed the spermogram of 2,126 men aged 20 to 64 who came for consultation for feminine indications for in vitro fertilization at the Clermont-Ferrand Human Reproduction Unit during the period 1980 to 1994. A search for a link between the age of the patient at the time of the spermogram and 10 sperm parameters, by studying a linear regression, did not reveal any evidence of a significant correlation between the age and the parameters studied. The mean values for volume, concentration of spermatozoa, percentage of mobile forms (normal, diminished), percentage of typical and mobile forms and percentage of abnormal forms were compared for age classes covering 5 years. These values showed no significant difference according to the age classes. Between 20 and 60 years the essential parameters of the spermogram seem generally to be independent of age, from which it can be deduced that ejaculate quality remains the same until 50 years of age. However a bias in the recruitment of the population studied and a very wide spread for the values for a given age mean that we may not have detected fluctuations in sperm characteristics linked with age.     

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.     

Le Gravettien et l’Épigravettien de l’Est de la Roumanie : une réévaluation

Opening towards the eastern steppe landmass, the Eastern Romania area covers 87,500 km², and shelters the biggest number of Gravettian and Epigravettian sites currently known. Archaeological researches in the area expanded in the 1950's, during the construction of dams on the Prut and Bistrița valleys. The efforts of the multidisciplinary teams involved and the subsequently published papers highlighted the archaeological potential of the region and, with some inevitable interruptions, investigations continued to this day. Although the time and resources spent were not modest, the outcomes regarding the Upper Palaeolithic cultural sequence often proved contradictory and somehow distant from the general European cultural dynamic. Thus, this reassessment tries to put the chronological, palaeoenvironmental, and empirical data in a more coherent framework. A synthesis of the available Gravettian and Epigravettian data east of the Carpathians reveals the following sequence: (1) an Aurignacian stage on the Prut Valley, paralleled by an indefinite Upper Palaeolithic stage, from sites on the Bistrița Valley, between 31 and 28 ka (uncal BP); (2) a quite early Gravettian presence, roughly between 27 and 25.5 ka, which includes backed laminar blanks, schematic decoration of one pendant, and the use of perforated shells as adornments; (3) a scant shouldered points stage, chronologically close to the European similar phases (25–23 ka), for which the feeble use of obsidian points toward contacts with Central European resources/populations; (4) a Gravettian/Epigravettian interface, between 21 and 19 ka, manifested within numerous archaeological layers, mainly through an increase in bladelets and organic artefacts production/use; (5) an Epigravettian stage, between 18 and 16 ka, largely defined through an upturn in raw material choices, backed implements production, and tool types; (6) one last, roughly 14 ka old Epigravettian stage, in which the technological choices recalled those of the previous one. Regional variability elements and radiocarbon chronology limitations considered, apparently, the Gravettian and the Epigravettian of Eastern Romania share quite a lot of traits with the corresponding Central and Eastern European technocomplexes.     

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.     

Apport de l’iode 131 dans le traitement de l’adénome thyroïdien toxique

IntroductionToxic thyroid adenoma is an evolutive condition requiring radical treatment. The purpose of this study is to evaluate the contribution of 131 in the treatment of toxic thyroid adenoma.Patients and methodsThis is a retrospective study of patients treated with iodine 131 for toxic thyroid adenoma. The diagnosis of toxic adenoma is confirmed by scintigraphy and/or ultrasound. Data collected were age, sex, previous treatments, pre treatment hormonal status, radioiodine activity received and post therapy hormonal status.Results and conclusionWe have 45 women to seven men with a sex ratio of 6.42. Mean age of our patients is 53 years. Mean age for women at time of treatment is 57.33 years and 52.85 years for men. 98.07% of our patients treated with iodine 131 gained euthyroidism or became hypothyroid vs. 1.92% in whom hyperthyroidism persisted. These results are comparable to literature. Moroccan patients socioeconomic status pleads for an expansion of use of radioiodine in toxic thyroid adenoma due to its favourable cost/effectiveness ratio.     

Prevention de l’infertilite d’origine infectieuse chez l’adolescent

Some causes of infertility can be prevented, as is the case for infertility of infectious origin. Genital infections represent a major source of infertility. Prostato-epididymitis consecutive to an urinary infection can be prevented by identifying and treating prostatic localizations at an early stage of urinary infection. The prevention of sexually transmitted diseases (STD), which cause male and female infertility, is, at the moment, accomplished by the prevention of the sexual transmission of the HIV. Teenagers represent a target of choice for the educational campaigns promoting condom use. The role of physicians, especially when teenagers are asking for a contraception, must be complementary to the public health campaign to decrease the spread of HIV and other STDs.     

Contraception thermique de l’homme

Several characteristics of spermatogenesis are heat-dependent in mammals. A similar process does exist in man in whom a qualitatively and quantitatively normal spermatozoa out put occurs for a mean testicular temperature ranging between 33 and 34.5°C. As in many animal species, an induced increase in the testis temperature results in a decreased spermatozoa out put and quality, decrease which is a function of both the intensity and the duration of the increase in temperature as well as the heated target (whole body, scrotum, testes). A daily increase of 1 to 2°C in the testis temperature for at least the waking hours induces on spermatogenesis an inhibitory effect strong enough to temporarily suppress the fecundity, i.e. to achieve a male contraception, withtout any major side-effects as reported for 37 couples during 411 cycles of exposure. Both spermatogenesis and fecundity recover initial values within one year after the heatng is stopped.     

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.     

Prevention de l’infertilite d’origine infectieuse chez l’adolescent

Some causes of infertility can be prevented, as is the case for infertility of infectious origin. Genital infections represent a major source of infertility. Prostato-epididymitis consecutive to an urinary infection can be prevented by identifying and treating prostatic localizations at an early stage of urinary infection. The prevention of sexually transmitted diseases (STD), which cause male and female infertility, is, at the moment, accomplished by the prevention of the sexual transmission of the HIV. Teenagers represent a target of choice for the educational campaigns promoting condom use. The role of physicians, especially when teenagers are asking for a contraception, must be complementary to the public health campaign to decrease the spread of HIV and other STDs.     

Place de l’imagerie dans l’évaluation de l’efficacité des traitements dans le cancer du sein

This paper describes, from the current literature, the role of various imaging methods to assess the response to therapy in breast cancer. Two different clinical situations are considered: neoadjuvant chemotherapy of locally advanced breast cancer and the metastastic breast cancer. Significant clinical data are available for three criteria: the volume of the tumour, the uptake of fluorodeoxyglucose using PET and the perfusion of the tumor evaluated either by dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) or by PET using ¹⁵O water. ¹⁸F FDG PET allows prediction of the response after one or two cycles of neoadjuvant chemotherapy. New approaches will offer opportunities to refine the role of imaging in monitoring the response to chemotherapy. PET using thymidine as biomarker is promising in assessing the tissular proliferation. Estrogen analogs could be used to predict hormonally responsive breast cancer. Many other approaches, although less developed, might offer new insights in the response to therapy of breast cancer like magnetic resonance spectroscopy or optical imaging of hemoglobin oxygenation. Imaging also offers potential of monitoring the down-regulation of specialized receptors of the cell membrane in response to treatment: the most studied receptor in preclinical model has been the human epidermal growth factor receptor type 2 (HER2). Integrin, a family of cell adhesion receptor, is also an important target for imaging. Apoptosis, multidrug resistance and hypoxia can also be studied using appropriate biomarkers. To allow reliable multicenter trials of new drugs, these different imaging approaches still require an improved standardization of image acquisition and processing.     

Variabilité de l’industrie lithique entre les structures de l’habitation no 1 de Mezhyrich,site du Paléolithique supérieur d’Ukraine

The investigation of the lithic assemblages from three archaeological structures of the Upper Palaeolithic Mezhyrich site, mammoth bone dwelling no. 1, nearby located pit no. 7 and workshop with a portion of cultural layer situated on the border of the pit, exhibits a sufficient diversity of the main indexes of flint assemblages. According to the latter, the main flint resources, cores and large pieces of flint, as well as blades and several tools (scrapers), were kept just in the dwelling. At the same time, the remains of “debitage” and the modification products of several tools (burin spalls) are more numerous in the pit and the workshop. The higher percentages of backed microliths, included the forms with diagnostic projectile impact fracture, and burins with several working edges are also observed in the assemblages of the last two archaeological structures.     

Le principe de l’anonymat du donneur de gamètes à l’épreuve de son contexte. Analyse des conceptions juridiques de l’identité

This study clarifies the lively debate surrounding the anonymity of gamete donors. This principle, which has not been challenged since 1994, is currently criticized by a number of people, who were conceived through medically assisted procreation technologies with donor and who now have reached adulthood. Their testimony has a very significant impact on French public opinion. Several official reports have already suggested that the anonymity of gamete donors may well be removed under certain circumstances. To understand why public opinion has evolved so dramatically, we must revisit the legal position of gamete donors in the specific context of less visible changes in the law. Indeed, the legal concepts of parenthood and identity have been reshuffled over time, and such changes have deeply affected the legal issues relating to the anonymity of gamete donors. Formerly, the law governing the identification of individuals was shaped by political and social objectives. Now it is more concerned with the sense of identity and personal fulfilment of people. This change, based on modern western notions of egalitarianism and individuality, has dramatically affected the outcome of parenthood trials. Moreover, biological tests have made the truth available like never before. The possibility of finding out the truth has shocked the practice of many areas of family law and has created a new set of challenges, especially when the secrecy of the genetic parents has been legally established. In France, women have traditionally been able to deliver their children anonymously. A deadlock has resulted, which may now be overcome by introducing a new concept of personal origins. Now the law is evolving to permit the children to demand their biological mothers’ identity under certain circumstances, but without affecting anyone’s rights. The concept of personal origins has been quite successful on the European scene and has also charged the debate. It is now recognized under French and European laws that individuals must have privileged access to their personal origins. Can the principle of anonymity of gamete donors remain immune from such a (r)evolution ?     

Mecanismes des phases de l’erection

The erectile phenomenon is scientifically described since the early 19 th century. During the last 10 years, new methodologies in experimental and clinical approaches added further details to our knowledge on the erectile process. Postaganglionic parasympathetic neurotransmitters as Acetyl-Choline, Vasoactive-Intestinal-Polypeptide or Calcitonine — Gene — Related — Peptide are identified; their information reaches the cavernous smooth muscle cells indirectly via the endothelium, mediated by Endothelium Derived Relaxing Factor. Sympathetic neurotransmitters as Norepinephrine seem to influence the smooth muscle cell directly, but recent studies suggest a role for endothelin, an endothelium derived contracting substance. The neurogenic information reaches the cavernous bodies probably via pace maker-cells that are connected with the other smooth muscle cells by gap junction. The balance between parasympathetic and sympathetic influences determines the state of erection.     

Commande nerveuse peripherique de l’erection

Local mechanisms causing penile erection and detumescence result from variation in tone of vascular and trabecular smooth muscles and in a lesser part of striated muscles around the crura penis. All these events are neurally mediated. We reviewed human and animal data concerning the functional peripheral neuroanatorny of erection. General organization of peripheral nervous system is recalled. Somatic efferents of the pudendal nerve, originating in the sacral spinal cord, innervate the striated musculature of the perineum. Somatic afferents of the penis are conveyed by the dorsal penile nerve, a branch of the pudendal nerve. Afferent terminations project into the spinal cord, their role is discussed. Parasympathetic pathways are involved in the reflexogenic erections. Sympathetic pathways destinated to the erectile structures are more complex. They are issued from thoracolumbar spinal cord and travel through the hypogastric nerve or the lumbosacral sympathetic chain. Sympathetic fibers originating in the sacral sympathetic chain are present in both pelvic and pudendal nerves. Inhibitory role on the erection of the sympathetic nervous system is well-known, it could be also responsible for psychogenic erections. Parasympathetic and sympathetic fibees are mixed in the pelvic plexus and the cavernous nerves which are described. Relations between the four sets of peripheral nerves (somatic efferents, penile afferents, thoracolumbar sympathetic sacral parasympathetic and sympathetic) are discussed.     

Les premiers villages agricoles de l’est du plateau Iranien à la vallée de l’Indus : état de la question

The birth of agriculture east of the Fertile Crescent, between the Iranian plateau, Central Asia and South Asia, is poorly known. This area is vast and the archaeological data relating to this period, the Neolithic, is extremely limited. Most researchers agree that plants and animals’ domestication was introduced in this area from south-west Asia, similarly to what happened in Europe. In this scenario, agriculture emerged in the Fertile Crescent, between the Levant, Anatolia and the Zagros, 12.000 to 11.000 years ago, and then spread to other regions further east, across the Iranian plateau to Central Asia and the north-western part of the Indian subcontinent, beginning between the 8th and 7th millennia BCE. This article summarizes the main available data relating to this topic with a focus on the Indo-Iranian Borderlands, between southeastern Iran and Pakistan. Currently available paleoclimatic, paleogenetic and archaeological records are presented. A synthesis and discussion is then provided in the conclusion as well as reconstructions based on these records. Issues or challenges relating to the research on the earliest farming villages are mentioned while directions for future research are evoked.     

Optimisation de l’utilisation du PSA

PSA is a tumor marker usually determined for prostate cancer at diagnosis for its pronostic value and at therapy follow-up. But lack of specificity of PSA for prostate cancer and variability between assays demonstrated by the quality program survey make this marker not valuable in mass screening program. Market control of Afssaps on analysis devices of PSA showed a correct harmonization for total PSA. Biological tools available and easy to perform could improve ability of PSA for early detection of prostate cancer at a curable stage without induction of unnecessary biopsies prescribed because elevated total PSA values.     

La géométrie fractale pour l’analyse de signaux médicaux : état de l’art

The diagnostic interpretation of medical images is a complex task aiming to detect potential abnormalities. One of the most used features in this process is texture which is a key component in the human understanding of images. Many studies were conducted to develop algorithms for texture quantification. The relevance of fractal geometry in medical image analysis is justified by the proven self-similarity of anatomical objects when imaged with a finite resolution. Over the last years, fractal geometry was applied extensively in many medical signal analysis applications. The use of these geometries relies heavily on estimation of the fractal features. Various methods were proposed to estimate the fractal dimension or multifractal spectrum of a signal. This article presents an overview of these algorithms, the way they work, their benefits and limits, and their application in the field of medical signal analysis.