Phénoménologie de la non-observance dans les maladies chroniques

One patient out of two does not follow medical recommendations. This non-adherence concerns all the aspects of the care, and they are often bunched. The purpose of this article is to present a phenomenological analysis of non-adherence to long-term therapies, on one hand by relying on empirical data found in the literature, on the other hand by referring to concepts developed by two disciplinary fields: the philosophy of mind and neuroeconomics. We propose that non-adherence is associated with two characteristics: on one hand impatience, which makes that certain individuals give the priority to the present. On the other hand, weakness of will, which prevents them from deciding wholeheartedly to give the priority in the future. We suggest that these two characteristics are psychologically linked.     

Phénoménologie de la subjectivité : Tatossian et la clinique psychiatrique

The human sciences are now celebrating the return of the Subject. However, as a form of resistance to science, the issue of subjectivity justifies a methodological resort to a phenomenological posture. This posture consists in “seeing” and “showing” the experience of foundations. In Arthur Tatossian’s distinction between Subject and subjectivity, the Subject carries out the synthesis of forms in which the subjectivity expresses and alienates itself. These forms include: the Self, the consciousness, the inner mind, etc. Subjectivity is what makes the Subject possible. Subjectivity is time, space, the body and the Other, and is shaped by time into a living present, by space into a common place, by the body into flesh, and by the Other as alterity. In psychiatric disorders, the patient fails to be a Subject. Whoever he or she is, a Self without subjectivity, as with a melancholic or a maniac, or subjectivity without Self, as with a schizophrenic, the issue of human identity arises. The central problem of the human condition, which is at the heart of psychiatric disorders, is the challenge of being a Self while retaining a degree of subjectivity. This in turn merges with another central problem: that of freedom. Subjectivity is the other face of freedom because it is the power to create meaning.     

Observations sur le mécanisme de l'agglutination sérique des microbes. (Phénomène de Charrin et Roger.)

Conclusion L'hypothèse que nous venons d'esquisser n'est certainement pas une généralisation définitive et elle devra subir de nombreuses retouches avant de pouvoir englober tous les faits connus, mais n'est ce pas là le propre de toutes les généralisations à leur début?Actuellement la théorie du potentiel-force d'attraction et de l'adsorption orientée a le gros avantage d'expliquer la plus grande partie des faits bien établis, ce qui constitue un progrès incontestable et très précieux.     

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.     

La division de la cellule phénomène bipolaire de caractère électro-colloÏdal

Sans résumé     

Etude expérimentale de la relation entre la forme physicochimique du zinc et sa disponibilité à l'égard de végétaux cultivés. Application à l'utilisation agricole de boues de stations d'épuration

Summary In order to appraise the relation between the physico-chemical forms of Zn and its availability to plants or water, we introduced various forms of this element in experimental systems according to whether it was associated with soil, mineral fertilizers or sewage sludges. These sludges were rich in organic matter and carbonates and one of them contained iron and aluminium oxides and hydroxides.The physico-chemical forms of Zn in soils and sludges were determined following a selective extraction procedure which showed that only a small amount of this metal was associated with the easily available phase. In accordance with these results, the exportsvia vegetables and leached waters were very low, regardless of the treatment.

     

Évaluation de la tomoscintigraphie de perfusion pulmonaire couplée à la tomodensitométrie dans la prédiction de la fonction respiratoire postopératoire

IntroductionThe aim of our study was to evaluate the performances of pulmonary perfusion single photon emission computed tomography-computed tomography (SPECT-CT) with semi-automatic analysis for preoperative assessment for lung cancer.Materiel and methodThirty-five patients underwent preoperative lung perfusion scintigraphy (planar and SPECT-CT acquisition) from august 2016 to December 2017. Predicted postoperative forced expiratory volume in one second (ppoFEV1 and FEV1) by both methods were compared between each other and with the actual FEV1 measured 3 months after surgery. We also evaluated interobserver reproductibility of SPECT-CT semi-automatic segmentation software and the concordance of the data simulating reductions of 30 and 50% of acquisition time.ResultsFor 30 lobectomies and 5 pneumonectomies, the mean ppoFEV1 was 69%, a difference with actual ppoFEV1 of ?8% for SPECT-CT and ?6.77% for planar (P < 0,001). Both methods were well correlated, correlation coefficient was 0,827, 95% CI [0.686–0.909] but underestimated the actual poppFEV1. For SPECT-CT, interobserver reproducibility was excellent for pulmonary and lobar evaluation. The lobar functions, without 30 and 50% of the time acquisition, had absolute difference < 3% in comparison to native data.DiscussionWe did not prove SPECT-CT superiority on planar scintigraphy, actual FEV1 being difficult to predict because of confounding factors. But this exam could be useful before lobectomy and in cases of heterogeneous perfusion. Easily made, this method is reproducible even on data simulating a reduction of 50% of time acquisition.     

Contribution à la connaissance des Desmidiées du Sud-est de la Province de Québec et de la Gaspésie

Sans résumé     

La contribution de la pensée d’Alfred Kraus à l’étude phénoménologique des troubles bipolaires

German psychiatry is one of the areas where we see the development of an unconventional psychiatry, characterized by its reference to philosophical traditions that are remote from the natural sciences, and by its emphasis on the overall nature of the mentally ill person. This approach first emerged during the period of comprehensive psychiatry promoted by Karl Jaspers and Kurt Schneider. This particular form of psychopathology focuses its attention on the inner experience of the ill person and attempts to understand it, in particular through empathy. This approach was soon reinforced by a philosophical method founded by Husserl and further developed by Heidegger: phenomenology. Firstly, this consists of a way of approaching and examining the discrete elements of consciousness, leading to the notion of intentionality (Brentano, Husserl). The central place of consciousness in this approach leads to the questioning of existence and of the person supporting this consciousness: this philosophy thus leads to existentialism (Jaspers, Sartre) and Heidegger’s concept of Dasein (the existential analytic, Dasein’s ontology). Phenomenological psychiatry is thus a clinical science characterized by its approach and its reference to what might overall be described as comprehensive anthropology. There are numerous authors who affiliate themselves with this phenomenological psychology. Our article is devoted to Alfred Kraus’s approach. We will first of all address the notions of comprehensive psychiatry and phenomenology. After introducing Alfred Kraus and the specific philosophical and clinical foundations of his work, we will examine the Krausian theory of identity based on Mead and Sartre, which establishes a distinction between ego-subject (a free element that produces ego achievements) and ego-object (identifications, in particular with social roles in the case of depressives). The ego-subject is the transcendent element (Sartre), which constantly exceeds what I am (ego-object) and there is thus an internal negativity. We will then address the clinical concept of manic-depressive illness. The identity structure of the depressive is characterized by hyper-identification. The notion of psychotic breakdown will then be covered, where it appears that melancholia is not an affective disorder, a mood disorder, but a case of depersonalisation. The personality disorder which precedes melancholia results from a threat that weighs on this fragile identity propped up against its identifications, which is expressed in hypernomic behaviour: this being a reinterpretation of the notions of a specifically depressive temperament, constitution, premorbid personality or typus melancholicus. Hypernomic behaviour is characterized by the scrupulous observance of role expectations and an extreme respect for laws and norms which is expressed as a form of hyperadaptation. Finally, the last part is devoted to the intolerance of ambiguity, which can be cognitive or emotional (the inability to experience negative feelings).     

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.