Reproduction humaine: le point de vue du philosophe

This article discusses and essential aspect of the link between ethics and life, as expressed in the concept of bioethics. It discusses the various issues related to human reproduction from “the philosopher’s point of view”. This discussion is limited to the principles of this field. The author starts by justifying a philosophical approach to ethical problems in the context of medicine in general and reproduction in particular, a field which specialists, theoreticians or practitioners of medicine and legal medicine in particular, appear to have ignored. This leads to a discussion of the human aspects of reproduction, from questions concerning the nature of living beings (individuals and species) to the relationship between nature and culture (symbol and freedom). Although man “reproduces” and “procreates”, he is also technically able to “produce himself”. This shift from biological reproduction to procreation must take into account problems related to technological science in medicine (technical control of living material and so-called “neutrality” of the technique). The main bioethical issues involving an ethics of decision-making in the field of human reproduction (contraception, abortion, status of the embryo, medically-assisted procreation, desire to master the “form” of the “reproduced” human, or even the “product”, cloning) are then discussed. Finally, the author proposes elements of a “philosophy of point of view”, requiring responsibility for each decision in the context of an “ethics of discussion”.     

Enjeux psychosociaux du don de sperme: le point de vue des couples

The French national debate, which took place during the review of bioethical laws, concerns the issue of anonymity of gametes donations, among other questions. More specifically, the debate was focused on sperm donations in which numerous arguments have advocated for a partial opening of sperm donor’s anonymity. But what about couples who are implicated in donation programs? What do they want? What sort of practical changes occur for receiving couples in countries which take away the donor’s anonymity? Our article presents some results of recent social psychological research conducted on a significant sample of French receiving couples. Results focus as much on their experience and their intention to share the secret of conception through sperm donation, as on specific aspects of this type of donation and its defining legislative principles in France. Finally, we question the organizing principles of their stand regarding donator’s anonymity and the convergence of parental strategies in dissident legal frameworks, through the lens of international scientific literature.     

Imagerie des tumeurs endocrines digestives : le point de vue du radiologue

Endocrine tumor (ET) can produce and secrete hormones to a variable degree. These neoplasms present a diagnostic challenge, both clinically and radiologically. ET is classified as either syndromic or nonsyndromic on the basis of their clinical manifestations, as differentiated and undifferentiated according to their histological patterns and as pancreatic or extra-pancreatic. Multi-detector row computed tomography (CT) plays an important role in the diagnosis and staging of these lesions. In general, syndromic ET are less than 3 cm in size. They are typically hyperenhancing on CT scans during arterial phase. Nonsyndromic ET tend to be larger than syndromic one and are more likely heterogeneous. Detection of pancreatic localisation and staging of hepatic metastasis could benefit to magnetic resonance imaging (MRI). Endoscopic ultrasound and somatostatin receptor scintigraphy are the two main tools for diagnosis and staging ET. This work presents the role of imaging in the staging and the treatment of these patients.     

L’imagerie TEP-traceurs des plaques amyloïdes : le point de vue du clinicien

The purpose of this article is to summarize the main elements of clinician point of view concerning the contribution of amyloid neuroimaging in the diagnostic approach of the Alzheimer's disease. The main pathological characteristics of the Alzheimer's disease are established by two types of protein aggregates: the extracellular plaques (containing Aβ aggregates) and neurofibrillary tangles (composed of aggregates of tau-protein). At present, the use of biomarkers is more and more included in the diagnostic approach of Alzheimer's disease. The possibility to highlight in vivo cortical amyloid deposits through the amyloid neuroimaging can allow the realization of an earlier diagnosis. However, the amyloid imaging is a “physiopathological” biomarker and is not correlated with the clinical evaluation. It is still difficult to differentiate the Alzheimer's disease of the other neurodegenerative diseases.     

Analyse cladistique et Trilobites: un point de vue

On the basis of precise trilobite examples, the difficulties and interest in cladistic analysis are emphasized. The problem of distinguishing plesiomorphic and apomorphic characters is exemplified in Morgatia with reference to auxiliary impressions of the glabella and vincular furrows. In Crozonaspis , cladograms by themselves do not clarify the distinction of primitive versus derived features; the stratigraphical distribution of species, although not conclusive, is helpful in clarifying relationships. Although stratigraphical data are essential for reconstructing species lineages, they may be misleading when dealing with taxa above the species level. For all phylogenetical reconstructions, the completeness of the palaeontological and biogeographical record must be taken into consideration. D Trilobita, Phacopida, cladistics, Ordovician.     

Cancer de prostate métastatique résistant à la castration : le point de vue de l’oncologue médical

Most of patient suffering from a prostate cancer will develop a castration resistance. In this common and clinically challenging situation, chemotherapy was not considered very useful until mid 2000s. Docetaxel is now recognized as a standard of care, improving overall survival and quality of life. However, new drugs are needed. Two compounds (cabazitaxel and abiraterone) are now underway to official registration and an autologous vaccin strategy (Sipuleucel) demonstrated a benefit in survival. Based on a greater knowledge of biology, many other agents are currently under development, such as new specific peripheral anti-androgens, anti-angiogenic therapies, or proteasome inhibitors. All these new drugs are promising and may provide more efficient therapies against this incurable disease in the near future.     

Prise en charge des cancers de la prostate : points de vue du radiothérapeute

In 2011, the prostate cancer positions itself clearly like a problem of public health. The radiotherapy has shown these twenty last years significant improvements with the advent of the three-dimensional conformation radiotherapy as a standard in the treatment of the adenocarcinoma prostate cancer, and now with the contribution of the modulation of intensity which makes it possible to consider an increment of amount on estimated target volume without toxicity added to the organs at risks. Radio-hormonotherapy association for high-risk cancers also went to current practice. The nuclear medicine through new tracers and new indications probably will allow the experts dealing with these patients to better define the indications and to better distinguish the patients who will profit authentically from a therapeutic strategy more than of another, and even to associate them…     

Place de la prostatectomie radicale dans le traitement du cancer de prostate

The screening of the prostate cancer with PSA has dramatically modified the circumstances of diagnosis. Nowadays, most of the patients have a localized disease. The treatment is based on prognostic factors and the spreading of the tumor. If the cancer is localized, some treatments are available. Among them, the radical prostatectomy can be performed either laparoscopically or by an open approach. Surgical treatment of prostate cancer is proven to be an effective way to decrease the occurrence of locoregional extension and metastatic disease. It has been proven that it allowed diminishing the mortality in patients who have a life expectancy more than 10 years. The side effects of the radical prostatectomy consist of impotency and incontinence which can be rehabilitated. The treatment of locally advanced cancer is a controversial issue that can consist in surgery as a unique treatment or in a multimodal treatment. This text summaries the recommendations of the French association of Urology.     

Technique du ganglion sentinelle dans le cancer de la prostate

Urological interest of sentinel lymph node procedure in prostate cancer, and methods, both are presented in conformity with the presentation of action concertée en medecine nucléaire (ACOMEN).