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.     

A propos des vésicules séminales: le point de vue du biologiste

Progress in assisted procreation techniques has led to decreased interest in seminal vesicle investigations. However, recent progress in comparative anatomy and physiology emphasize the important role played by the seminal vesicles in fertilization. Seminal vesicle secretions play a role in the mechanics of coitus, on the behaviour of spermatozoa and the female genital tract and they also protect against infections. They consequently facilitatein vivo fertilization and the andrologist should pay particular attention to the seminal vesicles to ensure physiological procreation under good conditions.     

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.     

Le vécu de l’AMP vu par l’homme: le point de vue du Psychologue

The medical management of infertile men has improved over the last twenty years: the man’s experience has been transformed from “castration” by his wife’s gynaecologist to technical management by ICSI, allowing the andrologist to deal with the patient’s global human complexity. Although failure is still a difficult experience, success raises the question of a modification of the man’s relationship to his child, resulting from this new method of procreation.     

Infection et fertilité —Corynebacterium seminale: point de vue du bactériologiste

The authors present two independent studies designed to identify corynebacteria isolated from the semen of patients consulting for infertility. Corynebacteria were identified by conventional biochemical and physiological tests and by determination of volatile fatty acids. In the first study based on 420 patients, the commonest species were Corynebacterium seminale (synonym C. glucuronolyticum) found in 7.4% of specimens, CDC group G (5%) and C. amycolatum (3.8%). Of the 92 semen specimens with more than 103 cfu/ml, 44 were positive for corynebacteria, including 15 C. seminale strains, whereas streptococci, staphylococci and enterobacteriacae were found in 23, 18 and 6 of the 420 specimens, respectively. The presence of C. seminale was more frequently associated with a high bacteria count than the other corynebacteria (p<0.02). In the second study, we compared the presence of corynebacteria in the semen of 1,902 patients with semen indices. C. seminale was present at levels greater than 103 cfu/ml in 2.7% of these specimens, while several other species of corynebacteria were detected in 5.3% of cases. Normal motility was found in only 25.4% of semen specimens with a high C. seminale count in contrast with 45% of specimens containing similar counts of other corynebacteria. These studies demonstrate that the isolation rates from human genital specimens and their clinical implications are different according to the species isolated. Microbiologists should be aware of the need to accurately identify these corynebacteria for further in vitro or in vivo studies on genital infections.     

Robotisation des laboratoires: le point de vue d’un ingénieur biomédical

Bio tribune magazine -     

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.     

Les prélèvements testiculaires dans les azoospermies sécrétoires: le point de vue du Biologiste de la Reproduction sur la lecture du prélèvement

The prognosis of severe male sterility (nonobstructive azoospermia) has considerably improved over recent years with the introduction of ICSI. The human reproduction biologist actively collaborates with the surgeon in the search for and extraction of sperm from testicular tissue (TESE). The presence of the biologist during surgery is mandatory to guide exploration and to avoid an excessive number of biopsies. Sperm extraction is performed in the laboratory by mechanical extraction with fine forceps. Enzymatic extraction with collagenase IV can be used in cases of nonobstructive azoospermia to optimize tissue dispersion and to improve retrieval of mature cells. The use of only one fraction (50%) of Pure Sperm (JC Diffusion, Lyon France) limits the loss of spermatozoa. to optimize the results in cases of akinesia, it may be useful to induce sperm motility by pentoxifylline or perform in vitro culture for three days. Sperm cryopreservation is compulsory in the case of nonobstructive azoospermia. This allows programming of TESE for a different time from that of ICSI. All results obtained with cryopreserved testicular sperm, in recent years, are encouraging. It is also recommended to freeze several small fractions of sperm in order to limit the number of surgical procedures on the testicle. This article presents the results of our experience in 36 cases of nonobstructive azoospermia. Extraction was negative in 13 cases (36%), similar to the rate reported in the literature.     

Une technique de chainage chronologique de dossiers et exploitation du fichier obtenu: Application au controle du fonctionnement des stimulateurs cardiaques

The application of information processing to the study of the evolution of the patient's state requires the constituting of a file which contains the value of different items as functions of time. There are many methods for doing this and most of them appeal to the construction of a complex database. The technique presented in the paper tries to at first to constitute, for each patient, some records, of which every one corresponds to a determined ‘operation’ (the term ‘operation’ is taken in the wide sense; example: consultation, surgical intervention, …) then to link them according to the chronological order. It has the advantage of being easy so that it may be used even on minicomputers. Furthermore, the exploitation of the resultant data file is very easy. This method is well suited to problems such as the examination of the longitudinal investigations, the treatment of records of the patients who went through several operations, etc. The application presented here is the checking of the functioning of pacemakers. We wrote on a minicomputer MITRA 15/125 transferable general program (using FORTRAN IV exclusively), which allows one to carry out the linking and to exploit the resultant file. It is so designed that the addition of new procedures involved in new applications may be very easy.     

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.     

Scintigraphie à l’OctréoScan® : aspects pratiques. Le point de vue du manipulateur

Evaluation of neuroendocrine tumors extent comprises a somatostatin receptor scintigraphy with OctréoScan^®. This examination begins with the radiopharmaceutical preparation and its quality control (dose, visual appearance, radiochemical purity, pH). The radiopharmaceutical is administered intravenously at a slow rate with respect of the contra-indications and recommendations. The patient's good respect of low residue diet and digestive preparations is essential for a good imaging quality. In addition, the technologist's psychological role (particularly for people suffering from claustrophobia) and adequate procedures must be taken into account. Several days are necessary to perform the examination that comprises whole body and planar (thoracic and abdominal) views, combined SPECT-CT imaging. This hybrid modality using fused images allows a good anatomical localisation of focal areas of increased uptake even in case of faint uptake. Some false-positive can be avoided (colonic stasis, gall bladder). SPECT-CT contribution to the diagnosis is certain.     

18FDG et radiothérapie externe,le point de vue du radiothérapeute.: Application des techniques de fusion d’images à la radiothérapie des carcinomes bronchiques

The prognosis of patients with localized non-small-cell lung carcinoma and treated with radiation therapy remains poor. The three-dimensional conformational radiotherapy aims to increase the dose of radiation at the tumor volume to increase the local control, while sparing the healthy tissue neighborhood. The reduction of the safety margins and the irradiated volumes obliges to determine with most acute precision the exact tumor volume. However, the scanner alone is insufficient, particularly at the mediastinal level and at a distance. The positron emission tomography allows distinguishing a biological tumor volume. It helps to define the lung tumor volume, especially when the tumor is accompanied by atelectasis, and to recover the lymph node staging at the mediastinal level and at a distance. Even if the sensibility and the specificity are not 100 %, positron emission tomography now becomes essential before considering an escalation of thoracic radiation dose.