Physiopathologie des troubles de l’érection chez l’homme paraplégique

Peripheral mechanisms responsible for penile erection are dependant upon a complex control by the nervous system, including peripheral nervous pathways, spinally mediated reflex loops and supraspinal nervous structures. Spinal cord injury is accompanied by a partial or a complete modification of these controls. In relation to the reflexogenic or psychogenic origin of penile erection, spinal cord injury does not cause the same effects. Reflexogenic erections sitll occur after spinal cord injury at a suprasacral level. After lesions at a level lower than the thoracolumbar spinal cord, tumescence following psychogenic stimulation has been observed. The hypotheses resulting from clinical and experimental observations and explaining the differences at the origin of these response are detailed. The recent developments in the neurophysiology of penile erection and the role of neurotransmitters allow a more analytical approach of the phenomenous and also bring new insights into possible compensatory pathways following spinal cord injury.     

De l’origine des anthropoïdes à l’émergence de la famille humaine

The human lineage has a very ancient origin, as most of the mammals. Its oldest representatives, anthropoid primates, have been described from Asia some 45 million years ago. During this long evolutionary story, two critical stages have appeared as especially important, their beginning in Asia and the emergence of hominids in Africa, some seven million years ago. These two stages are discussed hereby with new data relative to their Asian origins and their dispersal into Africa between 45 and 40 million years ago. Following this dispersal event, these primates evolved in Africa and gave rise to the early hominids. These appeared around seven million years ago and have three distinct representatives. Among them, Toumaï appears as the oldest and the closest to our ancestry, a point that is evidenced here.     

Etiologie des infertilités secondaires de l’homme

Introduction

Secondary infertility is defined as the inability to achieve a new pregnancy for a couple that has been able to procreate in the past.

Material and methods

Over a 16-year period, 49 patients consulted for male secondary infertility. Clinical, laboratory or ultrasound assessment demonstrated the cause of infertility.

Results

These patients had a mean age of 33.6 years (range: 26 to 44 years). These couples had an average of 1 living child per family, corresponding to a girl in two-thirds of cases and a boy in one-third. In these patients, infertility was due to the presence of varicocele in 15 patients (31% of cases), infection in 14 patients (29%), and varicocele associated with infection in 11 cases (22%).

Conclusion

This assessment revealed two main aetiologies, but some causes remain obvious, such as surgery with resection of the prostate or testicles, or certain cytotoxic therapies.     

Importance de l’étape pré-analytique en spermiologie pour le diagnostic et l’évaluation des thérapeutiques

Semen analysis is subject to great variability, partly due to the mechanism of ejaculation. This variability can be reduced by taking certain precautions, such as interviewing the patient to eliminate any external factor of variability, by imposing a 3- to 5-day period of sexual abstinence, by explaining the procedures to avoid bacterial contamination of the sample, by verifying whether the whole semen sample has been collected, by checking that the temperature of the sample is maintained at 37°C and finally, by carefully homogenising the sample to obtain good quality liquefaction.     

Apport de l’imagerie radioisotopique dans l’artérite inflammatoire des gros vaisseaux

The group of large vessel vasculitis includes giant cell arthritis and Takayasu's disease. If monophotonic nuclear medicine can sometimes show some unusual patterns in these diseases, positron emission tomography with fluorodeoxyglucose seems have a special attract and provide some indications during the monitoring of these patients. However, most of these indications remain to be validated, specially to differentiate weak vascular wall inflammatory activities from physiological and/or atherosclerotic accumulation.     

Les carnivores fossiles des sables de l’Orléanais

Fossil Carnivora from “Orléanais” continental sands. All the fossil carnivora from Orleanais are dated to middle Miocene. They belong to Amphicyonidae (7 species and 6 genera), Ursidae (3 species, 3 genera), Mustelidae (13 species, 8 genera), Nimravidae (1 species, 1 genus), Viverridae (3 species, 2 genera) and Felidae (4 species, 2 genera).     

Intérêt de l’imagerie hybride TEMP-TDM dans l’exploration des infections

Single-Photon Emission Computed Tomography-Computerized Tomography (SPECT-CT) is a new hybrid technique which offers new diagnostical capabilities in daily nuclear medicine practice. This technique not only allows to acquire fusioned anatomic and functional images in the same time, but also, it increases sensitivity and accuracy of SPECT thanks to attenuation and scattering corrections got from transmission data. Until now, SPECT-CT data have been mainly obtained in oncology and cardiology, but now, many authors use it in many scan studies and particularly for infectious diseases. In inflammatory bowel diseases, SPECT-CT seems to increase diagnostical performances and to modify management of many patients. In suspected vascular sepsis, SPECT-CT could increase sensitivity of white blood cell scintigraphy but also its specificity thanks to spatial resolution of CT. In osteoarticular sepsis, SPECT-CT has the advantage to distinguish osteomyelitis from soft tissue infection and to guide biopsies. Nevertheless, in the light of PET-CT works, SPECT-CT development will probably modify nuclear medicine practice and many studies have to be conducted to highlight consensual procedure guidelines.     

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.     

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.     

L’insémination intrautérine dans l’éjaculation rétrograde. Importance du pH et de l’osmolarité sur la mobilité des spermatozoïdes

The effect of pH and osmolarity on motility of human spermatozoa in retrograde ejaculation was studied in a freshly voided urine specimen. The maximum rate of motility is obtained when the pH ranged from 7.0 to 7.5 and osmolarity from 300 to 400 m.osmol/Kg. Thus the control of these two parameters allowed us to improve sperm motility and to perform intrauterine insemination with ovarian hyperstimulation. The different causes of retrograde ejaculation in this study are diabetes, surgical injury and idiopathic. Fifty-one intrauterine insemination cycles were realized in twenty-three patients, and eleven pregnancies are obtained (21.5% per cycle).     

évaluation des pratiques professionnelles dans le cadre de l’accréditation des établissements psychiatriques

As regards evaluation of professionnal practices (EPP), Formep’s has decided to stay in the limits of psychiatric institutions, for reason of experience. Every medical doctor working in these institutions is concerned by evaluation, but also institutions in the specific framework of V2 44, 45 and 46 references. The EPP is multidisciplinary and involves everybody who takes part of patient caring. Formep’s is adviser, training agent, and partner. Follow-up takes place both on-site and off-site all along the EPP, by a team including psychiatrists, medical practitioners, quality and risk management engineers. They are all experienced to work in psychiatric institutions. Formep’s program includes preliminary and definitive choice of themes, putting methology is place, work of teams, initial analysis of results and deviations, further work of teams, final analysis, which purpose is to improve practices and therefore medical benefit.     

Régulation des fonctions de l’épithélium épididymaire des mammifères: état des lieux

Male gametes formed in the testis, the site of spermatogenesis, continue their maturation outside of the gonad in the genital tract. The epididymis is at the centre of this process of post-testicular maturation of spermatozoa, responsible for acquisition of their mobility and their ability to recognize and penetrate an oocyte, essential events for fertilization. During their transit in the epididymal ducts, gametes evolve in a perpetually changing luminal environment due to complex interactions of secretion and reabsorption activities of the epididymal epithelium. These numerous secretion and reabsorption activities are closely regulated in space and time, which makes this epididymal epithelium a very complex tissue subject to an elaborate network of cross-regulations. Apart from classical endocrine and paracrine regulations, the proximal part of the epididymis is also subject to lumicrine regulation by testicular factors which increase the complexity of the regulation networks involved. The present study tries to present an exhaustive review of the factors demonstrated in the literature to exert a modulation of epididymal activity.     

Intérêt potentiel des images paramétriques des temps d’éjection et de relaxation en tomoscintigraphie des cavités cardiaques dans l’évaluation des cardiopathies asynchrones

Intraleft dyssynchrony is strongly correlated to contractile dysfunction associated to severe heart failure. Dyssynchrony is also a predictive marker for cardiac resynchronization therapy response. We measured dyssynchrony values for both ventricles from gated blood pool SPECT images.Material and methodsThree groups of patients were sampled from normal patients (n = 7), mild heart failure patients (n = 24) and severe heart failure patients (n = 9). Time-derivative parametric images were obtained from 24-time bins gated blood pool SPECT data. We measured intraleft and interventricular contractile and relaxing dyssynchrony values from these images.ResultsIntraleft dispersions values linked to ventricular peak emptying rate were 107 ± 21 ms, 141 ± 58 ms and 515 ± 104 ms for each of the three groups. The values linked to left ventricular peak filling rate were 122 ± 62 ms, 219 ± 117 ms and 603 ± 164 ms respectively. Statistical significant differences (p < 0.01) were observed both for contractile and relaxing phases for severe heart failure patients. Mild heart failure patients had isolated statistical significant (p < 0.01) alterations of the ventricular relaxing phase. Correlation between isotopic dyssynchrony values and left ejection fraction led to a R square coefficient of 0.71 and 0.64 for time to peak emptying and to peak filling respectively. Correlation to QRS width values led to a R square coefficient of 0.76 and 0.62 respectively.ConclusionVentricular dyssynchrony correlated to the importance of the ventricular mechanical dysfunctions is a robust predictor of heart failure. Separate analysis of contractile and relaxing dyssynchrony may lead to a better understanding and characterization of the mechanical dysfunctions involved in heart failure.     

Criblage de nouveaux gènes cibles des récepteurs nucléairesdes oxystérols LXRs impliqués dans le maintien de l’épithélium épididymaire et la maturation des spermatozoïdes dans l’épididyme

Liver X receptors (LXRs) are involved in cholesterol homeostasis and lipid metabolism.Ixr knock-out mice for the two isoformsIxra andIxrb exhibit severe disruption of the structure of caput epididymidis segment 1 and 2 epithelium and increased sperm fragility. These defects generate infertility in 10-month-old male mice. The role of LXRs in the epididymis have not yet been investigated. A cell line obtained from mouse caput epididymidis (B2 cells) was used to screen for LXR epididymal target genesin vitro. The presence of one isoform of LXR (LXRα) was detected by immunocytochemistry and the capacity of B2 cells to respond to a synthetic agonist of LXRs (T0901317) was verified. These results validated the use of B2 cells as a model. Bidimensional electrophoresis was performed on B2 cells treated with T0901317. Eight proteins up-regulated by LXRs were isolated. Only one protein has been identified: polyubiquitin, which has already been reported to be involved in cellular cholesterol homeostasis.     

Diversité spécifique et évolution des groupements végétaux supra forestiers des Pyrenèes centrales

Summary Calculations of various diversity indices in seral meadow communities from the Central Pyrenees subalpine zone were based on quantitative vegetational analyses by the point quadrat method. Species richness (S) increased rapidly toward a maximum then decreased markedly with increasing maturation of the meadows. In contrast, equitability measured as the Pielou index first inereases gradualy and then remains on more or less the same level, while decreasing a little in older stages, if not accelered by over-grazing. Not surprisingly, Patten's redundancy measure exibits inverse variations. Since it encompasses both the number of species and the distribution of individuals over the species, the Shannon and Weaver index of diversity behaved in a manner intermediate between richness and evenness. In the two toposequences investigated, diversity and equitability variations were highly correlated with the occurence of monopolistic dominant species.

Nom des plantes suivant P. Fournier (1961) Les quatre flores de France.     

Validation du logiciel de semi-quantification DaTQUANT® dans l’aide à l’analyse visuelle en TEMP au 123I-FP-CIT dans l’étude des pathologies neurodégénératives

ObjectiveSemi-quantification is a valuable tool increasing the diagnosis accuracy of the single photon emission computer tomography (SPECT) with FP-CIT-¹²³I (DaTSCAN^®), particularly in cases where visual analysis is unclear and especially on the posterior putamen. The DaTQUANT^® software (GE^® Healthcare), allows a quick and simple uptake assessment on several regions of interest. It also provides deviation values compared to a database of healthy subjects obtained in the ENC-DAT project. However, any threshold value is currently validated routinely.Patients and methodsA retrospective study was conducted in 55 patients (33 men, 22 women) referred for a suspicion of neurological disorders and who underwent SPECT imaging with DaTSCAN^® on camera D670 GE^®. Final diagnosis made by neurologist time after the SPECT was established as a reference, reinforced by clinical evolution. Analysis was initially visual without semi-quantitative results, realized by two experimented nuclear physicians, and then semi-quantitative analysis was made by DaTQUANT^® with calculation of Youden indices and ROC curves so as to define threshold values for six regions of interest (caudate, putamen anterior, posterior putamen, bilaterally).ResultsInterobserver match in the blind visual analysis was excellent with kappa coefficient = 0.91, CI at 95% = [0.87–0.95]. The semi-quantitative and statistical analysis by DaTQUANT^® determined pathological threshold values for each region of interest, setting a standard deviation percentage from a database of healthy subjects, worth −16.3% for the right posterior putamen (sensitivity of 100% and specificity of 88%) and −18.3% for the left posterior putamen (sensitivity of 100% and specificity of 97%).ConclusionThe pathological threshold values defined by our study would improve the data analysis obtained from DaTQUANT^® software and would support the DaTSCAN^® visual analysis. Nevertheless, such statistical values are complementary to visual analysis.     

L’échographie Doppler dans le diagnostic des duplications gastriques chez l’enfant

Gastric duplication is a rare congenital gastrointestinal malformation responsible for abdominal pain and digestive disorders in children. When it is not discovered prenatally, it raises the problem of diagnosis of abdominal cystic mass leading to surgical excision with histological confirmation. We report 4 cases of gastric duplication diagnosed in children aged 11 days, 4 months, 6 years and 13 years of the pediatric imaging unit of the southern Teaching hospital of Rennes (France). Our goal is to emphasize on the role of medical imaging in particular the color Doppler ultrasound in the diagnosis and the monitoring of this uncommon disease of the child.