La part de l’analyse phénoménologique dans l’étude de cas singulier

We argue that clinical psychiatry oscillates between two epistemological poles: inference and perception. The inferential approach categorises illnesses bottom up, from visible symptoms to the pathological category supposedly causing them. In doing so, psychiatry moves away from the possible instantaneous perception of a patient, as well as from illness as a changing, evolving, phenomenon. From a phenomenological point of view, the perceptive approach enables the therapist, within an encounter, to experience the emergence of an impression of a patient’s overall bearing, or attitude. Thanks to épochè, a sense of form, Gestalt will emerge. The clinical case, nevertheless, is always a construction, an intersubjective narrative about illness, recounted by the patient. Creating a library of clinical cases leads to the development of case types, each becoming a reference to which future clinical cases can be compared and categorised as belonging to a clinical family; it is the participant with respect to Plato’s eidos. Phenomenology contributes to clinical experience in that it makes possible the link between perception and inference, between subjective experience and intersubjective narrative, and between person and case type.     

Armes de chasse dans l’Épipaléolithique du Caucase du Nord

The article is devoted to the traceological study of points and geometric microliths that are characteristic of the Epipaleolithic sites of the northwestern Caucasus and the Elbrus region. The regularities between the type of stone tools and their functional use are analyzed. Composite hunting weapons were effectively used in hunting a variety of ungulate herd animals. The composition of faunal assemblages largely depended of climatic and landscape conditions of the sites in different periods of the Late Glacial period: from the Oldest Dryas to the Pleistocene–Holocene transition. The proximity of lithic industries within a vast region in the North Caucasus, similar shapes of projectiles and lithic inserts into composite hunting weapons could be associated with active human movements, which are confirmed by the transportation of obsidian from the Elbrus region to the northwestern Caucasus and the transportation of high-quality flint from the west to the Elbrus region in the north-central Caucasus.     

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.     

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.     

Évaluation de l’exposition des travailleurs du service de radioimmunoanalyse du Bénin aux rayonnements ionisants de l’iode 125

Occupational radiation dose of staff handling ¹²⁵I assessment at the Benin radioimmunoassay laboratory, have been undertaken from October 2012 to April 2013 to determine level of radiation safety. Equivalent dose to skin, whole body and extremities, were measured by the mean of thermoluminescence dosimetry. Firstly, three permanent workers and two students were provided with finger ring dosimeters to wear at index finger base of both hands. Ring dosimeters were used for four months. Secondly, three permanent workers and three students were provided with badge dosimeters to wear at the chest level. Badge dosimeters were renewed monthly for six months. The exposed ring and badge dosimeters were evaluated in Ghana. Permanent workers highest average equivalent dose received at index finger base of both hands was 142.75 ± 89.54, microSV/2 months and that of students was 34.69 ± 29.23, microSV/2 months. Workers skin exposure was below one third of prescribed dose limits for permanents workers (500mSv/yr) and students (150mSv/yr). Whole body exposure, expressed in mSv/month, of permanent workers and students, respectively ranged from 0.12 to 0.23 and from 0.11 to 0.16. Radio-immuno-assay laboratory workers are weakly exposed to ionizing radiation. They are safe from deterministic effect risk.     

Diagnostic de l’embolie pulmonaire chez la femme enceinte : apport de la scintigraphie. Étude rétrospective à propos de 116 cas

IntroductionPulmonary embolism during pregnancy is a leading cause of maternal mortality. The aim of our study was to evaluate pregnant women with suspected pulmonary embolism prevalence of lesions on the lung perfusion as well as the relationship between the parenchymal lesions and various clinical factors and biological risk.MethodsThis is a retrospective study of 116 pregnant patients referred for suspected pulmonary embolism. The median age was 30 years, ranging from 15 to 47 years and the median gestational term was 31 weeks with a range of 12 to 40 weeks. Suspicion of pulmonary embolism was established with the presence of clinical signs (dyspnea, chest pain and palpitations). No patient had received a chest radiograph. The patients underwent planar perfusion scintigraphy with injected activity of 40 to 50 MBq of macroaggregates of human albumin (MAA) labeled with 99mTc. The scintigraphic results were classified according to the PIOPED criteria, depending on the likelihood of EP. The scans with low or intermediate probability were included in the same group, that of indeterminate results.ResultsThe scan was positive (with high probability) in 16 patients (13.8%), normal in 78 patients (67.2%) and classified as inconclusive in 22 patients (18.9%). In 16 patients with a positive scan, the lesions were interested the left lung in 10 cases (62.5%), the right lung in 1 case (6.25%) and were bilateral in 5 cases (31.25%).ConclusionsIn cases of suspected pulmonary embolism in a pregnant woman, the choice of imaging technique depends on both its diagnostic value and also its adverse effects. Lung scintigraphy is the examination to be carried out first in pregnant women with a chest radiograph. In others, it is that angiography should be performed as first line.     

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.     

Étude CESAR : justification de l’assistance respiratoire extra corporelle pour les graves syndromes de détresse respiratoire de l’adulte

BackgroundSevere acute respiratory failure in adults still has a high mortality in adults despite improvements in ventilation techniques and other treatments. The evidence about the effectiveness of extracorporeal membrane oxygenation (ECMO) was equivocal.MethodNational multi-center pragmatic randomized controlled trial. 180 adults (18-65 years) with severe (Murray score > 3.0 or pH < 7.2) but potentially reversible respiratory failure were randomized to receive either continued conventional management (CM) or to be transferred to Glenfield Hospital, Leicester, UK for consideration of ECMO. Patients were excluded if they had been on high pressure (> 30 cm H₂O of peak inspiratory pressure) and/or high FiO₂ (> 0.8) ventilation for > 7 days; had signs of intra-cranial bleeding ; had any other contra-indication to limited heparinisation ; or had any contra-indication to continuation of active treatment. The primary outcome measure was death or severe disability at six months. Analysis was by intention to treat.Results766 patients were screened. 180 were randomised; 90 to the ECMO arm of whom 68 received ECMO. No cm patients received ECMO. Fewer patients in the ECMO arm than the cm arm had died or were severely disabled 6 months after randomisation, (33/90 (36.7%) vs 46/87 (52.9%) ; RR=0.69 (95%CI 0.50 to 0.97) ; p=0.030). Only one patient (in the cm arm) was known to be severely disabled at 6 months.Randomised controlled trial and economic evaluationControlled Trial of Conventional Ventilatory Support vs Extracorporeal Membrane Oxygenation for Severe Adult Respiratory Failure (CESAR) [ISRCTN47279827].     

Les enjeux de l’intégration de l’automate d’immunohématologie AutoVue d’Ortho-Clinical Diagnostics au sein du laboratoire

Evaluation des critères de sécurité, productivité et conformité à la réglementation. L’automatisation de la paillasse d’immuno-hématologie au laboratoire est une démarche dont l’objectif est d’optimiser les contraintes organisationnelles et économiques tout en préservant la qualité des résultats par l’utilisation des techniques analytiques de référence dans un cadre sécuritaire et réglementaire de haut niveau.     

Inventaire préliminaire du genre Andrena (Hymenoptera : Apoidea,Andrenidae) de quelques localités sahariennes de l’est de l’Algérie

Notre étude menée durant les années 2008, 2009, 2011, 2012 et 2013 sur le genre Andrena (Hymenoptera : Apoidea, Andrenidae) dans la région saharienne de l’Algérie orientale, a permis de dégager une liste d’espèces. La localité d’El Oued est prospectée pour la première fois et 383 spécimens ont été collectés (82 mâles, 301 femelles). On dénombre 30 espèces. La phénologie et les choix floraux sont aussi étudiés.     

Contribution à l’étude du Middle Stone Age (MSA) d’Afrique Centrale. Étude typo-technologique des industries lithiques du site préhistorique de Mpila,Brazzaville, République du Congo

The discovery of the prehistoric deposits of Brazzaville is the result of urban development works known as “Major Works” during the years 1930: The construction of the railway (C.F.C.O.), the railway station, the river port, the post office and the cathedral. During the earthworks related to the construction of the river port, Babet, geologist of the Mining Service of the A.E.F. Government, discovers traces of an important lithic in the gravels of a geological layer. Further research by Droux and Bergeaud in 1936 and 1937 revealed the existence of two more archaeological layers in the same area. Depending on the evolution of the works and research, the following sites have been discovered: Mpila 1, Mpila 2, Mpila 3, Plaine and Pointe Hollandaise. All these sites are grouped under the name of Mpila sites. They are characterized by the same stratigraphy and by identical and successive industries. From bottom to top, one can observe the A layer with two levels, upper and lower, corresponding to the lower Paleolithic. Then we have the B layer which constitutes the fourth layer c.4 favorite of Bergeaud. It contains fresh material attributed to Sangoen. Finally, there is the c layer that we have named “The Bulk” of Mpila, which includes artefacts of very advanced workmanship. It's Lupembien/Tshitolian. All the artefacts from these levels are in situ. They were not been transported or reworked, neither horizontally or vertically. The Sangoen question has long been the subject of much discussion and contradiction. We are trying to clarify this controversy by asking ourselves whether the Mpila 1 in general and the c.4 in particular have any Sangoen characteristics.     

Alcide d’Orbigny,un précurseur dans l’étude de la faune du Danien du bassin de Paris

One of the major contributions of Alcide d’Orbigny to palaeontology is his work on the Danian of the Paris Basin. The Danian material includes well-preserved external imprints of Invertebrates. By making casting of these imprints, Alcide d’Orbigny inaugurated an original technique, which enabled him to describe more than 40 species. The question of the age of the Danian localities has long been debated since that time. It was settled once and for all in the seventies by micropalaeontologists.     

Étude de l’expression de LAT-1 et de la fixation de la 18F-FDOPA dans les tumeurs cérébrales. Illustration par une série de cas

IntroductionPET imaging of amino acid analogues, in particular with ¹⁸F-FDOPA, is increasingly used for the diagnosis and post-therapeutic evaluation of brain tumors. The mechanism of ¹⁸F-FDOPA uptake in brain tumors is still debated in the literature, the main hypothesis being uptake via L-amino-transporter 1 (LAT-1).MethodWe present 4 cases of patients with primary or secondary brain lesions who underwent ¹⁸F-FDOPA PET/CT or PET/MRI for the evaluation of suspected tumor recurrence and who underwent surgical removal with immunostaining labeling of LAT-1 transporters within 3 months. For each of these patients, a correspondence between semi-quantitative PET parameters (SUVmax, TBRmax and TSRmax) and anatomopathological characteristics was performed.ResultsAll patients had a significant and intense tumor uptake on ¹⁸F-FDOPA PET. In contrast, the expression level of LAT-1 receptors was very variable from one patient to another (LAT-1 score ranging from 0 to 193).ConclusionThis article reflects the persistent questioning of the link between the LAT-1 receptor and the uptake intensity on ¹⁸F-FDOPA PET, especially in patients who have received a first line of treatment.