Syndrome de Klinefelter et AMP à l’aube de l’an 2000

Material and Methods

The patient is a 33 year old male, with a 47, XXY karyotype (cytogenetical investigation of 16 metaphases). Semen analysis revealed a severe oligozoospermia. (spermatozoa ?1×106/mL) and asthenozoospermia (60% of decreased motiliy), for an ejaculate volume of 1.8mL. Three-colourIn Situ Hybridization was performed on spermatozoa recovered from his cryopreserved semen, in order to simultaneously detect the chromosome X, Y and one with specific appropriate probes. Semen from two 23 year old men were also analyzed as controls.

Results

502 spermatozoa were analyzed from the patient and about 10,000 from the controls. There was an increase of about ten times of the percentage of hyperhaploïd (24XY) spermatozoa in the semen of the Klinefelter patient compared to the controls.

Discussion and conlustion

In a general view of IVF-ICSI practice in Klinefelter patients, we also discuss here several practical points such as (i) is there any morphological criteria which may prevent from injecting an aneuploid spermatozoa, (ii) is the risk of aneuploidy higher when using testicular spermatozoa than when using ejaculated spermatozoa, (iii) what do we know about the offspring obtained by IVF-ICSI in Klinefelter patients and (iv) when should prenatal and/or preimplantatory genetical diagnosisbe proposed in this particular context.     

Aspects cliniques et biologiques de l’azoospermie chez l’homme infertile en Tunisie

Objective

It is now very important to investigate azoospermia because the introduction of the intracytoplasmic sperm injection technique during the last decade has allowed many infertile men to achieve their dreams of fatherhood. The purpose of this study was to define the characteristics of infertile men with azoospermia, and to analyse the clinical and laboratory features and the causes of infertility in Tunisia. The authors also discuss various aspects that they consider to be very important in the diagnosis of male fertility.

Material and Methods

This retrospective study analysed the parameters of physical examination, laboratory tests, semen analysis, radiographic examinations, testicular biopsy, karyotype and AZF microdeletions.

Results

Based on the results of endocrinological and cytogenetic examinations, the aetiology of azoospermia was considered to be secretory in 43 cases of azoospermia. Physical examination revealed a high percentage of hypotrophic/atrophic testes (43.9%). Serum follicle stimulating hormone levels were high in 58.5% of cases. The overall incidence of chromosomal abnormalities was 31.4%. The most frequent anomaly was Klinefelter syndrome (9 cases). Seven out of 28 patients (25%) with nonobstructive azoospermia had AZF deletions. None of the patients with excretory azoospermia and severe oligospermia had an abnormal karyotype or AZF microdeletions. 48.8% of patients presented a varicocele, 13.9% had cryptorchidism and 13.0% had a history of genital tract infection.

Conclusion

In line with the literature, genetic abmormalities are the main causes of severe forms of impaired spermatogenesis in the Tunisian population.     

Risques et valorisation des insectes dans l’alimentation humaine et animale

In a context of dwindling lands and resources, associated with a strong dependence on protein for feed and food, new methods of production and/or new food must be developed without affecting the quality of food, natural habitat and biodiversity of animal and vegetable species. As such, insects appear more and more as a solution of the future. To date, the consumption of insects is indicated by the term “entomophagy”, from the Ancient Greek “entomos” meaning insect and “phagos” meaning food. In such a context, a global evaluation of entomophagy seems essential before allowing the introduction of this practice in animal and human feed. Firstly, through this review, elements concerning the potentialities of insect valorization and their nutritional qualities will be brought. Secondly, the environmental impact of such a practice as well as the biological, chemical, physical or sanitary risks and even the potential presence of allergens and antinutritional factors will be approached. Thirdly, a review of the current European regulations will be proposed. Finally, reflections will be brought on the economic perspectives of entomophagy.     

Le BNP dans l’exploration de l’insuffisance cardiaque et le syndrome coronarien aigu

Le BNP, ou “Brain Natriuretic Peptide”, initialement mis en évidence au niveau de l’encéphale de porc, est aujourd’hui renommé “B-type natriuretic peptide” en raison de l’origine myocardique chez l’homme. Sa synthèse, principalement réalisée au niveau du ventricule gauche, à partir d’une pro-hormone, le Pro-BNP, est liée à l’état d’étirement de la paroi ventriculaire.     

Personnages dans l’art saharien : le réel et l’imaginé

In the Sahara, wherever there are naked rock surfaces, engravings and paintings have been found in large numbers. This rock art includes various types of images — the oldest dating about ten millenniums — among which human beings, wild or domesticated animals, therianthrops and non-explicit images can be identified. According to periods and styles, the human being has been represented under extremely varied aspects from particularly realistic — similar to the reality — till very simplified, even caricatural drawings. For some realistic representations of women and men, we can observe anatomical or morphological peculiarities which, without being frequent, show cases of steatopygy and gynoïd or androïd obesity, pathological or not. For certain periods, we also find imaginary, fantastic or caricatural representations. These images characterize particularly styles previous to that called “Round Heads”. So, in the Saharan art, the human being has been represented either in his physical truth, or according to multiple stylistic conventions or graphic stereotypes, which could characterize certain ethnic groups.     

L’intersubjectif et l’intrasubjectif dans l’expérience de souffrance. Un regard psychanalytique

Psychoanalysis characterises subjectivity as a notion based on the “plurality of psychologically troubled persons”, revealed, for instance, in dreams. The author takes a closer look at a number of Freud’s dream analyses and argues that, in working with the dream, subjects often eject one of their psychologically troubled persons (often the “suffering child”) out of themselves, projecting the person into the Other. As a result, an intersubjective space is created, which is required to receive the divisions originating from the intrasubjective space. Freud’s 1895 Project, however, goes farther: the evacuation of the “disparate part” of the child to the Other grants access to logical and rational judgement, guaranteeing a child’s psychological life a fictional stability (the “Thing” or the “ego”). Freud adds that this process is possible if a Nebenmensch — or “fellow creature” — is present and has the quality of a “helping person” capable of receiving the child’s suffering cry. These two lines of thought, together, help clarify the intersubjective position underlying the analytical work: a tentative encounter between the patient’s distress and the analyst’s presence. Free-floating attention will enable the analyst to receive and hear this distress and ease the patient’s recovery of his or her intrasubjective space.     

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.     

Facteurs psychologiques et conjugaux de l’impuissance: Toujours d’actualite

Although many cases of impotence are associated with “hidden” organic lesions undetectable by normal clinical assessment, and only detectable by paraclinical examination, it is obvious that interactions between psychological and factors often prevail in such cases. The paper describes the main psychological factors implicated in impotence, as well as recent data wich start to provide an explanation of the mechanisms by which psychological factors perturb sexuality. At the peripheral level, stress-induced sympathetic hyperactivity probably inhibits erection by causing contraction of the cavernosal smooth muscle. At a central level, animal experimentation and results from the pharmacological treatment of human impotence, suggest that psychological factors might inhibit sexual drive, and perhaps erection, through α 2—adrenergic receptors and the hypersecretion of endogenous opioids. These data open some highly stimulating pharmacological pespectives.     

Comment l’externalisation remodèle l’industrie de l’instrumentation

On estime que le marché global de l’externalisation des dispositifs médicaux et de l’instrumentation représente actuellement plus de 6 milliards d’euros. D’après les cadres dirigeants de l’industrie, cette tendance devrait non seulement se poursuivre, mais aussi s’amplifier dans les années à venir.     

Le Gravettien et l’Épigravettien de l’Est de la Roumanie : une réévaluation

Opening towards the eastern steppe landmass, the Eastern Romania area covers 87,500 km², and shelters the biggest number of Gravettian and Epigravettian sites currently known. Archaeological researches in the area expanded in the 1950's, during the construction of dams on the Prut and Bistrița valleys. The efforts of the multidisciplinary teams involved and the subsequently published papers highlighted the archaeological potential of the region and, with some inevitable interruptions, investigations continued to this day. Although the time and resources spent were not modest, the outcomes regarding the Upper Palaeolithic cultural sequence often proved contradictory and somehow distant from the general European cultural dynamic. Thus, this reassessment tries to put the chronological, palaeoenvironmental, and empirical data in a more coherent framework. A synthesis of the available Gravettian and Epigravettian data east of the Carpathians reveals the following sequence: (1) an Aurignacian stage on the Prut Valley, paralleled by an indefinite Upper Palaeolithic stage, from sites on the Bistrița Valley, between 31 and 28 ka (uncal BP); (2) a quite early Gravettian presence, roughly between 27 and 25.5 ka, which includes backed laminar blanks, schematic decoration of one pendant, and the use of perforated shells as adornments; (3) a scant shouldered points stage, chronologically close to the European similar phases (25–23 ka), for which the feeble use of obsidian points toward contacts with Central European resources/populations; (4) a Gravettian/Epigravettian interface, between 21 and 19 ka, manifested within numerous archaeological layers, mainly through an increase in bladelets and organic artefacts production/use; (5) an Epigravettian stage, between 18 and 16 ka, largely defined through an upturn in raw material choices, backed implements production, and tool types; (6) one last, roughly 14 ka old Epigravettian stage, in which the technological choices recalled those of the previous one. Regional variability elements and radiocarbon chronology limitations considered, apparently, the Gravettian and the Epigravettian of Eastern Romania share quite a lot of traits with the corresponding Central and Eastern European technocomplexes.     

Cryptorchidie: influence sur la fertilité de l’âge au moment de l’orchidopexie, du siège et de la taille du testicule et de l’existence d’anomalies épididymaires

Despite surgical treatment, cryptorchidism is the most common cause of infertility. Through a literature review, the authors report current data on the influence of age at the time of orchidopexy, testicular size, the position of the testis, and the existence of epididymal anomalies on fertility.     

Diagnostic, traitement et surveillance de l’hypogonadisme de survenue tardive chez l’homme: Recommandations officielles de l’International Society for the Study of the Aging Male (ISSAM) et commentaires

There is increasing interest in the subject of hormone changes in the aging male, which is likely to become particularly important with the expected growth in the population of men over 50. The main concerns at present are androgen decline in the aging male (ADAM), or partial androgen deficiency of the aging male (PADAM), commonly known as the andropause. Although progress has been made in our knowledge of androgen deficiency in the aging male, it is still incomplete and sometimes confusing, and some aspects of androgen replacement therapy remain controversial. The International Society for the Study of the Aging Male (ISSAM) therefore felt it was a good time to review the current situation by publishing a series of practical and official guidelines concerning the diagnosis, treatment and monitoring of late-onset hypogonadism in males. The aim of this study is to present and discuss the French translation of these recent international guidelines.     

Les thérapies comportementales et cognitives, l’épicurisme et le stoïcisme

This article aims to show that philosophy, particularly Epicureanism and Stoicism, had an essentially therapeutic role in antiquity — the various schools of philosophy dispensing specific teachings aimed at treating mental suffering, in a precise place (the scholé), with a master and a specified methodology. Of course, it may seem anachronistic to try and compare a modern, progressive and proven therapeutic method such as cognitive behavioural therapy (CBT, TCC in French) with a frequently dogmatic, 2000-year-old school of philosophy. And yet, the difference is not as clear-cut as we might think, since the two have much in common, such as similar kinds of suffering, a referent (or therapist), common methods (language, reasoning) and a common goal (peace of mind). We therefore intend to try and synthesise the meeting points and also the differences between two main schools of antique philosophy and CBT.     

Acquérir l’ivoire vrai et lui donner forme : contraintes pratiques et techniques

Dealing with objects made on osseous materials as mammoth ivory involves questions about the availability of this raw material within the territories occupied by palaeolithic societies. In the case of green ivory procurement, this availability is directly linked with the geographical distribution of mammoth populations. The ways of procurement of this raw material seem to be guided also by some cultural traditions. The authors propose a reflexion about these zooarchaeological issues and the first technical gestures, which come in the initial stages of any exploitation of true ivory.     

Les relations entre l’Extrême-Orient eurasien et le nord de l’archipel du Japon au Paléolithique

The aim of this paper is to present a review of current knowledge concerning the Paleolithic records and the related natural environmental setting in the Eurasian Far East and Hokkaido, located at the northern tip of the Japanese islands. At present, it is quite difficult to answer whether the archaic humans dispersed from Siberia and northern China across the Amur River basin and Sakhalin into Hokkaido or not, because there is no reliable evidence indicating the Lower and Middle Paleolithic in Hokkaido. We demonstrate that the Upper Paleolithic assemblages in Hokkaido can be divided into at least three phases such as the early Upper Paleolithic (EUP), the middle Upper Paleolithic (MUP), and the late Upper Paleolithic (LUP), based on a synthesis of available radiocarbon dates and the techno-typological characteristics of lithic assemblages. It is reasonable to suggest that the lithic assemblage from the Rubenosawa site, located in northern Hokkaido, and some of lithic assemblages at the transition from the Middle to Upper Paleolithic or the initial Upper Paleolithic (IUP) in Siberia share the relative similarities of techno-typological attributes in the reduction sequences, although the reliable radiocarbon dates have not been obtained from the Rubenosawa site unfortunately. Also, the emergence of microblade technology at the MUP in Hokkaido, such as represented by the microblade assemblage recovered from the Kashiwadai-1 site, central Hokkaido, indicates a close interaction between the Eurasian Far East and Hokkaido. As a result, the comparison of archaeological evidence in these regions provides us with a suggestion that the appearance and development of the Upper Paleolithic assemblages in Hokkaido were sometimes associated with the human dispersions and the mutual contacts crossing between the Eurasian Far East and Hokkaido.     

Testostérone et contrôle central de l’érection

Testosterone orchestrates the perinatal organization and activation of cerebral and spinal neuronal structures involved in the expression of male sexual behaviour in adults. The present review briefly describes testosterone effects in the regulation of sexual motivation and erection, as well as the genetic models developed to date in order to unravel its central mechanisms of action.     

Prevention de l’infertilite d’origine infectieuse chez l’adolescent

Some causes of infertility can be prevented, as is the case for infertility of infectious origin. Genital infections represent a major source of infertility. Prostato-epididymitis consecutive to an urinary infection can be prevented by identifying and treating prostatic localizations at an early stage of urinary infection. The prevention of sexually transmitted diseases (STD), which cause male and female infertility, is, at the moment, accomplished by the prevention of the sexual transmission of the HIV. Teenagers represent a target of choice for the educational campaigns promoting condom use. The role of physicians, especially when teenagers are asking for a contraception, must be complementary to the public health campaign to decrease the spread of HIV and other STDs.