Etude des troubles psychiatriques et des mécanismes de défense psychologiques dans une population d’hommes stériles consultant en Andrologie

Results

26.2% of this population presented psychiatric disorders according to DSM-IV with a significant over-representation of generalized anxiety disorder and somatization disorder. The comparison between azoospermic males and oligoazoospermic males demonstrate the absence of significant difference in terms of psychiatric morbidity rate and use of defense styles. This population used similar defense modalities to the general population and preferentially used defense mechanisms corresponding to the mature defense style, such as humor, repression and anticipation. Psychiatric illness was significantly correlated with preferential use of withdrawal, consumption, reaction formation and lack of humor. This study also confirmed that subjects who essentially using neurotic defense styles were more likely to develop psychiatric disorders.

Conclusion

No difference in psychological effects was observed according to the degree of sterility. On the other hand, the presence of an over-representation of psychiatric disorders in sterile males compared to a control group indicates that Consultation-Liaison psychiatrists and andrologists must try to understand the patient’s suffering beyond the need for artificial insemination. Patients should therefore be given an opportunity to express all of the feelings related to their personal and marital drama in the department in which they are treated, as part of specialized management. Our study confirms the difficulty of determining whether certain defense mechanisms constitute risk factors for psychiatric disorders or whether defense mechanisms are an epiphenomenon of a particular psychiatric disorder, which is why many authors using DSQ agree that additional prospective studies are necessary to investigate correlations between defense mechanisms and specific psychiatric disorders. It would be useful to investigate defensive modalities before the diagnosis of infertility and after birth of a child in a larger population. A better understanding of the defensive modalities used by this type of population, in a psychotherapeutic context, could help to prevent or at least predict the appearance of psychiatric disorders.     

Techniques d’imagerie de la cardiopathie ischémique : le point de vue du clinicien

Coronary angiography often remains an unavoidable gold standard in cardiology practice for determining the severity, extent and prognosis of coronary artery disease and for therapeutic decision making, although established non-invasive testing – such as myocardial perfusion imaging or stress echocardiography – have demonstrated their diagnostic value and their incremental pronostic value over coronary angiography. Newer noninvasive techniques, such as multidetector computed tomography and magnetic resonance imaging, are currently being validated and will very soon be considered as alternatives to these imaging modalities in clinical practice. Facing this wide choice of tests, the cardiology community has the difficult task to determine the role and place of these various investigating techniques and to evaluate their resource implications, in other words, to optimize the cost-efficacy and ratios in the management of coronary artery disease.     

Apport du TDM en imagerie multimodalité : le point de vue du physicien médical

The recent introduction of hybrid systems SPECT/CT and PET/CT in nuclear medicine, greatly improved the diagnostic accuracy for particular clinical indications, due to the possible attenuation correction of functional images and the availability of helpful anatomic information. The introduction of CT in the nuclear diagnostic process results in a significant increase of the patient dose. This increase should be justified and optimized considering both the clinical question and the CT settings available on these systems. The choice of CT settings directly affects the effective dose. It varies basically as the square of the tube voltage, linearly with the length of the scan and the product of the current by the rotation time of the tube. It is also inversely proportional to the pitch. For attenuation correction, the literature shows that it is possible to use a low CT tube current without significant effect on tumor FDG uptake or lesion size. Conversely low CT voltage must be used with caution, depending on the algorithm implemented in the CT hybrid device to transform CT Hounsfield units to the attenuation map at the appropriate energy. The radiation dose for anatomic correlation can be substantially lower than for diagnostic-quality CT. It is possible to reduce the patient's radiation dose by a factor of 2 or 3 by acquiring a low-dose PET/CT scan for anatomic correlation of adequate image quality if compared with diagnostic ¹⁸FDG PET/CT. Using specific CT settings, the effective dose can range 7.3–11.3 mSv depending on the patient weight and age.     

Aspects réglementaires et organisationnels de l’activité d’autoconservation. Le point de vue du juriste

At the present time, legal texts in application of bioethics laws only briefly mention cryopreservation. The conditions of cryopreservation differ according to the type of tissue stored: while cryopreservation of oocytes and ovarian tissue corresponds to the field of biomedical research, semen cryopreservation corresponds to medically assisted procreation. Cryopreservation activity is more clearly defined in the draft revision of the bioethics law. Concerning the cryoconservation of ovarian tissue and oocytes, these difficulties result in particular in this activity’s mixed nature. It is located indeed, halfway between research and care. These two spheres of medical activity are subjected to their own distinct and exclusive, and their application is conditioned by the qualification of the implemented act. However, this qualification is dubious here, because of, in particular, the impossibility of determining which acts of sampling, cryoconservation and use might be concerned with a research protocol. Concerning the cryoconservation of sperm, the texts, first of all, seem to assimilate the activity of cryoconservation within an activity of assisted medical procreation. However, such assimilation would be equivalent to the impossibility of its implementation, because of the difficulty of respecting all of the legal conditions of assisted medical procreation. However, another more favourable interpretation of the provisions seems to be possible. Taking into consideration these uncertainties, contradictions and difficulties, the legislator intervened and devoted, by the widening of the indications of assisted medical procreation, the activity of cryoconservation in the project of revision of the laws of bioethics. He however did not solve all the difficulties. These cryoconserved elements can be restored only to the depositor. Indeed, the texts make obstacle to a delivery for a third party of the cryoconserved sperm, whatever the moment. They can also be used. This use can consist of assisted medical procreation, which is the first finality of cryoconservation — but it could only be implemented in respect of the whole of the legal conditions. It seems that the cryoconserved elements could also be used within the framework of research, whatever its nature (biomedical or not) and the moment of its implementation (while the person is alive or after his death). Its implementation should however be subjected to prior agreement and expressed while the person, whose elements were preserved, is alive. Such a use is expressly made possible in the project of revision of the laws of bioethics. Following a partial use or a lack of such a use, the destruction of the cryoconserved elements can be considered, as well as the continuation of the cryoconservation. However, these hypotheses raise difficulties that have not yet been resolved in the draft revision of the bioethics law.     

Rôle du pathologiste dans la prise en charge et le diagnostic d’une infection osseuse

The diagnosis of a bone infection is sometimes made difficult when clinical signs and imaging are not typical. In these cases, the role of a pathologist is important since he makes the diagnosis and improves the management of the infection. The main histopathological features of a bone infection and its complications, as well as the involvement of a pathologist in this pathology, are described in this article.     

Longueur du chromosome Y,intelligence et comportement dans une population de médico-légaux

Summary The Y/F ratio was established in 128 mentally disordered offenders in a maximum security hospital. The 50 Y/F 0.90 subjects were compared with the 78 Y/F<0.90 subjects as regards intelligence and behaviour. With the exception of the highest frequency of intelligence quotients lower than 70 in the criminal patients Y/F 0.90, no statistical correlation exists to support the theory of a relation between a long Y chromosome and the type of psychiatric (psychopathy, psychosis) or criminality diagnosis.

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To whom offprint requests should be sent     

Les hommes de Néandertal du Caucase du Nord : entre l’Ouest et l’Est

A geographical position of the Caucasus in the border between Europe and Asia defines a complex character of the Middle Paleolithic in the region as a whole and in the Northern Caucasus in particular. Today, we can recognize three major cultural areas existed during the Middle Paleolithic in the Northern Caucasus: (1) a local North Caucasian variant of Eastern Micoquian, which is closely related to Eastern Micoquian of Central and Eastern Europe, in the Northwestern Caucasus; (2) a specific Caucasian industry type (called Khostinian Mousterian), which penetrated during later MIS 3 to the Northwestern Caucasus from the Northeastern Black sea cost in the Southern Caucasus; and (3) a similar to Zagros Mousterian industry, which is presented in Weasel Cave in the Northeastern Caucasus.     

Place de la tomographie d’émission de positons (TEP) pour l’évaluation thérapeutique et le suivi du cancer du sein

Positron emission tomography (PET) with fluorodeoxyglucose (FDG) is a nuclear imaging method whose interest in oncology has only grown over the past fifteen years. This article summarizes the results in monitoring and therapeutic evaluation of breast cancer. For the search of locoregional or distant recurrence, the performance of FDG-PET are very interesting. The impact of FDG-PET on the therapeutic management is undeniable. For therapeutic evaluation, this imaging is useful to evaluate the neoadjuvant chemotherapy and hormonotherapy efficacy. FDG-PET is indicated in cases of suspected recurrence (clinical, biological or imaging suspicious). It is the most sensitive exam for the detection of bone or visceral metastases. It allows the re-staging during a relapse proved whether local or remote, and can change the therapeutic management.     

Estimation du taux d’aneuploïdies des spermatozoïdes épididymaires prélevés en vue d’ICSI chez des hommes à caryotype normal

Over the last ten years, fluorescent in situ hybridization in decondensed sperm nuclei has been used to study the chromosomal constitution of human spermatozoa. Studies have estimated that the disomy rate per chromosomal pairs is between 0.15% and 0.3%. The aim of this study was to evaluate the aneuploidy rate of human epididymal spermatozoa extracted from five men with obstructive azoospermia undergoing IVF. Genetic studies (karyotypes, Y micodeletion syndrome and mutation of the CFTR gene) did not reveal any abnormality. Disomy frequencies were determined by X-Y-8 multicolour fluorescence in situ hybridisation on 18,013 epididymal spermatozoa and 20,000 spermatozoa from healthy donors (control group). No significant difference was found between epididymal and ejaculated samples. However, isolated non-significant differences were observed between one of the patients and the control group. In conclusion, the present findings suggests that there is no increased risk for de novo chromosomal aberrations after IVF therapy with epididymal spermatozoa of men with obstructive azoospermia.     

Préconditionnement laser en site osseux membraneux : mise au point d’un modèle d’étude

ObjectiveThe application of a supraphysiologic stress (preconditioning) prior to an injury induces cellular and tissular resistance on soft tissues. The aim of this study is to evaluate X-ray irradiated bone healing with and without laser preconditioning.Materials and methodsThe laser shot is defined to induce a controlled increase of the bone temperature. Then, bone healing is in vivo observed through the evolution of the vascularization process. Optical chambers implanted on the skull of 20 rabbits allow the weekly observation of bone vascular plexus during 12 weeks. An original image processing determines the vascular density (VD) on four groups: #1: control group (n = 5); #2: laser treatment (n = 5); #3: X-ray irradiation (n = 5); #4: laser preconditioning prior to X-ray irradiation (n = 5).ResultsPreconditioning is performed by a diode-laser (815 nm, 36 J/cm²). VD remains stable during the 12-week follow up for groups #1 and #2. X-ray radiation induces a significant decrease of the vascular network in groups #3 and #4 compared to the group #1 (p < 0.001). However, the decrease of the vascularization is limited in group #4 versus group #3 (p < 0.05).DiscussionThis in vivo original model reproducibly evaluates VD and the impact of different stresses on bone healing. Laser treatment is a controlled heating method, which preserves the vascular network of X-ray irradiated bone. This innovative approach promotes the bone healing in which the vascular supply has been damaged.     

Marqueurs de défense antioxydative modulés par le polymorphisme génétique de la glutathion S-transférase: résultats d’une étude cas-témoins du cancer du poumon

Oxidative stress and xenobiotic metabolizing enzymes are suspected to be related to carcinogenesis by different cellular mechanisms. Hence, our study aimed at identifying potential relationships between antioxidant defense parameters measured in blood and glutathione S-transferase (GST) genetic polymorphisms of four GST izoenzymes in lung cancer patients and reference individuals. The case-control study included 404 lung cancer patients and 410 non-cancer subjects as controls, matched by age, gender and place of living (central Poland). In control subjects with GSTM3*A/*A, GSTT1 null, GSTM1 null + GSTT1 null, GSTM3*A/*A + GSTT1 null genotype, glutathione peroxidase activity was significantly higher (P?0.05) than in controls possessing respective potential protective GST genotypes. Controls with GSTM3*A/*A + GSTP1*B genotype presented significantly higher ceruloplasmin activity (P?0.05) than GSTM3*B + GSTP1*A/*A carriers. Zinc level was significantly higher (P?0.05) in controls and cases with GSTP1*B + GSTT1 null genotype and in cases with GSTM1 null + GSTP1*B genotype, when compared with respective potential protective GST genotypes. This case-control study indicates that particular defective GST genotypes may enhance the defense against oxidative stress. The potential relationship between the investigated antioxidative enzymes and microelements, and common functional genetic polymorphism of GST was observed mostly in control subjects.     

Diagnostic et traitement du déficit en androgènes des patients infectés par le virus de l’immunodéficience humaine

Androgen deficiency is frequent among men infected by the human immune deficiency virus (HIV), with an estimated prevalence of between 35% and 50%. Primary testicular damage has been described, either due to the virus itself, opportunistic agents such as CMV,Toxoplasma gondii orMycobacterium avium intracellulare, or less frequently neoplastic invasion by lymphoma or in a context of Kaposi’s sarcoma. However, secondary hypogonadism remains a more frequent cause. Hypogonadotropic hypogonadism can be secondary to opportunistic infections, malnutrition, and sometimes even certain therapeutic agents. Since the introduction of highly active antiretroviral therapies, the prevalence of hypogonadism has substantially decreased. However, it remains a significant clinical problem, particularly among patients suffering from wasting, as androgen deficiency may aggravate the loss of lean body mass observed in the wasting syndrome of HIV patients. Screening for androgen deficiency is therefore indicated in HIV patients suffering from wasting, even in the absence of specific symptoms. Androgen replacement therapy is justified in symptomatic (loss of libido, impotence) and asymptomatic patients with documented hypogonadism. We recommend replacement therapy with testosterone by subcutaneous or intramuscular injection. In the absence of specific symptoms, it should be remembered that testosterone replacement therapy of HIV-infected hypogonadic patients is associated with improvements in body composition and muscle strength, bone densitometry, quality of life and mood. Similar improvements have also been demonstrated in hypogonadic patients with wasting syndrome. Synthetic testosterone analogues such as oxandrolone or nandrolone do not seem to be more powerful than testosterone at replacement doses, and may be associated with more side effects, particularly severe hepatic dysfunction. In contrast, there is no proven benefit of androgen treatment of eugonadic HIV-infected patients, and the treatment of such patients with androgens, even in the presence of wasting, cannot be recommended.     

Découverte d’une industrie du Paléolithique inférieur en bordure de la commune de Nice,au Vallon obscur à Saint-Isidore

An archaic lithic assemblage has just been brought to light in border of the municipality of Nice (Alpes-Maritimes, France), in secondary position in a geologic context of middle fluviatile terrace in left bank of the Var. Lithic artefacts collected gather some shaping products (worked or broken pebbles) and débitage products (cores, flakes, angular fragments), obtained on pebbles mainly in marly limestone, stemming from the local plio-Pleistocene conglomerate and the alluviums of the Var. This lithic production shows essentially the beginnings of chaînes opératoires, with the first phases of pebbles cortex removing. Flakes are very mainly cortical or semi-cortical, and cores reveal a weak technical investment, with a reduced enough number of removal negatives. The débitage of orthogonal type is the most frequent, and the bipolar technique on anvil is attested. Some rare flakes are retouched by notches or by abrupt continuous retouches. The sector where was brought to light this lithic industry, in sediments reshaped below a level of fluviatile terrace of the Var in 70 m of height, made us suggest a very ancient age for these vestiges, being able to go back up at the beginning of Middle Pleistocene, even of Lower Pleistocene, what is in agreement with the technical characteristics noticed on this lithic assemblage.     

Tumeurs du grêle et du côlon : importance de l’anatomie en coupes

The aim of this article is to describe the anatomic specificities of each different digestive tumors in CT imaging and to show the interest of contrast-enhanced CT and bowel opacification. Some specific points about lymph nodes of the abdomen and peritoneum anatomy will be discussed.