Ectopie testiculaire croisée: à propos d’un cas

Crossed testicular ectopia, also called transverse testicular ectopia, is an uncommon congenital anomaly in which both testes migrate through a single inguinal canal toward the same hemiscrotum. More than 100 cases have been reported in the literature. This rare syndrome is commonly associated with abnormalities of genitourinary development, especially inguinal hernia and defective Müllerian regression. A conservative approach is recommended, now performed via laparoscopy. Long-term follow-up is required for assessment of fertility and early detection of testicular malignancy. The authors report a new case of crossed testicular ectopia in a 4-year-old boy who presented with right inguinal hernia and impalpable left testis.     

La collection d’Invertébrés fossiles d’Alcide d’Orbigny et la salle d’Orbigny

Fossil invertebrates collected or received by Alcide d’Orbigny, all his life long, have been brought together in a renowned collection that is very rich in terms of both species and specimens. The collection has resulted from a huge palaeontological work. Study of faunas from numerous French sites led Alcide d’Orbigny to do biostratigraphical comparisons and to erect geological stages, the definitions of which rest on their stratotypes. His wide knowledge of European fossil faunas was strengthened by a more global palaeobiogeographical view derived from his travel in South America. The d’Orbigny collection is housed in the ‘Muséum’ of Paris and is often visited by experts.     

Hommage à rené delépine à l'occasion de son départ à la retraite

A tribute to René Delépine on the occasion of his retirement. The career of René Delépine is reviewed on the occasion of his retirement. When he was a student, a meeting with Jean Feldmann led to a lifelong inclination towards phycology. Eventually appointed to the position of assistant professor at the University of Paris-VI (University Pierre-et-Marie-Curie), René Delépine worked and published primarily on the taxonomy of antarctic and subantarctic marine algae but he was also interested in seaweed aquaculture and utilizations. After organizing the national colloque ValVA (Valorisation des végétaux aquatiques), he became increasingly involved in the commercial application of seaweeds. His main activity, however, remained university teaching for which he was always enthusiastic, especially for teaching in the field and on the subject of the utilizations of algae. A list of his publications is given at the end of this article.     

La biodiversité entomologique comme source d’aliments à Kinshasa (République démocratique du Congo)

L’exploitation des produits forestiers non ligneux dont notamment les insectes comestibles jouent un rôle important dans les habitudes alimentaires et économies locales des populations autochtones du bassin du Congo. Bien que la consommation d’insectes en République Démocratique du Congo soit une pratique ancienne, l’inventaire et l’identification taxonomique des espèces consommées ainsi que la caractérisation de la filière « entomophagie » sont encore mal maitrisés. Toutefois, nos études axées sur la ville de Kinshasa ont permis d’inventorier 14 espèces comestibles régulièrement consommées. Elles appartiennent à l’ordre des Lépidoptères (46,7%), des Isoptères (18,6%), des Orthoptères (17,6%), des Coléoptères (9,7%) et des Hyménoptères (3,7%). De façon générale, 80% de la population de Kinshasa consomment au minimum une espèce d’insecte 5 jours par mois avec des quantités variant de 66,4 à 154 g d’insectes par personne par jour en fonction des différents ordres. Les acteurs de la filière sont majoritairement des femmes. Les revenus générés par l’activité concourent au bien-être des ménages, à la réduction de la pauvreté et de l’insécurité alimentaire dans de la capitale Kinshasa.     

La contribution de la pensée d’Alfred Kraus à l’étude phénoménologique des troubles bipolaires

German psychiatry is one of the areas where we see the development of an unconventional psychiatry, characterized by its reference to philosophical traditions that are remote from the natural sciences, and by its emphasis on the overall nature of the mentally ill person. This approach first emerged during the period of comprehensive psychiatry promoted by Karl Jaspers and Kurt Schneider. This particular form of psychopathology focuses its attention on the inner experience of the ill person and attempts to understand it, in particular through empathy. This approach was soon reinforced by a philosophical method founded by Husserl and further developed by Heidegger: phenomenology. Firstly, this consists of a way of approaching and examining the discrete elements of consciousness, leading to the notion of intentionality (Brentano, Husserl). The central place of consciousness in this approach leads to the questioning of existence and of the person supporting this consciousness: this philosophy thus leads to existentialism (Jaspers, Sartre) and Heidegger’s concept of Dasein (the existential analytic, Dasein’s ontology). Phenomenological psychiatry is thus a clinical science characterized by its approach and its reference to what might overall be described as comprehensive anthropology. There are numerous authors who affiliate themselves with this phenomenological psychology. Our article is devoted to Alfred Kraus’s approach. We will first of all address the notions of comprehensive psychiatry and phenomenology. After introducing Alfred Kraus and the specific philosophical and clinical foundations of his work, we will examine the Krausian theory of identity based on Mead and Sartre, which establishes a distinction between ego-subject (a free element that produces ego achievements) and ego-object (identifications, in particular with social roles in the case of depressives). The ego-subject is the transcendent element (Sartre), which constantly exceeds what I am (ego-object) and there is thus an internal negativity. We will then address the clinical concept of manic-depressive illness. The identity structure of the depressive is characterized by hyper-identification. The notion of psychotic breakdown will then be covered, where it appears that melancholia is not an affective disorder, a mood disorder, but a case of depersonalisation. The personality disorder which precedes melancholia results from a threat that weighs on this fragile identity propped up against its identifications, which is expressed in hypernomic behaviour: this being a reinterpretation of the notions of a specifically depressive temperament, constitution, premorbid personality or typus melancholicus. Hypernomic behaviour is characterized by the scrupulous observance of role expectations and an extreme respect for laws and norms which is expressed as a form of hyperadaptation. Finally, the last part is devoted to the intolerance of ambiguity, which can be cognitive or emotional (the inability to experience negative feelings).     

Le développement de l’inventaire de dépistage ERIraos: un outil global d’appréciation du risque d’évolution psychotique

Adequate identification of patients for early intervention programmes requires reliable and valid assessment tools. Within the German Schizophrenia Network (Kompetenznetz Schizophrenie) a set of schedules for early detection of schizophrenia has been proposed: the Early Recognition Inventory ERIraos. ERIraos is a two-step procedure with a 17-item checklist used at step 1 by GPs, psychologists, teachers, while a comprehensive 110-item symptom list is applied at early intervention centres at the expert level. In addition, ERIraos allows the assessment of several risk factors for psychosis such as familial load, childhood deficiencies, alcohol and drug use by special modules. Some preliminary results are presented here. The frequency of the 17 checklist symptoms increases from the early to the late prodrome, and more specific symptoms occur over time. The 17 checklist symptoms are grouped by factor analysis to 5 factors (psychotic, depressive, disorganised, withdrawn, dysphoric). In addition to prodromal symptoms, most patients (86.2%) report at least one additional risk factor (mean: 1.7 risks). 68% demonstrate some schizotypal features, 53% report alcohol and/or drug consumption, 24% demonstrate some deficiency or delay in childhood development, 21% report definite obstetric or birth complications, and 10% have a family history of schizophrenia or some schizophrenia-like diagnosis in first degree relatives. So far, the results are of a preliminary nature, and when sufficient information on psychotic transitions is available, the predictive value of ERIraos will be determined.     

Les travaux micropaléontologiques d’Alcide d’Orbigny

D’Orbigny has created the order of Foraminifera for minute animals classed, at this time, amongst Cephalopoda, and proposed the first classification of this order in 1826, laying the foundations of micropalaeontology. All along his life, he described, figured or clarified diagnosis of about 1500 recent and fossil species. His collections, stored in the National Museum of Natural History in Paris, represent an inestimable patrimony and are still actively consulted. Several micropalaeontologists had contributed to their valorisation and recognised the validity of most of his species. Nowadays, one hundred and two are considered as type species of genera.     

Essai d’archéologie expérimentale pour la production de perles à perforation double aurignaciennes

The small double perforated ivory beads are an important category of finds in the southwestern Germany during the Aurignacian. Thanks to his long experience in working with prehistoric lithic tools, the author tried to produce experimentally these tiny jewels being as close as possible to the archaeological pieces.     

Aspects éthiques des prélèvements d’organes à coeur arrêté

Medical progress in organ preservation during cardiopulmonary resuscitation allow to obtain organ for transplantation in patients suffering from a cardiac arrest. The different theoretical situations have been summarized in an international classification (Maastricht classification). In France, the fact that patients deceased after a phase of withholding/withdrawing active therapies in intensive care (Maastricht class III) are specifically excluded from this discussion represent an ethical safeguard for the public and the health-care providers. Ethically, in cardiac arrest patients, there is a will of maintaining a clear distinction between the care of the patients for therapeutic purposes for the patient (that cannot lead to an organ withdrawal except for the specific case of a secondary evolution towards brain death) and for a pursuit of therapeutic maneuvers in order to obtain organs for transplantation.     

Profil évolutif de la dénervation cardiaque sympathique dans l’amylose héréditaire à transthyrétine

IntroductionCardiac amyloidosis is a rare disease with poor prognosis, requiring an early diagnosis. I123-MIBG plays an important role in early evaluation of sympathetic cardiac innervation, which is decreased due to amyloid infiltration. The aim of this study was to assess the temporal evolution of cardiac denervation in patients with hereditary amyloidosis, particularly the rate of progression and regional abnormalities; and to identify progression markers.MethodsForty-six patients were included. All of them were carriers of a TTR mutation or received domino liver transplantation, and underwent at least two evaluations of cardiac innervation with MIBG, between February 2011 and February 2018. Progression of cardiac denervation was determined by comparing the H/M ratio at first and final assessment. Regional abnormalities were evaluated using the perfusion/innervation mismatch on a 17 segments model. Logistic regression analysis was used to identify predictors of progression.ResultsTwenty-two patients were stable and 24 were progressive. The mean delay between two MIBG scans was 3.2 ± 1.3 years. Late H/M decreased by 3.9%/year in progressive group, and tended to accelerate after symptoms onset (− 1.4 ± 5.4 vs − 0.49 ± 2.9, P = 0.03). Regional abnormalities were initally located in the infero-latéral segments and extended to the inferior and lateral walls at final assessment. LVEF (OR: 0.90, P = 0.003) and initiation of amyloidosis targeted treatment (OR = 5,35, P = 0.003) were independent predictors of sympathetic denervation progression.ConclusionProgression of myocardial sympathetic denervation in hereditary amyloidosis is slow, but accelerates after symptoms onset. LVEF and treatment are potential progression markers. Regional abnormalities are mainly located in the inferolateral segments and tend to extend at the borders of the denervated area.     

Enjeux,défis,opportunités et stratégie durable d’implantation de l’imagerie hybride TEMP/TDM dans un pays à ressources médicales limitées,la Côte d’Ivoire

From HO Anger's analogic gamma camera to digital camera, developed countries are at the time of hybrid cameras SPECT/CT and PET/CT. Sub-Saharan black Africa in the image of Côte d’Ivoire, a country with limited medical resources shows an important delay in the evolution of the health system in general and particularly in medical imaging equipment. The purpose of this paper was to approach the issues, challenges and sustainable strategy for the implementation of hybrid imaging SPECT/CT in a developing country where the rate of morbidity and mortality remains high due to infectious but also cancer diseases because of the inadequacy of the health technical platform. To address these challenges, Côte d’Ivoire like many countries in sub-Saharan Africa with limited medical resources must design, test and develop clinical strategies adapted to developing countries. Health authorities of this country must develop a policy for sustainable financing of medical imaging, including the training of the adequate health personnel according to a model of corporate leadership. In this perspective, Côte d’Ivoire must have a SPECT/CT instead of a simple gamma camera. This would allow to optimize its diagnostic health system in oncology, bone and joint disease and in many other medical disciplines. And especially since the SPECT/CT is a high-performance device that has largely demonstrated its diagnostic efficiency and that can be used as SPECT alone or as isolated CT. In addition, this country should take over digital imaging in the context of cooperation with some countries of Africa and Europe ahead in the field of modern medical imaging, seeking assistance from international organizations (IAEA, RAD-AID, WHO,…). Finally this country should implement methods of assessment, types of performance indicators to guide planning for future projects of its system.     

Aspects originaux de la trichinose domestique à partir d'une infestation familiale découverte à Montréal

An outbreak of domestic trichinosis occurred in an Italian family living in Montreal. All patients had a fever, facial edema and extreme eosinophilia, and results of serologic tests were positive. Larvae of Trichinella spiralis were seen in a muscle biopsy from one of the patients. The discussion emphasizes some characteristic clinical, serologic and histopathological aspects.     

Optimisation du protocole d’acquisition de la TEP à la fluorocholine dans la détection des lésions parathyroïdiennes

18F-Fluorocholine (FCH) PET/CT shows very promising potential for detection of hyperfunctioning parathyroid tumors. However, the optimal time to perform imaging after FCH administration has not yet been determined and protocols are highly variable. The aim of this study was to qualitatively and quantitatively compare 5, 10, 15, 20 and 60 min post-injection acquisition times in patients with primary hyperparathyroidism and equivocal traditional imaging. Thirty-one patients were included. Two observers retrospectively analyzed the five protocols. Any focal increase in FCH uptake was localized and graded on a discrete gradation scale between 1 and 5 to assess the likelihood of hyperfunctioning parathyroid tumors. Gold standard was histopathological findings for the 11 operated patients. Regarding quantitative analysis, ratio of SUVmax of parathyroid foci on SUVmean of thyroid background (as signal-to-noise ratio) were compared between protocols. After injection of 2.5 MBq/kg, FCH PET performed 60 min post-injection (2 min) had the best sensitivity and specificity by lesion (92% and 100% respectively and the best signal-to-noise ratio (median of 2). We suggest performing PET scan 60 min after injection, associated with early acquisition so as not to miss a wash-out hyperfunctioning parathyroid tumors.