Insuffisance rénale chronique : de la maladie osseuse à la maladie osseuse et vasculaire

The accelarated atherosclerosis occurring in patients with chronic renal failure (CRF) is a well-known complication since the beginning of dialysis. The relationship between vascular lesions and phosphocalcic abnormalities is a more recent concept. The relationship between increase in phosphate × calcium product and cardiac valvular calcifications was demonstrated in 1980. The relationship between high serum phosphate levels and mortality was shown in 1998. The strong prevalence of coronary calcifications in CRF patients was shown in 1996. In 2000, the association between these calcifications and the oral dose of calcium was strongly suggested. Thereafter, the mechanism of these calcifications appeared much more complex, involving hypercholesterolemia, inflammation, and other factors. The relationships between hyperparathyroidism and mortality were shown during the years 2000. There is also an association between hypoparathyroidism and mortality in dialysis patients but not in CRF patients before the dialysis stage. Another new concept is the discovery of a relationship between vitamin D deficiency, very frequent is CRF patients, and mortality. Treatment with active 1,25(OH)D is associated with a better survival. There is also an new interest in treatment with the 25(OH)D form since the enzyme 1-alpha-hydroxylase, which is responsible for its transformation in active form, is present in multiple organs.     

Intérêt de la tomoscintigraphie cardiaque à la 123I-mIBG couplée à la perfusion myocardique dans le diagnostic de l’atrophie multisystématisée

ObjectiveThe aim of this prospective study is to assess the pertinence of using ¹²³I-mIBG myocardial tomoscintigraphy coupled with perfusion scintigraphy as a diagnostic tool, to discriminate between multiple system atrophy (MSA) and idiopathic Parkinson's disease (PD) at first guided by clinical data and L-DOPA tests.Material and methodsForty patients, aged from 43 to 78 years (median 62 years) with Parkinson's syndrome were studied. Nineteen had a diagnosis of PD (criteria of brain bank) and 21 AMS (Gibbs criteria). All were given test to acute L-DOPA. Chest-centered planar imaging (128 × 128 matrix, 5 minutes of duration) is performed at 1 hour and 4 hours after injection of 220 MBq of ¹²³I-mIBG, in addition a non-synchronised tomoscintigraphy (64 × 64 matrix, 32 images of 50 seconds , zoom 1.45) was performed after the 4th hour and 15 minutes after injection of 200 to 400 MBq of ^99mTc-tetrofosmin. Besides neurological data, the parameters retained for comparison purposes with ¹²³I-mIBG cardiac tomoscintigraphy were patients’ age, duration of disease and L-DOPA test results. Two regions of interest (ROI) identical in size and in shape are used for ¹²³I-mIBG uptake quantifications (H/M and washout [Wo]). The first one was placed in projection of mediastinum (M) and the other one in projection of heart (H).ResultsWe found an overall decreased uptake of the myocardial ¹²³I-mIBG without perfusion abnormality in 15 of 19 patients with PD and 11 among them were L-DOPA sensitive (L-DOPA test greater than 30%). Normal tracer uptake with ¹²³I-mIBG associated with an almost quite normal perfusion was seen in 15 of 21 patients with MSA and they were little or not L-DOPA sensitive (L-DOPA test less than 30%). Therefore, 10 discordant cases (25%) between cardiac scintigraphy and clinical evolution of disease with also discordant L-DOPA tests were observed. In the PD group, quantification of data enhanced the diagnostic decision with low heart to mediastinum ratio (H/M) (1.32 ± 0.15 at the early stage and 1.25 ± 0.13 at the later stage). In the MSA group, the uptake of ¹²³I-mIBG (1.66 ± 0.43 at the early stage and 1.72 ± 0.42 at the later stage) was comparable to literature data, however, with significant inter-individual variations. The association of data of scintigraphy with L-DOPA test allows to improve sensitivity in 84% and specificity in 90.5%.ConclusionOur prospective study of 40 cases shows the relevance of cardiac sympathetic postganglionic imaging with ¹²³I-mIBG coupled with myocardial perfusion scintigraphy to discriminate between MSA and PD with a higher sensitivity (71.4%) compared to the test with L-DOPA but a lower specificity (78.9%) than the L-DOPA. The difficulty of diagnosis is firstly linked to damage occurring to both the pre- and postganglionic sympathetic systems in patients with MSA and secondly to the integrity of the sympathetic nerve endings in patients with PD. However, the association of data of scintigraphy with L-DOPA test show a significant improvement of sensibility (84%).     

Douleurs thoraciques et scintigraphie myocardique : à propos de 171 cas

Study aimTo find a correlation between epidemiological factors, risk factors and history and the results of myocardial scintigraphy according to the type of pain and discuss the role of scintigraphy in the diagnosis and therapeutic care.Patients and methodsOur study is retrospective, on 171 patients with typical chest pain (TCP) or atypical (ACP), addressed for myocardial scintigraphy.ResultsFemale predominance was clear. Average age was 59 years. Frequency of risk factors: smoking, diabetes, hypertension, hyperlipidemia, history of heart disease and hypothyroidism was respectively 21.6%, 39.8%, 73.7%, 25.1%, 11.1% and 6.4%. ACP was found in 57.9% of patients, it was more common among women (59.8%). Scintigraphy was abnormal in 36.8% of patients. Scintigraphy was normal in 59.7% of patients with TCP. In the case of ACP, scintigraphy was normal in 65.7%. This difference is not significant. All patients having abnormal scintigraphy had abnormal coronary angiography with a statistically significant correlation. Normal scintigraphy was more frequent (83.3%) in young patients ( < 40 years) and more common in women (67%) than men (55.9%). The sensitivity of scintigraphy is 100%. Its specificity is 66.6%. Its PPV of 57.1%. Its VPN is 100%.ConclusionMyocardial scintigraphy can help clinicians to identify the etiologic diagnosis and assess the prognosis of chest pain.     

Le cancer de la verge : à propos d’un cas et revue de la littérature

Cancer of the penis is rare. It often raises the issue of acceptability of the amputation of penis. We report a case of cancer of the penis following a late circumcision. The treatment consisted of amputation of two-thirds of the penis. The patient is alive without any local recurrence 2 years after surgery. Literature review suggests that this type of cancer is very rare. The factors associated with such cancer include lack of circumcision and infection with human papilloma virus.     

Effets d’une exposition à la Vinclozoline et à la Génistéine de la gestation à l’âge adulte sur la fonction de reproduction du ratWistar mâle: protocole et résultats préliminaires

Current evidence indicates that endocrine disrupters (EDs) can induce adverse effects on the male reproductive tract in various mammalian species. Recent reports indicate deterioration in male reproductive health in several human populations, but the evidence for a causal link with endocrine disruption is still weak. In addition, the experimental conditions of most of the reportedin vivo studies are not representative of environmental exposures (for example, high doses, short-term exposure, a single ED) and the mechanisms by which EDs disrupt the reproductive system are poorly understood. The objective of the present study is to develop an animal model to assess the reproductive effects and study the putative cellular and molecular mechanisms involved after exposure to genistein (phytoestrogen) and vinclozolin (fungicide with a known antiandrogenic potential) alone or in combination. The study will be performed in male Wistar rats, with administration of low and high doses of the compounds from conception to adulthood and a subset of the males in each treatment group will be mated with unexposed females. We plan to assess the level of sperm production, histology of the reproductive organs, motility and morphometry of spermatozoa and hormone levels, as well as DNA fragmentation of spermatozoa and determination of the number of germ cells, Sertoli cells and the diameters of seminiferous tubules. Estrogen, androgen, progesterone and FSH receptors will be detected and quantified and the level of testicular apoptosis and several apoptosis pathways will be studied to determine the putative cellular and molecular mechanisms involved. The preliminary results confirmed the developmental effects previously reported for high doses of vinclozolin. More interestingly, they indicated a number of deleterious effects for male rats exposed to low dosages alone or mixtures of low and high dosages compared to controls and rats exposed to high dosages alone. For example, a number of developmental anomalies of the genitalia were observed and a significant decrease of sperm motility and motion and fertilizing ability were observed. These preliminary results provide evidence that chronic exposure to environmental levels of EDs or mixtures of EDs have a detrimental impact on the male reproductive tract. The next step involves assessment of the anatomical disorders and the study of some of the cellular and molecular mechanisms possibly involved.     

Les tumeurs testiculaires à cellules de Leydig: à propos de quatre cas et revue de la littérature

Introduction

Leydig cell tumors of the testis are uncommon, and represent 1 to 3% of all testicular tumors, it’s the most common of sex cord stromal tumors. They can be found in all age groups, but they mainly occur in subjects aged 15 to 50 years (50%), 25% occurring in older men and a little less than 20% in children aged 5 to 9 years. The most common revealing symptom is gynecomastia in adults, whereas in children it is isosexual pseudo-precocious puberty. They pose a problem during diagnosis, nonpalpable tumors, and during the choice of surgical treatment, because it is difficult to make a clear distinction between benign and malignant tumors.

Material and methods

We describe four different presentations of this disease. The parameters studied were: age, revealing symptom, hormonal profile, type of treatment, and mode of evolution.

Results

The average age of our patients was 37.5 years. The first revealing symptom was a unilateral increasing size of purse in two cases, a bilateral increasing size of purse in one case, and gynecomastia in the last one. In all cases testosterone was normal or low, and oestradiol was normal or elevated. Our four patients underwent an orchidectomy, associated with an enucleation of the contralateral testis in only one case. A favorable evolution was observed in every case for a mean follow-up of 15 months.

Conclusion

On the basis of four different clinical observations and the analysis of the literature, the aim of this review is to present the various clinical, biological, radiological, pathological and therapeutic aspects of Leydig cell tumors of the testis.     

La cognition dans le trouble obsessionnel compulsif : à l’intersection de la clinique et de la neuro-imagerie

The investigation of neural activity in OCD (Obsessive Compulsive Disorder) has allowed to link obsessive compulsive symptoms and cortico-striatal dysfunction. In the present article, we try to show the significance of cognition in an integrative physiopathologic model of OCD. Clinically, patients are unable to inhibit irrelevant thoughts or actions. In a cognitive way, decision making, planification or organisation are impaired. Those impairments are related to an executive deficit, which depends on frontal structures. Finally, we present a current study which tries to identify executive deficit functions related to cerebral dysfunction in patients presenting different OCD features (washing, checking, hoarding).     

Identification ultrastructurale et étude immunocytochimique des cellules à somatostatine de la muqueuse antrale du lapin et de la souris

Résumé Les techniques d'immunofluorescence, d'immunoenzymatique, d'imprégnation ou de coloration sélective des cellules endocrines digestives, et de microscopie électronique ont été combinées pour permettre l'identification et l'étude des cellules à somatostatine chez des animaux normaux ou ayant reçu de la L-Dopa. Ces cellules n'ont pas de fluorescence induite à la formaldéhyde et ne sont que très faiblement argyrophiles en technique de Grimélius; elles ne réagissent pas en technique de Sevier-Munger, Hellerström-Hellman, Mac Conaill. Après administration de L-Dopa elles acquièrent und fluorescence (cellules GIC) et deviennent nettement argyrophiles en technique de Grimélius, plus faiblement en technique de Sevier-Munger.En microscopie électronique après identification immunologique sur coupe semi-fine on peut analyser les mêmes cellules sur coupes fines. Il s'agit de cellules basigranuleuses présentant, outre des grains denses difficiles souvent à distinguer de ceux des cellules G, trois structures fines caractéristiques par leur constance et leur coexistence; ce sont: des grains peu denses et homogènes—des graïns centrés par un matériel filamenteux grossier—des microfilaments nombreux. Les cellules à somatostatine semblent différentes des cellules X et D₁.

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Ultrastructural identification and immunocytochemical study of somatostatin cells in antral mucosa of the rabbit and the mouse

Summary In normal and L-Dopa treated rabbits and mice, combined immunochemical methods, photonic histological methods for endocrine cells and ultrastructural methods were used to elucidate ultrastructure and properties of somatostatin cells of the antral mucosa. In normal rabbits, immunoreactive cells giving no fluorescence with Falck's technic, they corresponded neither to serotonin cells nor gastrin cells; they were unreactive with Fontana, Hellerström-Hellmann, Sevier-Munger and Mac Conaill methods but very slightly stained with Grimelius methods. In L-Dopa treated animals somatostatin cells gave formaldehyde induced fluorescence (they were included in GIC cells, thus in Apud group), exhibited a good reaction with Grimelius and Sevier-Munger methods.In order to carry out the alternate semi-thin/thin section procedure (semi-thin sections for immunofluorescence or immunoenzymatic detection and serial thin sections counterstained for conventional ultrastructure studies), immunological treatment were performed on M.F.F.—glutaraldehyde fixed small fragments of mucosa before inclusion in Epon 812 or, after inclusion, on semi-thin sections. We succeeded in identifying ultrastructurally somatostatin cells. They displayed round or ovoïd shaped secretory granules, and three constant typical structures: numerous microfilaments—light and homogenous granules, often seeming like lipids—granules made up by coarsely filamentous cores surrounded by a large empty halo. Somatostatin cells seemed different of X cells because of their predominant localisation in the antral mucosa (in the rabbit X cells were predominantly in the fundus) and because of the lack of nuclear microfilaments; they also seemed ultrastructuraly different of D₁ cells.

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Travail effectué avec l'aide de la D.G.R.S.T.-Contract n^o 72.7.0043.     

Nutrigénomique: cas pour un terrain commun à la maladie cardiovasculaire et au cancer

The border between health and disease is often set by a complex equilibrium between two elements genetics on one hand, lifestyle on the other, To know it better, means to give new weapons, often crucial, in the hands of the doctors and their patients. It also means to adjust therapies, to find out which drug is good for a patient and which prevention strategy will work better for him/her. Nutrigenomics is an approach to individualize or personalize food and nutrition, and ultimately health, by tailoring the food to the individual genotype. In this review, we present the interaction between certain genetic polymorphisms and diet and increased cardiovascular or cancer risk. It is, indeed, now clear that a large number of bioactive food components may provide risk or protection at several stages of both atherosclerosis and cancer formation processes. We are giving here few examples of gene-food interactions relevant for both the risk of cardiovascular disease and cancer, since a common soil could exist in the genesis of cardiovascular disease and of some types of cancer (mainly gastrointestinal tract and hormonedependent).     

La filiation et l'aide médicale à la procréation

Kinship following artificial insemination by unknown donor defines the child's mother and father as unknown. Although it could have been possible to construct this kinship on the model of adoption, the model adopted was that of blood and organ donation, which completely erases the donor's identity so that the recipient can take complete possession of the donated substance. But is gamete donation the same thing? Gamete donation concerns procreation and the parents' sexuality. Would it be possible to no longer consider the parents' sexuality to be exclusively reproductive sexuality allowing recognition of the progenitors alongside the mother and father?     

TEP/TDM au 68Ga-PSMA-11 quand la 18F-fluorocholine ne localise pas la récidive biologique du cancer de la prostate : à propos d’un cas et revue de la littérature

A rise in prostate-specific antigen serum level (PSA) is an increasing issue, which occurs in more than one third of the patients who underwent radical prostatectomy. Thus, imaging these patients is of importance in order to localize residual disease and then to propose suitable therapy. The usefulness of ¹⁸F-fluorocholine (FCH) PET/CT in this indication has been demonstrated for several years. Recently, specific ligands of the prostate-specific membrane antigen (PSMA), which is expressed by almost all prostate cancers, were labelled with PET radionuclides. ⁶⁸Ga-PSMA-11 (PSMA-11) PET/CT has been described as superior to FCH and conventional imaging to detect prostate cancer recurrence. We present the case of a patient with history of prostate cancer, treated by surgery, referred for a rise in PSA serum level and without any residual disease targeted neither on FCH, nor on pelvic MRI. The PSMA-11 PET/CT demonstrated a pelvic lymph node, which was suspect of recurrence and allowed to initiate a specific curative therapy, replacing the “palliative” hormonotherapy, which was planned. A short review of the literature on this topic, focusing on the published PSMA-11 performances and main known interpretation pitfalls.     

TEP/TDM au FDG et hibernome : à propos d’un cas

Hibernoma is a rare benign tumour of soft tissue, generally asymptomatic, usually discovered in young adults. It is a form of lipoma that originates from brown adipose tissue. Its diagnosis is based on histology, the main differential diagnoses being lipoma and liposarcoma. Its appearance on FDG PET/CT has being described only in few case reports. We report here the case of a 68-year-old patient with ENT cancer in whom an adipose tumour in the left axilla has been discovered on CT performed for staging. The diagnosis of hibernoma was suggested in the report of FDG PET/CT examination and was consistent with results of other imaging modalities. On MRI, contrast enhancement was observed after gadolinium contrast injection, which was not typical for a lipoma. On PET/CT, the FDG uptake by the adipose tumour was very intense (SUVmax = 16), which is characteristic for hibernoma that derives from brown adipose tissue. Imaging was unable to distinguish between hibernoma and liposarcoma. The diagnosis of benign mixed hibernoma-lipoma was ascertained on histopathology after complete resection of the tumour. Elements favouring hibernoma over liposarcoma are present in this observation: high avidity for FDG (SUVmax > 10) and a fluctuating intensity of uptake, SUVmax of the tumour increasing from 16 to 48 within 16 months in the presented case. A high SUVmax on FDG PET in an adipose tumour on CT seems to be more suggestive of a benign tumour, hibernoma, than of its malignant counterpart, liposarcoma.     

Imprégnations rapides à la Nigrosine applicables à la micro-ecologie des surfaces

Summary The ecology of primary biological coatings (fouling films) is an important aspect of benthic ecology in general. Life in a fouling film is, to a large extent, governed by physico-chemical laws of contact surfaces and surface tension. These laws apply also to the microecology of the mesopsammon and surface microplankton. The conditions common to these ecological situations enforce common characteristics, both morphological and physiological, upon the organisms which inhabit them. Many of these organisms are therefore subject to certain general techniques.Nigrosin is employed as an impregnating agent, and the speed of activity of the micelles of nigrosin is under the control of 1) the colloidal nature of the medium, and 2) alteration of cytoplasmic structures by the action of formalin added to the solution as a fixative.The stain blackens a variety of organites having a filamentous ultrastructure: cilia, flagella, trichocysts, rhabdites, cnidocysts, spiny processes of thecae and shells, capsules, cuticles and cuticular setae. The excess nigrosin surrounding the specimen may be removed completely by simple washing.Two particular situations are discussed: that of microbiocoenoses which develop at the point of contact of water and air (for example, bacterial films) and that of glass slides immersed in water with a view to studying the organisms which colonize surfaces in a particular habitat.The method has been applied also for studies of plankton in general, to demonstrate the liberation of flagellate bodies by certain algae, and for preparation of mounts of various organisms such as rotifers, gastrotrichs and nematodes. The method is very useful for quickly obtaining a comprehensive picture of the protozoan fauna in ecological studies.     

Mammouth et comportements de subsistance à l’Épigravettien : analyse archéozoologique du secteur de la fosse no 7 associée à l’habitation no 1 de Mezhyrich (Ukraine)

Zooarchaeological analyses were carried on new large mammal bone materials, from the Epigravettian (Late Upper Palaeolithic) site Mezhyrich (Ukraine), in the pit n^o 7 area associated with the mammoth bone dwelling n^o 1. The results exhibit a usage of the pit as a dump area of food and technical remains from mainly mammoth, hare and fox processing, and bone fuels. The information about mammoth procurement by the last Palaeolithic hunter–gatherers in Eastern Europe allows to document the hunting activities on the mammoth populations, which were probably already weakened at the end of the Pleistocene.