L’anonymat dans l’insémination avec don de sperme: un regard éthique

Which is the link between secret and anonymity in the case of donor insemination? Do we need to know the name of our donor in order to understand our own personal history? What does the term origin mean? This article aims to analyze such questions from a philosophical point of view, in order to show the difference existing between secret — which concerns conception — and anonymity, which deals with the name of the sperm donor.     

La fecondation In Vitro avec des spermatozoides preleves dans l’epididyme

In-vitro fertilization (IVF) using spermatozoe aspirated from the epididymis can be considered in cases of congenital or acquired epididymal obstruction. In these particular conditions sperm maturation seems to occur earlier than in the normal physiological situation. In this way we have obtained two twin, term pregnancies using spermatozoa from the caput epididymis is cases with congenital absence of the vasa deferentia. Sperm preparation on mini-Percoll gradients gave the best results, although post-treament sperm motility was of no predictive value for the clinical outcome.     

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.     

L’étude des pointes foliacées dans l’archipel du Japon

Approximately 10,000 Paleolithic sites have been approved in Japan. Transitions of the hunting weapons that represent stone implements are as follows.1. Stone implements that represent the Trapezoids and the Proto knives appeared approximately 32,000 years ago.2. Stone implements that represent bilaterally retouched knives of willow-leaf sharp and bilaterally retouched transversal knives developed approximately 29,000 years ago.3. Approximately 28,000 years ago, after Aira-Tn volcanic ash fell down, the Kakusuijo-sekki appeared. This Kakusuijo-sekki got involved in the appearance of Bifacial points.4. As Bifacial points developed, Backed Blades also gradually declined approximately 20,000 years ago.5. Consequently, this led to the development of Micro-blades, which went well with Bifacial points approximately 19,000 years ago.6. Although Micro-blades became extinct under the influence of the appearance of Tanged points, Arrow-heads, and Potteries approximately 16,000 years ago, Bifacial points kept being produced.Approximately 18,000 years ago, bifacial points which were produced symmetrically and bifacially were widely developed in Japan; however, the stones, the size of the material by exfoliate technique, and the processing method were different from what was expected.Such transitions have been investigated in each region, which helps us understand that stone implements in the Paleolithic Era were found at multiple stratified sites in the thickly sedimented Pleistocene tephra at the Sagamino Terra, Kanagawa Prefecture.     

Apport de l’imagerie radioisotopique dans l’artérite inflammatoire des gros vaisseaux

The group of large vessel vasculitis includes giant cell arthritis and Takayasu's disease. If monophotonic nuclear medicine can sometimes show some unusual patterns in these diseases, positron emission tomography with fluorodeoxyglucose seems have a special attract and provide some indications during the monitoring of these patients. However, most of these indications remain to be validated, specially to differentiate weak vascular wall inflammatory activities from physiological and/or atherosclerotic accumulation.     

Apport de la scintigraphie rénale avec test au captopril dans l’exploration de l’hypertension artérielle rénovasculaire : à propos d’un cas

IntroductionDynamic renal scintigraphy with ^99mTc-DTPA and captopril test is a non-invasive functional method for the diagnosis of renovascular hypertension. It allows differentiating between hypertension induced by renal arterial stenosis from primary arterial hypertension with an incidental stenosis.Case reportA 14-year-old girl, without previous medical history, developed a severe arterial hypertension with cephalgias and ears buzzing. Auscultation revealed a murmur in the left lumbar pit. Renal angiography objectified a stenosis of the infrarenal aorta due to a circumferential parietal thickening associated to renal arteries stenosis more marked in the left side. Dynamic renal scintigraphy after administration of captopril highlighted a marked collapse of the rate of tracer uptake exceeding 40% on the left side with an increase in the time of collecting on the right side testifying a frankly positive test prevailing on the left. A transluminal angioplasty of the left renal artery and a revascularisation surgery on the right side were carried out. The evolution was marked by an improvement of blood pressure figures.DiscussionDynamic renal scintigraphy using ^99mTc-DTPA with captopril test constitutes a non-invasive process with a low dosimetry for the patients. Its principal goal is to affirm the role of renovascular stenosis in the origin of arterial hypertension and to determine which hypertensive patients with renal arterial stenosis can be treated successfully by surgical or endoscopic revascularisation of the kidney.     

Intérêt de l’imagerie hybride TEMP-TDM dans l’exploration des infections

Single-Photon Emission Computed Tomography-Computerized Tomography (SPECT-CT) is a new hybrid technique which offers new diagnostical capabilities in daily nuclear medicine practice. This technique not only allows to acquire fusioned anatomic and functional images in the same time, but also, it increases sensitivity and accuracy of SPECT thanks to attenuation and scattering corrections got from transmission data. Until now, SPECT-CT data have been mainly obtained in oncology and cardiology, but now, many authors use it in many scan studies and particularly for infectious diseases. In inflammatory bowel diseases, SPECT-CT seems to increase diagnostical performances and to modify management of many patients. In suspected vascular sepsis, SPECT-CT could increase sensitivity of white blood cell scintigraphy but also its specificity thanks to spatial resolution of CT. In osteoarticular sepsis, SPECT-CT has the advantage to distinguish osteomyelitis from soft tissue infection and to guide biopsies. Nevertheless, in the light of PET-CT works, SPECT-CT development will probably modify nuclear medicine practice and many studies have to be conducted to highlight consensual procedure guidelines.     

L’évaluation des nouvelles technologies en santé : un nouveau besoin,l’évaluation de l’adaptation à l’usage

In healthcare, technologies have a critical role in diagnostic, treatment and monitoring of the patients, either in hospitals settings or at home. But in order to be used in clinical routine, their assessment does not always comply with strict scientific criteria. In some situations, these technologies can also turn out useless, too costly or dangerous when integrated without precaution in the healthcare professional environment. In France, to address this issue, the Ministry of Health and the National Agency for Research in Medicine have installed new “Innovative Technologies” (IT) modules attached to existing Centres for Clinical Research (CRC). Eight CRC-IT (in short, CIT) have been accredited in different technological domains. They may support and secure the dissemination of promising IT applications in healthcare by assessing (i) the actual benefit for the patients, or medical service rendered, (ii) the potential drawbacks and (iii) the anticipated Return On Investment for the healthcare system. The procedures used to evaluate other healthcare innovations such as new drugs cannot be applied for the evaluation of innovative technologies. CIT also have to adapt their methodology to the type of device and domain. Besides the impact on the patient or public health, CIT are able to analyze the impact of innovative technologies on the quality of care and on their use by professionals.     

La cytométrie dans l’exploration de l’allergie

Les tests cellulaires pour l’explorationin vitro de l’hypersensibilité immédiate, utilisent le polynucléaire basophile du sang périphérique. Ce leucocyte qui possède la plupart des propriétés du mastocyte, un récepteur membranaire de forte affinité pour les IgE (FceR1) et des granulations contenant des médiateurs préformés de l’anaphylaxie, est un bon témoin de la sensibilisation mastocytaire contre un allergène. Mais comme ce dernier est d’un accès difficile, pour les étudesin vitro chez l’homme on préfère travailler sur le basophile.     

L’origine et l’évolution des éléphants

Origin and evolution of proboscideans. Recent palaeontological research has significantly enhanced our knowledge of the evolution of proboscideans, especially the beginning of their evolutionary history. New discoveries in the Early Eocene support, in particular, a lophodont ancestral morphotype for the Proboscidea and the African origin of the order, from which the Asiatic Anthracobunidae are excluded. The primitive Eocene proboscideans remain, however, poorly known. Other important discoveries have been made on the question of the origin of the moeritheres, of the deinotheres and elephantimorphs, and on the differentiation of elephantids. Palaeontology demonstrates in the Proboscidea a remarkably rich history, unsuspected from the extant relictual diversity, and one of the most spectacular morphological evolutions in the Mammalia.