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.     

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.     

Validation du logiciel de semi-quantification DaTQUANT® dans l’aide à l’analyse visuelle en TEMP au 123I-FP-CIT dans l’étude des pathologies neurodégénératives

ObjectiveSemi-quantification is a valuable tool increasing the diagnosis accuracy of the single photon emission computer tomography (SPECT) with FP-CIT-¹²³I (DaTSCAN^®), particularly in cases where visual analysis is unclear and especially on the posterior putamen. The DaTQUANT^® software (GE^® Healthcare), allows a quick and simple uptake assessment on several regions of interest. It also provides deviation values compared to a database of healthy subjects obtained in the ENC-DAT project. However, any threshold value is currently validated routinely.Patients and methodsA retrospective study was conducted in 55 patients (33 men, 22 women) referred for a suspicion of neurological disorders and who underwent SPECT imaging with DaTSCAN^® on camera D670 GE^®. Final diagnosis made by neurologist time after the SPECT was established as a reference, reinforced by clinical evolution. Analysis was initially visual without semi-quantitative results, realized by two experimented nuclear physicians, and then semi-quantitative analysis was made by DaTQUANT^® with calculation of Youden indices and ROC curves so as to define threshold values for six regions of interest (caudate, putamen anterior, posterior putamen, bilaterally).ResultsInterobserver match in the blind visual analysis was excellent with kappa coefficient = 0.91, CI at 95% = [0.87–0.95]. The semi-quantitative and statistical analysis by DaTQUANT^® determined pathological threshold values for each region of interest, setting a standard deviation percentage from a database of healthy subjects, worth −16.3% for the right posterior putamen (sensitivity of 100% and specificity of 88%) and −18.3% for the left posterior putamen (sensitivity of 100% and specificity of 97%).ConclusionThe pathological threshold values defined by our study would improve the data analysis obtained from DaTQUANT^® software and would support the DaTSCAN^® visual analysis. Nevertheless, such statistical values are complementary to visual analysis.     

évaluation des pratiques professionnelles dans le cadre de l’accréditation des établissements psychiatriques

As regards evaluation of professionnal practices (EPP), Formep’s has decided to stay in the limits of psychiatric institutions, for reason of experience. Every medical doctor working in these institutions is concerned by evaluation, but also institutions in the specific framework of V2 44, 45 and 46 references. The EPP is multidisciplinary and involves everybody who takes part of patient caring. Formep’s is adviser, training agent, and partner. Follow-up takes place both on-site and off-site all along the EPP, by a team including psychiatrists, medical practitioners, quality and risk management engineers. They are all experienced to work in psychiatric institutions. Formep’s program includes preliminary and definitive choice of themes, putting methology is place, work of teams, initial analysis of results and deviations, further work of teams, final analysis, which purpose is to improve practices and therefore medical benefit.     

L’échographie Doppler dans le diagnostic des duplications gastriques chez l’enfant

Gastric duplication is a rare congenital gastrointestinal malformation responsible for abdominal pain and digestive disorders in children. When it is not discovered prenatally, it raises the problem of diagnosis of abdominal cystic mass leading to surgical excision with histological confirmation. We report 4 cases of gastric duplication diagnosed in children aged 11 days, 4 months, 6 years and 13 years of the pediatric imaging unit of the southern Teaching hospital of Rennes (France). Our goal is to emphasize on the role of medical imaging in particular the color Doppler ultrasound in the diagnosis and the monitoring of this uncommon disease of the child.     

Recueil chirurgical de spermatozoïdes dans un groupe de 50 patients avec un antécédent de cryptorchidie bilatérale: facteurs pronostics d’extraction

Bilateral cryptorchidism is a severe factor of male infertility. We evaluated the results of testicular sperm extraction in 50 men with nonobstructive azoospermia associated with cryptorchidism between 1995 to 2001. We evaluated clinical parameters predictive of successful sperm extraction. Serum follicle stimulating hormone (FSH) was elevated in 67% of cases and testicular volume was decreased in 70% of cases, confirming the secretory origin of the azoospermia. Serum follicle stimulating hormone (FSH), testicular volume and histological parameters were examined as predictive factors for sperm recovery. The positive sperm recovery rate was 68%. As in the population of men with nonobstructive azoospermia, the sperm recovery rate for patients with a history of orchidopexy is approximately 68% and there are currently no clinical parameters predicting successful sperm retrieval in this subpopulation of patients.     

La place de l’examen direct des prélèvements bactériologiques dans le diagnostic des infections bactériennes

Routine examination of bacteriological sample presents two steps: direct examination and culture. Final aim of these examinations is to identify most of bacteria responsible of infection in order to justify an antibiotic treatment. Interest of direct examination in the identification of bacterial colony is well-established; however its importance in the appreciation of bacteriological samples is sometimes neglected by technician and intern of bacteriology. This presentation aim to remind us this importance in current bacteriological diagnosis by relating what responses it could bring in asked bacteriological analyses which are: cerebrospinal fluid, urine collection and cervicovaginal secretion.