Chirurgie cardiaque chez le nouveau-né et le nourrisson

During the past five years, 127 newborn infants with marked anoxia, severe cardiac failure or respiratory problems secondary to a cardiac lesion were operated upon at l''Hôpital Ste-Justine, Montreal, Quebec.Infants in cardiorespiratory distress from a cardiac lesion for which the surgical treatment is well established, such as complicated coarctation of the aorta, were either cured or improved in 78% of cases. The fatal outcome following medical treatment of patients suffering from lesions for which the surgical treatment is not yet well established, e.g. interruption of the aortic arch, led us to operate upon these infants with the hope of salvaging some of them despite the high surgical risk.The decision to operate was usually based on clinical grounds; however, cine-angiocardiography was at times required to establish the exact diagnosis. Light anesthesia was essential to the success of the operation. Postoperative care was facilitated by a team of nurses well experienced in the treatment of newborn subjects with heart lesions. Fluids were administered in a minimum quantity of 700 c.c./m.² for 24 hours, and potassium was the only electrolyte added to the replacement fluids. Respiratory problems were reduced to a minimum by active physiotherapy. However, intubation with aspiration of tracheobronchial secretions was carried out when necessary.     

Varicocèle et infertilité masculine

Introduction

Male responsibility in couple infertility has been established in several studies. The purpose of this research was to report varicocele clinical and spermatic aspects and assess the outcomes of open retroperitoneal varicocelectomy.

Patients and methods

Our study is a retrospective assessment of the outcomes of open retroperitoneal varicocelectomy at the urology department of Aristide Le Dantec teaching hospital (Senegal). Our focus is on patients with varicocelectomy facing couple infertility (inability for sexually active couples who are not using contraceptive methods to obtain a pregnancy over a year), patients among which no other infertility cause was revealed in their partner or partners in polygamist households. To assess the results, we compared the averages of preoperative and postoperative spermatic parameters by using the Z test (comparison test of two averages on two mated series). A difference was regarded as significant if P ?? 0.05.

Results

Five hundred and fourteen cases were examined over 6 years (January 2005?CDecember 2010). The average age of the patients was 36.5 ± 7.3 years. The infertility was primary in 62.4%. The analysis of the preoperative spermograms revealed that severe oligozoospermia (33.7%) was the most common abnormalities in the sperm cells concentrations. The abnormalities in the sperm cells concentrations were variously connected with an asthenozoospermia and to a theratozoospermia. The patients were monitored with an average hindsight of 22 months (6?C48 months). The improvement of the parameters was more significant on the concentration and the mobility of sperm cells. The natural pregnancy rate obtained in our study was 20.8%. The registered pregnancies were more important in the group IV (48%). No case of natural pregnancy was noted in the group I but an induction of the spermatogenesis was noted in 20.5% of the cases. About two thirds of natural pregnancies (64%) were noted during the first 12 post-operative months.

Conclusion

The surgical treatment of varicocele allows improving the spermatic parameters. Not only do these improvements help obtain natural pregnancies but also simplify the techniques of ART planned with the preoperative spermatic parameters.     

Vieillissement et fertilité de l'homme

The decreased androgen levels in the ageing male have an evident effect on libido, sex life and coital frequency, whereas its role in impotence, the frequency of which increases dramatically in old age, is only marginal. Sperm quality as well as its fertilizing capacity decreases only minimally with age: there is some decrease in motility as well as an increase in percentage of spermatozoa with abnormal morphology, but sperm density remains unchanged, notwithstanding decreased spermatogenesis. After age 25, apparent fecundability of the woman decreases; this is attributable, on the one hand to an increase of the intrauterine mortality and, on the other hand to the declining coital frequency. After age of 35, female fecundity decreases more rapidly, due to changes in female physiology (increased frequency of anovulatory cycles, short luteal phase etc), whereas the normal, age dependent, decrease in coital frequency has little impact on the age pattern of fecundability. As far as the influence of the age pattern on the fecundity of the couple is concerned, it is concluded that the age of the female partner, rather than the age of the husband is the predominant factor determining the fecundability of the couple.     

Température et plasticité du chromatisme de la coquille chez le mollusque pulmoné Helix aspersa

Phenotypic plasticity of shell pigmentation in the land snail Helix aspersa was investigated with the help of image processing followed by pixel counting for each colour present on the shell. Thus, the use of three different growth temperatures under artificial conditions showed, for the two subspecies considered, a continuous colour gradient from red to dark of the shell banding. Darker pigmentation characterized low temperatures while red bands were related to the higher temperature (25 °C). No interpretable difference appeared between the two forms.     

Influence de la température sur la cinétique,de croissance et le coefficient de maintenance de Candida lipolytica cultivé sur n-alcane

The effect of growth temperature on the evolution of kinetic parameters and yields was determined for Candida lipolytica cultures with ntetradecane as substrate, in a temperature range of 18°C to 30°C, which is below the critical growth temperature in order to work only in the activation zone of these parameters.In such a culture limited by substrate transfer, growth rate depends on biological rates, related to microorganisms characteristics, and diffusional rates, related to mass transfer. The effect of temperature thus depends on the limiting step. The activation energy, calculated from exponential growth rate determinations is .When the activation energy is calculated from the maximal rate of cell production (determined at the growth curve's inflexion point), it's found to be E _X=71,200 J/mole in the 18°C–24°C range, and E _X=28,000 J/mole in the 24°C–30°C range. The latter one is characteristic of a diffusion-limited process. Above 24°C, growth is controlled by substrate-transfer, as physiological potentialities are preferentially increased with temperature than diffusional ones: 24°C is thus the transition temperature T _t from physiological to diffusional limitation.The apparent yield is almost constant, over the 18°C to 30°C temperature range, although maintenance coefficients are very dependent on temperature. The activation energies related to maintenance coefficients for alkane and oxygen respectively are and .The m _s/m_{O 2} ratio is about 3 (g/g), whereas that, for a strict oxidation reaction of n-tetradecane ought to be 3.47 (g/g). A satisfactory correlation, relating maintenance coefficients to the maximal growth rate of yeast, is given.

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Liste des symboles A constante de saturation de modèle de croissance(1) - B vitesse spécifique considérée - C substrat carboné ou oxygène (g/l) - E energie d'activation (J/mole) - S _m quantité de substrat consommée par maintenance au cours d'une fermentation discontinue (g) - O₂ quantité d'oxygène transférée au milieu de culture (g/l) - R rendement global de la fermentation - R rendement global de la fermentation - constante des gaz parfaits (J/mole K) - S concentration en substrat carboné (g/l) - T température de croissance (°K) - X concentration en biomasse (g/l) - Y rendement limite - m coefficient de maintenance (h^-1) - t duree de fermentation (h) - tømpérature de croissance (^o Celsius) - taux de croissance (h^-1) Indices 1 relatif à la température 1. - 2 relatif à la température 2 - c relatif au substrat carboné ou à l'oxygène - f relatif au temps final - i relatif au point d'inflexion - m maximum - mO₂ relatif au coefficient de maintenance sur l'oxygène - m _s relatif au coefficient de maintenance sur le substrat carboné - o relatif au temps initial - O₂ relatif à l'oxygène - s relatif au substrat carboné - t de transition - T relatif à la température de croissance T - U _m relatif au taux de croissance maximal - X relatif à la productivité maximale en biomasse     

Préparation et contrôle de qualité de la solution injectable de gallium-68 édotréotide (DOTATOC (68Ga))

Radiopharmacists of the Nuclear Medicine department of hospital Tenon have prepared and controlled the ⁶⁸Ga-labeled DOTATOC, for 4 years, as part of a clinical research study. The aim of this article is to share our experience, since this activity is not yet developed in France. Radiolabelling of DOTATOC (⁶⁸Ga) requires the settling of a ⁶⁸Ge/⁶⁸Ga generator, which is connected to an automated PC-controlled radiopharmaceutical labelling device (Elusynth ⁶⁸Ga, Iason) and comprises several steps. Performed quality controls (QC) are those commonly used for radiopharmaceuticals including: appearance, pH, radiochemical purity (RCP), radionuclide purity (PRN) and determination of the physical half-life. Bacterial endotoxins and sterility tests are systematically done. We obtained a mean value of radiolabelling yield around 45%. The results of QC are always in accordance with the specifications. The preparation failed in 7% of the 195 DOTATOC (⁶⁸Ga), over the last 4 years. It is important to note that the preparation of DOTATOC (⁶⁸Ga) monopolizes the radiopharmacist during 3 hours. This radiolabelling technique can be easily applied to other peptides, in order to develop other ⁶⁸Ga-labelled PET tracers.     

Apport de l’exploration cytogénétique et ultrastructurale dans le pronostic de fertilité des sujets globozoospermiques

Globozoospermia is a severe form of teratozoospermia characterized by round-headed sperms with absence or presence of a rudimentary acrosome. The objective of this study is to analyze sperm from six patients with globozoospermia syndrome and report the results of 11 intracytoplasmic sperm injection (ICSI) attempts. The investigation of these issues was carried out by studying the sperm aneuploidy rate by fluorescent in situ hybridization (sperm-FISH) for chromosomes X, Yand 18. The rate of DNA fragmentation was studied by using the terminal deoxynucleotidyl transferase dUTP nick end labelling (TUNEL) technique and a detailed ultrastructural morphology study of the sperm using transmission electron microscopy. Eleven ICSI attempts were performed in patients with low fertilization rate, (9.37%) and pregnancy did not occur. This study confirmed the variability of sperm phenotypes observed in this syndrome and the low fertilization rates after IVF-ICSI regardless of the phenotype.     

Consanguinité et effectifs de la population des communes

Summary In a previous paper, we have used the density of the population as a sort of measure of the unknown size n of the isolates in Dahlberg's model, and shown an inverse relation between the coefficient of inbreeding and the density of the arrondissements. In the present paper, as the considered communes are smaller territorial subdivisions than arrondissements, we used, instead of the density, the population size of the communes. The results are even more eloquent as before: the inbreeding coefficients are large when the observed population size is small; the relative importance of second cousin marriages (233) versus cousin marriages (222) is greater in the latest period considered. The basic data have been collected for each commune in Belgium by Centre National de Radiobiologie et de Génétique.     

L’évolution chez les Phyllocerataceae,la variabilité des paramètres dimensionnels et relatifs. Variabilité de la complexité de la ligne cloisonnaire: Variabilité et paedomorphose

Evolution of the Phyllocerataceae, the variability of the dimensional and relative parameters. Variability of the complexity of the suture line. Variability and paedomorphosis. A recent study has shown the importance of heterochronies in the development of Phyllocerataceae. It was attractive to estimate with precision the variability of some morphological characters of the shell and of the suture line in order to study how this variability changed in the course of time (from Jurassic to terminal Cretaceous). This note gives the averages of the calculations of variability in dimensional and relative variables in the shell of Phylloceratidae and variability in the complexity C of their suture lines. Coefficient of variation V is the statistical parameter used here, because it allows the comparison between the dispersions of different populations. This study shows that the variability of the complexity in the suture line and h₁ + h₂ is more fluctuating among the taxa (usually subfamilies, genera and species) in which heterochrony is evident. On the other hand, the variability of other parameters (V₁, V₂, D) first grows and then slowly decreases till the branch or the lineage is extinct. This schema is mostly acceptable down to the Lower Cretaceous-Upper Cretaceous in the Tethys and in the marine shelf of Gondwana. In the family of Neophylloceratidae, very clearly in the Tethys, less clearly in marine shelf of Gondwana (it is less obvious in the genus Phyllopachyceras), the variability grows as far as the terminal Cretaceous. The extinction of this family may result from a catastrophic event and not from internal causes. In short, the decrease of variability comes before the extinction of the taxa and consequently it agrees with a Darwinian classic schema. On the other hand, the extinction of Neophylloceratidae that occurs when the variability is maximal probably takes place in another perspective, an external « catastrophic » event. To cite this article, B. Joly, C.R. Palevol 2 (2003).     

Rappels physiques et outils d’optimisation de la qualité image et de la dose

Many parameters can affect the patient's dose and the CT image quality. It is therefore essential, in order to optimize the patient's dosimetry, to know the influence of these parameters as well as their link with the dose modulation tools.     

Analyse de l’algorithme décisionnel basé sur la testostérone totale et recommandé pour le diagnostic de l’hypogonadisme acquis

Introduction

The diagnosis of acquired hypogonadism is still an important issue for laboratory medicine. Hypogonadism is defined as a sustained decrease of total testosterone confirmed by the biochemistry laboratory and total testosterone measurement is proposed as the initial step in the investigation of hypogonadism. If TT is over 12 nmol/l, the probability of hypogonadism is considered low and it is suggested that patients be referred to others methods of investigation. Only a small percentage of men aged 50 and over are treated for hypogonadism. Seventy percent of men investigated for hypogonadism have a TT of over 12 nmol/l and there is an unpredictable increase of SHBG during this period, reducing the bioavailability of circulating testosterone. The hypothalamic-pituitary gonadal axis is modified with age and contributes to hypogonadism. The efficacy of biochemical investigation of hypogonadism needs to be reassessed.

Materials and methods

Total testosterone and LH were measured on the Centaur immunoanalyser (Siemens) and SHBG was analysed on the Immulite 2000 (Siemens). Bioavailable testosterone was calculated using the formula provided by ISSAM.

Results

Using the algorithm based on TT, only 27.9% of men would have been investigated for hypogonadism. Of the 638 patients considered as normal, 325 showed an index of hypothalamic-pituitary gonadal axis stimulation and possible hypogonadism, revealed by an elevated LH. In these patients with TT superior to 12 nmol/l and a LH superior to 7 UI/l, SHBG level was at the upper limit of or over the reference range. No correlation was observed between calculated BT and the abnormal LH level found in these patients. Calculated BT was not considered a good marker of hypogonadism for these patients.

Conclusion

Elevated LH is a biochemical marker of hypogonadism and should be interpreted in the context of stimulation of the hypothalamic-pituitary gonadal axis. Based on our data, an initial step in the investigation of hypogonadism based only on TT does not seem suitable for the identification of all patients who might experience hypogonadism. A complete investigation should be offered to all patients with clinical evidence of hypogonadism whatever their TT level. In patients who might benefit from hormonal treatment, calculated BT should be interpreted with caution. A definition of hypogonadism based on TT does not seem appropriate and a new definition based on bioavailable testosterone and the hypothalamopituitary gonadal axis should be considered.     

Action de l'antimycine a sur l'activité succinoxydase des mitochondries du tubercule de Pomme de Terre,et comportement des cytochromes de type b

A kinetic study of the effect of antimycin A on succinate oxidase from plant mitochondria produced sigmoidal curves for the reduction of cytochromes b₅₆₀ and b₅₈₅ and for the inhibition of succinate oxidase. In the stationary state the interaction of the various components of the respiratory chain (flavins, ubiquinone, cytochromes…) occurs in a sequential mode which allows the application of simple equations utilizing rate constants and cytochrome concentrations. In these equations, it is assumed that there exists an excess of ubiquinone relative to other components of the respiratory chain as suggested by Kröger & Klingenberg (1970) and that the reoxidation of b cytochromes is fast. The inhibition by antimycin A, characterized by non-linear inhibition curves for succin-oxidase and inhibitor fixation in complex III on a component other than cytochrome c₁, is interpreted in terms of this model. This hypothesis presupposes the existence of an F factor between cytochrome b₅₆₀ and cytochrome c₁ as suggested by other authors. Utilizing these equations, theoretical curves for the inhibition of the reduction of cytochrome b₅₆₀ have been constructed and the results agree with the experimental data. The kinetic behavior of cytochrome b₅₆₆ during the induction of anaerobiosis suggests that it is not directly involved in the electron transfer chain but rather is either in thermodynamic equilibrium with cytochrome b₅₆₀ or in a shunt between cytochrome b₅₆₀ and factor F. From the experimental data, an equation is derived for the inhibition of the reduction of cytochrome b₅₆₆ by antimycin A. The actual effects of ATP and mClCCP on succinoxidase agree well with those predicted by the model.     

Le nid et le comportement de construction de la fourmiMessor ebeninus,Forel (Hymenoptera,Formicoïdea)

Résumé Le nid desMessor en général est formé d'un puits principal s'enfonçant très profondément dans le sol et duquel se détachent plusieurs chambres et galeries latérales. Celui deM. ebeninus présente deux parties: l'étage supérieur, sec en été, est transformé en grenier; l'étage inférieur arrive à la limite de la nappe phréatique: c'est l'abri de la reine et du couvain.Des expériences montrent que la reine et les ouvrières creusent les parties humides du sol. L'importance du travail effectué dépend du volume de la société. Plus le nombre des ouvrières actives est élevé, plus le réseau des galeries s'étend et se développe.La structure de la fourmilière, le volume des chambres et des greniers ainsi que leur emplacement par rapport au puits principal dépendent de la direction prise par l'eau qui s'infiltre ou s'accumule.Une sécheresse de cinq mois et la chaleur de l'été refoulent les fourmis vers les couches profondes du sol à la recherche d'un milieu humide et plus clèment.

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Summary The nest ofMessor is generally formed of a main shaft dig down deep into the earth from which several chambers and lateral galleries branch out. the nest ofM. ebeninus cosists of two parts, the upper floor, dry in summer, is transformed into granary; the lower floor, whose lower limits reach the aquatic stratum, becomes the shelter for the queen and his brood.Experiments show that the queen and the workers dig the humid parts of the soil. The importance of this work is a function of the size of the colony. The higher the number of the workers the more developed the tunnels become.The structure of the ant nest, the volume of the chambers and granaries, their placement in relation to the main shaft is a function of the direction of the seeping and accumuled water.The five months period of aridity and hot summer forces ants to go into deeper strata of soil until they find a humid and more favourable conditions.

     

La TEP-TDM à la F-Dopa aurait-elle un rôle dans le suivi postopératoire des patients atteints de carcinome médullaire de la thyroïde ? Résultats préliminaires de l’expérience strasbourgeoise et revue de la littérature

Aim

Retrospective study to assess the value of fluorine-18 dihydroxyphenylalanine (¹⁸F-Dopa) positron emission tomography (PET)/computed tomography (CT) in the post-surgical follow-up of patients with history of medullary thyroid carcinoma (MTC) and biological suspicion of disease relapse. A review of the literature was also performed.

Patients and methods

Ten patients (23-71 years) with MTC previously treated by surgery were examined by at least one ¹⁸F-Dopa PET/CT. All patients presented with elevated serum calcitonin (130-9076 ng/l) and/or CEA (1.2-518 ng/ml) levels. 3D whole body PET/CT was performed 45 and 120 minutes after intravenous injection of 4 MBq/kg of ¹⁸F-Dopa. Scintigraphic images were visually interpreted. For quantitative analysis, maximum standardized uptake value (SUV_max) per focus was employed. PET results were compared with histological findings and/or with the results of all other imaging procedures.

Results

Seven patients (70%) had a positive ¹⁸F-Dopa PET/CT. Twenty-five focal tracer accumulations were described. Histopathological confirmation of metastatic disease was obtained in four of the seven patients with pathologic ¹⁸F-Dopa PET/CT. No scintigraphic abnormalities were evidenced in the three other patients, whose conventional morphological imaging procedures were also negatives. Delayed PET/CT examinations didn’t increase sensitivity. No correlation between ¹⁸F-Dopa PET/CT results and both serum calcitonin and CEA levels was achieved.

Conclusion

Our results are in accordance with the existing literature, showing the potential role of ¹⁸F-Dopa PET/CT in the clinical management of patients with history of MTC and biological suspicion of relapse during post-surgical follow-up. Prospective studies including larger patient series are necessary to confirm the future place of ¹⁸F-Dopa PET/CT in follow-up of MTC.     

Mise en évidence de deux types de mycélium chez le Sphaerostilbe repens et étude de leur capacité d'agrégation

Résumé Le Sphaerostilbe repens qui différencie des corémies et des rhizomorphes, est constitué de deux types de mycélium végétatif: l'un aérien, l'autre intramatriciel. Le mycélium immergé se caractérise par une forte dominance apicale, est peu ramifié et se développe plus rapidement que le mycélium aérien. Le mycélium intramatriciel est incapable de s'agréger et le mycélium aérien se différencie faiblement en fournissant essentiellement des corémies. La différenciation complète du thalle exige la continuité physique entre les deux types de filaments. Les deux formes mycéliennes sont interconvertibles. Le mycélium aérien passe sous la forme intramatricielle en atmosphère appauvrie en oxygène et peut se différencier en rhizomorphes si une partie du thalle demeure en aérobiose. Le mycélium intramatriciel, remis au contact de l'air, régénère du mycélium aérien, ce qui s'accompagne d'une stimulation considérable de l'organogenèse. Ceci indique que les hyphes immergées du Sphaerostilbe repens pourraient synthétiser des molécules nécessaires à la différenciation du thalle.

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The phytopathogenic fungus, Sphaerostilbe repens which differentiate into coremia and rhizomorphs is composed of two types of vegetative mycelia: one is aerial, the other immersed in the culture medium. Hyphae within the substratum are characterized by a strong apical dominance, are little branched and elongate more rapidly than aerial filaments. Immersed mycelium is unable to aggregate and aerial mycelium differentiates weakly giving rise mainly to coremia. Complete differentiation of the thallus requires physical continuity between both types of hyphae. The two mycelial forms can change into each other. Aerial mycelium turns into immersed mycelium when exposed to oxygen-deficient atmosphere and moreover can differentiate into rhizomorphs if part of the colony is maintained in contact with air. Immersed mycelium transferred to air regenerates aerial mycelium, this change being accompanied by a strong stimulation of organogenesis. This indicates that in Sphaerostilbe repens immersed hyphae might synthetize molecules needed for the thallus differentiation.

     

En France, la majorité des donneurs de spermatozoïdes souhaite le maintien de leur anonymat

So far in France, sperm donor anonymity, which was a fundamental principle and has been twice confirmed in the law in 1994 and 2004, is debated nowadays. In this context, the Cecos wanted to know the donors opinion on anonymity. In 2006, 193 semen donors recruited in 14 Cecos answered anonymously a questionnaire: 73% were in agreement with the principle of anonymity and less than 30% agreed that the future law should change to allow the children to know the donor identity. In case of anonymity disclosure, 60% would give up their sperm donation. The same proportion of donors would accept that non identifying information on them could be given on request to the parents and the child.