Les théories de l’économie animale et l’émergence de la psychiatrie de l’Encyclopédie à l’aliénisme

The author analysesEncyclopédie’s articles devoted to nervous and mental functioning and disorders, showing that a new approach to lunacy as a mental illness, which is defined in some articles as a “general trouble of the animal economy”, progressively emerged. The term,animal economy, unified physical and moral aspects of the study of man. It was elaborated by XVIIIth century physiologists and was widely accepted by French physicians. This idea is based on the vitalistic thought of the Montpellier school, which equated life with sensibility, and on English medical conceptions of a nervous-centred organism. Later on Philippe Pinel’s work displayed the legacy of these conceptions. On one hand, the comprehensive view of physical and moral dimensions in theanimal economy neutralized the question of an organic or psychogenetic origin of madness. This enabled him to consider it as a determinate field of sensibility interactions and as a medical matter, and to legitimize the group of therapeutic practices that he namedtraitement moral. On the other hand, Pinel departed from the classical conception ofanimal economy by developing his concept of aprinciple of mania, which underlies the manifold symptoms and forms of madness, and which are only perceptible to a trained specialist (aliéniste). The historical development analysed in this article show how alienists were enabled to claim both the wholly medical nature of insanity as disease, and their specific competence as apart from the other medical disciplines. To this extent, Esquirol achieved Pinel’s scientific work.     

Quand l’évolution parle à la biologie fondamentale

Like many results in comparative anatomy, the works on bone histology led by Armand de Ricqlès have found their whole sense within the framework of the theory of evolution. It seems to be the same thing in genomics and molecular biology. However, some examples show that the fluidity of genomes is not realized by the same processes in eukaryotes and in prokaryotes. In the first taxon, transposons play a fundamental role, since in the other case horizontal gene transfers are essential. These dynamics seem to be necessary for understanding the bases of genomic evolution both from fundamental and applied points of view.     

De l’origine des anthropoïdes à l’émergence de la famille humaine

The human lineage has a very ancient origin, as most of the mammals. Its oldest representatives, anthropoid primates, have been described from Asia some 45 million years ago. During this long evolutionary story, two critical stages have appeared as especially important, their beginning in Asia and the emergence of hominids in Africa, some seven million years ago. These two stages are discussed hereby with new data relative to their Asian origins and their dispersal into Africa between 45 and 40 million years ago. Following this dispersal event, these primates evolved in Africa and gave rise to the early hominids. These appeared around seven million years ago and have three distinct representatives. Among them, Toumaï appears as the oldest and the closest to our ancestry, a point that is evidenced here.     

Application de la technique de PCR en temps réel à l’étude de l’ADN ancien

Real-time Polymerase Chain Reaction (PCR) for the study of ancient DNA. The properties of ancient DNA (aDNA) make difficult the retrieval of DNA sequence. The advantage of Real-Time PCR was exploited, for the first time, in the study of aDNA. We determined the optimal condition to amplify, in one round of PCR, aDNA, which should be directly sequenced. Beside the verification of aDNA authenticity, we compared two cleaning bone methods: scalpel and ethanol. The ethanol specimens showed the best DNA yield. The aDNA was extracted and amplified (mitochondrial hypervariable region I) from five skeletons exhumed from the archaeological site of Notre-Dame-du-Bourg (France), dated from 3rd to 17th century. To cite this article: R. Kefi et al., C. R. Palevol 2 (2003) 125–132.     

Azoospermias au Sénégal: quelle prise en charge à l’heure de l’ICSI?

Objective

to determine the place of azoospermia among the various causes of infertility in Senegal.

Material and methods

141 cases of azoospermia were identified from a series of 492 infertile patients. The clinical profile, laboratory results and outcome after management were studied.

Results

The mean age was 40.6 years. Testicular atrophy was detected in 34.75% of cases. Azoospermia was secretory in 71.69% of cases. A varicocele was associated in 56% of cases. Varicocele repair was performed in 32.62% and allowed an improvement of sperm parameters in 28.3% of cases. Testicular biopsy, performed in 53 cases, demonstrated 2 cases of Sertoli cell syndrome, 3 cases of arrested maturation, 8 cases of hypo spermatogenesis, and 25 cases of seminiferous tubules. Forty nine cases of azoospermia were associated with normal FSH levels. Only one patient was treated by assisted reproductive technologies (ART).     

Cytochrome P450 et activation génétique — de la pharmacologie à l’élimination du cholestérol et à la régression de l’athérosclérose

Background

Lipoproteins are closely associated with the atherosclerotic vascular process. Elevated levels of highdensity lipoprotein cholesterol (HDL-C) and apolipoprotein AI (apo AI) in plasma indicate a low probability of coronary heart disease (CHD) together with enhanced longevity, and elevated levels of low-density lipoproteincholesterol (LDL-C) and apo B indicate an increased risk of CHD and death. Studies linking gene activation and the induction of cytochrome P450 with elevated plasma levels of apo AI and HDL-C and lowered plasma levels of LDL-C presented a new potential approach to prevent and treat atherosclerotic disease.

Objective and methods

This is a review aimed at clarifying the effects of P450-enzymes and gene activation on cholesterol homeostasis, the atherosclerotic vascular process, prevention and regression of atherosclerosis and the manifestation of atherosclerotic disease, particularly CHD, the leading cause of death in the world.

Results

P450-enzymes maintain cellular cholesterol homeostasis. They respond to cholesterol accumulation by enhancing the generation of hydroxycholesterols (oxysterols) and activating cholesterol-eliminating mechanisms. The CYP7A1, CYP27A1, CYP46A1 and CYP3A4 enzymes generate major oxysterols that enter the circulation. The oxysterols activate — via nuclear receptors — ATP-binding cassette (ABC) A1 and other genes, leading to the elimination of excess cholesterol and protecting arteries from atherosclerosis. Several drugs and nonpharmacologic compounds are ligands for the liver X receptor, pregnane X receptor and other receptors, activate P450 and other genes involved in cholesterol elimination, prevent or regress atherosclerosis and reduce cardiovascular events.

Conclusions

P450-enzymes are essential in the physiological maintenance of cholesterol balance. They activate mechanisms which eliminate excess cholesterol and counteract the atherosclerotic process. Several drugs and nonpharmacologic compounds induce P450 and other genes, prevent or regress atherosclerosis and reduce the occurrence of non-fatal and fatal CHD and other atherosclerotic diseases.     

Introduction à l’anthropologie clinique

This paper discusses the concept of clinical anthropology. It recounts how an anthropological school of thought emerged in psychiatry and clinical psychology. Nowadays, that school spans the fields of philosophical anthropology, medical anthropology, cultural psychiatry, anthropological psychology, and clinical anthropology. After providing a conceptual and historical definition, we briefly introduce the ideas of the psychiatrist and philosopher, Ludwig Binswanger. In 1930, he became the first to introduce anthropological research into psychiatry, emphasising the a priori difference between homo natura and existence. Finally, we outline the development of phenomenological anthropology in Europe, with reference to the major philosophers and psychiatrists of the second half of the twentieth century.     

De la « théorie sexuelle » à l’anthropopsychiatrie

The creation of scientific psychiatry, which was modelled after the medical classification of diseases, was brought into question by the tenets of Sigmund Freud’s theory of psychoanalysis. We draw on Leopold Szondi’s method of developing an analytically inspired psychiatry in our effort to interpret Freud’s work from an anthropological perspective, removing psychiatry from the naturalistic medical model and giving it a genuinely human bearing. Szondi’s drive system ranges from the analysis of constitution (as in the animal biomedical model) to the analysis of destiny (as in Schicksalsanalyse). Within this system, the human is considered a driven being, existing in a psychological dimension from the outset, outside animal, sexual instincts. This distinction between mankind and animals accounts for the specificities of mental disorders and illnesses and paves the way to a purely anthropological psychiatry we can call cultural psychiatry. In this kind of psychiatry, any pathology is considered inherent in the destiny of a human being, a part of a person’s development. Its analysis, called pathoanalysis, deals with the human suffering at the heart of mankind’s place in the world.     

Ventriculographie isotopique : comparaison de l’acquisition sur gamma caméra CZT cardio dédiée à l’acquisition planaire

IntroductionGated equilibrium radionuclide venticulography is often used to determine left ventricule ejection fraction (LVEF), especially in case of follow up when cardio-toxic drugs are administred. During the last decade, the use of cardiac specific (CZT) gamma cameras has spread. They directly acquire 3D data. We wanted to determine the agreement between three nuclear medicine LVEF measurement techniques. We also wanted to determine the repeatability of these techniques.MethodsBetween April 16, 2016 and February 4, 2017 we consecutively included 77 patients who were adressed to the nuclear medicine department of CHU Martinique for LVEF measurement. Patients were injected with 99*Technetium labelled albumin. Usual planar scintigraphy was performed to serve as reference and 3D data was acquired with a CZT cardiac gamma camera. 3D data was analyzed directly with BPGS software, and also reprojected to planar data which was analyzed like the conventional planar acquisition.ResultsSeventy patients had acquisitions with both gamma cameras. The LVEF values from the CZT camera data were significantly higher than the reference planar LVEF measurements (+6.2 for 3D analysis, P < 0.01, concordance interval [?8.0; 20.3] and +1.7 for planar reprojection, P = 0.01, concordance interval [?8.9; 12.2]. For all three methods, the intra-method concordance intervals were within [?5; 5].ConclusionOur results indicate the same measurement method must be used in case of LVEF follow up. The variation between theses methods could lead to the false conclusion of impairment of LVEF (which is suspected in case of a 10% LVEF drop). Our secondary outcome show a good repeatability for all three techniques. Further studies should be initiated to determine which method is the most accurate and to determine the reproductibility of the CZT data acquisition process.     

Rôle de la TEP FDG dans l’évaluation de l’extension locorégionale et à distance du mélanome

FDG PET/CT is a relevant examination for patients with high-risk melanoma. For early stages with thickness ≥ 1 mm, lymph node ultrasound, and when negative, lymphoscintigraphy for determination of sentinel lymph node, remain necessary. For more advanced stages, FDG PET can map the lesions and guide the therapeutic strategy, either with surgical management, or systemic therapy (or sometimes both). In patients with high-risk melanoma, it allows to detect relapses early, including in asymptomatic patients, with a potential impact on therapeutic decisions. Beside the detection of classical secondary localizations, FDG PET has the advantage of allowing whole-body imaging, the identification of soft tissue lesions, frequent in melanomas, as well as rarer sites of involvement, such as those of the gastro-intestinal tract. For the assessment of cerebral and leptomeningeal involvement, MRI remains mandatory. Evolutions in the therapeutic management of advanced melanomas, and the search for biomarkers to guide the therapeutic strategy, ask for more refined analyses of PET, with metabolic tumour volume analysis and radiomics. The combination of metabolic imaging data with biological and molecular data, and the development of new PET tracers may improve the assessment of prognosis and the prediction of response to therapies, in order to tailor the therapeutic strategy to each patient. Further studies are needed to consolidate the role of PET/CT in this disease for which numerous therapeutic innovations are emerging.     

Anomalies de position des testicules dans l’enfance: conséquences à l’âge adulte

Non descended testes in the low scrotum is a common anomaly at birth, with about 4% of the newborn males affected. Only one quarter of these newborn babies will still have non descended testes when one year old. However, the testes that will descend within the first year of life seem no more to be considered as normally descended testes. Moreover, the retractile testis, which represents a secondary anomaly of testicular position occuring after the babies are older than one year, is no more to be regarded as a physiological variant of the normally descended testis, since several reports indicate histological and clinical modifications in such cases. The testicular non descent can be associated with two consequences in adult life. Firstly, an history of non descended testis is the only known risk factor for the testicular cancer. Secondly, such an history is a risk factor for the male fertility because of spermatogenesis alterations, as indicated by qualitative and quantitative histological analyses of the testicular tissue, and by depressed spermatozoa output and quality (motility, normal forms); moreover, testicular volumes are reduced, and the time to pregnancy as well as the rate of infertility are increased. Time is arrived for a reappraisal of the consequences in adult life of the abnormal testicular location (either congenital or acquired) during childhood.     

Infection génitale à chlamydia chez l’homme et retentissement sur la fécondité

Chlamydia trachomatis is responsible for the most common sexually transmitted disease, up to 40% of the non gonococcal urethritis. It is a compulsary intracellular parasite. Its peculiar metabolism makes the bacteria interfere with the host cell immunity. Infection can become chronic and induce inflammation, if not properly treated, by permanent emission of antigens and heat shock proteins, and stimulation of Tcells. Autoimmunization against sperm can occur and impair fertilization and embryo implantation. Thus, Chlamydial infection can be associated with male infertility because of tissue damage, altered movement and antisperm immunization. PCR and LCR are to date the most sensitive detection techniques for c.trachomatis. Our study aim was to determine the prevalence of Chlamydial infection by PCR in 6 groups of men in andrologic practice. The highest prevalences have been found in the infertile men group and in the symptomatic group. No Chlamydia culture was found positive in any group. The association of PCR with anti C. trachomatis seminal IgA and seric IgG are useful tools for andrologic exploration.     

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.     

Application de l’imagerie moléculaire par fluorescence à la clinique

Fluorescence probes and imaging methods have been extensively developed in microscopy to visualize biological pathways, cell trafficking and intracellular interactions, which are the main targets of molecular imaging. The translation of these methods from microscopy to preclinical and clinical applications requires to image through large thickness of live biological tissues, and to ensure the non-toxicity of the probes. We hereafter list the main issues that must be addressed to translate fluorescence techniques to clinic, and we present the main envisioned solutions. As first realistic clinical application, we present work in progress on intraoperative fluorescence guided surgery.     

Le principe de l’anonymat du donneur de gamètes à l’épreuve de son contexte. Analyse des conceptions juridiques de l’identité

This study clarifies the lively debate surrounding the anonymity of gamete donors. This principle, which has not been challenged since 1994, is currently criticized by a number of people, who were conceived through medically assisted procreation technologies with donor and who now have reached adulthood. Their testimony has a very significant impact on French public opinion. Several official reports have already suggested that the anonymity of gamete donors may well be removed under certain circumstances. To understand why public opinion has evolved so dramatically, we must revisit the legal position of gamete donors in the specific context of less visible changes in the law. Indeed, the legal concepts of parenthood and identity have been reshuffled over time, and such changes have deeply affected the legal issues relating to the anonymity of gamete donors. Formerly, the law governing the identification of individuals was shaped by political and social objectives. Now it is more concerned with the sense of identity and personal fulfilment of people. This change, based on modern western notions of egalitarianism and individuality, has dramatically affected the outcome of parenthood trials. Moreover, biological tests have made the truth available like never before. The possibility of finding out the truth has shocked the practice of many areas of family law and has created a new set of challenges, especially when the secrecy of the genetic parents has been legally established. In France, women have traditionally been able to deliver their children anonymously. A deadlock has resulted, which may now be overcome by introducing a new concept of personal origins. Now the law is evolving to permit the children to demand their biological mothers’ identity under certain circumstances, but without affecting anyone’s rights. The concept of personal origins has been quite successful on the European scene and has also charged the debate. It is now recognized under French and European laws that individuals must have privileged access to their personal origins. Can the principle of anonymity of gamete donors remain immune from such a (r)evolution ?     

Contribution à l’étude des groupements Végétaux du vercors méridional: Les groupements fontinaux et des bas-marais de l’étage subalpin

Conclusions L’important mémoire deJ. Braun-Blanquet (1971) sur les Associations des basmarais suisses ainsi que d’autres travaux (E. Oberdorfer, 1970;H. Ellenberg, 1963), permettent d’affirmer que les groupements de l’Eriophorion latifoliae (Br.-Bl. et Tx. 43) et des Caricetalia Davallianae (Br.-Bl. 49) sont représentés dans l’ensemble de la cha?ne alpine sur substrat riche en calcium et, en général, à partir de l’étage montagnard supérieur. Dans les Alpes et Préalpes fran?aises, plusieurs auteurs ont décrit des groupements du Caricion Davallianae (M. Guinochet en Tinée et en Haute-Savoie, 1938 et 1939;G. Aubert, L. Borel, A. Lavagne etP. Moutte dans l’étage subalpin de la feuille d’Embrun-Est, 1965). Dans le Vercors, seuleCh. Faure (1968) signale simplement l’existence du Caricion Davallianae (Klika 34) dans la partie septentrionale du massif (feuille de Vif). Enfin, dans les Préalpes du sud où les étages montagnard et, a fortiori, subalpin sont peu ou pas représentés.A. Archiloque, L. Borel etA. Lavagne (1970) constatent l’absence du Cratoneurion commutati (W. Koch. 28) et du Caricion Davallianae (Klika 34) sur la feuille de Javie (préalpes de Digne). Bien que la nature de la roche-mère soit déterminante pour l’existence des groupements de source et bas-marais alcalins, c’est en définitive la relative permanence de l’alimentation en eau courante et fra?che qui représente le facteur décisif pour ces associations. Dans la région étudiée, celles-ci sont à leur limite méridionale, ce qui confirme—s'il en était besoin—l’originalité et la richesse de ce secteur des Préalpes. Laboratoire de Taxonomie Expérimentale et de Phytosociologie de la Faculté des Sciences de BESAN?ON (25)—FRANCE.