Assurance qualité du circuit des médicaments radiopharmaceutiques du service de médecine nucléaire de l’hôpital Ibn Sina de Rabat

Since Law n^o 17-04 of the national code of medicine and pharmacy, published in the official newspaper of November 22, 2006, radiotracers used in nuclear medicine in Morocco have become drugs or diagnostic radiopharmaceuticals. As such, radiopharamaceuticals must meet the requirements of pharmaceutical quality and control that apply to any drug (Payoux and Prigent, 2009 [5]). This task must be undertaken under the pharmacist's responsibility with a specific skill known as “radiopharmacist” (Morera et al., 1993 [6]). In the situation of Moroccan hospital, like Ibn Sina hospital for which the only law of the national code is partially applied, nevertheless the pharmacy department cannot ignore this issue. As part of this work, we present the proposed new quality installation service for 24 months. It aims to improve the proper use of radiopharmaceuticals, to contribute to the quality of diagnostic and therapeutic procedures and especially to ensure the optimal conditions of safety for staff and patients. This activity closely affects the pharmaceutical supply, preparation, dispensing and management of radioactive waste resulting from handling radiopharmaceutical drugs. Radiopharmaceutical quality control of was also integrated into the global quality control program, despite the technical constraints encountered during their day-to-day practice. Our basic documentation referred to European directives (Pharmacopée européenne, 2010 [8]), French Pharmacopoeia (Bonnot-Lours, 2000 [2]) and good preparation practise rules (Afssaps, 2006 [3]). The reflection was undertaken within a multidisciplinary framework: nuclear physician, physicists, a pharmacist working in hospitalpharmacy, chemists of the drug control department, computer and paramedical staff (technicians, nurses, and cleaners).     

Influence de la méthode de fixation sur l'observation des divisions cellulaires dans l'adénohypophyse du rat mâle

Résumé Les mitoses de l'adénohypophyse du rat mâle ont été examinées comparativement après fixation par perfusion et après fixation par immersion.Après fixation par perfusion la répartition topographique des mitoses dans le parenchyme est homogène, et l'index mitotique est de 1,85 pour 1 000 cellules.Après fixation par immersion, la densité des mitoses décroit de la périphérie vers le centre, et l'index mitotique n'est que de 0,80 mitoses pour 1 000 cellules.La lenteur de pénétration du fixateur pendant l'immersion est tenue pour principal responsable des différences observées. Elle entraîne une modification de l'aspect des mitoses, telle que plus de la moitié d'entre elles ne sont pas identifiables et échappent aux comptages.

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Influence of fixation on the observation of mitoses in the male rat adenohypophysis

Summary The mitoses of the adenohypophysis in male rats have been observed comparatively after fixation by perfusion and fixation by immersion.After fixation by perfusion, the topographic distribution of mitoses throughout the parenchyma is homogenous and the mitotic index is 1.85 for 1 000 cells.After fixation by immersion, the density of the mitoses is decreasing from the periphery towards the center and the mitotic index is only 0.80 for 1 000 cells.The slow penetration of the fixative during fixation by immersion is considered to be the main cause in the differences observed. This slow action causes a modification in the aspect of the mitoses, and more than fifty percent of them cannot be identified and escape to the counts.

Avec la collaboration technique de Mademoiselle J. Rameau.     

Pathologie de la mémoire: du déficit lésionnel au trouble fonctionnel

The purpose of this presentation of pathological data is to demonstrate how our ideas have developed from a chronological point of view to our present interest in elementary cognitive processes. The present relative rarity of significant data in brain imagery, compared with what is observed in other fields of neuropsychology, is probably due to the complexity of this cognitive processes.     

Apport du TDM en imagerie multimodalité : le point de vue du physicien médical

The recent introduction of hybrid systems SPECT/CT and PET/CT in nuclear medicine, greatly improved the diagnostic accuracy for particular clinical indications, due to the possible attenuation correction of functional images and the availability of helpful anatomic information. The introduction of CT in the nuclear diagnostic process results in a significant increase of the patient dose. This increase should be justified and optimized considering both the clinical question and the CT settings available on these systems. The choice of CT settings directly affects the effective dose. It varies basically as the square of the tube voltage, linearly with the length of the scan and the product of the current by the rotation time of the tube. It is also inversely proportional to the pitch. For attenuation correction, the literature shows that it is possible to use a low CT tube current without significant effect on tumor FDG uptake or lesion size. Conversely low CT voltage must be used with caution, depending on the algorithm implemented in the CT hybrid device to transform CT Hounsfield units to the attenuation map at the appropriate energy. The radiation dose for anatomic correlation can be substantially lower than for diagnostic-quality CT. It is possible to reduce the patient's radiation dose by a factor of 2 or 3 by acquiring a low-dose PET/CT scan for anatomic correlation of adequate image quality if compared with diagnostic ¹⁸FDG PET/CT. Using specific CT settings, the effective dose can range 7.3–11.3 mSv depending on the patient weight and age.     

Comparaison de différents indices métaboliques et de la méthode SULTAN dans l’évaluation de la réponse thérapeutique par TEP au 18FDG dans le cancer du sein métastatique

Objective18F-FDG PET is a valuable tool in the evaluation of therapeutic response in breast cancer. This retrospective study was designed to compare the performance of six metabolic indices and to define their optimal thresholds, in patients treated with chemotherapy or hormone therapy for metastatic breast cancer. The performances of a parametric analysis by SULTAN method were also evaluated.MethodsTwenty patients, who underwent from 2 to 7 PET during the follow-up were analyzed. For each target, six indices were measured: SUVmax (maximum Standardized Uptake Value), SUVpeak, SAM (Standardized Added Metabolic activity), metabolic volume (MV), SUVmean using an adaptive threshold, and TLG (total lesion glycolysis). The percentage change of each target between each PET was calculated. A method based on parametric imaging (SULTAN) was also applied to each patient. The results were compared to the gold standard, defined by clinical evaluation, biological and morphological imaging RECIST 1.1 criteria. A per-lesion and per-patient analysis were performed and the optimal thresholds for each indices were calculated.ResultsFor the per-lesion analysis, 61 targets and 111 evolutions with 67 responders (R) and 44 non-responders (NR) were studied. Using ROC curve analysis and intercomparison, SUVmax, SUVpeak and SUVmean were significantly better than SAM, TLG and VM (P < 0.05). Using the optimal thresholds of −21%, –21%, –34%, –48% and –23% for SUVmax, SUVpeak, SUVmean, SAM and TLG respectively, these five indices were significantly correlated with the gold standard. SUVmax, SUVpeak and SUVmean showed the best performances of sensitivity (88%, 87% and 78% respectively), specificity (93%, 93% and 98% respectively) and negative predictive value (NPV) (84%, 69% and 74% respectively). For the per-patient analysis, 42 pairs of PET with 22 R and 20 NR were studied. Only SUVmax and SUVpeak were correlated to gold standard with the 30%-PERCIST-threshold and with optimal thresholds with performances of sensitivity of 73% and 77%, specificity of 95% and NPV of 76% and 79%. Parametric analysis with SULTAN showed excellent performances in the per-lesion and per-patient analysis (sensitivity 84% and 82%, specificity 98% and 90%, NPV 80% and 82%, respectively).ConclusionSUVmax and SUVpeak appeared the best indices to evaluate metabolic response in metastatic breast cancer. The SULTAN method was a reliable method to assist interpretation.     

Utilisation de lois de la mécanique pour l'Estimationde la vitesse de locomotion des Vertébrés tétrapodes du passé

Two computation methods are explained; theirobject is the estimation of the velocity of animals which are known by their footprints, and in the case of the first method, by their skeletons as well.The first method is based on the compound pendulum theory, because during the slow walking gait, the motion of the leg is similar to the oscillation of a pendulum, for the computation of the velocity (v), are considered: moment of inertia (I), radius of gyration (P) and period (T), time in seconds to cover one stride (E) in the case the maximum angle of divarication (δ) of the leg with the vertical is ≤20°. A comparison with the formula of Alexander (1976) is discussed.The second method concerns saltator animals. It is based on the fondamental laws of dynamics. With the length of the jump (E) it is possible to estimate the velocity of the trackmaker (v) and the height of the jump (K). For the vertebrates the angle of the trajectory with the horizontal plan (α) is between 20 and 45°. Thus, the result of this method is an interval of estimation in which the velocity is included.These methods do not give precise results. But these approximations supply valid informations on the velocity of extinct or living animals and can lead to the estimation of their maximum speed if the parameters E, T, vary. The problem of the errors is also discussed. It is shown that the errors in estimating the parameters have a no significant influence on the results.     

Étude de la cytodifférenciation du rein de l'Epinoche femelle après traitement par la méthyltestostérone

Résumé Au microscope électronique, l'action de la méthyltestostérone sur les cellules rénales de l'Epinoche femelle se traduit par une cytodifférenciation conduisant à la formation de cellules glandulaires muqueuses. Elle a lieu simultanément à deux niveaux distincts:Au niveau du tubule proximal, le premier signe visible de cytodifférenciation est une activation du nucléole, accompagnée par une augmentation de taille des cellules. Puis on assiste à un développement de l'ergastoplasme et de l'appareil de Golgi et à l'élaboration de deux types de sécrétions: d'abord des granules de 2000–2500 Å, ensuite des grains de mucigène typiques, qui subissent rapidement une transformation muqueuse.Une cytodifférenciation régressive intervient en même temps. Elle concerne la pinocytose apicale qui disparaît.Au niveau des tubules collecteurs, la cytodifférenciation se traduit par la formation d'un mucus hyalin d'origine golgienne. Elle s'accompagne également d'une disparition de la pinocytose.La méthyltestostérone est capable de provoquer, chez la femelle, une cytodifférenciation rénale identique à celle que l'on observe chez le mâle pendant la période de reproduction. La transformation muqueuse des cellules rénales est donc sous le contrôle de la seule testostérone, qui déclenche au niveau cellulaire un ensemble de processus conduisant à la formation de mucus.Au microscope électronique, on constate que l'élaboration de mucus prêt à l'excrétion est achevée au bout de trois jours dans les tubules proximaux alors que dans les tubules collecteurs elle ne demande que 24 heures.

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Action of methyl testosterone on the cytodifferentiation of the kidney of the female three-spined Stickleback

Summary At the microscopic level, the action of methyl testosterone on the cells of the kidney of the female three-spined Stickleback gives raise to a cytodifferentiation which leads to the formation of mucous glandular cells. This action is evident at two different levels:At the level of the proximal tubule, the first visible sign of cytodifferentiation is an activation of the nucleolus, accompanied by a growth of the cell size. Then a rapid development of the ergastoplasm and the Golgi apparatus takes place, which leads to the elaboration of two types of secretory particles: granules of 2000–2500 Å in diameter appear first, then typical mucigen granules become visible. These latter undergo a rapid mucous transformation.A regressive cytodifferentiation occurs at the same time. It concerns the apical pinocytosis which disappears in the cells undergoing the glandular differentiation.At the level of the collecting tubules, the cytodifferentiation is characterized by the elaboration of a clear mucus which originates in the Golgi apparatus and migrates to the apex of the cells. A disappearance of the pinocytosis is also noticeable.In the kidney of the female, methyl testosterone induces a cytodifferentiation which is identical to that occuring in the male during the breeding period. So the mucous transformation of renal cells is under the control of a single hormone: the testosterone, which is able to give raise to a succession of phenomena leading to the formation of a mucous secretion.With the electron microscope, it is possible to demonstrate that three days are necessary for the elaboration of the mucus ready to be discharged in the lumen of the renal proximal tubules. In the collecting tubules, the reaction occurs more quickly, after only two days of treatment.

L'auteur tient à remercier Monsieur le Professeur E. Follénius pour ses conseils et son aide précieuse au cours de la réalisation de ce travail.     

«Noir de Diaminobenzidine»: Une nouvelle méthode histochimique de révélation du fer exogène

Résumé Une nouvelle réaction de mise en évidence histochimique du fer exogène, utilisé comme traceur pour l'étude des connexions dans le système nerveux central, est décrite. Elle comporte la transformation du fer en bleu de Prusse, lequel est utilisé comme catalyseur de l'oxydation de la diaminobenzidine par l'eau oxygénée. La diaminobenzidine oxydée précipite sous forme d'un produit insoluble de couleur brun-noir. Cette réaction présente une sensibilité et un contraste nettement supérieurs à ceux de la réaction classique de Perls.

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Diaminobenzidine black as a new histochemical demonstration of exogenous iron

Summary A new reaction for the histochemical demonstration of exogenous iron, used as a tracer for the study of connectivity in the central nervous system, is described. It consists of, first, the conversion of iron into Prussian blue, which acts secondarily as a catalyst for the oxidation of diaminobenzidine by hydrogen peroxide. The oxidized diaminobenzidine precipitates by polymerization and gives rise to a brown-colored insoluble reaction product. This reaction has a strikingly better sensitivity and contrast than the classical Perls's reaction.

     

Suivi pluriannuel du peuplement à Abra alba dans la partie méridionale de la Mer du Nord (région de Dunkerque-France)

The Abra alba community is considered as a faunistical unity well established on coastal areas of North Sea. This community shows, since several years, very important recruitments of certain species. Since 1978, recruitments of Abra alba, Tellina fabula, Phyllodoce (Anaïtides) mucosa, Lagis koreni or Lanice conchilega have been observed. However these demographic phenomena does not affect the structure of the community, which shows, through rank-frequency diagrams, the characteristic of a mature population, principally constituted of 7 species.An annual cycle study shows a succession of recruitments of several species. A correspondance factorial analysis was realised from grain size datas as well as abundances of 18 main species. This analysis shows an annual cycle which seems to be linked to the clay part. Maximal values of clay part appears in summer and minimal values at the end of winter or early springtime.The hydrological parameters studied, allowed to make the difference between external factors (continental contributions, phytoplanctonic activity etc...) and benthic activity.

     

Longueur du chromosome Y,intelligence et comportement dans une population de médico-légaux

Summary The Y/F ratio was established in 128 mentally disordered offenders in a maximum security hospital. The 50 Y/F 0.90 subjects were compared with the 78 Y/F<0.90 subjects as regards intelligence and behaviour. With the exception of the highest frequency of intelligence quotients lower than 70 in the criminal patients Y/F 0.90, no statistical correlation exists to support the theory of a relation between a long Y chromosome and the type of psychiatric (psychopathy, psychosis) or criminality diagnosis.

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To whom offprint requests should be sent     

Le marquage de l''entrée du nid de bourdons

Résumé Cette étude met en évidence l'efficacité du dépôt d'un marquage odorant dans la reconnaissance de l'entrée du nid par les butineuses de bourdons. L'étude du comportement olfactif de ces ouvrières a consisté à observer leur réponse en présence d'un marqueur odorant déposé par d'autres ouvrières en utilisant la méthode du choix binaire. Les observations ont été faites avec des colonies de plusieurs espèces: Pyrobombus (P.) hypnorum L., Pyrobombus (M.) lapidarius L., Bombus lucorum L., Megabombus (T.) pascuorum Scop., Pyrobombus (P.) pratorum L. et Bombus terrestris L. L'expérimentation a consisté également à faire varier qualitativement la stimulation, ce qui a permis d'étudier la capacité des ouvrières à distinguer l'odeur de la substance déposée par les individus de leur propre colonie de celle déposée par les individus d'une autre colonie, isospécifique ou hétérospécifique. Pour chaque espèce étudiée, les ouvrières retournant au nid font un choix en fonction de la nature du marquage. L'écart entre les pourcentages de réponses est plus important dans le cas du choix entre papier marqué et papier vierge (expérience 1) que dans celui entre papier marqué par la colonie et papier marqué par une colonie étrangère hétérospécifique (expérience 3). Une moindre dispersion des réponses apparaît dans le choix entre papier marqué par la colonie et papier marqué par une colonie étrangère isospécifique (expérience 2). La discussion porte également sur le marquage de l'entrée du nid chez des espèces d'Hyménoptères solitaires terricoles, fonction attribuée à la sécrétion de la glande de Dufour. Le mécanisme de ce marquage chez les Apoïdes sociaux reste à étudier.     

Ultrastructure du lobe postérieur de l'hypophyse du rat et ses modifications au cours de l'excrétion de vasopressine

Résumé Le lobe postérieur de l'hypophyse a été examiné sur coupes ultrafines chez 45 rats (24 normaux, 17 déshydratés respectivement 1, 2 et 4 jours, et 4 anesthésiés à l'éther), après fixation au glutaraldéhyde ou selon la méthode de Karnovsky, post-fixation osmiée et double contraste à l'acétate d'uranyle et au citrate de plomb. Des fibres neurosécrétoires sombres et claires sont reconnaissables, mais les données manquent encore pour interpréter cette différence. Des densifications juxta-membranaires sont observées dans les terminaisons neurosécrétoires là où se trouvent des amas de microvésicules. Des fibres neurosécrétoires traversent parfois des pituicytes; il est aussi souvent observé des fibres, chargées de granules, libres dans un espace péricapillaire. Les espaces péricapillaires, ramifiés en tous sens loin des vaisseaux, développent une large surface de contact avec les extrémités nerveuses et les prolongements de pituicytes.Dans des conditions techniques bien contrôlées, la déshydratation n'entraîne pas de modifications appréciables des granules de neurosécrétat après 24 h. Ensuite les granules sont diminués en nombre, de façon très considérable le 4e jour; mais les granules restants ont un contenu dense normal; jamais il n'a été observé d'aspects de granules vides . Après anesthésie prolongée à l'éther, il n'y a aucune modification visible ni du nombre, ni de la densité des granules. Ces observations sont discutées quant au mécanisme de l'excrétion de vasopressine; elles sont en faveur de l'existence de deux pools hormonaux, l'un libre et rapidement disponible, l'autre plus fortement lié et certainement contenu dans les granules jouant le rôle de réserve. Toutefois un mécanisme d'exocytose granulaire ne peut être formellement exclu.

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Ultrastructure of the rat's hypophysial neural lobe and it's changes during vasopressin release

Summary Hypophysial neural lobes of 45 rats (24 controls, 17 dehydrated resp. 1, 2 and 4 days, and 4 ether anesthetized) were fixed either with glutaraldehyde or according to Karnovsky and post-fixed in osmium tetroxyde; ultrathin sections were stained by uranyl acetate and lead citrate. Dark and clear neurosecretory fibres were observed, but sufficient data are still lacking for a valuable interpretation of these aspects. Juxta-membraneous densifications are visible in limited areas of neurosecretory terminals where clusters of microvesicles are present. Neurosecretory fibres happen to be completely encircled by pituioyte cytoplasm; fibres loaded with elementary granules are frequently encountered running free in a pericapillary space. Pericapillary spaces stretch out branching far away from vessels, resulting in a widespread contact with nerve terminals and pituicyte processes.In accurately controlled technical conditions, dehydratation does not result in any noticeable change of neurosecretory granules after 24 h. A decrease of the number of granules follows and is extremely conspicuous after 4 days; though, remaining granules keep a normal dense content, and aspects of empty granules have never been observed. After prolonged ether anesthesia, no visible change either in number or electron density of granules was observed. These findings are discussed in consideration of the mechanism of vasopressin release; they support the hypothesis of two hormonal pools, one of which would be free and rapidly available for release, the other being more tightly bound and certainly located in granules representing a storage site. Though granular exocytosis cannot be absolutely excluded.

Travail effectué avec l'aide, en matériel et en assistance technique, du Centre National de la Recherche Scientifique. — Nous remercions particulièrement Mme J. Bottini pour son aide précieuse dans la préparation du manuscrit et Mr. B. Dutillet pour sa participation aux contrôles en microscopie optique.     

Aspects épidémiologiques du cancer différencié de la thyroïde (médullaire exclu) au Maroc

Epidemiology of thyroid carcinoma is a complex issue. Data on thyroid carcinoma incidence depend on the efforts undertaken through screening and on the diagnostic methods employed. The objective of this work is to carry out an epidemiologic approach of differentiated thyroid carcinoma (DTC) in our country, with an evaluation of the recent review of literature. This work consists of a retrospective analysis of 3144 cases of differentiated thyroid carcinoma followed in nuclear medicine department of Ibn Sina hospital in Rabat over a period of 20 years. Epidemiology has allowed us to study the influence of gender, age, tumour size, pathological type and prognosis factors in DTC. Epidemiological studies contribute to a better understanding and management of thyroid carcinoma. Further studies are mandatory to determine risk factors and elucidate pathogenetic mechanisms of DT.     

Taxonomie numérique de lactobacilles isolés du vin

Résumé L'auteur a déterminé les relations taxonomiques existant entre 65 souches de lactobacilles isolés du vin et 4 souches de collection, à l'aide de l'analyse adansonienne. Sept phénons 80 et deux phénons 72 sont décrits: ces deux derniers correspondent aux sous genres Streptobacterium et Betabacterium. Deux phénons 80 sont assimilables aux espèces Lactobacillus casei et Lactobacillus plantarum. Les autres phénons comportant plus d'une souche ne correspondent à aucune espèce décrite.Ce travail montre que l'on peut mettre en évidence les caractères phénétiques les plus représentatifs pour les regrouper ensuite dans une clé d'identification et que l'on peut juger de la valeur taxonomique d'un caractère d'intérêt pratique.

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Numerical taxonomy of lactobacilli isolated from wines

Summary The author has established the taxonomic relationships between 65 strains of lactobacilli isolated from wines and 4 named cultures, by means of adansonian analysis. Seven 80 phenons and two 72 phenons are described. The latter correspond to the subgenera Streptobacterium and Betabacterium. Two 80 phenons answer to the species L. casei and L. plantarum. The others 80 phenons of more than a strain do not correspond to any known species.This study shows that we can isolate the most representative phenetic characters and gather them again in an identification key and that we can appreciate the taxonomic value of a practical character.