Quelle scientificit�� pour la psychanalyse ?

From a strictly philosophical perspective, if one uses ??hard sciences?? as a standard to assess the scientificity of a theory, it will not be difficult to question the scientificity of psychoanalysis. But, rather than favouring such criticisms, I shall begin with the idea that different explanations may serve different explanatory goals while remaining valid, since to assess the validity of a theory, one must always consider the explanatory goals it has set. Hence, there is no such thing as an absolute, a historical and timeless criterion from which to judge the validity of a theoretical explanation. But the criteria and the epistemological constraints are normally relative to some set of explanatory goals. Therefore, the issue shifts towards the following question: what are the goals of psychoanalytic explanations and how (from which perspective) are we to judge the validity of its explanations according to the goals it aims at? I articulate together issues related to the object of psychoanalysis (what it theorises), to its explanatory goals (which dimension(s) of its object it seeks to explain) and to the epistemological constraints which are imposed on it. Which leads me to take into account the important role, in the psychoanalytic cure, of the rationalisation of pathological behaviours and of their reintegration into a story which ??makes sense??.     

Ancianos frágiles polimedicados: ¿es la deprescripción de medicamentos la salida?

Deprescribing is the process of reconstructing multiple medication use by review and analysis and which concludes with dose modification, replacement or elimination of some drugs or adding others. Its development is intended to resolve tensions and contradictions between two sets of questions: 1/is life expectancy shorter than the time the drug takes to obtain a benefit?, and 2/are the goals of prescribing-deprescribing consistent with those of care? The validity of the rationale on deprescribing is based on scientific and ethical reasons. The usefulness and safety of many drugs that frail elderly or terminally ill takes is unknown, and other drugs may cause troublesome or severe side effects. Thus, in some cases their removal could be justified, being substantially safe doing so.     

Y a t-il encore de la place pour la scintigraphie conventionnelle aux récepteurs de la somatostatine dans les tumeurs carcinoïdes à l’ère de la TEP ?

Our aim is to discuss, based on literature data, whether or not there is still a place for conventional somatostatin receptor scintigraphy (C-SRS) in the exploration of carcinoid tumours (CT) in the era of PET.MethodsBibliography was obtained by an interrogation of database: PubMed and Cochrane for the last 10 years. Keywords used were “neuroendocrine tumors”, “carcinoid tumors”, “pentetreotide”, “somatostatin”, “gallium-68” and “indium-111”.ResultsC-SRS visualized local or distant metastasis, with a sensitivity reaching 90% when size lesion is greater than 1 cm. It was more sensitive than morphologic exams in the detection of the primary lesion as well as the metastases and recurrent lesions. C-SRS had modified the therapeutic strategy in 21 to 53% of patients. It had determined resecability criteria and had predicted somatostatin analogue treatment efficiency. Furthermore, C-SRS was very useful in the follow-up of these tumours, mainly in the early detection of postoperative residues and recurrence. Recently, ⁶⁸Ga-DOTA-TOC PET had been used in some centers. According to many authors, it was superior to C-SRS for the detection of CT localization in the lung and skeleton and was similar for the detection of CT localization in liver and brain. According to these authors, ⁶⁸Ga-DOTA-TOC PET had evidenced lesions than C-SRS; nevertheless, there is always a global similar sensitivity in carcinoid tumours.Conclusion⁶⁸Ga-DOTA-TOC PET is surely more advantageous in guiding clinical management and follow-up, yet this imaging modality is expensive and not widespread. Nevertheless, C-SRS, which is cheaper, is an accurate technique in carcinoid tumours. Furthermore, if C-SRS proves negative, ⁶⁸Ga-DOTA-TOC PET should be indicated.     

Relations entre la tolérance ou la sensibilité à la salinité lors de la germination des semences et les composantes de la nutrition en sodium

Adsorption, absorption and translocation of sodium were compared in three species showing an ascending degree in tolerance to salinity: red cabbage (tolerant) shows higher Root Cationic Exchange Capacity than tomato (sensitive) or radish (intermediate). At low NaCl concentrations, tomato accumulates the greatest quantities of sodium; but Na⁺ translocation remains proportional to the quantity absorbed in the three plants. At high salt concentrations, diffusive phenomena explain similar accumulation in every plant, but red cabbage quickly localises 50% of Na⁺ amount in cotyledons, while this element stays stored in tomato roots. The consequence of these three nutrition phases was discussed in relation to the behaviour observed at the germination time of these same plants.      

Le zooplancton de la baie de Sh?diac (Nouveau-Brunswick)

Analyses of boreal zooplankton of Shediac Bay demonstrate theabundance of copepods (81%) and meroplankters (18%). Whetherexclusively pelagic or not, 67 species are mentioned for thefirst time in this Northumberland Strait area, out of 76 recordedwithin 23 higher taxa. The fluctuations were observed from Mayto November and pointed out the dominance of such copepods asAcartia tonsa, A. clausi, Oithona similis and Centropages hamatusin relation with temperature, salinity and food distributions. ¹Adresse actuelle: Station marine de Tul?ar, B.P. 141, Universit?de Madagascar, (R?p. Malgache)     

Risques prostatiques de la testostérone : nouveau retour du balancier?

Since the 1940??s, testosterone (T) is deemed dangerous to the prostate, though without solid evidence. Longitudinal studies do not show association between T levels and prostate cancer (PCa) incidence. To the contrary, aggressive PCa cases are associated with low T levels. Randomized placebo controlled trials of T therapy do not show any increase in PCa incidence in the T groups. These reassuring data have led some doctors to prescribe T replacement therapy to men with prostatic intraepithelial neoplasia, or previously treated for a low grade PCa, or under active surveillance for such untreated cancer without showing a high risk of progression or recurrence of cancer with this treatment. There is however no doubt that normal prostate and PCa, at least in its advanced forms, are made with androgen-dependent tissues. These apparent contradictions might be explained, besides the possibility of a very low diffusion of circulating T in the prostate, by the hypothesis of a saturation of the prostate androgen receptors from very low levels of circulating T, close to castration levels, explaining that an increase in T beyond this level cannot stimulate the prostate tissue. Some recent reports of PCa progression under T therapy, sometimes persisting despite T withdrawal, show that the reassuring results of the previous studies cannot be generalized. Objective data also suggest that the saturation level of the prostate androgen receptor is actually close to the lower limit of the normal T range. We must remain cautious about expanding the indication of T therapy in men with a history of PCa. Only large-scale, randomized, double-blind placebo controlled trials, will provide reliable information on the prostatic risks of such a treatment.     

Conséquences de la chimiothérapie anticancéreuse sur la fertilité de la femme

Sterility is a potential toxic effect of chemotherapy. This risk is well established for alkylating agents, but is less clearly defined for anthracyclines, methotrexate and fluorouracil and poorly defined for alkaloids, platinum, etoposide and taxanes. The main predictive factors for ovarian toxicity are the additive effect of cytotoxic drugs, the cumulative dose of each drug and the patient’s age. This effect of chemotherapy is evaluated on menstrual cycles, hormonal assays and the number of pregnancies observed in patient cohorts. Chemotherapy induces destruction of oocytes and granulosa cells. In mice, it has been shown that adriamycin may induce oocyte apoptosis, which can be prevented by modulation of cycle cell signalling (dysregulation of Bax gene or, on the contrary, expression of its antagonist gene Bcl-2 or inhibition of apoptosis with sphingosine-1-phosphate or caspase inhibitors). Clinical data in the literature are usually based on retrospective studies and are somewhat confused: global fertility after MOPP chemotherapy for Hodgkin’s disease is about 20%, adjuvant chemotherapy with CMF, F(A)C or TAC for breast cancer induces amenorrhea in 50% to 70% of cases, PVB or BEP chemotherapy for ovarian germ cell tumors has little effect on fertility when the uterus and one ovary can be preserved, and the majority of women treated with methotrexate, actinomycin D or various combinations for persistent trophoblastic disease remain fertile. Preservation of fertility is a major goal for cancer patients receiving chemotherapy: in vitro fertilization could preserve the couple’s fertility, but is usually not feasible as it would delay initiation of chemotherapy until after stimulation of ovulation; oocyte or ovarian tissue cryopreservation is at the stage of research; oral contraceptives have not been demonstrated to be effective to preserve ovarian function; gonadotropin releasing hormone (GnRH) agonists prevent cyclophosphamide toxicity in rat and monkey ovaries, and a few pilot clinical studies suggest that chemotherapy-induced amenorrhea could be prevented by administration of GnRH analogues simultaneously to chemotherapy, but randomised studies are necessary.