[Prostatitis and fertility: the biologist's point of view]. / Prostatite, fertilité : le point de vue du biologiste.

There are two leukocytospermia: the leukocytospermia below 10(6) cells/ml comes from the epididymis. It is physiological, improves sperm quality and ART outcomes and therefore must be respected. Leukocytospermia above 10(6) cells/ml are of prostatic origin and reflect a chronic prostatitis. The results of IVF and ICSI with these sperm are always surprisingly improved when compared to those obtained using semen without leukocytes at all. But this improvement is offset by a dramatic increase in the miscarriage rate. Should we treat this leukocytospermia or its cause? A clinical trial is conducted in Cochin hospital with the PHRC Sigma (Male Genital Track Inflammatory Syndrome) that will help us answer this question. It seems, a priori, that it is better to treat the cause and to respect the leukospermia.

[ART with sperm donor after intraconjugal ICSI failure]. / Prise en charge en don de sperme après échec(s) d'ICSI intraconjugale.

OBJECTIVES: To evaluate the ART results with sperm donation for couples who do not succeed after IC ICSI treatment for male infertility. PATIENTS AND METHODS: Retrospective study of 71 couples (November 1994-February 2009). Two control populations were determined to analyse this two-steps treatment (IC and sperm donation) based on different criteria such as the date of ICSI, the female age at the time of the first attempt and the male indication. RESULTS: In IC-ICSI, the proportion of azoospermic subjects and/or carrying chromosomal abnormalities was significantly higher in the studied population as compared to control. The fertilization rate (FR) and the embryo quality were significantly lower in the studied population. After donation, 30 couples (42.2%) succeeded in being parents. The donor IA pregnancy rates were similar to those of the control population except for the azoospermic patients with poor results. When IVF/ICSI-D was performed, the pregnancy rates were lower than in the control population. DISCUSSION AND CONCLUSION: Sperm donation constitutes an option for half of the couples initially treated with IC-ICSI for male infertility. For couples who failed in sperm donation, a female implication cannot be excluded, even though not detected.

Pyoderma gangrenosum as initial manifestation of Graves' disease.

Pyoderma gangrenosum (PG) is an uncommon ulcerative condition. It is most commonly associated with inflammatory bowel disease, haematological malignancies and autoimmune disease. We report on two patients have developed PG during the initial course of Graves' disease (GD), prior to treatment of this condition. The lesions completely cleared with treatment by colchicine in the first case and with oral ciclosporin in the second case. The report emphasizes that a diagnostics of PG should be considered in patients with GD and skin ulcers.

[Percutaneous closure of patent foramen ovale: preliminary experience with the PFO Star]. / Fermeture percutanée de foramen ovale perméable: expérience préliminaire avec le PFO Star.

This article reports the experience of percutaneous closure of patent foramen ovale with the PFO Star device. Between January 2000 and December 2002, 44 consecutive patients with a mean age of 53 years were included in this registry. The implantation of the prosthesis was successful in 43 patients (98%): in 1 patient the atrial septum could not be crossed at operation. An early complication was observed in 3 patients (7%): one had transient amnesia and two patients had temporary ST elevation in the inferior ECG leads. Four patients (7%) had late complications: there was one case of spontaneously regressive atrial fibrillation, two recurrences of stroke (one in the patient without an implanted prosthesis and the other in a patient in whom the patent foramen ovale had been closed). Finally, one patient developed a fistula between the aorta and right atrium which occluded spontaneously when the anticoagulants were stopped. Complete closure of the patent foramen ovale was confirmed at 1 year in 92% of patients. The authors conclude that this preliminary experience shows that closure of patent foramen ovale with this device is effective and safe.

Semen alterations in HIV-1 infected men.

BACKGROUND: Couples in whom the man is infected by human immunodeficiency virus (HIV) increasingly request assisted reproductive technology (ART) to allow safe procreation. Semen quality is critical in such situations. METHODS: Semen characteristics were evaluated in 189 HIV-infected men requesting ART. At the time of semen analysis all men were healthy and 177 were receiving anti-retroviral therapy. Comparisons were made with HIV-seronegative men, partners of women requiring IVF because of tubal infertility, after matching for age and sexual abstinence delay. RESULTS: The most significant semen alterations found in the HIV-infected men were reduced percentages of rapidly progressive sperm [median (range), 10% (0-30%) compared with 15% (5-30%) in the controls, P < 0.001], and increased concentrations of non-spermatic cells [3 x 10(6)/ml (0.2-16 x 10(6)/ml) compared with 1.1 x 10(6)/ml (0.1-14 x 10(6)/ml) in the controls, P < 0.001]. HIV-infected men also showed lower ejaculate volumes [2.8 ml (0.6-9.3 ml) compared with 3.6 ml (1.1-11 ml), P < 0.05] and total sperm counts [262.5 x 10(6) (0-1003 x 10(6)) compared with 310.5 x 10(6) (48.3-1679 x 10(6)), P < 0.05]. CONCLUSIONS: Semen evaluation in a large population of HIV-infected men requesting ART evidenced several alterations. Some of these anomalies might be related to anti-retroviral treatments.

Cationomycin and monensin partition between serum proteins and erythrocyte membrane: consequences for Na+ and K+ transport and antimalarial activities.

The ionophore properties of cationomycin and monensin were studied on human erythrocytes by measuring Na+ influx by 23Na NMR and concomitant K+ efflux by potentiometry in the presence of increasing amounts of serum. Both ion currents (Na+ or K+) decreased linearly with the reciprocal of serum amount. The serum effects on ion currents were stronger with cationomycin than with monensin. Assuming this decreased transport activity was due to drug binding to serum proteins, a partition coefficient between the protein and the membrane phase was determined for each ionophore by using a novel model. This partition coefficient is about 30 times higher for cationomycin than for monensin; the same result was obtained with purified human serum albumin, indicating that albumin may be the major ionophore binding protein of serum. In parallel, we also measured IC50 for 50% in vitro growth inhibition of Plasmodium falciparum, the agent of malaria. In the presence of increasing serum concentrations, the antimalarial activity was decreased for both ionophores. Serum effect was less severe for monensin than for cationomycin, in agreement with the weaker interaction of monensin with proteins as shown from the partition coefficient values. A correlation was established between the ion transport currents (sodium and potassium) and the IC50 measured on P. falciparum in the presence of the various concentrations of serum. The relative value of the ion transport currents (expressed as percentage of control in absence of serum) can be indicative of the ionophore unbound fraction in the medium.

[Cerebral hemorrhage in migraine]. / Hémorragies cérébrales au cours de la migraine.

We report a case of intracerebral hemorrhage which occurred during a migraine in a 62 year-old woman who had migraine since the age of 20. The patient was normotensive. The angiograms were normal. Cerebral hemorrhage in migraine appears to be very rare: we found 6 reported cases that were compared with our own. The hypothesis of recirculation in an infarcted tissue and the possible role of dissecting aneurysms are examined.

[VVI mode cardiac pacing: cause or risk factor of cerebral embolism?]. / La stimulation cardiaque VVI: cause ou facteur de risque d'embolies cérébrales?

Epidemiological studies suggest that VVI pacing is associated with a higher risk of embolic complications than atrial or dual chamber pacing. However, no studies have been performed on pacemaker patients admitted to a neurological department with a cerebral embolism. The authors report the cases of 8 patients (6 men and 2 women) with an average age of 74 years and having the following characteristics: 1) a cerebral embolism, 2) a permanent cardiac pacemaker (7 VVI and 1 DDD mode). The average delay between implantation of the pacemaker and the neurological complication was 31 months. Cardiological investigations at the time of admission showed: a clinically evident cause of cardiac embolism in 3 cases (2 with VVI and 1 with DDD pacing); paroxysmal or permanent atrial fibrillation in 4 cases with VVI pacing at the time of the embolic event (in only one case at the time of implantation); various echocardiographic abnormalities in 6 of the 7 patients who underwent this examination, mainly left atrial dilatation (6/7), septal wall motion abnormalities in all related to ventricular pacing and unexplained left ventricular dilatation in 2 patients with VVI pacemakers. These results suggest that although the etiology of cerebral embolism was probably multifactorial in some patients, VVI packing probably a predisposing role, though not the only cause, and could be considered to be an embolic risk factor as suggested by previous epidemiological studies. These preliminary retrospective data should be interpreted cautiously taking into account the small population size. Prospective studies on pacemaker patients with cerebral embolism are required.

[Infarcts in the region of the middle cerebral artery. Study of 501 cases in 484 patients]. / Les infarctus du territoire de l'artère cérébrale moyenne. Etude de 501 cas chez 484 patients.

We report a study of 501 infarcts in the middle cerebral artery (MCA) territory, in 484 patients. All cases had an appropriate low-density area on computed tomography. The basal (perforators) territory was involved in half the cases and the motor pathways either in the pre-rolandic area or in the internal capsule in 90%. In all locations, except for watershed infarcts, the main cause was cardiac embolism. Atrial fibrillation accounted for 59%, the two other main causes were myocardial infarction and paradoxical embolism. Atherosclerosis accounted for less than one third of the cases. Among 102 internal carotid artery occlusions less than one half were due to atherosclerosis, cardiac embolism and dissecting aneurysms accounted for 22% each. None of 34 MCA occlusions were due to atherosclerotic thrombotic occlusion. Transient ischemic attacks were recorded in 22% of the cases. Stroke-in-progression with a mean duration of 6-8 hours in hospital, was noted in nearly half the cases. In a small group of MCA infarcts paralysis began and predominated on the lower limb, fifteen contralateral old MCA infarcts were silent. Ten of these were on the right side. The 15 patients with silent infarcts were all right-handed.

[Cerebral vascular accidents in young subjects. A study of 133 patients 9 to 45 years of age]. / Accidents vasculaires cérébraux des sujets jeunes. Une étude de 133 patients âgés de 9 à 45 ans.

We report 133 cases of strokes in patients aged 9-45 (male: 68, female: 65), mean age: 33.5 years. There were 112 arterial infarcts (84%), 9 venous infarcts (7%), 12 hemorrhages (9%). Among the arterial infarcts, 23 (20.5%) were due to a dissecting aneurysm, 17 (15%) to atherosclerosis, 13 (12%) to cardiac embolism. Echocardiography with contrast was performed in 69 patients showing a patent foramen ovale in 15. Mitral valve prolapse was present in 8, among which 5 had in addition a patent foramen ovale. Among 16 migrainous patients there were 7 dissecting aneurysms and 3 patent foramen ovale. Twenty two of 65 women were taking oral contraceptives at the time of the stroke. Strokes in patients taking oral contraceptives or during the puerperium accounted for 43% of the strokes in women. Ten cases (9%) have had no explanation. Venous infarctions were mainly due to puerperium and oral contraceptives. Hemorrhages were mainly due to arterial hypertension. No cause was found in 4/12 cases. The most useful investigations were angiography and echocardiography with contrast. This study confirms that extensive and early investigations are necessary in strokes in the young and particularly in women taking oral contraceptives, migraine patients and patients with mitral valve prolapse.

[Dolichoectatic intracranial arteries. Association with aneurysms of the abdominal aorta]. / Artères Cérébrales dolichoectasiques. Association aux anévrysmes de l'aorte abdominale.

Dolichoectatic intracranial arteries (DIA) have been given several names, e.g. fusiform aneurysms, dolichomega-arteries. It is not an uncommon condition and it raises interesting points: 1) symptoms and signs result from compression (cranial nerve palsies; hydrocephalus) from ischemic or hemorrhagic episodes; 2) the diagnosis is made easier with CT since the arterial wall is often calcified; 3) the pathophysiology has long been assumed to be atherosclerotic in nature, but controversial assumptions are discussed; 4) associated arterial abnormalities are common: one of our cases and approximately half of the post mortem reported DIA were associated with aneurysm of the abdominal aorta. Two cases are reported here: 1) A 56 y/o male presented with progressive gait disorder, deafness and ischemic episodes. CT showed DIA and hydrocephalus. DIA involved the basilar artery, both intracranial carotid arteries, the abdominal aorta and probably one renal artery. A ventriculo-atrial shunt was performed unsuccessfully. Post mortem findings are reported; 2) A 52 y/o male had suffered from trigeminal neuralgia for about one year and from trigeminal permanent pain for two weeks. He had developed left hemiparesis and dysarthria. DIA involved the basilar artery and the left intracranial internal carotid artery. The right internal carotid artery and the right vertebral artery were hypoplastic. Clinical, radiographical and pathophysiological features are reviewed.

[Inflammatory lymphadenoid reactions around basocellular epitheliomas]. / Réactions inflammatoires lymphadénoïdes autour des épithéliomas baso-cellulaires.

The histological study of 3,960 basal cell epitheliomas (carcinomas) showed in 82 cases (2 p. 100) an inflammatory lymphoplasmocytic reaction of the lymphadenoid type characterized by the neoformation of differentiated germinative centers. These organoid structures are morphologically similar to those of normal lymphoid follicles of the lymph-nodes and occur most often around the basal cell carcinomas of the face and the neck (96 p. 100), mainly the temporal and peri-auricular skin areas (37,5 p. 100). The concerned tumours are mostly of the primordial type (90 p. 100); such a lymphadenoid reaction was never observed around morphea-like basal cell carcinomas and seldom around superficial spreading basaliomas of the trunk. In 85 p. 100 of the examined cases the tumours were ulcerated and invaded the depth of the reticular dermis (78 p. 100) or the subcutaneous fat (6 p. 100). The occurrence of a lymphadenoid stromal reaction seemingly does not limit the tumour growth and in most cases it concerns aggressive and ulcerated ulcus rodens of histologically nodular or large trabecular type (solid, pseudo-cystic or adenoid variants). It could account for the possible inhibition of the host T-cell mediated immune defense by the aggressive behaviour of the tumour and the induction of a B-lymphocytic secreting reaction with no evident efficiency on the proliferative pattern and activity of the tumour. Its prevalent occurrence around basal cell carcinomas of peri-auricular localization could be related to lymphopoietic remnants of this skin area.

Density of anhydrous acetone and estimation of water content of acetone from density measurements.

An equation is proposed which allows estimation of the water content of acetone samples from their densities.