[In search of the surgical sperm cell: do we have to perform a testicular biopsy systematically?]. / À la recherche du spermatozoïde chirurgical : doit-on effectuer une biopsie testiculaire systématique ?

INTRODUCTION: Testicular biopsies are diagnostic and therapeutic tools involved in male infertility care. However, this surgery is invasive and not systematically successful. We studied the preoperative clinical and hormonal factors allowing to predict the obtaining of sperm cells. PATIENTS AND METHODS: A retrospective study was conducted on 209 patients who all had a testicular biopsy for procreation medically assisted (PMA). The studied criteria were: the age at the time of the surgery, the male cause of the infertility, the testicular volume, the tobacco smoking exposure, the concentrations of estradiol, FSH, LH, prolactin, and testosterone. The comparison of both groups (successful biopsy versus failed biopsy) was made in bivariate analysis then in multivariate analysis. RESULTS: The testicular volume average and the cause were the two only factors which had a real influence on the negativity of the biopsy. In it was added in bivariate analysis a statistically significant correlation of the smoking exposure and the FSH with the failed biopsy. DISCUSSION: The existence of these factors, and their accumulation, was strongly predictive of a failure of the biopsy. However, we found germ cells in patients exposed to the studied factors, letting think that it is systematically necessary to propose the surgery at the risk of a limited profit.

Transport and sedimentation of solid particles in Bénard hexagonal cells.

The motion of particles moving under gravity in the velocity field of a liquid in a Bénard hexagonal cell is studied experimentally and numerically for Stokes flow conditions. We then explain the settlement of particles in the centers of cells to form a regular quincunx. It is found that sedimentation also occurs preferentially along the lines connecting the centers of adjacent cells to form a triangle deposition tessellation. Finally, it is explained why particles occupy the central part of each convective cell while the peripheral part of the cell quickly becomes limpid. Numerical results are in agreement with the experimental observations of Bénard and those of the present study.

Fatality due to combined use of the designer drugs MDMA and PMA: a distribution study.

We present a fatal case involving the combined ingestion of amphetamine, 3,4-methylenedioxymethylamphetamine, 3,4-methylenedioxyamphetamine, and paramethoxyamphetamine. Various postmortem specimens (e.g., several blood samples, urine, and tissue samples) were analyzed to study the distribution of the compounds and their metabolites in the human body. Quantitation took place using liquid chromatography-sonic spray ionization-mass spectrometry after pretreatment with a liquid-liquid extraction. The medico-legal findings were compatible with a disseminated intravascular coagulation induced by hyperthermia caused by the simultaneous intake of the amphetamine analogues.

An unusual case of homicide by use of repeated administration of organophosphate insecticides.

We present an unusual murder case by use of repeated administration of organophosphate insecticides. A 49-year-old woman suffering from mental retardation, epileptic fits and acromegaly was poisoned by her husband. At first, her death was considered as a 'sudden and unexpected' natural death. Abdominal abscesses of pancreatic origin found at autopsy were compatible with repeated administration of pesticides with anticholinergic action. In her medical history at least one episode consistent with an organophosphate intoxication was retrieved. Thorough inquiry revealed that the victim had ingested phosphamidon and/or omethoate orally. Organophosphate intoxication should be considered when unexplained neurological symptoms are associated with pancreatic disturbances.

One fatal and seven non-fatal cases of 4-methylthioamphetamine (4-MTA) intoxication: clinico-pathological findings.

We present a case history involving one fatal and seven survived cases of intoxication with 4-methylthioamphetamine (4-MTA), also called para-methylthioamphetamine (p-MTA) or methylthioamphetamine (MTA), a relatively new amphetamine analogue. Two of the seven survivors required a 24-h-period of observation in hospital. This report proves once again that the new amphetamine designer drugs are not without danger, as is thought by many young people. In addition, individually different subjective reactions are described. Finally, the medico-legal implications of new, as yet unregistered drugs are discussed.

[Accuracy of pressure measurements obtained with a new rectal balloon catheter]. / Exactitude des mesures de pression obtenues par une nouvelle sonde rectale à ballonnet à air.

UNLABELLED: The accuracy of measurements performed by a balloon catheter used to record abdominal pressure during urodynamic investigations was verified on a test bench. OBJECTIVE: To study the accuracy and precision of the pressure measurements obtained with a new rectal balloon catheter (ref. 95018 Laboratoires Vermed), designed to record abdominal pressure during urodynamic assessments. The clinical value of this catheter, using air for pressure transmission, is its simplicity, as there is no contamination of the perfusion circuit or transducer, no purging of the circuit, and artefacts related to movements of the tubing are eliminated. METHOD: The catheter was placed in a pressure chamber fitted with a precise, calibrated regulation system allowing programmed pressure variations from 10 to 150 cmH2O. Pressures recorded by the test catheter were compared to reference pressures applied to the chamber. The frequency of acquisition of pressure measurements was 100 Hertz and the resolution was 10 Hertz. This model was used to study the accuracy of pressure measurements and the response times of the catheter. Measurements were performed with a volume of 2 ml of air introduced into the catheter (volume recommended by the manufacturer), and the optimal volume was investigated by inflating the catheter until the best result was obtained. The evaluation was based on calculation of the mean difference observed between the two measurements and the scatter of the differences observed. RESULTS: When the catheter was filled with 2 ml of air, pressures measured by the catheter were overestimated an average of 1.1 cmH2O (standard deviation = 1), and 95% of the differences between the two measurements were within +/- 2.15 cmH2O. The optimal air volume was found to be 1.5 ml. With this air volume, no significant difference was observed between the two measurements. The mean observed difference was 0.2 cmH2O (SD = 1.2), which means that 95% of the differences were situated within the range of +/- 2.35 cmH2O. CONCLUSION: The pressure recording method with this new catheter is validated in terms of physical parameters.

Low dose T-cell lymphocyte infusion combined with marrow T-cell depletion as prophylaxis of acute graft vs host disease for HLA identical sibling bone marrow transplantation.

T-cell depletion (TCD) of the bone marrow graft remains the most effective method to prevent severe graft versus host disease after allogeneic bone marrow transplantation. Early studies of HLA-identical sibling transplants showed that although T-cell depletion decreased GVHD, T-cell depleted transplants had higher risks of graft failure and leukemia relapse, leukemia free survival (LFS) was not improved compared to non-T-cell depleted transplants. In order to avoid graft failure and increased risk of relapse associated with this approach, we initiated a pilot study of T-cell depletion of the marrow graft combined with reinfusion of a fixed quantity of CD2+ peripheral blood T-cells. Depletion technique consisted in negative purging using CD2 and CD7 monoclonal antibodies (MoAbs) followed by rabbit complement cytolysis. This approach was associated with an intensified conditioning regimen using total body irradiation, high-dose cytosine arabinoside and melphalan (TAM) for all but one patient. Twenty-one patients were included with a mean age of 40 years. Only one acute severe Graft Versus Host Disease (GVHD) was observed and all patients engrafted. At 63 months, probability of survival is 42.86% with a relapse risk of 19.89%, two patients died from B-cell lymphoproliferative disease, seven other died from the procedure partially because of the use of the TAM as pretransplant regimen. This approach is being pursued by a gene therapy trial using herpes-simplex - 1 thymidine kinase gene expressing peripheral donor T-cells.

Allogeneic bone marrow transplantation for high-risk acute lymphoblastic leukemia in first remission: long-term results for 42 patients conditioned with an intensified regimen (TBI, high-dose Ara-C and melphalan).

Attempts to improve the efficacy of pretransplant conditioning regimens have been published, the potential of a better antileukemic effect being impaired by more frequent and severe toxicities. The efficacy of an intensified regimen, TAM (TBI, high-dose cytosine arabinoside and melphalan), is evaluated by analyzing long-term follow-up of a homogenous group of 42 high-risk ALL patients allografted in first CR. Age at time of BMT was 25.9 +/- 10.4 years (3-41). Twenty-two patients had more than three adverse prognostic factors. Ten patients had a Ph chromosome. Probability of overall survival was 45 +/- 9%, and for all surviving patients median follow-up time was 66 months. Event-free survival was 40 +/- 8% at 7 years after transplantation and the expected relapse rate reached 31%. Twenty-two deaths occurred, six after a relapse but 16 appeared to be directly due to the BMT procedure. None of the pretransplant characteristics significantly affected outcome after BMT. TAM appeared to be an efficient antileukemic therapy for conditioning high-risk ALL patients before allogeneic transplantation, but was still very toxic. The use of TAM in adult ALL patients in first CR is not recommended and the real role of intensified conditioning regimens remains to be demonstrated.

Risques de desordres lies a la presence de fer et de manganese provenant de la ressource et du traitement

Se detallan los principales problemas surgidos de la presencia del hierro y del manganeso, que son del orden estético y no sanitario: turbiedad y color. Los estudios de casos demuestran los mecanismos de la formación de depósitos dentro de la red de distribución del agua. Se proponen dispositivos de prevención y se sugiere un programa de purgas. Es una condición esencial, una combinación de un tratamiento en las plantas y en los conductos

Risques de desordres lies a la presence de fer et de manganese provenant de la ressource et du traitement

Se detallan los pricipales problemas surgidos de la presencia del hierro y del manganeso, que son del orden estético y no sanitario: turbiedad y color. Los estudios de casos demuestran los mecanismos de la formación de depósitos dentro de la red de distribución del agua. Se proponen dispositivos de prevención y se sugiere un programa de purgas. Es una condición esencial, una combinación de un tratamiento en las plantas y en los conductos

[Instantaneous pressure/flow ratio for non-permanent flows. Impact on the assessment of urethral resistance]. / Relation pression/débit instantanée pour des flux non permanents. Conséquences sur l'évaluation de la résistance uréthrale.

OBJECTIVE: To verify the validity of the hypothesis of the almost continuous flow necessary for evaluation of instantaneous urethral resistance R by the pressure/flow relation R = P/Q2. METHOD: An experimental device allowed investigation of the pressure/flow relation for discontinuous flow in a flexible tube. The tube was submitted to various collapsing pressures and opened under the effect of flow. The flow was discontinuous because of the variations of the proximal pressure or oscillations in the hydraulic diameter of the tube. RESULTS: These experiments showed that the approximation of continuous flow is justified within the limits of precision of the measuring methods used in urodynamics. CONCLUSION: The formula R = Q2 is therefore theoretically correct and validated by the experimentation. There is no hydrodynamic obstacle to the application of this formula to the calculation of instantaneous urethral resistance.

Empleo de los inhibidores de corrosión en las redes de distribución; aplicaciones locales y resultados

Presentan las ventajas y desventajas de los inhibidores de corrosión en las redes de distribución de agua, y los métodos de selección de los compuestos mas adecuados para cada caso

Empleo de los inhibidores de corrosión en las redes de distribución; aplicaciones locales y resultados

Se presentan las ventajas y desventajas de los inhibidores de corrosión en las redes de distribución de agua, y los métodos de selección de los compuestos mas adecuados para cada caso

Metodología de diagnostico

La prevención y control de las molestias y deterioros en los circuitos de distribución del agua requieren un conocimiento profundo de los materiales del medio y de las condiciones de operación. Por ello es importante disponer de una metodología de diagnóstico y este artículo ofrece sugerencias al respecto

[Reliability of pressure measures determined with probes used for establishing the urethral pressure profile by the perfusion method]. / Fiabilité des measures de pressions obtenues par les sondes utilisées pour la réalisation du profil de pression uréthral par la méthode perfusionnelle.

The objective of this study was to evaluate the reliability of pressure measurements by the main catheters used to determine urethral profiles by the perfusion method. This evaluation, performed on a test bench, compared the reference pressure in a tank filled with water to that measured by the catheter tested. The reliability of the measurement varied from one catheter to another. This disparity was due to differences of load losses, leading to an overestimation of the measurement (by 2 to 17 centimetres of water), which must be corrected by adjustment of the zero pressure with a perfused catheter. Major differences in the rapidity of response (from zero to five seconds) were also observed, which appear to be related to elastic properties of the catheter. This study does not pretend to globally verify the reliability of the perfusion method, but only the reliability of pressure measurements.

Prognostic factors for autologous bone marrow transplantation in acute leukaemia: a single centre study of 105 patients.

Since the treatment of leukaemia by autologous bone marrow transplantation is becoming increasingly frequent, a retrospective study was undertaken to ascertain factors influencing the evolution of the disease (death and relapse). Data were collected over a period of 11 years for 105 patients with acute leukaemia (60 lymphoid cases and 45 myeloid cases). Multivariate analysis by the Cox model was used to determine prognostic factors for survival and disease free survival (DFS). Overall survival for the entire population was 35% after 8 years while DFS was 33% after 3 years. The major prognostic criteria were granulocyte recovery time (p < 0.001 at 5 weeks) and platelet recovery time (p < 0.02 at 6 weeks). Patients conditioned by an association of polychemotherapy and total body irradiation (TBI) showed a better survival rate than those conditioned by polychemotherapy alone (p < 0.01), with an overall survival of 48% after 3 years for the former group as compared to 19% for the latter. Other parameters influencing survival were the number of graft CFU-GM, sex and age. A knowledge of these factors could provide a means of predicting the long term evolution of leukaemia following autologous bone marrow transplantation. However, the present results require validation by a prospective study taking into account recent therapeutic protocols with haematopoietic growth factors.

[Incidence of the form and caliber of urethral resistance. Evaluation for a normal masculine urethra and in cases of obstruction due to prostatic hypertrophy]. / Incidence de la forme et du calibre dans la résistance uréthrale. Evaluation pour un urèthre masculin normal et en cas d'obstruction par hypertrophie de prostate.

Certain forms of benign prostatic hypertrophy are associated with a reduction of the calibre of the prostatic urethra of the median lobe, a defect of infundibulisation of the bladder neck and a dilated appearance of the bulbar urethra. The objective of this study was to verify whether hydrodynamic arguments could be used to confirm the concept that defective infundibulisation of the bladder neck is directly responsible for an obstructive syndrome or via a reduction in the calibre of the bladder neck orifice. More generally, this study was designed to quantify the distribution of resistance to flow along the normal urethra and to define the role of cervicoprostatic and urethral deformities in the obstruction associated with benign prostatic hypertrophy. Urodynamic studies are unable to answer this question, as the instantaneous urethral resistance is evaluated globally by the Pressure-Flow relation. The authors performed morphological analysis to divide the urethra into simple hydraulic segments for which the corresponding pressure drop coefficients were calculated. These coefficients constitute an approach to segmental resistance to flow and can be used to quantify changes in shape observed on voiding urethrography or ultrasonography. Digital analysis of voiding urethrographies showed that, under normal conditions, urethral resistance was regularly distributed along the urethra and essentially depended on friction of the urethral wall. In the case of benign prostatic hypertrophy, even with a median lobe, the increase in the pressure drop coefficients was due to a reduction in the calibre of the bladder neck orifice and prostatic urethra. Cervical deformities appeared to be minimally obstructive, according to urodynamic parameters, if they were not associated with a reduction in the calibre of the bladder neck orifice.

[Instantaneous pressure-flow relations in a continuous flow in a collapsible tube: impact on the evaluation of urethral resistance]. / Relation pression-débit instantanée en flux permanent dans un tube collabable: conséquences sur l'évaluation de la résistance uréthrale.

The urethra is a collapsed tube in the absence of micturition. Consequently, the evaluation of instantaneous urethral resistance by the pressure/flow relation (R = P/Q2) derived from Bernoulli's equation has been criticised for not taking into account the opening pressure or at least the fact that flow must maintain patency of the urethra during voiding. The objective of this study was to determine whether such a criticism is justified in terms of fluid mechanics. A study of the pressure/flow relation was performed in a soft tube, collapsed by various peritubular pressures, which subsequently opened in response to flow. Experiments demonstrated that the pressure/flow relation, the instantaneous resistance to flow and the pressure drop were identical when the tube reached the same calibre, despite different peritubular pressures. The same pressure therefore propels the flow and maintains the patency of the tube. Consequently, it would be unreasonable to expect to improve the evaluation of instantaneous urethral resistance by subtracting an opening pressure from the maximal bladder pressure. The formula R = P/Q2 is valid, experimentally, and complies with the principles of fluid mechanics. In theory and in practice, it constitutes a good method of evaluation of instantaneous resistance.

[Interleukin-2 and human seminal fluid]. / Interleukine-2 et liquide séminal humain.

Involvement of the cytokines in male infertility were considered from in vitro studies, however the nature and the role of the mediator susceptible of arising in vivo is not completely elucidated. The purpose of this study is to measure the concentrations of interleukin-2 (IL-2) in normal and pathologic seminal fluid and to analyse their relationship with semen parameters. Our results demonstrate the presence of IL-2 in seminal fluid. Comparatively to normal seminal fluid, significant lower IL-2 concentrations were observed in infected semen samples or with sperm antibodies. No correlation was found between the cytokines values and the sperm parameters.

Tumour necrosis factor alpha and interleukin 2 in normal and infected human seminal fluid.

The presence of cytokines such as the tumour necrosis factor alpha (TNF alpha) and interleukin 2 (IL2) in human spermatozoa is still to be defined. The aim of this study was to measure the concentration of both soluble factors in seminal fluid. Data from normal semen samples (n = 24) confirmed the presence of IL2 (258 +/- 84 fmol/ml corresponding to 953 +/- 369 fmol/total volume of ejaculate) and TNF alpha (62.2 +/- 16.4 fmol/ml corresponding to 231.3 +/- 86 fmol/total volume of ejaculate). A significant positive correlation (r = 0.59; P < 0.01) was observed between the TNF alpha and the IL2 concentrations. The concentrations of these cytokines were not related to sperm parameters. In contrast, IL2 concentrations (196.9 +/- 60.4 fmol/ml; 686.2 +/- 236.7 fmol/total volume of ejaculate) evaluated in 16 seminal fluids with identified bacterial agents were lower than in the control group, whereas TNF alpha concentrations (68.6 +/- 12.3 fmol/ml; 241.3 +/- 78.9 fmol/total volume of ejaculate) were not significantly different from the controls. Further studies are needed to determine the potential role of these cytokines in the physiology of semen and their usefulness as indicators of reproductive pathology.