Vécus psychologiques des démarches d'assistance médicale à la procréation

Assisted Reproductive Technologies (ART) come along with important emotional and psychological burden, as well as the physical constraints, for both the woman and her partner. Couples entering ART programs are usually infertile ones, but some specific settings, like serodiscordant couples where the male partner is HIV positive, involving fertile couples. These couples are usually well-adjusted and motivated ones. During the treatments, waiting for the outcome, and the unsuccessful cycles are among the most stressfull experiences. Common reactions are stress, anxiety and depression, but for some couples, the difficulties are so great that they discontinue the program after only one attempt. When parents, the couples usually experience good parenting competencies, and the “precious” children, despite a greater genetic risk, usually have a normal development, but some specific psychological difficulties may arise, that may request a specific help.     

Neoplasia sincrónica de endometrio y ovario

We report the case of a patient with synchronous neoplasms of the endometrium and ovary, which developed at a relatively young age (45 years). Clinical presentation consisted of hypermenorrhea. An ovarian tumor was subsequently detected through ultrasound and computed tomography. Pathological examination revealed endometrioid histology at both sites and, as in most synchronous tumors occurring in these locations, both the grade and the stage of the tumors were low. All these factors indicate a good prognosis.     

À propos du post-partum blues

Since postpartum blues was described by Savage in 1875, the controversy regarding its nature and cause has been sustained. In a first part, the author reviews the conventional clinical assessment of the blues as described in international medical literature. Its constitutive symptoms are mundane, of an affective, emotional, cognitive or psychosomatic nature. On the other hand, their originality resides in the mildness, unusual nature and progressive profile of their expression. Some elements speak in favour of the normality of this phenomenon, such as its mildness and great frequency. But others give indication of a pathological process, notably its links with various entities or illnesses such as the premenstrual syndrome, acute psychoses and postpartum depressive moods. This aspect has moreover led to search for shared causes to these different co-morbidities, such as a constitutional predisposition, somatobiological disorders, a psychosocial condition or psychodynamic mechanisms. This debate, however, is far from being settled. In a second part - and in continuity with a previous work - the author adds three other symptoms to this classical approach: drop in intrinsic weight, decrease of activity and positivity to the dexamethasone test. In order to do so, he defines the notion of “gross prepartal weight” (weight as measured before delivery) and “neat prepartal weight” (resulting from the substraction of the foeto-annexial package from the gross prepartal weight). At the same time, he compares these data with those resulting from a questioning of twenty-one new mothers out of a university hospital ward on obstetrical difficulties, end-of-pregnancy psychic disorders or PMS case history. These analyses establish no specific link between the appearance of blues, the average age of the parturients, the notion of previous blues, lacteal inhibition under bromocryptine. On the other hand, as stated in the literature, the appearance of postpartum blues is closely connected to previous PMS history, a painful delivery, or a psychologically difficult end of pregnancy. The originality of these results consists of two elements: (1) the correlation between the intensity of the blues and the weight gain during pregnancy; (2) a probable increase of neat weight, as the author has defined it, in the first days following postpartum. In a more general way, the role of weight variation stands out distinctly if the weight curves during gestation and the aggravation of psychiatric morbidity are observed in parallel. In the analysis of surgical blues by Illes, the severity of cluster scores of decrease of activity and of vigilance is noted, along with a culmination of the pathology on the second day (and not on the fifth day as in postpartum), which can justifiably be attributed to the suddenness and precocity of weight drop. Also related to the role of weight, numerous quasi-experimental, historical or clinical situations of weight loss and their psychiatric impact can be quoted. On another level, one should consider the decrease of activity in the approached situations. While basic metabolism increases during pregnancy progressively to 20%, delivery occurs through short but intense efforts. Postpartum implies a sudden deceleration in the course of which a physiological bradycardian phase around the fifth day can be underlined, as Magnin well described it. Some authors have positively correlated the blues to the intensity of labour, which corresponds to the degree of deceleration. In the same way, symptoms of sleep apnea syndrome have been linked to its fragmentation and to O₂ desaturation induced intellectual lapses, but an involvment of diurnal fits of sleepiness cannot be rejected. In the same spirit, the activating role, prior to their mood stabilizing effect, of antidepressants is well known and the role of the musculorespiratory peak of the convulsive crisis in sismotherapies can be looked into. Finally, the nearly constant positivity to the dexamethasone suppression test (DST) is a symptom devoid of causal participation. Since Carrol's study, the frequent positivity of this test has been observed in depressed subjects. But there are multiple causes for positivity, starting with immediate postpartum, to such an extent that some authors have considered the test as more characteristic of the postnatal period than of any psychic disorder. However, the frequency of denutrition complications in DST - positive cases (insufficiently controlled diabetics, alcoholics, the aged and postpartum of course) is to be underlined. Numerous Anglo-Saxon authors have moreover put the emphasis on the link between weight loss and DST positivity, although they underlined the limits of this explanation. This is how the variations of activity may constitute an additional etiology. Actually, even if Weitzman has privileged the level of hypnic inhibition in regulating plasma cortisol, the inverted correlation between the latter's variations and those of activity is indeed striking. In this hypothesis, depressed subjects’ curves would diverge mostly in the daytime to the extent of a difference in activity or a lack of activity more distinct than at night. To support this thesis, we will also point out the lower sensitivity of the test in ambulatory care, which may reflect a relative mildness of these cases but also a better activity, the standardization of the test when a depressive phase changes to excitement, the early standardization of the DST before the improvement of the mental state during sismotherapy or sleep deprivation. Weight loss and decrease in activity, which are of a physiological nature, would thus have a causal value, and the DST would only reflect these two elements. In the last part, the author engages in various physiopathological hypotheses and some commentaries. In his physiopathological hypotheses, he takes up Delay's idea of a regulating centre of mood, potentially subjected to variations of weight and activity. He mentions in particular that these variations may compensate each other, as with anorectics, or increase each other, as in postpartum blues. In his commentaries, he expands the previous ideas into his favourite theme, the deep motive for his research, which is the consubstantiality of acting and of being as the cornerstone of the holistic unity of the living, this concept being otherwise developed in an additional work quoted in reference.     

À propos de la psychiatrie de liaison en cancérologie

The psychiatrists practice in consultation-liaison psychiatry is peculiar. The work requires him/her to adapt to the terrain: to seize the opportunity of intervening in one way or another he will be obliged simultaneously to abandon his dual position with the patient, to integrate into the medical team and, also, to take into account the physiological specificity of the illness and its psycho-social repercussions. Whether on a formal or informal register all is subtle and delicate in these liaison interventions. Cancer and cancerology even add their own specificity and constraints to this mode of exercise. Consultation-liaison remains, more particularly in cancerology, a practice of mediation and of conciliation confronted to the problematics of risk, of incertitude and of finiteness.     

Deep brain stimulation for Parkinson''s disease: electropermeabilization and activation

Deep brain stimulation, DBS, is an accepted technique for the treatment of Parkinson's disease. DBS affects the electrical functions of neurons, but exactly how it alters those functions is not clearly explained. An electrical model is determined to simulate treatment with DBS of the sub thalamic nucleus. This model shows the difference in electrical fields between the inside and the outside the neurons. The generated electrical field near the electrodes is high enough to perform an electropermeabilization of the cell membranes, which most likely blockade normal nerve pulses or reduce the nerve impulse speed. Further away from the electrodes activation of large axons is performed.     

Expertises pour la sécurité sociale : méthodologie et spécificités

Mental disorders represent in France for the Social Security the second post of spending in consumption of care with 11,4 billion euro, that is 10,6% of the spending, behind the diseases of the circulatory system. They stay in the rank of the pathologies justifying the allocation of a disability pension, representing 26,7% of invalids. It is to say the importance of the psychiatric expertise for the Social Security. This type of expertises is particular among the expertises in psychiatry because the objective of the expertise is to establish an arbitrage between the position of CPAM's doctor and his regular doctor. Effectively, except legal flaw, the opinion of the expert imposes upon the parts (parties). The realization of the expertise and its editorial staff are detailed in their specificities. Problem specific of the psychiatry are approached as well as the functions (offices) of the expert which are well beyond arbitrator's role towards a function of teacher and intermediary.     

El cultivo celular en la investigación básica del cáncer de mama

Resumen La técnica del cultivo celular es la que ha permitido conocer el comportamientoin vitro de las células cancerosas. En esta revisión pretendemos introducir las peculiaridades básicas del cultivo celular, referido especialmente a líneas cancerosas mamarias, relacionar el origen de las líneas celulares más utilizadas en la investigación de este cáncer, mencionar las técnicas de laboratorio que pueden aplicarse sobre estos cultivos y ejemplificar la utilidad de las mismas, tomando como modelo diversos trabajos que estudian los efectos del factor de crecimiento epidérmico sobre líneas celulares hormonoindependientes de cáncer de mama.      

DeGarengeot hernia: transabdominal preperitoneal hernia repair and appendectomy.

BACKGROUND: The incarcerated appendix in the femoral hernia represents a rare clinical case that was first described by the Frenchman de Garengeot in 1731. Besides the open procedures, laparoscopy presented itself as a treatment option. CASE REPORT: Our case concerns a 38-year-old patient with a right femoral hernia with an inflamed incarcerated appendix. Because of the clinically inconclusive finding, we chose transperitoneal preperitoneal hernia repair (TAPP) combined with a laparoscopic appendectomy. The intra- and postoperative course was uneventful. This case shows that a laparoscopic procedure is possible even in the case of an incarceration in conjunction with an appendicitis that has not spread to the adjacent peritoneum. DISCUSSION: Compared with open interventions, the subjective social advantages (shorter hospital stay, earlier return to work, less need for pain killers, and others) of laparoscopic hernia treatment have been extensively studied. The use of both methods in the case of an incarcerated hernia is open to dispute, though various small series confirm the feasibility. CONCLUSION: Here, TAPP seems to be the more reliable method in terms of patient safety because of the simultaneous possibility of using laparoscopy.     

Neurophysiological aspects of chronic motor cortex stimulation

Chronic motor cortex stimulation is a treatment option for neuropathic drug-resistant pain and possibly associated movement disorders. Preliminary studies suggest the possibility to treat symptoms of Parkinson disease in selected patients. Recently, MCS has been suggested to enhance motor recovery in patients with poststroke hemiparesis. One or more electrodes are placed extradurally over the motor cortex through a burr hole or a small craniotomy, and then connected to a totally implantable neurostimulator. The accurate positioning of the stimulating electrodes over the motor cortex is the key point of the surgical procedure. Motor cortex identification results from the integration of anatomical, neuroradiological, functional, and neurophysiological data, taking into account the huge population variability. Intraoperative neurophysiological mapping of the motor cortex is of paramount importance, in spite of very sophisticated neuroradiological mathematical reconstructions of the motor area. We discuss and compare the different techniques that are utilized by different authors. Moreover, clinical neurophysiology is also helpful in evaluating the results of this neuromodulation procedure and in hypothesizing the mechanisms that are put in play by MCS.