[Oxytocin: the hormone of love, trust and social bond. Clinical use in autism and social phobia]. / L'ocytocine: hormone de l'amour, de la confiance et du lien conjugal et social.

Oxytocin, an octapeptide synthesized in the hypothalamus, stimulates milk election and uterine contractions. In the brain this hormone acts as a neuropeptide. It could inhibit through the GABAergic system the activity of limbic amygdala, which is involved in the response to fear. Oxytocin could also induce the protective behaviour of the mother towards its offspring through the dopaminergic system. In mankind, oxytocin plays a role in trust, empathy, generosity, stress and sexuality. Clinical studies are testing potential benefits of oxytocin administration in autism, depression and social phobia. Results are still preliminary.

[Neurosciences and the mind-brain connection: treatment of depression]. / Neurosciences et rapport pensée-cerveau: à propos des traitements de la dépression.

Neuroscientists claim that thoughts and intentions result only from brain activity. It is illustrated by the ability to control a robotic arm only by thought. However although they have a biological support, emotions, ideas and intentions are perceived at another level of reality than synapses and neurotransmitters. The reduction of mind to brain (called monism) represents a categorical error. Psychiatric praxis relies on a dualistic (complementary) position regarding e.g. depression treatment. Antidepressants and psychotherapy have distinct impacts on cerebral metabolism measured by fMRI and different ways to modify emotions. The combination of these two therapies is indicated in case of severe depression.

[Effects of folic acid on cerebrovascular and cancer risks]. / Effets de l'acide folique sur les risques cérébrovasculaires et oncologiques liés à l'homocystéine.

Homocysteine increase is associated with an elevated risk of cerebro-vascular (CV) disease as well as osteoporosis, dementia and depression. However, most secondary prevention trials did not show any CV benefit to decrease homocysteine levels through folate administration, with the possible exception of stroke. Reasons for these failures are analysed. Moreover, folate acid could decrease the risk of colon, breast and prostate cancers mainly in wine drinkers, whereas it increases the growth of preneoplasic cells of the latter cancers. In conclusion, folate acid does not benefit patients for secondary prevention of CV or malignant diseases but it still has to be proven that it could benefit patients for primary prevention.

[Effects of glucocorticoids administration on memory. Cognitive impairment in Cushing's disease]. / Effets des glucocorticoïdes sur lá memoire. Troubles cognitifs dans la maladie de Cushing.

The case of a 85 years old woman is reported. She suffered from a partially reversible episodic memory dysfunction after i.m. injections of bethamethasone for acute lumbalgia. Cognitive impairments observed in Cushing's disease are reviewed as well as the deleterious effects of glucocorticoid treatments on episodic memory. They could be prevented by memantine.

[Estrogens and male sexuality: efficiency of antiestrogens in case of hypothalamic hypogonadism and late onset hypogonadism]. / Oestrogènes et sexualité masculine: effets des antioestrogènes en cas d'hypogonadisme hypothalamique.

Estrogen treatment in eugonadal men diminishes libido, whereas libido is preserved by estrogens in orchidectomized transsexuals as well as in cases of aromatase deficiency. Hypothalamic hypogonadism can be caused by stress, depression, anorexia or excessive exercise. It may result in erectile dysfunction and decreased libido. A 7 day trial of clomiphen (25 mg/day) can be used to test the responsiveness of the axis and may be continued for up to 6 months as a means to stimulation endogenous LH and testosterone secretion. Other antiestrogens such as raloxifen or anastrazol may have similar effects in obese men and in aging men with late onset hypogonadism (LOH).

[Scientific research in family medicine: practitioners' experience, barriers and needs]. / Recherche scientifique en médecine de famille: expériences, barrières et besoins des praticiens.

Scientific data from family medicine are relevant for the majority of the population. They are therefore essential from an ethical and public health perspective. We need to promote quality research in family medicine despite methodological, financial and logistic barriers. To highlight the strengths and weaknesses of research in family medicine in the French-speaking part of Switzerland we asked practitioners from this region to share their experience, critics and needs in relation to research. This article summarizes their contribution in light of the international literature.

Human seminal plasma contains a protein that shares physicochemical, immunochemical, and immunosuppressive properties with pregnancy-associated plasma protein-A.

Pregnancy-associated plasma protein-A (PAPP-A) was detected by RIA in human seminal plasma. This was not due to interference with proteases or binding to seminal plasma proteins, since immunoreactivity was not affected by treatment with protease inhibitors, and the elution of [125I]PAPP-A was not altered by preincubation with seminal plasma. The major component of the seminal plasma PAPP-A coeluted with pure PAPP-A or plasma PAPP-A from pregnant and nonpregnant women. In the RIA, serial dilutions of seminal plasma gave parallel displacement curves to pregnancy plasma. Removing PAPP-A-like material from seminal plasma by adsorbtion to heparin-Sepharose reduced the inhibitory effect of seminal plasma on phytohemagglutinin-induced lymphocyte transformation. The source of seminal plasma PAPP-A-like immunoreactive material remains to be elucidated, but it is unlikely to be the testis, since PAPP-A levels in semen of vasectomized men were similar to those in nonvasectomized men.

Mitochondrial anomalies in a Swiss family with autosomal dominant myoglobinuria.

We report on a Swiss family in which 10 individuals of both sexes in 4 successive generations suffered from myoglobinuria, precipitated by febrile illness. It is the second family described with autosomal dominant inheritance of myoglobinuria. Four individuals suffered acute renal failure, which in two was reversible only after dialysis. In a recent case, a mitochondrial disorder was suspected because of an abnormal increase in lactate levels during an exercise test and because of a subsarcolemmal accumulation of mitochondria in a muscle biopsy, associated with a lack of cytochrome C oxidase in some muscle fibers. No mutation in the mitochondrial DNA was identified. Along with the inheritance pattern, these findings suggest that the myoglobinuria in this family is caused by a nuclear-encoded mutation affecting the respiratory chain.

Physiopathology of spermatogenic arrest.

OBJECTIVE: To review the world literature on the etiology, physiopathology, and treatment of spermatogenesis arrest. STUDY SELECTION: All the pertinent literature on spermatogenic arrest has been selected. Most studies related to this topic have been identified through Medline and through published literature. PATIENTS: Spermatogenic arrest has been diagnosed by testicular biopsy in men of reproductive age who had either severe oligospermia (partial arrest) or azoospermia (complete arrest), normal testicular volume, and depending on the etiology normal, high, or low levels of gonadotropins. INTERVENTIONS: The effects of heat, radiotherapy, and chemotherapy have been reported. Depending on the etiology of spermatogenic arrest, different hormonal treatments have been tested. MAIN OUTCOME MEASURE: Level of interruption of germ cell differentiation in testicular biopsy have been determined. Improvement of the sperm count or appearance of mature sperm after an hormonal treatment have been observed. RESULTS: Spermatogenic arrest can occur at spermatogonial level in case of gonadotropin insufficiency or after germ cell damage due to chemotherapy or radiotherapy. The arrest is most frequently observed at primary spermatocyte level. Reversible arrest at that level can be due to heat, infections, hormonal and nutritional factors. Irreversible arrest at primary spermatocyte or spermatid level have a genetic origin due to chromosomes anomalies either in somatic cells or in germ cells. CONCLUSIONS: Spermatogenic arrest is usually due to genetic factors resulting in irreversible azoospermia. However some cases may be consecutive to hormonal, thermic, or toxic factors and may be reversible either spontaneously or after a specific treatment.

[Do viagra and fertilization in vitro announce the end of etiologic treatments in andrology?]. / Le Viagra et la fécondation in vitro ont-ils sonné le glas des traitements étiologiques en andrologie ?

Viagra and in vitro fertilization (IVF) with intraovocyte injection of spermatozoa (ICSI) have revolutionized the treatments of impotence and male sterility. They are able to treat successfully most of the cases whatever is the cause of the problem. The andrologist is tempted to renounce to look for an etiological factor and to treat directly his patient. The risk is to miss a diagnosis such as genital tract obstruction, testicular cancer, gonadotropin deficiency, sperm autoimmunity, coital disorders, or reversible toxin exposures, which could benefit from a specific treatment. Moreover IVF can endanger the woman's health and genetic consequences must not be overlooked if ICSI is performed. Concerning impotence a diagnosis of prolactinoma, diabetes or ischemic cardiopathy must not be missed because Viagra can also have cardio-vascular side-effects. This article reviews some etiological factors responsible for male infertility or impotence. The importance of a global appraisal of the patient is underlined in order not to limit his role to the one of a sperm producer.

[Thymic hormones. Neuroendocrine interactions and clinical use in congenital and acquired immune deficiencies]. / Les hormones thymiques. Interactions neuroendocriniennes et utilité clinique dans les déficits immunitaires congénitaux et acquis.

The epithelial cells of the thymus synthesize at least 30 different polypeptides: the thymic hormones. The structure of 4 of them is well known. They are named thymosin alpha 1, thymopoietin, thymulin and thymic humoral factor. Biological functions and secretion regulation of thymic hormones are described as well as the interactions between brain, thymus and endocrine glands. Blood levels and clinical usefulness of thymic hormones are reviewed in different congenital or acquired immunodeficient states and in autoimmune diseases.

[Role of male factors in habitual abortion]. / Rôle du facteur masculin dans les avortements à répétition.

Paternal factors may play some role in habitual abortion in connection with teratospermia, antibodies against spermatozoa, and with chromosome abnormalities in karyotype or in spermatozoa. The role of paternal age and of environmental factors in abortions are discussed.

[Reproduction and immune factors in the male]. / Reproduction et facteurs immunitaires chez l'homme.

Sperm antigenicity is demonstrated by the formation of sperm antibodies following vasectomy and by the possible occurrence of hypersensitivity reactions in women to seminal fluid. It may be that immunosuppressor factors in seminal plasma, as well as certain placental hormones, could explain the fact that sperm are not rejected immunologically in the female genital tract. The role of these different immune factors in male infertility and in the pathogenesis of AIDS is discussed.

[Reproduction and immune factors in women. Pregnancy, habitual abortion and HLA histocompatibility]. / Reproduction et facteurs immunitaires chez la femme. Grossesse, avortements habituels et histocompatibilité HLA.

Immune tolerance of the mother towards the fetus, which is like an allograft, may be explained partially by the presence of immunosupressor factors produced by the placenta. The maternal production of antibodies against trophoblastic antigens would seem equally necessary to prevent the fetus being rejected by cytotoxic maternal lymphocytes. Where there is marked histocompatibility between partners the protecting antibodies are absent and that gives rise to repeated abortions. This hypothesis is discussed as well as the rationale of treatments that are aimed at increasing maternal production of protective antibodies in cases of habitual abortion.

[Neuropharmacological regulation of pituitary hormones. Role of acetylcholine, gamma-aminobutyric acid, histamine and endorphins (author's transl)]. / Régulation neuropharmacologique des hormones hypophysaires. Rôle de l'acétycholine, du GABA, de l'histamine et des endorphines.

The secretion of pituitary hormones is controlled by hypothalamic hormones which are synthetized by neurosecreting cells whose activity is modulated by different neurotransmitters as dopamine and serotonin. Centrally acting drugs interfere with the activity of these neurotransmitters. Thus they may influence the secretion of pituitary hormones. Acetylcholine, gamma-aminobutyric acid, histamine and endorphins seem also to influence the pituitary secretion. The endocrine effects of drugs (opiates, antiparkinson, antiepileptic, and antihistaminic agents) acting on these neurotransmitters is reviewed.

[Triggering role of emotional stress and childbirth. Unexpected occurrence of Graves' disease compared to 96 cases of Hashimoto thyroiditis and 97 cases of thyroid nodules]. / Rôle déclenchant des stress émotionnels et des accouchements. Dans la survenue de 98 cas de maladie de Basedow, comparés à 96 cas de thyroïdite de Hashimoto et 97 cas de nodules thyroïdiens.

98 patients with Graves' disease have been compared to 95 patients with Hashimoto's thyroiditis and to 97 patients with benign thyroid nodules (control group) in order to evaluate the triggering role of major stressors and pregnancy in the occurrence of autoimmune thyroid diseases. A stress factor has been encountered in 11% cases of Graves' disease and in 6% of Hashimoto's and thyroid nodes (chi 2 test, not different). Graves' disease occurred after a pregnancy in 25% of the women in child bearing age versus 10% of the cases of Hashimoto's (p < 0.05) and 13% of the thyroid nodes. The role of stressors, if any, in triggering Graves' disease seems to be weak and dubious compared to the role of pregnancy and post-partum. It is assumed that the decrease of immunosuppressive hormones occurring after stress or delivery could induce a rebound autoimmune reaction responsible for the thyroid disease. In Hashimoto's thyroiditis, stress and pregnancies do not seem to have any triggering role.

[Are the hormones of youth carcinogenic?]. / Les hormones de jouvence sont-elles cancérigènes?

The decrease of different hormones during aging could play some role in the decline of physical and mental functions of elderly people. Whereas estrogen secretion is almost abolished in menopause, there is a gradual decline of other hormones such as testosterone (T) in men as well as growth hormone (GH) or dehydropepian-drosteronesulfate (DHEAS). As "pause" means cessation in Greek, the term of "clise" (decline) seems to be more appropriate for the 3 latter hormones (e.g. androclise versus andropause). The administration of T and GH to elderly men can increase muscle mass, bone mineral content and decrease fat mass. Long term treatment with estrogens can decrease cardiovascular mortality of postmenopausal women. DHEA administration increases perceived well-being in both sexes. However treatments with T and DHEA risk to induce the growth of an occult prostate cancer and a long term treatments with estrogen can increase the risk of breast cancer. There is a strong association between circulating IGF-I levels and the relative risks of breast and prostate cancer. We hypothesize that the decrease of the latter hormones partially protects against the increasing occurrence of hormonosensitive cancers with aging. The administration of these hormones could oppose this process and increase the carcinogenic risk.

[Primary amenorrhea and arterial hypertension in a case of 17 alpha-hydroxylase deficiency]. / Aménorrhée primaire et hypertension artérielle dans un cas de déficit en 17 alpha-hydroxylase.

A 28 year old patient presented with primary amenorrhoea, streak ovaries, mosaicism with 46,XX/47,XXX, hypertension resistant to a tri-therapy and osteoporosis. The presence of hypergonadotropic hypogonadism, increased levels of corticosterone and desoxycorticosterone, a decreased response of cortisol and aldosterone to i.v. ACTH were characteristic of a 17 alpha-hydroxylase deficiency. Administration of 0.5 mg of dexamethasone normalized the blood pressure. Genetic origin of this disease and the different aspects of the ovaries that have been observed are discussed.

[Hypercarotenemia, amenorrhea and a vegetarian diet]. / Hypercarotinémie, aménorrhée et régime végétarien.

In order to analyse the role of hypercarotenemia in amenorrhoea, we have studied the ovarian function of 20 patients presenting with hypercarotenemia (serum carotene greater than 5 mumol/l). 12 of these were complaining of secondary amenorrhoea (group I), 7 with a normal weight (group I A) and 5 with a weight below 85% of ideal weight (group I B). Another group of 8 patients had normal menstrual cycles and a body weight within normal limits (group II). Group I presented an ovarian insufficiency of hypothalamic origin with an increase in the FSH/LH ratio. The patients in group I A although of normal weight differed from group II by a history of important weight variations, strenuous sports activity and an essentially vegetarian diet, the most likely reason for their hypercarotenemia. The high carotene levels however do not seem to be directly responsible for the amenorrhoea, in view of the normal menstrual cycles of the patients in group II. Hypercarotenemia can be considered as a biologic marker of weight loss with fat mobilisation and low T3 levels. It can also be due to a vegetarian diet. The latter may be an aetiological factor in anovulation by increasing faecal excretion of oestrogens and thus decreasing blood levels of oestradiol particularly when associated with other compounding factors such as excessive physical activity, loss of weight or affective problems.