Dépistage du cancer du sein: doit-on réévaluer son efficacité ?

Quintessence: L'impact du dépistage sur la mortalité du cancer du sein est avéré. Il baisse, indépendamment de la qualité du dépistage, en raison des importants progrès thérapeutiques des 20 dernières années.Les programmes de dépistage ont contribué à sensibiliser à la détection précoce, à améliorer la qualité de la mammographie et la prise en charge du cancer mammaire. Ces bénéfices s'étendent au-delà du dépistage et conduisent à sous-estimer l'effet du dépistage sur la mortalité.Les risques et les bénéfices du dépistage sont plus complexes à quantifier dans les programmes que dans les essais randomisés ; le recours à des méthodes appropriées et rigoureuses est nécessaire.Les faux-positifs et le surdiagnostic liés au dépistage n'ont pas diminué, augmentant le rapport risque/bénéfice de la mammographie.

Contribution à la connaissance des diptères nécrophages du Jorat (Vaud, Suisse)

A contribution to the knowledge of necrophagous flies of the Jorat (Vaud, Switzerlan). A survey of necrophagous flires has been realized from spring to fall (april-october) in a meadow and a forest using selective traps. Seventeen species of carrion flies were collected belonging to the Callophoridae (10 species), Sarcophagidae (3 species) and Muscidae (4 species). Among these species, 14 were found in the meadow, 11 in the forest with 8 common to both habitats. seasonal distribution of the dominant species for each habitat is presented.

Renan et la répugnance du miracle

(Résumé de l'ouvrage) L'immense succès du Jésus de Renan (1863) tient notamment à sa position sur le miracle, au carrefour du positivisme et du romantisme. L'auteur récuse le surnaturel, et rend compte des guérisons de Jésus à l'aide de catégories culturelles et psychologiques. Entre l'indéniable présence des miracles dans la tradition de Jésus et la répugnance de Renan à l'égard du surnaturel, comment l'auteur échappera-t-il au dilemme? Son argumentation est ici présentée et évaluée, puis mise en perspective dans le cadre de la quête du Jésus historique avant et après lui.

Les sciences religieuses et la morphogenèse du sacré

(Résumé de l'ouvrage) Quest'opera intende riaprire un dibattito teorico sul ruolo della bellezza nella scienza, nell'arte e nella filosofia. I contributi qui raccolti esplorano i diversi modi attraverso i quali la bellezza, come elemento nel contempo estetico, empirico e concettuale, appare implicata nell'attività stessa di scoperta e di creazione. Pur nella loro diversità, tali approcci sono concordi nel sottolineare la necessità di rivalorizzare la ricchezza straordinaria e il carattere vivente delle ''bellezze'' del pianeta e della natura. In tale orizzonte, in cui quest'opera si colloca, appare fondamentale oltre che naturale il voler riconciliare scienza e filosofia, creatività matematica e immaginazione artistica, natura e cultura.

Malaise du nourrisson pensez à une intoxication à l'anis étoil [Apparent life-threatening event in infants: think about star anise intoxication!].

In previous years, several publications have reported cases of infants presenting neurological and gastrointestinal symptoms after ingestion of star anise tea. Such teas are sometimes given in various cultures for the treatment of infant colic pains. In most cases, the cause of intoxication was contamination of Chinese star anise (Illicium verum) by Japanese star anise (Illicium anisatum). Indeed, the toxicity of Illicium anisatum, also known as Shikimi, is caused by its content in potent neurotoxins (anisatin, neoanisatin, and pseudoanisatin), due to their activity as non-competitive antagonists of GABA receptors. The main reasons explaining the frequent contaminations are the strong macroscopic resemblance of the 2 substances, as well as the fact that the fruits are often sold partially broken or in ground form. Therefore, in most cases, chemical analysis is required to determine the possible adulterations. CASE REPORT: A 2-month-old infant, in good general health, was brought to the emergency unit after 3 consecutive episodes of central cyanosis and tetany of the limbs with spontaneous recovery the same afternoon. The child was also very irritable, regurgitated a lot, and positioned himself in opisthotonos. Between these episodes, the neurological exam showed some perturbations (horizontal nystagmus and Bell's phenomenon, hypertony of the extensor muscles, and mild hypotony of the axial flexor muscles) with slow improvement over the following hours. The remaining clinical exam, the laboratory work (complete blood count, renal, hepatic, and muscular tests, capillary blood gas, plasmatic amino acids, and urinary organic acids), and the electroencephalogram findings were all normal. In the course of a detailed interview, the parents reported having given 3 bottles to their child, each one containing 200 mL of an infusion with 4 to 5 fruits of star anise, in the hours preceding the symptoms to relieve colic pains. The last seizure-like event took place approximately 8h after the last ingestion. We could prove the ingestion of anisatin, the toxic substance found in Japanese star anise, and the contamination of Chinese star anise by the Japanese species. Indeed, the anisatin analysis by liquid chromatography and mass spectroscopy (LC-MS) in a urine sample taken 22 h after the last infusion ingestion showed trace amounts of the substance. In another urine sample taken 33 h after ingestion, no anisatin could be detected. Furthermore, the analysis of the fruit sample gave an anisatin concentration of 7800 μg/kg while the maximum tolerance value in Switzerland is 1000 μg/kg. CONCLUSION: The evaluation of ALTE in infants should always include the possibility of intoxication. Star anise is generally considered a harmless medicine. Nevertheless, it can sometimes cause a severe intoxication resulting in various neurological and gastrointestinal symptoms. To prevent such events, not only the parents, but also the care personnel and pharmacists must be informed about the possible adverse effects caused either by the overdose of Chinese star anise or by the eventual contamination of herbal teas with Japanese star anise. A better control of the substances by the health authorities is also necessary.