The purpose of this study was to analyse the frequency of disomy for chromosomes 1, 13, 14, 18, 21, 22, X and Y in sperm nuclei of 50 infertile men and 10 healthy probands of proven fertility. Semen parameters (sperm count, global motility and morphology), urological clinical examination, genital ultrasound and lymphocyte karyotyping were performed for each patient. Disomy frequency was established by fluorescence in situ hybridization by using whole chromosome paint probes. The mean rate of disomy for the various autosomes studied was higher in infertile males than in subjects of proven fertility. Interchromosomal and interindividual differences in the disomy frequency were observed between the 50 patients. The mean frequency of homodisomy YY and heterodisomy XY was increased in spermatozoa of patients with low semen quality parameters (0.24% and 0.54%, respectively). The disomy frequency in infertile males was directly correlated with the severity of oligospermia. However, no relationship was established between aneuploidy rate, sperm motility, morphology or clinical phenotype. These results support the hypothesis that, during spermatogenesis of males with sperm parameter alterations, a decreased frequency of meiotic chromosome pairing and crossing over may lead to spermatogenesis arrest at the meiosis stage and/or to an increase of meiotic nondisjunctions. Meiotic arrest in some germ cells may be responsible for oligospermia and nondisjunctions in other cells for aneuploidy in mature male gametes.

Spermatozoa can be retrieved in semen sample and in testicular tissue of adolescent Klinefelter patients. Furthermore, the testis may also harbor spermatogonia and incompletely differentiated germ cells. However, the physician should discuss with the patient and his parents over a period of several months before collecting a semen sample and performing bilateral testicular biopsy. Fertility preservation might best be proposed to adolescent Klinefelter patients just after the onset of puberty when it is possible to collect a semen sample and when the patient is able to consider alternative options to achieve fatherhood and also to accept the failure of spermatozoa or immature germ cell retrieval.

l'utilisation d'un tel test. Méthode : Les bases théoriques du test, les principes concernant la tâche soumise aux candidats, la façon d' e n re g i s t rer les réponses et le processus d'établissement des scores sont expliqués. Les étapes à suivre pour constru i re un TCS sont décrites. Les qualités psychométriques observées dans une série de t ra vaux de re c h e rche sont ra p p o rtées. Résultats : Plusieurs études menées dans différentes disciplines ont montré que le test permet de discriminer des niveaux d'expérience différents avec des caractéristiques psychométriques intére s s a n t e s ( validité de construit, validité prédictive, fidélité). Ces résultats sont brièvement présentés et commentés. Conclusion :Le TCS permet une évaluation standardisée des processus de raisonnement sur des problèmes cliniques mal définis.Mots clés raisonnement clinique ; éva l u a t i o n ; problèmes mal définis ; étudiants en médecine ; résidents ; i n t e r n e s ; médecins Summary Context: The capacity to solve ill-defined problems is a characteristic of experienced and competent physicians. The current methods used in standard evaluation of competence is to get a panel of experts to reach a consensus about the «good answer» whereas it is observed that experienced physicians va ry in their reasoning process in the realm of ill-defined problems. Thus, these kinds of problems are usually excluded from the tests. This may explain why, on written assessments, experienced physicians frequently obtain lower scores than at the end-of-training physicians. Go a l : The Script Concordance Test (SCT) is set to measure the capacity to re s o l ve problems in the context of ill-defined clinical situations. The object of this article is to demonstrate the usefulness of the SCT to teachers in health sciences and to give all the practical information to use the test. Me t h o d :

BackgroundThere is currently a lack of consensus for the diagnosis, investigations and treatments of acute bacterial prostatitis (AP).MethodsThe symptoms, investigations and treatments of 371 inpatients diagnosed with AP were analyzed through a retrospective study conducted in four departments – Urology (U), Infectious Diseases (ID), Internal Medicine (IM), Geriatrics (G) – of two French university hospitals.ResultsThe cause of admission, symptoms, investigations and treatments depended markedly on the department of admission but not on the hospital. In U, patients commonly presented with a bladder outlet obstruction, they had a large imaging and functional check-up, and received alpha-blockers and anti-inflammatory drugs. In ID, patients were febrile and received longer and more appropriate antibiotic treatments. In G, patients presented with cognitive disorders and commonly had post-void urine volume measurements. In IM, patients presented with a wide range of symptoms, and had very diverse investigations and antibiotic regimen.Overall, a 3:1 ratio of community-acquired AP (CA-AP) to nosocomial AP (N-AP) was observed. Urine culture isolated mainly E. coli (58% of AP, 68% of CA-AP), with venereal agents constituting less than 1%. The probabilistic antibiotic treatments were similar for N-AP and CA-AP (58% bi-therapy; 63% fluoroquinolone-based regimen). For N-AP, these treatments were more likely to be inadequate (42% vs. 8%, p < 0.001) and had a higher rate of bacteriological failure (48% vs. 19%, p < 0.001).Clinical failure at follow-up was more common than bacteriological failure (75% versus 24%, p < 0.001). Patients older than 49 had more underlying urinary tract disorders and a higher rate of clinical failure (30% versus 10%, p < 0.0001).ConclusionThis study highlights the difficulties encountered on a daily basis by the physicians regarding the diagnosis and management of acute prostatitis.