Epstein-Barr virus-targeted immunotherapy for nasopharyngeal carcinoma

Epstein-Barr virus (EBV) is constantly present in undifferentiated and poorly-differentiated nasopharyngeal cancer. Thus, tumour-associated viral antigens are potential targets for immunotherapy. Recently, both preclinical and early clinical studies have shown that various strategies can enhance EBV-specific immunity. Moreover, significant anti-tumour effect has been observed, and was generally correlated with biological response. The present review discusses the rational for EBV-targeted immunotherapy and summarises the latest developments in this area.     

Synchronous occurrence of colonic intraepithelial neoplasia and small bowel stromal tumour

We report the diagnosis of synchronous gastrointestinal stromal tumours affecting the small bowel and intraepithelial neoplasia of the colon in a 52-year-old patient. After surgical resection of the two tumours outcome was favourable. We discuss the causality of this association, based on a literature review of the few previously published cases.     

Retrobulbar optic neuritis associated with infliximab in a patient with Crohn's disease

Background and aim:Infliximab is a chimeric human-murine monoclonal antibody with a high affinity and specificity for tumor necrosis factor α, which is nowadays widely used in Crohn's disease. An exacerbation of demyelinating disease as an adverse effect of this treatment is rare. The aim of this study was to discuss the relationship between infliximab and optic neuritis.Case report:We describe a 55-year old man with Crohn's disease who developed retrobulbar optic neuritis of the left eye after the infusion of infliximab. The outcome was favorable after systemic steroid treatment.Conclusion:Although the relationship between the onset of visual symptoms and the infusion of infliximab may have been coincidental, we believe that this case report underscores the clinical awareness of the possible association, especially in light of the increasing use of this cytokine inhibitor.     

Carcinoma of the papilla of Vater. Diagnostic and therapeutic problems. An analysis of 32 Tunisian cases

The aim determine the clinical, morphological, endoscopical and progressive profile of patients with ampullary carcinoma. PATIENTS AND METHODS: Thirty-two patients with a carcinoma of the ampulla of Vater, hospitalised in the Gastro-enterology service of Habib Thameur Hospital (Tunis) (1992-2002) have been analysed retrospectively. RESULTS: Twelve men and 20 women of an average age of 66 years have been included. Twelve patients (37%) had had a cholecystectomy into the 3 years preceding the diagnosis of the ampullary carcinoma. A duodenal tumour had been found at 29 patients (91%). After endoscopical sphincterectomy, an intra-ampullar exophytic tumour had been found in I case and an infiltrated aspect of the ampulla of Vater in 2 cases. The jaundice was frequent. The use of lateral duodenoscopy allowed carrying the positive diagnosis in all cases. Five patients had metastasis at the moment of diagnosis. A DPC has been practiced at 15 patients. A palliative biliary diversion has been realized at 9 patients. Six patients had an endoscopical palliative drainage with installation of a plastic prosthesis. The rate of post- operative mortality was 20%. The rate of morbidity linked to the surgery was 21.8%. CONCLUSION: The ampullary carcinoma is a rare tumour diagnosed belated. The postoperative mortality is raised. The identification of factors forecast and the utilization of adjuvant processing will be able to allow the improvement of the prognosis.     

Prospective study of 420 biopsies realised in patients with duodenal ulcer with positive Helicobacter pylori

It's a prospective study leaded between September 1997 and july 1999 (23 months ) in 75 patients with duodenal ulcer and positif for Helicobacter pylori. All patients had a first endoscopy with antral, fundic and duodenal biopsies, followed one month later by a second control fibroscopy with biopsies of the same sites. A total of 420 biopsies was realised. Chronic gastritis was evaluated according to sydney system. Patients was divided by randomisation in 4 groups. Every group was received a different therapeutic association. The results was conform to liberation concering activity 80%, intestinal metaplasia 12%. inflammation 100%. Atrophy was observed in 56% of cases, this percentage is variable in literature; chronic gastritis was predominant in antre relatively to fundus (p<0.005). After treatment, a significative fall of Helicobacter pylori and activity and atrophy was established, contrarity to intestinal metaplasia and chronic inflammation witch are persisted. The prevalence of follicular gastritis was 57%. The better rate of ulcer cicatrisation and Helicobacter pylori eradication was respectively of 79% and 66% in group 1 treated by omeprazol, amoxcillin, metronidazol by comparison with the others 3 groups (p<0.005).     

Aortic infectious endocarditis on native valve

Between 1990 and 2002, 32 patients with mean age of 34 years has been treated for an aortic infective endocarditis on native valve. All the patients had recognised heart disease before developing the infection. 24 patients are operated for aortic valve replacement. The hospital mortality was 15.6% (5 patients). The mean follow-up was 47.4 months. The survival rate was 75%. Aortic infective endocarditis remains a serious affection with poor prognosis, despite the contribution of echocardiography and advances in antimicrobial therapy and cardiac surgery. Significants morbidity and mortality are usually caused by sequele of the disease rather than by the infection itself.     

Mitral valve surgery in the elderly

We report a retrospective study about 34 patients operated for on mitral valve between 1981 and 2000. All patients were aged more than 65 years. 82% of them were in the class III or IV of the NYHA. 31 of patients had a valvular mitral replacement (by a mechanical protheses in 24 cases and a biological protheses in 7 cases) and 3 patients had a mitral valve reconstruction. An aortic valve replacement was associated in 7 cases, and a myocardial revascularisation in 4 cases. The early mortality rate was 17,6% and the late mortality was 12%. The high mortality is meanly related to the associate lesions (coronarography) and the prognosis is a better with the improvement of surgical technics and perioperative management.     

Value of prenatal corticotherapy in the prevention of hyaline membrane disease in premature infants. Randomized prospective study

OBJECTIVE: The aim of the study was to determine the feasibility, the cost and the effects of antenatal maternal corticosteroid treatment on preventing respiratory distress syndrome in premature neonates of our population. SUBJECTS AND METHODS: Between January, 1, 1998 and June, 31, 1999, 118 pregnant women at 26-34 weeks' gestation and at a high risk of premature delivery, were prospectively randomized in 2 groups: group 1 received intramusculary 24 mg of betamethasone (12 mg every 24 hours), group 2 didn't receive antenatal corticosteroids. At birth, premature neonates were systematically examined by a neonatologist. RESULTS: 131 premature neonates were born (63 from group 1, 68 from group 2). The incidence and the degree of severity of respiratory distress syndrome, appeared substancially reduced (4.8% vs 27.9%) by the use of antenatal corticosteroids. Moreover, neonatal mortality due to respiratory distress syndrome was statistically less in group 1 than in group 2 (22.9% vs 57%). There was no significant difference in the occurrence of maternal or neonatal corticosteroid complications such as infection between treated group and control subjects. We estimated a potential annual savings of 21 thousands tunisian dinars, when the cost implications for antenatal corticosteroid therapy were estimated to 2 thousands tunisian dinars. CONCLUSION: Maternal administration of corticosteroids before preterm delivery results in a decrease in the incidence and severity of respiratory distress syndrome and a decrease in neonatal mortality rate among premature neonates born to treated versus untreated mothers at 26-34 weeks' gestation; added to an annual savings estimated to 21 thousands tunisian dinars.