Sialendoscopy under conscious sedation versus general anesthesia. A comparative study

Objective

Sialendoscopy is a minimally invasive emerging approach, the general surgical technique has been published but many essential questions still need to be addressed with the aim of improving outcomes. For instance, should we systematically perform sialendoscopy under conscious sedation (CS) or general anesthesia (GA)? What are the limitations of CS? The objective of this study is to compare these two modalities.

Facteurs de risque de perforation œsophagienne après dilatation pneumatique au cours de l’achalasie

Pneumatic dilatation is an efficient treatment for achalasia. The most serious complication of this procedure is esophageal perforation. Over a period of 15 years (1990–2005), we treated 483 patients. The dilatations were performed ambulatory using a Witzel dilator (diameter: 4 cm). The first 118 patients (group 1) underwent dilatation with an initial inflation balloon pressure of 300 mmHg. In-group 2 (N = 365), we used a gradual dilatation with an initial pressure of 150 mmHg during the first session. In case of relapse, dilatation was repeated with an incremental pressure (200 and 300 mmHg) during the second and the third session. During the 1159 sessions of dilatations, five perforations occurred. All these perforations occurred in group 1, whereas no perforation took place in group 2. The medical conservative treatment was efficient for four patients. One patient was operated successfully after the failure of the medical treatment. There was no death. Inflation pressure, during the first session, and patient age were the only factors of risks, significantly associated to the perforation (P < 0.01).     

Epstein-barr virus genotypes in NPC biopsies from North Africa

The genotypes of Epstein-Barr virus (EBV) were investigated in North African nasopharyngeal carcinoma (NPC) biopsies, nasopharyngeal chronic inflammation (NCI) biopsies, and saliva of healthy individuals from Algeria and Tunisia where there is an intermediate incidence of NPC. The prevalence of A-type virus in NPC, NCI biopsies and saliva of healthy individuals was found in these regions by means of a PCR assay. Restriction enzyme polymorphism analysis by Southern blotting revealed that all North African EBV variants have a conserved restriction site on BamHI W'-1′ and XhoI LMP gene. No additional BamHI enzyme site on the BamHI-F fragment was observed; however, the presence of an extra BamHI site on the BamHI-H fragment giving 2 H1 and H2 fragment-like EBV M-ABA strains was found. All EBV strains present in NPC or NCI biopsies at all ages were homogeneous in these polymorphisms and no correlation was observed between the EBV genotypes from NPC patients and clinical stages of the cancer. These characteristics revealed a significant difference between the EBV variants common in Chinese NPC and those in North African NPC.     

BAMHI DNA Fragment H-Polymorphism of Epstein–Barr Virus is Associated with the Mutations Present in an 89 BP Sequence Localized in EBNA2 Gene

To characterize the genotypes of Epstein-Barr virus (EBV) isolate present in North Africa, viruses were isolated from B-lymphoblastoid cell lines established from the saliva of both Algerian Nasopharyngeal Carcinoma (NPC) patients and EBV-positive normal individuals, Algerian Burkitt's lymphoma cell lines, and NPC biopsies. By nucleotide sequence analysis, we showed that there were two specific missense mutations in an 89 bp region of EBNA2 gene at position 49390-49479 of the EBV genome: a mutation at 49449 (C-->A) and another mutation at 49444 (T-->C), changing their amino acid sequence. The first mutation was found in all B cell lines established from the saliva and 50% of BL cell lines, as well as the W91 cell line, while the second mutation was found in EBV isolates from NPC biopsies, BL cell lines and the M-ABA isolate. A PCR-RFLP analysis on the BamHI DNA fragment H showed that the Hl-H2-polymorphism was specifically associated with M-ABA-like mutation, while H-polymorphism was linked with W91-like mutation. The latter was not identified in NPC biopsies, but was found rather in saliva from NPC patients, normal individuals and BL cell lines. The M-ABA-like mutation, on the other hand, was found in 100% of NPC biopsies and some BL cell lines. This suggests that EBV with H1-H2-polymorphism is tightly implicated in NPC development in North Africa rather than EBV with H-polymorphism.