Predictive factors of difficult biliary cannulation: An experience of a tunisian tertiary center.

Introduction: Selective biliary cannulation is a prerequisite for a successful endoscopic retrograde cholangiopancreatography (ERCP). However, conventional biliary access can be difficult. The aims of our study were to determine the prevalence of difficult biliary cannulation (DBC) and its associated factors and to describe the efficiency and safety of used standard and advanced cannulation techniques. Methods: We conducted a single-center retrospective study including all patients with naïve papilla who had an ERCP procedure in Gastroenterology department of Mohamed Taher Maamouri Hospital from June 2019 to December 2021. Efficiency was defined as successful selective deep biliary cannulation. DBC was defined based on the presence of one or more of the European Society of Gastrointestinal Endoscopy (ESGE) criteria (5-5-1): more than five cannulation attempts, more than 5 min before cannulation and more than one accidental passage in the wirsung. Prevalence was measured using ESGE 5-5-1 cutoffs and chinese set cutoffs 15-10-2. Predictors of DBC were sought by univariate and multivariate analysis (SPSS software, p significant if < 0.05). Results: We included 664 patients (mean age 62 years and sex ratio M/W = 0.8). Main indication for ERCP was choledocholithiasis (67%, n = 442) followed by malignant biliary stenosis (21%, n = 138). Based on ESGE criteria, prevalence of DBC was 42.62% (n = 283). Prevalence was 21.15% when 15-10-2 cutoffs are applied in trainee-involved procedure. Cumulative biliary success rate was 96.46%. Standard cannulation method achieved access in 98.2% while advanced methods permitted success in 92.2% in fistulotomy, 94.1% in papillotomy and 77.3% in transpancreatic sphincterotomy. Independent predictive factors of DBC in multivariate analysis were: Trainee presence OR 1.80 [1.24-2.65], SOD OR 4.71 [1.11-19.88], biliary stenosis found on imaging examinations (OR 2.53 [1.63-3.92], small papilla OR 4.09 [1.82-9.17] and difficult orientation of the papilla OR 14.90 [3.28-67.62]. Conclusion: DBC is a frequent endoscopic situation. Predictors of DBC can be related to trainee involvement in the procedure, anatomical and clinical factors. A thorough understanding of these factors can actively contribute to ERCP management plans.

Synthesis of new pyrazoline-nucleoside analogue derivatives.

In this work, a synthesis of pyrazoline nucleosides analogues is presented, using the stereospecific sodium salt glycosylation procedure. In the first step, chalcones were prepared using Claisen­Schmidt reaction by reacting benzaldehyde with enolizable ketones in ethanolic NaOH solutions. Next, these chalcones were immediately reacted with hydrazine hydrochloride in the presence of dry methanol to obtain the corresponding 2-pyrazolines. Finally, the coupling of the pyrazolines with 1-chloro-arabinofuranose leads to different ß-nucleosides as the major product (13­17) in good yields. The structures of these derivatives were characterized by infrared and 1HNMR spectroscopy and mass spectrometry.

[Sarcoidosis and liver involvement: a case series of 25 patients]. / Sarcoïdose et atteinte hépatique : étude de 25 cas.

PURPOSE: Sarcoidosis is a systemic disease of unknown etiology that may affect many organs including the liver. Our aims were to determine the clinical, paraclinical and therapeutic characteristics of patients with liver sarcoidosis and to compare, on the one hand, the revealing hepatic involvement to the non-revealing form and, on the other hand, sarcoidosis with and without liver disease. METHODS: A retrospective and descriptive study over 14 years of 25 patients with liver involvement selected from 56 cases of systemic sarcoidosis. RESULTS: The study population was composed of 18 females and seven males. The mean age was 48.2 years. Liver involvement was the presenting manifestation in 56% of cases. The functional history was dominated by general signs and abdominal pain. Hepatomegaly was present in ten patients. Biological abnormalities were identified in 84% of the cases with cholestasis (80%) and cytolysis (36%). Abdominal tomography showed hepatomegaly in 68.4% of the patients. Hepatic impairment was histologically confirmed in 16 patients. Granulomas were located in portal region (18.8%), in lobular region (12.5%) and in both (56.2%). Necroinflammatory lesions were found in 56.2%, cholestatic lesions in 18.8% and vascular lesions in 6.3%. Portal fibrosis and cirrhosis were seen in 25% and 6.3%, respectively. Twenty-four patients were treated with corticosteroids with 1 mg/kg per day (66.7%) and 0.5 mg/kg per day (33.3%). Under treatment, the response was complete in 81% and partial in 9.5%. One patient had no response. The liver involvement was significantly associated with general signs, renal failure and lymphopenia. Abdominal pain, hepatomegaly and lymph node were significantly associated with the revealing form. CONCLUSION: Liver involvement is frequent in sarcoidosis and commonly asymptomatic. Hepatomegaly is the most common clinical sign. Biological disturbance are present in 20 to 40% of the patients. The treatment is based essentially on corticosteroid therapy.

Metaphyseal chondrodysplasia, type Jansen.

The Jansen type of metaphyseal dysplasia is a rare disorder with significant clinical and radiographic variability. Two cases of classical Jansen disease and one with some distinctive features suggestive of the Jansen variant are reported.

Acrania: a manifestation of the Adams-Oliver syndrome.

A 10-year-old male with acrania, distal limb anomalies, and abnormal arterial and venous cranial blood vessels is reported. Parental films and examination are normal. This case supports the hypothesis that acrania is a severe form of aplasia cutis congenita and is within the spectrum of Adams-Oliver syndrome. It is proposed that the diagnosis of acrania requires assessment of both parents and proband to assess other manifestations of vascular disruption in order to provide accurate genetic counselling.

Robin sequence with facial and digital anomalies in two half-brothers by the same mother.

Two half-brothers by the same mother presented with the Robin sequence and facial and digital anomalies. The mother has a normal face and mild hyperopia without abnormality on radiographs of the hands, feet, and pelvis. The older son is 4 years and the younger is 6 months old. Both have normal psychomotor development. To the best of our knowledge this familial association has not been reported before and probably represents a previously unrecognized heritable malformation syndrome. The occurrence of the syndrome in 2 half-brothers by the same unaffected mother suggests X-linked recessive inheritance.

Stress fracture of the fibula in the first decade of life. Report of eight cases.

Stress fracture of fibula in athletes and ballet dancers is a well recognised entity. Fibular fractures in children in the first decade of life who are not active in sport or ballet dancing are not well known and often diagnosed as osteomyelitis or malignant bone tumour. This misdiagnosis may be followed by CT, nuclear scan or MR. All these investigations are not necessary and biopsy if performed might even be misleading. The plain X-rays show diagnostic radiographic findings and a misdiagnosis is highly unlikely especially when they are evaluated in the context of clinical findings.

Antro-choanal polyp: a 10-year retrospective study in the pediatric population with a review of the literature.

Antro-choanal polyp is generally recognized to represent approximately 4-6% of all nasal polyps; however, it is much more prevalent in the pediatric population. It warrants special consideration in children because its clinical manifestations may be mimicked by other less benign conditions, such as juvenile angiofibroma, meningoencephalocele, and nasopharyngeal malignancies. Fifty patients with surgically treated nasal polyps were reviewed at the Montreal Children's Hospital, between 1976 and 1986. Fourteen (28%) were antro-choanal polyps. Our results are compared with the literature, and special emphasis was given to radiographic manifestations and the differential diagnoses.

Primary bone tumours in infants. Short literature review and report of 10 cases.

Ten cases of primary bone tumours in infants (1 osteosarcoma, 3 Ewing's sarcoma, 1 chondroblastoma and 5 angiomatosis) are reported. All cases of angiomatosis showed characteristic radiographic findings. In all the other tumours the X-ray appearances were different from those usually seen in older children and adolescents. In the authors' opinion the precise diagnosis of malignant bone tumours in infancy is very difficult as no characteristic X-ray features are present in this age period.