Facial Nerve Function and Quality of Resection in Large and Giant Vestibular Schwannomas Surgery Operated By Retrosigmoid Transmeatal Approach in Semi-sitting Position with Intraoperative Facial Nerve Monitoring.

INTRODUCTION: Large and giant vestibular schwannomas pose a real problem in their management. The preservation of facial nerve function may limit tumor resection despite the use of intraoperative monitoring of the facial nerve. In Algeria, vestibular schwannomas represent 5% of all intracranial tumors operated on, 80.5% of which are large or giant. METHODS: From January 2010 to December 2015, 151 large and giant vestibular schwannomas were operated in our department. Tumor diameter was between 30 and 60 mm. The most common presenting symptom was hearing loss, which was observed in 41.66% of all our patients. All patients were operated in the semi-sitting position with opening of the posterior wall of the internal auditory canal and under continuous intraoperative facial nerve function monitoring. RESULTS: Tumor resection was total in 126 patients. Anatomic preservation of the facial nerve was the reason for nontotal resection in 25 patients. The facial nerve was anatomically preserved in 149 patients. Two years after surgery, the facial nerve function was grade I-II House-Brackmann (H-B) score in 124 cases (82%), grade III-IV H-B score in 21 cases (14%), and grade V-VI H-B score in 06 cases (04%). The status and the improvement of postoperative facial nerve function depend on 4 factors: anatomic preservation of nerve, stimulation threshold, cystic form, and the presence of train activity. CONCLUSIONS: The development of anesthesia techniques and microsurgery and the systematic use of intraoperative monitoring of the facial nerve have allowed us to move from a life preservation era to another era of preservation of function.

ADRA2A Germline Gene Polymorphism is Associated to the Severity, but not to the Risk, of Breast Cancer.

Breast cancer (BC) prognosis and risk were associated to obesity, metabolic syndrome and type 2 diabetes mellitus. Two Single Nucleotide Polymorphisms (SNPs) of the adrenergic receptor-2a gene (ADRA2A): rs1800544 and rs553668, have been associated to these metabolic disorders. We investigated these SNPs in BC risk and prognosis. A total of 102 BC patients and 102 healthy controls were included. The rs1800544 and rs553668 were determined by real-time PCR. Genotypes and haplotypes frequencies between patients and controls, and for different clinico-pathologic parameters were compared. We found a significant association of rs1800544 GG genotype with young age at diagnosis, premenopausal status, higher tumor size, metastasis in lymph nodes, advanced TNM stages and higher Nottingham Prognosis Indicator (NPI) (p < 0.05). There was no association between rs1800544 and SBR stages, Her2, ER and PR statuses and the molecular classification. The rs553668 AA genotype was associated to young age at diagnosis and premenopausal status (p < 0.05). The haplotype GA was associated to the early age of diagnosis (p = 0.03), and the haplotype GG to higher tumor size, lymph node involvement, advanced TNM stages and Her2 positive status (p < 0.05). There was no polymorphism or haplotype association with BC risk (p > 0.05). ADRA2A polymorphism is associated with indicators BC poor prognosis but not with BC susceptibility. This is the first report suggesting that ADRA2A germline gene polymorphism could represent a predictor factor for BC outcome. Further investigation of other ADRA2A polymorphisms in BC risk or prognosis are needed and may lead to a genotype-based therapy.

Prevalence of type 2 diabetes in Algerian patients with hepatitis C virus infection.

AIM: To investigate the prevalence of, and risk factors for, diabetes mellitus (DM) in Algerian patients with chronic hepatitis C virus (HCV) infection and in a control group. METHODS: A cross-sectional study was undertaken. A total of 416 consecutive patients with viral chronic hepatitis attending the Internal Medicine Department of the University Hospital Center Touhami Benflis in Batna [290 HCV-infected and 126 hepatitis B virus (HBV)-infected patients] were prospectively recruited. RESULTS: The prevalence of DM was higher in HCV-infected patients in comparison with HBV-infected patients (39.1% vs 5%, P < 0.0001). Among patients without cirrhosis, diabetes was more prevalent in HCV-infected patients than in HBV-infected patients (33.5% vs 4.3%, P < 0.0001). Among patients with cirrhosis, diabetes was more prevalent in HCV-infected patients, but the difference was not significant (67.4% vs 20%, P = 0.058). The logistic regression analysis showed that HCV infection [odds ratio (OR) 4.73, 95% CI: 1.7-13.2], metabolic syndrome (OR 12.35, 95% CI: 6.18-24.67), family history of diabetes (OR 3.2, 95% CI: 1.67-6.13) and increased hepatic enzymes (OR 2.22, 95% CI: 1.1-4.5) were independently related to DM in these patients. CONCLUSION: The high prevalence of diabetes in HCV-infected patients, and its occurrence at early stages of hepatic disease, suggest that screening for glucose abnormalities should be indicated in these patients.

Association of hepatitis C virus infection and diabetes.

Epidemiologic studies have suggested a relation between hepatitis C virus (HCV) infection and diabetes mellitus. HCV infection is emerging as a metabolic disease, and diabetes mellitus as a risk factor for HCV infection. However, some data on the prevalence of antibodies to HCV in patients with diabetes are conflicting. These seroprevalence data should be interpreted with caution. Some potential bias may occur in those clinic-based studies that target a specific disease group. In this letter we explain some reasons for these conflicting studies.