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Adequate dosage of sublingual buprenorphine is now recommended for substitution treatment of severe opioid dependance. We report two cases of acute discomfort, probably linked to withdrawal syndrome, after an IV injection of high doses of buprenorphine in opiate dependant patients. Data on the pharmacokinetics and neurobiochemical aspects of buprenorphine are compared with those of other opiates. A major issue of this work is a guideline for inducing substitution treatment with this "unique" partial agonist/antagonist of endorphinic receptors.

The middle meatus is the site of abnormalities which are to a great extent responsible for naso-sinus pathology. Its exploration has benefited from improvements in optical systems (microscopes and endoscopes) and radiological investigations. We present our experience with exploration and surgery of the middle meatus under endoscopic control. The medical examination (past history, allergy, etc.) combined with radio-endoscopic findings helps to define the appropriate therapy. Functional surgery is sometimes necessary. This is performed under local anesthetic, which in our experience improves the condition for the procedure and decreases the post-operative complications.

The squamous cell carcinoma of the external auditory canal is extremely rare. The facial paralysis is usual, but pain seems to be the most common symptom. The mean age at diagnosis is 50 to 60 years, with chronic external otitis preceding. The CT-scan is the most important investigation before treatment: surgery and external radiotherapy. Surgical procedure must be large, with or without facial nerve dissection, following by irradiation of the temporal bone and cervical nodes. The generally poor prognosis is explained by the frequency of advanced disease at the time of diagnosis. This paper reports our 4 experiences, with a bilateral carcinoma case.