Surgery for jugular foramen schwannomas via a pure endoscopic transoral approach / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To report a new approach, endoscopic transoral approach for the resection of jugular foramen schwannoma.</p><p><b>METHODS</b>Nine patients with jugular foramen schwannoma (three males and six females, ranging in age from 15 to 61 years old) were treated by direct surgery via a pure endoscopic transoral approach to the jugular foramen. Eight patients complained of hypoglossal nerve palsy with hemiatrophy of the tongue; six cases complained of vagus nerve palsy. Three cases complained of glossopharyngeal nerve palsy, one case complained of facial nerve palsy and hearing loss.</p><p><b>RESULTS</b>The nerves in this area were preserved and radical intracapsular removal of the tumor was performed via endoscopic transoral approach in the nine cases. Tumor removal, as assessed by intraoperative endoscopic inspection, postoperative magnetic resonance imaging and clinical evaluation, revealed all tumors were completely removed. One patient suffered from temporary swallowing difficulties and temporary right vagus palsy 1 day after surgery. There were no others intraoperative and postoperative complications. All patients were followed up for 4 - 29 months, no recurrences were occurred in all these patients and the muscle bulk, motor and the pre-postoperative swallowing function, the vagus palsy, the facial nerve palsy and hearing loss had improved in these patients.</p><p><b>CONCLUSION</b>The endoscopic transoral approach and intracapsular removal of the tumor provided for successful minimally invasive surgery in the jugular foramen schwannomas.</p>

Construction, expression and refolding of recombinant luteinizing hormone releasing hormone-angiogenin toxin / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To express, purify and refold recombinant luteinizing hormone releasing hormone-angiogenin (LHRH-Ang) toxin using E. coli. expression system.</p><p><b>METHODS</b>Recombinant LHRH-Ang expression vector was constructed by replacing of EGF fragment in plasmid pET28a/EGF-Ang with LHRH-PII fragment amplified from plasmid pET28/MSH-PE40. DNA sequencing would be used to verify the correction of fused LHRH-PII-Ang gene. Then, E. coli strain BL21 (DE3) was transformed by pET28a/LHRH-Ang vector. Expression of recombinant LHRH-Ang toxin was induced by Isopropyl-β-D-Thiogalactoside (IPTG). Refolding effects of gradient dialysis was evaluated by SDS-PAGE.</p><p><b>RESULTS</b>Prokaryotic expression vector pET28a/LHRH-Ang, containing LHRH-PII-Ang fusion gene, was constructed by PCR amplification, restriction enzyme digestion and ligation method. Sequence correction of fusion gene was confirmed by DNA sequencing. After IPGT induction, recombinant LHRH-Ang protein was expressed in BL21 (DE3) as inclusion body, it took 18.43% of total protein. Inclusion body was resolved in 8 mol/L urea and purified by DEAE-Sepharose FF column, the purity was 85%. Recombinant LHRH-Ang toxin was refolded and concentrated by gradient dialysis and PEG 20000, respectively.</p><p><b>CONCLUSIONS</b>Recombinant LHRH-Ang protein was expressed in E. coli and refolded successfully.</p>

Endoscopic endonasal surgery for clival tumor / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To review our experience with endoscopic endonasal approach for surgical management of clival tumors.</p><p><b>METHODS</b>Twenty-four patients with clival tumors treated by endoscopic endonasal surgery between August 2002 and November 2005 were studied prospectively. The operative technique was described in detail. There were 5 chordoma, 2 ossifying fibroma, 1 meningioma, 1 craniopharyngioma, 1 hemangioblastoma, 6 squamous cancer, 2 chondrosarcoma, 2 chondrosarcoma, 1 lymphoma, 1 malignant giant cell tumor and 2 metastatic carcinoma.</p><p><b>RESULTS</b>Total tumor removal was obtained in 22 cases, subtotal removal in 2 case. Follow-up ranged 12 to 51 months. Three patients dead. Five patients with total removal recurred, one of them dead. Two patients with subtotal removal dead, one with chondrosarcoma and one with chordoma. The complications included subarachnoid hemorrhage in 1 patient, and transient cerebrospinal leakage in 2 cases.</p><p><b>CONCLUSIONS</b>The use of nasoendoscopy to perform clival tumor surgery is not only limited to the minimally invasive aspect, it also provides better visualization of deeper structures in the skull base, provides the ability to 'look around corners' and wide exposed field. This approach permits us to manage clival lesions properly.</p>

Endoscopic transnasal reconstruction of skull base defects with titanium mesh / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To investigate the feasibility of endoscopic transnasal reconstruction of skull base defect with titanium mesh.</p><p><b>METHODS</b>Eight cases were selected to reconstruct their anterior skull base defects by endoscopic transnasal approach with titanium mesh between April, 2006 and January, 2007.</p><p><b>RESULTS</b>Pathologies of these cases included two esthesioneuroblastomas, one squamous cell carcinoma, one chondrosarcoma, one malignant fibroma, two meningiomas, and one chordoma. The defects involved anterior-medial skull base in 2 cases, anterior skull base-sellar turcica in 2 cases, and anterior skull base sellar turcica-clivus in 4 cases. All patients were followed up for 2 to 10 months after operation and were monitored with endoscopic examinations and imaging. Replacement of titanium mesh was found in one case and other seven cases were successfully reconstructed without replacement of titanium mesh.</p><p><b>CONCLUSIONS</b>Endoscopic transnasal reconstruction with titanium mesh is a feasible technique for defects of the anterior skull base. This procedure is simple and safe. Result of this protocol is desirable.</p>

Using of titanium mesh for the reconstruction of skull base defect / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>The purpose of this study is to evaluate the possibility and surgical principle of titanium mesh used for the reconstruction of skull base bone defect.</p><p><b>METHODS</b>The clinical data of 11 patients with defect of skull base bone repaired with titanium mesh were retrospectively analysed.</p><p><b>RESULTS</b>Among 11 patients, there were 6 patients with skull base tumor, 3 patients with fibrosis hyperplasia, 2 patients with encephalomeningocele. The surgical approach included craniofacial approach in 7 patients, transfrontal and extended transfrontal approach in 3 patients, trans-midface approach in 1 patient. The anterior and lateral skull base was repaired in 2 patients, anterior and middle skull base and sellar repaired in 6 patients, anterior skull base and orbital floor repaired in 3 patients. In early postoperative period, there were 3 patients with intracranial pneumatosis, but without symptom, and 1 patient with transient cerebrospinal leakage. Following-up for average 14.4 months, there was no titanium mesh displacement and intracranial infection in all patients.</p><p><b>CONCLUSIONS</b>The titanium mesh used for the repair of skull base bone defect was both possible and safe.</p>

Effects of Astragalus and saponins of Panax notoginseng on MMP-9 in patients with type 2 diabetic macroangiopathy / 中国中药杂志

<p><b>OBJECTIVE</b>To investigate the role and mechanism of Astragalus (AS) and saponins of Panax notoginseng (PNS) in treating type 2 diabetic macroangiopathy.</p><p><b>METHOD</b>94 patients with type 2 diabetic macroangiopathy were divided into two groups randomly: group treated with Simvastatin and group treated with AS and PNS, compared with 40 healthy control subjects. Serum level of MMP-9 and lipid in patients and healthy subjects were measured before and after treatment.</p><p><b>RESULT</b>The serum levels of MMP-9, TG, TC, LDL-C, VLDL-C in patients with type 2 diabetic macroangiopathy were improved, while the levels of HDL-C were decreased. Like Simvastatin AS and PNS had the function of reducing MMP-9 and accommodating lipid metabolism.</p><p><b>CONCLUSION</b>Besides accommodating lipid metabolism, AS and PNS can also reduce the level of serum MMP-9 soas to treat type 2 diabetic macroangiopathy.</p>