Diagnostic value of ultrasound in the spontaneous rupture of renal angiomyolipoma during pregnancy: A case report.

BACKGROUND: Spontaneous rupture and hemorrhage of renal angiomyolipoma (RAML) is a life-threatening clinical emergency. When it occurs during pregnancy, it is compared to a "bomb explosion," which makes the diagnosis and treatment more challenging. An ultrasound examination is a quick and safe examination with the benefit of no radiation exposure, which is always preferred for pregnant women. Currently, cases of spontaneous rupture and hemorrhage of RAML during pregnancy are rare, as is the diagnostic value and characteristics of ultrasound. The lack of understanding of the condition among ultrasound doctors makes it prone to misdiagnosis. In this study, we present the case of a pregnant woman who was preliminarily diagnosed with spontaneous rupture and hemorrhage of the left RAML using ultrasound and discuss the ultrasound characteristics. CASE SUMMARY: A 38-year-old woman in her 19th wk of pregnancy (G2P1) was referred to our clinic for a sudden, persistent pain on the left side of the waist. She had not undergone any previous related abdominal examination. Ultrasound of the urinary system revealed a giant nonhomogenous lump in the left kidney area. The diagnosis was considered spontaneous rupture and hemorrhage of the left RAML in pregnancy via ultrasound. Her left-side waist pain continued to be intense. Subsequently, she underwent computed tomography, which led to the same diagnosis. Based on many factors, the patient underwent left nephrectomy after the induction of labor. The pathological result was the rupture and hemorrhage of a vascular leiomyoma lipoma. CONCLUSION: Ultrasound examination plays an important role in the diagnosis of the spontaneous rupture and hemorrhage of RAML during pregnancy.

Thyroid metastasis from breast cancer presenting with enlarged lateral cervical lymph nodes: A case report.

BACKGROUND: Secondary malignancy of the thyroid occurs infrequently and mainly originates from malignant tumors of the kidney, gastrointestinal tract, lungs, breast, and skin. The correct diagnosis is important but difficult. Importantly, there are major differences in the treatment of primary and metastatic thyroid cancer, which has a significant impact on prognosis and survival. Therefore, how to diagnose thyroid metastasis (TM) correctly before surgery is a major concern for surgeons. CASE SUMMARY: We report a 38-year-old woman who presented with palpable cervical lymph nodes after breast cancer (BC) surgery 2 years ago. Ultrasonography and computed tomography revealed thyroid nodules with irregular margins and enlarged cervical lymph nodes. Biopsy was performed for the right largest cervical lymph node, and immunohistochemical analysis revealed negativity for thyroglobulin, estrogen receptor, and progestin receptor and positive for human epidermal growth factor receptor 2. The diagnosis was TM from BC with cervical lymph node metastasis. Total thyroidectomy with bilateral central and lateral neck lymph node dissection was performed. After a 5-mo follow-up, no recurrence or novel distant metastasis was identified. CONCLUSION: TM from BC is a rare secondary malignancy. Broad differential diagnosis by biopsy and immunohistochemical analysis needs to be considered.

A comparison of three MDCT post-processing protocols: preoperative assessment of the ossicular chain in otitis media.

The aim of this study was to examine and assess comparative values of HRCT-based multiplanar reformation (MPR), volume rendering (VR) and virtual endoscope built on three-dimensional (3D) shaded-surface display (SSD-based CTVE) for detections of ossicular chain's damage in patients with otitis media. 70 human ears from 70 patients suffering by chronic otitis media or cholesteatoma, who were examined with a preoperative multi-slice computer tomography (MSCT) examination and tympanoplasty in our hospital were collected. The patients ossicular chains were reconstructed with the aforementioned three protocols and assessed via a three-point scoring system by three radiologists. Then, all the patients ossicular chains were reviewed by a surgeon and a radiologist via the same three-point scoring system used during surgeries at same time. By calculation, the Youden's index and coincidence rate were acquired without a significant difference for display of malleus. With regard to the incus, the Youden's index and coincidence rate of VR and MPR did not show any difference, however, both were higher than CTVE. For representation of the stapes, the accuracy of these three modalities is very low; especially, for the CTVE. In conclusion, both MPR and VR are relative robust, and CTVE is not effective for evaluation of small ossicular structures, particularly the stapes. Furthermore, the VR images are real 3D ones. Therefore, it could be the more valuable protocols for detection of the damage of ossicular chain in the patients with otitis media, and should be further applied in the future work.

Cytoplasmic expression of p33(ING1b) is correlated with tumorigenesis and progression of human esophageal squamous cell carcinoma.

p33(ING1b), a newly discovered candidate tumor suppressor gene and a nuclear protein, belongs to the inhibitor of growth gene family. Previous studies have shown that p33(ING1b) is involved in the restriction of cell growth and proliferation, apoptosis, tumor anchorage-independent growth, cellular senescence, maintenance of genomic stability and modulation of cell cycle checkpoints. Loss of nuclear p33(ING1b) has been observed in melanoma, seminoma, papillary thyroid carcinoma, oral squamous cell carcinoma, breast ductal cancer and acute lymphoblastic leukemia. Inactivation and/or decreased expression of p33(ING1b) have been reported in various types of cancer, including head and neck squamous cell, breast, lung, stomach, blood and brain malignancies. Since little is known about the clinicopathological significance of p33(ING1b) in esophageal squamous cell carcinoma (ESCC), this study aimed to investigate the association of p33(ING1b) expression with clinicopathological variables and particularly interesting new cysteine-histidine rich protein (PINCH) in patients with ESCC. p33(ING1b) expression was examined by immunohistochemistry in 20 normal esophageal mucosa and in 64 ESCC specimens. The results revealed that the positive expression of p33(ING1b) protein in normal squamous cells was localized in the nucleus alone and the positive rate was 95%, while in ESCCs, the positive expression was mainly in the cytoplasm, together with nuclear expression, and the positive rate was 36% (P<0.0001). Furthermore, the cases with lymph node metastasis showed a higher frequency of positive cytoplasmic expression than those without metastasis (P=0.001). The cytoplasmic expression of p33(ING1b) was positively related to PINCH expression (P<0.0001) in ESCC, and the cases positive for both proteins had a high lymph node metastasis rate (P=0.001). In conclusion, p33(ING1b) cellular compartmental shift from the nucleus to the cytoplasm may cause loss of normal cellular function and play a central role in the tumorigenesis and metastasis of ESCC.

PINCH expression and its clinicopathological significance in gastric adenocarcinoma.

OBJECTIVE: Particularly interesting new cysteine-histidine rich protein (PINCH) is an important component of the local adhesion complexes and upregulated in several types of malignancies, and involved in the incidence and development of tumours. PINCH expression is also independently correlated with poorer survival in patients with colorectal cancer. However, there is no study of PINCH in gastric cancer, therefore, the aim of this project was to investigate PINCH expression and its clinicopathological significance in gastric adenocarcinoma. PATIENTS AND METHODS: PINCH expression was immunohistochemically examined in normal gastric mucous (n=30) and gastric adenocarcinoma (n=73), from gastric cancer patients. RESULTS: PINCH expression in the associated-stroma of gastric cancers was heterogeneous, and its positive rate (75%) was higher than that of normal gastric mucosa (43%, X^{2} =9.711, p=0.002). The stronger staining was observed at the invasive edge of tumour when compared to the inner area of tumour. The rate of positive PINCH (88%) in the cases with lymph node metastasis was higher than that (52%) in the cases without metastasis (X^{2}=11.151, p=0.001). PINCH expression was not correlated with patients' gender, age, tumour size, differentiation and invasion depth (p> 0.05). COMCLUSION: PINCH protein might play an important role in the tumourigenesis and metastasis of gastric adenocarcinoma.

3D image of the middle ear ossicles: three protocols of post-processing based on multislice computed tomography.

The aim of this study was to examine and assess the comparative values of HRCT-based multiplanar reformation (MPR), volume rendering (VR) and virtual endoscope built on three-dimensional shaded-surface display (SSD-based CTVE) for evaluations of the ossicular chain. The normal pure tone audiograms, type-A tympanogram, and normal HRCT characteristics of 32 human ears of 18 patients were reviewed, whose ossicular chains were reconstructed with the three aforementioned protocols and assessed via the 3-point scoring system. The HRCT-based protocols could demonstrate a 3D image of the ossicular chain, except that of the footplate on the SSD-based CTVE. On the qualitative assessment, the efficacy of the MPR and VR, which were both superior to the SSD-based CTVE (P < 0.05), presented no statistical significance among the major and/or hyperdense structures (P > 0.05). As regards the lateral process of the malleus, VR was found to be significantly superior to the MPR and SSD-based CTVE (P < 0.05), both of which, however, showed no significant comparative differences (P > 0.05). Moreover, the three protocols in terms of efficacy were comparatively different in their representations of the anterior crus and footplates of the stapes, respectively (P < 0.05). On the MPR images, not all the images of the lenticular process were ideal; 20 of 32 cases were detected, but not defined. VR could be the more valuable protocol for the 3D reconstruction of the ossicular chain and ought to be more employed in future, especially for the education.

[Effect of REZ-I cochlear implantation on residual hearing in adult patients].

OBJECTIVE: To evaluate the effect of cochlear implantation with REZ-I straight electrodes on residual hearing of postlingually deafened adults, and to explore the audiologically safety and injury characteristics of cochlear implantation. METHODS: Sixteen unilateral REZ-I (22 channels) cochlear implantation recipients from September 2009 to December 2009 were picked out. Their pre-and post-implantation audiometry data including pure-tone audiometry (PTA), auditory steady-state responses (ASSR), auditory brainstem responses (ABR) and distortion product otoacoustic emissions (DPOAE) were retrospectively analyzed, in order to compare the change between pre- and post-implantation residual hearing. RESULTS: Among the 12 recipients who had some measurable residual hearing before implantation, 5 (41.6%) patients had conserved some measurable hearing but the other 7 (58.4%) recipients had lost all measurable hearing after implantation on the implanted side. The implanted ears had an average PTA threshold drop of 9.5 dB HL and a statistically significant difference between pre- and post-implantation (P < 0.05) PTA thresholds in the frequencies of 250 Hz, 500 Hz, 1000 Hz, 2000 Hz and 4000 Hz. Compared to non-implanted ears, the drop in 500 Hz and 1kHz had a statistically significant difference between pre- and post-implantation PTA thresholds (P < 0.05). The ASSR residual hearing threshold elevation were statistically significant (P < 0.05) between pre- and post-implantation ASSR at 250 Hz and 500 Hz on the implanted side, while the The ASSR residual hearing threshold elevation were statistically significant (P < 0.05) at 500 Hz when compared to non-implanted side. The difference of residual hearing between pre- and post-implantation was not statistically significant for both DPOAE and ABR. CONCLUSION: There will be a certain degree of damage to residual hearing of the implanted side following REZ-I cochlear implantation.

Expression and significance of FXYD-3 protein in gastric adenocarcinoma.

OBJECTIVE: FXYD-3, also known as Mat-8, is a member of the FXYD protein family. It was reported that this protein can associate with and modify the transport properties of Na, K-ATPase, and may play an important role in a variety of physiological and pathological states. This protein is up-regulated in certain types of cancers (such as breast, prostate and pancreatic cancer), but down-regulated in other types of cancers (such as colon and kidney cancer). No study has been performed in gastric cancer; therefore, the aim of this project was to investigate FXYD-3 expression and its clinicopathological significance in gastric adenocarcinoma. PATIENTS AND METHODS: FXYD-3 protein was examined by immunohistochemistry in normal gastric mucous (n= 29) and gastric adenocarcinoma (n=51), obtained from surgical resection of gastric cancer patients. RESULTS: FXYD-3 protein was present in the cytoplasm of normal gastric epithelial cells or gastric cancer cells. The rate of FXYD-3 strong expression was significantly higher in cancer (51% of 51) than in normal mucosa (10% of 29, X;{2}=13.210, p < 0.0001). FXYD-3 expressed strongly in ulcerative/infiltrating types of cancers compared to polypoid/fungating ones (X;{2}=5.765, p=0.016). However, FXYD-3 expression was not correlated with patient's gender, age, tumor size, lymph node status and histological grade (p > 0.05). Conclosion: Up-regulated expression of FXYD-3 protein may be involved in tumourgenesis and invasion of gastric adenocarcinoma.

[A new method for REZ-1 cochlear implant electrode array insertion].

OBJECTIVE: To develop a new method for REZ-1 cochlear implant electrode array insertion. METHODS: REZ-1 cochlear implant electrode array was implanted in 22 human temporal bone specimens. Cochlear diameters were measured from spiral CT scan before implantation. Cochlear views were taken before and after pullback technique. Modiolus-electrode distances were measured and compared. The diameters of sixty normal cochleae were measured. RESULTS: In 3 cases, 27 electrode rings were inserted into the cochlea, while in others, all 28 electrode rings were inserted into the cochlea. After pullback of the electrode array, No. 12 to No. 19 electrode rings were closer to the modiolus in 17 cases (paired t test, P<0.01). The cochlear diameters in the 17 cases were smaller than 9.50 mm, while in the other 5 cases, the cochlear diameters were at least 9.60 mm. The cochlear diameters in the 17 cases were 9.11 (0.57) mm, while the cochlear diameters in the 5 cases were 9.78 (0.28) mm (Mann-Whitney test, P<0.001). The diameters of normal cochleae were (9.04 +/- 0.45) mm, with 90% larger than 9.50 mm. CONCLUSIONS: In cases whose cochlear diameter is smaller than 9.50 mm, pullback technique can help some electrode rings be closer to the modiolus. Measurement of the cochlear diameter can help the surgeon to have a better choice in the selection of REZ-1 cochlear implantation methods.

[Improvement of immunogenicity of Streptococcus pneumoniae psaA DNA vaccine by prime and boost strategy].

OBJECTIVE: To study on the preparation of Streptococcus pneumoniae psaA DNA vaccine and to analyse the immunogenicity by the prime-boost strategy. METHODS: The psaA gene was amplified from the genome of Streptococcus pneumoniae by PCR, and then was inserted into plasmid pVAX1 and pET28a to construct recombinant expression vectors respectively. 293T cells were transiently transfected with pVAX1-psaA, and RT-PCR analysis of total cell RNA extracts showed successful expression of psaA. BALB/c mices (n = 5) were intramuscularly injected with 100 microg psaA DNA vaccine for three times, and then boosted with 50 microg recombinant PsaA protein. The antibody response against PsaA was measured by ELISA. RESULTS: The psaA gene was amplified and subcloned successfully. The constructed psaA DNA vaccine was confirmed by DNA sequencing, and the recombinant PsaA protein was purified by the one-step Ni(2+) affinity chromatography. Expression of the PsaA was observed in cells transfected with pVAX1-psaA. The animal experiment results showed that the anti-PsaA level of the DNA prime-protein boosting mice was higher significantly than the other groups (t = 87.518, P < 0.05). CONCLUSION: The psaA DNA vaccine was prepared successfully, and the immunogenicity of Streptococcus pneumoniae psaA DNA vaccine could be improved significantly by the DNA prime and protein boost strategy.

[Uptake and accumulation of gentamicin by mouse hair cells from the cochlear explants in vitro].

OBJECTIVE: To investigate the upstaging and accumulation of gentamicin by mouse hair cells in vitro. METHODS: Cochlear explants were prepared from the microdissected neonatal mouse cochlea. Cochlear explants were cultured with gentamicin-Texas-red conjunction (GTTR) for different time. Laser confocal microscopy was used to observe the distribution of GTTR in the cochlear sensory cells after labeling with phalloidin-alexa-488. RESULTS: Soon after culture, there was diffuse red staining all tissue cells in the explants. At later time the hair cells were more staining than other cells in the explants. There was no obviously accumulation of GTTR in the supporting cells. The peak level of fluorescent density was reached at 24 hours culture. The GTTR was seen in the infracuticular zone of the hair cells. There was still accumulation of GTTR in the hair cells of the explants after 7 days culturing. CONCLUSIONS: GTTR and cochlea explants were useful methods to investigate the pharmacokinetics and mechanisms of gentamicin accumulation over time.

[Diagnosis of superior semicircular canal dehiscence syndrome].

OBJECTIVE: To better understand superior semicircular canal dehiscence (SSCD) syndrome. METHODS: A retrospective study was conducted on 6 patients who were diagnosed with SSCD syndrome in the Otology and Skull Base Surgery group of Fudan University. The clinical presentations including symptoms, signs, auditory tests and high resolution temporal bone computed tomography were reviewed. RESULTS: Four patients presented with low frequency hearing loss while acoustic reflex responses were intact. Another patient was concomitance with chronic otitis media demonstrated profound sensorineural hearing loss. The sixth patient demonstrated normal hearing. Two patients also complained of autophony, but they were unable to tolerate their own voice. Five patients presented with vertigo while 2 patients were unable to tolerate the environmental noise. All patients showed slow component vertical torsional eye movement away from the effected eye which was induced by the presence of loud sound or pressure in the middle ear or valsalva maneuver. Four patients also demonstrated vertigo induced by the loud sound, 1 patient was induced head movement by 110 dB tone. All patients were revealed variable bone defect overlying on the SSC using high resolution temporal bone CT scan with SSC reformation. CONCLUSIONS: The diagnosis of SSCD syndrome was established on both the presence of bone defect overlying superior semicircular canal which was demonstrated using high resolution temporal bone CT scan, and the presence of associated vestibular and auditory symptoms and signs.

[Precise three-dimensional modeling and virtual visualization of human membranous labyrinthine].

OBJECTIVE: To establish a precise three-dimensional model of membranous labyrinth for further morphologic investigation and physiological research. METHODS: Complete series of serial unstained celloidin sections of a fresh human temporal bone were taken photos by high-pixel digital camera. The images were then processed with the technique of photo stitch and employed to reconstruct the three-dimensional model of the membranous labyrinth using the method of surface rendering. RESULTS: In 3D-Doctor software, the model was displayed by different methods. The model was also exported to VRML format and their virtual visualization was realized through the software of Cortona virtual reality modeling language viewer. CONCLUSIONS: Precise modeling of membranous labyrinth could be realized by advanced imaging technique. With the advanced virtual reality software and equipment, the virtual visualization of membranous labyrinth could be realized, which would benefit the morphologic investigation and education.

[Analysis of prognostic factors in microsurgery of intratemporal facial nerve schwannoma].

OBJECTIVE: To discuss prognostic factors in microsurgery of intratemporal facial nerve schwannoma. METHODS: Clinical and follow-up materials from 13 cases of facial nerve schwannoma were analyzed retrospectively. Spearman rank-order correlation and nonparametric Mann-Whitney U test from SPSS 10.0 for Windows was used for the analysis. RESULTS: Each of 13 cases was operated on using modern microsurgery. Eleven cases among them received facial nerve reconstruction. One of the 13 cases lost follow-up. Others had no residue or recurrence. The House-Brackmann grades of the cases received facial nerve reconstruction were II through V. Spearman rank-order correlation showed the postoperative facial nerve function was correlated with the preoperative duration of facial nerve paralysis (r = 0.925, P = 0.000) and the preoperative facial nerve function(r = 0.712, P = 0.021). Mann-Whitney U test showed that the tumor position had no effect on the postoperative facial nerve function (P = 0.889). CONCLUSIONS: Among most of the patients who received microsurgery of facial nerve schwannoma, facial nerve functions could be restored to great extent. The longer the preoperative duration of facial nerve paralysis or the worse the preoperative facial nerve function, the worse the postoperative facial nerve function in cases who received facial nerve resection and reconstruction. Facial nerve reconstruction was helpful for the patient with facial nerve schwannoma whose facial muscles were denervated but have fibrillation potentials, as well as for the patient whose facial nerve schwannoma intruded internal acoustic canal.

[Cultivation, identification and ultrastructural observation of the proliferative cells from the newborn rat cochlea].

OBJECTIVE: To explore whether there could be proliferative cells in the cochlea of the newborn rat or not and what kinds of cells should be differentiated from the proliferative cells while to study the effect of the growth factors on the proliferative cells and the ultrastructure of the proliferative cells. METHODS: The Corti's organ were dissected from the cochlea of newborn SD rats and cultured. The proliferative condition of cells was tested by infusing the 5-bromo-2-deoxyuridine (BrdU) into the culture medium. And the variety of the spheres and differentiated cells were identified by immunohistochemistry. Corti's organ from forty-eight surface preparations was randomly divided into 4 groups: control group; epidermal growth factor (EGF) group; basic fibroblast growth factor (bFGF) group and EGF + bFGF group, with each group including 12 Corti's organ, and then the number of cell spheres of each Corti's organ was counted. The data was statistically analysed with ANOVE. Finally, the proliferative cells were observed under scanning electron microscope and transmission electron microscope. RESULTS: (1) The cell spheres can be observed in the cell culture of the Corti's organ. In present experiment, 90.1% of cells in spheres were labeled by BrdU, while nestin of spheres, the marker of hair cells--myosin 7A, espin, and phalloidin of the differentiated cells were positive. The marker of neuron-microfilament-M was also positive, and some differentiated cells were labeled by myosin 7A and BrdU, espin and BrdU, NF-M and BrdU at the same time. (2) The average number (x +/- s) of spheres from single Corti's organ was: 45.3 +/- 23.00 in control group, 86.2 +/- 34.1 in EGF group, 96.5 +/- 33.6 in bFGF group and 131.2 +/- 47.00 in EGF + bFGF group. There were significant differences between other groups respectively (P < 0.05) but there was no significant differences between EGF group and bFGF group (P > 0.05). (3) Scanning electron microscopy and transmission electron microscopy showed that cells of the spheres were round and had the same size and many short and thin microvilli on the surface of these cells. The cytoplasm were rich of organellae such as endoplasmic reticulum, mitochondrion, and cytoskeleton such as microfilament, microtube, et al. Tight junction, desmosomes and gap junctions between two adjacent cells were seen. CONCLUSIONS: The proliferative cells are observed in the cochlea of the newborn rats and proliferative cells could differentiated into hair cells with bundles-like structure and neuron. Both EGF and bFGF possess the promoting effects for proliferation on the proliferative cells while the proliferative cells have characters of earlier immature cells.

Three-dimensional morphology of the vestibular cleft and its potential application.

HYPOTHESIS: To delineate quantitatively the spatial relationships of the utricle, saccule, and stapedial footplate, to locate the hole on the footplate, and to analyze the insertion depth into the vestibule and the direction of the piston during stapedotomy. BACKGROUND: The quantitative three-dimensional (3D) configuration of the utricle, saccule, and stapedial footplate is undetermined, and the stapedotomy procedures should be improved. METHODS: Four temporal bones were extracted from the fresh cadavers and were undecalcified polymer-embedded. The specimens were sectioned into serial 50-mum-thickness slices. After image processing and 3D reconstruction, a cartesian coordinate system was established to display the spatial relationships of the utricle, saccule, and stapedial footplate in the 3D Studio Max scene. The configuration of the utricle, the saccule, and the "vestibular cleft" was delineated quantitatively with the contour map method. With this contour map, any distance between one point at the surface of the footplate and another point at the surface of the utricle or saccule and its orientation can be measured. RESULTS: There was a V-shaped cleft between the utricle and the saccule named vestibular cleft. The angle of the cleft was 50.30 degrees +/- 19.90 degrees . The apex of the cleft always directed anterosuperiorly, whereas beneath the posteroinferior part of the footplate was an open and deep "seabed." The vertical distances between points on the tympanic surface of the footplate and points on the surface of the utricle or saccule were measured. The vertical distance from the center point of footplate to the vestibular end organs was 2.20 +/- 0.548 mm, the maximum distance being 3.0 mm, whereas the minimum distance was 1.6 mm. CONCLUSION: The posteroinferior area near the central point of the footplate is the optimal position for the fenestra through which the piston can be inserted relatively safely into a depth of 0.8 to 1.0 mm in the vestibule. If the deep end of the piston is inclined inferiorly and posteriorly by 8 to 10 degrees, respectively, the piston will be farther from the vestibular end organs. These manipulations may enhance surgical safety and efficiency in stapedotomy.

[Preparation of new protein carrier of vaccine against pneumococcal otitis media with genetic engineering technology].

OBJECTIVE: To prepare pneumolysin as a new protein carrier of vaccine against otitis media with genetic engineering technology and establish the base of the study on pneumococcal conjugative vaccines. METHODS: Genomic DNA was isolated from streptococcus pneumoniae. A pair of primers which included two restriction sites was designed based on the published pneumolysin gene sequence. The pneumolysin gene was amplified from pneumococcal DNA with PCR technology. The restriction enzyme digested fragment was linked into the cloning vector PET-28a and the recombinant plasmid DNA containing pneumolysin was then transfected into host cell E. coli JM109 (DE3). RESULTS: DNA fragments were subcloned to construct the complete pneumolysin gene by a conventional coning and PCR. The inserted pneumolysin gene sequence was confirmed by DNA sequencing and the pneumolysin protein was successfully expressed. The relative molecular mass of the expressed product was 52 000. The expressed product amounted to 8% of the total host cell protein. CONCLUSIONS: The pneumolysin gene was successfully cloned into host cell using genetic engineering technology. The recombinant pneumolysin was expressed and purified for preparation. This work laid a foundation of the preparation of pneumococcal conjugative vaccines.

[Diagnosis and management of facial nerve neuromas].

OBJECTIVE: To provide the experience for early diagnosis and management of facial nerve neuromas, and to discuss the clinic and imaging feature of facial nerve schwannoma and facial nerve fibroma in 22 cases. METHODS: Twenty cases facial nerve schwannoma and two cases of facial nerve neurofibroma were diagnosed and reviewed retrospectively. Surgical removal were performed through the middle cranial fossa in 2 cases, through intratemporal approach in 8 cases, through intraparotid approach in 2 cases, and combined intra-temporal with out-temporal approaches in 10 cases. Seventeen cases underwent facial nerve graft for repairing a facial nerve defect. Great auricular nerve was used in 3 cases with intratemporal approach and 1 case with intratemporal combined intraparotid approach. Sural nerve graft was used in 5 cases with intratemporal approach and 8 cases with intra-temporal combined intraparotid approach. Two cases were employed two-stage facial muscle flap-plasty. RESULTS: Facial nerve neuromas were totally removed in 21 cases and subtotal neuroma removed in 1 case. In these cases, 20 patients were no recurrence and 1 patient was lost follow-up. One patient with subtotal neuroma removal received Gamma Knife treatment before and after surgery, and this case was no recurrence. The CT imaging of the temporal bone showed that schwannoma was separated "white mass" with smooth margin along the region of facial nerve without intact canal. But neurofibroma locate in enlarge fallopian with intact canal. Magnetic resonance imaging had the advantage of evaluating all segments of the facial nerve and showed continuity of intratemporal and intraparotid mass with the facial nerve. Pathological results indicated that 20 cases were diagnosed as facial nerve schwannoma and 2 cases were neurofibroma. CONCLUSIONS: Although tumors originating from the facial nerve are extremely rare, it is possible to make early diagnosis through finding clinical feature and imaging methods. Generally, systematic surgical approach for tumor removal and facial nerve reconstruction should be considered in the cases with facial neurinoma.

[Clinical research about the distribution of perineural vascular plexus of the facial nerve].

OBJECTIVE: To objectively evaluate the usefulness and the reliability of the perineural vascular plexus as a landmark for facial nerve as well as whether it will be a landmark for identification of the facial nerve in surgery for otology and neurotology by means of investigating the location of the facial nerve for prevention of iatrogenic facial palsy. METHODS: Prospective case series were designed. Three hundred and eleven consecutive patients were studied which required tympanoplasty for chronic otitis media or microsurgery for facial nerve decompression and congenitally malformation of the ear from July 2002 to July 2005. All the patients were operated by the first author. Perineural vascular plexus as a landmark for identification of the facial nerve in surgery were observed to assess the utility. RESULTS: The well recognized perineural vascular plexus were seen on the horizontal mesotympanic segment of the nerve in 95.8% of patients (298 cases), and only in 4.2% of the patients (13 cases), the vessel plexus was difficult to identify. The 95% confidence interval was from 93.6% to 98.0%. CONCLUSIONS: The vascular plexuses around or over the horizontal portion of the facial nerve provide an early and direct indicator of the location of the facial nerve. The perineural vascular plexus could be a dependable and reliable landmark for the identification the horizontal part of the facial nerve in surgery for otology and neurotology.