Expression of survivin in human gastric carcinoma and gastric carcinoma model of rats

AIM: To study the expression of survivin, an inhibitor of apoptosis protein, in human gastric carcinomas and gastric carcinoma models of rats.METHODS: With the method of immunohistochemical staining, we studied the expression of survivin in 20 cases of chronic gastritis and 56 cases of gastric carcinomas. We used N-methyl-N′-nitro-N-nitrosoguanidine (MNNG) and high dose sodium-chloride diet to induce rat gastric carcinomas. Survivin expression was studied in glandular stomachs of normal rats, adenocarcinomas and tissues adjacent to the tumor, as well as in rats during the induction period.RESULTS: Survivin was expressed in 27 of 56 (48.2 %)cases of human gastric carcinoma tissues and 1 of 20 (5 %)cases of chronic gastritis. It was found that the expression of survivin had no relation with the elements of age, tumor depth, tumor size, and disease stage, but was significantly related to histological type. The positive rate of survivin expression in cases of intestinal type was significantly higher than that in cases of diffuse type (P＜0.05). In animal experiments, survivin expression in glandular stomachs of normal rats, of rats in middle induction period, in adenocarcinomas and tissues adjacent to tumor were 0,40.0 %, 78.3 % and 38.9 %, respectively. Compared with the survivin expression in normal rats, the differences were significant.CONCLUSION: These data imply that survivin plays an important role in the onset of gastric carcinoma and that high survivin expression is an early event of gastric carcinoma.

Effects of oxymatrine on experimental hepatic fibrosis and its mechanism in vivo

AIM: Hepatic fibrogenesis has close relation with hepatic stellate cells (HSC)and tissue inhibitors of metalloproteinase (TIMP). Oxymatrine (OM) is a kind of Chinese herb that is found to have some effects on liver fibrosis. We aimed to determine the effects of OM on hepatic fibrosis and explore the possible mechanism. METHODS: Thirty-two rats were randomly divided into four groups; 16 were used to develop hepatic fibrosis by carbon tetrachloride (CCI4) and treated with or without OM, and 16 were used as controls. The expression of tissue inhibitor of metalloproteinase-1 (TIMP-1) and α-smooth muscle actin (α-SMA) in the livers of rats was detected by immunohisto-chemical assay. Liver pathology was determined by H&E staining and reticulum staining. RESULTS: In CCl4-injured rats, the normal structure of lobules was destroyed, and pseudolobules were formed. Hyperplasia of fibers was observed surrounding the lobules. While the degree of fibrogenesis in liver tissues was significantly decreased in those rats with OM-treatment compared with those without OM treatment. The pseudolobules were surrounded by strong, multi-layer reticular fibers, which netted into pseudolobules in CCl4-injured rats, however, there was a significant decrease in reticular fibers in OM-treated rats. The expression of TIMP-1 in hepatic cells was weak in control groups, but strong in CCl4-injured groups, however, the expression of TIMP-1 was significantly inhibited by OM (F = 52.93, P<0.05). There was no significant change in the expression of α-SMA between CCl4-injured rats with or without OM treatment (F= 8.99, P>0.05). CONCLUSION: OM effectively inhibits CCl4-induced fibrogenesis in rat liver tissues, probably by reducing the expression level of TIMP-1.

Clinical Analysis of Pancreatic Cancer： A Report of 2340 Cases（2340例胰腺癌临床病例分析）

目的 探讨提高胰腺癌治愈性切除相关因素和获得更佳疗效。方法 中国抗癌协会胰腺癌专业委员会回顾性分析了8省2市14大医院的1990年一2000年诊治的2340例胰腺病例。多因素生存分析采用Cox比例风险模型找出可能影响胰腺癌病人预后的独立因素。单因素生存分析用寿命表法计算，以生存曲线描述生存率，并进行Gehan比分检验。结果 COX单因素分析表明在a=0．05水平上有意义的有年龄、职业、病程、肿瘤部位、手术方式、术后胰瘘、术后肝衰、化疗、TNM分期、免疫治疗、有无肝转移、肠系膜上血管有无侵犯等变量。COX多因素分析表明在a=0．05水平上有意义的有患者年龄、手术方式、术后胰瘘、术后肝衰、化疗、免疫治疗等变量，这些变量为影响胰腺癌预后的独立因素。根治性手术者相对于未手术者，以及化疗、免疫治疗均为保护性因素。其中40岁以上的占了92．91％，40岁以下的仅占7．09％。胰头癌根治性手术组中位生存时间为17．11个月，1年、3年和5年生存率分别为54．36％、13．47％、8．47％。结论 有必要将40岁以上的人群视为高危人群，能及时发现早期病例。各种综合治疗措施的结合都将有助于改善胰腺癌患者的生活质量和延长生存期。 Objective To investigate the factors related to curable resection and efficacy of pancreatic cancer.Methods A uniform questionnaire for national survey on clinical epidemiology of pancreatic cancer was designed by Committee of Pancreatic Cancer, CACA from January 1, 1990 to December 31, 2000. A total of 2340 cases were included. Survival analysis was conducted for selected cases with complete data. Cox regression was used to screen out single and multiple risk factors. Cumulative survival rate was calculated by life table and Gehan score test.Results COX single factor analysis revealed that significant variables at α = 0.05 level included age, occupation, duration of disease, location of neoplasm, operation type, postoperative pancreatic fistula, postoperative hepatic failure, chemotherapy, TNM stage, immunotherapy, liver metastasis, invasion of superior mesenteric vessel. COX multifactor analysis demonstrated that significant variables at α= 0.05 level were age, surgical procedures, postoperative pancreatic fistula, postoperative hepatic failure,chemotherapy, immunotherapy. These were independent factors for the prognosis of pancreas carcinoma. Among these factors, age less than 70 years, radical operation, chemotherapy and immunotherapy were all protective factors. 92.91% of the patients were more than 40 years of age. Only 7.09% of those were less than 40. The median survival time of group of radical resection of carcinoma in head of pancreas was 17.11 months and the 1-, 3-, 5-year survival rates were 54.36% , 13.47% , 8.47% respectively.Conclusion For early diagnosis, an effective way to screen population older than 40 years is really an effective way to detect patients early and promptly. And comprehensive therapy is conducive to better quality of life and longer survival time of pancreatic Cancer。

U0126 PREVENTS ERK PATHWAY PHOSPHORYLATION AND INTERLEUKIN-1β mRNA PRODUCTION AFTER CEREBRAL ISCHEMIA

Objective To study the role of extracellular signal-regulated kinase (ERK) in cerebral ischemia and the mechanism of protective effects of U0126 (1,4-diamino-2,3-dicyano-1,4-bis[2-aminophenylthio] butadiene) on ischemic brain. Methods Mice underwent left middle cerebral artery occlusion (MCAO) by introducing a suture in the lumen. U0126 was injected intravenously through the internal jugular vein. The immuno-activity of phosphorylated ERK1/2 (pERK1/2), phos-phorylated mitogen activated protein kinase kinase (pMEK), and phosphorylated Elk-1 (pElk-1) was assessed by Western blot analysis and immunohistochemistry. Interleukin (IL)-1βmRNA level was measured by ribonuclease protection assay. Results Phosphorylated ERK1/2 in 2 hours MCAO mice was down-regulated after intravenous injection of U0126. The inhibition was dose dependent and treatment time related. pMEK and pElk-1 were also reduced in a similar fashion after U0126 treatment. IL-1βmRNA increased after 1 and 2 hours of MCAO. After injection of U0126, it was down-regulated during 1 to 4 hours after MCAO. Conclusion Intravenous administration of the MEK inhibitor U0126 inhibits pMEK, pERK1/2, and pElk-1 up-regulation induced by cerebral ischemia. The protective effect of U0126 against ischemic injury is probably resulted from the reduction of IL-1βmRNA via the inhibition of ERK pathway.

Purification and characterization of 33.5 kDa vesicular protein in human bile

AIM: The present study was undertaken to purify and partially characterize the 33.5-kilodalton (33.5 kDa) vesicular protein in human bile and to explore the possible molecular mechanisms of the initial crystal nucleation process.METHODS: The 33.5 kDa vesicular protein was isolated by ultracentrifugation and further purified by sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) under nonreducing conditions. The purified 33.5 kDa vesicular protein was subjected to N-terminal amino acid sequencing and amino acid analysis. Cholesterol crystallization activity was detected by cholesterol crystal growth assay. The sugar chain of the 33.5 kDa vesicular protein was analyzed by dot-immunobinding assay of lectin coupled to a peroxidase (HRP-DSA, HRP-ConA, HRP-WGA) and was deglycosylated using two different enzymatic approaches (N-deglycosylation and O-deglycosylation) to determine the molecular weight of the protein component, the type of linkage between polypeptide and carbohydrate components.RFSULTS: The 33.5 kDa vesicular protein with complicated glycan was an extensively glycosylated (37.3 %) monomer and these sugar chains strongly bound to DSA, but did not bind to ConA. Amino acid sequencing indicated that the protein was unique. The 33.5 kDa vesicular protein exhibited potent cholesterol crystallization promoting activity in vitro with derived crystal growth curve indices It, Ig, Ic presented as 0.57, 1.52, and 1.63 respectively. Both enzymatic proteolysis and N-deglycosylation of the protein removed all activity.CONCLUSION: These data suggest the 33.5 kDa vesicular protein may be responsible for the pathogenesis of cholesterol gallstone disease, and the sugar chains play an important role in pro-nucleating process.

Inhibitory effects of docetaxel on expression of VEGF, bFGF and MMPs of LS174T cell

AIM: To study the effects of non-cytotoxJc concentrations of docetaxel on some important angiogenic factors of LS174T Cells.METHODS: The non-cytotoxic concentration of docetaxel and the activity of gelatinase were determined with MTT and gelatin zymography respectively, the expression of VEGF (vascular endothelial growth factor), bFGF (basic fibroblast growth factor), MMP (matrix metalloproteinase) 2 and MMP 9 was investigated with RT-PCR and Western blot.RESULTS: The maximum non-cytotoxic concentration of docetaxel on LS174T Cells was 1.0 ng/ml. Compared with the solvent control group, 0.1, 0.5, 1.0 ng/ml of docetaxel could downregulate the expression of VEGF, bFGF, MMP 2and MMP 9 and suppress the activity of gelatinase.CONCLUSION: Our study suggests that the non-cytotoxic concentrations of docetaxel have strong antiangiogenic activity on LS174T Cells, which suggests docetaxel may be a promising antiangiogenic agent.

Inhibitory effect of human telomerase antisense oligodeoxyribonucleotides on the growth of gastric cancer cell lines in variant tumor pathological subtype

AIM: To investigate the inhibitory effect of specialized human telomerase antisense oligodeoxyribonucleotides on the growth of well (MKN-28), moderately (SGC-7901)and poorly (MKN-45) differentiated gastric cancer cell lines under specific conditions and its inhibition mechanism,and to observe the correlation between the growth inhibition ratio and the tumor pathologic subtype of gastric cancer cells.METHODS: Telomerase activity in three gastric cancer cell lines of variant tumor pathologic subtype was determined by modified TRAP assay before and after the specialized human telomerase antisense oligodeoxyribonucleotides were dealt with under specific conditions. Effect of antisense oligomer under specific conditions of the growth and viability of gastric cancer cell lines was explored by using trypan blue dye exclusion assay, and cell apoptosis was detected by cell morphology observation, flow cytometry and TUNEL assay.RESULTS: Telomerase activity was detected in well,moderately and poorly differentiated gastric cancer cell lines (the quantification expression of telomerase activity was 43.7TPG, 56.5TPG, 76.7TPG, respectively).Telomerase activity was controlled to 30.2TPG, 36.3TPG and 35.2TPG for MKN-28, SGC-7901 and MKN-45 cell lines respectively after treatment with human telomerase antisense oligomers at the concentration of 5 μmol/L, and was entirely inhibited at 10 μmol/L, against the template region of telomerase RNA component, whereas no inhibition effect was detected in missense oligomers (P＜0.05). After treatment with antisense oligomers at different concentrations under specific conditions for 96 h, significant growth inhibition effects were found in MKN-45 and SGC-7901gastric cancer cell lines (the inhibition ratio was 40.89%and 71.28%), but not in MKN-28 cell lines (15.86%). The ratio of inactive SGC-7901 cells increased according to the prolongation of treatment from 48 to 96 h. Missense oligomers could not lead to the same effect (P＜0.05).Apoptosis of SGC-7901 and MKN-45 cells was detected not only by morphology and TUNEL assay but also by flow cytometry. The apoptotic rate reached 33.56% for SGC-7901 cells and 44.75% for MKN-45 cells.CONCLUSION: The viability and proliferation of gastric cancer cells can be inhibited by antisense telomerase oligomers. The growth inhibition of gastric cancer cells is correlated with concentration, time and sequence specialty of antisense oligomers. The inhibition mechanism of antisense human telomerase oligomers depends not only on the sequence specialty but also on the biological characteristics of gastric cancer cell lines.

Cloning and characterization of a mouse liver-specific gene mfrep-1,up-regulated in liver regeneration

Human fibrinogen-related protein-1/liver fibrinogen-related protein-1 (HFREP-l/LFIRE-1), a liver-specific protein, is a member of fibrinogen superfamily that exerts various biological activities. However, the function of HFREP-l/LFIRE-1 in liver remains unknown. Here we isolated its mouse ortholog gene-mouse fibrinogen-related protein-1 (mfrep-1), which encoded 314 amino acids, exhibiting 80.4% similarity to HFREP-l/LFIRE-1. Northern blot analysis revealed that 1.2-kb mfrep-1 mRNA was detected selectively in mouse liver. To explore the function of MFREP-1, we examined the levels of mfrep-1 mRNA during regeneration after 70% partial hepatectomy (PHx) in mice, mfrep-1 mRNA increased in the regenerating liver and reached the first shoulder peak at 2-4 h after PHx. Cycloheximide pretreatment could suppress the induction of mfrep-1, indicating the up-regulation of this gene need de novo protein synthesis. Its mRNA continued to elevate at 6 h thereafter and reached the second peak at 24 h. The enhanced expression of mfrep-1 maintained high until 72 h and then declined slowly to the basal level. Immunohistochemistry assessment confirmed the up-regulated expression of MFREP-1 protein in parenchymal cells during liver regeneration. These data suggested that MFREP-1 might play an important role in liver regeneration and be involved in the regulation of cell growth.

The Characteristics of Gastrin Receptor Expression in Gastric Cancer

Objective: To investigate the characteristics and significance of gastrin receptor (GR) expression in gastric cancer. Methods: The content and affinity of GR were determined in 34 specimens of gastric cancer using radioligand binding assay. The correlation was analyzed between GR expression in tumors and tumor sites, stages, grades, DNA of gastric cancer cells, GR of adjacent normal gastric mucosa, survival time. Results: Among the 34 cases of gastric cancer, 16 patients (47.1%) had positive GR in specimens of gastric cancer, with high-affinity GR in 14 cases (41.2%) and low-affinity GR in 2 cases. Of high-affinity GR, 9 cases had cancers with GR>10 fmol/mg.protein (39.5±14.4 fmol/mg.protein), 5 cases with GR≤10fmol/mg.protein (6.0±2.8 fmol/mg.protein). High-affinity GR was easier to be expressed in cancers ofgastric body (7/9) and cardia (3/6) than in gastric antrum (4/19). The expression of GR in gastric cancer accorded well with that in normal gastric mucosa at the same sites, but with more high-special binding sites than the latter (39.5±14.4 vs 26.1±16.6 fmol/mg.protein). A significantly greater proportion of patients withⅢ+Ⅳ stages (13/24) had high-affinity GR compared with I+II stages (1/10) of gastric cancers. During a follow-up of 23-61 months, 11 of 13 cases with high-affinity GR were dead, whereas 4 of 11 cases with low-affinity or negative GR were dead in Ⅲ+Ⅳ stages of gastric cancer. Conclusion: GR is an important factor in the autocrine growth of gastric cancer cells, and helpful in the prediction of prognosis and guidance of treatment with GR antagonists.

Establishment of a new pig model for auxiliary partial orthotopic liver transplantation

AIM: To establish a new pig model for auxiliary partial orthotopic liver transplantation (APOLT).METHODS: The liver of the donor was removed from its body. The left lobe of the liver was resected in vivo and the right lobe was used as a graft. After the left lateral lobe of the recipient was resected, end-to-side anastomoses of suprahepatic inferior vena cava and portal vein were performed between the donor and recipient livers,respectively. End-to-end anastomoses were made between hepatic artery of graft and splenic artery of the host.Outside drainage was placed in donor common bile duct.RESULTS: Models of APOLT were established in 5 pigs with a success rate of 80%. Color ultrasound examination showed an increase of blood flow of graft on 5th d compared to the first day after operation. When animals were killed on the 5th d after operation, thrombosis of hepatic vein (HV) and portal vein (PV) were not found. Histopathological examination of liver samples revealed evidence of damage with mild steatosis and sporadic necrotic hepatocytes and focal hepatic lobules structure disorganized in graft. Infiltration of inflammatory cells was mild in portal or central vein area. Hematologic laboratory values and blood chemical findings revealed that compared with group A (before transplantation), mean arterial pressure (MAP), central venous pressure (CVP), buffer base (BB), standard bicarbonate (SB) and K+ in group B (after portal vein was clamped) decreased (P＜0.01). After reperfusion of the graft, MAP, CVP and K+ restored gradually.CONCLUSION: Significant decrease of congestion in portal vein and shortened blocking time were obtained because of the application of in vitro veno-venous bypass during complete vascular clamping. This new procedure,with such advantages as simple vessel processing, quality anastomosis, less postoperative hemorrhage and higher success rate, effectively prevents ischemia reperfusion injury of the host liver and deserves to be spread.

Regional cerebral metabolic changes after acupuncture by FDG PET: effects and methodology

In order to investigate the therapeutic mechanisms of acupuncture points in cerebrovascular ischemic patients and normal volunteers, FDG PET was adopted. Changes in cerebral glucose metabolism and cerebral functional activity before and after electro-acupuncture treatment were studied in 12 normal volunteers and 11 cerebrovascular ischemic patients. The PET imaging was read by visual interpretation and calculated by semi-quantitative analysis. After acupuncture, cerebral glucose metabolism of the normal group is higher in the frontal lobe, temporal lobe, thalamus bilaterally and cerebellum contralaterally. The cerebrovascular ischemic patients had manifested greater response in their lesions than in their normal regions of the two tested groups, as well as than in their normal regions of the whole brain, after acupuncture treatment. The study shows that the regulatory effects of acupuncture on the central nervous system influence the brain at multiple-sections, multiple-directions and multiple-levels of brain function. Itconforms to the holistic and bi-directions regulatory laws of acupuncture.

Preparation, characterization and radiolabelling of antigranulocyte monoclonal antibody

The human granulocytes were isolated.Using hybridoma techniques,a hybridoma cell line (HSN) producing monoclonal antibody(McAb) against human granulocyte was obtained.The antibody belonged to IgG1 subclass.It was confirmed by immunohistochemical tests that HSN reacted selectively not only with human granulocytes.but also with their bone marrow precursors.Whereas human lymphocytes and red blood cells retained negative in the tests.No cross-reaction was observed with the peripheral blood cells in other animals.Its affinity constant was 5.7×10^8 L/mol,and the number of epitopes per granulocyte was 4.7×10^5.Monoclonal antibody displayed no loss of immunoreactivty after labelled with ^99mTc.

Large Pancreatic Cancer in the Elderly Surgery for Large Pancreatic Cancer in Old Patients（老年患者的大胰癌外科治疗）

目的 探讨老年患者胰腺癌接受胰十二指肠切除术，以期明确手术成功的相关因素。方法 本研究包括74例大胰癌患者。35例年龄大于70岁，30例为标准胰十二指肠切除术和5例为区域性胰十二指肠切除术，其中15例按“三步法”予以切除。这组患者的结果与另外39例非老年患者作比较。结果 老年患者的30天手术死亡率与并发症率分别为5．9％和26．4％；而在非老年患者中分别为5．2％和18．4％。危险因素、并发症率和死亡率差别有统计学意义。老年患者和非老年患者的5年生存率分别为11．7％和15．7％，无显著性差异。结论 本研究表明老年患者可安全接受根治性胰十二指肠切除术，而长期效果与非老年患者相似。减黄可改善肝、肾功能，增加患者对手术的耐受。术前介入化疗可在肿瘤与门静脉间产生“炎性水帘”，从而减少门静脉切除率。Objective To elucidate contributing factors that lead to successful management of large pancreatic cancer in geriatric patients.Methods The study involved 74 patients with larger pancreatic malignancy. Risks and benefits of pancreaticoduodenectomy at an advanced age were analyzed retrospectively in 35 patients older than 70 years of age. Of them, 15 elderly patients were radically resected by "3 steps procedure". Conventional and regional pancreaticoduodenectomy was performed in 30 and 5 patients, respec-tively. The results achieved in these patients were compared with those observed in 39 younger patients.Results The 30-day morality and morbidity rates for the elderly patients with large pancreatic cancer were 5.9% and 26.4% respectively; while for the younger patients, they were 5.2% and 18.4% respectively. A statistically significant correlation was observed between the presence of risk factors, the occurrence of complications, and the mortality rate. No difference was found between the two age groups when the risk factors were absent. The 5-year survival rate in the elderly patients and the younger patients was 11.7% and 15.7% respectively, with the difference being not significant.Conclusion Curative pancreaticoduedenectomy can be carried out safely in older patients, with long-term results comparable tothose achieved in the younger patients. The preoperative interventional chemotherapy can provide an inflammatory edema wall between the tumor and portal vein, so as to decrease the portal vein resection rates.

Extracorporeal regulation effect of cytokines combination on stem cell or progenitor of umbilical blood

AIM:To study the regulation effect of different cytokines combinations on stem cell or progenitor of umbilical blood when no blood serum and matrix exist. METHODS: Collect and analyze the 23 sample of umbilical blood. RESULTS:(1) The combination of SCF+Flk2/Flt3 ligand and(FL)±TPO can amplify CD34,+,CD34+Thy 1+,CD34+CD33+and LTC IC in umbilical blood effectively and rapidly.(2) After add solubility type (sIL 6R)of IL 6 and IL 6 receptor into this combination, the stem cell or progenitor proliferated prominently;When add IL 6 alone(without sIL 6R), the content of CD34+cells and LTC IC didn’t increased obviously in early stage, but the amplification of CFU Mix and BFU E was not prominent as CFU GM. (3)Detect apoptosis rate of cells by FITC Annexin Ⅴlabeled by membranous change in early stage of cellular apoptosis. After add Flt3L and /or IL 6+sIL 6R, the Annexin Ⅴpositive cells decreased from 15.2%～19.1%to 2.8%～3.5%. CONCLUSION: In suspending system composed with SCF+TPO+Flt3L+IL 6+sIL 6R without matrix and blood serum, the umbilical blood can not only produce large amount of committed progenitor but also keep certain quantitive hematopoietic cells of early stage.

Cutaneous lesions and visceral involvement of tuberous sclerosis

Tuberous sclerosis (TS) is an autosomal dominant disorder with a significantrange of clinical expressions. The involvement of vital organs, such as the brain, kidney, heart andlung is the main cause of death in patients with TS. The aim of this study is to summarize thecharateristic cutaneous features and common extracutaneous involvement of TS, which are helpful tothe early detection of visceral involvement. The analyzed clinical data from 78 patients with TSincluded those from detailed history, physical and dermatological examination, cranial computedtomography ( CT) and magnetic resonance imaging ( MRI) , abdominal ultrasonography, chestroentgenography, hand and foot X-ray and ophthalmologic examination. The skin, brain and kidney wereinvolved frequently in TS patients. Hypomelanotic macules were the most common and earliestcutaneous lesions. Their number was more than 3 in 81. 5% of'the patients. They were followed byfacial angiofibromas and Shangreen' s patch in a decreasing frequency. Forehead plaque, facialangiofibromas and Shagreen's patch appeared in patients at mean age of 2. 6, 6. 0 and 8. 1 yearsrespectively. Cranial CT showed a high positive rate in TS patients . Cutaneous features of TS arehelpful in the early diagnosis of the disease. Hypomelanotic macules are especially important forpatients with epilepsy or babies whose number of hypomelanotic malues is more than 3. Cranial CT isof great value in the diagnosis of TS. The involvement of visceral organs such as the brain andkidney should be examined in TS patients.

Primary cutaneous aspergillosis due to Aspergillus flavus: a case report

Infections caused by opportunistic organisms which have been known asetiologic agents of disease become more and more frequent. Aspergillus spp. is one of the agents.Fungi of aspergillus genus are widely distributed in nature, particularly in the soil and in thedecomposed vegetation. They are frequent opportunist pathogens in immunocompromised patients. Themost frequent causative organisms that cause cutaneous aspergillosis are A. fumigatus and A. flavus.In this report, we present a case of primary cutaneous aspergillosis manifested by ulceration ofthe shank due to A. flavus. The patient had no deficiency of immunological status and severe diseaseassociated with fungal infection. Excellent response was shown to anti-fungal therapy.

ENTRAPMENT OF POSTERIOR INTEROSSEOUS NERVE OF FOREARM REPORT OF 25 CASES

Of the 25 cases of entrapment, or compression syndrome of the posterior interosseous nerve of the forearm reported, 23 were treated surgically. The compressing or entrapping factors found during the operatious consisted of 14 sites in tendinous tissues, 12 in vessels, 6 in scar adhesions, and 3 unclear. Of 11 cases each had 2 or more compression sites. 19 patients underwent local decompression. And 4 cases had membranous and degenerated nerves resection and end-to-end anastomoses. Hypertrophy and inflammation appeared to be the main pathological changes in 10 cases. The causes and pathology are discussed and the early diagnosis and treatment emphasized.

AN EXTENSIVE SUBFRONTAL APPROACH TO THE LESIONS INVOLVING THE SKULL BASE

A modification of the transbasal approach of Dorome called extensive subfrontal approach and the surgical results with this approach in 22 cases are presented. Bilateral frontal craniotomies incorporated with the removal of orbital ridges and part of the orbital roofs were fashioned en bloc. It may give rise to good exposure of the midline lesions of the anterior, middle and posterior skull base, minimizing the need for the retraction of frontal lobes. There was no surgical mortality in this series of cases. Of the 20 cases with tumors, total resections were achieved in 11 cases, subtotal or large resections in 4 cases and partial resection in one case. Two patients with spontaneous rhinorrhea were successively treated surgically, 21 patients had a follow-up with a time ranging from 1-11 years (a mean of 3 years). 15 patients resumed their jobs with no evidence of recurrence of the original disease, and 5 patients able to live self-care. One patient with an olfactory neuroblastoma died 3 years after the operation owing to relapse of the tumor.