Caroli's disease is a rare autosomal recessive hereditary disease. The low mobidity, insufficient awareness of doctor and complex clinical manifestations of the disease are likely to result in misdiagnosis and missed diagnosis.The pathogen, typing, pathology, clinical manifesation and therapy of this disease are discussed to recognise the disease better.

Objective To investigate the selection and efficacy of operative medality for pancreatic transec-tion with major duct injury. Methods The clinical data were retrospectively analyzed in 21 patients with pancreatic disruption. They were treated in our hospital from Jan. 1995 to Feb. 2009. There were 14 males and 7 females in these cases with a mean age of 26 years (range 9-53 years). The trauma causes of them were blunt injuries in 13 and patent injuries in 8 cases. The injury grade (according to American Association for the Surgery of Trauma) distribution for these patients was grade Ⅲin 8 cases, grade Ⅳ in 8 cases, and grade V in 3. The early emergency operation was performed in eighteen within 12 hours, and delayed opera-tion was in three cases. Of these operative medalities, Roux-en-Y distal panereatojejunostomy was in 10 ca-ses, pancreatoduodenectomy was in 3, modified duodenal diverticulizatian was in 2, distal pancreatectomy was in 3, tube installing in major duct and external drainage, and suture of pancreatic section was in 2, su-ture of two broken sides in 1 (Roux-en-Y distal pancreatojejunostomy in second time). Results Twenty patients were cured, and one was died after a procedure of pancreatoduodenectomy. The postoperative pan-creatic fistula happened in 3 cases and recovered well with conservative line of management. Conclusions For improving the outcome of pancreatic transection, the earlier exploratory laparotomy and carrying out concept of "Damage Control Surgery" are critical. The individual operative modality based on the grade should be a-dopted in the surgical procedure.

Objective To investigate the effects of α-lipoic acid on mitochondrial energy metabolism of liver in the rat with obstructive jaundice. Methods Seventy-two male SD rats were randomly divided into groups of sham operation and bile duct-ligation + normal soldium( BDL + NS) and bileduct-ligation + α-lipoic acid( BDL + LA). Malondialdehyde(MDA) , superoxide dismutase(SOD) and ATP, ADP, AMP in rat liver's mitochondrion were examined on days 7,14,21 after operation. Results MDA contents, ADP contents and AMP contents of liver' s mitochondrion were significantly increased at each time point in BDL + NS-group,while SOD contents and ATP contents of liver' s mitochondrion decreased remarkably on the 7th, 14th days; MDA content of liver' s mitochondrion in BDL + LA group was more lower than that in BDL + NS group (P ＜ 0. 01 )on the 21st day; MDA content was further increased in BDL + NS group and in BDL + LA group but there was no difference in their comparisons. On the 7th, 14th days, SOD contents and ATP contents in BDL + LA group were significantly higher than that in BDL + NS group( 7th days,P ＜ 0. 01; 14th days,P ＜ 0.05 ), On the 21 st day SOD contents in BDL + NS group had no difference with that in BDL + LA group (P ＞ 0. 05). Conclusions LA has a protective effect on energy metabolism of liver' s mitochondrion in the initial ,metaphase stage of obstructive jaundice.

Objectives To investigate the expression and differential diagnosis value of Galectin-3 and Cyclin D1 in benign and malignant thyroid mass.Methods The expression of Galectin-3 and Cyclin D1 protein in 31 cases of nodular goiter(group A),65 cases of papillary thyroid carcinoma(PTC,group B) and 10 cases of normal thyroid tissues(group C,the control group)was detected by SP immunohistochemical method.The clinical data were analyzed.Results The expression level of Galectin-3 in group B was 83.03％ (54/65),significantly higher than that in group A(19.35％,6/31) and group C(0％).The difference of group A and group B in terms of the expression level of Galectin-3 protein had statistical significance(x2 =36.360,P ＜0.05).The expression level of Cyclin D1 protein in group B was 72.30％ (47/65),significantly higher than that in group A(12.90％,4/31)and group C(0％).The difference of group A and group B in terms of the expression level of Cyclin D1 protein had statistical significance(x2 =29.740,P ＜ 0.05).The combination detection of the positive expression of Galectin-3 and Cyclin D1 in benign and malignant thyroid mass showed that the difference between group A and group B had statistical significance(P ＜ 0.01).The expression of Galectin-3 and Cyclin D1 was positively correlated in group B(R =0.509,P ＜0.05).The positive expression rate of Cyclin D1 protein was 90％ (18/20) and 64.44％ (29/45)respectively in PTC patients with lymph node metastasis and without lymph node metastasis.The difference had statistical significance (P ＜ 0.05).Conclusions The expression of Galectin-3 and Cyclin D1 is positively correlated in PTC and the expression of the 2 proteins in PTC is higher than that in nodular goiter and normal thyroid tissues,indicating that the 2 proteins can be used as valuable markers for patients with thyroid carcinoma.Combined detection of Cyclin D1 and Galectin-3 protein in thyroid tissues is useful for the diagnosis of thyroid cancer.

Objective To investigate the diagnosis and treatment of rectal carcinoid. Methods Clinical data of 16 patients of rectal carcinoids in our hospital from January 2000 to December 2009 were analyzed retrospectively. Related literatures were reviewed. Results Among the patients included, 11 cases(68.8%)suffered from hypogastralgia, 3 cases(18.8%)bloody stool, 3 cases(18.8%)defecation number increase. All the patients underwent enteroscopy. The average size in diameter of all the tumors was 8.8 mm. 81.3% of the tumors ≤10 mm in diameter. The average distance from tumor to anus was 6.8 cm and 87.5% of the tumors ≤8 cm in distance, Only 25% of all the cases were diagnosed preoperatively, most cases were diagnosed as other diseases and definitely diagnosed by postoperative pathology. 14 cases underwent operation as radical resection of rectal carcinoma, and 2 cases endoscopic removal. There was no operative death and postoperative five-year survival rate is 69.2%. Conclusions Preoperative diagnosis rectal carcinoid is difficult.Misdiagnosis rate is high. The key point of improving diagnosis of this disease is annal digital examination. Enteroscopy and pathology, operation is the first choice to treat rectal carcinoid.

Objective Todiscuss the diagnosis and therapy of the pancreatoblastoma(PB).Methods The data of 2 cases of PB were analyzed retrospectively and related literatures were reviewed.Results Both cases were males,11 years old and 8 years old respectively.The 2 cases both had solid mass located in the tail of the pancreas.Alpha-fetal protein(AFP) was normal in case 1 and 2 903 ng/ml in case 2.The 2 cases underwent resection of the pancreas tail,and the postoperative pathological examination confirmed the diagnosis of PB.Followup of 26 months in case 1 and 10 months in case 2 showed that the survival was good.Conclusions PB is an extremely rare tumor of exocrine pancreas and often occurs in male children.The solid mass located in the pancreas with elevated AFP can be considered as PB.Our experience showed a pancreatic mass with normal AFP can also be PB.Surgery is the best management of PB.

There are three causes of cirrhotic portal hypertension(CPH)complicated by peripher-al blood cytopenia:splenic factors(about 80%),non-splenic factors(about 4%)and comprehensive fac-tors(about 16%).The treatment includes non-surgical treatment and surgical treatment.Mild to moderate peripheral blood cell reduction is suitable for non-surgical treatment.Severe peripheral blood cytopenia is feasible to surgical treatment.Splenic factors are the main cause of peripheral cytopenia in CPH,but not all;The treatment method should be based on the degree of peripheral blood cytopenia.