Objective:To summarize diagnosis and treatment of hashimoto's disease(HD) complicated with thyroid adenomas(TA) in 107 patients.Methods:Clinical data of 107 patients of HD complicated with TA were analysed retrospectively.Results:Complete serum immunologic examinations,B ultrasonography and fine needle aspiration biopsy were helpful for the diagnosis of HD with TA.Thirty-eight patients(35.5%) were diagnosed before operation.Misdiagnosis rate was 64.5%(69/107).Intraoperative frozen section diagnosis rate was 81.3%(87/107).Partial,large and total resection of thyroid gland can be selected according to frozen section and local disease focus.Afteroperation,87patients(81.3%)hada goodrecovery.Threepatients with total thyroid gland resection need thyroxin tablet.Thyroid hypofunction did not happented in 104 patients.Conclusions:HD with TA should be treated surgically.Intraoperation frozen section is helpful for selecting operationmethods.

Objective To analyze 137 cases of clinical invasive fungal infection (IFI), and to sum up clinical experiences in the treatment of early anti-fungal. Methods 137 patients with 91 males and 46 females, who suffered from invasive fungal infection in ICU from January 1, 2000 to June 30, 2006, were enrolled in this study. The age ranged from 17 to 82 years. Among 137 patients with IFI, the respective incidence of infection of Candida albicans, Candida glabirate, Candida tropicalis and Candida parapsilosis was 47.4%, 26.3%, 20.4% and 3.6%. The sputum, urine, blood and other excreta were collected for examination three days after admission and then every three days. Results Out of the 137 patients, 42 patients were complicated with hemorrhage (30.7%), 53 patients developed candida rash in the chest, abdomen and extremity (38.7%), and 49 patients developed organ dysfunction (35.8%). The chest films revealed that infiltration caused by IFI mainly occurred in the apex of lung in some patients. 137 patients were treated with fluconazole at first, and among them, 64 patients were cured. The cure rate was 46.7%. 39 patients out of 61 patients treated with Amphotericin B(AmB) or lipid AmB were cured. The cure rate was 63.9%. 11 patients were treated with voriconazole and 6 patients were cured. The cure rate was 54.5%. 28 patients failed to respond to the above therapy and died.The mortality was 20.4%. Conclusion The clinical symptons of IFI included hemorrhage, candida rash, organ dysfunction, and infiltration in apex of lung. Fluconazole and amphotericin B(AmB) or lipid AmB still have a good curative effect on invasive fungal infection.

Objective:To summarize experience of diagnosis and surgical treatment of tuberculosis in ileocecal junction.Methods:Clinical data of 74 cases of tuberculosis in ileocecal junction were analysed retrospectively.Results:Clinical manifestations consisted of chronic abdominal pain(87.8%),right lower abdominal mass(95.9%),low fever、emaciation and anemia(36.5%),alternation of constipation and diarrhea(39.2%).Diagnosis rate of barium enema was 63.8%,colonoscopy and biopsy was 100%.Diagnosis rate before operation was 68.9%(51/74).In 74 cases,53 cases performed right hemicolectomy,15 cases performed anastomosis of end of ileum and transverse colon,6 cases performed building fistula of end of ileum.Conclusion:Tuberculosis in ileocecal junction should be diagnosed early and be identified with cancer of ileoceum.Good prognosis depend on positive surgical treatment and systematic medicine treatment.

Objective To explore the etiology,diagnosis and treatment of omohyoid muscle syndrome(OMS).Method Clinical data of 34 OMS cases was analyzed retrospectively from 1980 to 2008.In the autopsy of 19 bodies we studied omohyoid muscle,especially the intermediate tendons,sheaths of tendon and projection of omohyoid muscles.Result The symptom of omohyoid muscle syndrome lies in a mass that can be seen on the neek while swallowing,and the patient feels discomfort and dysphagia.The mass disappears immediately after swallowing and cann't be found by palpation.Congenital fascia weakness,intermediate tendon sheath relaxation,atrophy,degeneration and contracture of omohuoid muscle causes OMS.OMS was diagnosed on clinical manifestation.All 34 patients were treated surgically including cutting off the cross part of omohyoid muscle and sternocleidomastoid muscle,separating adhesion of muscle and fascia.Postoperatively symptoms disappeared in all these 34 patients.Conclusions Omohyoid muscle syndrome is a disease that can be easily diagnosed basing on characteristic clinical symptom and sign,the prognosis is good if treated properly by an operation.

Objective To improve the diagnosis and treatment of sliding hernia of adult urinary bladder. Methods Clinical data of 32 cases of adult sliding hernia of the bladder from 1984 to 2009 were analyzed retrospectively. Discomfort was complained in all the 32 patients along with palpable mass. Twentynine cases suffered from urgency of micturition, ascheturesis and dysuria, 15 cases had interruption of urination. The mass was saddle-shaped in 29 cases, when the bladder was filling. In all the 32 cases of hernia block were in a sense of fluctuations and flat on percussion. In 26 cases the bladder appeared a dumbbell-shaped image on cystography. By B-ultrasonic examination an opaque dark area of fluid was detected in 29 cases when there was retention of urine. Results Preoperatively 29 cases were diagnosed of bladder sliding hernia, 3 cases with misdiagnosis ( misdiagnosis rate of 9.4% ). 32 cases were cured by surgical treatment. The prolapsed portion of the bladder including stones in 2 cases were resected. 32 cases were followed up from 1 to 5 years without recurrence. Conclusions Once the sliding hernia of the bladder is diagnosed, patient should receive surgery. Intraoperatively the key of preventing inadvertent cut or missed diagnosis is familiar with pathological anatomy and careful exploration.

Objective:To summarize diagnosis and surgical treatment of syndrome of splenic flexure of colon(SSFC) .Methods:The clinical data of SSFC in 81 patients between Jan,1987 and Dec,2008 were analysed retrospectively.Results:The main clinical manifestations were repeated abdominal pain,abdominal distension,constipation and chronic incomplete colon obstruction.X-ray barium enema showed that splenic flexure of colon was 7 cm higher than hepatic flexure of colon.The angle of splenic flexure of colon was less than 45 ?.Two patients underwent release of splenic flexure of colon and 3 patients accepted side-to-side anastomosis of splenic flexure of colon which were suitable to old,weak and emergent patients.The effects of these methods were well shorthy after operation,but not in long term(6 months to 2 years) .As to the rest 76 patients,thorough operation were done:subtotal resection of proximal segment colon(14 patients) ,subtotal resection of colon(20 patients) and total resection of colon(42 patients) .Conclusion:The diagnosis of SSFC is depended on clinical manifestations and barium enema.Thorough surgical treatment is the best method including proximal part resection,subtotal resection and total resection of colon.

ObjectiveTo study the effects of small-dose glucocorticoid (GC) on glucocorticoid receptor (GR) and cellular immune function in critical patients.MethodsForty ICU critical patients admitted in Shanghai Changzheng Hospital from March 2007 to March 2009 were enrolled in the study and were divided into GC group and non-GC group according to the use or absence of GC.Blood samples were collected at days 1,7 and 10 after GC treatment to detect GR binding affinity of mononuclear leukocytes (MNLs) and polymorphonuclear leukocytes (PMLs) in the peripheral blood and the CD4/CD8 ratio in the T lymphocytes.The method of GC use was that the hydrocortisone was given intravenously at a dose of 100 mg every eight hours.ResultsGR binding capacity of MNLs at day 1 and 7 showed no statistical difference between the GC and non-GC groups.GR binding capacity of MNLs in the GC group was lower at day 1 and was much lower at day 7 (P ＜ 0.05 ).However,in the non-GC group,it was lower at day 1,but showed significant improvement at day 7 ( P ＜ 0.05 ).The change of GR binding capacity of PMLs was similar to that of MNLs.There was no significant difference of CD4/CD8 ratio between the GC and non-GC group at day 1.The ratio of CD4/CD8 in the non-GC group was significantly higher than that in the GC group at day 10 (P ＜0.05).CD4/CD8 ratio in the GC group showed a slight reduction at day 10,with no significant difference from that at day 1.While,the non-GC group showed a significant increase of CD4/CD8 ratio at day 10 as compared with that at day 1 (P ＜ 0.05 ).ConclusionLow-dose GC plays some role in the negative feedback regulation of GR binding capacity of peripheral blood leukocytes and in the inhibition of cellular immune function.

Colon cancer is a common malignant tumor. Early diagnosis and treatment is one of the most important clinical challenges. Since MicroRNA is discovered to closely relate to cancer, it has been suggested to be used in the diagnosis and treatment of cancer. This review focuses on recent advances in the diagnosis and treatment of MicroRNA in colon cancer and the role of MicroRNA in Wnt signaling pathways and epidermal growth factor receptor (EGFR) signaling pathways.

Objective To summarize the diagnosis and surgical treatment of hepatic focal nodular hyperplasia (FNH). Methods The clinical data of 63 patients with FNH proved by pathology were analyzed retrospectively. Results The disease mainly affected young to middle aged, 50 cases (79. 4% )were of 31-50 years old. Male and female ratio was 2.94: 1. Fifty-six patients (89%) were asymptomatic, 3 cases were HBsAg positive (4.8%). Liver function was basically normal (92. 1%),5 cases (7.9%) were with elevated level of total bilirubin and rGT. AFP, CEA and CA19-9 was all negative. FNH occured as a single node in 95.2% cases, ranging from 1.5 cm to 17 cm in diameter ( average 4. 5 cm). Of these patients, 25 lesions were present in the left lobe, 29 in the right lobe, 6 in the mid lobe, and 3 in the caudate lobe. A big central artery was found in 2 cases (3. 2% ) as found by color Doppler ultrasound. CT scan showed transient immediate enhancement in 96. 8% (61/63) of patients, with central scar in 6 cases. MRI demonstrated early vigorous enhancement in 93. 7% (59/63) of patients, with central scar in 5 cases. All patients underwent surgical resection; including local resection in 34 cases;segmentectomy or hepatectomy in 13 cases; hemihepatectomy in 13 cases. There was no postoperative mortality and major complications. Conclusions FNH is a kind of hepatic benign disease and characteristic of high preoperative misdiagnosis rate (25. 4% ).

Objective To explore the diagnosis and treatment of cystic dilatation of the cystic duct in adults.Method Clinical data of 25 cases of the cystic dilatation of cystic duct in adults in 3 hospitals in Songhuajiang river drainage area from 1991 to 2012 confirmed by surgery were analyzed retrospectively.Results The 25 cases were with manifestations of chronic cholecystitis,and 14 patients with right upper quadrant recurrent biliary colic and nausea,vomiting and other gastrointestinal symptoms,9 patients with yellowish discoloration of sclera and skin,and fever.Ultrasonography was done in 25 cases,ERCP in 16 cases and MRCP in 9 cases,displaying liquid dark area of diameter from 1.6 cm × 1.6 cm to 2.5 cm ×2.5 cm in the gallbladder tube suspective of calculi,and characteristic dumbbell shape image.Preoperative diagnosis was cystic duct cyst with stones or gallstones which was confirmed by surgery.Gallbladder and cyst resection was performed in all 25 cases,and bile duct jejunum Roux-en-Y anastomosis was done in 2 of these cases because of introgenic bile duct injury.Conclusions Cysts of the cystic duct is the special type (Ⅵ type) of choledochocele,and its prognosis is good after surgical treatment.