胃肠道间质瘤合并其他肿瘤临床病理分析

目的探讨胃肠道间质瘤合并其他肿瘤的临床病理特点。方法回顾性分析滨州医学院附属医院自2009年-2017年收治的胃肠道间质瘤合并其他胃肠道恶性肿瘤病例32例,分析其合并其他肿瘤的部位、间质瘤的大小等临床病理特征。结果合并其他消化系统肿瘤的胃肠道间质瘤发生部位最常见为胃部24例,胃肠道间质瘤大小均值2.4cm,合并发生的消化系统恶性肿瘤最常见部位为胃部,合并胃癌19例,两者同时累及胃12例。组织学类型中以腺癌为主,其次为鳞状细胞癌。结论合并其他肿瘤的胃肠道间质瘤无特异性临床特征,病理无特异性免疫组化标志。     

Equine gastrointestinal motility--ileus and pharmacological modification

Colic is a common problem encountered in equine practice. Alteration of gastrointestinal motility is often the underlying cause for abdominal pain. Gastrointestinal motility can be measured as myoelectric activity, mechanical activity, and transit of intraluminal contents. Regulation of motility is based on a complex interaction between central innervation, autonomic innervation, and the enteric nervous system. Various humoral and neurochemical substances are required to interact flawlessly to allow propulsive motility. Ileus is defined as the absence of propulsive aboral movement of gastrointestinal contents, irrespective of its pathophysiology. Potential etiologies for ileus are described in this review. The prokinetic drugs available for clinical use are discussed. Choosing the appropriate prokinetic drug requires knowledge about the complex nature of gastrointestinal motility and its abnormalities.     

Upper gastrointestinal endoscopy

Upper GI endoscopy is a frequently performed endoscopic procedure that is particularly suited for the diagnosis of upper GI diseases with a luminal or mucosal location. Contraindications are few and complications are rare. Procedures that can be performed during upper GI endoscopy include mucosal biopsy, brush cytology, aspiration of duodenal fluid for culture and cytology, foreign body retrieval, bougienage of strictures, and endoscopic placement of gastrostomy tubes. Unresolved issues that face veterinary endoscopists include the interrelationship between contrast radiology and endoscopy, the advisability of routine combination of upper and lower GI endoscopy, the reasons for discordance among clinical signs, endoscopic appearance, and biopsy findings, and the role of post-treatment biopsies.     

Prevention and treatment of gastrointestinal adhesions.

As with many aspects of clinical medicine, there is yet to be a single or definitive cure for postoperative adhesion formation. Current methods of prevention target risk factors predisposing horses to adhesion formation. Systemic pharmacologic therapies, such as antimicrobials, nonsteroidal anti-inflammatory drugs, Salmonella antiserum, and hyperimmune plasma, help to reduce abdominal inflammation and minimize the effects of endotoxemia. Intra-abdominal or systemic heparin aids in enhancing peritoneal fibrinolysis. Prokinetic therapy promotes early postoperative return of intestinal motility, minimizing the propensity for adhesion formation between apposing adynamic segments of intestine. Mechanical separation of potentially adhesiogenic serosal and peritoneal surfaces is commonly achieved with use of abdominal lavage, protective coating solutions, and barrier membranes. Ongoing and future research is directed toward a better understanding of the local effects of intestinal trauma and the corresponding response of the fibrinolytic system. Recognition of horses at high risk for adhesion formation helps to guide the equine surgeon to an appropriate perioperative and intraoperative plan for adhesion prevention, including good surgical technique and a combination of adjunct therapies.     

Dietary and nutritional management of gastrointestinal diseases

The value of proper diet in the management of the gastrointestinal patient has been demonstrated. As experience and knowledge increase, diets will become more refined to address specific diet-related abnormalities. There is an increasing awareness in veterinary medicine, and justifiably so, of the benefit of nutritional support, administered enterally or parenterally. Aggressive, early, and adequate nutritional support may be the most important factor responsible for a successful response to other aspects of therapy and recovery, and has to represent an improvement in veterinary medicine.     

Complementary and alternative veterinary medicine and gastrointestinal disease

Gastrointestinal, hepatic, and pancreatic diseases provide a significant challenge to the veterinary practitioner. Specific causes and effective therapies can be elusive and sometimes frustrate both the animal caretaker and the veterinarian. The therapeutic options of a conventional veterinary practice are frequently limited and may come down to a decision of which is worse: the disease or the side effects of the treatment. This article provides information for the veterinary practitioner to consider for expanding his/her options. Acupuncture, herbal remedies, and homeopathy are not newly discovered modalities. They are old practices that are getting a fresh look from Western medicine as we seek new ways to better serve our patients and clients. The goal of this article is to provide the reader with many ideas and sufficient solid information to consider the use of these options. Specific therapies are suggested for numerous gastrointestinal and liver problems. Many of these may be used in conjunction with conventional therapies to aid in the healing process.     

Feline gastrointestinal lymphoma.

Gastrointestinal lymphoma is a common cause of anorexia and weight loss in older cats, with or without vomiting or diarrhea. Most cats are feline leukemia virus-negative and feline immunodeficiency virus-negative. Low-grade gastrointestinal lymphoma may be more common than previously thought, and these cats respond better to chemotherapy agents than cats with high-grade lymphoma. The most significant prognostic indicator is initial response to chemotherapy, with cats that survive the initial induction period generally achieving long-term remission. Thus far, investigations into molecular markers and immunophenotyping have failed to identify useful prognostic indicators.     

Maintenance of gastrointestinal endoscopes

Endoscopes are used for visualization and biopsy of gastrointestinal lesions, as well as therapeutic procedures, such as foreign body retrieval. In the past, they were primarily used in large institutional settings where specialized personnel could focus on their maintenance. Today, they are becoming increasingly common in general practice. The maintenance of gastrointestinal endoscopes in the veterinary setting involves many challenges, including safe handling, reprocessing, and storage. Meeting these challenges requires well-trained personnel and strict protocols. Reprocessing, which includes cleaning and disinfection, offers the greatest challenge. The complex structure of flexible endoscopes, particularly the long, narrow channels, makes them difficult to clean. Gastrointestinal endoscopes operate in a contaminated environment, exposing them to high levels of organic matter and bacteria. High-level disinfection is necessary for infection control, but liquid germicides available for endoscope disinfection can be toxic to medical personnel and patients.     

Rabbit gastrointestinal physiology.

The rabbit's gastrointestinal physiology is a complex system that centers around the separation of digestible and indigestible components of the diet in the proximal colon. The clinical importance of this system is the need for a consistent diet high in long particle length (> 0.5 mm) indigestible fiber to maintain the motility of the cecum and colon. Most of the common gastrointestinal problems seen in captive rabbits are related to inappropriate diets (low fiber; high protein; high carbohydrate) and infrequent feeding of treats to which the rabbit is not accustomed. Many of these problems can be avoided if captive rabbits are fed a diet consisting primarily of fibrous vegetation, such as grass, hay, and fibrous weeds. Feeding of fruits, grains, and carbohydrate or fat-based treats should be avoided. Pelleted feeds, although convenient, should be kept to a minimum, and where pellets are used those manufactured by an extrusion process, which retains the long particle length of the indigestible fiber, should be chosen.     

Gastrointestinal motility disorders and gastrointestinal prokinetic therapy.

Gastrointestinal motility disorders represent a diagnostic and therapeutic challenge. Disorders of gastrointestinal motility may result in accelerated transit, delayed transit, impaired relaxation, or inappropriate relaxation. The delayed transit disorders are the most important motility disorders of companion animals and may involve the esophagus (hypomotility and megaesophagus), stomach (delayed gastric emptying), small intestine (postoperative ileus and intestinal pseudo-obstruction), or colon (constipation and megacolon).     

Treatment of acute and chronic gastrointestinal inflammation.

Treating inflammation in the equine gastrointestinal tract remains a challenge. Our most potent anti-inflammatory drugs, COX inhibitors and glucocorticoids, have unwanted effects on the gastrointestinal tract and host defense that often limit their use. Newer strategies targeting specific cells and molecules that regulate a subset of the events occurring during inflammation are rapidly becoming available and should allow clinicians to reduce the detrimental effects of inflammation without inhibiting the beneficial aspects.