Gastrointestinal neuroendocrine tumors (GI-NETs) are rare neoplasms, like all NETs. However, the incidence of GI-NETS has been increasing in recent years. Gastric NETs (G-NETs) and duodenal NETs (D-NETs) are the commo...Gastrointestinal neuroendocrine tumors (GI-NETs) are rare neoplasms, like all NETs. However, the incidence of GI-NETS has been increasing in recent years. Gastric NETs (G-NETs) and duodenal NETs (D-NETs) are the common types of upper GI-NETs based on tumor location. G-NETs are classified into three distinct subgroups: type I, II, and III. Type I G-NETs, which are the most common subtype (70%-80% of all G-NETs), are associated with chronic atrophic gastritis, including autoimmune gastritis and Helicobacter pylori associated atrophic gastritis. Type II G-NETs (5%-6%) are associated with multiple endocrine neoplasia type 1 and Zollinger-Ellison syndrome (MEN1-ZES). Both type I and II G-NETs are related to hypergastrinemia, are small in size, occur in multiple numbers, and are generally benign. In contrast, type III G-NETs (10%-15%) are not associated with hypergastrinemia, are large-sized single tumors, and are usually malignant. Therefore, surgical resection and chemotherapy are generally necessary for type III G-NETs, while endoscopic resection and follow-up, which are acceptable for the treatment of most type I and II G-NETs, are only acceptable for small and well differentiated type III G-NETs. D-NETs include gastrinomas (50%-60%), somatostatin-producing tumors (15%), nonfunctional serotonin-containing tumors (20%), poorly differentiated neuroendocrine carcinomas (< 3%), and gangliocytic paragangliomas (< 2%). Most D-NETs are located in the first or second part of the duodenum, with 20% occurring in the periampullary region. Therapy for D-NETs is based on tumor size, location, histological grade, stage, and tumor type. While endoscopic resection may be considered for small nonfunctional D-NETs (G1) located in the higher papilla region, surgical resection is necessary for most other D-NETs. However, there is no consensus regarding the ideal treatment of D-NETs.展开更多
Esophageal diverticula are rare conditions that cause esophageal symptoms,such as dysphagia,regurgitation,and chest pain.They are classified according to their location and characteristic pathophysiology into three ty...Esophageal diverticula are rare conditions that cause esophageal symptoms,such as dysphagia,regurgitation,and chest pain.They are classified according to their location and characteristic pathophysiology into three types:epiphrenic diverticulum,Zenker's diverticulum,and Rokitansky diverticulum.The former two disorders take the form of protrusions,and symptomatic cases require interventional treatment.However,the esophageal anatomy presents distinct challenges to surgical resection of the diverticulum,particularly when it is located closer to the oral orifice.Since the condition itself is not malignant,minimally invasive endoscopic approaches have been developed with a focus on alleviation of symptoms.Several types of endoscopic devices and techniques are currently employed,including peroral endoscopic myotomy(POEM).However,the use of minimally invasive endoscopic approaches,like POEM,has allowed the development of new disorder called iatrogenic esophageal diverticula.In this paper,we review the pathophysiology of each type of diverticulum and the current state-of-the-art treatment based on our experience.展开更多
Severe alcoholic hepatitis(AH)has a high mortality,and it is associated with encephalopathy,acute renal failure,sepsis,gastrointestinal bleeding,and endotoxemia.The 28-d mortality remains poor(34%-40%),because no effe...Severe alcoholic hepatitis(AH)has a high mortality,and it is associated with encephalopathy,acute renal failure,sepsis,gastrointestinal bleeding,and endotoxemia.The 28-d mortality remains poor(34%-40%),because no effective treatment has been established.Recently,corticosteroids(CS)have been considered effective for significantly improving the prognosis of those with AH,as it prevents the production of pro-inflammatory cytokines.However,CS are not always appropriate as an initial therapeutic option,such as in cases with an infection or resistance to CS.We describe a patient with severe AH complicated by a severe infection caused by the multidrug resistance bacteria(Pseudomonas aeruginosa),and was successfully treated with granulocytapheresis monotherapy without using CS.The experience of this case will provide understanding of the disease and information treating cases without using CS.展开更多
文摘Gastrointestinal neuroendocrine tumors (GI-NETs) are rare neoplasms, like all NETs. However, the incidence of GI-NETS has been increasing in recent years. Gastric NETs (G-NETs) and duodenal NETs (D-NETs) are the common types of upper GI-NETs based on tumor location. G-NETs are classified into three distinct subgroups: type I, II, and III. Type I G-NETs, which are the most common subtype (70%-80% of all G-NETs), are associated with chronic atrophic gastritis, including autoimmune gastritis and Helicobacter pylori associated atrophic gastritis. Type II G-NETs (5%-6%) are associated with multiple endocrine neoplasia type 1 and Zollinger-Ellison syndrome (MEN1-ZES). Both type I and II G-NETs are related to hypergastrinemia, are small in size, occur in multiple numbers, and are generally benign. In contrast, type III G-NETs (10%-15%) are not associated with hypergastrinemia, are large-sized single tumors, and are usually malignant. Therefore, surgical resection and chemotherapy are generally necessary for type III G-NETs, while endoscopic resection and follow-up, which are acceptable for the treatment of most type I and II G-NETs, are only acceptable for small and well differentiated type III G-NETs. D-NETs include gastrinomas (50%-60%), somatostatin-producing tumors (15%), nonfunctional serotonin-containing tumors (20%), poorly differentiated neuroendocrine carcinomas (< 3%), and gangliocytic paragangliomas (< 2%). Most D-NETs are located in the first or second part of the duodenum, with 20% occurring in the periampullary region. Therapy for D-NETs is based on tumor size, location, histological grade, stage, and tumor type. While endoscopic resection may be considered for small nonfunctional D-NETs (G1) located in the higher papilla region, surgical resection is necessary for most other D-NETs. However, there is no consensus regarding the ideal treatment of D-NETs.
文摘Esophageal diverticula are rare conditions that cause esophageal symptoms,such as dysphagia,regurgitation,and chest pain.They are classified according to their location and characteristic pathophysiology into three types:epiphrenic diverticulum,Zenker's diverticulum,and Rokitansky diverticulum.The former two disorders take the form of protrusions,and symptomatic cases require interventional treatment.However,the esophageal anatomy presents distinct challenges to surgical resection of the diverticulum,particularly when it is located closer to the oral orifice.Since the condition itself is not malignant,minimally invasive endoscopic approaches have been developed with a focus on alleviation of symptoms.Several types of endoscopic devices and techniques are currently employed,including peroral endoscopic myotomy(POEM).However,the use of minimally invasive endoscopic approaches,like POEM,has allowed the development of new disorder called iatrogenic esophageal diverticula.In this paper,we review the pathophysiology of each type of diverticulum and the current state-of-the-art treatment based on our experience.
文摘Severe alcoholic hepatitis(AH)has a high mortality,and it is associated with encephalopathy,acute renal failure,sepsis,gastrointestinal bleeding,and endotoxemia.The 28-d mortality remains poor(34%-40%),because no effective treatment has been established.Recently,corticosteroids(CS)have been considered effective for significantly improving the prognosis of those with AH,as it prevents the production of pro-inflammatory cytokines.However,CS are not always appropriate as an initial therapeutic option,such as in cases with an infection or resistance to CS.We describe a patient with severe AH complicated by a severe infection caused by the multidrug resistance bacteria(Pseudomonas aeruginosa),and was successfully treated with granulocytapheresis monotherapy without using CS.The experience of this case will provide understanding of the disease and information treating cases without using CS.
