胃肠道间质瘤诊疗新进展

胃肠道与子宫一样是富于平滑肌的器官，因此，长期以来，胃肠道亦被认为同子宫一样是平滑肌肿瘤的好发部位。这种观点直至上世纪六十年代从未被怀疑过。然而，现在证明，这是医学上的一个历史性错误。当胃肠道间质瘤(gastrointestinal stromal tumors，GIST)的名称提出后，数十年来经过各学科尤其是病理学的不断研究和深入认识，     

胃肠道间质瘤研究进展

胃肠道间质瘤 (gastrointestinalstromaltumors ,GISTs)是一种来源于胃肠道原始间质细胞的缺乏分化或未定向分化的非上皮性肿瘤 ,是消化道独立的一类间叶性肿瘤[1] 。近年来 ,国内外文献中对GISTs的组织发生、临床病理、免疫组化表型及超微结构变化、诊断及鉴别诊断、生物学行为等有较多报道 ,现综述如下 :1　GISTs的组织发生　　关于GISTs的组织学起源 ,目前尚无定论 ,最早认为其为平滑肌源性和神经源性肿瘤 ,后来研究发现它既非平滑肌 ,也非神经源性 ,而是来源于非定向分化的间充质细胞肿瘤。最近Kindblom等[1] 研究发现胃肠道蠕动…     

《2009年NCCN肿瘤学临床实践指南》关于胃肠间质瘤内容解读

<正>胃肠间质瘤(gastrointestinal stromal tumors,GIST)是消化道最常见的间叶组织来源的肿瘤。目前认为,从分子生物学和临床两个方面来说,GIST都是一种特殊类型。许多临床医师对GIST并不熟悉,认识尚停留在"胃肠道平滑肌瘤/肉瘤"水平上,以致临床诊断、治疗方案相当混乱而且无     

胃肠道间质瘤24例临床分析

胃肠道间质瘤（gastrointe stinalstromal tumor，GIST）是消化系统最常见的间质肿瘤。以往GIST被认为是平滑肌瘤、平滑肌肉瘤或雪旺瘤等，近几年其诊断标准才确定，研究和治疗也有一定的进步。收集本院2001年1月-2009年12月手术并经病理证实的GIST患者24例，将其资料总结报道如下。     

胃肠道间质瘤治疗方面的新认识

胃肠道间质瘤(gastrointestinal stromal tumors，GIST)是胃肠道最常见的间叶源性肿瘤。过去，GIST常与胃肠道平滑肌瘤、平滑肌母细胞瘤和平滑肌肉瘤相混淆。近年来，随着对GIST发病机制更为深入的了解，有关GIST的诊断和治疗发生了根本性变化。现已明了，GIST是一种间质细胞肿瘤，其细胞表面表达一个跨膜受体CD117，该受体具有酪氨酸激酶活性，     

胃肠道平滑肌肿瘤36例临床分析

目的　探讨如何鉴别平滑肌肿瘤的性质以及肿瘤病理分型、大小、浸润和转移之间的关系。方法　 1993～ 1999年经我院治疗的胃肠道平滑肌肿瘤 36例 ,对其临床表现、发生部位、肿瘤大小、生长方式、淋巴转移、远处转移、辅助检查、组织学分类和外科治疗等进行分析。随访时间为1～ 5年。结果　平滑肌肿瘤的好发部位是胃 (2 3例 ) ,其次是小肠 (10例 )和食管 (2例 )。在平均 2 5个月的随访中 ,3例死于转移 ,3例有局部复发。结论　肿瘤组织学恶性与局部复发和远处转移明显相关 ,包括 (1)大小 :2cm以上 ,尤其是发生于十二指肠的肿瘤 ;(2 )组织学恶性 ;(3)生长方向 :向浆膜生长的肿瘤易侵犯周围组织 ;(4 )与临床脏器关系 :已侵犯周围组织的肿瘤。     

胃肠道间质瘤外科治疗现状和进展

胃肠间质瘤（castrointestinal stromal tumor,GIST）是胃肠道最常见的间叶源性肿瘤,占胃肠道间叶源性肿瘤的80％,约占小肠肿瘤的20％。过去常被误诊为平滑肌瘤或平滑肌肉瘤,直到最近10年才开始作为一个独立的疾病被认识,受到关注。     

胃肠间质瘤135例临床诊治分析

目的探讨胃肠道平滑肌肿瘤与胃肠间质瘤(GIST)的关系及外科治疗的效果。方法重新调出1993-2003年间收治的资料完整的86例胃肠道平滑肌瘤或平滑肌肉瘤患者的病理组织重新病理复检,结合2000年1月至2005年7月确诊GIST的71例病例资料进行分析。并完成随访。结果86例原诊断胃肠道平滑肌瘤或平滑肌肉瘤的患者共有78例完成免疫组化检测,有64例(82.1%)被纠正诊断为GIST。共计135例GIST患者中,男性65例,女性70例;平均发病年龄53岁。均接受手术治疗,130例(96.3%)为完全切除;术后总体5年生存率为79.7%。完全切除者术后总体生存率与首诊转移、肿瘤大小、核分裂和术后复发转移有关(P<0.01);无病生存率的多因素回归分析中发现,完全切除术后无病生存率与首诊已有转移和核分裂数有关(P<0.01)。结论既往胃肠道平滑肌肿瘤大部分应纠正诊断为GIST。GIST以外科治疗为主。完全切除很重要。首诊肿瘤转移和核分裂数是独立的预后因素。     

θ����������Ϻ�����

胃的非上皮肿瘤中，恶性淋巴瘤最常见，其次是平滑肌肿瘤、神经纤维或神经鞘膜肿瘤、横纹肌肿瘤等。随着病理学研究的深入，特别是免疫组化和电子显微镜的应用，发现原来被称为平滑肌肿瘤的病例，很多都缺乏免疫组化或超微结构方面的相应特征，先前那种分类和命名，显然不够科学和严谨。20世纪90年代，Mazur和Clark提出胃间质瘤     

规范胃肠间质瘤中文命名的建议

胃肠间质瘤（gastrointestinalstromaltumor,GIST）作为独立的一类疾病,近半个世纪以来受到国外学者的重视。作为一个较新的概念,近10年来,国内学者也加大了对其研究的力度。然而,目前国内学术界对于该疾病的命名仍存在不统一的现象。规范此类疾病的命名,有利于日后临床诊断及国内外的学术交流。早在1983年,Mazur等通过对28例生物学行为与起源不明的胃梭形细胞肿瘤的研究,首次提出胃间质瘤（stromaltumor）的概念（间质瘤的准确定义是来源于间叶结缔组织的肿瘤）。1996年,Rosai结合大量临床病理资料,系统地阐述了此类肿瘤的分类：平滑肌型、神经型、平滑肌神经混合型和未定型,并将胃肠道间叶来源的～大类梭形细胞肿瘤总称为胃肠道间质瘤（gastrointestinaltractstromaltumor,GITST）。     

牙体牙弓颌骨阻力中心及其临床意义

牙体、牙弓及颌骨的阻力中心在正畸矫治力系统中具有重要的意义,也是正畸学领域争论较多的一个问题。Dermaut等研究表明,当力作用于物体阻力中心时,物体将发生平动,否则将发生平动和转动的复合运动。目前,国内外多数学者认为牙体、牙弓及颌骨存在阻力中心,但其位置存在争议。本文就牙体、牙弓及颌骨的阻力中心及其临床意义作一综述。     

Hazards and complications of endoscopic transurethral ureterolithotripsy and lithoextraction and means of prevention

Complications related to ureterolithotomy and ultrasonic ureterolithotripsy performed under the control of visual endoscope were analyzed in 86 ureterolithiasis patients, methods of their prevention discussed. All the aforementioned complications were distributed into three groups: inapplicability of surgery due to anatomic and functional defects of lower and upper urinary tracts, intraoperative, and postoperative complications. The commonest ones were ureteral abruption and perforation, acute pyelonephritis, temporary vesicoureteral reflux. Their control measures were considered as relative methods of treatment: immediate surgical intervention in case of ureteral abruption, renal catheterization in patients with insignificant ureteral perforation or acute pyelonephritis. Adequate ureteroscopy, careful consideration of pro- and contraindications, catheterization of renal pelvis and urinary bladder performed within 2-3 days after the surgery and adequate antibacterial therapy are the most decisive steps in the control of aforementioned complications.     

Characterisation and differentiation of chondroblastomas and chondromyxoidfibromas - presence and expression of collagen types I and II

AIM: Chondroblastomas and chondromyxoidfiibromas are rare benign skeletal neoplasms with reported overlapping histology. Aim of this study was to analyse the biochemical composition of the matrix of these tumour entities in order to further characterise the cellular phenotypes of these neoplasms using typical cell biological marker genes. METHODS: The matrix compositions of chondroblastomas and chondromyxoidfibromas were analyzed by HE-histology, histochemistry, and immunolocalization techniques. Cellular gene expression patterns were detected by mRNA in situ hybridization. RESULTS: Chondroblastomas are rich in collagen type I and show foci of an osteoid-like matrix, whereas collagen type II as a typical marker of chondrocytic differentiation was not detected in any of the specimens. Chondromyxoidfiibromas had foci of chondroid appearance with chondroblastic cellular differentiation characterised by collagen type II expression. CONCLUSION: These results characterise chondroblastomas and chondromyxoidfiibromas as skeletal neoplasms that have a different biology and which can be distinguished by matrix protein expression products: collagen type II, the typical marker of chondroblast differentiation, could only be detected in chondromyxoidfibromas, but not in chondroblastomas. Thus, both neoplasms are clearly different on the cell biological level.     

Histochemical and contractile properties of striated muscles of urethra and levator ani of dogs and sheep

AIMS: To understand their possible importance in long- and short-term control of continence, some properties of the striated muscles of the urethra and pelvic floor (levator ani) of dogs and sheep were investigated, especially fiber types and contractile characteristics. MATERIALS AND METHODS: Striated muscles of urethra and levator ani of 29 male and 6 female dogs and 11 male and 6 female sheep were removed and cut into strips. Some strips were frozen and stained for ATPase at pH 9.4 and 4.3 for fiber typing; others were set up in an organ bath to study contractile responses to nerve stimulation. RESULTS: All muscles contained both type I (slow) and type II fibers, ranging from 97% type II in female greyhound urethra to 60% in female sheep levator ani. For each muscle, there were fewer type II muscles in sheep than in dog. The diameters of the urethral fibers were about 60% of the levator ani in dogs and 34% in sheep. Contraction of the urethral muscle was faster than for levator ani and declined to about 80% of the peak, 500 msec after the beginning of stimulation at 20 Hz. The levator ani contraction rose to a steady level as long as stimulation continued. CONCLUSIONS: Both the levator ani and urethral striated muscles contain slow and fast fiber types. The levator ani muscles are capable of sustained contraction with rapid onset which will produce long-term closure of the urethra. The circular urethral muscle contraction was faster but less well maintained.     

Effect of smoking and abstention on oxidative burst and reactivity of neutrophils and monocytes

BACKGROUND: Smoking is associated with surgical wound infections, impaired wound healing, and tissue-destructive disorders. The mechanisms are largely unknown, but changes in the function and activity of inflammatory cells may be involved. METHODS: Seventy healthy volunteers (54 smokers and 16 never smokers) were included. The smokers were studied while they smoked and after 20 days of abstinence. After the first 10 days of abstinence, they were randomized to double-blind treatment with transdermal nicotine patch 25 mg per day or placebo. Venous blood neutrophils and monocytes were sampled and isolated. In 22 randomly selected smokers and in all never smokers, the oxidative burst and chemotaxis were determined by a chemiluminescence response assay and a modified Boyden chamber technique, respectively. Stimulants were opsonized zymosan, formyl-Met-Leu-Phe, and zymosan-activated serum. RESULTS: The neutrophil and monocyte oxidative burst was 50% and 68% lower, respectively, in smokers compared to never smokers (P < .05). Neutrophil chemotaxis was 93% higher in smokers (P < .05). Monocyte chemotaxis was lower in smokers compared to never smokers (P < .05). After 20 days of abstinence, neutrophil oxidative burst increased to the level of never smokers (P < .05); monocyte oxidative burst increased by 50% (P < .05). Chemotaxis was only marginally affected. The changes induced by abstinence were less pronounced in the transdermal nicotine patch group compared to the placebo group. CONCLUSIONS: Smoking attenuates the oxidative burst of inflammatory cells and increases chemotaxis. Three weeks of abstinence normalize the oxidative burst, but affect chemotaxis only marginally.