Re common than type iii; types i and ii associated with increase in serum gastrin, tend to occur predominantly in fundus, multicentric, and small; type iii not associated with increase in serum gastrin, oc­curs anywhere in stomach, solitary, and smaller; types i and ii slow-growing, but metastasis possible; type iii more malignant, with positive nodes in majority of patients and liver metastasis in »25% of patients; 5-yr survival similar in types i and ii and <50% in type iii; carcinoid syndrome extremely rare in types i and ii, and atypical in type iii (predominantly caused by hyperhistaminemia) treatment: type i   —   if tumor small (<1 cm), endoscopic removal recommended; recurrent tumor seen in 55% of patients at median of 6 mo after removal of primary tumor (require multiple endoscopies); no majority agreement as to whether endo­scopic or surgical removal best choice for 1- to 2-cm tumors,; if >2 cm or shows evidence of local invasion, surgery neces­sary (extent of surgery controversial); some recommend total or subtotal gastrectomy, and others local resection with antrectomy (eliminates hypergastrinemia and has low incidence of recurrence); no consensus about satisfactory mar­gin and no substantive data to support extensive lymphadenectomy; type ii   —   recommendations generally same as type i, except that antrectomy for ze tumor will not reduce serum gastrin; prognosis same as for gastrinoma; type iii   —   requires aggressive resection with regional lymphadenectomy if tumor >2 cm or shows invasion of muscularis propria carcinoids of small intestine: 40% occur within 2 ft of ileocecal valve; usually found at surgery as firm submucosal nodule; invade serosa and causes dense desmoplastic reaction, which results in small bowel obstruction (sbo) in one-third of cases; multicentric in £33% of patients; vary in number from 2 to 30 tumors; average size 2 cm; more likely in younger patients; multicentric carcinoids more frequently associated with full carcinoid syndrome clinical presentation: mean delay in diagnosis 5. best price of viagra viagra sales mail order viagra online buy cheap viagra viagra bayer 5 mg viagra without a doctor prescription 100 mg generic viagra 5 yr in one series; no correlation between delay in diagnosis and extent of disease or death (due to slow growth of tumors); lymph node metastases seen in 90% at time of surgery (liver metastases in close to 50%); incidence of lymph node metastases directly related to size of primary tumor; if tumor <1 cm, metastasis seen in 18% (1-2 cm, 60%; >2 cm, almost 100%) diagnosis: somatostatin receptor scintigraphy    —   best test; sensitivity 80% to 90%, but size rate-limiting factor; not specific (detects other endocrine tumors); positron emission tomography generally not superior to computed tomography and magnetic resonance imaging; plasma chromogranin a    —   best screening mark. Can you buy viagra over counter philippines express viagra online 8080 cheap generic viagra female viagra for sale crush viagra under tongue Viagra viagra viagra helleva Can buy viagra malaysia generic viagra online cheap viagra usa first time viagra users 4rx generic viagra review reviews of viagra generic reviews of viagra generic viagra buy

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