Surgical treatment and perioperative multidisciplinary management of neuromuscular scoliosis in children / 中国小儿急救医学

Scoliosis is a common deformity in neuromuscular disease, which usually has the characteristics of early onset age, severe degree of deformity, and rapid progression.Neuromuscular scoliosis often leads to serious damages to the quality of life, and results in the loss of walking, standing and sitting, and cardiopulmonary insufficiency.Surgical treatment can improve the quality of life for children with neuromuscular scoliosis, but surgical treatment is still challenging due to the complex surgery and many complicated diseases.The complications are much higher than those of idiopathic scoliosis.A multidisciplinary team is necessary in the surgical treatment of neuromuscular scoliosis to promptly and effectively reduce the complications.

Multidisciplinary management and follow-up study of Alagille syndrome / 国际儿科学杂志

Objective:To explore the multidisciplinary management that centred on gastroenterology department, and follow-up study of children with Alagille syndrome(ALGS).Methods:The clinical data of 19 children diagnosed with ALGS in Pediatric Gastroenterology Department, Shengjing Hospital of China Medical University since June 2013 to December 2022 was retrospectively analyzed, and the clinical manifestations of various systems of the body were followed up and evaluated, and then developed the personalised management strategies.Results:Among the 19 confirmed patients, 18 cases were confirmed by genetic testing.Eighteen cases(94.7%) had characteristic facial features.To follow-up node, 8 cases(42.1%) had cholestasis, with alanine aminotransferase(210.20±110.50)U/L, aspartate aminotransferase(187.86±96.70)U/L, and direct bilirubin(110.93±108.15)μmol/L.Eighteen cases(94.7%) had pruritus.Eighteen cases(94.7%) of the patients had a high risk of malnutrition, and the level of total bilirubin[(76.17±107.34)μmol/L] and total bile acid[(100.18±83.78)μmol/L] were significantly increased in the children with obvious growth retardation.Thirteen cases(68.42%) had diffuse liver injury.The clinical opinions on genetic counseling, application of new drugs, liver transplantation, cardiac medicine and surgery follow-up, spine and oral surgery orthodontics were given by multiple disciplines.Conclusion:ALGS children have a high risk of long-term malnutrition and are associated with the severity of liver injury, and pruritus and jaundice are the main clinical manifestations.The management of ALGS patients should be centered around liver disease doctors, combined with multiple disciplines, paying attention to changes in various related organs of ALGS patients, and improving their quality of life.

Acretismo placentario con compromiso vesical en altura / Placental accreta with bladder involvement in height

Introducción: El acretismo placentario es una complicación obstétrica compleja. Según el grado de profundidad se clasifica en placenta acreta, increta y percreta, siendo esta última una presentación rara. Objetivo: Reportar la evolución clínica quirúrgica de una paciente con diagnóstico de acretismo placentario (placenta percreta) con compromiso vesical. Caso clínico: Paciente segundigesta de 28 años, con antecedente de una cesárea anterior hace aproximadamente 4 años, ingresa por consultorio externo debido a estudio ecográfico sugestivo de probable acretismo placentario con invasión vesical realizada en el tercer trimestre, motivo por el cual es hospitalizada para un mejor estudio y tratamiento. Sometida a cirugía por equipo multidisciplinario, a cesárea-histerectomía modificada, con resección parcial de vejiga y ligadura de hipogástricas, con corta estancia en Unidad de Cuidados Intensivos y hospitalización sin complicaciones urológicas posteriores. Conclusiones: La detección temprana permite una planificación preoperatoria adecuada con equipo multidisciplinario especializado, considerando la participación temprana del urólogo en la toma de decisiones(AU)

Introduction: Placental accreta is a complex obstetric complication. According to the degree of depth, it is classified into placenta accreta, increta and percreta, the latter being a rare presentation. Objective: To report the surgical clinical evolution of a patient with a diagnosis of placental accreta (placenta percreta) with bladder involvement. Clinical case report: A 28-year-old second-pregnant patient, with a history of a previous cesarean section approximately 4 years ago, was admitted to an outpatient clinic due to a probable placental accreta with bladder invasion performed in the third trimester which was suggestive in ultrasound study. She was hospitalized for better study and treatment and she underwent surgery by a multidisciplinary team. A modified cesarean section-hysterectomy, with partial bladder resection and hypogastric ligation, with a short stay in the Intensive Care Unit and hospitalization without subsequent urological complications. Conclusions: Early detection allows adequate preoperative planning with a specialized multidisciplinary team, considering the early participation of the urologist in decision-making(AU)

Chinese expert consensus on multidisciplinary management of malignant tumor-associated acute abdomen / 中华胃肠外科杂志

Malignant tumor-associated acute abdomen refers to a non-perioperative acute abdominal disease caused by malignant tumors or caused by various anti-tumor treatments with acute abdominal pain as the main clinical manifestation. It is often critical and even life-threatening. For patients with malignant tumor-associated acute abdomen, the occurrence and development of tumors and the evolution of acute complications are often causal to each other. Therefore, diagnosis and treatment of malignant tumor-associated acute abdomen usually require the surgery-based multidisciplinary treatment (MDT). According to imaging features and access to medical resources, oncologists and surgeons, working with other relevant professional teams need to develop the most appropriate treatment strategy through hierarchical management based on different oncology assessments and treatment goals. Yet there is no consensus on diagnosis and treatment of malignant tumor-associated acute abdomen. Therefore, Chinese College of Surgeons, Chinese Society for Clinical Oncologists, Chinese Society of Multidisciplinary Team, and the Chinese Journal of Gastrointestinal Surgery gathered multidisciplinary experts in China to discuss and develop the . This consensus consists of three parts, namely multidisciplinary diagnosis and evaluation, multidisciplinary prevention and treatment, and specific treatment of common malignant tumor-associated acute abdomen. The diagnosis and evaluation section mainly includes oncology, imaging diagnosis and surgical perioperative evaluation. The prevention and treatment section mainly includes the prevention of malignant tumor-associated acute abdomen, the principle of treatment based on surgery, anti-tumor therapy-induced acute abdomen, as well as the prevention and management of special biological types of malignant tumor-associated acute abdomen. The last part discusses specific treatment of malignant tumor-associated acute abdomen such as gastrointestinal obstruction (surgery, palliative care, endoscopic or interventional surgery), gastrointestinal perforation (perioperative and surgical treatment), gastrointestinal bleeding (medical treatment, endoscopic surgery, interventional surgery, and surgical treatment), biliary system-associated acute abdomen (treatment of acute cholangitis, acute cholecystitis, and gallbladder perforation), and rupture of liver cancer (general treatment, transarterial embolization, and surgical treatment). We hope this consensus will help clinicians to understand the multidisciplinary standardized diagnosis and treatment of patients with malignant tumor-associated acute abdomen and to serve as a practical reference.

Multidisciplinary cooperation strengthens individualized management of breast cancer in pregnancy / 中华外科杂志

As the pregnant patient with breast cancer is in a special physiological period, both the efficacy of mother and the safety of developing fetus should be considered during the whole process of diagnosis and treatment.It is particularly important for multidisciplinary teams including breast, obstetrics and nursing departments to make a secure and effective individualized plan for those in different gestational week and different stages of breast cancer development. Pregnancy risk assessment and whole-process multidisciplinary case management mode for breast cancer during pregnancy are helpful for the early detection of abnormal health status of pregnant women and fetuses, enabling rapid and efficient treatment, reducing the occurrence of adverse medical events, and maximizing the safety of pregnant women and fetuses. Obstetricians should pay attention to the chief complaints of pregnant women and conduct regular breast ultrasound examinations. Once anything suspicious is found, breast surgeons need to take charge of a multidisciplinary discussion. Not only should the multidisciplinary collaborative outpatient clinic determine the treatment plan for breast cancer during pregnancy, but also the concept of multidisciplinary collaboration should be incorporated into the follow-up treatment process, including active surgical treatment, selection of neoadjuvant chemotherapy and adjuvant chemotherapy, avoidance of endocrine therapy, targeted therapy and radiotherapy, and adherence to multidisciplinary follow-up, etc. Multidisciplinary case management of breast cancer during pregnancy is necessary and feasible, and more prospective clinical studies need to be carried out to help improve clinical diagnosis and treatment strategies.

Multidisciplinary cooperation strengthens individualized management of breast cancer in pregnancy / 中华外科杂志

As the pregnant patient with breast cancer is in a special physiological period, both the efficacy of mother and the safety of developing fetus should be considered during the whole process of diagnosis and treatment. It is particularly important for multidisciplinary teams including breast, obstetrics and nursing departments to make a secure and effective individualized plan for those in different gestational week and different stages of breast cancer development. Pregnancy risk assessment and whole-process multidisciplinary case management mode for breast cancer during pregnancy are helpful for the early detection of abnormal health status of pregnant women and fetuses, enabling rapid and efficient treatment, reducing the occurrence of adverse medical events, and maximizing the safety of pregnant women and fetuses. Obstetricians should pay attention to the chief complaints of pregnant women and conduct regular breast ultrasound examinations. Once anything suspicious is found, breast surgeons need to take charge of a multidisciplinary discussion. Not only should the multidisciplinary collaborative outpatient clinic determine the treatment plan for breast cancer during pregnancy, but also the concept of multidisciplinary collaboration should be incorporated into the follow-up treatment process, including active surgical treatment, selection of neoadjuvant chemotherapy and adjuvant chemotherapy, avoidance of endocrine therapy, targeted therapy and radiotherapy, and adherence to multidisciplinary follow-up, etc. Multidisciplinary case management of breast cancer during pregnancy is necessary and feasible, and more prospective clinical studies need to be carried out to help improve clinical diagnosis and treatment strategies.

Demographics and Clinical Profile of Orofacial Cleft in International Islamic University Malaysia from 2009 until 2018

@#Orofacial clefts (OFC) are the most common craniofacial anomalies. There is no published data regarding the demographic of OFC cases seen in International Islamic University Malaysia (IIUM), since the establishment of the IIUM Multi-Disciplinary Cleft Team (IIUM-MDCT). The present study aimed to build a database on demographic profile of OFC cases seen in IIUM from 2009 until 2018. Data from all registered OFC cases were obtained from the medical records. Birth prevalence was tabulated against the population statistics for the period, obtained from the Department of Statistics Malaysia. A total of 20 cases were seen over the period of nine years. The registry recorded about 60% of females and 40% of males. Age distribution was 40% below the age of 10 years old, 40% between 11 to 20 years old and 20% of 21 years old and above. As for race, 90% were Malay, 5% were Chinese and Indian, respectively. Majority of patients (75%) were from Kuantan, 10% from Kemaman and 5% from Pekan, Kuala Terengganu and Kota Bharu, respectively. The most common OFC was cleft lip and palate (80%), followed by cleft palate (15%) and facial cleft (5%). The LAHSHAL classification was recorded with 75% of cases were unilateral, of which 73% affecting the left side. Other health anomalies were recognised in 45% of cases and 20% of them has family history of cleft. The present study could provide a baseline information on the status of OFC patients seen by IIUM-MDCT.

Multidisciplinary cooperation strengthens individualized management of breast cancer in pregnancy / 中华外科杂志

As the pregnant patient with breast cancer is in a special physiological period, both the efficacy of mother and the safety of developing fetus should be considered during the whole process of diagnosis and treatment. It is particularly important for multidisciplinary teams including breast, obstetrics and nursing departments to make a secure and effective individualized plan for those in different gestational week and different stages of breast cancer development. Pregnancy risk assessment and whole-process multidisciplinary case management mode for breast cancer during pregnancy are helpful for the early detection of abnormal health status of pregnant women and fetuses, enabling rapid and efficient treatment, reducing the occurrence of adverse medical events, and maximizing the safety of pregnant women and fetuses. Obstetricians should pay attention to the chief complaints of pregnant women and conduct regular breast ultrasound examinations. Once anything suspicious is found, breast surgeons need to take charge of a multidisciplinary discussion. Not only should the multidisciplinary collaborative outpatient clinic determine the treatment plan for breast cancer during pregnancy, but also the concept of multidisciplinary collaboration should be incorporated into the follow-up treatment process, including active surgical treatment, selection of neoadjuvant chemotherapy and adjuvant chemotherapy, avoidance of endocrine therapy, targeted therapy and radiotherapy, and adherence to multidisciplinary follow-up, etc. Multidisciplinary case management of breast cancer during pregnancy is necessary and feasible, and more prospective clinical studies need to be carried out to help improve clinical diagnosis and treatment strategies.

Post partum headache: a case series

Postpartum headache is the complaint of head, neck, or shoulder pain occurring during the first 6 weeks following delivery. Among the women who underwent neuraxial aneasthesia Post Dural puncture headache is one of the most common presentations. However, physicians should be aware that post Dural puncture headache is not the only cause of postpartum headache. Authors present a series of four cases that had varied presentation of post partum headache with varied diagnosis, the first case was of subdural haematoma where CT scan revealed an acute on chronic SDH. The second case was diagnosed as meningitis and the CSF for culture sensitivity grew Streptococcus Pneumoniae .In our third case of cortical vein  thrombosis , NCCT followed by MR venogram  revealed left transverse venous sinus thrombosis and our last case in the series was of posterior reversible encephalopathy syndrome where MRI confirmed the findings of typical findings are symmetric edema involving the white matter of the posterior regions of the cerebral hemispheres. The diagnostic dilemma was resolved by neuroimaging because the clinical presentation was not making us reach a satisfactory diagnosis of the cause of headache. Early resort to neuroimaging and multidisciplinary team effort paved way to early diagnosis and appropriate recovery of the patients.

Management of ventricular arrhythmias in pregnancy / 中国实用妇科与产科杂志

Ventricular arrhythmias in pregnancy is a common disease of cardiovascular disease during pregnancy which can cause adverse outcomes in severe state,such as maternal heart failure,sudden death,fetal hypoxia,premature delivery and stillbirth.The management of ventricular arrhythmias requires multidisciplinary participation,including obstetrics,cardiology,anesthesiology and neonatology.This article discusses how to manage the ventricular arrhythmias from the following aspects:pre-pregnancy counseling and assessment,treatments,managements during pregnancy and managements of delivery in order to reduce the occurrence of maternal and fetal complications,and emphasizes the significance of multidisciplinary collaborative management to the prognosis of disease.

Educación al paciente con enfermedad inflamatoria intestinal: impacto de un equipo multidisciplinario / Education to IBD patients: impact of a multidisciplinary team

Inflammatory bowel disease (IBD) is a chronic, idiopathic disease characterized by inflammation of the gastrointestinal tract. It affects more than 5 million people worldwide and in Chile studies suggest that IBD incidence has increased in recent years. It is manifested by periods of remission and activity, requiring permanent pharmacological treatment. Both, the occurrence of a crisis episode and the need for lifetime medical treatment could affect the quality of life of IBD patients. Studies suggest that patients with IBD require education to develop self-management of their disease and adhere to treatment, thus reducing the risk of crisis episodes. The importance of this strategy or action is significant if we consider that studies have shown that the level of knowledge of IBD patients regarding their pathology is low. The purpose of this article is to review the effect of education on the management of IBD patients and the implications of a multidisciplinary team with an IBD specialist nurse.

La enfermedad inflamatoria Intestinal (EII) es una enfermedad crónica, idiopática, caracterizada por la inflamación del tracto gastrointestinal. Afecta a más de 5 millones de personas en el mundo y en Chile estudios sugieren que ha ido en aumento en los últimos años. Se manifiesta por períodos de remisión y actividad, siendo necesario un tratamiento farmacológico permanente. Tanto la presencia de crisis como la necesidad de un tratamiento médico de por vida, podrían afectar la calidad de vida de estos pacientes. Estudios sugieren que los pacientes con EII requieren de educación para poder desarrollar un buen autocuidado de su enfermedad, adherirse al tratamiento y disminuir así el riesgo de crisis. Esta estrategia o acción no deja de ser importante si consideramos que estudios han mostrado que el nivel de conocimiento de los pacientes con EII respecto a su patología es bajo. El propósito de este artículo es revisar el efecto de la educación en el manejo de los pacientes con EII, y las implicancias de un equipo multidisciplinario con una enfermera especialista en EII que realice el seguimiento de estos pacientes.

Síndrome de Ehlers-Danlos em paciente com dor crônica. Relato de caso / Ehlers-Danlos syndrome in chronic pain patient. Case report

RESUMO JUSTIFICATIVA E OBJETIVOS: A síndrome de Ehlers-Danlos é uma doença do tecido conjuntivo que em alguns casos torna-se incapacitante. O objetivo deste estudo foi apresentar um caso raro diagnosticado no Ambulatório de Controle de Sintomas e Cuidados Paliativos com quadro doloroso importante. RELATO DO CASO: Paciente do gênero masculino, 17 anos, apresentou-se ao ambulatório com queixa de dor no corpo generalizada havia 4 anos. Referia história de hipermobilidade articular notada desde a infância. CONCLUSÃO: Neste caso realizou-se o diagnóstico de Síndrome de Ehlers-Danlos, tipo hipermobilidade, com base na história clínica e no exame físico, além dos critérios de Brighton. A adesão ao tratamento multidisciplinar mostrou impactante melhora na qualidade de vida do paciente.

ABSTRACT BACKGROUND AND OBJECTIVES: Ehlers-Danlos Syndrome is a connective tissue disease which becomes disabling in some cases. This study aimed at presenting a rare case diagnosed in the Ambulatory of Symptoms Control and Palliative Care with severe pain. CASE REPORT: Male patient, 17 years old, who came to the ambulatory complaining of widespread pain for 4 years. He referred history of joint hypermobility noticed since childhood. CONCLUSION: Based on clinical history and physical evaluation, in addition to Brighton criteria, patient was diagnosed as having hypermobility-type Ehlers-Danlos Syndrome.

Progress in the clinical use of radiotherapy for bone metastasis in breast cancer / 中国癌症杂志

Bone remains the predominant site of metastasis in advanced breast cancer. Bone metastases dramatically decrease the quality of life. Moreover, pathologic fractures and other skeletal-related events (SREs) caused by bone metastases could result in higher mortality risk in patients with breast cancer. Palliative radiotherapy is a crucial element in bone metastases treatment. The present review discusses the emerging evidence in bone metastases of breast cancer, focusing on optimized radiotherapy strategies and multidisciplinary management.

A Case of Complete Response by Multidisciplinary Management in a Patient with Solitary Bone Metastasis after Curative Resection of Hepatocellular Carcinoma

Despite recent advances in the treatment of hepatocellular carcinoma (HCC), the prognosis of patients with extrahepatic metastasis from HCC still remains dismal. The current study presents a case of HCC that was metastatic to the pelvis and describes successful treatment with multidisciplinary approach to the skeletal metastasis. The patient was a 67-year-old male who presented with right pelvic pain 28 months following right hepatectomy for HCC. Computed tomography and magnetic resonance imaging indicated a solitary bone metastasis without intrahepatic recurrence. Complete response was achieved with multidisciplinary management including sorafenib, transarterial embolization, surgery to remove the metastatic mass and radiotherapy after surgery. A post-operative follow-up 15 months later found that the patient remained in good health with maintained complete response. This case suggests that a multidisciplinary approach can achieve long-term cancer-free survival and prolonged life expectancy beyond palliative care for patients with solitary bone metastasis after curative surgery for HCC.

Thymoma: First large Indian experience.

BACKGROUND: Thymoma is the most common tumor of the anterior mediastinum. Surgery is mainstay of treatment, with adjuvant radiation recommended for invasive thymoma. Because of rarity, prospective randomized trials may not be feasible even in multicentric settings hence the best possible evidence can be large series. Till date Thymoma has not been studied in Indian settings. MATERIALS AND METHODS: All patients presenting to Thoracic disease management group at our Centre during 2006‑2011 were screened. Sixty two patients’ with histo‑pathological confirmation of thymoma medical records could be retrieved and are presented in this study. Mosaoka staging and WHO classification was used. The clinical, therapeutic factors and follow up parameters were recorded and survival was calculated. Effects of prognostic factors were compared. RESULTS: Sixty two patients were identified (36M, 26F; age 22‑84, median 51.5 years) and majorities (57%) of thymoma were stage I‑II. WHO pathological subtype B was most common 30 (49%). Mean tumor size was smaller in patients with myasthenia (5.3cm) than the entire group (7.6cm). Neoadjuvant therapy was offered to five unresectable stages III or IV a patient’s with 40% resectability rates. Median overall survival was 60 months (Inter quartile‑range 3‑44 months) with overall survival rate (OS) at three year being 90%. Resectable tumors had better outcomes (94%) than non resectable (81%) at three years. Mosaoka Stage was the only significant (P = 0.03) prognostic factor on multivariate analysis. CONCLUSION: This is first thymoma series from India with large number of patients where staging is an important prognostic factor and surgery is the mainstay of therapy. In Indian context aggressive multimodality treatment should be offered to advanced stage patients and which yields good survival rates and comparable.

Dor pélvica crônica não visceral: tratamento multidisciplinar. Relato de caso / Chronic non-visceral pelvic pain: multidisciplinary management. Case report

BACKGROUND AND OBJECTIVES: The prevalence of chronic pelvic pain among females is approximately 4%, similar to the prevalence of migraine (2.1%), asthma (3.7%) and low back pain (4.1%). Its diagnosis and management are major challenges for the health team. This report aimed at showing the difficulty of diagnosing and managing chronic pelvic pain and the importance of the multidisciplinary team for pain relief. CASE REPORT: Forty-five years old patient with pelviperineal pain for six years after hysteroscopy and uterine polyp excision. Severe pain, starting in the immediate postoperative period has evolved along this period without improvement, leading her to look for the Chronic Abdominal, Pelvic and Perineal Pain Outpatient Clinic of the Interdisciplinary Pain Center, Clinicas Hospital, School of Medicine, University of São Paulo. CONCLUSION: Multidisciplinary management, involving drugs, inactivation of trigger-points (anesthetic infiltration, dry needling, acupuncture), physiotherapy, postural reeducation and psychosocial support, has provided patient's significant pain relief and improved quality of life.

JUSTIFICATIVA E OBJETIVOS: A prevalência de dor pélvica crônica no sexo feminino é de aproximadamente 4%, similar à prevalência da enxaqueca (2,1%), asma (3,7%) e dor lombar (4,1%). Seu diagnóstico e tratamento constitui um grande desafio para a equipe de saúde. Este estudo teve por objetivo mostrar a dificuldade no diagnóstico e tratamento de dor pélvica crônica e a importância da equipe multidisciplinar no alívio do quadro doloroso. RELATO DO CASO: Paciente de 45 anos, com quadro de dor pelviperineal há 6 anos, após histeroscopia para exérese de pólipo uterino. A dor que iniciou no pós-operatório imediato, de forte intensidade, evoluiu ao longo desse período sem melhora e motivou-a a buscar o Ambulatório de Dor Abdominal, Pélvica e Perineal Crônica do Centro Interdisciplinar de Dor do Hospital de Clínicas da Faculdade de Medicina da Universidade de São Paulo. CONCLUSÃO: O tratamento multidisciplinar que abrangeu o uso de fármacos, inativação dos pontos-gatilho (infiltração com anestésicos, agulhamento seco, acupuntura), fisioterapia, reeducação postural e suporte psicossocial, proporcionou melhora significativa da dor e da qualidade de vida da paciente.

Atendimento multidisciplinar do paciente ortodôntico com epidermólise bolhosa / Multidisciplinary management of the orthodontic patient with epidermolysis bullosa

O termo epidermólise bolhosa descreve um grupo variado de doenças hereditárias, crônicas, não inflamatórias, epiteliais e da mucosa, que são caracterizadas por excepcional fragilidade e reduzida resistência após trauma moderado. Esta doença é classificada em forma simples, juncional ou distrófica, com pelo menos 23 subtipos, e é uma doença rara que afeta toda a população, qualquer grupo racial e igualmente homens e mulheres. OBJETIVO: os autores relatam problemas sistêmicos e bucais associados à epidermólise bolhosa, norteando atitudes clínicas multidisciplinares quando o paciente necessita de tratamento ortodôntico.

The term epidermolysis bullosa describes a varied group of hereditary, chronic, non-inflammatory diseases of the skin and mucosa, which are characterized by remarkable skin fragility and reduced resistance after moderate trauma. This disease is classified as simple, junctional or dystrophic form, with at least 23 subtypes, and is a rare disease found in all populations and racial groups, equally affecting males and females. AIM: the authors reports systemic and oral problems associated with epidermolysis bullosa, guiding the multidisciplinary clinical attitudes when the patient needs orthodontic treatment.

The Teaching of Radiation & Oncology Guided by Multidisciplinary Tumor Management / 中华医学教育探索杂志

Multimodality Treatment is the general trend in cancer management,and is the inevitable result of the development in clinical oncology as well.We must alter the traditional conception and change the teaching pattern to match the model radiation & oncology teaching.