Molten aluminum is among the most common causes of burns in the metal industry.However,only few reports are available on molten aluminum injuries.Herein,we report an unusual case of molten aluminum burn.The patient ha...Molten aluminum is among the most common causes of burns in the metal industry.However,only few reports are available on molten aluminum injuries.Herein,we report an unusual case of molten aluminum burn.The patient had burns not only on the body surface but also in the respiratory tract and esophagus,adding to the difficulty of treatment.Multidisciplinary consultation and cooperation led to the development of a treatment plan for the patient,which included tracheotomy,respiratory management,endoscopic therapy,infection control,and psychological support.To our knowledge,this is the first report of molten aluminum-induced burns involving the face,neck,respiratory tract,esophagus,and eyes.We also describe our experience with multidisciplinary treatment for the management of molten aluminum burns.展开更多
BACKGROUND Although choriocarcinoma is thought to be a malignancy curable by chemotherapy,there remain difficult and challenging problems in cases with high prognostic scores or extensive metastases,for which the trea...BACKGROUND Although choriocarcinoma is thought to be a malignancy curable by chemotherapy,there remain difficult and challenging problems in cases with high prognostic scores or extensive metastases,for which the treatment is limited.Particularly,chemotherapy in combination with other treatments offers promising therapeutic potential for these cases.CASE SUMMARY We present the case of a 40-year-old female patient who suffered from lifethreatening hemoptysis and paraplegia due to choriocarcinoma with pulmonary,hepatic and spinal metastases.The patient successfully recovered after multidisciplinary treatment consisting of 21 cycles of intravenous chemotherapy,radiofrequency ablation of multiple hepatic metastases,intensity-modulated radiation therapy for spinal metastases and routine physiotherapy.To our knowledge,it is the first reported case of recovery from pulmonary,hepatic and spinal metastases of choriocarcinoma with no specific primary site.Moreover,this is the first reported clinical attempt on 5-d actinomycin D as primary chemotherapy in ultrahigh-risk gestational trophoblastic neoplasia.CONCLUSION The case supports the opinion that the individualized treatment of choriocarcinoma by a multidisciplinary approach can accomplish optimal therapeutic effects.展开更多
BACKGROUND Gastrointestinal tumors are a major cause of cancer-related deaths and have become a major public health problem.This study aims to provide a scientific basis for improving clinical treatment effects,qualit...BACKGROUND Gastrointestinal tumors are a major cause of cancer-related deaths and have become a major public health problem.This study aims to provide a scientific basis for improving clinical treatment effects,quality of life,and prognosis of patients with gastrointestinal tumors.AIM To explore the clinical effect of the multidisciplinary diagnosis and treatment(MDT)nutrition intervention model on patients with gastrointestinal tumors.METHODS This was a case control study which included patients with gastrointestinal tumors who received radiotherapy at the Department of Oncology between January 2021 and January 2023.Using a random number table,120 patients were randomly divided into MDT and control groups with 60 patients in each group.To analyze the effect of MDT on the nutritional status and quality of life of the patients,the nutritional status and quality of life scores of the patients were measured before and after the treatment.RESULTS Albumin(ALB),transferrin(TRF),hemoglobin(Hb),and total protein(TP)levels significantly decreased after the treatment.The control group had significantly lower ALB,TRF,Hb,and TP levels than the MDT group,and the differences in these levels between the two groups were statistically significant(P<0.05).After the treatment,the MDT group had significantly more wellnourished patients than the control group(P<0.05).The quality of life total score,somatic functioning,role functioning,and emotional functioning were higher in the MDT group than in the control group.By contrast,pain,fatigue,nausea,and vomiting scores were lower in the MDT group than in the control group(P<0.05).CONCLUSION MDT nutritional intervention model effectively improves the nutritional status and quality of life of the patients.The study provides a rigorous theoretical basis for improving the prognosis of cancer patients.In the future,we intend to provide additional treatment methods for improving the quality of life of patients with cancer.展开更多
BACKGROUND Patients with severe periodontitis often require multidisciplinary treatment to achieve healthy periodontal tissue,normal occlusion,and optimal aesthetics.In the present study,we aimed to evaluate the effic...BACKGROUND Patients with severe periodontitis often require multidisciplinary treatment to achieve healthy periodontal tissue,normal occlusion,and optimal aesthetics.In the present study,we aimed to evaluate the efficacy of multidisciplinary non-surgical treatment in a patient with stage IV/grade C periodontitis,malocclusion,and dentition defects.CASE SUMMARY A 47-year-old woman visited our periodontology department due to teeth mobility problems and difficulties chewing food.The patient had no history of drug allergies or systemic disease.Initial therapy involved scaling and root planning with a Gracey scaler and periodontal ultrasonic therapeutic apparatus using a periodontal endoscope(Perioscopy,Zest Dental Solutions,United States)to control the periodontal inflammation prior to treatment.Five months later,orthodontic treatment was then performed to treat occlusion and overall aesthetics.After completion,a Maryland bridge was used to restore Nos.22,31,and 41 teeth.Florida probing(Florida probe,United States)was performed every 2-3 mo to evaluate the periodontal condition throughout treatment.Overall,multidisciplinary non-surgical treatment resulted in satisfactory aesthetic results with healthy periodontal tissue and stable occlusion.CONCLUSION In some patients with stage IV/grade C periodontitis,systematic and sequential non-surgical treatment can provide excellent therapeutic results.展开更多
Incidence rates for esophagogastric junction cancer are rising rapidly worldwide possibly due to the economic development and demographic changes.Therefore,increased attention has been paid to the prevention,diagnosis...Incidence rates for esophagogastric junction cancer are rising rapidly worldwide possibly due to the economic development and demographic changes.Therefore,increased attention has been paid to the prevention,diagnosis,and the treatment of esophagogastric junction cancer.Although there are discrepancies in the treatment strategy between Asian and Western countries,surgery remains the mainstay of treatment for esophagogastric junction cancer.Recent developments of perioperative multidisciplinary treatment may lead to better therapeutic effect,higher complete resection rate,and better control of the residual diseases,thus result in prolonged prognosis.In this review,we will focus on the treatment of locally advanced resectable esophagogastric junction cancer,and discuss the current status and future perspectives of the perioperative treatment including chemotherapy,radiation therapy,and immunotherapy,as well as the surgical strategy.Better understanding of the latest treatment strategy and future overlook may enable to standardize and individualize the treatment for esophagogastric junction cancer,thus leading to better prognosis for those patients.展开更多
BACKGROUND As the perioperative risk of elderly patients with extremely unstable hip fractures(EUHFs)is relatively high and therapeutic effect is not satisfactory,new therapeutic strategies need to be proposed urgentl...BACKGROUND As the perioperative risk of elderly patients with extremely unstable hip fractures(EUHFs)is relatively high and therapeutic effect is not satisfactory,new therapeutic strategies need to be proposed urgently to improve the efficacy and clinical outcomes of such patients.AIM To determine the influence of two surgical treatment modalities on postoperative cognitive function(CF)and delirium in elderly patients with EUHFs.METHODS A total of 60 elderly patients consecutively diagnosed with EUHF between September 2020 and January 2022 in the Chongqing University Three Gorges Hospital were included.Of them,30 patients received conventional treatment(control group;general consultation+fracture type-guided internal fixation),and the other 30 received novel treatment(research group;perioperative multidisciplinary treatment diagnosis and treatment+individualized surgical plan+risk prediction).Information on hip function[Harris hip score(HHS)],perioperative risk of orthopedic surgery[Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity(POSSUM)],CF[Montreal cognitive assessment scale(MoCA)],postoperative delirium[mini-cognitive(Mini-Cog)],adverse events(AEs;internal fixation failure,infection,nonunion,malunion,and postoperative delirium),and clinical indicators[operation time(OT),postoperative hospital length of stay(HLOS),ambulation time,and intraoperative blood loss(IBL)]were collected from both groups for comparative analyses.RESULTS The HHS scores were similar between both groups.The POSSUM score at 6 mo after surgery was significantly lower in the research group compared with the control group,and MoCA and Mini-Cog scores were statistically higher.In addition,the overall postoperative complication rate was significantly lower in the research than in the control group,including reduced OT,postoperative HLOS,ambulation time,and IBL.CONCLUSION The new treatment modality has more clinical advantages over the conventional treatment,such as less IBL,faster functional recovery,more effectively optimized perioperative quality control,improved postoperative CF,mitigated postoperative delirium,and reduced operation-related AEs.展开更多
Objective:To investigate the effectiveness of applying a multidisciplinary collaborative model for the diagnosis and treatment of patients with vertigo.Methods:The study was carried out in Xianyang Hospital of Yan’an...Objective:To investigate the effectiveness of applying a multidisciplinary collaborative model for the diagnosis and treatment of patients with vertigo.Methods:The study was carried out in Xianyang Hospital of Yan’an University,in which 100 patients with vertigo were selected from April 2021 to April 2022 and were divided into two groups:the control group was under the single diagnosis and treatment model,whereas the experimental group was under the multidisciplinary collaborative diagnosis and treatment model,with 50 cases in each group.The diagnostic effects of the two groups were compared.Results:The diagnostic and therapeutic efficiency of the patients in the experimental group were 94%and 98%,respectively,while those of the patients in the control group were 78%and 82%,respectively,with a significant difference between the two groups(p<0.05).The balance scores of the patients in both groups were low before the treatment,in which the difference was not significant(p>0.05);after the treatment,the scores improved,with those of the patients in the experimental group being significantly higher than those in the control group(p<0.05).Moreover,the satisfaction rate of patients in the experimental group(98%)was significantly higher than that of the control group(80%)(p<0.05).Conclusion:The application of the multidisciplinary collaborative diagnosis and treatment model in the diagnosis of patients with vertigo is effective.The multidisciplinary model can improve clinical diagnosis,enhance the treatment effect,improve the clinical symptoms of patients,and increase the satisfaction of patient care.Hence,it is of high clinical application value.展开更多
Surgical resection offers the best opportunity for survival in patients with colorectal cancer metastatic to the liver,with five-year survival rates up to 58% in selected cases.However,only a minority are resectable a...Surgical resection offers the best opportunity for survival in patients with colorectal cancer metastatic to the liver,with five-year survival rates up to 58% in selected cases.However,only a minority are resectable at the time of diagnosis.Continuous research in this field aims at increasing the percentage of patients eligible for resection,refining the indications and contraindications for surgery,and improving overall survival.The use of surgical innovations,such as staged resection,portal vein embolization,and repeat resection has allowed higher resection rates in patients with bilobar disease.The use of neoadjuvant chemotherapy allows up to 38% of patients previously considered unresectable to be significantly downstaged and eligible for hepatic resection.Ablative techniques have gained wide acceptance as an adjunct to surgical resection and in the management of patients who are not surgical candidates.Current management of colorectal liver metastases requires a multidisciplinary approach,which should be individualized in each case.展开更多
BACKGROUND Gallbladder cancer is the most common malignant tumor in the biliary system,and it is characterized by high aggressiveness and an extremely poor prognosis.Current treatment for advanced gallbladder cancer r...BACKGROUND Gallbladder cancer is the most common malignant tumor in the biliary system,and it is characterized by high aggressiveness and an extremely poor prognosis.Current treatment for advanced gallbladder cancer remains unsatisfactory.Here,we report a patient with advanced gallbladder cancer who was cured by multidisciplinary treatment.CASE SUMMARY A 73-year-old male presented to our hospital with right abdominal pain for 3 d and was diagnosed with stage IVB gallbladder cancer with multiple liver metastases,peritoneum metastasis,diaphragm metastasis and lymph node metastases.The patient initially received chemotherapy,targeted therapy,125I seed implantation and immunotherapy,as there were no specific indications for radical surgery.During these palliative therapies,the level of tumor markers gradually decreased but remained higher than the normal level,lymph node metastases gradually disappeared,and liver metastasis was gradually limited to the left liver.Finally,the patient received radical surgery with left hepatectomy,radical lymphadenectomy and partial diaphragmatic resection.To date,the patient has survived for more than six years posttreatment,the levels of tumor markers are normal,and imaging examinations show no signs of tumor recurrence.CONCLUSION Currently,the prognosis of advanced gallbladder cancer remains unsatisfactory.A single treatment method is not sufficient for patients with advanced gallbladder cancer.Multidisciplinary individualized treatment is essential and should be utilized for advanced gallbladder cancer patients to further improve prognosis.展开更多
BACKGROUND Cerebral infarction patients need to be bedridden for long periods of time often resulting in pressure injuries,which may represent a serious threat to patients'life and health.An effective nursing prog...BACKGROUND Cerebral infarction patients need to be bedridden for long periods of time often resulting in pressure injuries,which may represent a serious threat to patients'life and health.An effective nursing program should be adopted for timely intervention in patients with pressure wounds.AIM To explore the value of nursing services based on a multidisciplinary collaborative treatment team in patients with pressure injury wounds following cerebral infarction.METHODS Patients with cerebral infarction pressure injury wounds in our hospital from December 2016 to January 2021 were selected and divided into one study group and one control group based on the simple random number table method.The control group was treated with conventional nursing care(CNC),and the study group was treated with care services based on multidisciplinary collaborative care(MDCC).The Pressure Ulcer Scale for Healing(PUSH),healing effect,Self-Perceived Burden Score(SPBS),and satisfaction with the intervention were calculated before and after 2 and 4 wk of intervention in both groups.RESULTS Sixty-two patients were enrolled,and 31 patients were assigned to each group.The results of the interventions were as follows:(1)There was no significant difference between the PUSH scores of the MDCC group(11.19±2.46)and CNC group(12.01±2.79)before the intervention(P>0.05),and the PUSH scores were lower after 2 and 4 wk of intervention in the MDCC group(6.63±1.97 and 3.11±1.04)than in the CNC group(8.78±2.13 and 4.96±1.35 points)(P<0.05);(2)The rate of wound healing in the MDCC group(96.77%)was higher than that in the CNC group(80.65%)(P<0.05);(3)There was no significant difference between the SPBS scores of emotional factors(21.15±3.11),economic factors(9.88±2.15),and physical factors(8.19±2.23)in the two groups before the intervention.The scores of emotional factors(13.51±1.88),economic factors(6.38±1.44),and physical factors(5.37±1.08)were lower in the MDCC group than in the CNC group(16.89±2.05,7.99±1.68 and 7.06±1.19)after 4 wk of intervention(P<0.05);and(4)Satisfaction with the intervention was higher in the MDCC group(93.55%)than in the CNC group(74.19%)(P<0.05).CONCLUSION Interventions for patients with cerebral infarction pressure wounds based on an MDCC treatment team can effectively reduce patients'self-perceived burden,improve pressure wound conditions,facilitate wound healing,and increase patient satisfaction with the intervention.展开更多
目的了解医务人员对肿瘤多学科协作诊疗(multidisciplinary diagnosis and treatment,MDT)有效实践的认知现状,分析其影响因素,为后续研发MDT评价工具、优化MDT管理与监督等提供依据。方法采取方便抽样方法,以参与肿瘤诊治的医务人员作...目的了解医务人员对肿瘤多学科协作诊疗(multidisciplinary diagnosis and treatment,MDT)有效实践的认知现状,分析其影响因素,为后续研发MDT评价工具、优化MDT管理与监督等提供依据。方法采取方便抽样方法,以参与肿瘤诊治的医务人员作为调查对象,针对医务人员的人口学特征、参与肿瘤MDT的情况、对肿瘤MDT有效实践重要性的感知进行问卷调查和数据分析。结果护理人员参与过肿瘤MDT讨论会占39.66%,仅18.97%加入MDT,且临床医生对肿瘤MDT工作的熟悉程度高于护理人员(χ^(2)=20.147,P<0.001)。“结构-过程的特征”版块中,子表“团队状况”(4.73±0.53)分和维度“会议前的准备”(4.74±0.48)分重要性评分最高;“结果(成效)”版块中,维度“诊疗效果”(4.72±0.52)的重要性评分最高。职称、管理工作年限、对肿瘤MDT工作的熟悉程度是两个版块重要性评分的共同影响因素,高级职称者、一般熟悉者评分高的可能性小,管理年限为6~<11年者评分高的可能性大。结论护理人员参与MDT活动较少,且参与深度有限;医务人员对肿瘤MDT总体重要性感知较高,但“会议的日程安排”“服务效率”等维度有待提高;初级及以下职称、管理工作年限6~<11年、对肿瘤MDT工作熟悉的医务人员对肿瘤MDT实践的重视程度更高。建议重视以患者为中心的服务理念,关注MDT发展的可持续性,并建立有效的考核和激励机制,确保肿瘤MDT模式的有效持久开展。展开更多
Despite surgical removal of tumors with portal vein tumor thrombus(PVTT) in hepatocellular carcinoma(HCC) patients, early recurrence tends to occur, and overall survival(OS) periods remain extremely short. The role th...Despite surgical removal of tumors with portal vein tumor thrombus(PVTT) in hepatocellular carcinoma(HCC) patients, early recurrence tends to occur, and overall survival(OS) periods remain extremely short. The role that hepatectomy may play in long-term survival for HCC with PVTT has not been established. The operative mortality of hepatectomy for HCC with PVTT has also not been reviewed. Hence, we reviewed recent literature to assess these parameters. The OS of patients who received hepatectomy in conjunction with multidisciplinary treatment tended to be superior to that of patients who did not. Multidisciplinary treatments included the following: preoperative radiotherapy on PVTT; preoperative transarterial chemoembolization(TACE); subcutaneous administration of interferon-alpha(IFN-α) and intra-arterial infusion of 5-fluorouracil(5-FU) with infusion chemotherapy in the affected hepatic artery; cisplatin, doxorubicin and 5-FU locally administered in the portal vein; and subcutaneous injection of IFN-α, adjuvant chemotherapy(5-FU + Adriamycin) administration via the portal vein with postoperative TACE, percutaneous isolated hepatic perfusion and hepatic artery infusion and/or portal vein chemotherapy. The highest reported rate of operative mortality was 9.3%. In conclusion, hepatectomy for patients affected by HCC with PVTT is safe, has low mortality and might prolong survival in conjunction with multidisciplinary treatment.展开更多
As a result of donor shortage and high postoperative morbidity and mortality after liver transplantation,hepatectomy is the most widely applicable and reliable option for curative treatment of hepatocellular carcinoma...As a result of donor shortage and high postoperative morbidity and mortality after liver transplantation,hepatectomy is the most widely applicable and reliable option for curative treatment of hepatocellular carcinoma(HCC).Because intrahepatic tumor recurrence is frequent after loco-regional therapy,repeated treatments are advocated provided background liver function is maintained.Among treatments including local ablation and transarterial chemoembolization,hepatectomy provides the best long-term outcomes,but studies comparing hepatectomy with other nonsurgical treatments require careful review for selection bias.In patients with initially unresectable HCC,transarterial chemo-or radio-embolization,and/or systemic chemotherapy can down-stage the tumor and conversion to resectable HCC is achieved in approximately 20%of patients.However,complete response is rare,and salvage hepatectomy is essential to help prolong patients’survival.To counter the short recurrence-free survival,excellent overall survival is obtained by combining and repeating different treatments.It is important to recognize hepatectomy as a complement,rather than a contraindication,to other nonsurgical treatments in a mul-tidisciplinary approach for patients with HCC,including recurrent or unresectable tumors.展开更多
Although recent diagnostic and therapeutic advances have substantially improved the survival of patients with gastric cancer(GC), the overall prognosis is still poor. Surgery is the only curative treatment and should ...Although recent diagnostic and therapeutic advances have substantially improved the survival of patients with gastric cancer(GC), the overall prognosis is still poor. Surgery is the only curative treatment and should be performed in experienced centers. Due to high relapse following surgery, complementary and systemic treatment aimed at eradicating micrometastasis should be performed in most cases. Cytotoxic treatments are effective in downstaging locally advanced cancer, but different sensitivities and toxicities probably exist in different GC subtypes. Current treatment protocols are based primarily on clinical data and histological features, but molecular biomarkers that would allow for the prediction of treatment responses are urgently needed. Understanding how host factors are responsible for inter-individual variability of drug response or toxicity will also contribute to the development of more effective and less toxic treatments.展开更多
Liver transplantation is a major abdominal operation and the intimate anatomic relation of the liver with the right hemidiaphragm predisposes the patient to various manifestations in the chest cavity.Furthermore,chron...Liver transplantation is a major abdominal operation and the intimate anatomic relation of the liver with the right hemidiaphragm predisposes the patient to various manifestations in the chest cavity.Furthermore,chronic liver disease affects pulmonary function before and after liver transplantation resulting in a considerable percentage of patients presenting with morbidity related to chest complications.This review aims to identify the potential chest complications of surgical interest during or after liver transplantation.Complications of surgical interest are defined as those conditions that necessitate an invasive procedure(such as thoracocentesis or a chest tube placement)in the chest or a surgical intervention performed by a thoracic surgeon.These complications will be classified as perioperative and postoperative;the latter will be categorized as early and late.Although thoracocentesis or a chest tube placement is usually sufficient when invasive measures are deemed necessary,in some patients,thoracic surgical interventions are warranted.A high index of suspicion is needed to recognize and treat these conditions promptly.A close collaboration between abdominal surgeons,intensive care unit physicians and thoracic surgeons is of paramount importance.展开更多
BACKGROUND Duodenal obstruction is a common clinical scenario that can either be mechanical or a pseudo-obstruction.Clinical management of intestinal obstruction starts from localization and proceeds to histological e...BACKGROUND Duodenal obstruction is a common clinical scenario that can either be mechanical or a pseudo-obstruction.Clinical management of intestinal obstruction starts from localization and proceeds to histological examination of the stenotic intestine.Systemic factors and dysfunction of distant organs might contribute to the development of intestinal obstruction.Here,we report a unique case of idiopathic mechanical duodenal obstruction,which resolved spontaneously after 3 mo of conservative treatment,but was followed by intestinal pseudo-obstruction.CASE SUMMARY An 84-year-old woman presented with worsened postprandial vomiting accompanied by prolonged pneumonia.Thorough noninvasive investigations revealed complete circumferential stenosis in the descending duodenum without known cause.Exploratory surgery was postponed due to septic shock and possible pulmonary fungal infection.Conservative treatment for 3 mo for ileus and control of pulmonary infection resolved the intestinal obstruction completely.Unfortunately,2 wk later,she had regurgitation and postprandial vomiting again,complicated by deteriorating wheezing and dyspnea.Computed tomography revealed a dilated stomach and proximal duodenum without new intestinal stricture or pulmonary infiltration.The patient fully recovered after combined treatment with antireflux agents,enema,prokinetics,and bronchodilators.CONCLUSION This complicated case highlights the inter-relationship of local and systemic contributions to ileus and gut dysfunction,which requires multidisciplinary treatment.展开更多
BACKGROUND Double-hit lymphoma is a highly aggressive B-cell lymphoma that is genetically characterized by rearrangements of MYC and BCL2 and/or BCL6.Lymphoma is often accompanied by atypical systemic symptoms similar...BACKGROUND Double-hit lymphoma is a highly aggressive B-cell lymphoma that is genetically characterized by rearrangements of MYC and BCL2 and/or BCL6.Lymphoma is often accompanied by atypical systemic symptoms similar to physiological changes during pregnancy and is often ignored.Herein,we describe a gravid patient with high-grade B-cell lymphoma with a MYC and BCL-2 gene rearrangement involving multiple parts of the body.CASE SUMMARY A 32-year-old female,gestational age 22+5 wk,complained of abdominal distension,chest tightness and limb weakness lasting approximately 4 wk,and ovarian tumors were found 14 d ago.Auxiliary examinations and a trimanual gynecologic examination suggested malignant ovarian tumor and frozen pelvis.Coupled with rapid progression,severe compression symptoms of hydrothorax,ascites and moderate anemia,labor was induced.Next,biopsy and imaging examinations showed high-grade B-cell lymphoma with a MYC and BCL-2 gene rearrangement involving multiple parts of the body.She was referred to the Department of Oncology and Hematology for chemotherapy.Because of multiple recurrences after complete remission,chemotherapy plans were continuously adjusted.At present,the patient remains in treatment and follow-up.CONCLUSION The early detection and accurate diagnosis of lymphoma during pregnancy can help expedite proper multidisciplinary treatment to delay disease progression and decrease the mortality rate.展开更多
BACKGROUND Birt-Hogg-Dubé(BHD)syndrome is a rare autosomal dominant disease caused by germline mutations in the folliculin(FLCN)protein gene,which usually manifests as cutaneous fibrofolliculoma,pulmonary cysts,r...BACKGROUND Birt-Hogg-Dubé(BHD)syndrome is a rare autosomal dominant disease caused by germline mutations in the folliculin(FLCN)protein gene,which usually manifests as cutaneous fibrofolliculoma,pulmonary cysts,renal cell carcinoma,and spontaneous pneumothorax.CASE SUMMARY A 26-year-old woman with no history of smoking was admitted to the Respiratory Department of our hospital due to intermittent wheezing that lasted for 8 mo.She had experienced recurrent spontaneous pneumothorax more than four times during the past 8 mo.After admission,the patient again suffered from left pneumothorax without a clear reason.Lung computed tomography(CT)showed multiple low-density cystic changes in both lungs.Physical examination on admission revealed multiple white dome-shaped papules in the neck,the nape,and behind the ear.In addition,the patient had a family history of spontaneous pneumothorax.Her mother had suffered from pneumothorax four times(at age 36,37,42,and 50 years).Her second maternal aunt had suffered from a right pneumothorax at the age of 40.The multidisciplinary diagnosis of BHD,which included the Respiratory Department,Radiology Department,Pathology Department,and Dermatological Department,was BHD and was later confirmed by family genetic testing.The same variation(FLCN gene)was found in the patient’s mother and aunt.CONCLUSION This case highlights the importance of multidisciplinary diagnosis and a treatment platform for the diagnosis of BHD.展开更多
With recent advances in both knowledge and available technology,therapeutic strategies for gastric cancer have become diversified.1 Surgical instruments and devices have improved,and chemotherapeutic drugs and targete...With recent advances in both knowledge and available technology,therapeutic strategies for gastric cancer have become diversified.1 Surgical instruments and devices have improved,and chemotherapeutic drugs and targeted agents have become more advanced as we gain a more comprehensive understanding of gastric cancer biology.The epidemiology of gastric cancer has also been changing due to mass screening programs and improved survival rates.2 However,these collective achievements have not reached the point of making patients satisfied.The relationship between doctors and patients is a very sensitive and hot topic in Chinese medical fields.It is like complex hair knots that can not easily be smoothed without suffering and pain.Keywords：gastric neoplasm; multidisciplinary treatment展开更多
基金supported by the Biomaterials and Regenerative Medicine Institute Cooperative Research Project at Shanghai Jiao Tong University School of Medicine(grant no.2022LHA05)the Shanghai Clinical Research Center of Plastic and Reconstructive Surgery funded by the Science and Technology Commission of Shanghai Municipality(grant no.22Mc1940300).
文摘Molten aluminum is among the most common causes of burns in the metal industry.However,only few reports are available on molten aluminum injuries.Herein,we report an unusual case of molten aluminum burn.The patient had burns not only on the body surface but also in the respiratory tract and esophagus,adding to the difficulty of treatment.Multidisciplinary consultation and cooperation led to the development of a treatment plan for the patient,which included tracheotomy,respiratory management,endoscopic therapy,infection control,and psychological support.To our knowledge,this is the first report of molten aluminum-induced burns involving the face,neck,respiratory tract,esophagus,and eyes.We also describe our experience with multidisciplinary treatment for the management of molten aluminum burns.
文摘BACKGROUND Although choriocarcinoma is thought to be a malignancy curable by chemotherapy,there remain difficult and challenging problems in cases with high prognostic scores or extensive metastases,for which the treatment is limited.Particularly,chemotherapy in combination with other treatments offers promising therapeutic potential for these cases.CASE SUMMARY We present the case of a 40-year-old female patient who suffered from lifethreatening hemoptysis and paraplegia due to choriocarcinoma with pulmonary,hepatic and spinal metastases.The patient successfully recovered after multidisciplinary treatment consisting of 21 cycles of intravenous chemotherapy,radiofrequency ablation of multiple hepatic metastases,intensity-modulated radiation therapy for spinal metastases and routine physiotherapy.To our knowledge,it is the first reported case of recovery from pulmonary,hepatic and spinal metastases of choriocarcinoma with no specific primary site.Moreover,this is the first reported clinical attempt on 5-d actinomycin D as primary chemotherapy in ultrahigh-risk gestational trophoblastic neoplasia.CONCLUSION The case supports the opinion that the individualized treatment of choriocarcinoma by a multidisciplinary approach can accomplish optimal therapeutic effects.
文摘BACKGROUND Gastrointestinal tumors are a major cause of cancer-related deaths and have become a major public health problem.This study aims to provide a scientific basis for improving clinical treatment effects,quality of life,and prognosis of patients with gastrointestinal tumors.AIM To explore the clinical effect of the multidisciplinary diagnosis and treatment(MDT)nutrition intervention model on patients with gastrointestinal tumors.METHODS This was a case control study which included patients with gastrointestinal tumors who received radiotherapy at the Department of Oncology between January 2021 and January 2023.Using a random number table,120 patients were randomly divided into MDT and control groups with 60 patients in each group.To analyze the effect of MDT on the nutritional status and quality of life of the patients,the nutritional status and quality of life scores of the patients were measured before and after the treatment.RESULTS Albumin(ALB),transferrin(TRF),hemoglobin(Hb),and total protein(TP)levels significantly decreased after the treatment.The control group had significantly lower ALB,TRF,Hb,and TP levels than the MDT group,and the differences in these levels between the two groups were statistically significant(P<0.05).After the treatment,the MDT group had significantly more wellnourished patients than the control group(P<0.05).The quality of life total score,somatic functioning,role functioning,and emotional functioning were higher in the MDT group than in the control group.By contrast,pain,fatigue,nausea,and vomiting scores were lower in the MDT group than in the control group(P<0.05).CONCLUSION MDT nutritional intervention model effectively improves the nutritional status and quality of life of the patients.The study provides a rigorous theoretical basis for improving the prognosis of cancer patients.In the future,we intend to provide additional treatment methods for improving the quality of life of patients with cancer.
基金Supported by the Nanjing Medical Science and Technology Development Program,No.YKK17139
文摘BACKGROUND Patients with severe periodontitis often require multidisciplinary treatment to achieve healthy periodontal tissue,normal occlusion,and optimal aesthetics.In the present study,we aimed to evaluate the efficacy of multidisciplinary non-surgical treatment in a patient with stage IV/grade C periodontitis,malocclusion,and dentition defects.CASE SUMMARY A 47-year-old woman visited our periodontology department due to teeth mobility problems and difficulties chewing food.The patient had no history of drug allergies or systemic disease.Initial therapy involved scaling and root planning with a Gracey scaler and periodontal ultrasonic therapeutic apparatus using a periodontal endoscope(Perioscopy,Zest Dental Solutions,United States)to control the periodontal inflammation prior to treatment.Five months later,orthodontic treatment was then performed to treat occlusion and overall aesthetics.After completion,a Maryland bridge was used to restore Nos.22,31,and 41 teeth.Florida probing(Florida probe,United States)was performed every 2-3 mo to evaluate the periodontal condition throughout treatment.Overall,multidisciplinary non-surgical treatment resulted in satisfactory aesthetic results with healthy periodontal tissue and stable occlusion.CONCLUSION In some patients with stage IV/grade C periodontitis,systematic and sequential non-surgical treatment can provide excellent therapeutic results.
文摘Incidence rates for esophagogastric junction cancer are rising rapidly worldwide possibly due to the economic development and demographic changes.Therefore,increased attention has been paid to the prevention,diagnosis,and the treatment of esophagogastric junction cancer.Although there are discrepancies in the treatment strategy between Asian and Western countries,surgery remains the mainstay of treatment for esophagogastric junction cancer.Recent developments of perioperative multidisciplinary treatment may lead to better therapeutic effect,higher complete resection rate,and better control of the residual diseases,thus result in prolonged prognosis.In this review,we will focus on the treatment of locally advanced resectable esophagogastric junction cancer,and discuss the current status and future perspectives of the perioperative treatment including chemotherapy,radiation therapy,and immunotherapy,as well as the surgical strategy.Better understanding of the latest treatment strategy and future overlook may enable to standardize and individualize the treatment for esophagogastric junction cancer,thus leading to better prognosis for those patients.
基金Supported by the Chongqing Medical Scientific Research Project(Joint Project of Chongqing Health Commission and Science and Technology Bureau),No.2020FYYX211Medical Research Project of Wanzhou District(Joint Project of Health Commission and Science and Technology Bureau),No.wzstc-kw2020023.
文摘BACKGROUND As the perioperative risk of elderly patients with extremely unstable hip fractures(EUHFs)is relatively high and therapeutic effect is not satisfactory,new therapeutic strategies need to be proposed urgently to improve the efficacy and clinical outcomes of such patients.AIM To determine the influence of two surgical treatment modalities on postoperative cognitive function(CF)and delirium in elderly patients with EUHFs.METHODS A total of 60 elderly patients consecutively diagnosed with EUHF between September 2020 and January 2022 in the Chongqing University Three Gorges Hospital were included.Of them,30 patients received conventional treatment(control group;general consultation+fracture type-guided internal fixation),and the other 30 received novel treatment(research group;perioperative multidisciplinary treatment diagnosis and treatment+individualized surgical plan+risk prediction).Information on hip function[Harris hip score(HHS)],perioperative risk of orthopedic surgery[Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity(POSSUM)],CF[Montreal cognitive assessment scale(MoCA)],postoperative delirium[mini-cognitive(Mini-Cog)],adverse events(AEs;internal fixation failure,infection,nonunion,malunion,and postoperative delirium),and clinical indicators[operation time(OT),postoperative hospital length of stay(HLOS),ambulation time,and intraoperative blood loss(IBL)]were collected from both groups for comparative analyses.RESULTS The HHS scores were similar between both groups.The POSSUM score at 6 mo after surgery was significantly lower in the research group compared with the control group,and MoCA and Mini-Cog scores were statistically higher.In addition,the overall postoperative complication rate was significantly lower in the research than in the control group,including reduced OT,postoperative HLOS,ambulation time,and IBL.CONCLUSION The new treatment modality has more clinical advantages over the conventional treatment,such as less IBL,faster functional recovery,more effectively optimized perioperative quality control,improved postoperative CF,mitigated postoperative delirium,and reduced operation-related AEs.
基金supported by the Key Research and Development Program of Shaanxi Province(Grant Number:2020SF-146)the Science and Technology Project of Xianyang City(Project Number:2021ZDYF-SF-0062).
文摘Objective:To investigate the effectiveness of applying a multidisciplinary collaborative model for the diagnosis and treatment of patients with vertigo.Methods:The study was carried out in Xianyang Hospital of Yan’an University,in which 100 patients with vertigo were selected from April 2021 to April 2022 and were divided into two groups:the control group was under the single diagnosis and treatment model,whereas the experimental group was under the multidisciplinary collaborative diagnosis and treatment model,with 50 cases in each group.The diagnostic effects of the two groups were compared.Results:The diagnostic and therapeutic efficiency of the patients in the experimental group were 94%and 98%,respectively,while those of the patients in the control group were 78%and 82%,respectively,with a significant difference between the two groups(p<0.05).The balance scores of the patients in both groups were low before the treatment,in which the difference was not significant(p>0.05);after the treatment,the scores improved,with those of the patients in the experimental group being significantly higher than those in the control group(p<0.05).Moreover,the satisfaction rate of patients in the experimental group(98%)was significantly higher than that of the control group(80%)(p<0.05).Conclusion:The application of the multidisciplinary collaborative diagnosis and treatment model in the diagnosis of patients with vertigo is effective.The multidisciplinary model can improve clinical diagnosis,enhance the treatment effect,improve the clinical symptoms of patients,and increase the satisfaction of patient care.Hence,it is of high clinical application value.
文摘Surgical resection offers the best opportunity for survival in patients with colorectal cancer metastatic to the liver,with five-year survival rates up to 58% in selected cases.However,only a minority are resectable at the time of diagnosis.Continuous research in this field aims at increasing the percentage of patients eligible for resection,refining the indications and contraindications for surgery,and improving overall survival.The use of surgical innovations,such as staged resection,portal vein embolization,and repeat resection has allowed higher resection rates in patients with bilobar disease.The use of neoadjuvant chemotherapy allows up to 38% of patients previously considered unresectable to be significantly downstaged and eligible for hepatic resection.Ablative techniques have gained wide acceptance as an adjunct to surgical resection and in the management of patients who are not surgical candidates.Current management of colorectal liver metastases requires a multidisciplinary approach,which should be individualized in each case.
基金Supported by National Natural Science Foundation of China,No. 81873156 and No. 82000075Liaoning Province Education Foundation,No. LZ2019051National Natural Science Foundation of Liaoning,No. 2020-BS-195
文摘BACKGROUND Gallbladder cancer is the most common malignant tumor in the biliary system,and it is characterized by high aggressiveness and an extremely poor prognosis.Current treatment for advanced gallbladder cancer remains unsatisfactory.Here,we report a patient with advanced gallbladder cancer who was cured by multidisciplinary treatment.CASE SUMMARY A 73-year-old male presented to our hospital with right abdominal pain for 3 d and was diagnosed with stage IVB gallbladder cancer with multiple liver metastases,peritoneum metastasis,diaphragm metastasis and lymph node metastases.The patient initially received chemotherapy,targeted therapy,125I seed implantation and immunotherapy,as there were no specific indications for radical surgery.During these palliative therapies,the level of tumor markers gradually decreased but remained higher than the normal level,lymph node metastases gradually disappeared,and liver metastasis was gradually limited to the left liver.Finally,the patient received radical surgery with left hepatectomy,radical lymphadenectomy and partial diaphragmatic resection.To date,the patient has survived for more than six years posttreatment,the levels of tumor markers are normal,and imaging examinations show no signs of tumor recurrence.CONCLUSION Currently,the prognosis of advanced gallbladder cancer remains unsatisfactory.A single treatment method is not sufficient for patients with advanced gallbladder cancer.Multidisciplinary individualized treatment is essential and should be utilized for advanced gallbladder cancer patients to further improve prognosis.
文摘BACKGROUND Cerebral infarction patients need to be bedridden for long periods of time often resulting in pressure injuries,which may represent a serious threat to patients'life and health.An effective nursing program should be adopted for timely intervention in patients with pressure wounds.AIM To explore the value of nursing services based on a multidisciplinary collaborative treatment team in patients with pressure injury wounds following cerebral infarction.METHODS Patients with cerebral infarction pressure injury wounds in our hospital from December 2016 to January 2021 were selected and divided into one study group and one control group based on the simple random number table method.The control group was treated with conventional nursing care(CNC),and the study group was treated with care services based on multidisciplinary collaborative care(MDCC).The Pressure Ulcer Scale for Healing(PUSH),healing effect,Self-Perceived Burden Score(SPBS),and satisfaction with the intervention were calculated before and after 2 and 4 wk of intervention in both groups.RESULTS Sixty-two patients were enrolled,and 31 patients were assigned to each group.The results of the interventions were as follows:(1)There was no significant difference between the PUSH scores of the MDCC group(11.19±2.46)and CNC group(12.01±2.79)before the intervention(P>0.05),and the PUSH scores were lower after 2 and 4 wk of intervention in the MDCC group(6.63±1.97 and 3.11±1.04)than in the CNC group(8.78±2.13 and 4.96±1.35 points)(P<0.05);(2)The rate of wound healing in the MDCC group(96.77%)was higher than that in the CNC group(80.65%)(P<0.05);(3)There was no significant difference between the SPBS scores of emotional factors(21.15±3.11),economic factors(9.88±2.15),and physical factors(8.19±2.23)in the two groups before the intervention.The scores of emotional factors(13.51±1.88),economic factors(6.38±1.44),and physical factors(5.37±1.08)were lower in the MDCC group than in the CNC group(16.89±2.05,7.99±1.68 and 7.06±1.19)after 4 wk of intervention(P<0.05);and(4)Satisfaction with the intervention was higher in the MDCC group(93.55%)than in the CNC group(74.19%)(P<0.05).CONCLUSION Interventions for patients with cerebral infarction pressure wounds based on an MDCC treatment team can effectively reduce patients'self-perceived burden,improve pressure wound conditions,facilitate wound healing,and increase patient satisfaction with the intervention.
文摘目的了解医务人员对肿瘤多学科协作诊疗(multidisciplinary diagnosis and treatment,MDT)有效实践的认知现状,分析其影响因素,为后续研发MDT评价工具、优化MDT管理与监督等提供依据。方法采取方便抽样方法,以参与肿瘤诊治的医务人员作为调查对象,针对医务人员的人口学特征、参与肿瘤MDT的情况、对肿瘤MDT有效实践重要性的感知进行问卷调查和数据分析。结果护理人员参与过肿瘤MDT讨论会占39.66%,仅18.97%加入MDT,且临床医生对肿瘤MDT工作的熟悉程度高于护理人员(χ^(2)=20.147,P<0.001)。“结构-过程的特征”版块中,子表“团队状况”(4.73±0.53)分和维度“会议前的准备”(4.74±0.48)分重要性评分最高;“结果(成效)”版块中,维度“诊疗效果”(4.72±0.52)的重要性评分最高。职称、管理工作年限、对肿瘤MDT工作的熟悉程度是两个版块重要性评分的共同影响因素,高级职称者、一般熟悉者评分高的可能性小,管理年限为6~<11年者评分高的可能性大。结论护理人员参与MDT活动较少,且参与深度有限;医务人员对肿瘤MDT总体重要性感知较高,但“会议的日程安排”“服务效率”等维度有待提高;初级及以下职称、管理工作年限6~<11年、对肿瘤MDT工作熟悉的医务人员对肿瘤MDT实践的重视程度更高。建议重视以患者为中心的服务理念,关注MDT发展的可持续性,并建立有效的考核和激励机制,确保肿瘤MDT模式的有效持久开展。
文摘Despite surgical removal of tumors with portal vein tumor thrombus(PVTT) in hepatocellular carcinoma(HCC) patients, early recurrence tends to occur, and overall survival(OS) periods remain extremely short. The role that hepatectomy may play in long-term survival for HCC with PVTT has not been established. The operative mortality of hepatectomy for HCC with PVTT has also not been reviewed. Hence, we reviewed recent literature to assess these parameters. The OS of patients who received hepatectomy in conjunction with multidisciplinary treatment tended to be superior to that of patients who did not. Multidisciplinary treatments included the following: preoperative radiotherapy on PVTT; preoperative transarterial chemoembolization(TACE); subcutaneous administration of interferon-alpha(IFN-α) and intra-arterial infusion of 5-fluorouracil(5-FU) with infusion chemotherapy in the affected hepatic artery; cisplatin, doxorubicin and 5-FU locally administered in the portal vein; and subcutaneous injection of IFN-α, adjuvant chemotherapy(5-FU + Adriamycin) administration via the portal vein with postoperative TACE, percutaneous isolated hepatic perfusion and hepatic artery infusion and/or portal vein chemotherapy. The highest reported rate of operative mortality was 9.3%. In conclusion, hepatectomy for patients affected by HCC with PVTT is safe, has low mortality and might prolong survival in conjunction with multidisciplinary treatment.
基金Supported by Grant-in-aid from the 106~(th) Annual Congress of the JSS Memorial Surgical Research Fund,Tokyo,Japan
文摘As a result of donor shortage and high postoperative morbidity and mortality after liver transplantation,hepatectomy is the most widely applicable and reliable option for curative treatment of hepatocellular carcinoma(HCC).Because intrahepatic tumor recurrence is frequent after loco-regional therapy,repeated treatments are advocated provided background liver function is maintained.Among treatments including local ablation and transarterial chemoembolization,hepatectomy provides the best long-term outcomes,but studies comparing hepatectomy with other nonsurgical treatments require careful review for selection bias.In patients with initially unresectable HCC,transarterial chemo-or radio-embolization,and/or systemic chemotherapy can down-stage the tumor and conversion to resectable HCC is achieved in approximately 20%of patients.However,complete response is rare,and salvage hepatectomy is essential to help prolong patients’survival.To counter the short recurrence-free survival,excellent overall survival is obtained by combining and repeating different treatments.It is important to recognize hepatectomy as a complement,rather than a contraindication,to other nonsurgical treatments in a mul-tidisciplinary approach for patients with HCC,including recurrent or unresectable tumors.
文摘Although recent diagnostic and therapeutic advances have substantially improved the survival of patients with gastric cancer(GC), the overall prognosis is still poor. Surgery is the only curative treatment and should be performed in experienced centers. Due to high relapse following surgery, complementary and systemic treatment aimed at eradicating micrometastasis should be performed in most cases. Cytotoxic treatments are effective in downstaging locally advanced cancer, but different sensitivities and toxicities probably exist in different GC subtypes. Current treatment protocols are based primarily on clinical data and histological features, but molecular biomarkers that would allow for the prediction of treatment responses are urgently needed. Understanding how host factors are responsible for inter-individual variability of drug response or toxicity will also contribute to the development of more effective and less toxic treatments.
文摘Liver transplantation is a major abdominal operation and the intimate anatomic relation of the liver with the right hemidiaphragm predisposes the patient to various manifestations in the chest cavity.Furthermore,chronic liver disease affects pulmonary function before and after liver transplantation resulting in a considerable percentage of patients presenting with morbidity related to chest complications.This review aims to identify the potential chest complications of surgical interest during or after liver transplantation.Complications of surgical interest are defined as those conditions that necessitate an invasive procedure(such as thoracocentesis or a chest tube placement)in the chest or a surgical intervention performed by a thoracic surgeon.These complications will be classified as perioperative and postoperative;the latter will be categorized as early and late.Although thoracocentesis or a chest tube placement is usually sufficient when invasive measures are deemed necessary,in some patients,thoracic surgical interventions are warranted.A high index of suspicion is needed to recognize and treat these conditions promptly.A close collaboration between abdominal surgeons,intensive care unit physicians and thoracic surgeons is of paramount importance.
基金Peking Union Medical College Hospital Science Fund for Junior Faculty,No.pumch-2016-2.13.
文摘BACKGROUND Duodenal obstruction is a common clinical scenario that can either be mechanical or a pseudo-obstruction.Clinical management of intestinal obstruction starts from localization and proceeds to histological examination of the stenotic intestine.Systemic factors and dysfunction of distant organs might contribute to the development of intestinal obstruction.Here,we report a unique case of idiopathic mechanical duodenal obstruction,which resolved spontaneously after 3 mo of conservative treatment,but was followed by intestinal pseudo-obstruction.CASE SUMMARY An 84-year-old woman presented with worsened postprandial vomiting accompanied by prolonged pneumonia.Thorough noninvasive investigations revealed complete circumferential stenosis in the descending duodenum without known cause.Exploratory surgery was postponed due to septic shock and possible pulmonary fungal infection.Conservative treatment for 3 mo for ileus and control of pulmonary infection resolved the intestinal obstruction completely.Unfortunately,2 wk later,she had regurgitation and postprandial vomiting again,complicated by deteriorating wheezing and dyspnea.Computed tomography revealed a dilated stomach and proximal duodenum without new intestinal stricture or pulmonary infiltration.The patient fully recovered after combined treatment with antireflux agents,enema,prokinetics,and bronchodilators.CONCLUSION This complicated case highlights the inter-relationship of local and systemic contributions to ileus and gut dysfunction,which requires multidisciplinary treatment.
基金Special Talent Project of Jilin Provincial Health Department,No.2019SCZT038.
文摘BACKGROUND Double-hit lymphoma is a highly aggressive B-cell lymphoma that is genetically characterized by rearrangements of MYC and BCL2 and/or BCL6.Lymphoma is often accompanied by atypical systemic symptoms similar to physiological changes during pregnancy and is often ignored.Herein,we describe a gravid patient with high-grade B-cell lymphoma with a MYC and BCL-2 gene rearrangement involving multiple parts of the body.CASE SUMMARY A 32-year-old female,gestational age 22+5 wk,complained of abdominal distension,chest tightness and limb weakness lasting approximately 4 wk,and ovarian tumors were found 14 d ago.Auxiliary examinations and a trimanual gynecologic examination suggested malignant ovarian tumor and frozen pelvis.Coupled with rapid progression,severe compression symptoms of hydrothorax,ascites and moderate anemia,labor was induced.Next,biopsy and imaging examinations showed high-grade B-cell lymphoma with a MYC and BCL-2 gene rearrangement involving multiple parts of the body.She was referred to the Department of Oncology and Hematology for chemotherapy.Because of multiple recurrences after complete remission,chemotherapy plans were continuously adjusted.At present,the patient remains in treatment and follow-up.CONCLUSION The early detection and accurate diagnosis of lymphoma during pregnancy can help expedite proper multidisciplinary treatment to delay disease progression and decrease the mortality rate.
文摘BACKGROUND Birt-Hogg-Dubé(BHD)syndrome is a rare autosomal dominant disease caused by germline mutations in the folliculin(FLCN)protein gene,which usually manifests as cutaneous fibrofolliculoma,pulmonary cysts,renal cell carcinoma,and spontaneous pneumothorax.CASE SUMMARY A 26-year-old woman with no history of smoking was admitted to the Respiratory Department of our hospital due to intermittent wheezing that lasted for 8 mo.She had experienced recurrent spontaneous pneumothorax more than four times during the past 8 mo.After admission,the patient again suffered from left pneumothorax without a clear reason.Lung computed tomography(CT)showed multiple low-density cystic changes in both lungs.Physical examination on admission revealed multiple white dome-shaped papules in the neck,the nape,and behind the ear.In addition,the patient had a family history of spontaneous pneumothorax.Her mother had suffered from pneumothorax four times(at age 36,37,42,and 50 years).Her second maternal aunt had suffered from a right pneumothorax at the age of 40.The multidisciplinary diagnosis of BHD,which included the Respiratory Department,Radiology Department,Pathology Department,and Dermatological Department,was BHD and was later confirmed by family genetic testing.The same variation(FLCN gene)was found in the patient’s mother and aunt.CONCLUSION This case highlights the importance of multidisciplinary diagnosis and a treatment platform for the diagnosis of BHD.
文摘With recent advances in both knowledge and available technology,therapeutic strategies for gastric cancer have become diversified.1 Surgical instruments and devices have improved,and chemotherapeutic drugs and targeted agents have become more advanced as we gain a more comprehensive understanding of gastric cancer biology.The epidemiology of gastric cancer has also been changing due to mass screening programs and improved survival rates.2 However,these collective achievements have not reached the point of making patients satisfied.The relationship between doctors and patients is a very sensitive and hot topic in Chinese medical fields.It is like complex hair knots that can not easily be smoothed without suffering and pain.Keywords：gastric neoplasm; multidisciplinary treatment
