ObjectiveTo summarize the comprehensive multidisciplinary team (MDT) treatment and holistic scientific management approach in a case of hepatocellular carcinoma (HCC) in S7+S9 segments with prostatic metastasis. MethodsA retrospective analysis was conducted on the clinical data and follow-up outcomes of a patient with HCC in S7+S9 segments who developed prostatic metastasis during treatment, admitted to the Tenth Affiliated Hospital of Southern Medical University (Dongguan People’s Hospital of Guangdong Province). ResultsDue to the complexity of the patient’s condition, an MDT discussion was held upon initial admission. It was concluded that the HCC diagnosis was clear, with lesions confined to the liver (S7+S9 segments) and a tumor diameter less than 3 cm, making surgical resection or ablation therapy the preferred options. However, the patient declined liver transplantation and surgical resection. Therefore, CT-guided microwave ablation (MWA) was performed on the primary HCC lesions in segments S7 and S9b. Prior to subsequent treatments for recurrent disease, MDT discussions were held again, and treatments were tailored to the discussion outcomes while respecting the patient’s wishes. Over time, the patient underwent CT-guided liver puncture MWA, re-ablation for recurrent tumors, transarterial chemoembolization (TACE), stereotactic body radiation therapy (SBRT), targeted therapy, and immunotherapy. Following this comprehensive MDT treatment plan, the patient had survived for over 78 months, with no evidence of active tumor lesions in the liver, prostate, or other parts of the body. Alpha-fetoprotein levels and liver function remained normal, and the patient’s quality of life was good. ConclusionComprehensive MDT treatment incorporates various technologies and approaches, along with holistic scientific management, can yield favorable outcomes for patients with complex and challenging HCC.
ObjectiveTo explore the application value of multidisciplinary collaborative team (MDT) model in retroperitoneal tumors involving large vessels.MethodsThree cases of retroperitoneal tumors involving great vessels admitted to Xiang’an Hospital of Xiamen University in 2019 were retrospectively analyzed. With the support of 3D visual reconstruction and virtual reality (VR) technology, we performed MDT discussion and three cases received treatment of surgery, intervention, and targeted therapy.ResultsCase 1 was discussed by MDT and concluded that, based on CT examination, 3D reconstruction, and VR virtual image results, the tumor on the right side was determined to be completely resectable. The left tumor was judged to be unresectable, and the proposed treatment plan was right metastatic tumor resection + left metastatic tumor radiofrequency ablation. After surgery case 1 had been followed up for 6 months. The symptoms of diarrhea were significantly improved. CT reexamination showed that liver lesions and left retroperitoneal lesions were the same size and the condition was stable. After discussion by MDT, radiofrequency ablation around the tumor was proposed for case 2. This case was followed up for 3 months after surgery, and CT reexamination showed no new lesion in retroperitoneum. After MDT discussion, we concluded that arteriovenous fistula of case 3 had no indications for surgery, and proposed interventional combined with targeted therapy. After treatment, the tumor was found to be smaller after reexamination in 8 months than before treatment, and the efficacy was evaluated as partial remission. The follow-up was continued.ConclusionThe future development trend of retroperitoneal tumor therapy involving great vessels is to evaluate each patient’s condition under the MDT mode by using 3D visual reconstruction and VR technology, and to formulate the individualized treatment plan of operation combined with other treatments.
ObjectiveTo explore value of multidisciplinary team (MDT) discussion in comprehensive downstaging treatment of liver cancer.MethodThe clinical data of 2 patients with liver cancer who could not undergo the radical surgery admitted to the Affiliated Hospital of Southwest Medical University were analyzed retrospectively.ResultsCase 1 was diagnosed as the liver cancer with extensive double lung metastasis at admission. The clinical stage was stage Ⅲb; After MDT discussion, the patient was treated with chemotherapy and embolization via hepatic artery and bronchial artery; At the same time, the patient was treated with apatinib; At present, the metastasis of both lungs disappeared completely; The clinical stage was stage ⅡB, and the radical resection was proposed. Case 2 was diagnosed as the right liver cancer at admission. The clinical stage was stage Ⅰ b. The preoperative examination showed that the hepatic reserve function was poor and the patient could not tolerate the half hepatectomy; After MDT discussion, the patient was treated with the combination of chemotherapy and embolization via the hepatic artery and apatinib in the same period; At the same time, the patient was treated with liver protection. The clinical stage was reduced to stage Ⅰ a. The hepatic reserve function improved and the laparoscopic right hemihepatectomy was performed, no recurrence or metastasis was found after 3 months follow-up.ConclusionComprehensive downstaging treatment based on MDT model could bring better clinical outcomes for patients with liver cancer who are unable to undergo one-stage radical surgery.
Objective To explore the treatment of a case of clonorchiasis with Budd-Chiari syndrome through multidisciplinary team (MDT) discussion. Methods A case of clonorchiasis with Budd-Chiari syndrome was treated in the Second Affiliated Hospital of Chongqing Medical University in August 2021. We summarized the discussion of MDT and the process of diagnosis and treatment. Results The patient was admitted because of “more than 8 years after partial hepatectomy and more than 1 year of abdominal distension”. Eight years before admission, the patient underwent right hepatic trisegmentectomy and left hepaticojejunostomy due to a huge space occupying right liver. Postoperative pathological examination revealed multifocal necrosis with granulomatous reaction, and parasitic infection was considered. One year before admission, the patient began to have ascites, and the medical treatment was ineffective. The CT examination of the upper abdomen after admission showed hepatic segmental stenosis of the inferior vena cava, unclear display of the hepatic veins and a large amount of ascites. After MDT discussion, this patient underwent direct intrahepatic portosystemic shunt (DIPS) and percutaneous transluminal angioplasty (PTA) , and the stent was unobstructed in the 9-month follow-up after discharge, and no recurrence of ascites was found. Conclusions DIPS combined with PTA can significantly improve the clinical symptoms of clonorchiasis with Budd-Chiari syndrome. Discussion through MDT mode can improve the effectiveness of treatment and obtain better prognosis.
ObjectiveTo explore the efficacy of artificial intelligence (AI) detection on pulmonary nodule compared with multidisciplinary team (MDT) in regional medical center.MethodsWe retrospectively analyzed the clinical data of 102 patients with lung nodules in the Xiamen Fifth Hospital from April to December 2020. There were 57 males and 45 females at age of 36-90 (48.8±11.6) years. The preoperative chest CT was imported into AI system to record the detected lung nodules. The detection rate of pulmonary nodules by AI system was calculated, and the sensitivity, specificity of AI in the different diagnosis of benign and malignant pulmonary was calculated and compared with manual film reading by MDT.ResultsA total of 322 nodules were detected by AI software system, and 305 nodules were manually detected by physicians (P<0.05). Among them, 113 pulmonary nodules were diagnosed by pathologist. Thirty-eight of 40 lung cancer nodules were AI high-risk nodules, the sensitivity was 95.0%, and 25 of 73 benign nodules were AI high-risk nodules, the specificity was 65.8%. Lung cancer nodules were correctly diagnosed by MDT, but benign nodules were still considered as lung cancer at the first diagnosis in 10 patients.ConclusionAI assisted diagnosis system has strong performance in the detection of pulmonary nodules, but it can not content itself with clinical needs in the differentiation of benign and malignant pulmonary nodules. The artificial intelligence system can be used as an auxiliary tool for MDT to detect pulmonary nodules in regional medical center.
Tracheotomy is a commonly used measure in clinical rescue of critically ill patients, and it has an important impact on the survival outcome of patients. The time of extubation directly affects the recovery process of the patient. This article reviews the research progress of extubation management of tracheotomy patients at home and abroad, and mainly summarizes and elaborates from four aspects, including the role of the multidisciplinary team in tracheostomy management, where tracheostomy patients are extubated, conditions for extubation in tracheotomy patients, and wound care after extubation in tracheotomy patients. The purpose is to provide a reference for the selection of extubation timing and extubation management for patients with tracheotomy, to improve the success rate of extubation and improve the quality of life of patients.
Objective To investigate the value of multidisciplinary team (MDT) diagnosis and treatment model in the conversion therapy of liver cancer. Method The clinical data of a patient with high-risk giant liver cancer of the right liver who was admitted to People’s Hospital of Leshan in April 2019, and who was successfully conversion therapy and safely underwent hepatectomy after MDT discussion was retrospectively analyzed. Results A 62 years old male patient was admitted to our hospital with “abdominal distension for more than 1 month, and liver mass was found for 10 days”. The relevant auxiliary examinations were perfected. The patient was diagnosed as huge primary hepatocellular carcinoma in the right liver. One-stage surgical resection cannot be performed safely due to the huge tumor. After MDT discussion, transcatheter arterial chemoembolization (TACE) combined with sorafenib targeted therapy was decided to reduce the lesions, and two-stage surgical resection was performed safely after conversion therapy. After two cycles of TACE combined with sorafenib targeted drug therapy, MDT discussed the feasibility of safe surgical resection, and underwent fluorescence-guided laparoscopic right posterior lobectomy. The postoperative pathological examination revealed moderately differentiated hepatocellular carcinoma. The patient recovered and was discharged from the hospital one week later. Outpatient followed-up for 32 months showed no obvious abnormality. Conclusions MDT discussion can formulate a more individualized treatment plan, improve the conversion rate and resectable rate of advanced liver cancer, and has important value in the diagnosis and treatment of advanced liver cancer.
With the widespread application of high-resolution and low-dose computed tomography (CT), especially the increasing number of people participating in lung cancer screening projects or health examinations, the detection of pulmonary nodules is increasing. At present, the relevant guidelines for pulmonary nodules focus on how to follow up and diagnose, but the treatment is vague. And the guidelines of European and American countries are not suitable for East Asia. In order to standardize the diagnosis and treatment of pulmonary nodules and address the issue of disconnection between existing guidelines and clinical practice, the Lung Cancer Medical Education Committee of the Chinese Medicine Education Association has organized domestic multidisciplinary experts, based on literature published by experts from East Asia, and referring to international guidelines or consensus, the "Chinese expert consensus on multidisciplinary minimally invasive diagnosis and treatment of pulmonary nodules" has been formed through repeated consultations and thorough discussions. The main content includes epidemiology, natural course, malignancy probability, follow-up strategies, imaging diagnosis, pathological biopsy, surgical resection, thermal ablation, and postoperative management of pulmonary nodules.
ObjectiveTo evaluate the role and value of multidisciplinary team (MDT) in the decision-making for the treatment of elderly patients with large hepatocellular carcinoma (HCC) with multiple organ dysfunction. MethodThe clinicopathologic data of an elderly patient with large HCC with multiple organ dysfunction admitted to Dongguan Hospital of Southern Medical University were analyzed retrospectively. ResultsThe patient was an 82 years old male patient with asthmatic bronchitis, long-term hormone use, severe pulmonary ventilation dysfunction, moderate pericardial effusion, hypertension, and poor liver function compensation. After MDT discussion including 10 departments and full communication with the patient and his families, the open hepatectomy for hepatic S5 and S4b and cholecystectomy were proposed to perform. The operation process was smooth, and the patient was discharged on the 15th day after the operation without any complications. After discharge, lenvatinib was taken and thymosin alpha for injection was injected. At present, the patient’s quality of life was better, and there was no tumor recurrence or metastasis. ConclusionsFor the elderly patients with large HCC with severe cardiopulmonary dysfunction, the risk of treatment is higher. By MDT mode, the optimum treatment scheme for patient could be formulated to ensure efficient and accurate diagnosis and ensure high-quality treatment process, so as to maximally benefit patient.
ObjectiveTo summarize the injury characteristics and therapeutic strategy of patients injured in " 8·8” Jiuzhaigou earthquake.MethodsThe clinical data of 48 patients injured in " 8·8” Jiuzhaigou earthquake who were admitted to Mianyang Central Hospital were analyzed retrospectively. There were 25 males and 23 females with an average age of 36 years (range, 5-87 years). The average interval from injury to admission was 30 hours (range, 3-53 hours). The patients from Sichuan province accounted for 45.8% (22 cases), from other province for 52.1% (25 cases), and from abroad for 2.1% (1 case). Patients were primarily hurted by collapsing houses and flying stones. Thirty-seven patients (77.1%) had single injury, mainly involving 36 patients (75.0%) in limbs, and the other 11 patients (22.9%) had multiple injuries. Ten patients (20.8%) had open fractures, including 1 case rated as typeⅠ, 2 as typeⅡ, 3 as type Ⅲa, 2 as type Ⅲb, and 2 as type Ⅲc according to Gustilo classification criteria. The abbreviated injury scale (AIS) score was 2-3 in 37 patients of single injury, and the injury severity score (ISS) was 8-22 (mean, 13.2) in 11 patients of multiple injuries. Sixteen patients (33.3%) were diagnosed as mental disorders by Hamilton rating scale for anxiety (HAMA), including 8 cases had their anxiety scores≥29, 4 cases of 21-28, 3 cases of 14-20, and 1 case of 7-13. Of the 16 patients, 2 showed suicidal tendency.ResultsExcept 2 referrals, 30 patients received operation［28 patients (93.3%) for orthopaedic surgeries］and 16 patients received conservative treatment. The procedures included internal fixation, soft tissue debridement, external fixation, bipolar femoral head replacement, embolization of carotid cavernous sinus arteriovenous fistula, and amputation. Among the 46 patients treated in this hospital, 21 discharged from hospital at 2-12 days (mean, 6.7 days) after admission, the others received further rehabilitation in this hospital or local hospital. No undesirable consequence occurred in 16 patients with mental disorders. Five cases of infection occurred out of hospital were cured after debridement. No dead and nosocomial infection case reported.ConclusionIntensive treatment, specialist management, multidisciplinary team, and early intervention of nosocomial infection and deep venous thrombosis are the key to improve the general level of successful earthquake medical rescue.