multidisciplinary management

多学科管理
  • 文章类型: Case Reports
    异物(FB)吸入是儿童中最常见的危及生命的紧急情况之一,也是儿科人群死亡的主要原因之一。最常见的是,吸入的物品是有机材料,如坚果和种子。无机物体通常是塑料或金属。误吸的症状可能因位置而异,堵塞的面积和数量,以及对象大小和形状。由于儿童的气道解剖困难,多学科方法-包括耳鼻喉科,肺科,麻醉,和普外科手术-清除气道FBs是必要和谨慎的,以避免更多的侵入性手术参与。这份报告讨论了一名九岁的男性,他吸了两个球形磁铁,它被卡在他的气管支气管树上,需要多学科的方法来去除。
    Foreign body (FB) aspiration is one of the most common life-threatening emergencies in children and one of the leading causes of mortality in the pediatric population. Most commonly, aspirated items are organic materials, such as nuts and seeds. Inorganic objects are usually plastic or metal. Symptoms of aspiration can vary depending on the location, area and amount of blockage, and object size and shape. Because of the difficult airway anatomy of children, a multidisciplinary approach - including otolaryngology, pulmonology, anesthesia, and general surgery - for the removal of airway FBs is necessary and prudent to avoid more invasive surgical involvement. This report discusses a nine-year-old male who aspirated two ball magnets, which became lodged in his tracheobronchial tree and required a multidisciplinary approach for removal.
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  • 文章类型: Case Reports
    Schwannmas,起源于周围神经或颅神经的雪旺鞘,是头颈部或四肢常见的罕见肿瘤。肾上腺神经鞘瘤,然而,非常罕见,占所有肾上腺肿瘤的1%以下。这里,我们介绍了一个31岁的高加索女性,诊断为肾上腺神经鞘瘤,这是在成像研究中偶然发现的一个无关的问题。腹腔镜肾上腺切除术后,患者出现乳糜腹水(CA)和乳糜胸,构成诊断挑战,需要多学科的管理方法。
    Schwannomas, originating from the Schwann sheath of peripheral or cranial nerves, are rare tumors commonly found in the head and neck or extremities. Adrenal schwannomas, however, are exceedingly rare, accounting for less than 1% of all adrenal tumors. Here, we present a case of a 31-year-old Caucasian woman diagnosed with an adrenal schwannoma, which was incidentally discovered during imaging studies for an unrelated issue. Following laparoscopic adrenalectomy, the patient developed chylous ascites (CA) and coexistent chylothorax, posing a diagnostic challenge and necessitating a multidisciplinary approach to management.
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  • 文章类型: Journal Article
    糖尿病足是糖尿病的常见并发症,影响约15-20%的糖尿病患者。这是一种合并症,严重影响患者的常规生活。本研究旨在评估多学科管理策略及其对糖尿病足患者预后的影响。
    对56例糖尿病足患者进行了一项前瞻性观察研究。结果指标包括手术类型,手术频率,发病率,死亡率,患者满意度,重返工作岗位,以及使用假体的患者数量。
    大多数患者(87%)接受了手术治疗。最常见的手术类型是清创术(55%),其次是轻微截肢(脚趾截肢/前足截肢)(28%)和主要截肢(膝盖以下(B/K)或膝盖以上(A/K))(15%)。超过70%的患者进行了多次手术。死亡率很低(7%),71%的存活患者对他们的治疗感到满意。67%的患者提前重返工作岗位。使用假体的患者数量也很高(占主要截肢病例的73%)。
    多学科管理是糖尿病足患者最有效的方法。这些患者的发病率可能较低,并且可以早日恢复工作。糖尿病足患者的专业护理诊所对于防止治疗失败至关重要,随访记录丢失,永久性肢体丧失,和社会的经济负担。
    UNASSIGNED: Diabetic foot is a common complication of diabetes mellitus, affecting approximately 15-20% of individuals with diabetes. It is a comorbid condition that significantly impacts the routine life of patients. This study aimed to assess multidisciplinary management strategies and their impact on the outcomes of patients with diabetic foot.
    UNASSIGNED: A prospective observational study was conducted on 56 patients with diabetic foot. Outcome measures included the type of surgery, frequency of surgery, morbidity, mortality, patient satisfaction, return to work, and the number of patients using prostheses.
    UNASSIGNED: The majority of the patients (87%) received surgical treatment. The most common type of surgery performed was debridement (55%), followed by minor amputations (toes amputation/forefoot amputation) (28%) and major amputations (below-knee (B/K) or above-knee (A/K)) (15%). More than 70% of patients had multiple surgeries. The mortality rate was low (7%), and 71% of surviving patients were satisfied with their treatment. Sixty-seven percent of patients had an early return to work. The number of patients using prostheses was also high (73% of major amputation cases).
    UNASSIGNED: Multidisciplinary management is the most effective approach for diabetic foot patients. These patients may experience less morbidity and an early return to work. A specialized care clinic for diabetic foot patients is essential to prevent treatment failure, loss of follow-up records, permanent limb loss, and economic burdens on society.
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  • 文章类型: Case Reports
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  • 文章类型: Case Reports
    没有确定的基因突变的先天性异常综合征通常在儿科护理中提出重大挑战。需要跨多个专业的协调努力。此病例报告一名10岁女性患者,病情复杂,这体现了管理孩子的复杂性,需要长期随访和全面护理。本病例报告旨在深入分析她的医疗历程,包括各种干预措施,如气管造口术和G管放置,以及用于解决她的先天性异常和相关健康问题的管理策略。
    Congenital anomalies syndrome without an identified genetic mutation often presents significant challenges in pediatric care, requiring coordinated efforts across multiple specialties. This case reports a 10-year-old female patient with complex medical conditions, which exemplifies the intricate nature of managing children, necessitating long-term follow-up and comprehensive care. This case report aims to provide an in-depth analysis of her medical journey, including various interventions like tracheostomy and G-tube placement, and management strategies employed to address her congenital anomalies and associated health issues.
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  • 文章类型: Case Reports
    肝细胞腺瘤(HCA)是一种罕见的良性肝肿瘤,表现出多种亚型,每个都有独特的分子改变。该病例报告描述了一名43岁的有酗酒史的男子,他表现出胃痛。影像学显示肝脏多发病变和乙状结肠炎症,而实验室检查显示中性粒细胞增多和肝酶升高。肿瘤标志物正常。肝活检证实HCA与肝细胞核因子-1α(HNF-1α)失活,以谷氨酰胺合成酶免疫染色阴性为特征,核β-连环蛋白,血清淀粉样蛋白A,C反应蛋白,和肝脏脂肪酸结合蛋白(L-FABP)。由于患者的性别和缺乏典型的危险因素,如激素水平异常,这种情况是独一无二的。男性的HCA,特别是HNF-1α失活,是罕见的,并提出诊断挑战。全面的诊断方法,包括活检和免疫组织化学分析,对于准确的亚型识别至关重要。恶性转化的可能性,尤其是男性患者,强调需要警惕的监测和适当的管理。这个案例强调了在鉴别诊断中考虑HCA的重要性,无论性别和典型的危险因素如何。为与HCA相关的各种演示和风险提供有价值的见解,并强调需要认识和进一步研究,以改善这种罕见疾病的诊断和管理。
    Hepatocellular adenoma (HCA) is an uncommon benign liver tumor that exhibits a variety of subtypes, each distinguished by unique molecular alterations. This case report describes a 43-year-old man with a history of alcoholism who presented with stomach pain. Imaging revealed multiple hepatic lesions and sigmoid colon inflammation, while laboratory tests showed mild neutrophilic leukocytosis and elevated liver enzymes. Tumor markers were normal. A liver biopsy confirmed HCA with hepatocyte nuclear factor-1 alpha (HNF-1α) inactivation, characterized by negative immunostaining for glutamine synthetase, nuclear beta-catenin, serum amyloid A, C-reactive protein, and liver fatty acid-binding protein (L-FABP). This case is unique due to the patient\'s gender and the absence of typical risk factors such as abnormal hormone levels. HCAs in males, particularly with HNF-1α inactivation, are rare and pose diagnostic challenges. Comprehensive diagnostic approaches, including biopsy and immunohistochemical analysis, are crucial for accurate subtype identification. The potential for malignant transformation, particularly in male patients, underscores the need for vigilant monitoring and appropriate management. This case highlights the importance of considering HCA in differential diagnoses regardless of gender and typical risk factors, contributing valuable insights into the diverse presentations and risks associated with HCA, and emphasizing the need for awareness and further research to improve diagnosis and management of this rare condition.
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  • 文章类型: Case Reports
    本病例报告提出了需要切除植入物的极端种植体周围炎的多学科治疗的兴趣,强调了不同的手术方式,并表明常规桥的卵形桥体是前磨牙部门康复的最佳选择。尽管它的主要扩散一直在前部,由于高需求的美学。
    种植体周围炎导致种植体周围骨逐渐丢失。严重和极端的情况会导致植入物完全失败,并意味着必须移除丢失的植入物。移除植入物后的残留脊畸形处理是有助于改善美学和功能效果的因素之一。已经开发了各种接枝程序来实现该目标。本报告描述了一名51岁女性患者因晚期种植体周围炎而从右上第一前磨牙移除种植体的情况。使用同种异体骨移植物和可吸收的胶原膜结合滚蒂结缔组织移植物进行引导骨再生,可用于窝和软组织增强。这与卵形设计传统的临时桥梁相结合。经过6个月的愈合阶段,获得了临时修复周围边缘牙龈的完美适应。锥形束计算机断层扫描显示出显着的骨填充和颊舌尺寸稳定性。选择具有椭圆形桥体设计的常规全陶瓷桥作为最终的假体解决方案,以补偿开胃病并保持良好的美学效果。根据在这个临床病例中获得的令人鼓舞的结果,在需要移除植入物的晚期种植体周围炎的情况下,与衰竭组织的手术重建相关的常规假体修复可被视为成功的治疗方法。
    UNASSIGNED: This case report presents the interest of multidisciplinary management of extreme peri-implantitis requiring removal of implant emphasizing the different surgical and showing that the ovate pontic of conventional bridge is an optimal alternative for rehabilitation of the premolar sector, despite the fact that its main diffusion has been in the anterior sector due to the high demand aesthetic.
    UNASSIGNED: Peri-implantitis leads to gradual peri-implant bone loss. Severe and extreme cases lead to complete implant failure and imply lost implants have to be removed. Residual ridge deformity management after implant removal is one of the factors contributing to improved aesthetic and functional results. Various grafting procedures have been developed to achieve this goal. This report describes a case of implant removal from the upper right first premolar due to advanced peri-implantitis in a 51-year-old female patient. Guided bone regeneration with a alloplastic bone graft and resorbable collagen membrane combined with roll pedicle connective tissue graftt was used for both socket and soft-tissue augmentation. This was combined with ovate design conventional provisional bridge. After a 6-month of healing phase, a perfect adaptation of the marginal gingiva around the provisional restoration was obtained. Cone beam computed tomography revealed significant bone fill and buccolingual dimensional stability. A conventional all-ceramic bridge with an oval pontic design was chosen as a definitive prosthetic solution to compensate for edentulism and maintain the good aesthetic results. According to the encouraging result obtained in this clinical case, the conventional prosthetic restoration associated with surgical reconstruction of failing tissues can be considered as a successful treatment in the case of advanced peri-implantitis requiring implant removal.
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  • 文章类型: Case Reports
    背景:滑膜肉瘤是一种罕见的软组织恶性肿瘤,偶尔在头颈部发现。诊断需要涉及临床表现的多学科方法,适当的影像学研究和组织学确认,进行分子测试以进行最终鉴定。治疗需要手术切除,并根据需要进行辅助治疗。
    方法:一名33岁的男性患者表现为球形感并伴有右侧颈部肿胀。临床上发现他有右扁桃体增大并向后延伸。因此,他接受了右扁桃体切除术和咽成形术。组织病理学检查显示与滑膜肉瘤一致的双相肿瘤,通过免疫组织化学和荧光原位杂交证实。
    结论:扁桃体滑膜肉瘤是一种诊断挑战,需要高度怀疑和综合评价。文献中只记录了20个以前发表的案例,对这种罕见表现的认识对于及时诊断和适当管理至关重要.多学科医疗团队之间的合作和正在进行的研究工作对于优化诊断准确性至关重要。治疗功效,以及这种罕见恶性肿瘤的患者预后。
    BACKGROUND: Synovial sarcoma is a rare soft tissue malignancy, occasionally found in the head and neck region. The diagnosis necessitates a multidisciplinary approach involving the clinical presentation, proper imaging studies and histological confirmation, with molecular testing for definitive identification. Treatment entails surgical resection with adjuvant therapies as needed.
    METHODS: A 33-year-old male patient presented with globus sensation concomitant with right-sided neck swelling. He was clinically found to have right tonsil enlargement with posterior extension. Therefore, he underwent right tonsillectomy with pharyngoplasty. Histopathological examination revealed a biphasic tumor consistent with synovial sarcoma, confirmed by immunohistochemistry and fluorescence in situ hybridization.
    CONCLUSIONS: Tonsillar synovial sarcoma represents a diagnostic challenge, requiring a high index of suspicion and comprehensive evaluation. With only twenty previously published cases documented in the literature, awareness of this rare presentation is crucial for prompt diagnosis and appropriate management. Collaboration among multidisciplinary healthcare teams and ongoing research efforts are essential for optimizing diagnostic accuracy, treatment efficacy, and patient outcomes in this rare malignancy.
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  • 文章类型: Case Reports
    结节病由于其不同的临床表现和模仿恶性肿瘤的潜力而提出了诊断挑战。我们报告了一例临床病例,涉及一名46岁的女性,该女性被诊断为接受手术治疗的局部卵巢和子宫内膜癌。辅助化疗和放疗后,该患者在影像学研究中观察到可疑的肺小结节和淋巴结病,引起人们对癌症复发的担忧。组织病理学分析显示慢性肉芽肿性炎症没有恶性肿瘤的证据,导致诊断为继发于化疗的结节病样反应。值得注意的是,这些病变在没有特殊干预的情况下自发消退.此病例强调了多学科方法在管理复杂的肿瘤学表现中的重要性,并强调了组织病理学检查在区分恶性肿瘤和化疗引起的结节病样反应中的重要性。
    Sarcoidosis presents a diagnostic challenge due to its diverse clinical manifestations and potential to mimic malignancies. We report a clinical case involving a 46-year-old woman diagnosed with localized synchronous ovarian and endometrial carcinomas treated with surgery. Following adjuvant chemotherapy and radiotherapy, the patient developed suspicious pulmonary micronodules and lymphadenopathy observed in imaging studies, raising concerns about cancer recurrence. Histopathological analysis revealed chronic granulomatous inflammation without evidence of malignancy, leading to a diagnosis of a sarcoidosis-like reaction secondary to chemotherapy. Remarkably, these lesions resolved spontaneously without specific intervention. This case emphasizes the importance of a multidisciplinary approach in managing complex oncological presentations and underscores the significance of histopathological examination in distinguishing between malignancy and chemotherapy-induced sarcoidosis-like reactions.
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  • 文章类型: Case Reports
    腹部钝性创伤会导致一系列伤害,从表面挫伤到严重的内脏穿孔。我们介绍一名52岁男性参与自行车与卡车相撞的案例,导致复杂的腹内损伤.患者出现急性腹痛及腹膜炎征象,促使紧急诊断检查和手术干预。影像学检查显示气腹,自由流体,和多处肋骨骨折表明严重创伤。剖腹探查术揭示了空肠穿孔,并伴有肠系膜撕裂和肠套叠,需要进行节段性肠切除和修复。组织病理学分析证实急性出血性炎症与外伤性穿孔一致。这个案例突出了与腹部钝性创伤相关的挑战和复杂性,强调迅速承认的重要性,多学科管理,以及优化患者预后的手术干预。
    Blunt abdominal trauma can result in a spectrum of injuries, ranging from superficial contusions to severe hollow viscus perforations. We present the case of a 52-year-old male involved in a bicycle-truck collision, leading to complex intra-abdominal injuries. The patient presented with acute abdominal pain and signs of peritonitis, prompting urgent diagnostic workup and surgical intervention. Imaging studies revealed pneumoperitoneum, free fluid, and multiple rib fractures indicative of significant trauma. Exploratory laparotomy unveiled a perforated jejunal loop with an associated mesenteric tear and intussusception, necessitating segmental bowel resection and repair. Histopathological analysis confirmed acute hemorrhagic inflammation consistent with traumatic perforation. This case highlights the challenges and complexities associated with blunt abdominal trauma, emphasizing the importance of prompt recognition, multidisciplinary management, and surgical intervention in optimizing patient outcomes.
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