Challenge For Multidisciplinary Team Research Articles

Clinical management of Hypoplasic Amelogenesis Imperfecta: a challenge for multidisciplinary team. A case report

Amelogenesis imperfecta (AI) refers to a group of rare genetic disorders that involve tooth development and are passed down through families. Hypoplasic AI phenotypes include the absence of enamel as a result of a defect in the secretory stage. This case report describes the diagnosis and treatment of a patient with hypoplastic AI. The clinical implications include sensitive teeth, functional problems, and aesthetic complaining. The diagnosis was done through history, clinical examination and imaging. The intervention was performed by Direct Resin Veneers. This treatment showed to improve occlusion, esthetics, and selfimage of the teenager. The satisfactory clinical result has made it possible to avoid more invasive and expensive treatments.

Optimizing care for high-risk neuroblastoma patients treated with dinutuximab: Challenges for the multidisciplinary team.

Current treatment protocols for high-risk neuroblastoma include high-dose chemotherapy, surgery, stem cell transplantation and radiation. Recently, dinutuximab, a chimeric monoclonal antibody, specifically targeting the disialoganglioside highly expressed on neuroblastoma cells, has been licensed. Its incorporation in maintenance therapy represents a promising treatment approach. The introduction of its use was a challenge for the entire multidisciplinary team in our pediatric hematology and oncology ward just as for the pharmacy team. An overview of the key points that were observed is presented.

Chemical Anaplasia in Atypical Debut of Non-small Cell Lung Cancer with Inguinal and Obturator Lymph Node Metastases

Non-small cell lung cancer (NSCLC) represents almost 80-85% of lung cancer cases. It is the most frequent malignancy after skin cancer. The therapeutic options for stage IV of disease consider histology, molecular characteristics, age, performance status, comorbidities, and not in the lust, patient�s option. This paper presents the case of a male patient, 73 years old, smoker, presented and treated in May 2016 in the Sf. Ap. Andrei Emergency Clinical Hospital Galati. The first sign of disease was inguinal and obturator right lymph node metastases whose histopathological test revealed metastases from malignant melanoma. Immunohistochemical tests (IHC) indicated undifferentiated carcinoma with lung as starting point, (Ck7 (+), TTF1 (+)). Thorax, abdominal and pelvic computed tomography (CT) imaging not evidenced space replacement processes in lung, but with mediastinal, right obturator and inguinal adenopathy. From personal pathological history we retain basocellular carcinoma in lumbar region, treated with surgery in 2009. It was initiated palliative chemotherapy and radiotherapy with remission of obturator and inguinal adenopathy, and at 9 months from diagnosis the Positron Emission Tomography (PET-CT) evidenced primary lung tumor situated in right superior lobe (RSL). At the present, patient is alive performing palliative chemotherapy. This case presented diagnostic and treatment issues, being a challenge for multidisciplinary team. We are mentioning the paucity of literature data regarding cases of primary tumors situated upper diaphragm which metastases in inguinal lymph nodes.

Frank Donal Schofield

The management of radiation-induced secondary malignancies in the female genital tract after pelvic radiation treatment for a primary gynecological tumor is a challenge for multidisciplinary teams that follow survivors. Considering...

Treating high grade gliomas in the elderly: the end of ageism?

Introduction Treating high grade gliomas in the elderly is a challenge for multidisciplinary teams. Most studies on this topic exclude patients aged >65 and a Karnofsky Performance Status (KPS) score of <70, a group most likely to have a poor outcome. We undertook this study to analyze the outcomes in a cohort of patients which included such patients. Methods Ours was a retrospective cohort study. About 71 consecutive patients with high grade gliomas, who were seen in the neurooncology clinic in 2004, were included. The case records of these patients were scrutinized for the demographic, clinical data, follow-up and survival. The cohort was divided into two groups; Age > or =65 and age <65 for analysis. The factors influencing survival were analyzed using the Cox's proportional hazards model in each group. Results In the age group > or =65 years, patients treated with a radical resection +/- adjuvant therapy had a lower risk of death (hazard ratio 0.14, 95%CI 0.04-0.51, P = 0.003) when compared to patients undergoing a biopsy +/- adjuvant therapy and palliative treatment. In the group <65 years, the greater the age, greater was the risk of death (hazard ratio 2.05, 95%CI 1.13-3.73, P = 0.01). The median survival was 12 months in the group <65 years and 5 months in age > or =65 years (P = 0.001). In the group > or =65 years, those patients who had radical resection +/- adjuvant treatment had a median survival of 7 months as compared to 3 months in the patients who had biopsy +/- adjuvant treatment (P = 0.003). KPS, presence of co-morbidities, duration of symptoms, location of the lesion and sex were not found to be significant independent predictors of survival in our study. Conclusions Age is an important predictor of survival in younger patients, however in the elderly treatment matters most. Elderly patients undergoing radical surgery +/- adjuvant treatment had a longer median survival as compared to the elderly patients undergoing a biopsy +/- adjuvant treatment. KPS was not found to be a significant independent predictor of survival probably because of underrepresentation of patients with poor KPS. Radical treatment should not be denied to elderly patients who are deemed fit as the outcome is significantly better.