Multimodal Management of Grade 1 and 2 Pancreatic Neuroendocrine Tumors

Pancreatic neuroendocrine tumors (p-NETs) are rare tumors with a recent growing incidence. In the 2017 WHO classification, p-NETs are classified into well-differentiated (i.e., p-NETs grade 1 to 3) and poorly differentiated neuroendocrine carcinomas (i.e., p-NECs). P-NETs G1 and G2 are often non-functioning tumors, of which the prognosis depends on the metastatic status. In the localized setting, p-NETs should be surgically managed, as no benefit for adjuvant chemotherapy has been demonstrated. Parenchymal sparing resection, including both duodenum and pancreas, are safe procedures in selected patients with reduced endocrine and exocrine long-term dysfunction. When the p-NET is benign or borderline malignant, this surgical option is associated with low rates of severe postoperative morbidity and in-hospital mortality. This narrative review offers comments, tips, and tricks from reviewing the available literature on these different options in order to clarify their indications. We also sum up the overall current data on p-NETs G1 and G2 management.

Case Reports On The Multimodal Management of Refractory Chronic Oncological Pain of The Chest Wall: The Use of The Spinal Erector Plane Neurolysis

Chronic pain of oncological origin is one of the most frequent complications and is difficult to control, that results in a decrease in the quality of life and disability among patients suffering from this pathology. Primary or metastatic tumors originating from lung, colonic, or breast neoplasms can invade the chest wall, causing progressive respiratory pain and symptoms that require multiple interventions to achieve adequate control. Many of these cases presenting with advanced-stage cancer are often incurable; thus, pain management and palliative care are primary objectives. Multimodal management is the strategy of choice in these cases through the participation of a multidisciplinary team. Analgesic therapy covers the use of potent opioids, opioid rotation, adjuvant analgesics, and interventional pain management strategies. We report two cases of chronic oncological pain of the chest wall refractory to pharmacological analgesic management. The optimization of multimodal management and the performance of neurolysis by phenolization of the erector spinae plane achieved an adequate response.

Co-animation and the Multimodal Management of Contextualisation Problems when Jointly ‘Doing Being’ Others

In everyday interaction, participants speak on their own behalf but may temporarily speak as or on behalf of a figure (i.e. past or fictional self, others or objects). This practice of ‘animation’ can be continued or extended by co-participants in responsive position, resulting in co-animation (Cantarutti, 2020) of the same figure. Animation relies on the successful ascription of roles, participation framework shifts and projected stances to either the here-and-now of interaction or the there-and-then of animated content. In turn, the recognition of a response as a co-animation requires the creation of similarity between animated contributions. Through a multimodal interactional linguistic analysis of 89 cases of co-animation, this paper discusses how participants jointly solve these interactional contextualisation ‘problems’ smoothly through multimodal gestalts of lexico-grammatical, prosodic and gestural detail.

Randomized, double-blind, placebo-controlled clinical trial measuring the effect of a dietetic food on dermatologic scoring and pruritus in dogs with atopic dermatitis

Background Canine atopic dermatitis (AD) is a common condition that often requires multimodal therapy. Including a diet in the multimodal management of AD may reduce medication doses, saving pet owners money and reducing side effects. The objective of this randomized, double-blind, placebo-controlled clinical trial was to determine if a diet fortified in antioxidants, polyphenols, and omega-3 fatty acids can reduce the clinical signs of AD. Forty client-owned dogs with AD were enrolled in the study and assigned to either an enriched diet (diet B) or control diet (diet A) for 60-days. CADESI-4 index scores and owner-reported pruritus scores were measured periodically. Results Total CADESI-4 index scores for dogs eating diet B were lower on day 60 compared to baseline (P = 0.003). There was no statistical difference in scores for dogs eating diet A over a 60-day period. Diet B dogs had 25 and 49% reductions in CADESI-4 index scores on days 30 and 60, respectively (P = 0.0007) while diet A had no change over the study period. When comparing the percent change in owner-reported pruritus scores, diet B also performed better than diet A. By day 60, owners feeding diet B to their dogs reported a significant reduction (P < 0.0001) of 46.4% in itching, while those on diet A reported a 26.8% reduction, which was not statistically significant (P = 0.08). Conclusions These study results demonstrate feeding a diet enriched with ingredients to improve skin health and reduce inflammation improves the clinical signs of AD in dogs.

Veterinary management of feline osteoarthritis

Osteoarthritis is a progressive, degenerative condition, which causes mobility issues and behavioural changes in affected cats as a result of chronic pain. Despite reports in the literature suggesting a vast prevalence of the condition among the domestic cat population, the condition appears to be underdiagnosed. This is likely due to a combination of subtle clinical signs, lack of owner awareness and poor correlation between radiographical changes and severity of clinical signs. Multimodal management of feline osteoarthritis is likely to be most successful in alleviating pain and improving quality of life. This may include some or all of the following: medical management, rehabilitation therapies, weight loss, environmental adaptations, joint supplements and surgery.

Complete Response in Metastatic Hepatocellular Carcinoma with Cardiac and Lung Involvement via Multimodality Treatment

Background: Until recently, advanced HCC patients with major vessel and cardiac involvement have had an extremely poor prognosis without satisfactory treatment. Case presentation: A 63-year-old Taiwanese male presented with metastatic HCC with RA and IVC thrombi, as well as pulmonary metastases that were successfully treated by multimodal management, encompassed by surgical thrombectomy, concurrent systemic sorafenib and locoregional therapies, and immunotherapy. The patient has achieved a complete response over the past 33 months. Conclusion: Through this case report, which shows a successful outcome via multimodal management, a more aggressive approach should be considered when a patient is expected to tolerate the risks and side effects of various treatments.

Perceptions and experiences of a manual therapy trial: a qualitative study of people with moderate to severe COPD

Background Chronic obstructive pulmonary disease (COPD) presents with physical, emotional and social difficulties that affect quality of life. Multimodal management includes both pharmacological and non-pharmacological strategies, and pulmonary rehabilitation (PR) plays an important role. Recent research has suggested that manual therapies may improve perceptions of dyspnea for people with COPD. Methods Focus group interviews were conducted as part of a mixed methods study to assess the feasibility of implementing a manual therapy technique—muscle energy technique (MET)—as an adjunct to PR for people with moderate to severe COPD. Focus group interviews were conducted to examine trial participants views of the intervention and the trial design. A thematic analysis was undertaken to explore the data. Results Twelve participants with moderate to severe COPD participated in three focus groups. Participants were motivated to participate in the trial to be proactive about their health. They perceived MET to be a gentle, comfortable form of stretching that allowed them to ‘breathe easier’ and prepared them for PR. A small number of participants reported mild muscular discomfort during MET, but this was short-lasting and was not bothersome. Participants enjoyed the one-on-one contact with researchers and learned more about their breathing while performing spirometric testing. Most participants wanted longer and more frequent MET sessions, and some requested ‘homework’ stretching exercises. Conclusions The findings of this study show that a manual therapy intervention was received well by participants in a clinical trial setting. A small number of participants reported mild musculoskeletal discomfort in relation to the MET treatment. Participant preferences for additional and longer treatment sessions should be carefully considered against available resources in future clinical trials. Trial registration ANZCTR, ACTRN12618000801213. Registered 11 May 2018 - Retrospectively registered. http://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=374643&isReview=true

Treatment of Patients with Somatic Tinnitus Attributed to Temporomandibular Disorder: A Case Report

Tinnitus is a common symptom described in patients with temporomandibular disorders (TMDs), affecting quality of life and frequently causing distress. Somatic or somatosensory tinnitus can be attributed to the somatic system of the temporomandibular or cervical spine. Due to the multifactorial etiology of TMD, its management should be based on a multidisciplinary approach. Dentists and physical therapists may play a role in the individual and multimodal management of such patients. The aim of this case study is to analyse the effects of the conservative multidisciplinary management of tinnitus in patients with coexisting tinnitus, TMD and bruxism.

Lumbar Disc Herniations in Children. A Five-Year Single Center Experience

Lumbar disc herniations represent one of the most common complications of degenerative disc disease in adults and have a favorable outcome with surgery. In children, on the other hand, disc prolapse is a relatively rare pathologic entity mandating cautious multimodal management. This paper presents the five-year long experience of a single pediatric neurosurgical unit and our management strategy for children diagnosed with lumbar disc prolapse.