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At least 217 records · Page 12Linked to original sources
PubMed2005

Randomized clinical trial of multimodal optimization of surgical care in patients undergoing major colonic resection.

BACKGROUND: The aim of this trial was to compare multimodal optimization with conventional perioperative management in a consecutive series of patients undergoing a wide range of colorectal procedures. METHODS: Thirty-nine patients undergoing major elective colonic resection were recruited prospectively. Patients were randomized to receive a ten-point multimodal optimization package or conventional perioperative care. All patients were administered epidural analgesia and opiates were avoided. Outcome measures recorded related to length of hospital stay, physical and mental function, and gut function. RESULTS: Optimization was associated with a significantly shorter median (interquartile range) hospital stay compared with conventional care (5 (4-9) versus 7.5 (6-10) days; P = 0.027). Duration of catheterization (P = 0.022) and duration of intravenous infusion (P = 0.007) were also less. Optimization was associated with a quicker recovery of gut function (P = 0.042). Grip strength was maintained in the postoperative period in the optimized group (P = 0.241) but not in the control group (P = 0.049). There were no differences in morbidity or mortality between the groups. CONCLUSION: Optimization is safe and results in a significant reduction in postoperative stay along with other improved endpoints. This cannot be directly attributed to improvement in any single outcome measure or to the use of epidural analgesia. Improvements are more likely to be multifactorial and may relate to an earlier return of gut function.

Adult↗
PubMed1990

Lipid-rich metastatic balloon-cell melanoma: diagnosis by a multimodal approach to aspiration biopsy cytology.

Fine needle aspirates from one of multiple liver nodules revealed a large number of discohesive malignant cells with abundant vacuolated cytoplasm. The patient had had left eye enucleation the year before, for a melanoma with focal areas of clear cell change. Pap stained preparations from the liver FNA displayed well the nuclear features of balloon cell melanoma, including anisonucleosis, prominent nucleoli and intranuclear inclusions. Diff-Quik stain demonstrated best the cytoplasmic features such as distinct cell margins and finely dispersed and sharply delineated clear vacuoles. No pigmentation was noted but melanoma was suspected after the history prompted comparison with the enucleated specimen resected a year previously. A multimodal battery of ancillary methods including electron microscopy (EM) and immunocytochemistry (ICC) allowed the confirmation of balloon-cell melanoma, a rare variant not previously described in the eye. By EM, abundant lipids were identified along with melanin-containing structures resembling melanosomes. S-100 positivity along with negativity for epithelial, lymphohistiocyte and germ cell markers was compatible with melanoma. These findings are consistent with the view that cytologic detection of poorly cohesive, hypervacuolated cells does not exclude the possibility of melanoma. This rare example of a lipid-containing melanoma stresses the value of obtaining good clinical history, comparing FNAs to any pre-existing material and utilizing a multimodal approach to cytologic diagnosis in select cases.

Aged↗
PubMed2004

An in vitro model to optimize dose scheduling of multimodal radioimmunotherapy and chemotherapy: effects of p53 expression.

Several reports have appeared on the use of combined radioimmunotherapy (RAIT) and chemotherapy. The choice of drug to use with RAIT and how to space the two treatments has not been completely addressed. Because every patient's cancer presents with a specific molecular phenotype, we hypothesized that it may be necessary to tailor therapy based on specific gene expression. We addressed how the form of expression of a single gene, the p53 tumor suppressor, would impact the choice of agents, as well as sequence and spacing of agents. p53 regulates cell cycle arrest to allow for DNA repair after therapy-induced small DNA damage or induction of apoptosis if damage is great and has been shown to affect chemo- and radiosensitivity of cancer cells. We established 3 stable p53 transfectants of the SKOV-3 p53null parental line (p53(wt), p53(143mut) or p53(273mut)). p53 expression was confirmed using flow cytometry, using the DO1 pan-p53 Ab and the PAb240 anti-p53mut Ab. The colorimetric MTT assay was then used to measure dose-dependent growth inhibition from single modality chemotherapy (doxorubicin, carboplatin, paclitaxel or topotecan) or radioimmunotherapy (90Y-RS-7 IgG anti-EGP1). The % survival vs. log [drug] were plotted to obtain the IC50. We then used a matrix design in which we varied the sequence of the first and second modality of treatment and the spacing between the 2 treatments to determine the most synergistic and antagonistic combinations for the parental SKOV-3 and each of the 3 transfectants. The IC50 for each therapeutic agent varied as a function of the form of p53 expressed. For example, of the 4 lines, the p53wt transfectant was the most resistant to topotecan and the 143mut was the most resistant to carboplatin. The 273mut was quite sensitive to both doxorubicin and paclitaxel, whereas the p53null and wt were not. For multimodal treatments, most combinations of RAIT and chemotherapy resulted in a 30-40% growth inhibition (GI) and were either additive or moderately antagonistic. The 3 best (>60% GI) and 3 worst (<25% GI) combinations were identified and were unique to the parental p53null and to the 3 transfectants. Certain combinations showed clear synergy and others were antagonistic, with the first treatment modality blocking the growth inhibitory effects of the second treatment modality. The form of p53 expressed affects chemosensitivity and radiosensitivity and will influence optimal multimodal therapy with RAIT and chemotherapy and the dose-schedule (sequential with RAIT first or with drug first) when more than 1 agent is used.

Antineoplastic Agents↗
PubMedDate not supplied

Effects of a multimodal pain rehabilitation program: a pilot study.

The purpose of this pilot study was to examine the effects of a multimodal pain rehabilitation program on pain perceptions, opioid usage, activity, down time, sleep, and role function status of 23 chronic pain patients. Data were collected at the start of the program, at the program's completion, and again during a follow-up period (3-11 months afterwards). At the end of the program, patients reported a significant reduction in pain levels, opioid usage, and hours of disturbed sleep. During the follow-up period, patients continued to report significant improvements in activity and role functions as well as significant reductions in opioid usage, sleep disturbance, and down time. These findings provided encouraging preliminary evidence that multimodal pain rehabilitation programs for chronic pain patients may be effective in pain management and functional restoration.

Activities of Daily Living↗
PubMed2004

A multimodal behavioral approach to performance anxiety.

Cognitive-behavior therapy (CBT) stresses a trimodal assessment framework (affect, behavior, and cognition [ABC]), whereas the multimodal approach assesses seven discrete but interactive components--behavior, affect, sensation, imagery, cognition, interpersonal relationships, and drugs/biological factors (BASIC I.D.). Only complex or recalcitrant cases call for the entire seven-pronged range of multimodal interventions. Various case illustrations are offered as examples of how a clinician might proceed when confronted with problems that fall under the general heading of performance anxiety. The main example is of a violinist in a symphony orchestra whose career was in serious jeopardy because of his extreme fear of performing in public. He responded very well to a focused but elaborate desensitization procedure. The hierarchy that was eventually constructed contained many dimensions and subhierarchies featuring interlocking elements that evoked his anxiety. In addition to imaginal systematic desensitization, sessions were devoted to his actual performance in the clinical setting. As a homework assignment, he found it helpful to listen to a long-playing record of an actual rehearsal and to play along with the world-renowned orchestra and conductor. The subsequent disclosure by the client of an important sexual problem was dealt with concomitantly by using a fairly conventional counseling procedure. Therapy required 20 sessions over a 3-month period.

Adult↗
PubMed1988

Multimodality treatment of non-small cell lung cancer: response to cisplatin, VP-16, and 5-FU chemotherapy and to surgery and radiation therapy.

Twenty-one patients with unresectable non-small cell lung cancer (NSCLC), 11 with stage III M0, five with malignant pleural effusion, and five with a single resectable metastasis were treated with multimodality therapy. All received two to three cycles of preoperative chemotherapy with a new sequential combination of cisplatin (50 mg/m2 IV X 1) followed by 5-FU infusion (40 mg/m2/hr X 72) and etoposide (80 mg/m2/day X 3). Thirteen of 21 (62%) had a partial response, and three (14%) had a minor response to chemotherapy. Of the 19 who underwent surgical exploration, 17 were confirmed to have NSCLC. Ten patients with NSCLC and one with choriocarcinoma were rendered disease free by resection of the primary tumor and lymph nodes. Six received intra- and/or perioperative interstitial therapy with 125I and/or 192Ir. Another patient was treated with 32P. Postoperative external radiotherapy was administered in 15 patients, and adjuvant chemotherapy was administered in ten. This multimodality therapy was well tolerated, safe, and highly effective, resulting in excellent palliation even in patients with pleural effusion and metastasis. The most promising results were in unresectable stage III M0 with a partial response rate of 82% following neoadjuvant chemotherapy and a complete response rate of 73% after surgery. In this group, median survival has not yet been reached and will exceed 12 months.

Adult↗
PubMedDate not supplied

Role of multimodal treatment in oropharynx, larynx, and hypopharynx cancer.

Due to recent advances in radiation fractionation, radiochemotherapy, and conservative surgical techniques, the concept of multimodal therapy in head and neck cancer is currently changing. The recently published RTOG Phase III trial 9003, with 1,113 patients accrued, showed that hyperfractionation and accelerated fractionation with concomitant boost are more efficacious than standard fractionation for locally-advanced head and neck cancer. Acute, but not late, toxicity was also increased. Three meta-analyses have suggested that the impact of chemotherapy in head and neck cancer is small but is highly associated with the timing of therapy. Concomitant administration of radiation therapy and chemotherapy led to an absolute benefit in 5-year survival of about 10%. This finding has been further supported by recently published randomized prospective trials comparing concomitant radiochemotherapy with radiotherapy alone in advanced head and neck cancer. There is now clear evidence that radiochemotherapy provides a substantial and statistically significant improvement in survival and local-regional control, as compared to radiotherapy alone. Radiochemotherapy should be considered an accepted standard of care in cancers of the oropharynx, particularly for patients with locally-advanced disease who have a good performance status. Two randomized studies conducted by the Department of Veterans' Affairs and the EORTC, with a total of 534 patients accrued, showed that induction chemotherapy followed by radiotherapy of responders yields survival rates equal to those of total laryngectomy with postoperative radiotherapy. After 4 years, one-half to two-thirds of survivors of the chemotherapy arm retained a functional larynx. Larynx preservation using induction chemotherapy can now be regarded as feasible but still investigational. Current phase II studies show excellent larynx preservation rates using a primary concomitant radiochemotherapy with an altered fractionation regimen. More clinical and laboratory research is required to further evaluate the different treatment options of the multimodality concept, and to develop prognostic models that will allow individualization of the therapy.

Combined Modality Therapy↗
PubMedDate not supplied

Conservative management of rectal carcinoma: the efficacy of a multimodality approach.

The goals of the conservative management of adenocarcinoma of the distal rectum are to preserve rectal sphincter function and achieve excellent local tumor control. Multimodality therapy for more advanced disease suggests that these goals will be met by conservative surgery combined with radiation therapy and chemotherapy. Over 100 patients with T0-3 N0-1 lesions have been treated in prospective single institution trials with either local excision or anterior resection with coloanal anastomosis, usually combined with chemotherapy and radiotherapy. The typical criteria for local excision have been for lesions to be 4.0 cm or less, mobile, and not poorly differentiated or mucinous. Patients with larger or more advanced lesions may undergo anterior resection with coloanal anastomosis. Following resection, radiotherapy is delivered to the pelvis and tumor bed often with concomitant chemotherapy. The overall rate of local failure in the trials in which local excision is performed with postoperative chemoradiotherapy is 3% for T1 lesions, 5% for T2 lesions, and 30% for T3 lesions with a median follow-up of at least 25 months. Local failure in patients with a coloanal anastomosis is 9% overall. Salvage was successful in about half of the patients who failed locally. Importantly, nearly all patients remained continent. These institutional studies show that sphincter preservation can be used in patients who are objectively selected for this procedure. However, before this multimodality approach may be considered standard therapy the rate of local control must be confirmed in a large, Phase II, multicenter, prospective trial such as that now underway in many of the cooperative groups.

Adenocarcinoma↗
PubMed1996

Multimode high-performance liquid chromatography of fluorescently labeled oligosaccharides from glycoproteins.

A polymeric, secondary amine stationary phase was used to develop a method for the separation of 2-aminobenzamide (AB)-labeled neutral and anionic oligosaccharides from glycoproteins. Sequential hydrophilic interaction liquid and anion exchange chromatography were performed in the same chromatographic analysis (multimode HPLC) and unambiguous separation between neutral and anionic oligosaccharides was accomplished. Improved resolution was also achieved. The oligomannosidic-type structures from bovine ribonuclease B (Man4GlcNAc-AB-Man9GlcNAc-AB) were separated not only by size, but also by the branch location of terminal Manalpha(1 --> 2)-linked residues. Sialylated lactosamine-type oligosaccharides from human alpha1 acid glycoprotein were resolved according to charge, Fuc content, and the number of Galbeta(1 --> 4)Galbeta(1 --> 3) repeats. The minor fucosylated and polylactosamine species were well separated from the major sialylated tetra-antennary oligosaccharides. Volatile mobile phases were used to minimize sample handling for matrix assisted laser desorption mass spectrometric analysis of peak fractions. Novel polylactosamine structures (3-5 repeats) from alpha1-acid glycoprotein were deduced from the molecular weight analysis. Multimode HPLC should prove useful for preparing low pmol quantities of fluorescently labeled oligosaccharides with fewer steps and minimal sample handling for mass spectrometric analysis, important requisites for structural studies of sample-limited glycoproteins.

Animals↗
PubMed1999

Novelty effects in a multimodal warning signal.

The warning signals of toxic insects are often 'multimodal', combining bright coloration with sounds or odours (or both). Pyrazine (a common insect warning odour) can elicit an intrinsic avoidance in domestic chicks Gallus gallus domesticus, both against novel coloured food, and also against food colours that are specifically associated with aposematism, namely yellow and red. In three experiments, we investigated the role of novelty in this innate bias against yellow coloured food in the presence of pyrazine. Naive chicks were familiarized either to pyrazine odour or to coloured food before being tested for a bias against yellow (warningly coloured) food as opposed to green (nonwarningly coloured) food. In experiment 1, pyrazine novelty was shown to be vital for eliciting a bias against yellow food. However, experiment 2 suggested that colour novelty was not important: chicks familiarized with coloured crumbs still avoided yellow crumbs when pyrazine was presented. In a third experiment that gave chicks an even greater degree of pre-exposure to coloured crumbs, the bias against yellow food eventually waned, although pyrazine continued to elicit an aversion to yellow even after birds had had experience of up to 24 palatable yellow crumbs. Pyrazine novelty has been an important pressure in the evolution of multimodal warning signals, and can continue to promote the avoidance of warningly coloured food, even when it is relatively familiar. The implications for warning signals are discussed. Copyright 1999 The Association for the Study of Animal Behaviour.

Journal Article↗
PubMed1993

Evaluation of brain function in acute carbon monoxide poisoning with multimodality evoked potentials.

The median nerve somatosensory evoked potentials (SEP), pattern reversal visual evoked potentials (VEP), and brain stem auditory evoked potentials (BAEP) were studied in 109 healthy adults and in 88 patients with acute carbon monoxide (CO) poisoning. The upper limits for normal values of peak and interpeak latencies of multimodalities of evoked potentials in the reference group were established by a stepwise multiple regression analysis. SEP changes selectively affecting N32 and N60 were found in 78.8% of patients. There was prolonged P100 latency of VEP in 58.2% of the cases examined. The prevalence of BAEP abnormalities in comatose patients (36%) was significantly higher than that (8.6%) in conscious patients. BAEP abnormalities were most frequently seen in comatose patients who had diminished brain stem reflexes (77.8%). It has been found that a consistent abnormality involving N20 and subsequent peaks in SEP, a remarkable prolongation of P100 latency in VEP, or a prolongation of III-V interpeak latency in BAEP as well as the reoccurrence of evoked potential abnormalities after initial recovery all indicate unfavorable outcomes in patients with acute CO poisoning. The multimodality evoked potentials have proved to be sensitive indicators in the evaluation of brain dysfunction and in the prediction of prognosis of acute CO poisoning and the development of delayed encephalopathy.

Adult↗
PubMed2001

Sarcoma in association with multimodality management of vulvar cancer: two case reports.

BACKGROUND: Radiation-induced or -associated sarcoma is a rare event which has been well described in the literature. However, this entity has been infrequently described in association with genital tract malignancies. To our knowledge it has never been described in association with the management of vulvar cancer. CASES: . Two different cases of sarcoma developing after primary management for vulvar cancer are presented, the first being a case of angiosarcoma developing in the lower abdominal wall 36 months after initial therapy and the second a case of fibrosarcoma developing on the vulva 7 years after multimodality treatment. CONCLUSION: Radiation-associated sarcoma after treatment for vulvar carcinoma is a rare event. A multimodality treatment of carcinoma of the vulva should not be withheld because of fear of sarcomagenesis.

Abdominal Neoplasms↗
PubMed1993

Multimodal imaging integration and stereotactic intracerebral electrode insertion in the investigation of drug resistant epilepsy.

Insertion of intracerebral electrodes for EEG recording is sometimes necessary during the pre-operative evaluation of patients with drug resistant epilepsy to define the site of seizure onsets. The precise and accurate placement of the electrodes requires a stereotactic technique of insertion based on correlated information derived from computerised imaging and stereotactic angiography. Described methods of multimodal stereotactic image integration present limitations in terms of satisfactory relocation and ability to spread data acquisition over a period of time. An alternative method of stereotactic acquisition of multimodal image information using the Gill-Thomas stereotactic repeat localiser is presented. Digital Angiographic (DSA), Computerised (CT) and Magnetic Resonance Imaging (MRI) data were correlated and used for target selection. The positional accuracy of the electrodes was confirmed repeatedly during the recording period with standard radiographic and MRI means and found to be satisfactory. There were no permanent complications in any of the patients included in the study. Stereoangiography correlative to computerised neuro-imaging offered a high degree of safety during the operation. Non-invasive relocation was an important feature of the combined system which was particularly helpful and duly appreciated by the patients. The temporal freedom provided during the investigative and operative period offers the advantage of an unhurried multi-image integration and targeting combined with less discomfort for the patient. The positional accuracy of the electrodes was easily verified during the post-operative period and this information added to the electroence-phalographic localising value of the technique.

Brain↗
PubMed1983

Periodic, multimodal distribution of granule volumes in mast cells.

The areas of 2327 mast cell granules in transmission electron micrographs of sections of peritoneal mast cells from adult rats were measured by digitized planimetry. A histogram constructed using equivalent volumes calculated from the measured areas assuming approximation of the granules to spheres showed a periodic multimodal distribution in which the modes fell at volumes that were successively larger integral multiples of the volume at the first mode. Application of a moving-bin technique to the data confirmed the presence of the modes. We propose a mechanism of fusion of unit sized granules to account for the multimodal distribution. The presence of pear- and dumbbell-shaped granules in mast cells is consistent with this mechanism.

Animals↗
PubMed1987

Multimodality evoked potentials and electroencephalography in severe coma cases. Clinical experiences in a neurosurgical intensive care unit.

In a neurosurgical intensive care unit 26 patients with unconsciousness and unresponsiveness were investigated by means of multimodality evoked potentials and electroencephalography in order to obtain information on the functional state of the nervous system. Multimodality evoked potential techniques allowed us to differentiate patients with EEG alterations due to drug treatment from those without therapy. The functional state and prognosis can be better evaluated by means of evoked potential techniques. Patients with raised intracranial pressure seem to undergo some characteristic alterations in FEP and far field potential derivations.

Adolescent↗
PubMed1994

Computer supported multimodal bed-side monitoring for neuro intensive care.

Multimodal monitoring in neuro-intensive care requires computer supported data analysis and archiving. This paper describes a computer system that is able to integrate the results of analysis of intracranial pressure, cerebral perfusion pressure, transcranial Doppler blood flow velocity, jugular bulb oxygen saturation, laser Doppler blood flow, near infrared spectroscopy. A research-oriented software installed in a standard IBM PC equipped with a low-cost analog-to-digital converter allows a broad spectrum of waveform analyses, from calculation of simple mean values to a selective waveform detection and cross-correlation analysis. The architecture for the signal processing algorithm, the principles of system interfacing and data presentation are discussed briefly. Results from two years of multimodal monitoring in neuro-intensive care show that, apart from simple recording of time trends of monitored variables, certain calculated parameters are particularly useful in the continuous assessment of cerebral haemodynamic and compensatory reserves. Such parameters include: transcranial Doppler pulsatility indices, the dependence between blood flow velocity or laser Doppler flux and cerebral perfusion pressure and the correlation coefficient between pulse amplitude and mean intracranial pressure.

Adolescent↗
PubMed1997

Multimodal therapies in ductal pancreatic cancer. The future.

CONCLUSIONS: Intra-arterial infusion chemotherapy via the celiac axis combined with external beam radiotherapy might be an effective method for palliative and perioperative multimodal treatment in pancreatic cancer. To improve the dismal prognosis in resectable and nonresectable pancreatic cancer, the results of multimodal palliative, adjuvant, and neoadjuvant therapies were reviewed and put into perspective with the results of two intra-arterial palliative and adjuvant treatment studies conducted at our department. The benefits and pitfalls of each method were outweighed, resulting in a concept for performing intra-arterial chemotherapy with radiotherapy in nonresectable stage UICC-III pancreatic cancer that eventually will be developed as a combined neoadjuvant/adjuvant treatment of all potentially resectable ductal pancreatic carcinomas.

Carcinoma, Ductal, Breast↗
PubMedDate not supplied

Effectiveness of multimodality treatment for resectable pancreatic cancer.

Since November 1983, 16 patients with resectable pancreatic cancer have been treated by a multimodality approach at the National Cancer Center Hospital. This therapy included extended pancreatic resection, intraoperative irradiation by 30 Gy of electrons, and intraoperative hepatic arterial or portal infusion of mitomycin C. Furthermore, postoperative chemotherapy with mitomycin C, using Seldinger's method or intravenously, was added. The patients consisted of 12 with carcinoma of the pancreatic head and four with carcinoma of the body and tail. The 1- and 3-yr survival rates for these patients were 88 and 53%, respectively. The rates were markedly better than the 26 and 10% after conventional radical pancreatectomy from 1962 to 1983. The cancers consisted of Stage I, 1 case; II, 1; III, 11; and IV, 3 according to the p-TNM pathological classification by UICC, and the 1- and 3-yr survival rates for the 14 patients other than those with Stage I and II were 85 and 57%, respectively. According to our experience, pancreatic carcinoma usually pursues an aggressive course and is unlikely to be cured by surgery alone. A multimodality therapy in addition to radical surgery appears to be necessary in the treatment of resectable pancreatic cancer.

Aged↗