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At least 487 records · Page 27Linked to original sources
PubMed2004

Osteosarcoma in children: long-term functional analysis.

Multimodal, limb-saving therapy is the treatment of choice in children with osteosarcoma. However, few data are available on long-term functional problems and disabilities in surviving patients. Seventy-eight children treated for Stage II-B osteosarcoma who were treated between 1970 and 1997 were evaluated. Beyond the clinical examination, functional results were assessed using the scoring system of the Musculoskeletal Tumor Society. Patients reported their physical disabilities when completing the Toronto Extremity Salvage Score. The most recent cohort of patients who had tumor resection combined with preoperative and postoperative chemotherapy had the best 10-year survival rate at 70%. Thirty-four children (44%) were treated by limb-sparing therapy with 25 children requiring an endoprosthesis. Ten of these 25 children (40%) required one or in some cases several replacements of the endoprostheses because of complications. The original prostheses were in place for a median of 4.9 years before the first exchange (range, 2.0-12.0 years). Evaluations with rating scales showed that the subjective estimation of disabilities by the Toronto Extremity Salvage Score was significantly higher than a rating of limb functions by a doctor using the Musculoskeletal Tumor Society score. Best results were observed in children with an endoprosthesis of the distal femur who achieved as much as 90% ability to do their daily life routine. Limb-saving therapy in children with osteosarcoma enables a return to activities of daily living in long-term survivors with a minimum of remaining disability.

Activities of Daily Living↗
PubMed1991

[Clinical importance of determination of lipid peroxidation of erythrocyte membrane in children with mucoviscidosis].

The intensity of membranous red blood cell metabolism (lipid peroxidation /LPO/ and malonic dialdehyde /MDA/ metabolism) was examined in children suffering from mucoviscidosis depending on the gravity of the clinical manifestations of the disease. The membranopathological processes accompanied by different disorders of membranous metabolism, depending on the patient's status gravity and the intensity of inflammation in the respiratory organs were revealed. Based on the disagreement between different parameters that characterize LPO of red blood cells and MDA metabolism the conclusion is drawn that in children with mucoviscidosis, the metabolic processes occurring at the level of cellular membranes are not balanced. The data obtained point to the necessity of an individual approach to the use of membranoprotectors in multimodality treatment of children with mucoviscidosis together with the control over the treatment efficacy on the basis of a dynamic follow-up of membranous LPO with the aid of the method employed in the work.

Child↗
PubMedDate not supplied

[Recurrence after radiotherapy and/or surgery of carcinoma of the oropharynx and the pharynx. Possibilities of salvage surgery].

Forty-seven laryngeal and 21 oropharyngeal recurrences were treated with salvage surgery alone or combined with radiotherapy at the ENT Clinic and Radiotherapy Division of the University of Turin, Italy. Primary tumors had been treated with surgery alone in 10 cases (larynx) and in 21 cases (oropharynx), with combined surgery and radiotherapy in 2 and 8 patients, and with radiotherapy alone in 9 and 18 cases. We observed 26/47 (larynx) and 12/21 (oropharynx) recurrences at the site of primary tumor, 20/47 and 9/21 in loco-regional nodes, and 9/47 and 3/21 in locations adjacent to the primary tumor. Salvage treatment employed surgery alone in 12 (oropharynx) and 16 (larynx) cases; radiotherapy was combined in 9 and 31 cases. Five-year actuarial NED survival was 45.5% for laryngeal and 24% for oropharyngeal cancer patients. After salvage surgery, 50% of laryngeal lesions and only 25% of oropharyngeal recurrences were completely cured. In our series, in 2 cases only the complications caused the patient's death, while in the extant cases a prolonged postoperative hospitalization was necessary. Our study was aimed at investigating the curative potentials of secondary therapy for recurrent carcinomas. A review of the literature on the subject is reported. The small amount of published data prevents "universal" treatment protocol from being assessed. The authors suggest the opportunity of employing a multimodal treatment policy for recurrences of head and neck cancers.

Adult↗
PubMed1987

[Radiotherapy combined with BRM (biological response modifiers) in the treatment of cancer].

The latest treatment of biological response modifiers (BRM) with or without another cancer treatment modalities has been increased. In this paper, radiotherapy combined with some BRM, which were used in systemic administration and intra-arterial infusion, was demonstrated. 1) In experimental study, radiation and IL-2 indicated the synergic effects on the tumor growth inhibition. 2) Radiotherapy and IFN-beta for advanced head and neck and pelvic tumor were successful in tumor effects and tolerable in side effects. 3) The clinical trial showed that pathological effects and clinical tumor response (CR rate) of radiation and LC9018 for cervical cancer stage IIb, III were significantly better than those of radiotherapy alone. These data suggested that the treatment of radiation and BRM was useful and should be considered in multimodal therapy for cancer.

Adjuvants, Immunologic↗
PubMed2002

Estramustine phosphate enhances the effects of hyperthermia and induces the small heat shock protein HSP27 in the human prostate carcinoma cell line PC-3.

The antimicrotubule drug estramustine phosphate (EMP) has been shown to sensitize prostate carcinoma cells to radiation via synchronization at the G2/M phase of the cell cycle. This synchronization may also render cells more sensitive to hyperthermia, providing a rationale for multimodal treatment approaches. We have investigated the effects of EMP and hyperthermia, as well as the regulation of heat shock proteins (HSP) in the PC-3 prostatic carcinoma cell line. Cells were incubated with four doses of EMP for 48 h followed by a 1-h hyperthermia treatment ranging from 41 degrees C to 44 degrees C. Cell cycle distribution at the end of the EMP incubation was investigated by flow cytometry. Cytotoxicity was assessed by colony formation assays. HSP accumulation was investigated by Western immunoblotting. Doses of 1, 5, 10 and 15 microM EMP synchronized 27, 28, 46, and 68% of PC-3 cells at G2/M. With 5, 10 and 15 microM, a sensitizing effect of EMP was assessed at hyperthermic temperatures of 42, 43 and 44 degrees C. EMP did not alter the expression of HSP72, but substantially induced the synthesis of HSP27 in PC-3 cells. Our data show that EMP sensitizes PC-3 cells to hyperthermia induced cytotoxicity. This observation supports the rationale for multimodal treatment approaches in locally advanced prostate cancer.

Antineoplastic Agents↗
PubMed1998

The National Cancer Data Base report on patterns of care for adenocarcinoma of the rectum, 1985-95.

BACKGROUND: The Commission on Cancer data from the National Cancer Data Base (NCDB) examining current time trends (1985-1995) in stage of disease, treatment patterns, and survival relating to patients with rectal adenocarcinoma are described in this report. METHODS: Seven calls for data to hospital cancer registries across the U.S. have yielded a total of 5,850,000 cancer cases for the years 1985-1995 and include 20,461 rectal and rectosigmoid junction adenocarcinoma cases in 1985-1986, 36,007 cases in 1989-1990, and 42,069 cases in 1994-1995. These data represent 24.4%, 44.5%, and 52.5%, respectively, of the estimated cases of rectal and rectosigmoid adenocarcinoma cases diagnosed in the U.S. in each of the 3 respective time periods. Analysis of the data is limited to cases with American Joint Committee on Cancer (AJCC) Stage I-IV disease. RESULTS: Four trends were observed. 1) Stage I disease was diagnosed with decreasing frequency, decreasing from 37.1% of cases with known AJCC stage of disease in 1985-1986 to 33.8% in 1994-1995. 2) There was an increase in the frequency with which local excision was utilized as all or part of the primary treatment for Stage I disease. 3) Stage for stage, there was an increase in the frequency with which anterior/posterior resections were utilized and a corresponding decline in the use of abdominoperineal resections. 4) Multimodal treatment regimens are being used with greater frequency, particularly in patients with Stage II and III disease. CONCLUSIONS: The NCDB data have important implications for analyzing cancer treatment and outcome in the U.S. These data suggest that rectal adenocarcinoma is being diagnosed at a later stage, especially among the young and African Americans. The guidelines for colorectal carcinoma screening issued by the American Cancer Society and the American Gastroenterological Association should be promoted more vigorously to increase the proportion of patients presenting with early stage disease and improve overall survival. The increased use of multimodal therapy for the treatment of Stage II and III disease continues.

Adenocarcinoma↗
PubMed1996

Three- to five-dimensional biomedical multisensor imaging for the assessment of neurological (dys) function.

This report describes techniques and protocols implemented at the Geneva Canton University Hospitals (HUG) for the combination of various biomedical imaging modalities and sensors including electromagnetic tomography, to study, assess, and localize neurological (dys) function. The interest for this combination stems from the broad variety of information brought out by (functional) magnetic resonance imaging, magnetic resonance spectroscopy, computed tomography, single-photon emission tomography, positron emission tomography, and electromagnetic tomography. Combining these data allows morphology, metabolism, and function to be studied simultaneously, the complementary nature of the information from these modalities becoming evident when studying pathologies reflected by metabolic or electrophysiologic dysfunctions. Compared with other current multimodality approaches, the one at the HUG is totally compatible with both clinical and research protocols, and efficiently addresses the multidimensional registration and visualization issues. It also smoothly integrates electrophysiology and related data as fully featured modalities.

Computer Graphics↗
PubMed2004

[Radicular low back pain: is there a relationship between the treatment regimen and outcome?].

OBJECTIVE: To identify a possible relationship between the non-surgical treatment regimen and outcome. METHODS: In a sample of 170 patients with sciatica due to a herniated disk the intensity of a conservative multimodal inpatient treatment in a neurological department was extracted. The outcome was examined using two prospective cohorts (183 patients). These results were compared with published data from orthopaedic inpatient rehabilitation in Germany. RESULTS: The neurological inpatient treatment regimen was more intense than the orthopaedic inpatient rehabilitation, especially with regard to physiotherapy. In contrast, physical therapy was applied more often in orthopaedic rehabilitation. A better short-term outcome with regard to pain intensity was found after multimodal conservative treatment. CONCLUSIONS: Further studies are needed to compare different treatment regimens in patients with sciatica.

Cohort Studies↗
PubMedDate not supplied

Failure in the neck following multimodality treatment for advanced head and neck cancer.

Failure in the neck is an important cause of morbidity and mortality in head and neck cancer. Patients who underwent therapeutic or elective radical neck dissection at Memorial Sloan-Kettering Cancer Center between 1960 and 1966 developed recurrence of cancer in the dissected neck in 36.5% of the cases when metastatic carcinoma was present in the cervical lymph nodes at one level, and in 71.3% when metastases were present at multiple levels. Between 1975 and 1980, we treated 114 previously untreated patients with stages III and IV epidermoid carcinoma of the oral cavity, oropharynx, hypopharynx, or larynx with the combination of surgery and elective postoperative radiation therapy. Of these, 106 patients underwent radical neck dissection and 94 were proven to have metastatic carcinoma in the neck. Eleven patients developed recurrences in the neck. Recurrence developed in 16% of 19 patients with metastases at one level, and in 13% of 75 patients with metastases at multiple levels. For 53 patients, radiation therapy was started within 6 weeks after neck dissection and only 2% of them developed recurrence in the neck; for 41 patients, radiation therapy started later than 6 weeks and 29% of them developed recurrence (P less than 0.01). Comparison of these data with our historical control group suggests a decrease in the number of failures in the neck when a multimodality treatment is used. It appears, however, that irradiation must be started within 6 weeks after surgery for the best results.

Carcinoma, Squamous Cell↗
PubMed2002

[Is neoadjuvant therapy for locally advanced stomach carcinoma standard?].

Despite surgical efforts and encouraging data of a few postoperative therapy trials, locally advanced gastric cancer is in need of the development of effective multimodal therapeutic concepts. Regarding preoperative therapy the goal is to raise the number of complete tumor resections (R0-resections) leading to an improved prognosis of the disease. Neoadjuvant therapy has the theoretical advantage of early destruction of distant micrometastasis with a consecutive reduction of tumor relapse outside the resection margins. The likelihood of R0-resections should be increased with the response of the primary tumor to neoadjuvant therapy. Neoadjuvant chemotherapy using platinum based regimens in gastric cancer has shown its activity in a number of phase II studies. Especially after response to chemotherapy the survival was significantly better after complete surgical tumor resection. The neoadjuvant use of a sequence of chemotherapy followed by radiotherapy before gastrectomy did result in a complete histopathological response in 20-25% of gastric cancer patients. This regimen seems to be promising, but there are still no long term results available. Parallel to the expected data from the first phase III studies the main impact of research in this field has to be focused on to the development of new and effective therapeutic agents and with accompanying identification of factors which are able to predict the response to neoadjuvant treatment.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed2005

Multimodal antiemetic therapy and emetic risk profiling.

INTRODUCTION: Postoperative nausea and vomiting (PONV) is a common problem with no simple solution. This review highlights factors that are known to increase the risk of PONV. It examines the various data on pharmacological and non-pharmacological methods that have been used to prevent PONV. METHODS: Peer-reviewed journals on the subject were covered. CONCLUSION: Patient, surgical and anaesthetic factors increase the risk of PONV. While patient and surgical factors are understandably difficult to control, a multimodal approach involving both pharmacological and non-pharmacological interventions has been successfully adopted to reduce the incidence of PONV. Various factors have been identified to categorise patients into different profiles to determine their risk of PONV. Perioperative strategies can then be targeted at these patient groups.

Anesthesia, General↗
PubMed1990

Can psychotherapists transcend the shackles of their training and superstitions?

Formal courses and training in psychological diagnosis and treatment often undermine the talents and skills with which many trainees are endowed naturally. Too many seem to acquire a stylized professionalism replete with general labels, questionable theories, and unfortunate proscriptions. Despite lip service paid to prescriptive eclecticism, most graduate programs socialize their students into delimited schools of thought. Meanwhile, hundreds of psychotherapeutic systems have proliferated. Unsubstantiated claims abound. Nevertheless, there are data that show that specific treatments of choice exist for many disorders. It is argued that a multimodal, systematic, technically eclectic model can point the way to a genuinely scientific approach to psychotherapy.

Attitude of Health Personnel↗
PubMed1998

Portfolio: a prototype workstation for development and evaluation of tools for analysis and management of digital portal images.

PURPOSE: The purpose of this investigation was to design and implement a prototype physician workstation, called PortFolio, as a platform for developing and evaluating, by means of controlled observer studies, user interfaces and interactive tools for analyzing and managing digital portal images. The first observer study was designed to measure physician acceptance of workstation technology, as an alternative to a view box, for inspection and analysis of portal images for detection of treatment setup errors. METHODS AND MATERIALS: The observer study was conducted in a controlled experimental setting to evaluate physician acceptance of the prototype workstation technology exemplified by PortFolio. PortFolio incorporates a windows user interface, a compact kit of carefully selected image analysis tools, and an object-oriented data base infrastructure. The kit evaluated in the observer study included tools for contrast enhancement, registration, and multimodal image visualization. Acceptance was measured in the context of performing portal image analysis in a structured protocol designed to simulate clinical practice. The acceptability and usage patterns were measured from semistructured questionnaires and logs of user interactions. RESULTS: Radiation oncologists, the subjects for this study, perceived the tools in PortFolio to be acceptable clinical aids. Concerns were expressed regarding user efficiency, particularly with respect to the image registration tools. CONCLUSIONS: The results of our observer study indicate that workstation technology is acceptable to radiation oncologists as an alternative to a view box for clinical detection of setup errors from digital portal images. Improvements in implementation, including more tools and a greater degree of automation in the image analysis tasks, are needed to make PortFolio more clinically practical.

Algorithms↗
PubMed2001

From living related to in-situ split liver transplantation: how to reduce waiting-list mortality.

The insufficient number of suitable cadaveric organs for pediatric recipients is the cause of high pretransplant mortality rates and long waiting times. With the introduction of split and living related liver transplantation, the waiting list mortality rate has dropped from greater than 15% to less than 5% and children are transplanted more rapidly. A 5-year patient and graft survival rate of greater than 80% has been obtained in those centers where split and living related liver transplantations are routinely performed. The data analyzed in this paper show that the only current solution to cadaveric organ shortage is a 'multimodal' approach, where whole liver cadaveric transplantation is associated with split and living related liver transplantation.

Adolescent↗
PubMed1996

Placement of observations for the efficient estimation of a psychometric function.

Psychometric functions for different psychophysical tasks describe the relationship between physical stimuli and subjects' responses. Although a psychometric function is of considerable value, characterizing the function is time consuming and, hence, is not carried out routinely in psychophysical experiments. A principal reason for the lack of efficiency in characterizing the psychometric function is the use of unimodal (e.g., Gaussian and uniform) sampling methods. As an alternative, a multimodal four-point sampling method is proposed. A psychometric function is then fitted to the four data points (each with several trials) to estimate the threshold and slope parameters of the psychometric function. Results from three examples demonstrate that a 60% savings in data-collection time can be achieved.

Auditory Perception↗
PubMed2000

Gene therapy: a molecular approach to cancer treatment.

The current delineation of the molecular basis of cancer provides a strong rationale to consider gene therapy approaches for cancer as a complement to other cancer therapies. Phase III trials focused on adenoviral vector-mediated delivery of wild-type p53 to compliment p53 mutations were recently initiated for head and neck cancer and ovarian cancer. Clinical testing of the tumor inhibitory gene E1A, delivered by synthetic vectors is ongoing. Positive clinical data from these clinical studies will establish the use of gene therapy as a component of the multimodal treatment for certain cancers.

Adenovirus E1A Proteins↗
PubMed2005

[Surgery for the thymoma combined with pure red cell aplasia and myasthenia gravis].

UNLABELLED: Pure red cell aplasia (PRCA) and myasthenia gravis (MG) are respectively combined with thymoma, however, these 3 complications are extremely rare coexisted as a clinical triad. A 73-year-old female with mediastinal tumor found in 2000 was pointed out anemia in June 2002. As PRCA was diagnosed by the bone marrow examination, blood transfusion had been performed. By a chest computed tomography (CT), a thymoma in size of 7 x 5 cm in diameter was recognized in the anterior mediastinum. The serum level of anti-acetylcholine receptor antibody was elevated to be 35 nmol/l. MG was simultaneously diagnosed with a decreased power of neck muscle. The extended thymectomy was performed in August 2002, and pathological diagnosis disclosed a 'type AB' by World Health Organization (WHO) classification. After the operation, the decreased power of neck muscle had been improved, however, PRCA had not been remitted in the early-postoperative term. Blood transfusion had been required (2-4 units/1-2 weeks) for the postoperative 7 months' term. A cyclosporin (250 mg/day) as an adjuvant therapy was administered in April 2003. One month later, the patient's serum level of Hb had been over 10 g/dl without blood transfusion. The patient has been followed up with reducing the dose of cyclosporin. CONCLUSIONS: Surgery for a thymoma combined with PRCA and MG was effective for MG but not for PRCA in an early-postoperative term, however, a multimodality therapy with immunosuppressant as a postoperative adjuvant should bring a favorable outcome to patient's clinical data, and the postoperative long-observation must be critical in this case.

Aged↗
PubMedDate not supplied

[Longitudinal study of evoked responses (VEP, BAEP, SSEP) in multiple sclerosis].

The Authors have examined 20 subjects affected by "possible" multiple sclerosis by means of a multimodal (VEP, BAEP, SEP) electrophysiologically evaluation longitudinally conducted during a time period of 1 year. The electrophysiological data obtained are related to the clinical picture, the disease's evolution, and to the adopted pharmacological therapy, in order to attempt a more precise diagnostic and prognostic assessment of these patients.

Adult↗