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At least 595 records · Page 33Linked to original sources
PubMed2002

Malignant peripheral nerve sheath tumor of the vulva: a multimodal treatment approach.

BACKGROUND: Malignant peripheral nerve sheath tumors (MPNSTs) are rare in the gynecological population and have a high risk for local and distant failures. Multimodal management of a patient with MPNST of the vulva and review of the literature are outlined. CASE: A 34-year-old woman presented with a complaint of a rapidly increasing pelvic mass, pain, and difficulty ambulating. A disfiguring 20 x 20-cm vulvar mass was identified and a recurrent MPNST diagnosed. Therapy included external-beam radiation, anterior pelvic exenteration with pelvic reconstruction, and adjuvant chemotherapy without complication. CONCLUSION: It is recommended that for malignant peripheral nerve sheath tumors of the vulva, complete surgical resection be performed with adjuvant radiation and chemotherapy in selected cases.

Adult↗
PubMed1997

Matching a computerized brain atlas to multimodal medical images.

A method for matching a digital brain anatomical atlas to multimodal medical images (MRI, PET, and SPET) was implemented. The digital atlas was derived from anatomical templates of the brain, cut according to the orbitomeatal orientation. The atlas consists of a set of contiguous slices schematically describing the brain as anatomical contours and of a set of regions of interest (ROIs) classifying the brain into functionally homogeneous areas. The matching procedure includes (a) an edge detection method for the extraction of anatomical contours and (b) a warping algorithm based on contour matching to fit the atlas to the individual brain anatomy, as described by MRI. Once the atlas is matched to MRI, the associated templates of ROI can be overlapped with functional PET/SPET studies, individually registered to MRI. The method was tested on MRI studies. The efficacy of the warping algorithm in overlapping atlas and MRI contours was assessed by calculating for each slice an index representing the extent of overlapping (I). Values of I in the range 0.8-0.9 were found (I = 1 complete overlapping). Local accuracy was also verified by comparing the position of correspondent anatomical ROI in the atlas and MRI images before and after warping. The atlas-matching procedure was applied to representative MRI/PET clinical images for an objective regional analysis of functional data.

Algorithms↗
PubMed2005

Cerebral vasospasm: results of a structured multimodal treatment.

Symptomatic cerebral vasospasm (CVS) with delayed ischemic neurologic deficits affects about one third of the patients after aneurysmal subarachnoid hemorrhage (SAH). In spite of the lack of definite evidence of large clinical trials, the devastating outcome of the natural history of symptomatic CVS demands an aggressive CVS treatment in a practically oriented, structured multimodal treatment regimen. With our treatment protocol good functional outcome could be reached in 66% of the patients with symptomatic CVS. This policy requires close and fast multidisciplinary collaboration between neurosurgeons, neuroradiologists, competent in endovascular interventions, and specialists for neurointensive care. We report on our experience with 79 cases with symptomatic CVS and delayed ischemic neurologic deficit (DIND) after aneurysmal SAH. The different treatment options with CVS are reviewed and practical guidelines for a step by step treatment are given.

Brain Ischemia↗
PubMed1996

Hyperthermia in the multimodal therapy of advanced rectal carcinomas.

The synergistic effects of hyperthermia (raising temperatures to 40 degrees C and above) when combined with radiotherapy and cytotoxic drugs and a modulation of immunological phenomena have been demonstrated in the laboratory. Pre-clinical data relating to hyperthermia are summed up, along with their implications for clinical application. Controlled studies of local and regional hyperthermia have been performed during recent years, and these show us that the adjunction of hyperthermia provides at least an improvement of local control compared with radiotherapy alone. Current clinical results are summarized. Therapy systems based on radiowave irradiation have been commercially available for regional hyperthermia of the pelvis since the mid 1980s. This technology allows us to perform sufficiently tolerable and effective regional hyperthermia on rectal carcinomas. Used as part of curative preoperative and postoperative multimodal therapeutic strategies, hyperthermia can lead to improvement in local control (resectability, down-staging, progression-free time, recurrence rate), at least for certain risk groups. The preoperative radio-chemo-thermotherapy of advanced primary and recurring rectal carcinoma, uT3/4, was tested in a phase-I/II study of 20 patients. Therapy procedure, acute toxicity, thermal parameters, and response are described and discussed for this patient group. The regimen proved to be sufficiently tolerable, and complications did not occur. Tumor resection was performed on 14 of the 20 patients; 13 of the procedures were R0-resections and one was an R2 resection. In 64% of the resected rectal carcinomas, histopathological down-staging of the pretherapeutic endosonographical stadium was achieved; in three of the patients, despite continued non-resectability, local control has now been maintained for more than 12 months. In two patients with nonresectable rectal carcinomas, local progress was seen during the neoadjuvant combination therapy.

Clinical Trials as Topic↗
PubMed2004

Modern multimodal neuroimaging for radiosurgery: the example of PET scan integration.

Radiosurgery relies critically on medical imaging modalities. Leksell Gamma Knife (LGK) radiosurgery presents the highest requirements in terms of imaging accuracy as the treatment is applied in a single high-dose session with no other spatial control than medical imaging. The advent of new imaging modalities opens challenges for LGK planning strategies. The integration of stereotactic PET in LGK represents an example of such application of modern multimodality imaging in radiosurgery. Our experience consists of 80 patients treated with the combination of MR/CT and PET guidance. In order to analyze the specific contribution of PET findings, we developed a classification reflecting the strategy used to define the target volume. When combining PET and MR information, 102 target volumes were defined, because some patients presented with multiple lesions or multifocal tumor areas. Abnormal PET uptake was found in 86% of the lesions, and this information altered significantly the MR-defined tumor in 73%. In conclusion, integration of PET in radiosurgery provides additional information opening new perspectives for the treatment of brain tumors. The use of a standardized classification allows to assess the relative role of PET. A similar approach could be useful and may serve as a template for the evaluation of the integration of other new imaging modalities in radiosurgery.

Adenoma↗
PubMed1998

Continuous intracranial multimodality monitoring comparing local cerebral blood flow, cerebral perfusion pressure, and microvascular resistance.

Maintaining cerebral perfusion pressure (CPP) above 70 mmHg is currently a mainstay of neurosurgical critical care. Shalmon, et al. recently showed poor correlation between CPP and regional cerebral blood flow (CBF) [1]. To study the relationship between CPP and CBF, at a microvascular level, we retrospectively analyzed multimodality digital data from 12 neurosurgical critical care patients in whom a combined intracranial pressure (ICP)--laser Doppler flowmetry (LDF) probe (Camino, San Diego) had been placed. Over the entire interval of continuous monitoring for all patients, 97% of local CBF data was at ischemic levels below a CPP of 70 mmHg. For CPP above 70 mmHg, local CBF data had considerable dispersion ranging from ischemic (71%), to normal (19%), and hyperemic (10%) levels. Elevated jugular bulb oxyhemoglobin saturation levels (SjO2) complemented intervals of hyperemia. Autoregulation was impaired or absent in all monitored patients. We conclude that with disrupted autoregulation, CPP above 70 mmHg does not necessarily insure adequate levels of cerebral perfusion. Restoration and maintenance of adequate cerebral perfusion should be performed under the guidance of direct CBF monitoring.

Adolescent↗
PubMed1998

Multimodal hemodynamic neuromonitoring--quality and consequences for therapy of severely head injured patients.

Fifty-five head injured patients (GCS < 8) were studied at an average of 7.5 +/- 3.4 days on the ICU to check quality of hemodynamic monitoring and the consequences for therapy. Multimodal neuromonitoring included intracranial pressure (ICP), mean arterial pressure (MAP), cerebral perfusion pressure (CPP), endtidal CO2 (EtCO2) as well as brain tissue--pO2 (p(ti)O2), regional oxygen (rSO2) and jugular venous oxygen saturation (SjO2). Regional p(ti)O2 as well as global SjO2 were sensitive technologies to detect hemodynamic changes. However analyzing reliability and good data quality regional p(ti)O2 (up to 95%) was superior to jugular bulb oximetry (up to 50%). Longterm-measurements of rSO2 using near infrared spectroscopy reached, if possible, a restricted reliability (good data quality up to 70%) and sensitivity in comparison to p(ti)O2. Especially p(ti)O2 enabled detection of critical p(ti)O2 (< 15 mm Hg) in up to 50% frequency during the first days after trauma and a second peak after day 6 to 8 according to evidence of CPP insults. Knowledge of baseline p(ti)O2 and CO2-reactivity allowed minimizing risk of ischemia by induced hyperventilation and improvement on cerebral microcirculation after mannitol administration could be individually recognized.

Blood Pressure↗
PubMedDate not supplied

Preoperative staging of gastric cancer as precondition for multimodal treatment.

Preoperative staging of gastric cancer plays a crucial role every multimodal treatment protocol. At present, staging intends to be far more than evaluation of the depth of tumor infiltration into the organ wall, that is, T stage, nodular status (N category), and the presence of distant metastases (M stage) according to UICC criteria. In modern surgical oncology it includes more often the evaluation of prognostic factors such as the RAS-protein, p53 tumor suppressor gene, growth factor receptors, cell adhesion molecules, proteolytic factors, and proliferation-associated antigens. Furthermore, evaluation of nodular status is possible by sophisticated computer programs. The conventional staging of gastric cancer using endoscopy and sonography, conventional ultrasonography, computed tomography, and magnetic resonance imaging is discussed. Possible improvements of staging in oncologic centers should include surgical laparoscopy, laparoscopic ultrasonography, and meticulous evaluation of an abdominal lavage including immunohistochemical detection of free tumor cells. The most promising tumor biology-related prognostic factors in gastric cancer are briefly discussed.

Combined Modality Therapy↗
PubMedDate not supplied

Staging gastrointestinal cancer as a precondition for multimodal treatment.

Staging gastrointestinal cancer is useful only if it has an impact on treatment. When applying modern multimodal therapies (i.e., neoadjuvant, adjuvant, or additive treatment), meticulous staging is mandatory. Preoperative staging should include all relevant prognostic factors. If possible, modern cellular biology-related parameters should also be investigated, although their validity has not yet been analyzed properly. Using such modern techniques as endoluminal ultrasonography or video-laparoscopy, a preoperative diagnostic accuracy of 85% can be achieved, providing a sound foundation for therapeutic decisions. Assessment by TNM staging (UICC) and surgical resection without residual tumor (UICC/R0) are crucial, as it has been shown by multivariate analyses that these factors have the most impact on prognosis. Postoperative staging is mainly done by pathohistologic evaluation of the surgical specimen. It is the basis for any postoperative adjuvant or additive therapy. In this paper the diagnostic methods and their validity are discussed in relation to the various gastrointestinal tumors.

Combined Modality Therapy↗
PubMedDate not supplied

Multimodal treatment for squamous cell esophageal cancer.

Preoperative chemotherapy (CTx) and combination radiochemotherapy (RTx/CTx) in patients with squamous cell esophageal carcinoma has recently received increasing attention. Although several prospective randomized trials could not show any benefit of neoadjuvant therapy in patients with potentially resectable tumors, preoperative CTx and combination RTx/CTx appear to increase the resection rate, the rate of complete tumor resection, and survival time in patients with locally advanced tumors. Most available studies show that a survival benefit from multimodal therapy can be expected primarily in patients who have a complete histopathologic response to preoperative treatment (i.e., no viable tumor in the resected specimen). Preoperative RTx/CTx increases the response rate and improves local tumor control compared to preoperative CTx alone, but it is associated with substantial perioperative mortality and morbidity. Distant tumor recurrences are insufficiently controlled with current combined modality protocols. These data indicate that neoadjuvant therapy must be considered investigational in patients with potentially resectable esophageal carcinoma but may soon become standard in patients with locally advanced tumors. Research must focus on modalities that allow pretherapeutic identification of those patients who will respond to neoadjuvant therapy. Furthermore, more effective and less toxic preoperative therapy regimens are required to increase the response rates and combat systemic recurrences. Finally, randomized prospective studies are essential to assess the role, extent, and timing of surgical resection for the combined modality approach to patients with squamous cell esophageal carcinoma.

Antineoplastic Agents↗
PubMedDate not supplied

Anal cancer: multimodal therapy.

Anal cancer is a rare clinical entity which represents 1-2% of all gastrointestinal tract cancers. Due to the paucity of this malignancy it has been difficult to establish generally accepted guidelines for treatment, although various therapy modalities have been evaluated. For a long time radical surgery was the primary treatment for anal cancer and still about 30% of the patients undergo abdominoperineal rectotomy. However, recurrence rates of 20-40% have been observed after this mutilating procedure. Therefore, other treatment options, including external or interstitial radiotherapy and chemotherapy, are used increasingly with the intention to preserve sphincter function. In the last years much interest has been addressed to multimodal therapy with radiation (50 Gy) and chemotherapy (5-fluorouracil and mitomycin C). Presently radiochemotherapy appears to be the most efficient therapy in advanced anal cancer. Locoregional tumor control is obtained in 60-80% of the patients and there is evidence that radiochemotherapy can improve disease-free survival. Despite considerable toxicity, radiochemotherapy should be recommended as primary therapy to most patients.

Anus Neoplasms↗
PubMed1989

Correlation between multimodal evoked potentials and magnetic resonance imaging in multiple sclerosis.

Sixty multiple sclerosis (MS) patients (33 definite, 13 probale and 14 suspected were investigated by computed tomography (CT), magnetic resonance imaging (MRI), multimodality evoked potentials (EPs) and cerebrospinal fluid (CSF) electrophoresis. MRI abnormalities were found in 50 cases, while at least one abnormal evoked potential was detected in each of 52 cases. Brain-stem auditory evoked potentials were more sensitive than MRI for the detection of brain-stem involvement. All the patients with oligoclonal bands had abnormal MRI and none of the patients with normal MRI had oligoclonal bands in the CSF. The number and the extent of MRI lesions were significantly correlated with the duration of disease and with the degree of disability. Our observations stress the importance of the combined use of MRI and EPs in detecting silent CNS lesions in MS patients.

Adult↗
PubMed1989

Multimodal treatment of hepatocellular carcinoma.

Our multimodal treatment of hepatocellular carcinoma (HCC) has brought about a significant improvement of the survival rate. It consists of a combination of hepatectomy and transcatheter arterial embolization using lipiodol (L-TAE). In order to facilitate L-TAE, we have developed a special catheter with notches. A group of patients with HCC (124 cases), excluding cases with absolutely non-curative resections and operative deaths, were treated between December 1980 and November 1986. Each case was treated for more than 1 year after hepatectomy. The patients were divided into two groups: A, patients with a single tumor not larger than 5 cm, and B, cases with larger tumors or more than one lesion. Some patients in each group were treated with L-TAE after hepatectomy. In group A, there was no significant difference in survival between treated and non-treated cases. In group B, L-TAE gave a significantly better survival than no postoperative treatment.

Carcinoma, Hepatocellular↗
PubMed1998

Utility of multimodal evoked potential study and electroencephalography in mitochondrial encephalomyopathy.

We performed electroencephalography (EEG) and multimodal evoked potential (EP) studies in 16 patients with various forms of mitochondrial encephalomyopathy (ME). The electrophysiological investigations revealed signs of involvement of the peripheral and central nervous system (CNS) in 14 patients, with a high incidence of visual-EP (VEP) alterations, indicative of visual pathway vulnerability in mitochondrial diseases. No specific pattern of abnormalities emerged and, in particular, clinical and laboratory findings did not correlate with each other. EP (particularly VEP and electroretinogram) investigations should be part of the diagnostic work-up of patients with mitochondrial disorders in order to better characterize the clinical picture, disclose involvement of specific sensory systems of the CNS, and assess patients with atypical clinical presentations.

Adult↗
PubMed1980

Multimodal evaluation of therapy versus consultation components in a large inner-city early intervention program.

Cincinnati's Social Skills Development Program (SSDP) used a social competence model to direct its interventions for children. Systematic screening identified 15-25% of the primary grade children who showed behavioral problems and deficits in social skills at seven elementary schools. Multimodal evaluations comparing therapy and consultation interventions included three types of assessments over a 1 year period. Tests of social skills revealed that children who received both therapy and consultation services, compared to those who received only consultation, improved in a basic empathy skill and increased their externality in locus of control. School record data showed that therapy and consultation children improved in grades; but, consultation children improved most. Finally, trained observers found that therapy children, compared to children in consultation only, increased cooperative interactions with teachers and maintained appropriate solitary behaviors. The data are discussed as providing some support for the hypothesis that therapy produced increased benefits for children compared to the less costly consultation intervention. However, since therapy and consultation conditions were not differentiated on many assessments (e.g., tests of interpersonal problem-solving and advanced empathy skills; lateness; achievement), more intense behaviorally oriented interventions may be warranted.

Child↗
PubMed1983

Multimodal biofeedback in the treatment of migraine.

The purpose of this study was twofold: (a) to compare the effects of three behavioral strategies for the relief of migraine, and (b) to examine different combinations of the treatments to assess the effectiveness of multimodal biofeedback with this problem. Twenty-four volunteer migraine sufferers not on medication, and with at least weekly occurrence of headaches, participated in the study. Results indicated that (a) subjects who learned temporal cooling, frontalis relaxation, and progressive muscular relaxation exhibited the best success with headache relief; (b) control subjects, who did not show the same psychophysiological changes as experimental subjects, reported no headache relief; and (c) subjects in the group with only relaxation exercises performed similarly to control subjects and reported no headache relief.

Biofeedback, Psychology↗
PubMed1992

Integrated presentation of multimodal brain images.

This article discusses the fusion of brain images from multiple modalities as well as the presentation of the integrated image information. The paper has three parts. First, individual brain imaging modalities are compared as regards clinical appreciation, invasiveness, dimensionality, spatial resolution, temporal resolution, and cost. Next, methods to combine multiple images are briefly surveyed and collated by characteristics as accuracy, patient-friendliness, reproducibility, labour-extensiveness, feasibility of retrospective matching, and general applicability. Finally, techniques to display multimodal image information are outlined and examples of the various options for integrated presentation are shown.

Brain↗
PubMed1992

Geometry driven multimodality matching of brain images.

Clinical diagnosis, as well as therapy planning and evaluation, are increasingly supported by multimodal images. There are many instances desiring integration of the information obtained by various imaging devices. This paper describes a new approach to match images of different modalities. Differential operators are used in combination with Gaussian blurring to extract geometric features from the images that correspond to similar structures. The resulting 'feature' images may be used with existing matching techniques that minimize the distance between the features in the images to be matched. Our first application of this new approach concerns matching of MRI and CT brain images. The so-called L upsilon upsilon operator produces a ridge-like feature image from which in CT and MRI the center curve of the cranium is easily extracted. First results of this operator's performance in matching tasks are shown. Another promising operator is the 'umbilicity' operator, which is presented in combination with SPECT images.

Brain↗