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At least 613 records · Page 34Linked to original sources
PubMed2003

Online assessment of brain tissue oxygen autoregulation in traumatic brain injury and subarachnoid hemorrhage.

Monitoring of brain tissue oxygenation (ptiO2) enables early diagnosis of secondary cerebral ischemia and may guide a cerebral perfusion pressure (CPP) orientated therapy. The purpose of our study was to explain the concept of ptiO2-autoregulation, defined as the ability of the brain to maintain ptiO2 despite changes in CPP, and to show the different states of ptiO2-autoregulation we found. Microcatheters to assess ptiO2 and intracranial pressure were implanted into cerebral 'tissue at risk' of patients suffering from traumatic brain injury or subarachnoid hemorrhage. By using a multimodal neuromonitoring setup and in-house built software we assessed and displayed online the relationship between ptiO2 and CPP based on a data buffer consisting of 12 h. Depending on the linear regression slope (bptiO2 = delta ptiO2/delta CPP), we defined the state of ptiO2-autoregulation as present (0 < or = bptiO2 < or = 1/6), moderate (1/6 < bptiO2 < or = 1/3), impaired (bptiO2 > 1/3) or inverse (bptiO2 < 0). When ptiO2-autoregulation is present, an elevation in CPP is ineffective to raise ptiO2. In contrast, an increase in CPP elevates ptiO2 more pronounced in impaired than in moderate ptiO2- autoregulation, but decreases ptiO2 in inverse ptiO2-autoregulation. We conclude that online assessment of ptiO2-autoregulation gives valuable information on which patient will benefit from an increase in CPP and which CPP should be achieved to do so.

Adult↗
PubMed2001

[Multimodality therapy concept in stage I-IIIA small cell bronchial carcinoma. Case follow-up over 15 years].

We analysed our results of multimodal therapy including chemotherapy, radiotherapy and surgery in 150 consecutive patients with SCLC stage I-IIIa operated on in our hospital between 1983 and 2000. Median age: 58 years, stages see Table 2. Patients with proven SCLC had induction chemotherapy prior to surgery. All patients received three cycles of adjuvant chemotherapy, some with additional radiotherapy. Perioperative mortality: 2%. Median survival: 22.4 months. R0 resection was possible in 84% of all patients. Pre- and post-surgery staging differed in the majority of the patients. Rotes of 1-, 2- and 5-year survival were 79%, 47%, and 32%, respectively. A median survival of 22.4 months in multimodally treated LD-SCLC, most of them stage IIb/IIIa appears promising. Randomized studies based on clinical staging procedures are not recommended. Survival data are promising.

Carcinoma, Bronchogenic↗
PubMed1978

[Psychological care in pediatric oncology: patients, family, and personnel (author's transl)].

The improved outlook in many pediatric tumour and leukemia patients has brought about new psychological problems: we no longer have to focus our attention only on death and its implications, but also on the impact of aggressive multimodal therapy, of remission and relapse, of permanent cure alas sometimes paid for by lasting physical defects. There are relatively few "hard" physical data, based on controlled studies, concerning the reactions of the patients themselves and of their environment to the different phases of cancer in children, but certain empirical findings, based on clinical observations and the work of some interested psychologists, allow a number of conclusions to be drawn. The reactions of children to a life-threatening disease and to the possibility of death are mostly age-dependent; parents' reactions, as a rule, follow certain typical patterns superimposed by individual particularities (initial shock, non-acceptance and escape; finally, ways of coping) which ought to be taken into account by the medical and nursing team. The ability to convey hope and trust, competence, self-confidence, emotional stability and continuous personal engagement of those who treat such children are of paramount importance in minimizing psychological damage. Organized group discussions may sometimes be of additional help.

Adolescent↗
PubMedDate not supplied

Prognostic factors of rectum carcinoma--experience of the German Multicentre Study SGCRC. German Study Group Colo-Rectal Carcinoma.

A reliable evaluation of results of multimodal treatment requires the knowledge of the course of disease in patients treated by surgery alone and of the relevant prognostic factors. The data of a prospective multicentre observation study (Study Group Colo-Rectal Carcinoma, SGCRC) were analyzed by uni- and multivariate methods for the endpoints locoregional recurrence and observed overall survival. 1121 patients with invasive rectum carcinomas are included. In 1056 (94.2%) patients the tumor was resected, 34 patients (3.0%) received postoperative adjuvant therapy, 61 patients (5.4%) preoperative and 25 (2.2%) pre- and postoperative radiation. The observed 5-year survival rate for R0 (no residual tumor) was 55% (95% confidence interval 52-58%), for R1 and R2 only 7% (3-11%). Following R0 resection the 5-year survival rates varied according to pT (74-24%) and pN (68-33%). The 5-year survival was 74% (68-80%) for stage I, 62% (56-68%) for stage II, 40% (35-45%) for stage III and 9% (0-21%) for stage IV. Stage III is prognostically inhomogeneous: pN1: 5-year survival 47% (39-55%), pN2, 3: 34% (27-41%) (p < 0.01). The rate of locoregional recurrence is influenced by tumor related factors (stage and tumor site) and treatment related factors. Local spillage of tumor cells, the treating institution and the individual surgeon are independent factors influencing locoregional recurrence. Between locoregional recurrence and observed 5-year survival exists a highly significant correlation. The most important tumor related prognostic factors following surgical treatment are residual tumor status (R classification) and anatomic extent as described by pTNM and stage grouping UICC). The treating institution as well as the individual surgeon are further independent "prognostic factors" which determine the frequency of locoregional recurrence and thus survival. In analysis of treatment results the institution and the surgeon should be considered, in studies on adjuvant treatment a stratification according to department and surgeon is needed.

Analysis of Variance↗
PubMed2000

Active treatment of chronic neck pain: a prospective randomized intervention.

STUDY DESIGN: A randomized comparative study with single-blind outcome assessments. OBJECTIVES: To compare the efficacy of a multimodal treatment emphasizing proprioceptive training (ACTIVE) with activated home exercises (HOME) and recommendation of exercise (CONTROL) in patients with nonspecific chronic neck pain. SUMMARY OF BACKGROUND DATA: The efficacy of active exercises and passive physiotherapy for neck trouble has been somewhat disappointing in the previous few studies. METHODS: Seventy-six patients (22 men, 54 women) with chronic, nonspecific neck pain participated. Sixty-two participated the 1-year follow-up. Subjective pain and disability, cervical ranges of motion, and pressure pain threshold in the shoulder region were measured at baseline, at 3 months, and at 12 months. The ACTIVE treatment consisted of 24 sessions of proprioceptive exercises, relaxation, and behavioral support. The HOME regimen included a neck lecture and two sessions of practical training for home exercises and instructions for maintaining a diary of progress. The CONTROL treatment included a lecture regarding care of the neck with a recommendation to exercise. RESULTS: The average self-experienced total benefit was highest in the ACTIVE group, and the HOME group rated over the CONTROL group (P < 0.001). Differences between the groups in favor of the ACTIVE treatment were recorded in reduction of neck symptoms and improvements in general health and self-experienced working ability (P < 0.01-0.03). Changes in measures of mobility and pressure pain threshold were minor. CONCLUSIONS: Regarding self-experienced benefit, the multimodal treatment was more efficacious than activated home exercises that were clearly more efficacious than just advising. No major differences were noted in objective measurements of cervical function between the groups, but the content validity of these assessments in chronic neck trouble can be questioned.

Adult↗
PubMed1998

Evaluation of multimodal treatment program for fibromyalgia.

A quasi-experimental design was used to assess a multimodal pain treatment program for female patients with fibromyalgia to ascertain immediate and long-term effects. Laboratory and self-report pain measures together with psychological measures were obtained from patients who were tested up to 6 months after treatment. Comparison data were also obtained from fibromyalgia patients who failed to qualify for the treatment program because of insurance coverage. Immediate and long-term treatment effects were evident with the psychological measures and the subjective pain measures but not with the laboratory pain measures. Participants who attended the month-long multimodal program achieved significant and positive changes on most of the outcome measures. However, relapse prevention must be addressed.

Activities of Daily Living↗
PubMed1984

A brief methodological comment on possible inaccuracies induced by multimodal measurement analysis and reporting.

The use of multiple response system measurement adds an important dimension to behavioral medicine research. However, multiple measurement can result in problems in both analyzing and reporting outcome data. Problems in analysis include the increasing of chance findings as the measurement number increases. Problems in reporting include a blurring of response categories when general labels are used, a biased emphasis on the minority of variables showing experimental differences, and a misleading tendency to base comparative conclusions on general labels which do not accurately represent all data measured. Some examples of these problems from methodologically sound studies are described and alternative ways of dealing with the findings from multiple measurements are suggested.

Adult↗
PubMed2002

Multimodality therapy for esophageal cancer.

Esophageal cancer is undergoing a major shift in its epidemiology. Its incidence is dramatically growing and it more commonly affects younger and healthier patients. Based on the published data, there is no strong evidence to recommend routine preoperative chemotherapy for the treatment of surgically resectable esophageal carcinoma. It might be that a large-scale randomized study-which will be published in the near future-will shed some different light on this subject. The role of preoperative CRT remains undetermined. To settle this issue, larger, clinical, controlled trials are needed. Improvement in the preoperative regimen and use of new drugs should be evaluated. Concomitant CRT should be considered for potential benefit in survival and local control in patients who have localized disease and are candidates for radical non-surgical treatment. Patients with pCR following neoadjuvant therapy have a consistent, substantial survival benefit. Biologic markers can be used to predict response to therapy and might allow designation of treatment based on the individual tumor. Pretreatment staging is necessary for standardization of patients undergoing treatment protocols and for outcome evaluation. Pretreatment staging will be even more important in the future for adjusting treatment to individual patient. Video-assisted thoracoscopy and laparoscopy have been found to be the most accurate lymph node staging techniques.

Chemotherapy, Adjuvant↗
PubMed2001

Molecular biology of Barrett's adenocarcinoma.

OBJECTIVE: To review the current knowledge on the genetic alterations involved in the development and progression of Barrett's esophagus-associated neoplastic lesions. SUMMARY BACKGROUND DATA: Barrett's esophagus (BE) is a premalignant condition in which the normal squamous epithelium of the esophagus is replaced by metaplastic columnar epithelium. BE predisposes patients to the development of esophageal adenocarcinoma. Endoscopic surveillance can detect esophageal adenocarcinomas when they are early and curable, but most of the adenocarcinomas are detected at an advanced stage. Despite advances in multimodal therapy, the prognosis for invasive esophageal adenocarcinoma is poor. A better understanding of the molecular evolution of the Barrett's metaplasia to dysplasia to adenocarcinoma sequence may allow improved diagnosis, therapy, and prognosis. METHODS: The authors reviewed data from the published literature to address what is known about the molecular changes thought to be important in the pathogenesis of BE-associated neoplastic lesions. RESULTS: The progression of Barrett's metaplasia to adenocarcinoma is associated with several changes in gene structure, gene expression, and protein structure. Some of the molecular alterations already showed promise as markers for early cancer detection or prognostication. Among these, alterations in the p53 and p16 genes and cell cycle abnormalities or aneuploidy appear to be the most important and well-characterized molecular changes. However, the exact sequence of events is not known, and probably multiple molecular pathways interact and are involved in the progression of BE to adenocarcinoma. CONCLUSIONS: Further research into the molecular biology of BE-associated adenocarcinoma will enhance our understanding of the genetic events critical for the initiation and progression of Barrett's adenocarcinoma, leading to more effective surveillance and treatment.

Adenocarcinoma↗
PubMed2003

[Efficacy of inpatient rehabilitation for chronic back pain in Germany: a systematic review 1980-2001].

BACKGROUND: Chronic back pain has a high personal impact, is frequent and of outstanding economical relevance. Analysis of the international literature indicates strong or moderate evidence for the effectiveness of multimodal multidisciplinary team care of chronic back pain. Our review aims at a complete review and critical appraisal of German studies of inpatient medical rehabilitation. METHODS: We conducted a systematic search for relevant German studies (1/1980 - 6/2001) using electronic data bases, manual search of congress abstracts and postal questionnaires of 712 German rehabilitation clinics. Relevant studies were categorized according to the recommendation of the Cochrane Back Review Group. For all studies, aims, participants, type of intervention, evaluation time, main outcomes and results were extracted and tabulated. The effect size for 6 central outcome parameters (pain intensity, functional status, catastrophizing, depression, vitality, days on sickness leave) were calculated using pre-post comparisons and were integrated into short and long term weighted means of intra-group effect sizes. RESULTS: 30 studies, both controlled and uncontrolled, report a multitude of positive changes with inpatient rehabilitation treatment. Improvements included both somatic and psychological parameters. However, methodological quality was often poor; only three studies fulfilled the criteria for high quality. Comparison of meta analyses of German and international studies indicates partly good agreement (e. g. changes in pain intensity), partly discrepancies (e. g. functional ability in daily activities). Taken together, inpatient rehabilitation treatment for chronic low back pain in Germany appears to be of low to moderate efficacy. DISCUSSION AND CONCLUSIONS: In the era of evidence based medicine, inpatient rehabilitation has to show its usefulness, necessity and efficiency as any other type of health care. For the German system of inpatient rehabilitation of chronic back pain available evidence is not conclusive, due to a lack of randomised controlled studies. The prevailing design of observational cohort studies has severe limitations in proving a causal relationship between outcomes and intervention. The international literature however provides more valid evidence in favour of the multimodal multidisciplinary intervention in chronic back pain. Under the assumption of a "class effect" of medical rehabilitation the German data seem to corroborate the conclusions drawn from international studies.

Germany↗
PubMed2006

The best local therapy for unfavorable risk prostate cancer: the role of surgery.

High-risk prostate cancer has an increased rate of local and systemic recurrence after locally definitive therapy. High-risk prostate cancer is defined by using a combination of pretreatment tumor related factors (prostatic specific antigen [PSA] level, stage, Gleason score, and extent of involved biopsy cores) and by pathological findings. Pretreatment PSA kinetics may allow the identification of more patients at high risk of treatment failure who otherwise would have been included in lower risk groups according to conventional risk assignment systems. Eight months of neoadjuvant androgen deprivation therapy prior to radical prostatectomy has been shown in a randomized trial to significantly reduce rates of positive margins compared to 3 months of therapy; however, no significant difference in PSA recurrence rates is apparent 5 years postsurgery. The use of early chemotherapy in prostate cancer has until recently been limited by lack of evidence of an effective chemotherapeutic agent for more advanced disease. Recent data, confirming a survival advantage of docetaxel based regimes in metastatic disease, has focused attention on the use of early chemotherapy in these men with high-risk disease. The technical requirements of surgery on high-risk patients are now better defined and one challenge for the specialty is to take this knowledge and apply it successfully in the laparoscopic setting. However, the limit of surgery alone in reducing recurrence in high-risk disease from technical advancements has plateaued. In order to take the field forward, successful multimodal treatment strategies are needed to improve the outcomes over surgical monotherapy for high-risk disease. Novel nucleotide therapy targeting the production of cell survival proteins has provided promising phase 1 data in prostate cancer. This experimental therapy has been built on an understanding of the observed effects that androgen deprivation therapy has on cancer cell survival proteins produced during periods of cellular stress.

Combined Modality Therapy↗
PubMed2004

Solving the neuroimaging puzzle: the multimodal integration of neuroelectromagnetic and functional magnetic resonance recordings.

In this chapter, advanced methods for the modeling of human cortical activity from combined high-resolution electroencephalography (EEG) and functional magnetic resonance imaging (fMRI) data are reviewed. These methods include a subject's multicompartment head model (scalp, skull, dura mater, cortex) constructed from magnetic resonance images, multidipole source model, and regularized linear inverse source estimates. Determination of the priors in the resolution of the linear inverse problem was performed with the use of information from the hemodynamic responses of the cortical areas as revealed by block-designed (strength of activated voxels) and event-related (coupling of activated voxels) fMRI. As an example, these methods were applied to EEG (128 electrodes) and fMRI data, which were recorded in separate sessions while normal subjects executed voluntary right one-digit movements.

Brain Mapping↗
PubMed2000

Method for determining antiphase dynamics in a multimode laser

We measure the cross spectrum of the intensity fluctuations of pairs of modes for a multilongitudinal mode neodymium-doped yttrium aluminum garnet laser operating in the steady state regime. From the data we build up a picture of how the longitudinal mode fluctuations interfere and directly show the antiphase dynamics of the intensity fluctuations.

Journal Article↗
PubMed2000

PACS and multimodality in medical imaging.

A PACS (Picture Archiving and Communication System) is a system that is able to store, exchange, display and manipulate images and associated diagnoses from any modality within a hospital in a timely and cost-effective way. Several developments, such as the DICOM standard, fast and convenient networking, and new storage solutions for large amounts of data, make the setup of such a PACS system possible. As the information acquired with various imaging modalities is then available and often complementary, it is desirable for the clinician to have a point-by-point spatial co-registration of images from different modalities in order to enable a synergistic use of the multimodality imaging of a patient for increased diagnostic accuracy. Various types of algorithms are available for the matching of medical images from the same or from different modalities. Co-registration algorithms based on voxel properties consist of a similarity or dissimilarity measure and an iterative or non-iterative method minimizing the dissimilarity or maximizing the similarity between the two images by a transformation of one image relative to the other.

Belgium↗
PubMed2005

Intravenous ketoprofen in postoperative pain treatment after major abdominal surgery.

In recent years considerable attention has been paid to the treatment of postoperative pain, with regard to the favorable effect of adequate analgesia on patient outcome. Multimodal analgesia (e.g., opioids and nonsteroidal anti-inflammatory drugs [NSAIDs] or local anesthetics) is recommended for effective postoperative pain relief. There are few data on the use of NSAIDs in postoperative pain treatment after abdominal surgery. We conducted a randomized, double-blind, placebo-controlled study to assess the analgesic efficacy and safety of ketoprofen after major abdominal surgery. One and nine hours postoperatively patients received 100 mg of ketoprofen i.v. (n = 21) or placebo (n = 22) in addition to a pain-treatment protocol consisting of continuous infusion of tramadol 200 mg and metamizol 5 g over 24 hours with additional 25 mg i.v. tramadol in case of inadequate analgesia. Pain was assessed by numeric rating scale at rest and at deep breath 3, 6, 12, and 24 hours postoperatively and the total dose of tramadol used in the first 24 hours was recorded. Patients in the ketoprofen group had significantly lower pain scores both at rest and at deep breath, at 3 (p < 0.01), 6, and 12 hours (p < 0.05) postoperatively. The 24-hour use of tramadol was significantly lower in the ketoprofen group (p < 0.01), with less nausea and vomiting. There were no bleeding complications or other adverse events related to ketoprofen therapy. The study showed the value of short-term use of ketoprofen to improve the quality of analgesia after major abdominal surgery without significant adverse effects.

Aged↗
PubMedDate not supplied

Surgical oncology: a specialty in evolution.

Surgical oncology has established its role in the multidisciplinary care of the cancer patient. Surgical oncology fellowships are organized to teach multimodality treatment. The typical fellow has completed 6 years of general surgery residency and 1 year in the laboratory with the resultant eight publications. Data compiled from the review of two Society of Surgical Oncology-approved fellowship programs, the Surgical Residency Review Committee and the American Board of Surgery, indicate that the majority of fellows join academic faculties and enhance the training of general surgeons, who, in turn, have the major responsibility for oncologic care of the population at large.

General Surgery↗
PubMed1999

Esophageal cancer: therapeutic approaches and nursing care.

OBJECTIVES: To review the various treatment approaches, complications, and nursing management of patients with esophageal cancer. DATA SOURCES: Review articles, staging manual, textbook chapters, and research studies. CONCLUSIONS: The diagnosis and treatment of esophageal cancer is a complicated process. Combined multimodal therapy with chemotherapy, radiotherapy, and surgery is showing promising results. However, each treatment approach has complications and side effects that must be managed. IMPLICATIONS FOR NURSING PRACTICE: Nursing care is complicated and requires coordinating various support services, patient and family education, clinical assessment, nutritional management, management of side effects, and palliative care.

Combined Modality Therapy↗
PubMed2004

[Therapy of tic-disorders].

BACKGROUND: Within the last decade therapeutic approaches to tic disorders are reflected in many new studies. The advent of novel neuroleptics and the more sophisticated behavioural therapeutic techniques may give new hope to children and adolescents with tic disorders. OBJECTIVE: Hence, the progress in the field should be explored to find out the state of the art. METHOD: A critical review of the empirically based literature and practical experience. RESULTS: Worldwide, drug treatment with clonidine and (from the group of novel antipsychotics) risperidone show the broadest empirical basis while in Europe benzamides have a good empirical clinical background. Behaviour therapy presents more and more helpful empirical data. CONCLUSIONS: Risperidone may become the first-line drug in treatment of tic disorders and behaviour therapy might be increasingly used within a multimodal treatment program.

Antipsychotic Agents↗