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At least 613 records · Page 34Linked to original sources
PubMed1992

Spatial integration of multimodal brain images in cerebral infarction.

Different structural as well as functional imaging techniques are becoming increasingly important in the investigation of patients suffering from an ischemic stroke. Available imaging procedures usually provide complementary data, but the images can not easily be compared due to differences in patient positioning, angulation, and slice thickness. We studied the value of spatial integration of images from different modalities in a patient with an ischemic stroke and used skin markers to integrate the obtained information. Computed tomography (CT), magnetic resonance imaging (MRI), 99mTcHMPAO-single photon emission computed tomography (SPECT) and magnetic resonance spectroscopic imaging (MRSI) were performed in a patient, presenting with a right sided hemiparesis caused by an ischemic stroke. Combination of MRI with CT demonstrated that the infarction visible on CT and MRI corresponded in size and volume. Furthermore, structural and functional images could readily be integrated, thus allowing us to obtain accurate information in this stroke patient. Different imaging modalities provide complementary information in the acute phase of cerebral infarction and multimodality matching can be of great value for improvement of our understanding of the pathophysiology and course of ischemic stroke.

Brain↗
PubMed1993

Perspectives of surgery and multimodality treatment in gastric carcinoma.

Surgery still represents the therapy of choice for patients with primary gastric adenocarcinoma. The best survival results can be achieved if a potentially curative (R0) resection can be performed whatever the extent of resection of the primary tumor (total versus subtotal distal gastrectomy). Either procedure should be accompanied by systematic lymph node dissection since lymphadenectomy has relevant diagnostic (i.e. staging) and therapeutic implications (i.e. improved survival in stage II/IIIA disease). Since most gastric carcinomas are diagnosed in advanced tumor stages, the number of patients to be treated curatively by surgery alone remains limited. Multimodality treatment, consisting of chemotherapy and surgery, may be an encouraging alternative strategy. With actual chemotherapy protocols (i.e. 5-FU/doxorubicin/methotrexate, etoposide/doxorubicin/cisplatin) high remission rates in locally advanced irresectable lesions without distant metastases can be induced. Survival in these patients has been significantly improved after chemotherapy and second-look surgery. The effectiveness of these protocols in an adjuvant setting seems a worthwhile study for the future. In addition, immunological and somatic gene therapy may be of therapeutic impact in the next decade.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1991

Prediction of secondary deterioration in comatose neurosurgical patients by serial recording of multimodality evoked potentials.

In 75 comatose neurosurgical patients suffering from various types of intracranial lesions, multimodality evoked potentials (auditory, somatosensory, visual) were serially recorded at short intervals in order to evaluate their usefulness for early detection of secondary deterioration in the clinical course. The best parameter for prediction of secondary deterioration (as estimated by pupillary status) was a diminution in amplitude or disappearance of the primary cortical SEP peak. Considering these parameters, sensitivity of the prediction of pupillary behaviour was 71%, specificity 84%. Additional consideration of SEP latencies or BAEP or VEP parameters did not further increase the efficacy of prediction. In cases of correct positive prediction, deterioration of SEP occurred 4 to 144 hours before the deterioration of pupillary physiology.

Brain Damage, Chronic↗
PubMed1988

Cell kinetics and multimodal prognostic evaluation in glial tumours investigated by serial stereotactic biopsy.

A retrospective evaluation of the prognostic value of different parameters available in patients affected by glial tumours and submitted to serial stereotactic biopsy is presented. The series investigated includes thirty-three untreated patients with proven brain gliomas submitted to stereotactic biopsy. All patients have been clinically and neuroradiologically monitored for three years. The factors investigated belong either to the preoperative data (clinical history and symptomatology, CT pattern and volume of the lesion) or to histological and biological data obtained after the stereotactic biopsy. The results suggest the need of a multimodal prognostic evaluation in glial tumours and particularly stressed is the accuracy of prognostic indications derived from cell kinetic studies.

Adult↗
PubMed1997

A clinical trial to evaluate the worth of preoperative multimodality therapy in patients with operable carcinoma of the rectum: a progress report of National Surgical Breast and Bowel Project Protocol R-03.

PURPOSE: National Surgical Adjuvant Breast and Bowel Project Protocol R-03 was designed to determine the worth of preoperative chemotherapy and radiation therapy in the management of operable rectal cancer. METHODS: Thus far, 116 patients of an eventual 900 with primary operable rectal cancer have been randomized to receive multimodality therapy to begin preoperatively (59 patients) or identical therapy beginning after curative surgery (57). All patients received seven cycles of 5-fluorouracil (FU)/leucovorin (LV) chemotherapy. Cycles 1 and 4 through 7 used a high-dose weekly FU regimen. In Cycles 2 and 3, FU and low-dose LV chemotherapy was given during the first and fifth week of radiation therapy (5,040 cGy). The preoperative arm (Group 1) received the first three cycles of chemotherapy and all radiation therapy before surgery. The postoperative arm (Group 2) received all radiation and chemotherapy after surgery. Primary study end points included disease-free survival and survival. Secondary end points included local recurrence, primary tumor response to combination therapy, tumor downstaging, and sphincter preservation. RESULTS: Overall treatment-related toxicity was similar in both groups. Although seven preoperative patients had events after randomization that precluded surgery, eight events occurred during an equivalent follow-up period in the postoperative group. No patient was deemed inoperable because of progressive local disease. Sphincter-saving surgery was intended in 31 percent of Group 1 patients and 33 percent of Group 2 patients at the time of randomization. Such surgery was actually performed in 50 percent of the preoperatively treated patients and 33 percent of the postoperatively treated patients. The use of protective colostomy in patients undergoing sphincter-sparing surgery and the development of perioperative complications in all surgical patients were similar in both groups. There was evidence of tumor downstaging in evaluable patients undergoing preoperative therapy, with 8 percent of Group 1 patients having had a pathologic complete response. CONCLUSION: These data do suggest that the preoperative chemotherapy and radiation therapy regimen used are, at least, as safe and tolerable as standard postoperative treatment. There is presently a trend to tumor downstaging and sphincter preservation in the preoperative arm. Whether this arm will have greater or lesser survival and long-term toxicity awaits the completion of this relevant study.

Adenocarcinoma↗
PubMed1995

Intensive multimodality therapy for carcinoma of the esophagus and gastroesophageal junction.

BACKGROUND: We designed a trial of intensive multimodality therapy for carcinoma of the esophagus and gastroesophageal junction to assess tumor response and operability after neoadjuvant chemotherapy and to determine the impact of trimodality therapy on longterm survival. METHODS: Thirty-two patients with resectable (clinical stage IIa, n = 17; IIb, n = 1; III, n = 14) squamous cell cancer (n = 15) or adenocarcinoma (n = 17) were treated with neoadjuvant chemotherapy (cisplatin, 5-fluorouracil, leukovorin), resection, and postoperative chemoradiotherapy (hydroxyurea, 5-fluorouracil; 50-66 Gy). RESULTS: Use of neoadjuvant chemotherapy yielded the following results: a measurable clinical response in 22 patients, stable disease in eight patients, disease progression in one patient, and death in one patient. Thirty-one patients underwent resection, with the following results: two operative deaths (6.5%) and nonfatal morbidity in 17 (59%); the median hospital stay was 13 days. Pathologic staging was stage 0, n = 1; I, n = 2; IIa, n = 11; IIb, n = 5; III, n = 7; and IV, n = 5. Postoperative chemoradiotherapy was completed in 23 patients with one death, for an overall treatment-related mortality rate of 12.5% (four of 32). At a mean follow-up of 22.5 months, median survival is 19.7 months and 14 patients are alive and disease free. CONCLUSIONS: Neoadjuvant therapy for cancer of the esophagus and cardia results in good tumor response. Esophagectomy in this setting can be accomplished with acceptable morbidity and mortality. Results of an interim analysis of survival are encouraging and suggest that further investigation of this regimen is warranted.

Adenocarcinoma↗
PubMed1989

Brainstem impairment in multiple sclerosis: an assessment by multimodal evoked potentials.

The usefulness of multimodal evoked potentials for the diagnosis of Multiple Sclerosis (MS) is established. Our purpose was to try to set of 3 EPs (BAEP, median SEP and trigeminal SEP) in the evaluation of brainstem dysfunction. 53 definite and probable MS patients have been examined; they were allotted to 3 groups according to the duration of the disease. Our results showed that median SEP is the most sensitive investigation, while BAEP and trigeminal SEP were abnormal in a smaller number of cases. The combined use of median and trigeminal SEPs supplied sufficient information on brainstem function, without using the complete set of EPs. No significant relation between EP abnormalities and duration of the disease was found.

Acoustic Stimulation↗
PubMed1989

Multimodality evoked potentials in myotonic dystrophy.

Multimodality evoked potentials were performed in 18 patients affected by myotonic dystrophy (8 males and 10 females); the aim was to make an electrophysiological evaluation of the central nervous system involvement in this disease. We observed brainstem, somatosensory and visual evoked potential abnormalities respectively in 53%, 62.5% and 71.4% of cases, with no apparent relationship to the severity of the disease. Our abnormal findings provide further confirmation of CNS involvement in myotonic dystrophy and occur in various combinations suggesting an aspecific involvement at different levels, reflecting the multisystemic character of this disease.

Adolescent↗
PubMed1990

Multimodality evoked potentials in HIV infected subjects: a longitudinal study.

18 subjects with symptomless HIV infection were investigated with multimodal evoked potentials for possible CNS involvement and again after an 8-12 month interval. 13 subjects showed neuropsychological changes, which were confirmed at the second examination. The 5 subjects found normal remained so at the second examination. On WAIS assessment the only patient to earn pathological scores was the one with the greatest evoked potentials changes. Thus the evoked potentials procedure proved capable of identifying early CNS involvement by HIV infection.

Adult↗
PubMed1994

Evoked potentials in inherited ataxias: a multimodal electrophysiological study.

A multimodal electrophysiological study, including median nerve somatosensory evoked potentials (SSEPs), motor cortical stimulation (CS) and brainstem evoked potentials (BAEPs), was performed on 34 patients with hereditary ataxias (HAs): 15 with Friedreich's disease (FD), 10 with early onset cerebellar ataxia (EOCA), and 9 with autosomal dominant cerebellar ataxia (ADCA). A higher incidence of abnormal central motor conduction was observed in FD than in EOCA patients, but was never observed in ADCA. A relationship between central motor conduction abnormalities and disease duration and clinical impairment was found only in FD patients. All FD patients showed severe impairment of the SSEPs that was not related to disease duration. In EOCA patients, less frequent and more variable SSEP abnormalities were observed. The lowest incidence of central SSEP abnormalities was observed in ADCA. The BAEP findings in all 3 groups of patients (but particularly those with EOCA) suggest prevalent brainstem damage.

Adolescent↗
PubMed2002

The Mayo Clinic experience with multimodality treatment of locally advanced or recurrent colon cancer.

BACKGROUND: Patients with incompletely resected locally advanced and recurrent colon cancers have a dismal prognosis. Since 1981, 100 colon cancer patients have been treated with combination therapy including surgical resection, chemotherapy, and external plus intraoperative radiotherapy. METHODS: A prospective computerized intraoperative radiation database identified patients for this retrospective review. Data collection included patient demographics, tumor and treatment variables, and morbidity, recurrence, and survival statistics. RESULTS: The mean age was 55.2 years. Follow-up was available for all patients. Fifty-nine patients have died. Median follow-up of survivors was 70.5 months. Twenty-five patients with locally advanced colon cancer had a median survival of 38.2 months and a 5-year survival of 49%. Eleven of these patients are still free of disease. Seventy-three patients treated for recurrent colon carcinoma had a median survival of 33.3 months from the time of recurrence, with a 5-year survival of 24.7%. Twenty-one are alive without evidence of recurrence. The 38 patients with recurrent disease whose disease was completely resected had a 37.4% 5-year survival. CONCLUSIONS: A multimodality approach using en-bloc surgical resection with radiotherapy and chemotherapy affords some patients with locally advanced and recurrent colon cancer a chance for long-term survival.

Adult↗
PubMedDate not supplied

Multimodality multidimensional image analysis of cortical and subcortical plasticity in the rat brain.

In this work, we developed and implemented a multimodality multidimensional imaging system which is capable of generating and displaying anatomical and functional images of selected structures and processes within a vertebrate's central nervous system (CNS). The functional images are generated from [14C]-2-deoxy-D-glucose (2DG) autoradiography whereas the anatomic images are derived from cytochrome oxidase (CO) histochemistry. This multi-modality imaging system has been used to study mechanisms underlying information processing in the rat brain. We have applied this technique to visualize and measure the plasticity (deformation) observed in the rat's whisker system due to neonatal lesioning of selected peripheral sensory organs. Application of this imaging system revealed detailed information about the shape, size, and directionality of selected cortical and subcortical structures. Previous 2-D imaging techniques were unable to deliver such holistic information. Another important issue addressed in this work is related to image registration problems. We developed an image registration technique which employs extrinsic fiduciary marks for alignment and is capable of registering images with subpixel accuracy. It uses the information from all available fiduciary marks to promote alignment of the sections and to avoid propagation of errors across a serial data set.

Animals↗
PubMed1997

Peri-operative multimodal pain therapy for caesarean section: analgesia and fitness for discharge.

PURPOSE: To compare, the efficacy of a multi-modal analgesic regimen and single drug therapy with iv PCA morphine alter Caesarean delivery with spinal anaesthesia. METHODS: Forty ASA 1-2 parturients presenting for elective Caesarean section were randomized to receive multimodal pain treatment with intrathecal morphine, incisional bupivacaine and ibuprofen+acetaminophen po until hospital discharge (Group 1) or conventional therapy with iv PCA morphine weaned to acetaminophen+codeine po (Group 2). Both groups received spinal anaesthesia with 1.7 ml hyperbaric bupivacaine 0.75%. Visual analog pain scores at rest (RVAPS) and with movement (DVAPS) were recorded q 2 hr during the first 24 hr, then q 4 hr until discharge. Time to first walking, eating solid food, flatus, bowel movement, voiding and hospital discharge were recorded. RESULTS: Pain scores were lower in Group 1 patients during the first 24 hr after spinal injection RVAPS 0.6 +/- 0.1 in Group 1 vs 2.1 +/- 0.1 in Group 2 (mean +/- SEM), DVAPS 1.9 +/- 0.1 in Group 1 vs 4.1 +/- 0.1 in Group 2 (P < 0.0001). Times to first flatus, 36.1 hr +/- 2.9 vs 20.5 +/- 1.8 (P < 0.05) and to first bowel movement, 74.8 hr +/- 5.6 vs 57.4 +/- 4.7 (P < 0.0001) were longer in Group 2 patients. There was no difference between groups in time to eating solid food, walking or hospital discharge. CONCLUSION: Multi-modal pain therapy resulted in improved early post-operative analgesia during the first 24 hr after Caesarean delivery. Patients receiving iv PCA morphine followed by acetaminophen+codeine po were more likely to develop decreased bowel mobility. All patients, with one exception, achieved discharge criteria (eating solid food, absence of nausea, normal lochia, dry incision and DVAPS < 4) at 48 hr after spinal injection.

Analgesia, Obstetrical↗
PubMed1997

[Radiotherapy in the multimodal treatment of esophageal carcinoma. A review].

BACKGROUND: The curative potential of exclusively applied surgery or radiotherapy on esophageal carcinoma is exhausted. The 5-year survival rate of surgically treated esophageal carcinoma is stagnant at 20 to 30%, that for radiotherapeutically treated esophageal carcinoma at < or = 10%. The unchanged bad prognoses motivate the search for multimodal therapeutical concepts in order to improve the results of basic therapies. METHOD, RESULTS AND CONCLUSIONS: While neither perioperative radiotherapy nor perioperative chemotherapy were able to improve the treatment results significantly, a progress in the field of primary and preoperative radiochemotherapy emerges. On locally restricted tumors the latest findings show that a simultaneous radiochemotherapy with Cisplatin is more effective than radiotherapy alone. 20 to 30% histologically verified complete remissions can be reached through preoperative radiochemotherapy. These results will influence future treatment concepts. Brachytherapy can be taken into consideration in highly palliative situations as exclusive method of treatment or for support of laser treatment or bouginage for removal of stenosis. As the number of clinically controlled studies is not sufficient the importance of the brachytherapy boost for potentially curative intentions is not yet clear. Up to now the intraluminal hyperthermia is a underestimated method for improving the results of radiotherapy. Our overview summarizes all presently published randomized studies and relevant phase I/II-studies.

Antineoplastic Agents↗
PubMed1997

[Quality control in multimodal postoperative therapy].

Effects of anaesthesia and analgesia on postoperative morbidity and mortality remain controversial. Numerous studies have demonstrated that epidural anaesthesia and pain relief by epidural analgesia reduces perioperative stress responses and thus may reduce postoperative morbidity and mortality. In patients undergoing vascular surgery, epidural anaesthesia diminished postoperative hypercoagulability. These patients may benefit from less thromboembolic complications as well as a reduced risk of a re-operation. However, regional anaesthesia does not affect cardiopulmonary morbidity or overall mortality significantly in most clinical studies. One reason for this disappointing finding may be the missing integration of improved postoperative pain relief into general surgical care. A multimodal therapeutic approach, which consists of preoperative patient information, sufficient analgesia, early mobilisation and enteral feeding, may solve this discrepancy. Therefore, prospective controlled studies are needed to assess the influence of this perioperative approach on outcome.

Clinical Trials as Topic↗
PubMed1996

Studies of multimodal evoked potentials in treated phenylketonuria: the pattern of vulnerability.

We performed studies of multimodal evoked potentials and peripheral sensory and motor nerve conductions in 33 early and 6 late treated patients with phenylketonuria. The studies revealed the following picture: 1. In 27% of early treated patients latencies of visual evoked potentials were increased. The cause for these changes in unknown. 2. Nerve conduction studies showed the presence of a minor sensory neuropathy which in rare cases may also affect peripheral motor nerves. This neuropathy did not have features of a central-peripheral distal axonopathy which argues against a toxic/nutritional causation. 3. Deficits in the central sensory, motor, and auditory pathways were present, but rare in early treated patients. If the results of electrophysiological studies reported by different groups are compared, the emerging picture is very similar and the majority of the-minor-differences is likely to be explained by technical aspects.

Adolescent↗
PubMed2002

[Local recurrence and survival rate after rectal cancer operations and multimodal therapy].

INTRODUCTION: In the guidelines of the German specialist medical societies, postoperative chemoradiotherapy is recommended for rectal carcinomas in stages II and III. In the meantime, there are important study findings favoring preoperative radiotherapy as against postoperative irradiation. In the present unicentric study, the clinical results after preoperative irradiation and postoperative chemotherapy are to be determined. In period I, sandwich radiation without total mesorectal excision was applied. In period II, the treatment was developed further with exclusive preoperative radiation and total mesorectal excision. Since from 1994 the therapy regimen has changed with the introduction of total mesorectal excision and improved radiotherapy, the present study was carried out to check whether this has led to better results of therapy. PATIENTS AND METHODS: Over a period of 7 years, data from 607 patients with rectal carcinoma were recorded and stored in an Excel file. The carcinomas were grouped into lower, middle and upper segment levels and classified endosconographically. Multimodal treatment was administered in stage uT3. In period I, sandwich radiation was carried out with 24 Gy preoperatively and 24 Gy postoperatively, followed by adjuvant chemotherapy. Total mesorectal excision was not performed. In period II, 50.4 Gy were applied preoperatively, followed by adjuvant chemotherapy. The operation comprised total mesorectal excision of the lower two thirds of the rectum. Calcium folinate and 5-fluoroucil were administered in six chemotherapy cycles. Primarily inoperable patients received preoperative irradiation with up to 50.4 Gy in both periods to attain down-staging. The following surgical procedures were applied: abdominal perineal extirpations, deep anterior resections, coloanal anastomoses, colon pouch anal anastomoses and transanal microsurgical resections. RESULTS: In 469 curatively operated patients, including primarily inoperable patients after down-staging radiotherapy, the rates of local recurrence were 5.8% with a mean follow-up observation of 4.29 years, and the carcinoma-specific 4-year actuarial survival was 84%. The rate of recurrence was highest in the lowest segment level of the rectum (7.6 as compared to 2.4%, P = 0.042). The rates of local recurrence were 7.4% in period I and 4.3% in period II (P = 0.44). The carcinoma-specific 4-year actuarial survivals were 81% in period I and 87% in period II (P = 0.202). Investigation of the subgroups of irradiated patients showed complete freedom from recurrence after a mean follow-up observation time of 3.58 years for patients in stage uT3 with total mesorectal excision, preoperative radiotherapy and postoperative chemotherapy (n = 51). The difference from patients without postoperative chemotherapy was significant (P = 0.018). After radiotherapy, the complication observed was a raised rate of sacral cavity infections after total resection of the rectum (p = 0.039). CONCLUSION: Total mesorectal excision, preoperative radiotherapy and postoperative chemotherapy can effectively influence the rate of local recurrences after rectal carcinoma operations (0-4.3% after a mean period of follow-up observation of 3.58 years). No appraisal can be made with regard to the benefit resulting from the individual measures.

Actuarial Analysis↗
PubMed2002

[Multimodal interdisciplinary therapy to improve function and long-term survival in patients with high-grade osteosarcoma of the extremities].

INTRODUCTION: The probability for survival of patients with highly malignant osteosarcoma of the extremities was essentially improved by (neo-)adjuvant chemotherapy. The goal was to further improve survival rates by introducing operative treatment of metastases. In the last 20 years, the percentage of limb-preserving operations has increased. PATIENTS AND METHODS: A consecutive series of 23 patients with localized highly malignant osteosarcoma of the extremities received (neo-) adjuvant chemotherapy according to the Cooperative Osteosarcoma Study (COSS) protocol. Local treatment was performed by wide (22 patients) or radical (1 patient) resection (17 limb salvage procedures, 5 amputations, and 1 rotationplasty). In four of seven patients who developed pulmonary metastases, the metastases (up to four) were resected. The patients did not receive salvage chemotherapy. RESULTS: The cumulative survival was 87% at 174 months. The four patients who underwent metastasectomy survived between 42 and 116 months without evidence of disease. One local recurrence developed outside the operative field and could be resected without influencing the functional or oncological outcome. After limb salvage procedures, the mean score according to the Musculoskeletal Tumor Society (MSTS) was 83%, and after rotationplasty 67%. CONCLUSIONS: In patients with osteosarcoma of the extremities, limb salvage is possible in a high percentage of cases with a low risk of local recurrence by an effective interdisciplinary cooperation between diagnostic radiologists, oncologists, and orthopedic surgeons. The midterm survival could be improved by the multimodal therapy from about 20% up to about 80%. Metastasectomy gives patients with a limited number of pulmonary metastases a realistic chance to survive.

Adolescent↗