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PubMed1991

Magnetic transcranial brain stimulation and multimodality evoked potentials in an adrenoleukodystrophy patient and members of his family.

In a patient with adrenoleukodystrophy (ALD), prolonged conduction times along the corticospinal tract and afferent sensory pathways were demonstrated using magnetic transcranial brain stimulation and multimodality evoked potentials, respectively. On investigation of two healthy family members (one an obligate carrier), slight latency increases in evoked potentials suggested impaired conduction along the respective pathways. Thus, the combined use of these methods (1) is helpful in assessing the location and extension of demyelinating lesions and (2) may raise the sensitivity in detecting subclinical involvement in patients with ALD and in carriers.

Adrenoleukodystrophy↗
PubMed1992

Multimodality imaging and intracranial EEG display for stereotactic surgery planning in epilepsy.

We describe a computer program for stereotactic surgery planning based on multimodality imaging and the display of intracranial EEG data in relation to anatomical data. The program is primarily designed to be used by surgeons to assist them in localizing brain structures and plan the safe and accurate insertion of surgical tools and depth electrodes. The mathematics underlying these concepts are briefly described. Estimates of the accuracy of the procedures are calculated and made available to the user. An extension of the program was developed to integrate intracranial EEG data with conventional images in order to help the neurologist and neurosurgeon in visualizing the EEG data in relation to the anatomy. It can be used to visualize the measured EEG voltages, or processed signals such as the application of the tetrahedral field calculation, which provides an extension of conventional bipolar EEG to 3 dimensions.

Brain↗
PubMed1995

Multimodal treatment for the locally advanced stage IB, IIA, IIB patients of cervical cancer.

By employing neoadjuvent chemotherapy (NCT) before radical hysterectomy (RS) and pelvic radiotherapy (RT) in bulky locally advanced cervical cancer (IB, IIA, IIB), the study was focused to update the results of the author's therapeutic experience with multimodal treatment by observing tumor free survivals along with related prognostic factors in different treatment modalities with NCT. The chemotherapy regimen for induction is composed of Vinblastin, Bleomycin and cis-Platin regimen (VBP). The effect of neoadjuvent chemotherapy was evaluated by the WHO definition of clinical response (CR, PR, ST, PG). As a result of NCT study in the stage IA, IIA, and IIB cervical cancer patients recurrence occurred in 50 out of 138 patients (35.5%) treated with radical hysterectomy only (RS) compared with 17 out of 92 patients (18.5%) treated with NCT followed by radical surgery. In conjunction with the NCT study in the cervical cancer, another two groups of patients who were treated by neoadjuvent chemotherapy followed by radical hysterectomy (NCST) and adjuvent radiation (NCSRT) were evaluated in the high-risk patients of cervical cancer with stage IB, IIA, and IIB. Primary responses in the NCST group (n = 61) were CR (68.9%), PR (22.9%), ST (4.9%) and PG (3.3%) respectively, while the chemoresponse of the NCSRT group (n = 101) were CR (65.3%), PR (18.9%), ST (4.9%) and PG (10.9%), respectively. The survival rates of the NCSRT group (n = 101) were 100% in all 1-5 years in CR group, while the rate of the NCST group was 100% at 1 year and 98.5% at 5 years in the CR group of patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

Multimodal treatment programmes for chronic pain: a quantitative analysis of existing research data.

This article reviews the empirical data obtained in existing studies on the multimodal treatment of chronic pain. The majority of these 'treatment packages' are based on a cognitive/behavioural perspective. The articles for review were selected from the scientific literature on this subject which has appeared since the first publication of Fordyce in 1973. The following aspects have been analysed: the goal and structure of the treatment programmes; the method of evaluating treatment results; and the indications for treatment. Programmes for in-patients and out-patients have been compared because it is very likely that there are differences between the treatment methods and study populations. The interval validity and clinical relevance of the available research are discussed in the conclusion.

Back Pain↗
PubMed1993

Primary progressive versus relapsing remitting multiple sclerosis in Japanese patients: a combined clinical, magnetic resonance imaging and multimodality evoked potential study.

Thirty-five Japanese patients with relapsing remitting multiple sclerosis (RRMS) and 11 Japanese patients with primary progressive MS (PPMS) were compared by a combined clinical, magnetic resonance imaging (MRI) and multimodality evoked potential (MEP) study. Patients with PPMS showed a more common occurrence of gait disturbance as the initial symptoms as well as a more common occurrence of cerebellar symptomatology than did those with RRMS, while spinal cord symptomatology was frequently observed in both conditions. On brain MRI, patients with PPMS had 3 times more lesions than did those with RRMS (P < 0.001, chi 2-test). The percentage of infratentorial lesions was also significantly higher in PPMS than in RRMS on MRI. Moreover, we found a significantly higher frequency of abnormal records in visual, brainstem auditory and somatosensory evoked potentials in PPMS than in RRMS. Interestingly, clinically unexpected abnormalities were significantly more common in PPMS than in RRMS throughout all modalities of MEPs. Thus, in Eastern MS, there exists a distinction between PPMS and RRMS in the MRI and MEP findings as well as in the clinical findings. Our result therefore suggest that there may be two distinct subtypes in MS.

Adult↗
PubMed1996

Autosomal dominant cerebellar ataxia type I: multimodal electrophysiological study and comparison between SCA1 and SCA2 patients.

A multimodal electrophysiological study was performed on 41 patients from 24 families with autosomal dominant cerebellar ataxia type I (ADCA I). Upper- and lower-limb motor evoked potentials (MEPs) to transcranial magnetic stimulation, median and tibial nerve somatosensory evoked potentials (Mn and Tn-SSEPs), orthodromic sensory (SCV) and motor conduction (MCV) velocity along median and tibial nerve, brainstem auditory evoked potentials (BAEPs), and visual evoked potentials (VEPs) were examined. Molecular analysis showed 2 SCA1 families and 2 families linked to the SCA2 locus. A sural nerve biopsy was performed in 5 patients. Brainstem damage of the auditory pathway was observed in 79% of patients examined. VEP abnormalities possibly of central origin were found in 52% of patients. MEP and SSEP abnormalities were differently distributed along the pathways examined: the longer the pathway, the higher the occurrence and severity of impairment. Peripheral dying-back neuropathy (confirmed by nerve bioptic data) was a frequent finding (56%). A progressive degenerative process involving first the longest tracts of the central motor and central and peripheral branches of somatosensory pathways is hypothesized in ADCA I. MEP abnormalities were more frequent in SCA1, and the sensory-motor neuropathy was more severe in SCA2.

Adolescent↗
PubMed1986

Oral complications of multimodality therapy for advanced squamous cell carcinoma of head and neck.

Investigational treatment of advanced localized stage III or stage IV squamous cell carcinoma of the head and neck may include chemotherapy in addition to radiotherapy and surgery. Such therapy, while effective in eradicating local tumors, often produces considerable oral toxicity. In this study we reviewed the oral complications of 22 patients receiving multimodality cancer treatment. The addition of chemotherapy to the treatment regimen did not increase the incidence of complications (osteoradionecrosis, mucositis, xerostomia, radiation caries, or infection) when compared with historical controls receiving radiotherapy alone. Pretreatment dental evaluation and close follow-up of these patients are encouraged.

Carcinoma, Squamous Cell↗
PubMed1992

Multimodality treatment of deep periventricular cerebral arteriovenous malformations.

The surgical treatment of arteriovenous malformations (AVMs) located in deep periventricular regions such as the basal ganglia is associated with marked morbidity and mortality. Approaches through critical brain regions afford limited exposure of the lesions, while surgical dissection is sometimes complicated by acute severe brain swelling and/or hemorrhage in the surrounding tissues. In our approach to deep AVMs, our regimen has evolved from direct staged microsurgical excision under routine fentanyl-N2O-relaxant anesthesia (first four patients) to the use of elective high-dose barbiturate anesthesia (subsequent 12 patients). In the first group of four patients, 11 operations were performed. Two patients improved, one of whom returned to normal neurologically. There were three episodes of acute brain swelling and/or hemorrhage. One patient died as a result, and another deteriorated. In the second group of 12 patients, all but two lesions were completely excised. Among the 10 patients in whom the AVM was completely excised, seven improved, six of whom achieved a good to excellent outcome, with two regaining full neurologic function. Three patients worsened (one as the result of acute brain swelling and/or hemorrhage). There was no death in this group. Only one incidence of acute brain swelling and/or hemorrhage occurred in 26 operations. Even though the number of patients is too small in the first group for meaningful statistical comparison, our intraoperative observations and postoperative results suggest that our evolved multimodality regimen, such as staged excision and the use of elective high-dose barbiturates, was likely to have contributed to the improved treatment results of these formidable lesions.

Adolescent↗
PubMed1983

Multimodality treatment of adenocarcinoma of the vagina Stage IV: potential for cure.

A 26-year-old nulligravida presented with a Stage IV adenocarcinoma of the vagina with a frozen pelvis and positive lymph nodes in the right external iliac and inguinal regions. Following transposition of the ovaries laterally, a successful treatment program of cyclic radiotherapy and 5-fluorouracil was undertaken. Patient is now alive 3 years posttherapy with a functional vagina, return of menses, and without evidence of tumor. She experienced a small-bowel stricture 5 months posttherapy which required small-bowel resection. This case suggests that an integrated multimodality program is feasible and that 5-fluorouracil may be synergistic with radiation.

Adenocarcinoma, Mucinous↗
PubMed1990

Lack of acute toxicity associated with a multimodality treatment of stage III ovarian epithelial carcinoma.

Eleven patients with advanced stage III ovarian epithelial carcinoma were treated primarily according to an aggressive multimodality plan utilizing cytoreductive surgery, chemotherapy (high-dose cisplatin and Cytoxan), and consolidative radiation therapy (abdominopelvic "bath" plus pelvic boost). The treatment was tolerated remarkably well. There was no evidence of progressive disease during treatment, and all patients showed a positive response. There was a notable lack of significant acute morbidity, with the exception of a severe symptomatic peripheral neuropathy associated with cisplatin doses of 200 mg/m2. This was not evident with doses of cisplatin up to 150 mg/m2.

Adult↗
PubMed1993

Pre- and intra-irradiation multimodal image registration: principles and first experiments.

Accurately repositioning the patient with respect to CT or MR images is essential for high precision radiotherapy. We show that portal images may be automatically registered with 3D pre-session data (typically morphological images like CT or MR images), thus enabling an automatic adjustment of the planned strategy to the actual position of the patient. Based on computer vision techniques, the principles of this new method of multimodal image registration are presented, and the first experiments with a phantom are analysed.

Humans↗
PubMed1984

Monitoring of multimodality evoked potentials during open heart surgery under hypothermia.

Multimodality evoked responses (ERs) were monitored in 16 adults who had cardiac surgery under cardiopulmonary bypass and moderate hypothermia (19-25 degrees C). Cooling affected all sensory ERs by progressively increasing the latencies of the major components. The effect was more profound on the later than on the earlier ER components. Visual evoked responses (VERs) were most inconsistent and always disappeared at temperatures below 25 degrees C. The later components of the long latency somatosensory evoked responses (SERs) also attenuated or disappeared rather early during hypothermia. On the other hand, short latency SERs were more resistant to the effects of hypothermia. They were always recordable at temperatures of 25 degrees C or above; and usually persisted even at temperatures between 20 and 25 degrees C. Brain-stem auditory evoked responses (BAERs) were consistently present at temperatures above 25 degrees C, wave V was recordable in majority between 20 and 25 degrees C. All sensory ERs disappeared with severe hypothermia (20 degrees C or less) except the components generated more peripherally such as N10 of the short latency SERs. We feel that BAERs and short latency SERs may serve as useful intraoperative monitors of brain function during hypothermia.

Adult↗
PubMed1985

Multimodality evoked potentials in patients and carriers with adrenoleukodystrophy and adrenomyeloneuropathy.

A combination of brain-stem auditory evoked potentials (BAEPs), short latency somatosensory evoked potentials (SEPs) and pattern reversal visual evoked potentials (VEPs), were studied in two patients with adrenoleukodystrophy (ALD) and one patient with adrenomyeloneuropathy (AMN), as well as in one female carrier of each of the respective diseases. Abnormalities in at least 1 of the 3 evoked potentials were found in every case, including the carriers of ALD and AMN. The two most common findings were prolongation of the I-V interval of the BAEP and the N13-N20 interval of the SEP. These abnormalities were recorded either alone or in combination in all 5 cases. This finding suggests delayed conduction time in the central sensory pathways in both diseases, probably due to demyelination. The remarkable result, which distinguished AMN from ALD, even in their respective carriers, was delay of the N9 latency of the SEP, indicating slowing in conduction velocity of the peripheral nerve. Multimodality evoked potentials are useful not only in raising the detection rate for abnormal findings, but also in providing additional information about the functional state of separate afferent pathways. It is also of value in detecting and differentiating the carriers of ALD and AMN.

Adrenal Gland Diseases↗
PubMed1995

Multimodality therapy in unresected stage III non-small cell lung cancer: the American Cooperative Groups' Experience.

Since the mid-1980s, the American Cooperative Cancer Treatment Groups (Cancer and Leukemia Group B, Eastern Cooperative Oncology Group, North Central Cancer Treatment Group. Radiation Therapy Oncology Group, Southwest Oncology Group) have performed several multimodality trials exploring combinations of chemotherapy and radiation in patients with Stage III non-small cell lung cancer. The initial trials had a sequential design with induction chemotherapy followed by radiation. Later trials have emphasized concurrent chemoradiation with or without induction chemotherapy. These trials have begun to have an impact on what is considered 'standard' therapy for patients with Stage III non-small cell lung cancer (NSCLC).

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1985

Localized Ewing's sarcoma of bone: ten years' experience at the Istituto Ortopedico Rizzoli in 124 cases treated with multimodal therapy.

The results obtained in the treatment by multimodal therapy (surgery, radiation therapy and chemotherapy) of 124 cases of Ewing's sarcoma are presented. At a medium follow-up of 65 months 48% of the patients are disease-free. One patient died of leukemia and two patients developed an irradiation-induced sarcoma. Analysing the data, three factors seem to be correlated to prognosis: location of the initial lesion outside the pelvis and sacrum, a four-drug chemotherapy protocol and the use of surgery in the treatment of the initial lesion seem to give better results.

Adolescent↗
PubMed1989

Efficacy of a minimal contact version of a multimodal smoking cessation program.

A five-week multimodal smoking cessation program was delivered in two formats: Weekly Contact Group meetings led by graduate student leaders versus a minimal contact By-Mail version consisting of weekly mailings of program materials. By-Mail subjects also had access to a "hotline" number they could call with questions and problems. Of 43 smokers who began the Contact Group program, 37% were abstinent at one-year follow-ups; 41% of the 49 By-Mail subjects were abstinent at one year. These results suggest that cost effective minimal contact cessation programs can benefit the many smokers who are unwilling or unable to visit cessation clinics.

Adult↗
PubMed1993

The evolution of acute stroke recorded by multimodal magnetic resonance imaging.

Events associated with an evolving cerebral infarction were studied using multiple magnetic resonance imaging (MRI) techniques at 4.7 T in a rat model of middle cerebral artery occlusion. High resolution perfusion images revealed a core of absent perfusion surrounded by a zone of slow, but measurable perfusion. Only the core of severest perfusion deficit demonstrated restricted water diffusion as early as 1 hr, consistent with "cytotoxic" cellular edema in the most vulnerable region. Within 24 hours, the area of restricted diffusion encompassed the entire region destined to become infarcted. In spin-echo images, hypointensity, likely reflecting deoxygenated hemoglobin, was visible in the ischemic hemisphere. Edema accumulated over 72 hr primarily in the surrounding slowly perfused rim, consistent with the concept of "vasogenic" edema. These studies demonstrate that multimodal MRI can visualize events which define the ischemic penumbra--deoxygenation, maintenance of transmembrane ionic gradients, reduced flow, and delayed cell death. These experiments noninvasively visualized differential hemodynamic and biochemical processes within the core and perifocal penumbra and will allow quantitation over time of the relationship between blood flow, cytotoxicity and edema in stroke.

Acute Disease↗
PubMed1990

Chemical aversion therapy in the treatment of cocaine dependence as part of a multimodal treatment program: treatment outcome.

A pilot feasibility study of chemical aversion therapy in the treatment of cocaine dependence as part of a multimodal treatment program was conducted at the Schick Shadel Hospital of Santa Barbara. Twenty (20) patients (9 treating for cocaine only and 11 treating for cocaine/alcohol), who primarily snorted cocaine, completed a program which included chemical aversion therapy to develop a conditioned aversion to the sight, smell, and taste of a cocaine substitute (tetracaine, mannitol, and quinine with Psychem. Ninety-five (95) percent of patients were followed up in six months with a total abstinence rate from cocaine of 56% (78% current abstinence of at least 30 days prior to follow-up) in the cocaine only group and total abstinence from cocaine of 70% (also 70% current abstinence) for the cocaine/alcohol group. Ninety (90) percent were followed up at 18 months. Thirty eight (38) percent of the cocaine only group had been totally abstinent (75% were currently abstinent). Fifty (50) percent of the cocaine/alcohol group had been totally abstinent (80% were currently abstinent). Validation of results was obtained from "significant others" for 90% of patients.

Administration, Inhalation↗