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PubMed2003

Treatment strategies in childhood cancer.

Strategies for the treatment of childhood cancer have significantly evolved over time. Years ago, surgery was the only option for treating childhood cancer. Now, research has advanced treatment options to include multimodal therapy with chemotherapy, radiation, surgery and hematopoeitic stem cell transplantation. The focus on gene therapy research is also increasing. Pediatric nurses must have a thorough understanding of the treatment for childhood cancer so that as frontline healthcare providers, they give accurate information to patients and their families, deliver appropriate care, and assist with gathering data in support of ongoing research.

Adolescent↗
PubMed1990

A stochastic model for haematopoiesis in cats.

Haematopoiesis is the process by which progenitor cells differentiate into competent mature blood cells. Only those cells in the latter stages of haematopoiesis can be observed in vitro, so theories about the early stages of the process cannot be tested directly. Experimental data of bone marrow samples from Safari cats provides evidence for the clonal succession hypothesis of early haematopoiesis. In this paper, a hidden Markov model is constructed to quantify this support. Recursive updating techniques are derived and are used to calculate the likelihood and to construct fitted values for the model. Inference is based on multimodal likelihood surfaces.

Animals↗
PubMed1990

Gender and schizophrenia outcome: a clinical trial of an inpatient family intervention.

Several studies document sex differences in premorbid and intermorbid role functioning, showing less functional deficit among females. The specific nature of sex differences in role functioning is still poorly understood. The purpose of the present study was to investigate sex differences in symptomatology and role functioning in a sample of 92 inpatients hospitalized for an episode of DSM-III-diagnosed schizophrenic disorder. Patients were randomized at hospital admission to either of two treatment conditions: (1) multimodal hospital treatment with the addition of an inpatient family intervention (IFI) or (2) multimodal hospital treatment without IFI. Results indicated (1) sex differences in levels of substance abuse and antisocial behavior (worse for males both at admission and followup)--dimensions of psychopathology unrelated to the core features of schizophrenia; (2) superior family and occupational functioning in females at followup; and (3) superior clinical response of females to IFI. Data on family response to IFI suggest some ameliorative effects of IFI on critical family attitudes toward female patients as well as greater family compliance with IFI treatment among the families of females. Sex differences in intermorbid family and occupational functioning and response to a family-based psychosocial intervention are discussed in light of data on rejecting family attitudes toward the patient and sex differences in symptomatology. The possible influence of sex-differentiated social role demands on response to IFI is also discussed.

Adult↗
PubMed2006

Biomarkers of oxidative stress in critically ill patients: what should be measured, when and how?

PURPOSE OF REVIEW: This review is dedicated to updating the knowledge on oxidative stress in critically ill patients with an intense inflammatory reaction, and to link it with recent findings supporting the possible involvement of oxidative injuries in systems and organs that frequently fail in the critically ill. RECENT FINDINGS: Some direct or indirect biomarkers of oxidative stress have been validated in critically ill patients, and further support the major role of oxidative stress in these conditions. SUMMARY: The assessment of oxidative stress, defined as the association between an increased production of oxygen-derived species and an exhaustion of the stores of antioxidants, requires a multimodal approach. Oxidative damage itself can be much better estimated by quantifying the oxidative byproducts of the lipids and proteins associated with an evaluation of the remaining stores of the corresponding functional antioxidants, or the activity of antioxidant enzymes, than by global tests of the total oxidative damage or the total antioxidant stores. Recent clinical data confirm an important role of increased oxidative stress in the acute dysfunctions of the respiratory, renal and cerebral systems.

Antioxidants↗
PubMed1991

[Use of cranio-cerebral hypothermia among the complex resuscitation measures in mental disorders].

Craniocerebral hypothermia was employed in multimodality treatment of 10 patients with hypertoxic schizophrenia and 60 patients with intoxication psychoses, the clinical picture of which was characterized by increasing hypoxia and edema-swelling of the brain. Hypothermia was made to a cerebral temperature of 28-30 degrees C for 4-6 hours in the presence of the neurovegetative blockade. The data obtained attest to a high therapeutic efficacy of craniocerebral hypothermia.

Adult↗
PubMed2005

Multimodal and three-dimensional imaging of prostate cancer.

Accurate characterization of prostate cancer is crucial for treatment planning and patient management. Non-invasive SPECT imaging using a radiolabeled monoclonal antibody, 111In-labeled capromab pendetide, offers advantage over existing means for prostate cancer diagnosis and staging. However, there are difficulties associated with the interpretation of these SPECT images. In this study, we developed a 3D surface-volume hybrid rendering method that utilizes multi-modality image data to facilitate diagnosis of prostate cancer. SPECT and CT or MRI (or both) images were aligned either manually or automatically. 3D hybrid rendering was implemented to blend prostate tumor distribution from SPECT in pelvis with anatomic structures from CT/MRI. Feature extraction technique was also implemented within the hybrid rendering for tumor uptake enhancement. Autoradiographic imaging and histological evaluation were performed to correlate with the in-vivo SPECT images. Warping registration of histological sections was carried out to compensate the deformation of histology slices during fixation to help the alignment between histology and in-vivo images. Overall, the rendered volumetric evaluation of prostate cancer has the potential to greatly increase the confidence in the reading of radiolabeled monoclonal antibody scans, especially in patients where there is a high suspicion of prostate tumor metastasis.

Humans↗
PubMed1989

[Multimodal evoked potentials: standardized study of 51 individuals in a Brazilian population].

The authors report the results of normative studies of pattern-shift visual, brainstem auditory and somatosensory evoked potentials of upper and lower limbs carried out in a sample of 51 normal subjects of a Brazilian population. Normal values were thus established for the main components of each modality of evoked potentials, with special emphasis on those having more clinical utility. The results were compared to the data available in the literature.

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↗
PubMed1994

Strategies in the surgical treatment of gastric carcinoma.

Surgical therapy still represents the treatment of choice for patients with primary gastric adenocarcinoma, but surgery may have reached its limits concerning the rate of resectability, postoperative mortality and survival rates. Resectability is as high as 80%, mortality after resection ranges between 3% and 5% and the best survival data can be achieved if potentially curative tumor-free (R0-) resection including systematic lymphadenectomy can be performed. Significant prognostic benefits are to be expected in tumor stages II and IIIA. Most gastric carcinomas, however, are diagnosed in far advanced tumor stages (i.e., stage IIIB and IV) and the survival rates in these patients remain disappointing. Multimodality treatment, consisting of preoperative chemotherapy and surgery, may be an encouraging alternative strategy. By endoscopic ultrasonography and staging laparoscopy it may be possible to identify patients with locally advanced tumors, so that these patients should be subjected to multimodal therapy to improve their prognosis. Primary surgical treatment should be exclusively performed in patients with tumor stages up to IIIA and those who are not eligable for aggressive chemotherapeutic regimens, while the concept of multimodality therapy needs to be investigated in the other cases within controlled prospective clinical trials.

Antineoplastic Agents↗
PubMed2003

Outcomes after cerebral aneurysm clip occlusion in the United States: the need for evidence-based hospital referral.

OBJECT: In an age of multimodality and multidisciplinary treatment of cerebral aneurysms, patient outcomes have improved significantly. For a number of complex surgical procedures, hospitals with high case volumes yield superior outcomes. The effect of hospital volume on the mortality rate after emergency and elective cerebral aneurysm clip occlusion in a nationally representative sample of patients is unknown. METHODS: Using clinical data derived from the Nationwide Inpatient Sample for the years from 1995 through 1999, 12,023 patients who underwent clip occlusion of a cerebral aneurysm (International Classification of Diseases, Ninth Revision, Clinical Modification code 3951) were included. Patient age, comorbid conditions, nature of admission, and diagnosis of subarachnoid hemorrhage were abstracted. Hospital case volume was grouped into quartiles. Unadjusted and case-mix adjusted analyses were performed. The mean patient age was 53.2 +/- 13.5 years. The overall crude postoperative mortality rates for emergency and elective aneurysm clip occlusion were 12.2 and 6.6%, respectively. Very low volume hospitals demonstrated higher mortality rates than very high volume hospitals for both emergency (14.7 compared with 8.9%, p < 0.001) and elective (9.4 compared with 4.5%, p < 0.001) aneurysm surgery. Patient-specific predictors of death in the multivariate model were renal disease (odds ratio [OR] 3.32, p < 0.042); age (> 60 years, OR 2.36, p < 0.001; 51-60 years, OR 1.63, p < 0.001; 40-50 years, OR 1.25, p = 0.047); chronic obstructive pulmonary disease (present, OR 1.52, p < 0.001); and nature of admission (emergency, OR 1.18, p = 0.03). Provider-specific predictors of death included very low volume (OR 1.59, p < 0.001); low-volume (OR 1.37, p = 0.001); and high-volume (OR 1.45, p < 0.001) hospitals compared with very high volume hospitals. CONCLUSIONS: A significant volume-outcome effect exists for surgical treatment of cerebral aneurysms in the US. Factors influencing this effect should be investigated to guide future healthcare policy and evidence-based referral. Whenever possible, healthcare practitioners should refer patients to centers in which superior outcomes are consistently demonstrated.

Adult↗
PubMed1996

Chemotherapy in non-small cell lung cancer: a review.

Lung cancer, of which non-small cell carcinoma is the most common, has been a significant therapeutic challenge for decades and will remain so for decades to come. Despite its prevalence, progress in the management of non-small cell lung cancer has been relatively slow. This is in part due to the pessimism of most physicians treating this disease, which has resulted in a relatively lackadaisical attitude with regards to clinical trials when compared to other solid tumours like breast or colorectal cancers. Nevertheless, the past decade has seen significant progress, specifically with regards to the management of locally advanced disease. Chemotherapy, though shown to be biologically active in non-small cell lung cancer, is considered an ineffective palliative tool in the setting of metastatic disease due to its toxicities and the "less than encouraging" response rates generated by the cisplatin-based combination regimen which is generally considered to be the most active currently available. The advent of new active agents such as paclitaxel and vinorelbine which are potentially less toxic may change this view. Conversely, the response rate of locally advanced disease to chemotherapy is significantly higher and this has resulted in numerous multimodality trials of neoadjuvant chemotherapy prior to surgery and/or radiation. To date, a number of randomised trials have shown that this approach can result in significant survival benefit for patients with locally advanced disease. An alternative approach makes use of the potential synergism between certain chemotherapeutic agents (such as cisplatin) and radiation when used concurrently. However, data on concurrent chemoradiotherapy in locally advanced disease have been largely based on single-arm studies and are inconclusive. Three randomised trials on concurrent chemoradiotherapy have been shown benefit for the use of combined modality in locally advanced disease. Hence, treatment of locally advanced disease should include chemotherapy as part of the combined modality approach. However, the optimal sequencing of these modalities would require well-designed randomised trials to determine.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1997

Magnetoencephalographic investigation of human cortical area V1 using color stimuli.

The aim of this study was to determine the response properties of the human visual cortex to chromatic stimuli using magnetoencephalography (MEG). Evoked responses were recorded to isoluminant red/green sinusoidal gratings for a wide range of spatial and temporal frequencies. For each condition the response was dominated by a single major component which was well modeled by an equivalent current dipole. Coregistration of MEG and MRI data provided evidence that the principal evoked cortical activity originated from visual area V1. To investigate the chromatic response properties of this area, the maximum global field power of the evoked response was plotted as a function of stimulus spatial and temporal frequency. The spatial-frequency tuning was lowpass and the temporal-frequency tuning was multimodal, with peaks at 0 and 4 Hz. The results demonstrate the use of MEG as a technique for investigating activity from discrete regions of cortex.

Adult↗
PubMed2002

Neoadjuvant chemotherapy in non-small cell lung cancer.

Non-small cell lung cancer (NSCLC) is a systemic illness. More than half of those patients who present with stage I-IIIA disease and are resected will experience distant relapse. Postoperative adjuvant chemotherapy has been evaluated in several randomized trials but the results of these trials have been inconclusive with increased survival reported in few trials. In resectable stage IIIA NSCLC the findings of three randomized trials have indicated that the survival of these patients is better with neoadjuvant chemotherapy plus surgical resection than with resection alone. Phase II trials using preoperative concurrent chemoradiotherapy have been carried out with encouraging results. The majority of patients with stage IIIA NSCLC require multimodality therapy if they are to achieve a 5-year survival. Combined modality treatment in locally advanced NSCLC continues to evolve and is a subject of ongoing research. One focus for present research is to integrate new active agents into the neoadjuvant setting. Another challenge is to find better treatment approaches in earlier stages of disease. Some data suggest that induction chemotherapy in stage I-II is feasible, does not appear to compromise surgery and yields high response rates. A further aim is to use molecular biological markers of malignancy to identify patients at highest risk of metastatic relapse.

Carcinoma, Non-Small-Cell Lung↗
PubMed2000

[Neoadjuvant strategies in the treatment of non-small cell lung cancer].

The prognosis of patients with resectable non-small cell lung cancer (NSCLC), other than stage IA disease, remains disappointing, with 5 year survival rates ranging from 40-55%. For the past 15-20 years, several phase II trials have investigated the efficacy of chemotherapy and chemoradiotherapy prior to surgery in the management of stage IIIA NSCLC, with encouraging results. Phase III trials comparing surgery alone with chemotherapy plus surgery have confirmed the efficacy of this multimodality approach. Gemcitabine, one of the new agents with significant activity against NSCLC, has undergone extensive clinical testing in combination with cisplatin in this setting. In 47 patients with stage IIIA disease, induction with gemcitabine/cisplatin was well tolerated and yielded a response rate of >70%. Downstaging of the mediastinal lymph nodes occurred in 53% of patients. Preliminary data from another study employing mitomycin C, ifosfamide and cisplatin in resectable NSCLC suggest that there are favourable effects of induction treatment, especially in early-stage disease. With the availability of chemotherapeutic combinations such as gemcitabine/cisplatin, which are both effective and well tolerated, combination therapy is likely to become a major advance in the treatment of patients with early-stage (IB, II) NSCLC.

Animals↗
PubMed1978

["Functional and anatomical organization of associative" cortical areas 7, 21 and 22 in monkeys. A study of the cortical projections from the pulvinar by means of HRP tracing technique (author's transl)].

The thalamic projections to the parietal and temporal associative areas (Brodmann's areas 7, 21 and 22) have been revealed by means of the retrograde axonal transport of horseradish peroxidase (HRP). The medial pulvinar (PM) was found to send afferents to the three studied areas. Labelled neurones of the PM appeared to be grouped in terms of their cortical target; indeed, neurones of origin of projection fibres to areas 7, 21 and 22 were respectively localized in the dorso-lateral, ventro-lateral and ventro-medial part of the PM. Although the multimodal sensory nature of the PM has been demonstrated by electrophysiological works, the function of PM neurones and the significance of their topographical repartition remain unknown. However PM could be involved in the transmission of specific sensory informations to the three associative areas 7, 21 and 22. Such an hypothesis is discussed according to the hitherto available data.

Afferent Pathways↗
PubMed1986

Management of squamous cell carcinoma of unknown origin in cervical lymph nodes.

Forty-three patients with the diagnosis of metastatic squamous cell carcinoma from unknown primary to the cervical lymph nodes were treated in EOVAMC between 1962-1982. Six of these patients were N1, 19 N2, and 18 N3. Five-year survival was 41 per cent for N1, 15 per cent for N2, and 6 per cent for N3 nodes. There was no significant difference in the treatment failure of those patients treated with unimodality versus multimodality. A subsequent primary was detected in the head and neck in 23 per cent of these patients (10/43), and eight of these patients had received previous radiotherapy. The most common site for these subsequent primaries was hypopharynx. Nine of the 43 patients developed distant metastasis with no correlation to stage of disease or treatment modality. These data show that the survival of these patients correlates with the stage of nodal disease, and that radiotherapy did not decrease the subsequent appearance of the primary lesions.

Adult↗
PubMed1998

[Phase II study on preoperative radio-chemo-thermotherapy in locally advanced rectal carcinoma].

BACKGROUND: Recent studies show that preoperative radio-chemotherapy can increase resectability and local control of locally advanced rectal carcinomas. Additional regional hyperthermia might increase remission rates and tumor response. We therefore tested regional hyperthermia together with radio-chemotherapy in a phase-II study on locally advanced rectal carcinomas. PATIENTS AND METHODS: Thirty-seven patients with primary advanced stage uT3/T4 rectal carcinomas were treated with preoperative radio-chemo-thermo-therapy. The initial tumor depth was determined using endosonography, CT, and MRI. Radiotherapy was carried out in prone position (on a belly board) using standard techniques, with 5 x 1.8 Gy per week up to 45 Gy at the reference point. 5-Fluorouracil (300 to 500 mg/m2) was administered with low doses of leucovorin (50 mg) on days 1 to 5 and 22 to 28. The patients were treated with regional hyperthermia each week prior to radiotherapy and simultaneously with chemotherapy, using the Sigma 60 ring from the BSD-2000 system. Temperature/position curves and temperature/time curves were recorded in endocavitary (endorectal) catheters in tumor contact and as well in bladder and vagina. Following endosonographic restaging, the operation was carried out 4 to 6 weeks after the end of preoperative therapy and adjuvant chemotherapy continued in four cycles. In cases where tumors were non-resectable, a boost up to 64 Gy was aimed. RESULTS: Thirty-one of the 37 patients (84%) with primary carcinoma proved locally R0-resectable. In addition we had 1 R1-resection (3%) and 5 non-resectable tumors (13%). Among the resected tumors, 53% experienced a reduction of depth infiltration from the initial endosonographic stage during preoperative therapy. The actuarial survival rate after 4 years is 65% (free of progression 57%). The actuarial 4-year survival rate was particularly favorable for the group of responders. Overall, the preoperative multimodal therapy was well tolerated, and premature termination was only necessary in 1 case (3%). Grade III/IV toxicities in the intestine and skin were reduced as far as possible by field blockings and cooling of the perineal region. They occurred only in 5/37 patients (13%) at the intestine and in 6/37 patients (16%) at the skin. The thermal data were subjected to a statistical analysis. The quality of temperature distribution (T90, cum min T90 > or = 40.5 degrees C) depends on the power level and relative power density. The response (reduction of tumor size or depth infiltration) correlated significantly with quality parameters of the temperature distributions. This dependency is found as a trend for progression-free survival, too. CONCLUSIONS: Preoperative radio-chemo-thermo-therapy proved to be practical and effective, with encouraging remission rates and excellent local control rates. For this reason, a phase-III study to test regional hyperthermia has been initiated. At the same time, certain technical improvements are still under development for regional hyperthermia.

Adult↗
PubMed2001

Neuro-fuzzy systems for computer-aided myocardial viability assessment.

This paper describes a multimodality framework for computer-aided myocardial viability assessment based on neuro-fuzzy techniques. The proposed approach distinguishes two main levels: the modality-independent inference level and the modality-dependent application level. This two-level distinction releases the hard constraint of multimodality image registration. An abstract description template is used to describe the different myocardial functions (contractile function, perfusion, metabolism). Parameters extracted from different image modalities are combined to derive a diagnostic image. The neuro-fuzzy techniques make our system transparent, adaptive and easily extendable. Its effectiveness and robustness are demonstrated in a positron emission tomography/magnetic resonance imaging data fusion application.

Artificial Intelligence↗