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PubMed2002

[Management of learning disorders and attention deficit in children]

OBJECTIVE: This review aims at providing pediatricians with an update on the main causes involved in low school achievement. A more detailed approach is given for the management and treatment of attention deficit hyperactive disorder. SOURCES: Data was obtained by a systematic review of published literature in Medline, through a search on Pubmed in the last five years. The key words used were learning disability, attention deficit, dyslexia (reading disorder) and dyscalculia (mathematical disorder). Studies focusing evaluation and management were retrieved. Governmental population educational data on literacy was also included. SUMMARY OF THE FINDINGS: Statistical medical Brazilian data on the subject is scarce. Hearing, visual and mental deficiency, together with attention deficit hyperactive disorder and specific learning disorders should be part of the differential diagnosis of children with poor school achievement. Development should be carefully followed until school entrance, particularly in children at risk. CONCLUSIONS: Therapy with stimulants, anti-depressive drugs or cloninidine with multimodal treatment improves school achievement in children with attention deficit hyperactive disorder.

Journal Article↗
PubMed2007

Pediatric craniopharyngiomas: classification and treatment according to the degree of hypothalamic involvement.

OBJECT: The current treatment of craniopharyngiomas is evolving into one of a multimodal approach in which the aim is disease control and improved preservation of quality of life (QOL). To date, an appropriate classification system with which to individualize treatment is absent. The objectives of this study were to identify preoperative prognostic factors in patients with craniopharyngiomas and to develop a risk-based treatment algorithm. METHODS: The authors reviewed data obtained in a retrospective cohort of 66 children (mean age 7.4 years, mean follow-up period 7 years) who underwent resection between 1984 and 2001. Postoperative recurrence rates, vision status, and endocrine function were consistent with those reported in the literature. The postoperative morbidity was related to hypothalamic dysfunction. The preoperative magnetic resonance imaging grade, clinically assessed hypothalamic function, and the sugeon's operative experience (p = 0.007, p = 0.047, p = 0.035, respectively) significantly predicted poor outcome. Preoperative hypothalamic grading was used in a prospective cohort of 22 children (mean age 8 years, mean follow-up period 1.2 years) treated between 2002 and 2004 to stratify patients according to whether they underwent gross-total resection (GTR) (20%), complete resection avoiding the hypothalamus (40%), or subtotal resection (STR) (40%). In cases in which residual disease was present, the patient underwent radiotherapy. There have been no new cases of postoperative hyperphagia, morbid obesity, or behavioral dysfunction in this prospective cohort. CONCLUSIONS: For many children with craniopharyngiomas, the cost of resection is hypothalamic dysfunction and a poor QOL. By using a preoperative classification system to grade hypothalamic involvement and stratify treatment, the authors were able to minimize devastating morbidity. This was achieved by identifying subgroups in which complete resection or STR, performed by an experienced craniopharyngioma surgeon and with postoperative radiotherapy when necessary, yielded better overall results than the traditional GTR.

Adolescent↗
PubMedDate not supplied

Data and image processing for abdominal imaging.

Modern imaging techniques allow information from within the human body to be obtained by using noninvasive or minimally invasive means. This article is intended as a summary of the tools used for processing and displaying such datasets, with a focus on abdominal imaging. Although these tools and their applications are permanently evolving, their use for clinic and research is already recognized as essential. As an insight into the near future, advanced protocols such as multidimensional and multimodality diagnostic and therapy planning are also demonstrated with a few clinical examples.

Abdomen↗
PubMed1993

Progressive dissociation of pectin.

The structural organization of alkaline soluble peach pectin was investigated over size ranges extending from micrometers to tenths of nanometers. Analysis was by electron microscopy and high-performance anion-exchange chromatography (HPAEC). Superimposed and individual circular microgels in the micrometer size range were isolated from mesocarp tissue of cell walls and visualized by rotary shadowing. Dilute NaCl and 50% aqueous glycerol disaggregated these microgels into rods, segmented rods, and kinked rods, which collectively comprised the internal gel network of the microgels. Image analysis of the shadowed specimens before and after disaggregation followed by curve fitting of the smoothed distributions revealed a multimodal distribution of lengths. HPAEC revealed that the multimodal aggregates were stable for the most part to further dissociation by increasing ionic strength.

Carbohydrate Sequence↗
PubMed2005

Cross-modal activation of visual cortex during depth perception using auditory substitution of vision.

Previous neuroimaging studies identified multimodal brain areas in the visual cortex that are specialized for processing specific information, such as visual-haptic object recognition. Here, we test whether visual brain areas are involved in depth perception when auditory substitution of vision is used. Nine sighted volunteers were trained blindfolded to use a prosthesis substituting vision with audition both to recognize two-dimensional figures and to estimate distance of an object in a real three-dimensional environment. Using positron emission tomography, regional cerebral blood flow was assessed while the prosthesis was used to explore virtual 3D images; subjects focused either on 2D features (target search) or on depth (target distance comparison). Activation foci were found in visual association areas during both the target search task, which recruited the occipito-parietal cortex, and the depth perception task, which recruited occipito-parietal and occipito-temporal areas. This indicates that some brain areas of the visual cortex are relatively multimodal and may be recruited for depth processing via a sense other than vision.

Acoustic Stimulation↗
PubMed2006

Multimodality approach to sinus and nasal disorders: results of treatment as determined by a patient survey.

Patients with sinus and nasal disorders whose symptoms persist despite primary care may benefit from a referral to a dedicated nose and sinus center where all treatment modalities are available. The essential principle of a multimodality approach is that medical therapy, allergy treatment, and surgery are all important and useful tools. While various medical and surgical treatments of sinus and nasal disorders have been well described in the literature, overall assessments of comprehensive treatment are uncommon. For more than 7 years, the office practice of the senior author (D.G.B.) has been dedicated to the treatment of sinus and nasal disorders. In an effort to assess the results of the multimodality approach to therapy delivered there, we mailed questionnaires to 1,800 patients who had been treated at this practice over a 3-year period. Responses from 222 of these patients revealed that patients required less medication following treatment with a multimodality approach and that they expressed a high degree of satisfaction with the comprehensive care they received. In addition, most patients with asthma experienced relief of their asthma symptoms following treatment for sinonasal disease. We conclude that a stepwise, multimodality, specialty-center approach to treatment is beneficial for patients with persistent sinonasal disorders.

Anti-Asthmatic Agents↗
PubMed2004

Multimodal imaging of somatosensory evoked cortical activity.

Somatosensory evoked cortical activity is well investigated in both fMRI and MEG/EEG. Investigation with functional magnetic resonance spectroscopic (fMRS) imaging is relatively new and provides a means to image the metabolic activity of the brain. We for the first time combined fMRS, fMRI, MEG and EEG. This provides information about the metabolic, hemodynamic and electrical activity of the brain and also the verification of one imaging modality with the other. The dipolar source localized from the EEG/MEG data is in the vicinity of the fMRI activation site and also in the same area where lactate consumption is high as measured with fMRS imaging.

Electroencephalography↗
PubMed1991

Control of orienting gaze shifts by the tectoreticulospinal system in the head-free cat. I. Identification, localization, and effects of behavior on sensory responses.

1. The input-output connectivity, in cat, of tectoreticular (TRNs) and tectoreticulospinal (TRSNs) neurons [together called TR(S)Ns] suggests a role for these cells in the sensorimotor transformations necessary for controlling orienting behavior. Multimodal sensory information converges directly onto these tectal neurons, and they project to several brain stem and spinal cord centers involved in the control of eye- and head-orienting movements. In this and the following two papers, we describe the sensorimotor discharges of antidromically identified TR(S)Ns. Here we describe the process of localizing and identifying them, characteristics of both their antidromic and sensory responses, and effects of behavioral context on these responses. 2. In 13 alert, chronically prepared cats, a total of 293 neurons were antidromically identified from either the predorsal bundle (PDB) immediately rostral to abducens nucleus or the ventromedial funiculus of the spinal cord at the level of the first cervical vertebra (C1). The cell bodies of all identified TR(S)Ns were confined to the intermediate and deep laminae of the superior colliculus (SC). The antidromic nature of the action potential evoked by stimulating either the PDB or C1 was verified by the use of a number of established criteria, including collision testing. 3. The mean antidromic latency from the PDB (TRNs + TRSNs) was 0.84 +/- 0.59 (SD) ms (n = 217). The conduction velocities of all cells activated by PDB stimulation ranged from 4 to 40 m/s. The mean latency from C1 (TRSNs) was 1.03 +/- 0.52 ms (SD) (n = 64), whereas conduction velocities ranged from 14 to 80 m/s. 4. One hundred thirty-eight TR(S)Ns were studied long enough to yield significant data regarding their involvement in visuomotor-orienting behavior. Ninety-eight percent (130/133) of the TR(S)Ns tested for visual responses could be induced to discharge action potentials in response to some form of visual stimulation. The other three neurons remained silent, even in response to the most provocative stimuli. These silent neurons nevertheless were shown to be depolarized by visual stimuli. TR(S)Ns were occasionally tested for auditory and somatosensory responses and some were multimodal. 5. TR(S)Ns had visual receptive fields that conformed to the retinotopic map of the visual field that is represented within the SC. Cells found in the lateral SC had receptive fields located in the lower visual field, whereas neurons that were situated medially had receptive fields in the upper visual field. Cells found in the rostral SC had small fields that included a representation of the area centralis.(ABSTRACT TRUNCATED AT 400 WORDS)

Abducens Nerve↗
PubMed2003

National Cancer Data Base report on osteosarcoma of the head and neck.

BACKGROUND: Osteosarcoma is the most common primary bone malignancy overall but is encountered infrequently in the head and neck. Limited data are available on the significance of prognostics factors and results of therapy for patients with head and neck osteosarcoma (HNOS). It is known that surgical therapy is critical to successful outcome. The impact of adjuvant chemotherapy has not been defined well. METHODS: The National Cancer Data Base has collected data on cases of HNOS by voluntary accrual from participating hospitals. This database was used to assess patient demographics, tumor characteristics, treatment, and outcome for an 11-year period extending from 1985 to 1996. RESULTS: The data set contained 496 cases of HNOS. Overall, the 5-year disease-specific survival rate was 59.7%. Factors associated with a poor prognosis were age older than 60 years; nonmandibular tumor location; tumor size > 6 cm; histologic type of osteoblastic, not otherwise specified (NOS); advanced disease stage; nonsurgical initial therapy; and positive margins of resection. Increased use of multimodality therapy was noted during the later years of the study. No substantial difference in the 5-year survival rate was noted between treatment with surgery alone (74.7%) and surgery with adjuvant chemotherapy (71.3%), despite the greater prevalence of tumors with poor prognostic factors in the surgery and adjuvant chemotherapy group. CONCLUSIONS: Surgery with clear margins is an important factor in successful therapy for patients with HNOS. Improved survival has been noted within the last 2 decades compared with historic controls. Multiple negative prognostic factors have been identified and should be considered in treatment planning. The role of chemotherapy has not been defined well, but its incorporation into treatment of patients with high-risk tumors may improve survival.

Adult↗
PubMed2001

Multimodality therapy in early-stage neuroendocrine carcinoma of the uterine cervix.

OBJECTIVE: Patients with early-stage neuroendocrine cervical carcinoma (NECC) have a high mortality rate despite aggressive therapy. The rarity of this tumor precludes initiation of a randomized, prospective trial. We reviewed our experience in early stage disease and performed a meta-analysis of the literature to identify prognostic factors and determine optimal multimodality therapy. METHODS: Eleven women with International Federation of Gynecology and Obstetrics (FIGO) early stage (IB--IIA) NECC were treated with surgery and chemotherapy at our institutions between 1978 and 1998. Administration of radiation therapy was recorded, but not required for inclusion in this study. A gynecologic pathologist reviewed all histopathologic sections. Medical records were retrospectively reviewed and clinical data obtained. Twenty-three early-stage NECC patients who were similarly treated during the study interval were identified by a Medline search of the English literature and included in the analysis. The Kaplan--Meier method and log-rank test were used for survival analysis. RESULTS: The overall 2-year survival rate for the 34 patients was 38%. The median age was 37 years (range, 20--75 years). Median cervical tumor diameter was 3.2 cm (range 0.5--11.0 cm). Lymphovascular space invasion was present in 21 (78%) of 27 patients (7 unknown). Fifteen (52%) of twenty-nine had lymph node metastases (5 unknown). Fifteen patients received postoperative platinum/etoposide (PE), seven received vincristine/adriamycin/cyclophosphamide (VAC), two received alternating cycles of VAC and PE, and ten received other chemotherapy regimens. Twenty women were treated with radiation therapy. The presence of lymph node metastases was a poor prognostic factor (P < 0.001). PE and VAC chemotherapy was associated with increased survival (P < 0.01). CONCLUSION: NECC is a highly lethal variant of cervical cancer. The presence of lymph node metastases is the most important prognostic variable. Postoperative VAC or PE appears most likely to improve chances for survival.

Adult↗
PubMed2005

Physiological system identification with the Kalman filter in diffuse optical tomography.

Diffuse optical tomography (DOT) is a noninvasive imaging technology that is sensitive to local concentration changes in oxy- and deoxyhemoglobin. When applied to functional neuroimaging, DOT measures hemodynamics in the scalp and brain that reflect competing metabolic demands and cardiovascular dynamics. Separating the effects of systemic cardiovascular regulation from the local dynamics is vitally important in DOT analysis. In this paper, we use auxiliary physiological measurements such as blood pressure and heart rate within a Kalman filter framework to model physiological components in DOT. We validate the method on data from a human subject with simulated local hemodynamic responses added to the baseline physiology. The proposed method significantly improved estimates of the local hemodynamics in this test case. Cardiovascular dynamics also affect the blood oxygen dependent (BOLD) signal in functional magnetic resonance imaging (fMRI). This Kalman filter framework for DOT may be adapted for BOLD fMRI analysis and multimodal studies.

Algorithms↗
PubMed2005

The role of cyclooxygenase-2 inhibition in foot and ankle arthrodesis.

Cyclooxygenase-2 (COX-2) inhibitors are an important adjunct in controlling postoperative pain. Concerns exist regarding the use of NSAIDs for postoperative pain management because of the possible deleterious impact on bone healing in patients undergoing hindfoot arthrodesis. Orthopedic surgeons are concerned with: (1) a multimodal approach for postoperative pain control, and (2) bone healing following arthrodesis, fracture repair with rigid internal fixation, and cementless implants. The use of COX-2 inhibitors has been shown to be an important component of a pain control strategy but questions about their effects on bone healing have inhibited their use. This article discusses the laboratory and clinical data available on the use of COX-2 inhibitors on bone healing and their effects on foot and ankle arthrodesis procedures.

Animals↗
PubMed2002

Chemoradiation schedules--what radiotherapy?

UNLABELLED: Synchronous chemoradiation (SCRT) is playing an increasing role in the primary and multimodality management of cancer in many disease sites. Current schedules have been in the main empirically derived, and the addition of chemotherapy has in some cases led to a compromise in the total dose or scheduling of radiotherapy. Non-randomised phase II studies abound, but there are few well designed phase III randomised studies with comprehensive acute toxicity data and mature follow-up. In many sites long-term survival is unusual. So severe morbidity and long term functional outcome is poorly documented. It is therefore difficult to assess the real benefit of SCRT. This review uses the endpoints of local control and overall survival from randomised trials in small and non-small cell lung cancer, head and neck cancer, oesophageal cancer, rectal and anal cancer. We explore the evidence for total dose; fractionation; fraction size; the effects of a gap in treatment; and scheduling of radiation in SCRT. CONCLUSIONS: An optimal schedule of SCRT has not yet been derived. The enhanced acute toxicity and persistent high risk of local failure in many disease settings with current SCRT schedules demand that more effective and less toxic treatment strategies must be identified in the future. These schedules should be tested in randomised trials with the emphasis on meticulous reporting of acute toxicity endpoint and documenting the field sizes or proportions of critical organs within the high dose area if we are to derive the optimal therapeutic ratio.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed2004

Development of an integrated optic oxygen sensor using a novel, generic platform.

This paper describes the development of a generic platform for enhanced, integrated optic sensors based on fluorescence detection. The platform employs a novel optical configuration in order to achieve enhanced performance and has inherent multianalyte detection capability. The sensor element comprises a multimode ridge waveguide that has been patterned with an analyte-sensitive fluorescent spot, which is excited directly using a LED. The platform was applied to the detection of gaseous oxygen as a proof of principle. The sol-gel-derived sensor spots were doped with an oxygen-sensitive fluorescent dichlororuthenium dye complex and intensity-based calibration data were generated from the oxygen-dependent waveguide output. The sensor achieved a LOD of 0.62% and a resolution of less than 0.96% gaseous oxygen, which compares favourably with a similar, recently reported system. This device highlights the combination of inexpensive rapid prototyping techniques and a dedicated sensor enhancement strategy that together facilitate the production of an effective prototype sensor platform.

Journal Article↗
PubMed1988

Computer graphics in medicine: a survey.

Increased interest is presently given to three-dimensional (3-D) medical applications due to simultaneous emergence of high-resolution imaging systems and computer graphics techniques. This paper intends to present a survey of this field together with discussion and prospective views. The general framework is composed of six parts: data acquisition and preprocessing, polygonal object representation, voxel description, system architecture, medical applications, and prospects. Data base acquisition includes characterization of imaging modalities and medical specificity. Preprocessing schemes are directed to improvements (filtering), windowing, and spatial anisotropy (linear or spline interpolation). The two following sections are devoted to descriptions of the main object representations. Particular emphasis is given to optimal contour approximation, surface triangulation, mathematical surfaces on one hand, and cuberille and voxel representations on the other. Display capabilities--hidden surface removal, surface normal shading, structure enhancement--and data base structuration--hierarchical and nonhierarchical (graph and tree encoding)--are, respectively, described. An overview of 3-D systems is further given (Section V), and features of medical applications are reviewed and gathered in basic functionalities, surgery, and radiotherapy specifications (Section VI). The last section provides some prospective views on reconstruction from a few projections, model-guided labeling, multimodality image overlay, and local image network. Some of these issues are illustrated by examples of 3-D images.

Computer Graphics↗
PubMed1995

[Locally advanced non-small cell lung tumors: curative or palliative radiotherapy].

The best treatment for inoperable "non small cell" lung cancer remains unknown. While metastatic patients are usually treated palliatively, the therapeutic course for locally advanced disease is less clear cut and more controversial. The common habit was been to treat these patients only when disturbing symptoms are present. But this is now changing, because defined radiotherapy techniques and combinations with chemotherapy and/or radiosensitizers produce better results. Also, in palliative treatments new dose-fractionalised schemes are being sought, with the aim of less discomfort and better efficacy. Two clinical trials are presented. The first is a palliative, 10 Gy single-dose treatment of 17 patients with chest symptoms. Results have been encouraging: 67% symptoms palliated at 1 month from treatment. Palliation was however short: 42% at 2 months, 32% at 3 months. The low incidence and mildness of acute complications in this small number of patients permit us to conclude that the treatment is feasible and tolerable; short-lived palliation could be used in patients with a short life expectancy. In the second study, was a multimodality treatment-polychemotherapy (Cisplatin 100 mg/mq days 1, 22 and Vinblastine 5 mg/mq days 1, 8, 15, 22) followed by radiotherapy (60 Gy/30 fractions/42 days) with Cisplatin (5 mg/mq/d) as a radiosensitizer. 15 patients have been recruited, but only 7 could be evaluated. 5/7 objective responses were observed (3 complete). Whole acute toxicity is acceptable. The lack of data concerning late toxicity does not allow conclusions about the feasibility of this therapeutic.

Adult↗
PubMed1997

[Image fusion of different tomographic methods (PET/CT/MRI) effectively contribute to therapy planning].

Image fusion (and image registration) is a fundamental topic of three-dimensional (3D) medical image processing. The need to register different imaging modalities arises for several reasons: some anatomical details, especially soft tissues, are more easily seen in MRI than CT images, but the bony structures are better visualised by CT. The visualisation of any morphological volume with a functional data set which may come from SPECT or PET is a very important method both for research purposes and for routine diagnostics. Our developed programs allowing us to solve image fusion tasks also contained some free available softwares. These packages helped us to start additional software development for more advanced applications having elaborated this way the informatical background of multimodality image processing. This paper presents three oncological applications of the image fusion: PET-CT-MRI registration for 3D radiotherapy planning, PET-MRI registration in planning surgery and metastasis localization. All these registration processes were solved by the landmark-matching registration method.

Decision Making↗
PubMed1998

Multimodal output mapping of human central motor representation on different spatial scales.

1. Non-invasive mapping by focal transcranial magnetic stimulation (TMS) is frequently used to investigate cortical motor function in the intact and injured human brain. We examined how TMS-derived maps relate to the underlying cortical anatomy and to cortical maps generated by functional imaging studies. 2. The centres of gravity (COGs) of TMS maps of the first dorsal intersosseus muscle (FDI) were integrated into 3-D magnetic resonance imaging (MRI) data sets in eleven subjects. In seven of these subjects the TMS-derived COGs were compared with the COG of regional cerebral blood flow increases using positron emission tomography (PET) in an index finger flexion protocol. 3. Mean TMS-derived COG projections were located on the posterior lip of the precentral gyrus and TMS-derived COG projections were in close proximity to the mean PET-derived COG, suggesting that the two methods reflect activity of similar cortical elements. 4. Criteria for a reliable assessment of the COG and the number of positions with a minimum amplitude of two-thirds of the maximum motor-evoked potential (T3Ps) were determined as a function of the number of stimuli and extension of the stimulation field. COGs and T3Ps were compared with an estimate of the size of the human motor cortex targeting alpha-motoneurons of forearm muscles. This comparison suggests that TMS can retrieve spatial information on cortical organization below the macroanatomic scale of cortical regions. 5. Finally, we studied the cortical representation of hand muscles in relation to facial and foot muscle representations and investigated hemispherical asymmetries. We did not find any evidence for a different ipsi- or contralateral representation of the mentalis muscle. Also, no difference was found between FDI representations on the dominant versus the non-dominant hemisphere.

Adult↗