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At least 1,135 records · Page 63Linked to original sources
PubMed1992

A randomized study of long-term out-patient treatment in alcoholics. Psychiatric treatment versus multimodal behavioural therapy, during 1 versus 2 years of treatment.

Seventy-two alcoholic patients (60 men and 12 women) were randomized into four groups who received psychiatric treatment (PT) or multimodal behavioural therapy (MBT), for either 1 or 2 years. PT was based on psychodynamic principles, and MBT is a cognitive-behavioural treatment. The patients accepting treatment had a mean age of 37 +/- 9 years, and they were socially stable. There was no difference in attrition rate (35%) in relation to therapy and length of treatment. The rate of favourable drinking outcome during the third year was similar in all four alternatives, at 40-44%. A favourable drinking outcome was predicted by a better initial psychic status and few psychiatric symptoms at intake. In PT patients a favourable outcome was more strongly related to a better psychic status than in MBT patients (P = 0.58). The mean number of sessions, 23, did not differ in relation to outcome. The main conclusion from this study is that there were only small and inconclusive differences between the therapies of different types and different duration.

Alcoholism↗
PubMed1992

[Long-term results of small cell lung cancer treated by surgical resection and multimodality therapy].

241 patients with small cell lung cancer (SCLC) were operated in our hospital from 1957 to 1985. The early postoperative mortality was 1.7%. The 5-yr survival rate was 23.2% (56/241). The 10-yr survival rate was 16.5% (15/91) (only 4 patients died during 5-yr to 10-yr after surgery but none of them died of SCLC). We analysed the 5-yr survival group. The 5-yr survival rate for stage I patients was 52.3% (23/44), stage II 34.1% (14/41), stage III 12.8% (19/149) [IIIa12.3% (17/138),IIIb 18.2% (2/11)]. Stage IV 0 (0/3). The P value: I vs IIIaP < 0.001, II vs IIIaP < 0.01. 125 patients received chemotherapy (CT) and/or radiotherapy (RT) postoperatively (group A) and the other 112 cases received surgical resection only (group B). 4 patients (3 IIIa, 1 IIIb) who died in early postoperative period were not counted. The 5-yr survival rate for group A and B was 40.8% (51/125) and 4.5% (5/112) respectively, P < 0.001; for group A and B stage I was 71.4% (20/28) and 18.8% (3/16), P < 0.01;for group A and B stage II was 54.5% (12/22) and 10.5% (2/19), P < 0.01; for group A and B stage IIIa was 25.4% (17/67) and 0 (0/71), P < 0.001. There were no differences in 5-yr survival rate on types of surgical resection and locations of the disease. The present results revealed that the total 5-yr survival rate for SCLC was 23.2%, among them for resection only was 4.5% and for resection plus multimodality therapy was 40.8%.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

Integrated multimodal therapy of children with attention-deficit hyperactivity disorder.

Attention-deficit hyperactivity disorder (ADHD) affects about 3-9% of children in the United States. It is a complex, multidetermined ailment that causes profound difficulty not only for the children but also for their families and those in the broader social environment (e.g., schools). Although medication helps an ADHD child's day-to-day functioning, it is less effective in producing long-lasting improvement when used alone. The author therefore discusses the rationale and techniques for multimodal treatment, including the use of education, cognitive-behavioral therapy, behavior modification, and structural and dynamic therapy, as well as medication. He emphasizes that the use of multiple modalities produces therapeutic benefit greater than the sum of each modality's contribution. The author's basic premise is that psychodynamic understanding is crucial in determining how to combine various therapies and make them mutually facilitative.

Attention Deficit Disorder with Hyperactivity↗
PubMed2003

[Multimodality therapy in progressive rectal carcinoma].

Rectal carcinoma cannot be controlled only by surgical technique despite radical resection (TME, systematic lymphadenectomy). Therefore, progressive rectal carcinoma of stage 2 + 3 that are detectable pre-operatively by CT and 3-D endosonography, should be treated by a multimodal concept. Based on recent Scandinavian and Dutch studies, we introduced a modified post-operative short-term radiation in which the acute toxicity on tumor tissue corresponds to that of the Swedish and Dutch studies (5 x 5 Gy), its late toxicity, however, is reduced by 20%. Thus, we expect to reduce long-term damages to the pelvic organs, i.e. incontinence. A phase 2 study revealed good therapeutic management due to interdisciplinary tumor conference and a high acceptance by patients. The post-operative rate of wound healing is a bit higher, but does not influence the time of hospitalization.

Carcinoma↗
PubMed2003

Tramadol--a multimodal, multipurpose analgesic for the surgeon.

Tramadol is a multimodal analgesic with proven dose-related efficacy over a variety of perioperative surgical fields and is efficacious in treating both neuropathic and cancer pain. It is of particular use in patients with impaired cardiorespiratory, hepatic or renal function, and is an important addition to the armamentarium of the surgeon.

Analgesics, Opioid↗
PubMedDate not supplied

Patient profile and treatment outcome of rectal cancer patients treated with multimodality therapy at a regional cancer center.

BACKGROUND: Incidence of rectal cancer has wide geographical variation. Disease pattern in developing countries is different from developed countries as majority of the patients present in advanced stage because of delayed referral and lack of uniform treatment practices. AIMS: Present study describes the patient profile and treatment results from a tertiary care cancer center in India. SETTING AND DESIGN: Tertiary care Regional cancer center. Retrospective analysis 89 patients with rectal adenocarcinoma treated between 1995 and 2002 were analyzed. METHODS: Patients with adenocarcinoma rectum were evaluated in a G.I. Oncology clinic and were treated using multimodality protocols involving surgery, radiotherapy and adjuvant chemotherapy. STATISTICAL ANALYSIS: A descriptive analysis of patient and disease profile, treatment patterns and out come was performed. Survival analysis was performed using Kaplan-Meier method. RESULTS: Mean age of the patients was 45.4 years and majority of them had tumor in lower third of rectum with evidence of extrarectal spread. Seventy five percent of the patients underwent curative resection with abdominoperineal resection being the commonest procedure. Forty seven percent of patients were given short course preoperative radiotherapy and the remaining received postoperative radiotherapy. Sixty four percent of patients could complete planned adjuvant chemotherapy. Operative mortality was 2% and 23% had morbidity. Local recurrence rate was 8.9%. 5-year disease free and overall survival was 54% and 58% respectively. CONCLUSION: Majority of rectal cancer patients present with locally advanced and low rectal growths leading to low sphincter salvage rates. Despite the advanced stage of presentation optimal oncologic results can be obtained by using a good surgical techniques in combination with adjuvant radiotherapy and chemotherapy. Short course preoperative radiotherapy seems to be more feasible in Indian context. Timely referral and uniform treatment guidelines throughout the country are needed for optimal management of rectal cancer in India.

Adenocarcinoma↗
PubMed2004

[Multimodality therapy for diffuse malignant pleural mesothelioma].

Despite the rising incidence of diffuse malignant pleural mesothelioma (MPM), there is still no standard treatment for this disease, and the prognosis for patients remains poor. Recently, long-term survival has been reported when multimodality therapy is used, combining extrapleural pneumonectomy with perioperative chemotherapy and/or radiotherapy in highly selected patients. We report a case of a patient who presented with MPM, accompanied by a large malignant pleural effusion and pneumothorax, who was successfully treated with combination therapy. After being diagnosed with epithelial type MPM using thoracoscopic surgery, the patient underwent extrapleural pneumonectomy. Examination of the surgical specimen revealed invasion of the chest wall muscle and fat, as well as several positive mediastinal lymph nodes. The patient received 2 courses of postoperative chemotherapy using cisplatin and gemcitabine. He is currently alive and has been disease-free for 2 years.

Aged↗
PubMed2004

[Evaluation of multimodality therapy for synchronous liver metastases of gastric cancer].

We evaluated the significance of multimodality therapy for cases of liver metastases of gastric cancer. Accumulated survival rate and median survival time were analyzed for twenty cases of such gastric cancer. Survival rates of H1+H2 group and hepatic resection (HR) group were higher than that of H3 group and non-HR group. MST of HR group and hepatic arterial infusion (HAI) group were longer than that of non-HR group and non-HAI group. Survival rate of HAI group was higher than that of non-HAI group among eleven cases of HR group. On the other hand, survival rate of HR group was higher than that of non-HR group among eleven cases of HAI group. These results suggested that HAI chemotherapy after hepatic resection for gastric cancer patients with synchronous liver metastasis would improve prognosis.

Adult↗
PubMed1992

Involvement of ventromedial medulla "multimodal, multireceptive" neurons in opiate spinal descending control system: a single-unit study of the effect of morphine in the awake, freely moving rat.

In the present work, we have studied the effects of systemic morphine on the electrophysiological properties of ventromedial medulla (VMM) neurons in the awake, freely moving rat. By means of a chronically implanted single-unit recording device, a drug delivery catheter, and the use of controlled innocuous and noxious cutaneous stimuli, we were able to study precisely the spontaneous and evoked VMM neuronal activities. We have particularly focused our attention upon the VMM "multimodal, multireceptive" units, excited by non-noxious and noxious stimuli (VMM MULT ON), which we have already determined as the neuronal class potentially involved in nociceptive processes at VMM level. We found that morphine (3 mg/kg, i.v.) does not affect the spontaneous activity of these neurons whereas their responses to noxious heat are strongly attenuated (70%), over a prolonged period (about 2 hr) associated with an increase in the response latency. This action of morphine appears to be pharmacologically specific since it is dose dependent to some extent, and is reversed by 0.3 mg/kg of naloxone. In parallel with this pharmacological specificity, we have also demonstrated a preferential physiological effect since the response of the VMM MULT ON neurons to light touch application is not affected by morphine. This specificity is emphasized by the fact that morphine does not modify the activity of the other VMM neuronal groups such as the units unresponsive to any kind of peripheral stimuli, and does not reveal "new" neuronal classes such as those we have found in previous studies after barbiturate administration. The differential effect upon the noxious versus innocuous inputs of these units produced by the opiate reinforces their participation in nociceptive processing since similar effects have been reported in well-known nociceptive somatosensory structures such as the dorsal horn of the spinal cord. Furthermore, although the precise mechanisms of action have not yet been determined, the spinal projection of the VMM MULT ON neurons, previously demonstrated by our group, suggests their involvement in an opiate descending spinal control system of nociception. Although speculative, one can imagine either a direct facilitatory MULT ON spinal effect being attenuated by morphine (disfacilitation), or a morphine-induced disinhibition of inhibitory GABAergic neurons acting upon the MULT ON neurons.

Animals↗
PubMed2004

Multimodal monitoring: head injury management using SjvO2 and LICOX.

Monitoring methods following severe head injury currently use indirect measurements of cerebral oxygenation and perfusion defined as intracranial pressure (ICP) and cerebral perfusion pressure (CPP) monitoring. Adequate information regarding cerebral blood flow and oxygenation is necessary to guide treatment and prevent secondary cerebral ischemia. Because of the ineffectiveness of ICP and CPP monitoring in detecting early ischemic changes in healthy, as well as compromised, brain tissue, patients' neurological outcome and recovery may be less than optimal. New technology has been recently developed to provide early detection of poor cerebral oxygenation and perfusion. The LICOX brain tissue oxygenation and jugular venous bulb catheters are two types of monitors currently available. Patients can benefit from a unique combination of multimodal monitoring when cerebral oxygenation and consumption measurements are quantified on both a local and global level. This unique combination helps reflect early changes in brain tissue viability. As with any new monitoring device, there are associated advantages and disadvantages as well as cost issues, to consider. Patients with head injuries can benefit from technology that guides decisions and prevents treatment delays.

Cerebrovascular Circulation↗
PubMed2005

Multimodal antiemetic therapy and emetic risk profiling.

INTRODUCTION: Postoperative nausea and vomiting (PONV) is a common problem with no simple solution. This review highlights factors that are known to increase the risk of PONV. It examines the various data on pharmacological and non-pharmacological methods that have been used to prevent PONV. METHODS: Peer-reviewed journals on the subject were covered. CONCLUSION: Patient, surgical and anaesthetic factors increase the risk of PONV. While patient and surgical factors are understandably difficult to control, a multimodal approach involving both pharmacological and non-pharmacological interventions has been successfully adopted to reduce the incidence of PONV. Various factors have been identified to categorise patients into different profiles to determine their risk of PONV. Perioperative strategies can then be targeted at these patient groups.

Anesthesia, General↗
PubMed1992

[Intravascular laser irradiation of blood in multimodal treatment of patients with obliterating diseases of the lower limb vessels].

The work analyses the results of the multimodality treatment of 80 patients among whom 20 suffered from endarteritis obliterans and 60 from atherosclerosis obliterans of the lower limb vessels. In the process of complex treatment intravascular laser irradiation of blood (ILIB) was carried out by introducing the light guide into a peripheral vein. In 31 (73.8%) patients with decompensated circulatory disorders in the limbs, a course of ILIB produced a good clinical effect. A positive effect was encountered in 35 (92.1%) of patients with subcompensated circulatory disorders in the lower limbs. The clinical efficacy of ILIB is due to normalization of blood coagulative properties, increase of the fibrinolytic potential, improvement of hemorheology, and normalization of the lipoprotein ratio.

Adult↗
PubMed1992

Differential diagnosis between mesothelioma and adenocarcinoma: a multimodal approach based on ultrastructure and immunocytochemistry.

Most compensations for asbestos-related deaths secondary to cancer center around mesothelioma and bronchogenic carcinoma. The differential diagnosis between mesothelioma and adenocarcinoma is a common and troublesome one, necessitating the correlation between clinical history, radiographic findings, and pathologic examination of tissues and cells. We describe a multimodal approach based on the use of routine and special stains, immunocytochemistry, and electron microscopy for distinguishing between mesothelioma and adenocarcinoma. Once a malignant diagnosis is arrived at by careful pathological examination, the tumor is classified as mesothelioma if mesothelial cells are identified as the constituent cells of the neoplasm. Mesothelial cells are recognized by (1) their main ultrastructural features: slender and elongated microvilli, abundant intermediate filaments, and lacking secretory granules; and (2) their characteristic immunocytochemical reactivity: positivity for cytokeratin, EMA, and vimentin, and negativity for carcinoembryonic antigen (CEA), B72-3, Leu-M1, and other gland-cell markers. A variety of methods have been attempted in an effort to distinguish between reactive and malignant mesothelial cells. In practice, however, such distinction depends more on experience and expertise than in any fool-proof ancillary tests. A number of these tests are discussed along with the illustration of classical and unusual examples of mesothelioma and other pleural tumors.

Adenocarcinoma↗
PubMed2005

[A long-term survival of the patient with hepatocellular carcinoma and advanced portal vein and bile duct tumor thrombosis successfully treated with multimodal treatments].

We reported a 60-year-old male patient with hepatocellular carcinoma (HCC) of 5cm in diameter with advanced tumor thrombosis in the left main trunk of portal vein and bile duct. He was treated with multimodal treatments resulting in a long-term survival of more than 4 years. At first, he was treated with transcatheter arterial chemoembolization (TACE) in April 1999, but the therapeutic effect was insufficient. Therefore, we performed an extended left hepatic lobectomy in July. Since six HCCs appeared in a posterior segment in January 2000, we achieved microwave coagulation therapy under laparotomy. Because of diffuse relapse of HCCs in the same segment of the liver, we performed hepatic arterial chemotherapy (HAC) using low-dose CDDP and 5-FU. As a result, complete disappearance of the tumors was observed. A new lesion appeared in S7 in January 2001. We performed TACE, but relapsed in June, so we selected percutaneous radio-frequency ablation under CO2 angiography. Since a recurrent tumor was detected at the same therapeutic site with invasion to the diaphragm in September 2002, we performed a partial liver resection with synchronous excision of the diaphragm. We continued TACE and systemic chemotherapy for relapses in and out of the liver. Accordingly, he lived for over four years. We conclude that a long-term survival in this patient can be attributable to appropriate treatment selections and timing, such as hepatic resection, TACE, HAC and ablation therapies based on changes in diagnostic imaging and tumor markers. In addition, we have to pay attention to keep good hepatic reserve in order to continue treatment for recurrences of HCC.

Bile Ducts↗
PubMedDate not supplied

[Malignant pleural mesothelioma: early diagnosis and multimodality management].

Malignant pleural mesothelioma (MPM) is a cancer with a poor prognosis, and its incidence increase, mainly as a result of exposure to asbestos. Universally acknowledged therapeutic approaches still don't exist at the moment, because of its refractory behaviour to all standard therapies; treatment protocols inclusive of either surgery, radiotherapy or chemotherapy have been largely employed, but usually with little impact on survival. For potentially operable pleural mesotheliomas new treatments tend to combine surgery both with new chemotherapy drugs and radiotherapy, in order to improve remarkably survival rates in selected cases. Other approaches, i.e. palliative, proved to be useful in the treatment of two major symptoms, namely dyspnea and thoracic pain. In this work the Authors are reporting their experience with malignant pleural mesothelioma, stressing the role of videothoracoscopy in the early diagnosis, weighing the radical cancer resection option and the effectiveness of multimodal treatment.

Adult↗
PubMed2005

Multimodal effects of available drugs for ischemic stroke.

Recent research demonstrates the complexity and variety of pathophysiologic processes underlying cerebral ischemia. This review will focus on the multimodal effects of the various drugs currently used for stroke prevention. The most recent clinical studies of each will also be reviewed, and the implications for clinical use and future research discussed. An evolving approach for stroke prevention will include a combination of antiplatelets, increased use of statins, ACE inhibitors and possibly vitamin therapy.

Angiotensin-Converting Enzyme Inhibitors↗
PubMed2005

A grand challenge for research: multimodal, multilevel and multiscale systems in medicine and biology.

Computational modelling, nano-bioscience and information technology in biology and medicine will play a major role in the interdisciplinary attempts to elucidate structures and functions of living systems. Developing tools capable to integrate the new advances and make benefit of them is crucial: accumulation of data and knowledge base with only storage and retrieval capabilities will have a poor impact if they are not made "active" or "operational". This is where models will play a central role in offering, not only sound ways for representation or simulation, but also the appropriate frames to put the players in the right place, with intra- and inter-level coupling and multisource handling. This paper advocated that sequential observations of multiple and complex mechanisms will be of limited interest to understand the inter-relations that are occurring at the same time, and therefore, that designing multimodal, multilevel and multiscale experiments, matched with these models, are of major importance.

Animals↗
PubMed2005

[Multimodal treatment concepts in children and adolescents with attention deficit/hyperactive disorder].

ADHD is usually associated with such comorbidities as aggression, dissocial behavior, anxiety, depression, and dyslexia or a poor ability to do sums. This fact must receive careful consideration both during the diagnostic work-up and when deciding an appropriate treatment strategy. In order to take proper account of these comorbidities when deciding treatment strategies, it must not be forgotten that in addition to medication with psychostimulants, multimodal therapeutic approaches also make good sense.

Adolescent↗