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PubMedDate not supplied

[Multimodal approach to rectal carcinoma with hepatic metastasis].

BACKGROUND: The role of surgery in the treatment of rectal cancer has been demonstrated worldwide. Moreover, curative liver resection of colorectal liver metastases is the only treatment offering a chance of long-term survival. Unfortunately, the liver resection can be performed in only 10% of the patients. AIM: In order to extend the frontiers of surgical indications in the treatment of liver metastases from colorectal cancer, we describe, in the video, a multimodal approach to rectal cancer with liver metastasis in the right lobe. Patient and methods. A 51 years old woman was admitted to our Department for adenocarcinoma of the distal rectum and a resectable solitary synchronous liver metastasis located across the right and the middle hepatic vein. Unfortunately, the future remnant liver was too small, risking severe post-operative liver failure. For this reason, a portal vein embolization or occlusion has been proposed. First of all, the patient has been submitted to laparoscopic low anterior resection with simultaneous right portal vein ligature. Two months later, after a CT estimation of liver volume in vivo, she was submitted to right hepatectomy (open surgery). RESULTS: Both postoperative courses were uneventful. CONCLUSIONS: As a preparation for large hepatic resection for liver rectal metastasis the laparoscopic ligature of the right portal vein performed simultaneously to the laparoscopic low anterior resection is feasible and safe.

Combined Modality Therapy↗
PubMed2006

Multimodal venous thromboembolic disease prevention for patients undergoing primary or revision total joint arthroplasty: the role of aspirin.

Venous thromboembolic disease (VTD), which consists primarily of deep venous thrombosis (DVT) and pulmonary embolism (PE), is of significant concern to orthopedic surgeons who perform total hip and total knee arthroplasties. DVT and PE can be prevented in multiple ways; each method or combination of methods has its benefits and drawbacks. Seemingly, the more efficacious a medication or method for preventing VTD, the higher the associated risk for adverse events such as bleeding and wound complications. For each patient, then, the balance or homeostasis between significant clotting event and bleeding must be determined. Examining this balance and understanding the benefits and risks associated with each medication or intervention may allow surgeons to make educated decisions about prophylaxis for their patients. Furthermore, risk stratification and multimodal management may prove to be the safest and most effective way to manage VTD prevention.

Arthroplasty, Replacement, Hip↗
PubMed2006

Predicting fear of heights, snakes, and public speaking from multimodal classical conditioning events.

BACKGROUND: Two hundred fifty one men and women participated in a study of the prediction of fear of heights, snakes, and public speaking by providing retrospective accounts of multimodal classical conditioning events involving those stimuli. The fears selected for study represent those believed by some to be innate (i.e., heights), prepared (i.e., snakes), and purely experientially learned (i.e., public speaking). This study evaluated the extent to which classical conditioning experiences in direct, observational, and verbal modes contributed to the prediction of the current level of fear severity. MATERIAL/METHODS: Subjects were asked to describe their current level of fear and to estimate their experience with fear response-augmenting events (first- and higher-order aversive pairings) and fear response-moderating events (first- and higher-order appetitive pairings, and pre- and post-conditioning neutral presentations) in direct, observational, and verbal modes. RESULTS: For each stimulus, fear was predictable from direct response-augmenting events and prediction was enhanced by the inclusion of response-moderating events. Furthermore, for each fear, maximum prediction was attained by the addition of variables tapping experiences in the observational and/or verbal modes. CONCLUSIONS: Conclusions are offered regarding the importance of including response-augmenting and response-moderating events in all three modes in both research and clinical applications of classical conditioning.

Adolescent↗
PubMed2006

A remote controlled multimode micro-stimulator for freely moving animals.

This paper presents a remote controlled multimode micro-stimulator based on the chip nRF24E1, which consists mainly of a micro-control unit (MCU) and a radio frequency (RF) transceiver. This micro-stimulator is very compact (18 mmx28 mm two layer printed circuit board) and light (5 g without battery), and can be carried on the back of a small animal to generate electrical stimuli according to the commands sent from a PC 10 meters away. The performance and effectiveness of the micro-stimulator were validated by in vitro experiments on the sciatic nerve (SN) of the frog, where action potentials (APs) as well as artifacts were observed when the SN was stimulated by the micro-stimulator. It was also shown by in vivo behavioral experiments on operant conditioned reflexes in rats which can be trained to obey auditory instruction cues by turning right or left to receive electrical stimulation ('virtual' reward) of the medial forebrain bundle (MFB) in a maze. The correct response for the rats to obey the instructions increased by three times and reached 93.5% in an average of 5 d. This micro-stimulator can not only be used for training small animals to become an 'animal robot', but also provide a new platform for behavioral and neurophysiological experiments.

Acoustic Stimulation↗
PubMed2005

The multimodal treatment of eating disorders.

The treatment of eating disorders is based on a multimodal model, recognizing that these disorders do not have a single cause or a predictable course. The treatment strategy is determined by the severity of illness and the specific eating disorder diagnosis. For the treatment of anorexia nervosa, the key elements are medical management, behavioral therapy, cognitive therapy and family therapy, while pharmacotherapy is at best an adjunct to other therapies. In bulimia nervosa, the treatment of choice is cognitive-behavioral therapy, but a greater improvement in mood and anxiety occurs when antidepressant therapy is added. In binge eating disorder, cognitive-behavioral therapy and interpersonal therapy produce substantial and long-lasting changes and pharmacological treatment has often a useful role.

Journal Article↗
PubMed1991

[Long-term results of multimodality therapy of small cell bronchial cancer including surgery].

The results of a prospective Phase II study of a multimodal treatment regimen including surgery of operable stages of small cell lung cancer are reported. Of 45 patients 24 received all parts of the projected treatment. The 5-year survival probability is 56% and 8 patients are still living after more than 60 months. Eleven patients with N2 lymph node metastases receiving the complete therapy have a projected 5-year survival of 60%.

Austria↗
PubMed2006

Multimodal therapy for painful bladder syndrome/interstitial cystitis.

Most patients who suffer from PBS/IC can now be simply and effectively treated. The first step to successful management is accurate and timely diagnosis, which has become easier with available and validated screening and diagnostic tools such as PUF and PST. Once PBS/IC is correctly diagnosed, prompt treatment should address the main components of the disease, a dysfunctional urothelium, mast cell activation and neural upregulation. Multimodal treatment that has shown benefit includes oral PPS plus an antihistamine, such as hydroxyzine, and a TCA, such as amitriptyline. Behavioral interventions and intravesical instillation therapy are adjunctive measures that will promote symptom relief. Intravesical "rescue" solutions using lidocaine and heparin or PPS (dissolved in water or in the instillation solution [off-label use of PPS]) can provide immediate relief while patients develop a response to oral PPS. Patient education and support are critical in managing this complex but treatable disorder.

Administration, Intravesical↗
PubMed2006

Multimodal treatment of craniopharyngioma: defining a risk-adapted strategy.

Craniopharyngiomas remain a therapeutic challenge in terms of treatment-related morbidity. The fact that they are rare, that they are histologically benign, and that anatomically they are located in a challenging area, made them worthy surgical prizes. Whilst surgery has allowed us to meet the challenge of visual salvage, and the advances in hormone replacement therapy are addressing the endocrine challenge, we are becoming increasingly aware that for many children radical resection comes with the cost of devastating effects on quality of life. Increasingly we are recognizing that the next challenge is preservation of hypothalamic function. This consciousness of the morbidity of radical resection has led us, like many pediatric units, to re-examine multimodal treatment strategies. This review examines the Necker experience, aiming to analyze the factors influencing our decision making for treatment.

Combined Modality Therapy↗
PubMed2006

Management of malignant pleural effusion by multimodality treatment including the use of paclitaxel administered by 24-hour intrathoracic infusion for patients with carcinomatous pleuritis.

For successful intrapleural chemotherapy, intrapleural drug activity should be maintained for as long as possible. This interim report presents the results of treatment with paclitaxel administered by 24-hour intrathoracic infusion as an adjunct to selective surgical management and/or systemic chemotherapy for controlling malignant pleural effusion. Thirteen patients with carcinomatous pleuritis were enrolled in the study between October 2001 and September 2004. The sites of primary disease were the lung in 12 patients and the breast in one patient. Paclitaxel (120 mg/m2) was administered by 24-hour intrathoracic infusion. Seven patients underwent elective surgical treatment and 11 patients received adjuvant systemic chemotherapy. Mild toxicity occurred in 7 cases, and chest pain and neutropenia were dominant. During a median follow-up period of 9 months (range, 2-33 months), malignant effusion was controlled successfully in 11 patients (84.6%). The multimodality treatment, including the use of paclitaxel, in this manner merits further investigation for possible intervention for malignant pleural effusion originating in lung and breast neoplasms.

Adult↗
PubMedDate not supplied

Fournier's gangrene. Immediate diagnosis and multimodality treatment is the comerstone for successful outcome.

BACKGROUND: Fournier's gangrene is a synergistic necrotic fasciitis or myositis of genitalia, perineum and abdominal wall. Several etiologic factors have been reported, microorganisms isolated and co-morbidity factors identified. Immediate and accurate diagnosis decreases mortality rate, which ranges from 3-67%. Aggressive resuscitation and surgical debridement consist the appropriate treatment. MATERIAL AND METHODS: Six cases of Fournier's gangrene treated the last ten years were reviewed. Three of them presented with mild infection while the other three with severe. The mean time interval between first symptoms and initial treatment was 2.1 days. The diagnosis was set immediately and the treatment included fluid-electrolyte resuscitation, aggressive surgical debridement, and broad-spectrum antibiotics administration. RESULTS: All patients survived. The defects healed by second intention in four patients and only in two patients specific plastic reconstructive techniques were required. Hyperbaric oxygenation administrated in one patient induced surprisingly the healing of the lesion. CONCLUSIONS: The Authors confirm that Fournier's gangrene is a rare and potentially fatal disease. Early suspicion, accurate diagnosis and multimodality treatment including aggressive surgical intervention are essential for successful outcome.

Adult↗
PubMed2006

Multimodal evoked potentials in three siblings with mitochondrial disease.

Mitochondrial diseases are heterogeneous disorders affecting multiple systems. Here, we presented the findings of multimodal evoked potential (EP) studies of three siblings with a specific A8344G mutation of mitochondrial DNA. One of them had DM and another two had a history of encephalopathy. Visual EPs were abnormal in one patient and motor, somatosensory and brainstem auditory EPs were observed in all three patients. Our EP studies showed that the A8344G mutation of mitochondrial DNA involved multiple levels of the central nervous system even though there were no correlated symptoms. Therefore EP is an adjunct of methods to detect the functional disturbance and to screen the distribution of the involvement of the nervous system in mitochondrial diseases.

Adult↗
PubMed2006

[Rational of oncological surgery in multimodality treatment of cancers].

The infiltrative cancers permanently swarm circulating cancer cells, and in 2006 it is no more possible to consider that localized cancer exists. So, we must question our self about the place of a treatment like surgery, which is localized in the time and in the space. Moreover, it is now proved that surgery increases the number of circulating cancers cells, gives a transient immunodepression which promotes cancer implantations, and that the cicatrisation stimulates growth factors, which act also on tumor growth. In spite of these deleterious effects, the oncological surgery stays an important tool by achieving an optimal cytoreductive surgery which facilitates the effect of the adjuvant treatments, by eliminating the vascular sanctuaries present in the center of any big tumor, and because it is a striking-force very localized in the space and in the time. The role of the oncological surgery must be integrated in the new aspect of the biology of the tumors and must take in account the recent improvements concerning functional imaging, genomic and proteomic. It is currently only one of the different compounds of the multimodality treatments for cancers, and its modalities, as its timing must be reconsidered. At last, considering the future technologies, we must elaborate the future modalities of the oncological surgery.

Chemotherapy, Adjuvant↗
PubMed1990

Chemotherapy and multimodality treatment in thyroid carcinoma.

With the combination of pre- and postoperative chemotherapy and radiotherapy, the majority of patients with anaplastic giant cell thyroid carcinoma will achieve local tumor control. A few patients may even be cured by this treatment. Only few patients with differentiated thyroid carcinoma respond to chemotherapy treatment. However, at present it is not possible to discern these few. Chemotherapy for advanced thyroid carcinoma cannot as yet be routinely recommended. Doxorubicin, cisplatin, and VP16 are the drugs currently considered most effective. Side effects may be severe. Multimodality treatment may be an alternative.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed2006

[ADHD and multimodal intervention].

During the year 2003, the National Register of the Attention deficit hyperactivity disorder (ADHD) has been implemented in Italy. It was commissioned by the Ministry of Health to the Istituto Superiore di Sanità, which is its leading technical and scientific body, with the aim to set up a sound database gathering detailed information on the prescription of Ritalin at the national level. The latter represents the most diffused elective drug treatment for such an early-onset neuropsychiatric syndrome. To this aim, the more prevalent theories on the pathogenesis of ADHD and the debate on therapy are reviewed and discussed. This paper is aimed at emphasizing that this kind of systematic data gathering of such a Register has not to be meant an unconditional approval of a therapeutical approach based on drug therapy only. Pharmacological therapies may or may not be included within the frame of a multimodal complex treatment plan which should also rely on psychological intervention.

Attention Deficit Disorder with Hyperactivity↗
PubMed2006

Multimodality imaging features in a case of bronchial carcinoid including FDG PET.

BACKGROUND: Pulmonary carcinoid tumors are rare, low-grade neuroendocrine malignancies which comprise 1-2% of all lung neoplasms. Approximately 80% of carcinoid tumors occur in the central airways and present clinically as obstructive pneumonia or hemoptysis. Experience with F18 FDG PET to image pulmonary carcinoid tumors is limited. CASE REPORT: A 67 year old woman presented with two episodes of hemoptysis within one month. A whole body FDG PET scan was performed in addition to a contrast enhanced chest CT, a whole body In111 octreotide scan, and quantitative lung perfusion scan during the diagnostic evaluation. An endobronchial lesion was discovered and the patient underwent a successful resection of the right middle and lower lobes. The histopathology of the lesion was consistent with a typical carcinoid tumor. CONCLUSIONS: We describe multimodality imaging findings along with the histopathology and a review of the literature, focusing on the role of FDG PET in the management of patients with bronchial carcinoid tumors.

Aged↗
PubMed2006

[A 42-month disease free survival case of combined hepatocellular-cholangiocarcinoma with lymph node metastases treated with multimodal therapy].

Combined hepatocellular and cholangiocarcinoma (HCC-CC) is a rare type of liver cancer. We herein report a case of HCC-CC with lymph node metastases treated by multimodality therapy. The patient has been alive for more than 42 months. A 52-year-old man with a 9 cm diameter mass lesion in the liver was admitted to our hospital. The tumor was diagnosed as peripheral type of cholangiocarcinoma. Preoperative transhepatic arterial chemoenbolization (TACE) was performed. An accumulation pattern of lipiodol after TACE and an increase of serum alpha-fetoprotein led us to diagnosis of combined HCC-CC. A three segmentectomies of the liver and dissection of the local lymph nodes were performed. A histological examination of the resected specimen showed combined HCC-CC with lymph node metastases. Alpha fetoprotein, cytokeratins 7 and 19 were partially positive with immunohistochemical staining. The final diagnosis was a mixed type of combined HCC-CC. To improve a poor prognosis of combined HCC-CC, adjuvant chemotherapy with CDDP, 5 FU and radiation therapy were achieved. Fortunately, the patient is alive without any recurrence for 42 months after the operation.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1991

Endoscopic management of bleeding peptic ulcers in Singapore: a multimodality approach.

Endoscopic haemostasis is becoming increasingly important in the management of bleeding peptic ulcers. In this study, rather than being confined to one modality of treatment, the endoscopist was allowed to customize the treatment according to the configuration of the ulcer, accessibility, and rate of bleeding in any particular patient. Fifty patients with actively bleeding peptic ulcers or stigmata of recent haemorrhage were treated endoscopically. Initial haemostasis was achieved in 48 (96%) patients. Eleven patients rebled of whom eight underwent repeat endoscopic treatment. Of these eight patients, three rebled of whom two required surgery. Permanent haemostasis was achieved in 43 of 50 patients (86%). The rate of surgery in the endoscopically treated group was 10%. There was one death due to causes not related to bleeding. The multimodality approach is a useful method of treatment in bleeding peptic ulcers, giving flexibility to the endoscopist in deciding on the best way to deal with the problem.

Adolescent↗
PubMed1991

A multimodality approach to endoscopic treatment of bleeding peptic ulcers.

The role of endoscopic haemostasis in the treatment of bleeding peptic ulcers is widely studied. Many trials to date have compared one or more modalities against a medical control with variable results. To date, no single modality has been shown conclusively to be superior to others. As such, in this study we have not confined the endoscopist to one modality of treatment but allowed him to customize the method of endoscopic haemostasis according to the configuration, accessibility and rate of bleeding in any particular patient. Seventy-three patients with non-variceal upper gastrointestinal (GI) bleeding were admitted to the National University Hospital in Singapore between May 1, 1988 and April 30, 1989. All were gastroscoped and 48 were found to have chronic peptic ulcer. Twenty-nine (60%) with actively bleeding peptic ulcer or stigmata of recent haemorrhage (SRH) were treated endoscopically. Initial haemostasis was achieved in 27 (93%) patients. Seven patients rebled (26%) of which four underwent repeat endoscopic treatment. Of these four patients only one rebled again and required surgery. Permanent haemostasis was achieved in 23 of 29 patients (79%). The multimodality approach for the treatment of bleeding peptic ulcers gives the endoscopist flexibility in deciding on the best way to deal with a bleeding gastric or duodenal ulcer. Each instrument has its strengths and weaknesses and the right choice of instrument is often a critical factor especially in treating a bleeding ulcer in a situation where access poses a problem.

Adult↗