Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “multimodality”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 1,171 records · Page 65Linked to original sources
PubMedDate not supplied

[Value of the studies of multimodal evoked potentials for evaluation of neurotoxic effects of combined exposure to lead, copper and zinc].

Central nervous system dysfunction was studied in workers with occupational exposure to Pb+Cu+Zn by measuring somatosensory evoked potentials of short and long latency, visual evoked potentials and brain-stem evoked auditory potentials. The tests were done in 40 workers with a history of exposure from 6 to 19 (mean 14.3) years in a copper foundry. Pb poisoning was not diagnosed in them, but 18 workers had some abnormalities of heme synthesis. Pb concentration in blood was from 11.4 to 62.8 (mean 35.7) mcg% in the whole group. Pb concentration in air in the foundry exceeded 1.1-175 times the MAC value, the concentration of CU exceeded it 7.25 times. Zn concentration was half the MAC value. No significant abnormalities were found in the parameters of multimodal evoked potentials. The obtained data suggest a protective effect of copper and zinc on heme , Pb blood level and conduction velocity of somatosensory, visual and auditory impulses in workers exposed to high Pb air concentration.

Air Pollutants, Occupational↗
PubMed1991

Multimodality evoked potential testing in acute mild closed head injury.

Multimodality evoked potential (MEP) testing, including brainstem auditory, visual, and somatosensory evoked potentials, have been reported to be useful in predicting outcome in severe closed head injury. Brainstem auditory evoked potentials have been demonstrated to be abnormal in 10% to 40% of acute mild head injury. A prospective study of 18 patients with mild closed head injury was undertaken to determine the usefulness of MEP screening within two weeks of the acute event. Long latency event-related potentials (P300s), in response to auditory stimuli with an oddball paradigm, were included in the screening. The subjects had several symptoms consistent with the postconcussive syndrome at the time of the evoked potential testing. Only one patient had an abnormal evoked potential response (greater than three standard deviations from the mean) from all the testing done. The standard methods of MEP testing were insensitive to quantifying the possible physiologic changes that are associated with memory deficits, lethargy, and emotional irritability after mild closed head injury.

Adolescent↗
PubMed1991

Multimodality evoked potentials and neurological phenomenology in patients with multiple sclerosis and potentially related conditions.

A comparative study of evoked potential recordings and neurological phenomenology was performed in 151 patients. The material included 95 subjects with MS, myelopathy of unverifiable etiology or optic neuritis. Multimodality evoked potentials (VEP, BAEP, median and tibial nerve SEP) and clinical data were evaluated independently. The highest rates (86-98%) of evoked potential abnormalities were found in patients with MS (clinically definite or probable) and myelopathies. More than one pathological evoked potential modality occurred in 47-69% of these subjects. Tibial nerve SEP yielded the highest frequency of abnormalities. The occurrences of silent lesions and missed lesions (i.e. normal evoked potentials in spite of clinical manifestations) were investigated for the various evoked potential modalities. Silent lesions were detected in 50-68% of the MS and myelopathy patients; SEP and VEP exhibited similar abnormality rates for clinically unaffected pathways. Missed lesions most often occurred for BAEPs but were not uncommon for the other modalities. Further evaluation of the SEP data revealed significant differences of amplitudes between patients with missed lesion and controls.

Adult↗
PubMed1991

Multimodal characterization of population responses evoked by applied electric field in vitro: extracellular potential, magnetic evoked field, transmembrane potential, and current-source density analysis.

An external electric field applied parallel to longitudinal axis of neurons selectively depolarizes either end and thereby activates voltage-sensitive conductance changes in a large population of neurons. Here, we characterized such population responses in the in vitro turtle cerebellum. The responses were recorded and analyzed using a multimodal approach: the magnetic evoked field was measured using a Superconducting Quantum Interference Device (SQUID) magnetometer, and concurrently the electric field potentials were recorded. Laminar profile and current-source density analysis were used to uncover the pattern of activation due to the applied electric field. Intracellular recording provided further information for identifying the elements producing the observed responses. Finally, pharmacological manipulations confirmed the nature of the conductance changes. Our results show that it is possible to activate a defined cell population of the cerebellum by an applied field and obtain a magnetic response of the order of 0.5-2 pT. A field applied from the dorsal to the ventral side of cerebellum produced tetrodotoxin-sensitive population spikes. This component was followed by a kynurenic acid (KYNA)-sensitive postsynaptic response, most likely comprised of Ca(2+)-mediated action potentials occurring at the proximal pole of the Purkinje cell dendrites and evoked by climbing fiber inputs. The applied electric field directed from the ventral to the dorsal side of cerebellum gave rise to a complex of responses that was made up of a KYNA-sensitive component (presumably synaptically activated) and an Mn(2+)-sensitive but KYNA-insensitive component (probably due to a directly activated calcium conductance change). This study provides insights into the effects of electric and magnetic fields applied to the nervous tissue of experimental animal and human studies.

Animals↗
PubMed1990

Multimodality approach to a massive carcinoma of the vulva.

The presentation, combination therapy and clinical course of a patient with a massive vulvar carcinoma are described. Therapeutic aspects in the treatment of such advanced malignancies are considered. A multimodality approach to locally advanced, unresectable vulvar carcinomas may benefit this group of patients.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1990

[Multimodal evoked potentials and heart rate variability in comatose patients. 3. Electrophysiologic findings in inflammatory diseases of the brain].

Multimodal evoked potentials and heart-rate variability (HRV) measurements were performed in a total of 15 comatose patients with inflammatory diseases of the brain. The following potentials were recorded: Brainstem auditory evoked potentials (BAEP), early (SSEP) and long latency (SEP) somatosensory evoked potentials and visual evoked potentials (VEP). The results of the initial BAEP recordings indicate that in 83% of the patients the IV-V interpeak latency was prolonged and out of the range of normal values. Additionally an atypical form of the IV-V wave complex was detected. The SSEP after electrical stimulation demonstrated pathological findings in 90% of the patients; long latency components after mechanical vibration could be identified only by 30%. The results of the VEP show an attenuation of vertex VEP (mean value: 43%). Heart-rate variability of the patients was calculated (mean +/- SD) to be 2.5 +/- 1.4% (norm: 7.8 +/- 2.5%) with a mean heart-rate of 95.2 +/- 16.6/min (norm: 67.8 +/- 10.7/min).

Adolescent↗
PubMed1990

[Multimodal evoked potentials in human immunodeficiency virus infection].

We have studied 95 HIV seropositive patients (77 males and 18 females; mean age: 31 years): 67 had no neurological symptoms or signs, 28 had various neurological symptoms and signs. This study included a full multimodal evoked potentials (MEP) assessment: visual evoked potentials by flash and reversal checkerboard; brainstem auditory evoked potentials; somatosensory evoked potentials obtained by stimulation of the median nerve. Patient evaluation further included: electroencephalography, electromyography with measurement of conduction velocities and neuroimaging (brain CT scan and/or MRI). We found abnormal MEP for all modalities. The prevalence of abnormal results was high in neurological symptomatic patients; in non neurological ones, the changes tended to be more frequent with the progression of the HIV infection. Whatever the stage of the disease, the various modes were equally affected. MEP were abnormal in 54.7 p. 100 of the cases: in 41.8 p. 100 (28/67) of patient without neurological signs (in 4/12 of fully asymptomatic subjects, 11/34 ARC patients and 13/21 AIDS patients) vs 85.7 p. 100 of neurological symptomatic patients. In neurological asymptomatic patients, a similar proportion of abnormal MEP was found in asymptomatic and ARC patients, while the evolution into AIDS was associated with a higher prevalence of abnormal MEP. In the latter group, MEP changes were nearly as frequent as in neurological symptomatic patients. Comparison between MEP and other electrophysiological procedures (EEG, EMG) and with neuroimaging techniques (CT Scan, MRI) showed the high sensitivity of the MEP technique at all stages of the disease. EMG was a sensitive method and complementary to MEP. The EEG and neuroimaging techniques showed abnormalities principally at the neurological symptomatic stage. Previous studies could not be properly compared.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

[Multimodal treatment of locally advanced carcinoma of the breast. Experience at the Galliera di Genova Hospital].

All patients with locally advanced breast cancer receiving definitive irradiation (with or without surgery) at the Radiation Oncology Service, Ospedali Galliera, Genova, Italy, from 1969 through 1986, were retrospectively reviewed. Group A consisted of 187 patients, affected with stage III disease, who received radiation therapy after radical surgery. Irradiation of the chest wall and regional lymph node chains was accomplished with divergent tangential beams of Cobalt: the dose was calculated at the mid-plane of the tangential field separation and was 50Gy (2 Gy/day, 5 fractions/week), followed by additional 10-15 Gy boost to the scar. One hundred and five patients received combined hormonotherapy and/or chemotherapy. After a mean follow-up of 49+ months we observed 21 local recurrences (16 in metastatic patients); 64 patients developed only distant metastases. Actuarial survival at 5 years is 55%. Group B consisted of 36 inoperable patients who received definitive irradiation. Radiation therapy planning was very similar to that in group A, even though after 50 Gy the breast and the tumor area were boosted with restricted fields up to a total dose of 80-90 Gy. Fifteen patients received combined hormonotherapy and/or chemotherapy. At the end of the treatment overall response rate was 89%; actuarial survival at 5 years is 38%. Toxicity was generally mild and no death related to the treatment was observed. Our retrospective analysis confirms the importance of a multimodal approach to locally advanced breast cancer in order to free most patients from disease and to produce excellent local control, even though more randomized studies are necessary to improve the long-term survival of these patients.

Adult↗
PubMed1990

Multimodality therapy for advanced and recurrent vulvar squamous cell carcinoma. A pilot project.

From 1985 to 1989 eight women with advanced or recurrent vulvar carcinoma were treated at the Women's Cancer Center of the University of Minnesota Hospital and Clinic. Each received a combination of 5-fluorouracil, mitomycin C and cisplatin during radiotherapy. Five of the eight women who underwent posttreatment radical vulvectomy had acceptable operative morbidity. Six patients experienced a complete clinical response. Of them, one had microscopic residual disease in the surgical specimen. One patient with recurrent vulvar carcinoma experienced progression of disease on therapy. One death was attributable to chemotherapy toxicity, and two patients died of intercurrent disease. The overall survival rate at 27 months was 33%. This multimodality approach to the treatment of advanced vulvar carcinoma should be considered when designing a therapeutic approach to treating extensive or resistant vulvar carcinoma.

Aged↗
PubMed1987

Pulmonary complications of multimodality therapy for esophageal carcinoma.

Thirty patients with cancer of the esophagus were treated with multimodality therapy. We studied the incidence of pulmonary complications in these patients. The value of chest radiographs and sequential measurements of carbon monoxide diffusing capacity (DLco) in predicting pulmonary toxicity was determined. Patients were divided into two groups, according to treatment. Patients in group I (n = 16) received two cycles of chemotherapy (bleomycin 15 units/m2, cisplatinum 120 mg/m2, vincristine 2 mg) and radiotherapy (50 Gy). Based on the presence of interstitial lesions on chest radiographs in five patients the incidence of pulmonary toxicity was 32%. In four of these five patients such an appearance was preceded by a drop in DLco: this was documented in 8 of the 16 patients. Nine patients of group I underwent esophagectomy and four (44%) developed adult respiratory distress syndrome (ARDS). In group II (n = 14) the tumor was resected without other treatment and four (29%) of these patients developed ARDS. The incidence of ARDS in both groups demonstrates that pulmonary complications are mainly related to surgical manipulation and to preexisting lung disease. Preoperative radiotherapy and chemotherapy may be associated factors. Sequential measurements of DLco are more sensitive for detecting pulmonary damage than chest radiographs and should be used to predict pulmonary toxicity.

Bleomycin↗
PubMed1987

[Multimodality treatment of nasopharyngeal carcinoma].

In the treatment of nasopharyngeal carcinoma (NPC), radiation has been the treatment of choice, because it is effective for locoregional disease. However, the results of radiotherapy for NPC have revealed that local relapse and/or distant metastases occur frequently, and consequently the five-year survival rate is as low as around 30%. Since 1982, we have adopted chemotherapy initially applied prior to radiotherapy (= pre-radiation chemotherapy) for the treatment of NPC in order to achieve better results. The chemotherapy mainly consists of a combination of cisplatin and peplomycin. Twenty-one previously untreated patients with NPC were evaluable. Three complete and fifteen partial remissions were achieved, with an 86% response rate to the chemotherapy. The treatment involving a combination of pre-radiation chemotherapy and radiotherapy resulted in local relapse in one patient and distant metastases in two patients with an 87.5% survival rate according to the Kaplan-Meier method. Immunotherapy is also indispensable in the treatment of NPC. Our present multimodality treatment for NPC consists of a combination of pre-radiation chemotherapy and radiotherapy followed by long-term administration of a biologics such as OK-432.

Adolescent↗
PubMed1988

[A case of advanced penile cancer treated with multimodal therapy--combination with tensor fascia lata myocutaneous flap].

A 40-year-old male with advanced penile cancer, whose left inguinal node was ulcerated at the time of initial presentation, underwent multimodal therapy. Four cycles of chemotherapy were given from September 20, 1984 to February 8, 1985. Partial penectomy and left ilioinguinal lymphadenectomy with removal of left groin ejaculation were performed on February 20, 1985, followed by right ilioinguinal lymphadenectomy on March 20, 1985. The skin defect of the left groin was covered with tensor fascia lata myocutaneous flap. The patient is alive with no evidence of disease 30 months after the surgery.

Adult↗
PubMed1989

[Brain function and blood flow velocity in the middle cerebral artery in subarachnoid hemorrhage: evaluation with multimodality evoked potentials (MEPs) and transcranial Doppler (TCD) ultrasound].

Brain dysfunction and blood flow velocity changes in the middle cerebral artery (MCAFV) were studied in 59 patients with ruptured cerebral aneurysms presenting subarachnoid hemorrhage. Brain function and blood flow velocity were evaluated by multimodality evoked potentials (MEPs) consisting of ABR, SEP and VEP as reported, and transcranial Doppler (TCD) ultrasound. The abnormality on MEPs were graded into 4 grades. Nearly normal, mildly abnormal, moderately abnormal and severely abnormal. The results on MEP study were compared with clinical Hunt and Hess (H. H) grade or Fisher's CT group of subarachnoid hemorrhage in 44 patients. MCAFV was measured in 15 patients and mean velocity as well as CO2 reactivity and effect of head elevation were studied. Control value of MCAFV was 64 +/- 13 cm/sec in 50 healthy adults. CO2 reactivity was determined by K values obtained from the modified formula of cerebral blood flow by Olesen et al. MEP grade in H. H grade III and IV patients showed, on admission, variations in their grades in comparison with those in H. H grade I II and V patients. There was no definite correlation between the abnormality in MEPs and the degree of subarachnoid hemorrhage in Fisher's group 3 and 4 patients. When the surgical results in early and late operation in H. H grade III and IV patients were compared, it was shown that the outcome was favourable in early operated patients of H. H grade III if initial MEP grades were between I-III.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

The importance of surgical and multimodality treatment for small cell bronchial carcinoma.

In a cooperative international lung cancer multimodality treatment trial, 112 patients with small cell lung cancer underwent initial surgical resection and were then randomized to receive one of two intensive postoperative chemotherapeutic regimens, followed by prophylactic cranial irradiation in the disease-free patients. Regimen A consisted of eight courses of cyclophosphamide, doxorubicin, and vincristine and regimen B of two courses of three sequential drug combinations: (1) cyclophosphamide, lomustine, and methotrexate; (2) cyclophosphamide, doxorubicin, and vincristine; and (3) ifosfamid and etoposide. In 47 patients the diagnosis was known preoperatively and in 65 it was not confirmed until the resected specimen was examined (all diagnoses were reviewed by a referee pathologist). Each patient was classified by the pathologic TNM characteristics. There were 38 patients with stage I disease, 39 patients with stage II, and 35 patients with stage IIIa disease. In stage IIIa there were nine patients with T3 N0-1 disease and 26 with T1-3 N2 disease (most N2 disease was clinically undetected until thoracotomy or was discovered only by routine histologic examination of the resected mediastinal nodes). Early survival rates at 24 months calculated by the life table method are as follows: stage I, 76%; stage II, 56%; and stage IIIa, 49% (T3 N0-1, 89%; T1-3 N2, 35%). Survival rates at 36 months are 62%, 50%, and 41% (74% and 29%), respectively. The projected 36-month survival rate for 43 patients with N0 disease is 65%; for 43 with N1 disease, 52%; and for 26 with N2 disease, 29%. No difference in survival has been noted in either chemotherapy treatment group. It is concluded that initial surgical resection for limited small cell cancer (stage I, II, and T3 N0-1) followed by intensive chemotherapy is an appropriate therapeutic approach. For T1-3 N2 disease the results are inconclusive.

Actuarial Analysis↗
PubMed1989

Developmental orofacial deficits associated with multimodal cancer therapy: case report.

Multimodal cancer therapy for pediatric head and neck tumors may be associated with significant developmental orofacial morbidity. This report details these effects in a child (C.I.) diagnosed at 2.5 years of age with a rhabdomyosarcoma, primary to the left buccinator. This case is of interest as C.I. has an unaffected identical twin (D.I.) for comparative study. Both were assessed by comparing panoramic radiographs and lateral and frontal tracings of cephalometric radiographs obtained at 8.25 years of age. C.I. had multiple dental anomalies which included agenesis, ectopia, crown malformation, and root malformation. Root malformation, ectopia, and agenesis were restricted to the left dentition, whereas crown malformation was noted bilaterally. C.I. had a generalized craniofacial skeletal hypoplasia relative to D.I. in all three planes, growth defects were greater on the side of the tumor, and the mandible was affected more than the nasomaxillary complex.

Anodontia↗
PubMed1977

Acute myelogenous leukemia as a late complication of the multimodality therapy for Hodgkin's disease.

Progressive thrombocytopenia developed in a patient following the completion of total lymphoid irradiation and combination chemotherapy for Hodgkin's disease. Thorough evaluation eventually yielded a diagnosis of acute myelogenous leukemia (AML). Previous workers have suggested that the development of thrombocytopenia with a hypoplastic marrow following total lymphoid irradiation indicated recurrent Hodgkin's disease. When the combination cytopenias and hypoplastic marrow is recognized these workers have recommended early combination chemotherapy. Recent data suggest a 1300-fold increase in the risk of AML following multimodality therapy for Hodgkin's disease. We feel that a careful search for AML should be conducted in patients with deteriorating hematologic parameters following therapy for Hodgkin's disease and that this search should include sampling bone marrow outside irradiated areas.

Adult↗
PubMed1989

A longitudinal study of multimodal evoked potentials in diabetes mellitus.

Abnormal findings in visual (VEP), brainstem auditory (BAEP) and somatosensory (SEP) evoked potentials at early stages of Type 1 and Type 2 diabetes have recently been reported by our group. Our aim here was to perform a longitudinal study in diabetic patients at an early stage of the disease using a combined evoked potential analysis in order to evaluate the variation of neurological abnormalities over time. Nine Type 1 and 12 Type 2 diabetic patients were examined and a second recording was carried out after a mean interval of 15.7 months +/- 6.2 SD. VEP, BAEP and SEP were measured in all patients. At the first recording electrophysiological abnormalities, present in both Type 1 and Type 2 diabetes were more evident when a multimodal evaluation was used (44.4% and 66.7% respectively). The follow-up study showed that overall neurological abnormalities persisted in all those patients who had previously presented pathological values. Whereas the number of patients with pathological values remained unmodified, a tendency to progression, namely the number of nervous levels with electrophysiological abnormalities, was observed. Thus, our study confirms the appearance of anatomofunctional disorders in the central nervous system in short-term diabetes, shows the persistence of neurological impairment in such patients and reveals a progressive segmental involvement at different nervous levels.

Acoustic Stimulation↗
PubMed1987

[Controlled multimodality treatment of brain stem gliomas].

Thirty-eight children were diagnosed as having a brain stem glioma at Nagoya University. Thirty-three patients in our previous series from 1957 to 1983, were treated traditionally with radiation and at late stage with shunting operation for hydrocephalus and/or suboccipital decompression, but not with direct operation for tumors. In general, tumors constantly grew regardless histology and their mean survival time was only 7.0 months even with transient neurological remission. On the other hand, recent five patients since 1984 were treated with prospective multimodality treatment. According to neuroradiological studies by X ray and/or NMR, CT scanning, the brain stem glioma cases were classified into subgroups of intrinsic and exophytic. Then the former were treated non-surgically with adjuvant therapy of Interferon-ACNU-Radiation (IAR) and the latter were treated surgically at first by resection of the tumor followed by adjuvant therapy of IAR or interferon-CDDP. Four out of five patients responded to adjuvant therapy (complete response = 2, partial response = 2, response rate = 80%) and they are all alive after 7-28 months follow-up period. It is concluded from our results that CT scanning can diagnose the accurate location and nature of brain stem gliomas, surgical therapy benefits at least in exophytic cases, and IAR adjuvant therapy may prolong the survival time of patients.

Adolescent↗