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PubMed1982

Multimodality evoked potentials: clinical applications and assessment of utility.

Visual evoked potentials (VEP), brain stem auditory evoked potentials (BAEP), somatosensory evoked potential (SEP), and long latency event related potentials (ERP) have been used to assess various aspects of the central nervous system. Multimodality evoked potential (MEP) testing uses a combination of these tests in the same clinical setting. In the diagnosis of multiple sclerosis and in the diagnosis of brain death, MEP testing has been shown to be more effective than any one evoked potential test used alone. In head trauma, MEP testing is an effective means of localization and prognostication. There are potential uses for MEP testing in Parkinson's Disease and uremia.

Brain Death↗
PubMed1982

[Multimodal treatment of unresectable pancreatic cancer including intra-operative radiotherapy].

A multimodal treatment was consisted of intraoperative radiation, external radiation, by-pass operation, chemotherapy and total parenteral nutrition if necessary to cover decreased oral-intake. Thirty-three cases were subjected to this therapy for 6 years. The stage of the tumors varied from a localized tumor in the pancreas to a huge tumor with multiple metastases, though the latter abandoned recently to be contraindication to this therapy. At laparotomy, a high energy electron beam was irradiated to the tumor with a dosage of 3,000 rad using a 20Me V Betatron. The tumor was carefully prepared in order to avoid irradiating the duodenum and stomach. Choledochojejunostomy and gastrojejunostomy were performed in almost all of patients with cancer of head of pancreas. In some patients, external radiation was added with a dosage of 3,000 rad by lineacX-ray. After radiotherapy, chemotherapy employing 5-FU or FT-207 was continued including. The survival time after this therapy was varied mainly according to the stages of the tumor. In patients with multiple metastasis to the liver or peritoneal dissemination, no remarkable effects were obtained by this therapy. On the other hand, among 14 patients with localized tumor in the pancreas, 7 survived more than one year and the mean survival time of treated patients was never shorter than that of patients who received resection of the tumor. Most of the treated patients could spend at home until their condition became critical, because by-pass operation could overcome jaundice or the duodenal stenosis and intraoperative radiation could palliate the pain of cancer of pancreas. Tumor effect of intraoperative radiation was confirmed by both of the second laparotomy for twice intraoperative radiation and laparotomy.

Drug Therapy, Combination↗
PubMed1981

High-risk thyroid cancer. Prolonged survival with early multimodality therapy.

Eleven patients with high-risk thyroid carcinoma of anaplastic or mixed anaplastic-differentiated histology were treated using an early multimodality approach. Patients were classified using the prognostic index for thyroid carcinoma developed by the EORTC. Therapy consisted of a four-drug chemotherapy combination, radioiodine (131I), and Bacille-Calmette-Guerin (BCG) immunotherapy. Treatment was designed to maximize effects against both anaplastic and differentiated tumor components. There has been prolonged disease-free survival (14+ to 73+ months) in patients with clear cell, small cell, and mixed anaplastic histologies. Currently five patients have been in complete remission for over 4 years. Treatment has been well tolerated. The long-term participation in care by a multispecialty team has produced promising results which we hope can be valuable as a basis for multicenter trials.

Adult↗
PubMedDate not supplied

Multimodality evoked potentials in aortoarteritis.

Brainstem auditory evoked potentials (BAEPs) have been used to detect early and even asymptomatic brain ischemia. There is a need to detect subclinical brain and/or spinal cord ischemia in patients with aortoarteritis so that ischemic deficits can be prevented by early intervention. We studied multimodality (Visual evoked potentials--VEPs, Somatosensory evoked potentials--SEPs and BAEPs) evoked potentials (EPs) in 10 neurologically asymptomatic subjects with aortoarteritis. EP latencies were normal in all the patients studied. The possible value of EP latencies in detection of early brain and/or spinal cord ischemia in patients with aortoarteritis is discussed.

Adolescent↗
PubMed1995

Prospective multimodality treatment of SCLC--experience during the past 18 years.

Lung cancer has been one of the leading malignancies in China. Since 1989 it has ranked first among common malignancies in the male population, and second in females. In 1975, a multimodality treatment study group for lung cancer was organized in our institute. The group has since expanded to 15 institutions in the Beijing and Tianjin area during the past four years. The present communication is based on our experiences and data, and tries to explain the treatment strategy of our study group.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1995

[Preoperative (neoadjuvant) chemotherapy in multimodality treatment concept of stomach carcinoma].

In spite of standardization of surgical procedures in the treatment of gastric carcinomas including increased resection rates as well as decreased postoperative mortality long-term survival rates are poor. An improvement of the prognosis by surgery alone can be expected only by tumor free R0-resection. In locally advanced gastric carcinomas with questionable R0-resection some studies could show promissing results using preoperative chemotherapy. This treatment modality enabled increased R0-resection rates with a positive impact on median survival in relation to surgery alone. Randomized trials have to start in the future to verify or to modify these results incorporating new options of multimodality treatment.

Antineoplastic Agents↗
PubMedDate not supplied

[Multimodal treatment of intrahepatic lithiasis with traditional surgery, endoscopy, and extracorporeal lithotripsy. Report of a clinical case].

A patient with residual intra-/extra-hepatic bile duct stones, previously admitted in emergency for acute necrotic pancreatitis and cholangitis, underwent the following procedures: 1) endoscopic sphincterotomy and naso-biliary tube drainage; 2) surgical operation (choledocholithotomy, operative choledochoscopy and T-tube external biliary drainage); 3) extracorporeal shock-wave lithotripsy; 4) endoscopic sessions of fragmented stones removal. The above mentioned multimodal treatment, which resolved the intrahepatic lithiasis as shown 12 months later by endoscopic retrograde cholangiography, is therefore suitable in order to avoid, at least initially, invasive radiologic or surgical procedures, i.e. transparenchymal approaches, intrahepatic derivations and hepatic resections.

Bile Ducts, Intrahepatic↗
PubMed1994

Display of merged multimodality brain images using interleaved pixels with independent color scales.

UNLABELLED: This article reviews common methods for two-dimensional display of registered multimodality brain images and describes a software package for presentation of merged MRI and PET images that runs on a workstation with an eight-bit color display. The software package displays merged brain images from multiple modalities in a way that is readily manipulated, visually pleasing and easy to interpret. The display method used, i.e., interleaving of alternate pixels with independent color scales, is effective in producing merged images with high contrast-detail for each volume. Interleaving images from different volumes creates unusual perceptual effects, one of which is the apparent camouflage of low-contrast signals by high values in the paired volume. METHODS: The camouflage effect was thought to arise from perceptual merging of adjacent pixels. An observer experiment was conducted to investigate this tendency of high-activity PET data to obscure low-contrast detail in interleaved MRI data in spite of the digital independence of neighboring pixels. Four observers were presented with 20 combinations of signal plus background targets with uniform mask images, using a two-alternative forced-choice experimental design with 50 trials per combination. RESULTS: The psychophysical evaluation of the ability of human observers to detect the simple test objects in an interleaved image presentation indicated a statistically significant camouflage effect of one volume on the other for some combinations of target and mask. The concept of perceptual merging of adjacent pixels was able to predict which combinations caused the greatest degradations in performance. CONCLUSIONS: The image interleaving approach to the display of two-dimensional slices from registered image volumes makes efficient use of an eight-bit color display. Contrast resolution of both individual volumes is high compared with that in other techniques and the volumes are presented in familiar color scales. However, the method yields an unexpected camouflage effect that tends to obscure low-contrast signals. The practical effect of such camouflage on the interpretation of clinical images remains to be investigated.

Brain↗
PubMed1994

Multimodality therapy for non-small-cell lung cancer.

The optimal treatment strategy for patients with locally advanced (stage III) non-small-cell lung cancer remains controversial. Primary surgical resection or conventional thoracic irradiation alone results in poor long-term survival for the majority of stage III patients. Several multimodality strategies are reviewed in this article. Radiation followed by surgery may increase resectability, but its effects on survival are unproven. Sequential chemotherapy and radiation have demonstrated a survival advantage for selected stage III patients. Chemotherapy followed by surgery has also shown encouraging results, and additional studies are in progress. Concurrent chemoradiotherapy has shown conflicting results in a few randomized studies. Concurrent chemotherapy and radiation followed by surgery has been tested only in phase II trials and awaits further studies.

Carcinoma, Non-Small-Cell Lung↗
PubMed1993

Multimodality evoked potentials and electroretinography in a test battery for an early diagnosis of brain death.

A test battery conformed by multimodality evoked potentials (MEP) and electroretinography (ERG) was applied to 30 brain-dead patients. Three patterns of brainstem auditory evoked potentials (BAEPs) were observed: (1) No identifiable waves (73.34%); (2) an isolated bilateral wave I (16.66%) and (3) an isolated unilateral wave I (10%) (Fig. 1,2,3). Waves II, III, IV, and V were not observed in any of the cases. Whenever wave I was recorded, it was always significantly delayed. For short latency evoked potentials (SSEPs) a characteristic pattern was found: absence of cortical N20 and later responses in scalp-cephalic records and preservation of the so-called subcortical components in the rest of the derivations. For visual evoked potentials (VEPs) and electroretinography (ERG) the same pattern was found in all cases: when a cephalic reference was used for both, VEPs and the ERG, waves a and b of the ERG were recognized in all cases. The visual evoked responses consisted of waves with less amplitude but very similar in latency and morphology to the ERG. When a non-cephalic channel was chosen for the ERG and VEPs, the ERG waves showed no changes either in morphology or in latency, while the VEP lead showed no response. It is discussed that the consideration of MEP and ERG in a battery test to evaluate brain-dead patients increase diagnostic reliability, which is fundamental for an early diagnosis of brain death.

Adolescent↗
PubMed1993

[Multimodality treatment of esophageal carcinoma: evaluation of preoperative (neoadjuvant) chemotherapy].

Recently, esophageal carcinoma has shown a wide variation in spread, from carcinoma in situ to the far-advanced type. Therefore, the treatment must be performed on the basis of accurate clinical stagings, and not only the prognosis but also the quality of life of patients should be considered. Surgical resection has been regarded as standard treatment for patients with advanced carcinoma, but in some cases, preoperative treatments should be added to perform curative resections. Our objectives in preoperative (neoadjuvant) chemotherapy with cisplatin and other chemotherapeutic agents are three-fold: 1) To reduce the extent of direct invasion of neighboring structures (e.g., aorta, trachea or bronchus). 2) To reduce the degree of lymph node metastasis. 3) To preserve the larynx in cases of cervical esophageal carcinoma. For the past 4 years, we treated 13 cases of advanced esophageal carcinoma with this chemotherapy method preoperatively. Two of 13 patients showed a partial clinical response, including one with no viable carcinoma cells pathologically, and 4 had a minor clinical response. However, the impact on overall survival must be further investigated. We conclude that this multimodality treatment is effective for local tumor control, but should be applied for selected patients with careful management of its side effects.

Aged↗
PubMed1993

Development and implementation of multimodal and combined treatment studies in children and adolescents: NIMH perspectives.

Over the last decade, combined psychosocial and pharmacologic treatment studies have been marked by increasing methodologic sophistication and complexity. While the design and implementation of such studies with adults is difficult, even more levels of complexity must be faced by investigators who develop such studies with children. This paper reviews the rationale, background, and design considerations related to the development and implementation of such studies. In particular, issues related to the choice of particular treatment combinations, subject selection strategies, and assessment approaches are discussed. Because most childhood conditions have complex roots lying both in biological and psychosocial phenomena, greater use of multimodal treatment research approaches will be critical to advance the field of child and adolescent treatment research. Recommendations are outlined for future study designs for child and adolescent treatment trials.

Adolescent↗
PubMedDate not supplied

Multimodality evoked potentials in sporadic amyotrophic lateral sclerosis: a statistical approach.

The involvement of sensory pathways in patients suffering from amyotrophic lateral sclerosis (ALS) is well reported in histopathological studies. Several laboratories have also used evoked potentials to evidentiate subtle dysfunctions of sensory systems in such patients. However, conflicting results have been presented in studies using evoked potentials. In the present experiment we have evaluated multimodality evoked potentials in subjects with sure diagnosis of sporadic ALS, by means of the Bonferroni multiple comparisons procedure. Our principal findings are: a) no statistical difference between patients and controls in BAEP and VEP recordings; b) a reduction of N13 amplitude and a prolonged P22 latency in SEP recordings. Due to the sources of N13 and P22, these latter alterations, however, do not implicate the involvement of somatosensory pathway. In conclusion, the current investigation does not provide an electrophysiological support for the involvement of sensory systems in the sporadic ALS.

Aged↗
PubMed1993

Outcome of two multimodal back treatment programs with and without intensive physical training.

We compared the results of two multimodal back treatment programs (program A: n = 134; program B: n = 175) using pain, functional capacity, sickness absence, subjective state of health, depression, and work status as outcome variables. Whereas in program A exercise was guided by pain, in program B a "no pain, no gain" rationale was used as a basis for intensive physical training. Neither of the programs included direct attempts to influence the patient's environment (i.e., to find employment or to modify working conditions). In both programs, a clear decrease in pain and an increase in functional capacity was found from the pretreatment phase to the 12-month follow-up. These changes were, however, stronger in program B. Days of absence decreased significantly in group B, but the change was not significantly different from that in group A. On the whole, the more intensive training showed somewhat better results, even though the difference was not substantial. In contrast to some earlier results, there was no statistically significant increase in the proportion of those employed after treatment in either group. The results indicate that intensive physical exercise does not, as such, solve the problem of back disability in a country that has a highly developed social security system. More active interventions in work and work-life are needed.

Adult↗
PubMedDate not supplied

[Results of multimodal treatment of patients with glial tumors of cerebral hemispheres].

The outcomes of multimodality treatment were assessed in 42 patients with glial tumors of cerebral hemispheres. Radical surgery turned out to be feasible only in 52.4% of patients with high-grade tumor histological variants and 66.7% of patients with low-grade tumors. Five-year survival rates did not improve when a cumulative radiation dose was increased from 33 to 70 Gy and amount to 21.4 and 73.8% in high- and low-grade tumours, respectively.

Adult↗
PubMed1996

[High-dose multimodal radiotherapy of confluent destructively growing aggregated keratoacanthoma. 2 case reports].

BACKGROUND: Keratoacanthoma is a fairly common, benign, usually self-resolving skin lesion that arises from the hair follicle. This nodular lesion shows a predilection for areas exposed to light, mainly for the face. We report on the intensive radiation therapy of 2 cases of a rare subset of keratoacanthoma which showed a locally aggressive, seriously destructive growth. PATIENTS AND METHODS: Two female patients with previously treated, confluent-destructive growing keratoacanthoma were treated by multimodal, high-dose radiotherapy. Patient 1 showed a rapid progress of midfacial tumor with destructive infiltration of the left cheek, nasal cartilage, the cribriform plate of ethmoid and congestion of the conjunctiva close to the lacrimal caruncle. This could be shown in clinical and histopathological investigations and CT-scans. The coexistence of cutaneous and conjunctival lesions in locally rapidly enlarging keratoacanthoma of the face is unusual and unreported to our knowledge. One case of simultaneous conjunctival and multiple, eruptive keratoacanthoma of the body has been reported. Patient 2 had received soft X-ray pretreatment because of a large, relapsing keratoacanthoma of the left cheek. RESULTS: Patient 1 underwent a parallel, intensive treatment of the conjunctiva with 90Sr-contact therapy, percutaneous high-dose 60Co-gamma- and megavoltage electron treatment (10 and 18 MeV) of the midfacial lesions. Conjunctiva and caruncle showed a complete remission of keratoacanthoma. In the other facial areas no long-term regression could be reached, despite giving a fully cancericidal, total dose of more than 100 Gy in some regions. Patient 2: Further high dose radiotherapy using megavoltage electron treatment with a total dose of 50 Gy showed a complete remission of the lesion for 5 months. Another relapse of this keratoacanthoma could be operated successfully. There was no more relapse established in follow-up checks. CONCLUSIONS: The 2 case reports show that in treatment of locally destructive growing subsets of keratoacanthoma a sufficient therapy should be initiated in time. Keratoacanthoma and subsets of this lesion that do not respond well to initial treatment, recur early or show seriously aggressive growth should be treated early by combined therapy that takes previous experiences into consideration.

Aged↗
PubMed1995

[Multimodality therapy of late stage lung cancer].

A prospective randomized study of 80 cases of stage III lung cancer treated with different multimodality therapy was carried out. Life table and Kaplan-Meir curve were employed to calculate survival rate. Log rank-multivariate analysis and time t test were used to evaluate statistical values of the 80 cases, 40 SCLC were randomly treated with either chemotherapy (CT)-surgery-CT or CT-radiotherapy (RT)-CT. The year survival rates were better in the group treated with CT-surgery-CT, a statistical difference was observed in 2yr survival rate (P < 0.05). Thus, surgical resection for SCLC was better than RT after CT. The remaining 40 cases of NSCLC were randomly treated with either CT-RT-CT or RT-CT. Multivariate analysis showed a better statistical meaning in the 20 cases treated with CT-RT-CT than the other group, their 1, 2 year survival rates were 27%, 40% and 22%, 15%, respectively. Thus preradiative CT was beneficial for survival.

Adult↗
PubMedDate not supplied

Amebic liver abscess "a 5 year Mexican experience with a multimodality approach".

BACKGROUND/AIMS: Amebic liver abscess is a frequent problem in Mexico. The morbidity and mortality is reported to be high in different series. The aim of this study was to evaluate the morbidity and mortality of ALA in our center and evaluate our current management used. MATERIALS AND METHODS: Fifty patients were included in our study. Thirty-four (68%) were males, 16 (22%) were females. The age range was between 22 and 83 years (mean 50 years). The majority presented abdominal pain (95%), fever (82%) and hepatomegaly (72%). leukocytosis was observed in 72%, hypoalbuminaemia in 62%, thrombocytosis in 42%. The seroemeba reaction was positive in 90%. The diagnostic methods used were ultrasound in 42, computed tomography in 20 and isotope scan in 12. RESULTS: Medical treatment alone was used in 24 patients, 15 required percutaneous drainage and 11 surgery. Fifteen patients (38%) presented medical complications. The hospital stay raged between 5 and 44 days (mean 15 days). One patient died in a median follow up of 31.4 months. Multimodality management was liberally used in our patients. Amebicidal drugs were used initially and controlled the disease in 24 patients, 15 patients required percutaneous drainage because of lack of control of the disease or risk of complications and 11 patients required surgery to treat complications. CONCLUSION: With these approaches the morbidity and mortality of ALA in our center has remained low.

Adult↗