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PubMedDate not supplied

[Multimodal evoked potentials and central mechanisms of afferentation in trigeminal neuralgia].

Multimodal evoked potentials in patients with trigeminal neuralgia are analyzed in the paper. The comprehensive studies of cortical trigeminal somatosensory evoked potentials, visual evoked potentials, and brainstem auditory evoked potentials have revealed their changes that are indicative of the impaired central mechanisms of afferentation in patients with trigeminal abnormality. The findings are discussed in the light of the theory of generator mechanisms of neuropathological pain syndromes.

Adult↗
PubMed1996

Multimodal treatment to prevent the late whiplash syndrome.

In order to assess the long-term efficacy of a multi-modal rehabilitation approach on whiplash injury, 60 patients were recruited within two months after neck injury. They were randomly allocated either to an experimental multimodal treatment (A) consisting of postural training, manual technique and psychological support or to a control treatment (B), using physical agents only, such as electrical and sonic modalities. Pain level, range of movement, self-rating scale of treatment efficacy and return-to-work delay were evaluated before and at the end of treatment, and later, 30 and 180 days after randomisation. The benefit obtained with treatment "A" was greater and longer lasting than that experienced using "B", despite the fact that the same benefit was obtained in joint mobility in the two groups. Patients undergoing the experimental treatment returned to their usual occupations sooner than the controls. The results seem to confirm the hypothesis of a multifactorial involvement as a possible mechanism for the late whiplash syndrome.

Adolescent↗
PubMed1996

Multimodality treatment using AK-2123, hydralazine, radiation & hyperthermia on a transplantable mouse tumour.

The in vivo response of a transplantable mouse tumour, Sarcoma 180 to AK-2123 (AK), local irradiation (RT) and local hyperthermia, as influenced by a vasoactive drug, hydralazine (HDZ), was assessed on the basis of tumour cure (complete response CR), volume doubling time (VDT), regrowth delay (RD) and animal survival up to 120 days. A single ip injection of 200 mg/kg b.wt. AK produced more than 15 per cent CR. Combination of any two agents resulted in a better response than the single agent treatments. AK in combination with 43 degrees C, 30 min (HT) was more effective than HT combination with 10 Gy. The presence of 5 mg/kg HDZ, injected immediately after 5 Gy, in combination with AK increased the therapeutic effect over that produced by AK+10Gy. Combination of all the three agents (AK+10Gy+HT) produced 100 per cent CR and prolonged disease free animal survival. A similar response could be obtained by the presence of HDZ with a lower radiation dose of 5 Gy in combination with AK and HT (AK+5Gy+HDZ+HT). This multimodality treatment offers the possibility of further reduction in the doses of individual agents, and in the possible side effects on normal tissues without compromising the tumour cure effect.

Animals↗
PubMed1996

[Use of reactor neutrons in the multimodal treatment of patients with breast cancer].

The results of multimodality treatment are analyzed in 56 patients with local breast cancer. Combined gamma-neutron therapy with the use of fast reactor neutrons enhances the efficiency of breast cancer treatment and does not increase the number of radiation reactions and complications. The three-year survival increased from 44 +/- 12 to 75 +/- 9%. The test reactors specifically adjusted may be useful for the radiation therapy of patients with various malignant neoplasms. Combined gamma-neutron therapy is more promising for this purpose than neutron therapy alone.

Adult↗
PubMed1996

Three-dimensional description of pulmonary deposition of inhaled aerosol using data from multimodality imaging.

UNLABELLED: Three-dimensional assessment of pulmonary deposition of inhaled aerosol may be performed using SPECT. The use of aligned anatomical images enables improved accuracy of quantification and anatomical localization of deposition. METHODS: Techniques of analyzing these data and their application to deposition studies of two nebulizer-generated aerosols (mass median diameter 1.5 and 6.5 microM respectively) in 12 normal subjects are described. The deposition data were transformed to a standard hemispherical shape and the mean distribution pattern for each aerosol evaluated. Deposition by airway generation was then calculated using a spatial model of airway morphology. The results were compared to those from planar image analysis. RESULTS: The hemispherical transform yielded considerably more qualitative information on deposition pattern. The central-to-peripheral concentration ratio between conducting and alveolated airways was 5.27 for the coarser aerosol and 2.43 for the fine. The two-dimensional spatial estimates of the ratio were 2.61 and 2.03 respectively. CONCLUSION: Analysis of multimodality imaging data considerably enhanced information on deposition compared to planar imaging. It provides new data on aerosol deposition which will be of value to physicians involved in drug inhalation therapy.

Aerosols↗
PubMed1996

[Use of parenteral feeding in the multimodality treatment of Crohn's disease and nonspecific ulcerative colitis].

The paper reviews publication on the use of complete parenteral feeding in the multimodality treatment of inflammatory bowel disease. Complete parenteral feeding was performed in patients with skeletization and physical retardation, in severe diseases, in inefficiency or intolerance of conventional therapy with sulfanilamides and steroids, in those who had intestinal fistulas, as well in the preparation of patients for surgical treatment. The use of complete parenteral feeding, under the above circumstances allow one to achieve persistent remission, spontaneous healing of intestinal fistulas, elimination of abnormal metabolism, nutrition, constitution, water-electrolyte balance, to reduce a surgical risk and the incidence of postoperative complications and the length of patients' hospital stay.

Colitis, Ulcerative↗
PubMed1996

[Social and medical aspects of multimodality therapy for lymphogranulomatosis in children].

The high efficiency of treatment of lymphogranulomatosis in children by the currently available protocols determines the necessity of assessing them in terms of the quality of further life. The opportunity of creating a life and having the offspring, that of getting education and a profession are one of the main characteristics of the quality of life. The data on the reproductive function and social adaptation of 443 children receiving multimodality treatment for lymphogranulomatosis by 3 protocols (from 1976, 1978, and 1987). Two hundred and fifty eight individuals were 18 years old or more. Sixty four former patients have 88 children who are all healthy. The treatment performed in childhood intensively, which yielded a complete effect, exerts no substantial impact on the formation and performance of their reproductive function. The former patients have a high intellect, without limitations in getting professions, and they are easily adaptable to the changing social conditions.

Adolescent↗
PubMed1996

[Multimodality treatment for retinoblastoma in children].

A comprehensive programme was developed for the treatment of uni- and bilateral retinoblastoma in children with due regard to the disease stage by the TNM system. The use of the current sources of teletherapy and cyclic polychemotherapy expanded indications for organ-saving therapy at most common stages. Treatment by the program was performed in 202 patients, including 125 children with unilateral damage and 77 with bilateral damage. An attempt made treat 140 (75%) children at the first stage. More than 70% of cases were diagnosed as having disease stage T3 in one or two stage, while such patients underwent ocular enucleation. A complete or partial (more than 50%) tumor regression without signs of its progression for 2 years or more was achieved in 62% of cases. At the first stage of therapy, conservative therapy insignificantly affected the children's longevity in uncomplicated cases, which is particularly important in bilateral involvement, while this preserved the organ of vision in more than half the patients (62%). Five-year survival was 92 and 82% in unilateral retinoblastoma surgically treated and untreated, 83 and 84%, respectively. Adequate multimodality treatment brought about low incidence rates of recurrence and metastasis (10%) in conservative therapy and 7.7% among all patients.

Child, Preschool↗
PubMed1997

Therapist-client similarity on the multimodal Structural Profile Inventory as a predictor of early session impact.

Views differ concerning the importance of therapist-client similarity, but the theory underlying multimodal therapy suggests that similarity would be most advantageous for treatment outcome and client satisfaction. To explore this question, 43 therapist-client pairs were evaluated with the Session Evaluation Questionnaire (SEQ) after the second psychotherapy session. Similarity was determined by computing D"2 statistics from the Structural Profile Inventory, administered to both therapist and client. Regression analyses indicated therapist-client similarity was significantly predictive of client session rating on the SEQ. The more similar the dyad, the more "positive" and "arousing" (versus "still" or "dull") clients rated early sessions. Although there were several nonsignificant analyses, none of the results suggested that dissimilarity was positively associated with higher levels of client satisfaction and rapport.

Adolescent↗
PubMed1996

[Gastrointestinal lymphomas: results of multimodal therapy in 57 patients of one center].

From 1982-1995, 57 patients with primary gastrointestinal lymphoma were treated with a multimodality therapy. Of these patients, 36 were primary operated, 43 were given an isolated or postoperative chemotherapy and 17 were treated with radiation. Primary operated patients have a significantly better chance of relapse-free survival than those only treated conservatively.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1997

The role of surgery in the multimodality management of non-small cell lung cancer.

The majority of patients with lung cancer have disseminated disease at the time of presentation. For the minority of patients with disease localized to the chest, the concept of staging becomes particularly important because it has a major impact on the treatment plan. Guided by findings on the computed tomographic scan, mediastinoscopy remains the definitive invasive staging procedure to document unequivocally the involvement of the mediastinal lymph nodes. Equally as important is the documentation of absence of disease in contralateral lymph nodes. Patients with locally advanced non-small cell lung cancer, especially those with involvement of mediastinal lymph nodes (N2), are candidates for a multimodality approach to treatment involving either chemotherapy alone or in combination with radiation therapy. Surgical excision may be important in the management of these patients after an induction regimen. If surgical excision is performed, complete excision is the single most important factor. Postoperative adjuvant therapy may reduce the incidence of local recurrence but has not been shown to improve survival.

Carcinoma, Non-Small-Cell Lung↗
PubMedDate not supplied

Responses of preterm infants to unimodal and multimodal sensory intervention.

PURPOSE: To examine the immediate responses of preterm infants to two forms of unimodal [auditory only (A) and tactile only (T)] and two forms of multimodal sensory stimulation [auditory, tactile and visual (ATV); auditory, tactile, visual and vestibular (ATVV)]. METHOD: A convenience sample of 54 clinically stable preterm infants (33-34 postconceptional weeks) was randomly assigned to 1 of 5 experimental groups [Control (C); (A); (T); (ATV); and (ATVV)]. Stimulation was applied for 15 minutes once daily for 4 consecutive days. RESULTS: Outcome measures included pulse (PR) and respiratory rate (RR), oxygen saturation, behavioral state (BS), and body temperature. Repeated measures ANOVA identified significant differences among the groups during intervention for PR (p < .001), RR (p = .01), and BS (p < .02). Infants receiving any intervention with a tactile component showed increasing arousal (change in BS), and increased PR and RR during stimulation. Group T infants had higher proportions of PR > 180 while Group ATVV had higher proportions of PR < 140 (p = .0001). Group ATVV showed increased alertness following stimulation (24%) in contrast to having the least alertness during stimulation (11%). CONCLUSIONS: Tactile stimulation alone may be too arousing for these infants while the addition of vestibular stimulation may modulate arousal and facilitate optimal arousal prior to feeding.

Arousal↗
PubMed1997

Open heart operations without transfusion using a multimodality blood conservation strategy in 50 Jehovah's Witness patients: implications for a "bloodless" surgical technique.

BACKGROUND: Blood transfusion persists as an important risk of open heart operations despite the recent introduction of a variety of new pharmacologic agents and blood conservation techniques as independent therapies. A comprehensive multimodality blood conservation program was developed to minimize this risk. STUDY DESIGN: To provide a strategy for operating without transfusion, this program was prospectively applied to 50 adult patients who are Jehovah's Witnesses and have undergone open heart operation at our institution since 1992. The blood conservation program used for these patients included the use of high-dose erythropoietin (800 U/kg load, 500 U/kg every other day), aprotinin (6 million U total dose full Hammersmith regimen), "maximal" volume intraoperative autologous blood donation, intraoperative cell salvage, continuous shed blood reinfusion, and drawing as few blood specimens as possible. RESULTS: Procedures performed included first-time coronary bypass operations (n = 30) and more complex operations, including reoperations, valve replacements, and multiple valve replacements with or without coronary bypass (n = 20). Despite the absence of transfusion, the mean discharge hematocrit in these patients was greater than 30 percent, and there was no anemia-related mortality rate in this group. The overall in-hospital mortality for the group was 4 percent. A subset analysis was performed between the 30 first-time coronary bypass patients (group 1) and a control group of 30 consecutive patients who were not Jehovah's Witnesses but had undergone first-time coronary bypass during the same period (group 2). The blood conservation program described in the previous paragraph was not used in group 2 patients and specific transfusion criteria were prospectively applied. The chest tube output in group 1 patients was less than 40 percent of that for group 2 patients at all points measured after operation (p < 0.01). Postoperative hematocrit levels in group 1 were greater than those for group 2, despite the absence of red blood cell transfusion and despite a significantly lower admission hematocrit and red blood cell mass in group 1. The average length of stay and ancillary costs for the two groups were equivalent. Although group 1 and 2 patients were well matched for preoperative transfusion risk factors, none of the group 1 patients required transfusion, but 17 (57 percent) group 2 patients met transfusion criteria and received 3.0 +/- 4.8 U (mean plus or minus standard deviation) of homologous blood or blood products. CONCLUSIONS: These results suggest that even complex open heart operations can be performed without homologous transfusion by optimally applying available blood conservation techniques. More generalized application of these measures may increasingly allow "bloodless" operations in all patients.

Adult↗
PubMed1997

Aggressive multimodality treatment for locally advanced irresectable rectal cancer.

BACKGROUND: Local failure rates are high for locally irresectable primary or recurrent colorectal cancer, even when chemoradiation therapy is employed. AIM: This review evaluates evidence supporting aggressive preoperative chemoradiation followed by maximal surgical resection and intraoperative radiation therapy to achieve disease control and cure for patients with locally advanced irresectable primary or recurrent rectal cancer. RESULTS: A 5-year survival rate of 42 per cent with a central failure rate of 2 per cent may be achieved in patients with locally irresectable primary rectal cancer. In patients with locally recurrent disease, these values at 5 years are 18 and 28 per cent respectively. The 5-year incidence of distant metastasis remains high, affecting 64 per cent of patients with primary cancer and 75 per cent of those with recurrent cancer. CONCLUSION: A disease-free surgical resection margin remains paramount to achieve cure. Encouraging trends exist, however, for further evaluation of multimodality therapy as a means of reducing local recurrence of disease.

Brachytherapy↗
PubMed1997

Reflex sympathetic dystrophy of the upper extremity. Clinical features and response to multimodal management.

The weight of available evidence suggests that reflex sympathetic dystrophy (RSD) is a complex clinical entity that (1) occurs predominantly in young adult women; (2) has five clinical types but presents most frequently as minor traumatic dystrophy; (3) has primary signs and symptoms (e.g., pain, edema, stiffness, and discoloration) that are expressed highly in each clinical type, whereas secondary signs and symptoms are variable; (4) responds well to treatment, regardless of its clinical type; and (5) is managed best when treatment is started early. It can be concluded that RSD is a multifaceted disease that responds well when managed with a multimodal treatment program aimed at the various interacting components of the disorder. The recognition and documentation of the variation of the clinical features of RSD may allow for its earlier diagnosis and treatment and thus significantly improve the chances for a successful outcome.

Analysis of Variance↗
PubMed1997

The role of multimodality therapy in locoregional non-small cell lung cancer.

Surgical treatment is offered to all patients with stage I or II disease and to specific groups of patients with stage III or IV disease. Cisplatin based on regimens of induction chemotherapy or chemoradiotherapy have proven to be valuable in stage IIIA (N2) disease. We now recommend induction therapy on an investigational basis to most patients with stage I or II tumors and to all those with stage IIIA tumors, when the 5 year survival is anticipated to be less than 50% with conventional therapy. Many new chemotherapy agents effective in advanced stage lung cancer are currently integrated into this multimodality approach in hopes of further improvement in tumor control and survival.

Antineoplastic Agents↗
PubMed1997

Trichocyst membrane fate in living Paramecium primaurelia visualized by multimodal confocal imaging.

Trichocysts are secretory organelles located at the surface of several ciliates, docked at the plasma membrane. Their secretion is similar to other exocytic processes: the trichocyst membrane fuses with the plasma membrane, its content is released outside the cell, and the membrane is retrieved back into the cell. The fate of the trichocyst membrane in living Paramecium primaurelia was investigated by inducing massive synchronous exocytosis in the presence of fluorescein isothiocyanate-conjugated lectins or of cationized ferritin. The marker is trapped within the retrieved trichocyst membrane sac, and many regularly spaced, fluorescent ghosts are formed. As time proceeds, the number of labeled ghosts decreases, and few fluorescent vacuoles appear within the cell. The relationship between trichocyst ghosts and the vesicles of the phagosome-lysosome system was examined by labeling cells with Texas Red-conjugated bovine serum albumin, a fluorescent marker for phagocytosis. Starting from two confocal images of the same cell labeled with the two fluorescent probes, a new single image was generated by associating each image with a different red or green value. This multimodal analysis showed that trichocyst ghosts fuse with secondary lysosomes or are incorporated into digestive vacuoles. The vacuolar content is degraded and fluorescence is then found in the vesicles of the phagosome-lysosome system, and, at last, in small weakly labeled vesicles located on the cell surface.

Animals↗
PubMed1997

Multimodality treatment in the management of esophageal cancer: neoadjuvant chemoradiotherapy followed by transhiatal esophagectomy.

Esophageal cancer, although not one of the more common malignancies in the United States, remains a significant problem. Nearly as many patients as are diagnosed die in the same year, regardless of the treatment employed. Surgery is considered the mainstay of therapy. Esophagectomy with the use of the stomach as a substitute is preferred. Radical procedures have not proven more effective in extending survival. Because of the poor five-year survival rate, multimodality therapy with preoperative chemoradiotherapy (neoadjuvant therapy) followed by esophagectomy has shown encouraging results. Two illustrative cases are presented, one with adenocarcinoma and one with a squamous cell carcinoma, that were treated in this manner.

Adenocarcinoma↗