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Multimodal outpatient group treatment for the psychiatrically disabled.

Outpatient clinics gradually accumulate patients with longstanding disabilities. The traditional treatment approach is to see such patients in brief, intermittent, individual visits. Staff generally dislikes treating such patients and patients may, in part, maintain their symptoms in order to maintain ties with a nurturing institution. The experience with an alternative approach, weekly group meetings using a number of helping modalities, is described. Although no panacea, the approach appears to provide a reasonably effective, efficient, and enjoyable way of helping chronically disabled patients.

Adult↗

Multimodality imaging of osteomyelitis.

Early diagnosis of osteomyelitis continues to be a clinical problem. Multiple imaging modalities are being used for the diagnosis of osteomyelitis, but none of them is ideal for all cases. The choice of modality depends on several factors based on an understanding of the pathophysiologic aspects of different forms of osteomyelitis. After a brief introduction outlining some basic principles regarding the diagnosis of osteomyelitis, pathophysiologic aspects are reviewed. Advantages and disadvantages of each imaging modality and their applications in different forms of osteomyelitis are discussed. The use of different imaging modalities in the diagnosis of special forms of osteomyelitis, including chronic, diabetic foot, and vertebral osteomyelitis, and osteomyelitis associated with orthopedic appliances and sickle cell disease is reviewed. Taking into account the site of suspected osteomyelitis and the presence or absence of underlying pathologic changes and their nature, an algorithm summarizing the use of various imaging modalities in the diagnosis of osteomyelitis is presented.

Adult↗

A brief methodological comment on possible inaccuracies induced by multimodal measurement analysis and reporting.

The use of multiple response system measurement adds an important dimension to behavioral medicine research. However, multiple measurement can result in problems in both analyzing and reporting outcome data. Problems in analysis include the increasing of chance findings as the measurement number increases. Problems in reporting include a blurring of response categories when general labels are used, a biased emphasis on the minority of variables showing experimental differences, and a misleading tendency to base comparative conclusions on general labels which do not accurately represent all data measured. Some examples of these problems from methodologically sound studies are described and alternative ways of dealing with the findings from multiple measurements are suggested.

Adult↗

Multimodal tests of cerebrovascular reactivity in migraine: a transcranial Doppler study.

Altered cerebral vasoreactivity (CVR) has been implicated in migraine. To test this hypothesis, we studied CVR as measured by transcranial Doppler ultrasound (TCD) in 11 migraineurs and 12 healthy controls of similar age. Mean flow velocities (MFV) in the middle cerebral artery (MCA) were recorded during a cognitive and two motor tasks. MFV in the posterior cerebral artery (PCA) were measured during photic stimulation and observation of complex images. The increase of MFV in the MCA during the cognitive task was greater in migraineurs than in controls (9.1% vs 5.0%; P = 0.06). The increase of MFV in both tests for PCA reactivity was significantly greater in migraineurs than in controls: 17.4% vs 9.9% for photic stimulation (P less than 0.05) and 20.3% vs 10.2% for observation of complex images (P less than 0.05). Owing to overlap of individual results, the discriminative value of both tests was unsatisfactory. The variability of flow velocities as measured by standard deviations of MFV was significantly greater in migraineurs than in controls during all tests of PCA vasoreactivity. Differences in CVR between migraineurs and normal controls may be detected by TCD testing, in particular in the PCA territory. For individual diagnostic purposes, CVR tests proved to be insufficient.

Adult↗

Multimodal approach to diagnosis of hamartoma of the spleen.

Splenic hamartoma is a benign, primary neoplasm which usually causes a mass in the left upper quadrant of the abdomen. If radionuclide studies show a space-occupying lesion in the spleen that appears solid on the ultrasonogram, and selective abdominal arteriography reveals a richly vascular splenic tumor, hamartoma of the spleen should be the preoperative diagnosis.

Hamartoma↗

Multimodality image display: desirable frame buffer characteristics.

The intent of this paper is to understand the characteristics of those frame buffers currently used to display images, versus more ideal frame buffers for medical image display purposes. This study is based on current needs and what characteristics might be desirable. Two case examples are presented: (1) a system developed for high quality computer graphics and (2) a system developed for nuclear medicine and radiation therapy treatment planning. Our study considers: (1) defining a pixel depth sufficient to hold data, (2) the desirability of multiple color look-up tables, (3) how cine loops are managed, and (4) display memory size.

Computer Graphics↗

Intravenous administration of high doses of carboplatin in multimodal treatment of high grade gliomas: a phase II study.

The object of this study is to evaluate the efficacy of a high dose of carboplatin in 20 patients operated on for high grade glioma (Group A) compared with a matched control (Group B) treated with BCNU administered after radiotherapy. The toxicity profile has been evaluated during the therapy. The survival of patients entering this study was measured in terms of months: the mean survival time was 10.45 months and the median 11.0 months in the group treated with carboplatin (8 patients are still alive); the 18-month survival rate was 10%. The mean survival time of the control group was 9.85 months and the median 10.5 months; no patients are still alive and the 18-month survival rate was 0%. On the basis of our phase II clinical study, we could conclude that i.v. administration of high-doses of carboplatin in high grade gliomas is generally well tolerated and the results are better than those of a matched control treated with 1-2 courses of BCNU (low-dose). The adjuvant treatment and the role of carboplatin in the therapy of high grade gliomas is discussed.

Adult↗

Continuous transcranial Doppler ultrasonography and electroencephalography during carotid endarterectomy: a multimodal monitoring system to detect intraoperative ischemia.

Transcranial Doppler ultrasonography (TCD) and EEG monitoring during carotid endarterectomy provide continuous information on the electrical activity of the cerebral cortex, blood flow velocities in the ipsilateral middle cerebral artery, and the occurrence of microemboli. One hundred thirty carotid endarterectomies performed with TCD and EEG monitoring were studied prospectively. During cross-clamping of the carotid artery a high correlation was found between EEG asymmetry and reduction of blood flow velocity in the middle cerebral artery (p < 10(-6), Student's t test). Microemboli were detected in 80 patients during the operation. Although not statistically significant, this occurrence of microemboli was associated with signs and symptoms of intraoperative ischemia (p = 0.08, Fisher's exact test). In comparison with earlier studies, a tendency toward intraoperative stroke reduction was noted. Only one nondisabling intraoperative stroke occurred (0.8%). In addition to the EEG, TCD monitoring of hemodynamic changes and microemboli in the middle cerebral artery provides important information to the surgeon instantaneously. TCD monitoring of blood flow velocities and embolism during carotid endarterectomy may help to reduce the number and gravity of intraoperative stroke.

Adult↗

Multimodality electroneurophysiological findings in intra-axial and extra-axial lesions of the brain stem.

In 330 patients with a space occupying lesion of the posterior cranial fossa, the blink (BR) and masseter (MR) reflexes and brain stem auditory (BAEP) and somatosensory evoked potentials (SEP) were registered. The aim of our study was to look for electrophysiological criteria of differentiating between lesions within or outside the brain stem. The ipsilateral loss of BAEP in cerebellopontine angle tumours and the altered SEP in tumours within the brain stem turned out as frequent, almost specific findings. Prolonged ipsi-and contralateral late BR responses and prolonged MR responses, a long somatosensory central conduction time of the SEP and a prolonged wave III latency as well as a prolonged interpeak latency of the BAEP are not indicative but highly suspicious for a lesion within the brain stem. Prolonged early responses of the BR together with prolonged interpeak latencies of the BAEP are characteristic findings in cerebello-pontine angle tumours.

Blinking↗

Multimodality evoked responses in the neurological assessment of the newborn.

In recent years increased attention has been devoted to evoked potentials (EP) in newborns. This paper reviews the literature and data from our research group in an attempt to assess the diagnostic and prognostic value of evoked responses in the first weeks of life and their use in different age-specific clinical conditions. The results show that EP are a very sensitive measure of the integrity of the sensory pathways. They make it possible to follow normal physiological maturation and the abnormalities of development resulting from neurological lesions. Repeated measurements of visual evoked potentials and somatosensorial evoked potential are prognostically useful in term infants, but seem much more limited in preterm newborns in predicting neurodevelopmental outcome.

Evoked Potentials↗

Frequency stabilisation of multimode helium-neon lasers in laser Doppler flowmetry.

Low-frequency noise in laser Doppler recordings can be generated because of thermal instabilities in the gas laser cavity. Mode partition noise can be eliminated by thermal stabilisation of the laser cavity. The paper describes a method for closed loop temperature control of the laser cavity. The method uses orthogonal properties of longitudinal laser modes for the temperature control. The signal-to-noise ratio is considerably improved by the procedure. It is recommended that all gas laser equipped Doppler instruments used for precision blood flow studies should be equipped with stabilised laser sources.

Electricity↗

Multimodality therapy for small cell carcinoma of the lung--the role of surgical treatment.

Reviewing the outcome of 70 cases of clinically localized small cell lung cancer (SCLC) treated with combined modality treatment, we attempted to define the role of resection in this disease. The survival rate for all cases was 37 per cent at 2 years and 23 per cent at 3 years with a median survival time (MST) of 14 months. For 25 resected cases the overall 5-year survival rate was 37 per cent with an MST of 26 months. According to clinical staging, 5-year survival was 64 per cent for stage I and 20 per cent for stage II. However, none of the stage III cases achieved long-term survival, of over 3 years. In 45 non-resected cases, the overall response rate was 84 per cent with a 44 per cent complete response. The overall survival rate was 27 per cent at 2 years and 14 per cent at 3 years with an MST of 11 months. The 20 cases who achieved complete response had an MST of 26 months with 51 per cent alive at 2 years and 19 per cent at 5 years. Thus, we consider that lung resection is definitely indicated in cases with stage I and probably stage II SCLC. For stage III, however, particularly in cases with N2 disease, resection seems to offer no special benefit in favor of survival compared to combination chemotherapy and radiotherapy.

Adult↗