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PubMed2001

Hepatocellular carcinoma: multimodality management.

BACKGROUND: Hepatocellular carcinoma is one of the most common tumors worldwide. Surgical resection has been the standard treatment but can only be applied to a small percentage of patients. In recent years, several other treatment options, including ablative procedures and transplantation, have been used in patients with hepatocellular carcinoma. METHODS: For 6 years, 110 patients with hepatocellular carcinoma were managed at the Medical College of Wisconsin. Fifty-five patients received only chemotherapy (n = 5) or palliative treatment (n = 50) because of advanced cirrhosis (P <.03) or tumor. Thirty-one patients had tumor ablation with percutaneous ethanol injection, cryoablation, radiofrequency ablation, or arterial chemoembolization. Twenty-eight patients underwent surgical resection (n = 18) or hepatic transplantation (n = 10). Relatively more patients (38%; P <.001) were treated with ablation in the second period of the study (1998-2000). RESULTS: Thirty-day mortality was 3% with ablation and 0% with resection. Median survival was 6 months with no treatment, 27 months with ablation (P <.001), and 35 months with resection (P <.001). Patients who underwent liver transplantation had the longest median survival (53 months). A multivariate analysis suggested that treatment modality (ablation or resection; P <.001) and Child-Pugh classification (P <.01) were the most important factors predicting outcome. CONCLUSIONS: This study suggests that treatment of hepatocellular carcinoma requires multidisciplinary expertise and that ablation and operation can be performed safely. Outcome is influenced most by treatment modality and Child-Pugh classification. Patients in Child-Pugh classes A and B should be treated with ablation, surgical resection, or liver transplantation.

Adult↗
PubMed1997

Suppressive effect of multimodal surface representation on ocular smooth pursuit of invisible hand.

A human observer can smoothly pursue her/his own voluntarily moved hand with the eyes in total darkness. The effects of a perceived stationary surface during ocular pursuit of the invisible hand were investigated. The task was to track the invisible hand smoothly with the eyes in a Ganzfeld (experiment 1), with a stationary visual surface in the light (experiment 2), or with a solid stationary surface in total darkness (experiment 3). It was found that smooth pursuit of the invisible hand occurred in the Ganzfeld as well as in total darkness, but was replaced by frequent saccades when a stationary surface was perceived through either the visual or the tactile sense. The results obtained with a Ganzfeld suggest that light alone does not prevent smooth pursuit of the invisible hand, and those obtained with a stationary surface suggest that perception of such a surface prevents smooth pursuit of the invisible hand and evokes saccades, regardless of the sense modality.

Adult↗
PubMedDate not supplied

"Fast-track"-rehabilitation in surgery, a multimodal concept.

The rates of postoperative local surgical complications (e.g. wound-infection, abscess, anastomotic leakage) and the postoperative mortality have markedly decreased over the past decades. However the occurrence of general medical complications (e.g. cardio-pulmonary or renal dysfunction, nosocomial infections, thromboembolism) after abdominal surgery is still frequent with an incidence of 20-60% (1-6). "Fast-track"-surgery, also called "Fast-track"-rehabilitation or "ERAS" (enhanced recovery after surgery) programme, is a combination of different pre- and intraoperative measures, which have been mainly validated in elective colonic surgery, but they can be principally employed in all surgical settings. With this approach it is possible to accelerate the postoperative convalescence and reduce the rate of general complications markedly (4, 7-10).

Clinical Protocols↗
PubMed1991

The use of a multimodal image, the apple technique, to facilitate clinical hypnosis: a brief communication.

A 1- to 3-minute exercise involving imagination (of an apple) and ideomotor ideation (hand levitation) is a simple, benign technique that is useful for illustrating to patients the nature of imagery and hypnosis. It avoids power struggles and allows a reasonable approximation of the patient's capacity for imagery and hypnotic responsiveness, without emphasizing the use of a hypnotic procedure. When administered to 35 college students, the hand levitation component of this exercise correlated with the Stanford Hypnotic Susceptibility Scale, Form C (Weitzenhoffer & E. R. Hilgard, 1963) (r = .66, p less than .001) and with the Stanford Hypnotic Clinical Scale: Adult (Morgan & J. R. Hilgard, 1975, 1978/79) (r = .60, p less than .001).

Adult↗
PubMed1994

Multimodal evoked potentials after subarachnoid haemorrhage.

In 59 comatose patients after subarachnoid haemorrhage somatosensory, visual, auditory and magnetic motor evoked potentials were registered. Evoked potentials proved to be of much less predictive value than in other causes of coma, such as head injury and others. While loss of cortical function was a safe predictor of a fatal outcome, preservation of evoked potentials has little prognostic relevance.

Adult↗