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Results for “multimodality”

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At least 1,783 records · Page 99Linked to original sources
PubMed2005

Does multimodal analgesia with acetaminophen, nonsteroidal antiinflammatory drugs, or selective cyclooxygenase-2 inhibitors and patient-controlled analgesia morphine offer advantages over morphine alone? Meta-analyses of randomized trials.

The authors analyzed data from 52 randomized placebo-controlled trials (4,893 adults) testing acetaminophen, nonsteroidal antiinflammatory drugs, or selective cyclooxygenase-2 inhibitors given in conjunction with morphine after surgery. The median of the average 24-h morphine consumption in controls was 49 mg (range, 15-117 mg); it was significantly decreased with all regimens by 15-55%. There was evidence of a reduction in pain intensity at 24 h (1 cm on the 0- to 10-cm visual analog scale) only with nonsteroidal antiinflammatory drugs. Nonsteroidal antiinflammatory drugs also significantly reduced the incidence of nausea/vomiting from 28.8% to 22.0% (number needed to treat, 15) and of sedation from 15.4% to 12.7% (number needed to treat, 37) but increased the risk of severe bleeding from 0% to 1.7% (number needed to harm, 59). Selective cyclooxygenase-2 inhibitors increased the risk of renal failure in cardiac patients from 0% to 1.4% (number needed to harm, 73). A decrease in morphine consumption is not a good indicator of the usefulness of a supplemental analgesic. There is evidence that the combination of nonsteroidal antiinflammatory drugs with patient-controlled analgesia morphine offers some advantages over morphine alone.

Acetaminophen↗
PubMed1997

Single-stage, multimodality treatment of soft-tissue sarcoma of the extremity.

The present study describes the techniques available for single-stage sarcoma resection, soft-tissue reconstruction, and radiotherapy for limb preservation in patients who are unable to undergo primary wound closure after a complete soft-tissue resection of their primary sarcoma. From 1989 to 1994, 19 patients (age range, 18-79 years; mean, 51.2 years) underwent radical resection of extremity sarcomas followed by immediate reconstruction. Seven patients had tumors in the upper extremity and 12 patients had tumors in the lower extremity. There were 13 primary tumors and 6 recurrent tumors. Fifteen patients (79%) received radiation therapy, 7 patients by external beam and 8 patients by brachytherapy. Reconstruction included 16 regional flaps in 13 patients and 7 free tissue transfers in 6 patients. Commonly used flaps included the rectus abdominis (N = 5), the latissimus dorsi (N = 4), the anterolateral thigh (N = 4), the reverse-flow radial forearm (N = 2), and the gastrocnemius (N = 2) flaps. Complications included wound breakdown (N = 2), partial skin graft failure (N = 1), hematoma requiring operative evacuation (N = 1), and partial flap necrosis (N = 1). There were no operative mortalities. Eight patients underwent wide local excision, flap closure, and brachytherapy. Mean length of hospital stay for this group was 12.3 days compared with 13.8 days for the remaining 11 patients. There was one complication (13%) in this group and four complications in the remaining patients (4 of 11; 36%). Our study confirms the utility of soft-tissue reconstruction to permit wide local excision with clear margins as well as the delivery of postoperative radiotherapy. It demonstrates the ability of pedicled flaps and free tissue transfers to remain viable and provide sufficient wound coverage in the setting of early postoperative brachytherapy. In addition, this series illustrates the efficacy of a team approach and one-stage therapy for extremity soft-tissue sarcomas that includes excision, reconstruction, and early postoperative brachytherapy in a single hospitalization.

Adolescent↗
PubMed1998

Malignant fibrous histiocytoma of the hand: multimodal therapy and extensor tendon reconstruction.

A patient with malignant fibrous histiocytoma of the dorsum of the hand, managed with irradiation and wide local excision, is presented. Biopsy technique, the rationale for preoperative irradiation, and the details of extensor tendon reconstruction are discussed. Tendon grafts, rather than transfers, were used to reconstruct the extensor tendon defects. Although this approach is simple, little is known regarding the healing of irradiated tendons or the use of dynamic splinting protocols in this setting. Our patient experienced no difficulty with either tendon healing or early dynamic splinting and achieved an acceptable range of motion.

Combined Modality Therapy↗
PubMed1991

The role of multimodality therapy in soft-tissue sarcoma.

Soft-tissue sarcomas are uncommon malignancies. The development during a period of 8 years, in one institution, of a prospective data base incorporating more than 1600 patients with these tumors is described. The most common sites for occurrence are the extremities, but they can occur in any of the soft tissues of the body. Liposarcoma and leiomyosarcoma are the most common histopathologic conditions identified. Prognostic factors for both recurrence and survival include site, histopathology, size, grade, and adequacy of resection. A prospective randomized trial of the use of adjuvant radiation by the brachytherapy technique in extremity lesions has shown a decrease in local recurrence, but no impact on survival. Eligible patients not randomized to the trial show no difference in local recurrence or survival, regardless of whether they received adjuvant radiation.

Adolescent↗
PubMed2001

Event-related potentials and audiovisual stimuli: multimodal interactions.

In a discrimination task event-related potentials (ERPs) were recorded in human participants to simultaneously presented visual and auditory stimuli with relevant and irrelevant auditory and visual features. Stimuli consisted of combinations of a sine-wave tone (either target or non-target frequency) and a rectangle of particular (target or non-target) orientation. In two conditions either the auditory or the visual discrimination was easier. Stimuli with just one target feature elicited attention-related ERP components (selection negativity and N2b in the visual, and N2b in the auditory modality) only if that feature could be easily discriminated. This finding shows the hierarchical organization of attentional processing of auditory and visual features. Target stimuli in both conditions elicited visual and auditory attention-related components. This finding, together with the similarity of ERPs to stimuli without target features suggest, that these components cannot be considered as on-line correlates of elementary discrimination processes.

Acoustic Stimulation↗
PubMed1990

Multimodality imaging of a pancreatic transplant. A case report.

A 41-year-old man who had insulin-dependent diabetes mellitus from the age of 14 underwent cadaveric renal transplant in 1984. Two years later, the patient underwent pancreatic allograft transplantation. The patient did well for eight days after the operation and did not require exogenous insulin. After the eighth day, serum glucose levels rose. Multiple radiologic studies were performed to assess the possibility of graft rejection. A Tc-99m DTPA study revealed a gradual decrease in perfusion, and an In-111 oxine WBC study showed nonspecific inflammation. CT scanning and MRI displayed postsurgical anatomical relationships and excluded a peripancreatic fluid collection, but were unable to demonstrate parenchymal abnormality of the pancreas. Tests for infection proved negative. Because the decreased blood flow demonstrated by DTPA study indicated transient ischemia, the patient was treated for graft rejection and stabilized quickly.

Adult↗
PubMed1997

Ventilation-perfusion scintigraphic correlation with multimodality imaging in a proven case of Swyer-James (Macleod's) syndrome.

The scintigraphic findings in a rare case of a unilateral matched ventilation perfusion defect, Swyer-James (Macleod's) syndrome, are presented. A 40-year-old man underwent ventilation/perfusion imaging for acute onset of dyspnea. The scan showed markedly diminished ventilation, vascular flow, and perfusion unilaterally on the left hemithorax. Chest radiography showed hyperlucency of the left lung. Pulmonary angiography showed left-sided hypovascularity, and the CT scan of the chest showed apical bullae and peribronchial thickening of the left lung. Ventilation/perfusion imaging and other radiologic assessment, along with the patient's medical history, confirmed the diagnosis of the Swyer-James syndrome. This condition should be considered as a differential diagnosis in a patient with unilaterally matched ventilation/perfusion deficits without an obvious etiology.

Adult↗
PubMed1987

A silicone gel phantom suitable for multimodality imaging.

A silicone gel phantom material is described. It can be molded into any shape and it can contain internal cavities. The material is selfsealing allowing the cavities to be filled with liquids. A simple geometric phantom consisting of a rectangular solid with a single internal spherical cavity was fabricated and imaged using MRI, CT, and PET. Properties important for imaging are described.

Gels↗
PubMed1994

Multimodality correlative study of canine brain tumors. Proton magnetic resonance spectroscopy, positron emission tomography, and histology.

RATIONALE AND OBJECTIVES: Structural/functional relationships in an induced canine brain tumor were studied using proton-magnetic resonance spectroscopy (1H-MRS), positron emission tomography (PET), and histology. METHODS: Proton-MRS and PET data of implanted canine brain tumors were correlated with quantitative analysis of the tissue composition within the MRS and PET regions of interest (ROIs). Linear regression analysis was employed to correlate the 1H-MRS and PET data with the percent tumor and the percent total lesion (comprising tumor plus associated pathology ie, edema, cysts, hemorrhage, inflammation) within the ROI. RESULTS: Using 1H-MRS, N-acetyl aspartate concentrations were indirectly correlated with the amount of tumor (P = .058), as well as the amount of tumor plus associated pathology (P = .032) within the ROI. Total creatine concentrations were indirectly correlated with the amount of tumor and the amount of tumor plus associated pathology within the ROI (P < .05). Lactate concentrations were directly correlated with the amount of tumor (P = .053) and the amount of tumor plus associated pathology (P = .058) within the ROI. Using PET, Oxygen metabolic rates were indirectly correlated with the amount of tumor and with the amount of tumor plus associated pathology within the ROI (P < .05). Glucose metabolic rates were directly correlated with both the amount of tumor and with the amount of tumor plus associated pathology at P < .05. Proton-MRS measured concentrations of choline and PET measured values for blood flow, and oxygen extraction showed correlations with the amount of tumor and with the amount of tumor plus associated pathology at P > or = .08. CONCLUSIONS: The PET and MRS data were complementary with respect to suggesting anaerobic glucose metabolism for the tumor. Unlike other tumors, no increase in choline was noted in the canine tumor.

Animals↗
PubMed1993

The effects of a multimodal intervention with attention-deficit hyperactivity disorder children: a 9-month follow-up.

Using a double-blind, placebo design, we evaluated 96 attention-deficit hyperactivity disordered children for the effects of methylphenidate alone and in combination with behavioral parent training plus child self-control instruction. Seventy one of the children completed the treatment protocol. As reported previously, main effects were found for medication at posttest; however, there was no evidence of additive effects. Nine months after the termination of the behavioral interventions and the withdrawal of the stimulant medication, we found limited support for the hypothesis that the combined conditions would produce greater maintenance of treatment gains than would medication alone.

Achievement↗