PubMed Health⌕ Search

SEARCH · PubMed Health

Results for “multi-modal”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 217 records · Page 12Linked to original sources
PubMed1994

Clinical and pharmacokinetic studies of all-trans-retinoic acid in pediatric patients with cancer.

This review will summarize the rationale for pursuing investigations into the use of retinoids for pediatric patients with cancer, describe the phase I results of all-trans-retinoic acid (ATRA) in children, and discuss the results of a series of preclinical and clinical pharmacokinetic studies of ATRA. The prognosis for children with advanced stage neuroblastoma, the most common extracranial solid tumor of childhood, has remained poor despite significant increases in the intensity of multi-modality therapy. Observations that neuroblastoma has the potential in vivo to differentiate into the more mature neuronal phenotype of a ganglioneuroma or to spontaneously regress, combined with the ability of ATRA to induce differentiation of neuroblastoma cell lines in vitro, suggests that neuroblastoma may be a prime candidate for a retinoid-based approach to differentiation therapy. We previously performed a standard pediatric phase I trial of ATRA and defined the maximum tolerated dose (MTD) in children to be 60 mg/m2/day, significantly lower than the MTD in adult patients. Pharmacokinetic results revealed that the plasma half-life of ATRA was short (45 min) relative to 13-cis-RA (12-24 h), and that plasma drug exposure decreased significantly by day 28 of daily drug administration. Preclinical studies using an i.v. formulation of ATRA in a Rhesus monkey pharmacokinetic model then demonstrated that ATRA is eliminated by a capacity-limited (saturable) process. This elimination process was rapidly induced within the first week of daily i.v. ATRA administration, and suggested that an intermittent schedule of drug administration might allow for down-regulation of the elimination process. These pre-clinical studies formed the basis for investigating whether an intermittent schedule of ATRA administration would allow for repeated periods of relatively higher plasma drug concentrations. Preliminary results of two clinical trials using intermittent schedules of administration suggest that this approach may result in significantly higher plasma drug exposure over time. Plans to study the role of intermittent schedules of ATRA administration in pediatric phase II trials in patients with neuroblastoma are underway.

Adolescent↗
PubMed1995

[Pain and convalescence after ambulatory inguinal herniotomy during local anesthesia].

Postoperative pain and convalescence following ambulatory inguinal herniotomy in local infiltration anesthesia was evaluated in this descriptive study. Sixty consecutive patients (median age 63 yr) were included. Per- and postoperative pain treatment were pre- and postoperative oral tenoxicam and methadone plus infiltration of the surgical field with up to 60 ml of 0.25% bupivacaine. Intraoperative pain intensity was slight and was treated with supplemental bupivacaine. Patients were totally relieved of pain at rest and during mobilisation in the first hours after surgery, but more than half of the patients had moderate pain from the first to the third postoperative day and still had light pain seven days after surgery. Normal daily activity was re-established five days postoperatively (median). Fifty-two patients were satisfied with the anesthesia and eight patients not satisfied due to fear of intraoperative pain. This study shows that inguinal herniotomy can be performed routinely as an outpatient procedure under local infiltration anesthesia. However, late postoperative pain was significant and should be improved with multi-modal analgesia.

Adult↗
PubMed1994

[Pathogenetic therapy of pulmonary tuberculosis in adolescents].

The paper presents the therapeutical results of 82 adolescents suffering from respiratory tuberculosis. During multi-modality therapy by using tuberculin, oliphen plus prednisolone there were clear-cut changes in immunological parameters, an increase in therapeutical efficiency and an average 3-month reduction in hospital stay.

Administration, Oral↗
PubMed1994

[Systemic dysfunctions in patients with tuberculous spondylitis and their clinical significance for surgical treatment].

The paper provides the results of studies into the pathophysiological mechanisms of respiratory and cardiovascular dysfunctions in patients with tuberculous spondylitis complicated by spinal marrow disorders. It also shows their clinical value at various stages of surgical treatment. The authors shows it necessary to perform a multi-modality rehabilitative therapy by monitoring the functions in the postoperative period, which is aimed at recovering functions of vital viscera and systems of the body, as well as locomotor functions.

Adult↗
PubMed1994

A high-speed network for cardiac image review.

A high-speed fiber-based network for the transmission and display of digitized full-motion cardiac images has been developed. Based on Asynchronous Transfer Mode (ATM), the network is scaleable, meaning that the same software and hardware is used for a small local area network or for a large multi-institutional network. The system can handle uncompressed digital angiographic images, considered to be at the "high-end" of the bandwidth requirements. Along with the networking, a general-purpose multi-modality review station has been implemented without specialized hardware. This station can store a full injection sequence in "loop RAM" in a 512 x 512 format, then interpolate to 1024 x 1024 while displaying at 30 frames per second. The network and review stations connect to a central file server that uses a virtual file system to make a large high-speed RAID storage disk and associated off-line storage tapes and cartridges all appear as a single large file system to the software. In addition to supporting archival storage and review, the system can also digitize live video using high-speed Direct Memory Access (DMA) from the frame grabber to present uncompressed data to the network. Fully functional prototypes have provided the proof of concept, with full deployment in the institution planned as the next stage.

Cardiology↗
PubMed1994

Clinical and pharmacokinetic studies of all-trans-retinoic acid in pediatric patients with cancer.

This review will summarize the rationale for pursuing investigations into the use of retinoids for pediatric patients with cancer, describe the phase I results of all-trans-retinoic acid (ATRA) in children, and discuss the results of a series of preclinical and clinical pharmacokinetic studies of ATRA. The prognosis for children with advanced stage neuroblastoma, the most common extracranial solid tumor of childhood, has remained poor despite significant increases in the intensity of multi-modality therapy. Observations that neuroblastoma has the potential in vivo to differentiate into the more mature neuronal phenotype of a ganglioneuroma or to spontaneously regress, combined with the ability of ATRA to induce differentiation of neuroblastoma cell lines in vitro, suggests that neuroblastoma may be a prime candidate for a retinoid-based approach to differentiation therapy. We previously performed a standard pediatric phase I trial of ATRA and defined the maximum tolerated dose (MTD) in children to be 60 mg/m2/day, significantly lower than the MTD in adult patients. Pharmacokinetic results revealed that the plasma half-life of ATRA was short (45 min) relative to 13-cis-RA (12-24 h), and that plasma drug exposure decreased significantly by day 28 of daily drug administration. Preclinical studies using an i.v. formulation of ATRA in a Rhesus monkey pharmacokinetic model then demonstrated that ATRA is eliminated by a capacity-limited (saturable) process. This elimination process was rapidly induced within the first week of daily i.v. ATRA administration, and suggested that an intermittent schedule of drug administration might allow for down-regulation of the elimination process. These pre-clinical studies formed the basis for investigating whether an intermittent schedule of ATRA administration would allow for repeated periods of relatively higher plasma drug concentrations. Preliminary results of two clinical trials using intermittent schedules of administration suggest that this approach may result in significantly higher plasma drug exposure over time. Plans to study the role of intermittent schedules of ATRA administration in pediatric phase II trials in patients with neuroblastoma are underway.

Adolescent↗
PubMed1994

[Changes of immune and non-specific reactivity in patients with chronic suppurative obstructive bronchitis in comprehensive treatment with thymogen].

A total of 33 patients with chronic pyoobstructive bronchitis with immunological disorders (of T-cell and other links) and nonspecific responsiveness. The use of thymogen in multi-modality treatment contributed to normalization of T-cell immunity (increases in E-rosette formation, responses of blast cell transformation to phytohemagglutinin, Tx/Tc ratio), as well as nonspecific responsiveness parameters (C3c, NBT-test, natural killers), resulting in higher clinical efficacy.

Adjuvants, Immunologic↗
PubMed1993

Management of implant-related problems and infections.

Problem-solving and treating various types of infections that can cause alveolar bone loss or inferior alveolar nerve dehiscences by failed implants or teeth are discussed. The reasons why implants fail from either surgical or prosthetic errors are reviewed. Treatment remedies which have solved numerous implant-related problems are offered. The eclectic, multi-modal implant surgical and prosthetic abilities of the clinician necessary today for successfully treating patients presenting with troubled or infected implants are reviewed.

Blade Implantation↗
PubMed1994

[Progress of the treatment of gastric cancer in Cancer Institute Hospital, Tokyo].

From 1946 to 1990, a total of 10,485 cases of gastric cancer patients were treated at the Cancer Institute Hospital (CIH), Tokyo. During the past 46 years, CIH contributed to various aspects of surgical treatment of gastric cancer; extensive radical surgery for advanced cancer, safe reconstruction methods after total gastrectomy, modified surgery for early stage cancer, and multimodality therapy for moderately advanced cancer. Five-year survival rate was 20% for all cases in 1940s, and 66.5% for 1980s. Improvement in the treatment results could be attributed to the relative increase in the number of early stage cancers, the increase in the rate of curative surgery (R0), and incorporation of multi-modality therapy before or after curative surgery. Stage-oriented therapy is mandatory for further improvement in the treatment results and the patient's quality of life after surgery.

Adult↗
PubMed1993

[Dynamic magnetic resonance tomography in aortic valve insufficiency: methodologic comparison with aortography and color Doppler echocardiography].

To evaluate the usefulness of cine-MRI for the quantitative assessment of aortic valve regurgitation, 31 patients (54 +/- 15 years of age; 22 M, 9 F) and 10 normal volunteers underwent a multi-modality imaging protocol comparing cine-MRI with color Doppler echocardiography and contrast aortography. Twenty-one patients had aortic regurgitation with an associated transvalvular gradient, 10 patients had pure valve incompetence. Aortic insufficiency as assessed by the signal void from regurgitant flow on cine-MRI was best analyzed on transversal tomograms. Both the volume of the signal void caused by turbulence above a threshold velocity, and the ratio of the diameters of the regurgitant jet and the outflow tract (dAL-Jet/DLVOT) were found to correlate closely with the (Seller's) angiographic regurgitant score by r = 0.86 each (p < 0.001), and the color Doppler echocardiographic index by r = 0.74 and 0.89, respectively (p < 0.001). Cine-MRI failed to differentiate the angiographic grades I and II, however, clearly separated grades II, III, and IV in contrast to other non-invasive imaging modalities. Moreover, a semiquantitative index derived from cine-MRI allowed a rapid assessment of the severity of regurgitation, similar to color Doppler echocardiography and the semiquantitative angiographic Seller's score. Thus, cine-MRI volumetric evaluation of transvalvular flow turbulences provides a useful and reproducible means to quantify aortic regurgitation. It also allows serial atraumatic investigations as a diagnostic alternative to color Doppler examination in patients less suitable for echocardiographic evaluation and may prove helpful in monitoring the natural course of aortic valve disease.

Adult↗
PubMedDate not supplied

Laparoscopic evaluation of abdominal malignancy.

Diagnostic laparoscopy, developed in the early 1900s, has become an integral part of evaluation in the management of abdominal malignancy, including hepatocellular carcinoma, metastatic hepatic cancer, and abdominal lymphoma. When compared with computerized tomography and ultrasound, laparoscopic diagnosis is superior, or at least complementary, to conventional imaging. Laparoscopic evaluation and staging of abdominal cancer will become of greater importance because of the increasing role of palliative procedures and multi-modality therapy.

Abdominal Neoplasms↗
PubMed1993

Risk taking and decision making of adolescent long-term survivors of cancer.

Late effects of multi-modal treatments for long-term survivors of childhood cancer may affect their ability to make decisions related to risk behaviors. Adolescent survivors may be at greater risk than those in the general population because of late effects of organ compromise and oncogenesis. The purposes of this study were to (1) describe the prevalence of risk behaviors among adolescent long-term survivors of cancer; (2) describe these survivors' perceptions of the quality of their decision making; (3) test the hypothesis that the poorer the decision-making quality, the more risk behaviors exhibited by an adolescent long-term survivor; and (4) examine the effects of central nervous system (CNS) prophylactic leukemia therapy and academic achievement problems on quality of decision making and risk behaviors. In this descriptive study, a semi-structured interview was used at the time of the yearly clinic visit. The sample consisted of 36 long-term survivors who were disease-free for five years, had no medical treatment for two years, and were 14-19 years of age. The major conclusions drawn regarding adolescent long-term survivors were that (1) although there was a trend toward higher experimental use of some risk behaviors, essentially, the prevalence rates were comparable to those of the general population; (2) some were good decision makers; however, quality decision-making skills were poorly practiced by the majority; (3) with better decision-making quality, fewer risk behaviors were exhibited; and (4) prior CNS prophylactic leukemia therapy and academic achievement problems may be associated with poor quality decision making.

Adolescent↗
PubMed1993

Demonstration of coexistent B-cell lymphoma and therapy-related acute myelogenous leukemia in lymph nodes by flow cytometry and immunohistochemistry. Case report and review of the literature.

A 58-yr-old white woman, with a 9-yr history of non-Hodgkin's lymphoma with recurrences and multi-modality therapy, presents with acute leukemia and residual lymphadenopathy. By flow cytometric analysis, cytochemistry, and cytomorphology, the leukemia is classified as acute myelogenous leukemia (AML), M4, and the lymph nodes are found to contain residual NHL in addition to an AML infiltrate. Immunohistochemistry performed on the lymph nodes correlates with the flow cytometric data. A review of the literature of AML secondary to therapy for non-Hodgkin's lymphoma is also conducted. There are no documented cases in the English literature of simultaneous involvement of lymph nodes by residual lymphoma and an AML infiltrate. Thus, this report is unique in the simultaneous involvement of lymph nodes by residual lymphoma and therapy-related AML. It emphasizes the application and usefulness of flow cytometry and immunohistochemistry in such cases.

Female↗
PubMedDate not supplied

[Computer-assisted surgery: assessment and perspectives].

The hospital in the future will be faced with the major problem of managing and optimizing the use of images provided from numerous sources examining both anatomy (MRI, CT-scan...) and function (gamma-camera, PET-scan...). One of the first to benefit from such rationalization will be the surgeon. After studying the results of the physical examination, the laboratory reports and the medical imaging, the surgeon will decide on the best curative measured and the best surgical route before operating. He thus needs a computer to assist him in integrating the multi-modal information available for his patient, in particular the imaging with automatic integration and visualisation in synoptic mode (perception step), showing the trajectory of possible access routes to the target organ, memorization of the chosen route (decision step) and real operation either using laser or a manuel tool, or with robot assistance under human control (action step). This close cooperation between surgery and computers is called computer-assisted surgery. A few examples of current uses an future perspectives of this new field of surgery are presented.

Diagnosis, Computer-Assisted↗
PubMed1996

[Chemotherapy of gastrointestinal carcinomas and non-small-cell pulmonary carcinoma: a controversy].

Patients with metastatic gastrointestinal cancers and metastatic non-small cell lung cancer present an important challenge in medical oncology and palliative care. Symptoms caused by tumor progression should undoubtedly be treated. The management of asymptomatic patients, however, is still controversial. A clinical decision on whether an asymptomatic patient should be treated with chemotherapy at an early or at a late stage in the evolution of the disease must often be reached on an individual basis. Ongoing clinical research to improve treatment results is still urgently needed. Research programs should aim at (a) evaluating new drugs and (b) testing new multi-modal treatment strategies.

Antineoplastic Agents↗
PubMed1996

[Perioperative chemotherapy of squamous cell carcinoma of the hypopharynx].

The aim of this prospective study was to decrease the rate of locoregional recurrence (LRR) and distant metastasis (DM) with a multi-modality approach in hypopharyngeal squamous cell carcinoma (HSCC). Patients presenting with squamous cell carcinoma of the pyriform sinus, epilarynx or postcricoid area with indication of pharyngolaryngectomy, without previous treatment, distant metastasis, multiple primaries or general contraindications for surgery and chemotherapy were included in the study. Patients received three consecutive cycles of chemotherapy (CDDP cisplatinium 100 mg/m2 D1, 5-FU 1 g/m2 D1 to D5) before surgery, then two postoperative courses of the same chemotherapy at day 10 and 31 after surgery. Postoperative radiotherapy was initiated at day 50. Between 1986 and 1989, of 198 patients with HSCC, 60 were included in this study. Tumour response of the induction chemotherapy was: no response (NR): 22; partial response (PR): 25; complete response (CR): 11; non evaluable: 2. Forty-seven patients underwent surgery. Only two patients had no viable tumour in the surgical specimen and two others only keratin debris. Of 39 patients in which protocol treatment was respected, 4 LRR, 4 LRR + DM, 8 DM, three second head and neck primaries, and one acute myeloblastic leukemia were observed. Results were compared with those of historical series, with the same mean delay of follow up. The rate of survival at 2 and 5 years was 78% and 42% in the present series, while it was 77% and 33% in the control group, respectively (NS).

Actuarial Analysis↗
PubMed1996

Radical cystectomy for stage T3b bladder cancer.

Radical cystectomy with pelvic lymphadenectomy is the mainstay of treatment of muscle-invasive transitional cell carcinoma of the bladder. Outcome in patients with pathologically organ-confined disease is excellent, with local control rates exceeding 90% and 5-year survival approaching 80%. It is apparent, however, that radical cystectomy alone is inadequate therapy for patients with clinical or pathological extravesical extension. These patients are at high risk for relapse both locally and distantly. The development of more effective chemotherapy and optimal integration of systemic therapy with locally applied therapeutic modalities are needed. Recent data suggest that patients with clinical extravesical extension (T3b/T4) may benefit from combined local therapy with the addition of preoperative radiotherapy as well as multi-agent systemic chemotherapy. Furthermore, it appears that clinical staging modalities are reliable in the selection of patients for this multi-modal approach with only a small number of patients thereby subjected to unnecessary treatment.

Carcinoma, Transitional Cell↗
PubMed1996

Molecular heterogeneity of beta-thalassaemia in Malaysia: a practical approach to diagnosis.

The beta-thalassaemia mutations in 20 Malaysian children with beta-thalassaemia major were characterised by using a multi-modal approach, consisting of a slot-blot hybridisation with selected allele-specific oligonucleotides (ASO), followed by reverse dot-blot assay (RDB), amplification refractory mutation system (ARMS) and genomic sequencing. This strategy yielded a 94.4% mutation detection rate. The 6 most common mutations were codons 41/42 (-TTCT), IVS II nt 654(C --> T), IVS I nt 5(G --> C), IVS I nt 1(G -->T), codon 35 (-C) and codon 19 (A --> G), which accounted for 83.3% of all mutations detected. A strategy of initial screening with the above 6 selected ASOs for slot-blot hybridisation followed by RDB assay for the less common Asian mutations would give a mutation identification of 91.7%. Another feasible approach would be to analyse alleles from a particular racial group, by a judicious selection of 4 ASOs common to that particular subpopulation and then supplement this with RDB assay. This could yield a 100% coverage for the Chinese subpopulation in Malaysia. With these strategies, a practical approach has been identified to overcome the pitfalls posed by the molecular heterogeneity of beta-thalassaemia to enable prenatal diagnosis and carrier screening to be carried out. Regional collaborative studies are to be encouraged as an indispensable tool in providing better health care services to our patients.

Asian People↗