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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↗

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

[The early breast cancer].

In general usage, the term early breast cancer conjures up the image of a small-sized cancer with good prognosis. In medical circles, it is expected to refer to T1, n0 cases (n0 according to pathological evaluation). However, early breast cancer should be defined by clinical conditions. Thus, although in the strict sense, early breast cancer is limited to T1, n0 cases, in practice, T1N0 and T1N1a cases also suit this diagnosis, since it was found that in over 80% of such cases could be expected a favorable prognosis. For early breast cancers, multi-modality diagnosis, not only of the breast cancer itself, but also of its spread inside the breast will be necessary if breast conservation is to be expected.

Breast Neoplasms↗

PubMed1996

Panoramic radiography in dental diagnostics.

Panoramic radiography was studied with the aim to answer some questions about technical and diagnostic properties regarding dental diagnostics. A unit with an intraoral X-ray tube was studied regarding radiation beam area, absorbed doses, and image quality for various screen-film combinations. The beam area for lateral views was wider than optimal and the contact dose high. Modifications of shielding cylinders would reduce both radiation beam and contact dose. One screen-film combination was most sensitive and produced radiographs with best subjectively perceived image quality. Agreement between panoramic (rotational and intraoral X-ray tube techniques) and intraoral radiography in diagnosis of periapical pathology, assessment of marginal bone height, and caries diagnosis was evaluated in 400 patients. Average agreement between panoramic and intraoral radiographs in periapical diagnosis was 55% for the rotational and 46% for the intraoral tube technique. Agreement in marginal bone height was 55% and 49%, respectively and in caries diagnosis 34% and 46%. Radiographs from 40 patients were used to evaluate a procedure starting with rotational panoramic radiography followed by intraoral radiographs considered necessary to achieve a comprehensive examination of teeth and surrounding bone. The number of intraoral radiographs, information loss, and monetary costs with this procedure were evaluated. Mean number of adjunct intraoral radiographs was 5.1 per patient whilst 8.5 should have been chosen to satisfy a "gold standard" used. Monetary costs were similar for an optimal combination of panoramic and intraoral radiography as for a survey with 20 intraoral images Sensitivity for a combination of radiographs was 80-96% in periapical diagnosis and marginal bone loss assessment, and 42-96% in caries diagnosis. Specificity was 95-97% for periapical and caries diagnosis and 50-92% for marginal bone loss. Radiographs from six conventional units and two programs ("dental" and "jaw" panorama) of a new multi-modal unit were compared in diagnostic quality of periapical and crestal bone areas. Number of adjunct intraoral radiographs to achieve a comprehensive evaluation of periapical and marginal bone was estimated. Quality of the "dental" panorama was significantly better than that of other machines/programs. There were no significant differences between images obtained with conventional units and the "jaw" panorama. Number of adjunct intraoral radiographs was lowest for the "dental" panorama. Quality obtained with an old unit was similar to that from modern machines. Rotational and intraoral X-ray tube panoramic radiography perform equally well. Agreement between panoramic and intraoral radiography is not sufficient for panoramic radiography to be used alone to diagnose periapical lesions, marginal bone loss and caries. It is possible to perform a full-mouth survey with a combination of panoramic and intraoral radiography but when limited regions need to be examined intraoral radiography is the method of choice.

Alveolar Bone Loss↗

PubMed1996

[MALT-lymphoma--surgical therapy].

To perform laparotomy in each histological sub-type of a primary gastric lymphoma with the intention of a total resection seems to be rather aggressive and should be seen with respect to other effective treatment modalities. But for curative treatment total gastrectomy with systematic lymphadenectomy or sampling respectively seem to be necessary. Classification is changing and there is an uncertainty about nature and dissemination of the tumor and even an uncertainty with respect to diagnosis. Basic informations become available only by standardized operative procedures. Multi-modal therapy planning is based on this knowledge but it has to hold up to clinical investigation such as the German multi-center trial. Preliminary data show an overall total resection rate of 88%.

Gastrectomy↗

PubMed1997

Facilitation of early and masking of late cortical responses in dementia.

Topographic differences in longlatency SSEP and flash VEP data are compared in 3 different psychiatric patient groups. Differences between schizophrenia and affective disorder are restricted to somatosensory P100 amplitude gradients along the antero-posterior axis. In contrast EP-differences between psychiatric patients and dementia are prominent, encompassing both late and early (< 100 ms) responses. Our flash P 2 and somatosensory P 3 data are in accordance with previous findings. Multi-modal positive responses with a latency of 40-80 ms are significantly increased in dementia. This facilitation suggests cortical dysfunction and/or subcortical gating impairment.

Adult↗

PubMed1997

Nonrhabdomyosarcoma soft tissue sarcomas in children.

Nonrhabdomyosarcoma soft tissue sarcomas are very rare tumors in the pediatric population and consist of a heterogeneous collection of subtypes. They can occur anywhere in the body, with the extremities the most common anatomic site. In the initial evaluation of a soft tissue mass, proper radiographic evaluation is best performed with magnetic resonance (MR) imaging, while tissue for diagnosis should be obtained with a well planned incisional biopsy. Complete surgical resection remains the cornerstone of therapy, but it is now recognized that multi-modal strategies incorporating surgery, radiotherapy, and chemotherapy should be studied for incompletely resected tumors and those with poor prognostic indicators.

Adolescent↗

PubMedDate not supplied

[Basic plans for the combined orthopedic treatment of patients with rheumatoid arthritis and involvement of the joints of the lower extremities].

The paper focuses on the main principles of multi-modality orthopedic treatment of patients with rheumatoid arthritis (RA) presenting with the lower limbs affection, depending upon stage, activity, as well as particular features of disease course, functional incompetence of the joints and the limb as a whole, with due regard to the patient's volition and psychological status. It is necessary that opportunities for the RA patient's orthopedic rehabilitation be found before declaring him to be an invalid.

Acute Disease↗

PubMed1997

Interferons in oncology.

The interferons are natural glycoproteins secreted in response to various stimuli, including viral infection. They have antiviral, antiproliferative and immunomodulatory effects on different target cell populations. Since recombinant human interferons have become available, they have been tested in a wide range of malignancies. They are well established in the treatment of hairy cell leukaemia, chronic myelogenous leukaemia and multiple myeloma. Although they have documented activity against lymphoma, melanoma, renal cell cancer and carcinoid tumours, their role in the treatment of these tumours is less clear. In the common solid tumours, such as lung cancer and colorectal cancer, the use of interferons remains experimental. Here we will summarise their practice applications in oncology, using randomised studies where available to establish their place in multi-modality treatment. We will not discuss their use as antiviral or immunomodulating agents in viral and autoimmune diseases, multiple sclerosis or after organ transplantation.

Antineoplastic Agents↗

PubMedDate not supplied

Accelerated-interrupted radiation therapy given concurrently with chemotherapy for locally advanced non-small cell lung cancer.

PURPOSE: To evaluate the efficacy of multidrug chemotherapy combined with accelerated radiation therapy in the treatment of localized but unresectable non-small cell lung cancer. PATIENTS AND METHODS: Between September 1990 and February 1993, 35 patients with Stage III (15 IIIA & 20 IIIB) non-small cell lung cancer were entered on a protocol using combined accelerated radiation therapy and chemotherapy. Radiation therapy consisted of 55.6 Gy in 30 fractions (1.8 Gy bid for 5 consecutive days given in 3 weeks [total of 15 days], every other week). Chemotherapy consisted of cisplatin (10 mg/m2), vinblastine (4 mg/m2), 6-thioguanine (40 mg bid), and 5-fluorouracil (400 mg/m2 as continuous infusion) given concomitantly with radiation therapy. Approximately 3 weeks following completion of radiation therapy, two cycles of consolidation chemotherapy were given, consisting of two doses of cisplatin (120 mg/m2) 4 weeks apart and six doses of vinblastine (4 mg/m2) given on two consecutive days every other week for 3 weeks. RESULTS: Six patients were still alive at last follow-up; for them the median follow-up time is 47 months (range, 39-55.8). The median survival time is 17.5 months. The 1-, 2-, 3- and 4.5-year survival rates are 69%, 37%, 20% and 17%, respectively. Overall response rate is 63%, with 51.5% partial response and 11.5% complete response rates. Esophagitis occurred as follows: Grade 4 = 0, Grade 3 = 1, Grade 2 = 6, and Grade 1 = 13. No patient developed Grade 3 or 4 acute respiratory toxicity. Significant hematologic toxicity occurred as follows: 37% Grade 3 and 31% Grade 4 leukopenia. Radiation pneumonitis occurred in two patients. DISCUSSION: The regimen tested in this protocol appears to be very well tolerated with minimal pulmonary or esophageal toxicity. This, coupled with the shortened course of radiation therapy and the ability to deliver the combined radiation and chemotherapy portion of the treatment on an outpatient basis most of the time, has made multi-modality treatment for this malignancy much easier and more convenient for patients. In addition, the favorable survival in this group of patients with locally advanced disease is very encouraging and warrants further study.

Adenocarcinoma↗

PubMed1996

A multimodal approach for diagnosing patients with acute promyelocytic leukaemia.

A practical and efficient multi-modal protocol for processing specimens for patients referred with a question of acute promyelocytic leukaemia (APL) is described. The initial analysis comprises haematological evaluation of the bone marrow and peripheral blood smears using Romanowsky-stained slides. Concomitantly, a sample is processed for direct preparation as well as 1- and 2-day unstimulated cultures using conventional cytogenetic techniques. Communication between the cytogenetic and haematological laboratories is of critical importance so that the optimal conditions for culture (i.e. longer term versus unstimulated overnight and direct preparations) for the cytogenetic detection of chromosome rearrangements can be selected. The likelihood of detecting the characteristic translocation of APL, t(15;17), is enhanced in a longer term culture versus unstimulated overnight and direct preparations. Fluorescent in situ hybridization (FISH), utilized as an adjunct to GTG-banding, was found to be a powerful technique for detecting the t(15;17), especially where the GTG-banded preparation was of suboptimal quality. Results of five recent representative cases of APL are described to illustrate a practical approach which can be adapted by any clinical pathology laboratory.

Adolescent↗

PubMed1997

Intraabdominal desmoplastic small round cell tumour in an 11-year-old boy.

A case of desmoplastic small round cell tumour (DSRCT) is presented. This aggressive and rare neoplasm predominantly affects males and is almost exclusively intraabdominal in location. It is unique in that neural, mesenchymal and epithelial markers are co-expressed. Despite multi-modal therapy, the prognosis is extremely poor. The present report details the clinical features and typical pathological findings of DSRCT in an 11-year-old boy, who succumbed to the disease 16 months after diagnosis despite multiple chemotherapeutic regimes.

Abdominal Neoplasms↗

PubMedDate not supplied

Rationale and clinical status of 41.8 degrees C systemic hyperthermia tumor necrosis factor, and melphalan for neoplastic disease.

Dramatic clinical results have been obtained in malignant melanoma and sarcoma using hyperthermic limb perfusion in combination with tumor necrosis factor (TNF) and melphalan (L-PAM). In order to extrapolate these results to systemic treatment, a preclinical research program was initiated to study the interactions of hyperthermia, TNF, and L-PAM. Based on these results, a Phase I clinical trial of whole body hyperthermia (WBH) and L-PAM was initiated and completed. Clinical results obtained were consistent with initiating two second generation studies: a) a Phase II study of WBH and L-PAM for malignant melanoma; b) a Phase I study of WBH, TNF and L-PAM. Both of these studies are currently active at the University of Wisconsin Comprehensive Cancer Center. The following review summarizes the laboratory and clinical data obtained to date regarding this systemic multi-modality treatment approach.

Antineoplastic Agents, Alkylating↗

PubMed1997

Jim Henry's world revisited--environmental "stress" at the psychophysiological and the molecular levels.

Ever increasing applications of sophisticated technologies in western civilization have placed great and growing demands for the rapid and accurate processing of multi-modal sensory information. These information streams may exceed an individual's performance capabilities. Failure to respond appropriately may have serious consequences, not only for the individual but also for others, as in command situations in the aerospace environment. There are, for example, consistent patterns common to EEG records in a population of astronaut candidates, when exposed to increasing visual information overload, simulating hazardous flight conditions. The records are dominated at the point of "information overload" by sharply and progressively increased theta wave (4-7 Hz) activity in temporal regions, major increments in frontal beta (> 14 Hz) activity, and markedly reduced occipital alpha (8-12 Hz) levels. These responses to a simulated stress raise questions about the brain's ability to distinguish natural reality from the mediated reality in modern life. It has been hypothesized that an individual's reactions with computers, television and new media are fundamentally social and natural, just as in interactions in real life. Also immune responses may here offer valuable benchmarks concerning reactions to mentally stressful stimuli. Another type of environmental influences in modern society is that of electromagnetic fields. Even fairly weak (athermal) electromagnetic fields have proven to be useful tools to study regulatory mechanisms in cells from brain and other tissues. There is growing evidence that nitric oxide may influence normal EEG patterns and that it may also participate in the pathophysiology of oxidative stress disturbances, including influences in e.g. Parkinson's and Alzheimer's diseases, then behaving as a free radical with reactive-oxygen-species or reactive-nitrogen-species. As a free radical, nitric oxide is sensitive to a variety of imposed magnetic fields, with theoretical and experimental evidence that its actions in regulating the rate and amount of product of cerebral biochemical reactions may also be modulated by imposed magnetic fields.

Electroencephalography↗

PubMed1997

Photodynamic therapy: the clinical perspective. Review on applications for control of diverse tumorous and non-tumorous diseases.

Photodynamic therapy (PDT) is an innovative and attractive modality for the treatment of small and superficial tumours. PDT, as a multi-modality treatment procedure, needs both, a photosensitizer with distinct tumour selectivity and a powerful light source that matches the absorption spectrum of the photosensitizer. The purified haematoporphyrin derivative Photofrin is so far the only sensitizer approved for phase III/IV clinical trials. Major drawbacks of this product are: lack of chemical homogeneity, skin phototoxicity, unfavourable physicochemical properties and poor selectivity in terms of uptake and retention by tumour versus normal cells. Most second generation photosensitizers, including the phthalocyanines, show an increased photodynamic efficiency in the treatment of animal tumours and reduced phototoxic side effects. In 1997, there were more than half a dozen new sensitizers in or about to start clinical trials. To introduce the basic principles of photodynamic therapy, the current review article discusses in some more detail the treatment of endobronchial lung cancer, one of the leading indications of PDT. Moreover, a broad overview is given on the use of PDT for treatment of a wide variety of tumorous and nontumorous diseases, including new strategies for control of rheumatoid arthritis and application of PDT for extracorporeal bone marrow purging.

Animals↗

PubMedDate not supplied

[The use of acupuncture reflexotherapy in treating patients with rheumatoid arthritis].

Efficiency was studied of multi-modality treatment of rheumatoid arthritis (RA) involving acupuncture (A). Indices were assessed for the number of the inflamed joints, the joint index, duration of the morning rigidity and visual scale of pain. Combined treatment of RA using A was found to more effectively lower the values for the joint index and visual scale of pain. A conclusion was reached to the effect that A may improve results of drug treatment.

Acupuncture Therapy↗

PubMedDate not supplied

Chemosensitivity of human pancreatic cancer cell lines serially transplanted in nude mouse.

BACKGROUND: Pancreatic cancer frequently recurs or metastasizes even after apparently curative surgical resection. Because of a low, five-year survival rate after radical surgery, multi-modal adjuvant treatment must be used to prevent recurrence of systemic spread. MATERIALS AND METHODS: The effectiveness of the experimental cancer chemotherapy of mitomycin C (MMC), cisplatin (DDP), doxorubicin (DXR) and 5-fluorouracil (5-FU) was evaluated in three human pancreatic cancer xenografts serially transplanted in nude mice. RESULTS: When the effects of these agents were evaluated by 3-(4,5-dimethylthiazol-2yl)-2,5-diphenyl-2H tetrazolium bromide (MTT) assay, only MMC and DDP were effective on PAN-3-JCK, a poorly differentiated adenocarcinoma. When PAN-12-JCK, a moderately differentiated adenocarcinoma, was used an in vitro assessment of combined chemotherapy of MMC and DDP, a synergistic combination effect was observed. Three xenografts were transplanted subcutaneously into nude mice and the maximum tolerated doses of these agents were administered intraperitoneally or intravenously (DXR). MMC showed positive antitumor activity on PAN-3-JCK and PAN-12-JCK, and 5-FU was effective on PAN-12-JCK. CONCLUSIONS: These results reflect the low sensitivity of clinical pancreatic cancer to conventionally available antitumor agents, and suggest the possible synergistic combination antitumor activity of MMC and DDP.

Animals↗