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PubMed2006

The North Carolina-Louisiana Prostate Cancer Project (PCaP): methods and design of a multidisciplinary population-based cohort study of racial differences in prostate cancer outcomes.

BACKGROUND: The North Carolina-Louisiana Prostate Cancer Project (PCaP) is a multidisciplinary study of social, individual, and tumor-level causes of racial differences in prostate cancer aggressiveness. METHODS: A population-based sample of incident prostate cancer cases from North Carolina and Louisiana will include 1,000 African Americans and 1,000 Caucasian Americans. Study nurses administer structured questionnaires and collect blood, adipose tissue, urine, and toenail samples during an in-home visit. Clinical data are abstracted from medical records, diagnostic biopsies are reviewed and assayed, and tissue microarrays are constructed from prostatectomy samples. Prostate cancer aggressiveness is classified based on PSA, clinical stage, and Gleason grade. RESULTS: Preliminary data demonstrate between- and within-group differences in patient characteristics, screening, and treatment by race and state. Participation exceeds 70% in all groups. CONCLUSIONS: Preliminary data support the feasibility of this comprehensive study to help determine the focus of public health efforts to reduce racial disparities in prostate cancer mortality.

Black People↗
PubMed2004

Congenital constriction band of the upper arm: the role of three-dimensional ultrasound in diagnosis, counseling and multidisciplinary consultation.

Constriction band syndrome represents a sporadic condition that may result in amputations, constrictions and other deformities of the fetal limbs and body. Prenatal diagnosis by two-dimensional ultrasound has been reported. We present a case of constriction band involving the upper arm in which the assessment by three-dimensional ultrasound significantly contributed to the diagnosis and the multidisciplinary counseling. In fact, multiplanar imaging and surface rendering allowed a clear depiction of the extent of the constriction, the club-hand deformity and the relationship between the amniotic band, the cord and the fetal limb. This case represents a unique and effective application of three-dimensional ultrasound in prenatal diagnosis.

Amniotic Band Syndrome↗
PubMed1993

Assessing the neurotoxic potential of chemicals--a multidisciplinary approach.

Since 1981, the development of methodology to assess the neurotoxic potential of chemicals has been a high priority within the International Programme on Chemical Safety (IPCS). Following the completion of an in-depth review of the scientific principles and methods for the assessment of neurotoxicity associated with chemical exposures, IPCS started to develop a multidisciplinary and comprehensive approach for neurotoxicity testing of chemicals. In view of the complexity of the nervous system and the variety of effects caused by chemicals, no single test or approach will be appropriate. Initially, IPCS evaluated neurobehavioral tests as well as in vitro procedures as screening tests, and an international collaborative study of neurobehavioral tests appropriate for screening chemicals for neurotoxicity is now in progress. Possible integration of higher level neurobehavioral tests with neurophysiological, biochemical, and pathological procedures in future testing strategies are discussed.

Hazardous Substances↗
PubMed1999

A patient with brain metastasis from ovarian cancer who showed complete remission after multidisciplinary treatment.

We describe a case with brain metastasis from ovarian cancer who showed complete remission after multidisciplinary treatment. The case was diagnosed as epithelial ovarian cancer, FIGO stage IIIc. She underwent cisplatin-based chemotherapy after optimal cytoreductive surgery and achieved clinical complete remission. Thirty-two months after surgery for ovarian cancer, a solitary metastasis occurred in the left frontal lobe of the brain. No recurrent lesions were observed outside the brain. The metastatic tumor was resected. Five days after operation, adjuvant chemotherapy comprising carboplatin and cisplatin was initiated (a total of three courses at 4-week intervals), and whole brain irradiation at 55 Gy was added. After these treatment methods, complete remission of the brain metastasis has been observed for 57 months with good quality of life.

Brain Neoplasms↗
PubMedDate not supplied

Multidisciplinary approach to the treatment of unresectable breast cancer.

Between January 1960 and December 1990, 163 patients with locally advanced breast cancer (LABC) were treated by multidisciplinary treatment regimens. Forty-six cases received preoperative intraarterial perfusion of cytotoxic drugs. Fifty-four cases received preoperative systemic chemotherapy. Forty-one cases received preoperative radiotherapy, and twenty-two cases received both radiotherapy and chemotherapy. Preoperative systemic chemotherapy gives the best results. Postoperative chemotherapy and radiotherapy did not improve the survival rate as compared to the control group. The authors suggest that preoperative induction chemotherapy be used for LABC patients.

Breast Neoplasms↗
PubMed1993

The indications for tumor mass reduction surgery and subsequent multidisciplinary treatments in stage IV hepatocellular carcinoma.

The indications for tumor-mass reduction surgery and subsequent immunotherapy in patients with stage IV hepatocellular carcinoma (HCC) were elucidated in this study. About 42% of the resected specimens from stage IV-A patients (n = 26) contained well-differentiated multicentrically occurring HCC, which was not found in any of the stage IV-B patients (n = 9). The 2-year survival rate after reduction surgery was 49% for the stage IV-A patients and only 13% for the stage IV-B patients, while 6 of the stage IV-A patients who survived for more than 2 years had no vascular invasion or distant organ metastases. Some of the stage IV patients maintained normal peripheral natural killer (NK) activity and were also able to tolerate surgical insults immunologically, provided that appropriate postoperative immunotherapy was given. Thus, stage IV-A HCC has a greater possibility of containing slow-growing intrahepatic tumor clusters, and the removal of any rapidly growing tumors from among these should be undertaken by reduction surgery followed by subsequent multidisciplinary treatment for residual tumor cells, including appropriate immunotherapy.

Carcinoma, Hepatocellular↗
PubMed1992

Significance of multidisciplinary therapy for hepatocellular carcinoma.

The effect of multidisciplinary therapy for hepatocellular carcinoma (HCC) was evaluated in 121 resected cases. The 5-year survival was 100% for absolute curative resection (12 cases), 59.1% for relative curative resection (n = 37) and 10.9% for relative non-curative resection (n = 59). However, none of the patients survived for more than 3 years after absolute non-curative resection (n = 13). The non-recurrence in the preoperative TAE groups was different from that in non-TAE groups undergoing absolute and relative curative resection. The 1- and 3-year non-recurrence rates for relative non-curative resection were 92.3% and 53.8%, respectively, for the preoperative TAE group and 56.1% and 28.1%, respectively for the non-TAE group. These data show that preoperative TAE is effective in relative non-curative resection. Functional disturbances of the coagulation-fibrinolysis system in cirrhotic patients were improved after PSE. All patients undergoing hepatectomy after PSE had an uneventful postoperative course, including well-maintained function of the coagulation-fibrinolysis system and a decrease in splenic volume. At 1 year after hepatectomy, cirrhotic patients with critical liver function and poor coagulation-fibrinolysis showed appreciable hepatic regeneration. One patient died of hepatic failure 1 year after the operation. In recurrent HCC, the 1-, 2- and 3-year survival values after reresection were 100%, 75.0% and 25.0%, respectively. The respective values following TAE were 79.0%, 42.0% and 9.0%. Three cases of recurrent HCC were effectively treated, i.e., two patients achieved a partial response and one showed no change, by continuous intra-arterial infusion of 5-FU and lentinan with intermittent one-shot injections of epirubicin using a subcutaneous infusion pump. These three patients are alive at 1 year and 7 months, 1 year and 4 months and 6 months after the treatment, respectively.

Adult↗
PubMed1996

Complications after multidisciplinary treatment of cerebral arteriovenous malformations.

PATIENTS AND TECHNIQUES: A series of 67 patients treated for cerebral AVMs with a multidisciplinary approach is reported, with special attention for the complications due to treatment. The malformations were classified after the Spetzler Grading Scale, with 67% low-grade and 33% high-grade AVMs. Three modes of treatment were used: surgical resection, endovascular embolization, and radiosurgery (linear accelerator technique). The actual treatment was: resection alone (25% of cases), embolization plus resection (24%), embolization alone (21%), and radiosurgery (30%), either alone or after embolization or surgery. The following eradication rates were obtained: overall 80%, after resection (with or without embolization) 91%, after embolization alone 13%, after radiosurgery 87%. CLINICAL OUTCOME: The outcome was evaluated in terms of deterioration due to treatment. A deterioration after treatment occurred in 19 patients (28%), and was a minor deterioration (19%), a neurological deficit (4%), or death (4%). As far as the mode of treatment is concerned, surgical resection was responsible for deterioration (minor) in 17% of all cases operated upon. Radiosurgery was followed by a minor deterioration in 10% of irradiated cases. Embolization gave a complication in 25% of all embolized cases (minor or neurological deficit, or death). The mechanism of the complications was: resection or manipulation of an eloquent area during surgery, radionecrosis after radiosurgery, ischaemia and haemorrhage (50% each) following embolization. In most cases of haemorrhage due to embolization, occlusion of the main venous drainage could be demonstrated. DISCUSSION: The haemodynamic disturbances to AVMs and to their treatment are reviewed in the literature. The main haemodynamic mechanisms admitted at the beginning of a complication after treatment of cerebral AVMs are the normal perfusion pressure breakthrough syndrome, the disturbances of the venous drainage (venous overload or occlusive hyperaemia), and the retrograde thrombosis of the feeding arteries. CONCLUSIONS: According the authors' experience, the emphasis of treatment for cerebral AVMs has now shifted from surgical resection to endovascular embolization. One of the explanations is that endovascular techniques are now employed in the most difficult cases (high grade AVMs). As severe complications of endovascular embolization may also occur for low-grade malformations, the question arises whether surgery or radiosurgery should not be used first for this low-grade group even if embolization is feasible.

Adult↗
PubMed1986

Management of medulloblastoma in children, a multidisciplinary problem.

The diagnosis and treatment of the medulloblastoma has made remarkable advances in the 60 years that this tumor has been known. The survival time has increased but the quality of survival leaves much to be desired, according to a survey of the literature and the limited experiences in this study. The psychologic sequelae are particularly striking. This study gives a survey of diagnostic and therapeutic possibilities at this moment and goes further into some problems which are met during this process. A multidisciplinary approach is necessary because of the multitude of problems which are encountered. The problematic factors in the treatment and the course of the disease justify taking the patients into a trial in order to evaluate the different forms of treatment.

Adolescent↗
PubMed1995

Multidisciplinary approach to fibromyalgia. A pilot study.

The aim of the study was to instruct a group of fibromyalgia patients how to solve problems related to activities of daily life. Sixteen female fibromyalgia patients completed a ten week multidisciplinary program, consisting of a cognitive and an exercise part. After ten weeks a reduction in general pain intensity (p < 0.05) was found. At six months follow-up sensory (somatic) pain intensity was reduced compared to baseline recordings (p = 0.05). All patients had made adjustments to their everyday life after ten weeks. Eight patients reported that they regularly practised relaxation techniques, and seven patients had undertaken dietary changes. Thus, the study shows that adjustment of activities in daily living may reduce pain in patients with fibromyalgia. Controlled studies are needed in the future.

Activities of Daily Living↗
PubMed1989

Development of a multidisciplinary feeding profile for children who are dependent feeders.

The multidisciplinary feeding profile (MFP) is the first statistically based protocol for the quantitative assessment of feeding disorders in severely disabled children. This assessment can be completed in 30-45 min with foods and facilities that are available in homes, hospitals, and chronic care units. This paper describes the state of current testing methods, the parameters of successful feeding activity, the development of the test protocol, and the results of statistical analyses.

Adolescent↗
PubMed1989

The multidisciplinary feeding profile: a statistically based protocol for assessment of dependent feeders.

The development of the multidisciplinary feeding profile entailed a level of statistical analyses not commonly utilized in test development. This paper describes the statistical analyses and offers an explanation of why specific statistical tests were chosen. It also serves to identify where clinical knowledge and experience overrode specific statistical tests.

Persons with Disabilities↗
PubMed1990

Effects of a multidisciplinary management program on neurologically impaired patients with dysphagia.

Dysphagia is a major problem in patients with neurologic disorders. Aspiration pneumonia and impaired nutritional status are consequences of dysphagia that result in high morbidity and mortality rates. Assessment and treatment of the dysphagic patient by a multidisciplinary team have been advocated but to date the effects of such an approach have not been demonstrated quantitatively. This prospective study was conducted to determine if a dysphagia program would improve patients' caloric intake and body weight, decrease the instances of aspiration pneumonia, or improve patients' feeding ability. Patients were referred from a 26 bed neurology/neurosurgery unit. A time series design was utilized. The control group consisted of 15 patients (mean age = 46.1 years), managed according to the existing ward routine. Subsequently, nursing staff attended a dysphagia training program. Following this, the treated group of 16 patients, (mean age = 49.3 years) was assessed by the dysphagia team, using bedside and videofluoroscopic examinations to determine the specific swallowing disorder. An individualized treatment program was designed for each patient. The groups were compared on the basis of deviation from their baseline weight, deviation from ideal energy intake, and the incidence of aspiration pneumonia. Statistical analysis revealed that the groups were comparable in age, number of days on the study, and Glasgow Coma Scale score; and that a significant weight gain and increase in caloric intake occurred in the treated group. No incidence of aspiration pneumonia was reported in either group. We speculate that this may have been influenced by the meticulousness of the care delivered in an acute unit as well as greater attention to prevention given in both groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

Dysphagia in cerebral palsy: a comparative study of the Exeter Dysphagia Assessment Technique and a multidisciplinary assessment.

Eighteen children with cerebral palsy in a special school, most of whom had feeding difficulties, were studied to compare the diagnostic value of the Exeter Dysphagia Assessment Technique (EDAT) with an exhaustive clinical assessment undertaken by a multidisciplinary team experienced in the diagnosis and treatment of dysphagia of neurological origin. Four feeding skills were assessed by each method independently, viz. anticipation, intraoral sensory perception, oral-motor efficiency, and pharyngeal triggering. Comparison of the two sets of results showed agreement in at least 78% of the assessed skills. The possible reasons for the few discrepancies are discussed. The noninvasive EDAT equipment was easy to use with the children, who had a range of type and severity of cerebral palsy. The test was undertaken in their familiar surroundings and took 15 to 20 min per child. Interpretation of the results showed that EDAT provided a rapid, reliable diagnostic aid which assisted in the assessment of the degree of feeding impairment within each of the four feeding skills tested.

Adolescent↗
PubMed1991

Evidence of effective multidisciplinary treatment for resectable pancreatic cancer from the viewpoint of the CA19-9 level.

Nineteen patients with resectable pancreatic cancer have been treated by a multidisciplinary approach at the National Cancer Center Hospital. This therapy included extended pancreatic resection, intraoperative irradiation by 30 Gy of electrons, and intraoperative hepatic arterial or portal infusion of mitomycin C. Furthermore, postoperative chemotherapy with mitomycin C, using Seldinger's method or iv administration, was added. The study consisted of 13 patients with carcinoma of the pancreatic head and six patients with carcinoma of the body and tail. The one- and three-year survival rates for these patients were 88 and 50%, respectively. The five-year survival rate was calculated as 28%, although there is only one five-year survivor. The effectiveness of this therapy was studied by changes in Carbohydrate Antigen 19-9 (CA19-9) level. Thirteen of the 15 patients with high CA19-9 levels showed a decrease to a level less than 50 U/mL after this therapy. In the postoperative course, the patients showing a tendency of elevation of the CA19-9 level could be suspected of having cancer recurrence at this time without any physical sign or other laboratory findings.

Aged↗
PubMed1986

[Reason for admission and cause of death in a multidisciplinary pediatric intensive care unit].

In contrast with neonatal intensive care services, paediatric intensive care units are relatively new; thus, it is not surprising that their clientele has not been well described in the medical literature. In order to better define it, we did a retrospective analysis of 4646 consecutive admissions of children aged between a week and 18 years to a multidisciplinary paediatric intensive care unit over a period of five years (1979-83). This unit belongs to a 700-bed paediatric hospital delivering medical as well as surgical tertiary care. Of the 4646 admissions, 2527 (54.3 per cent) were surgical and 2119 (45.6 per cent) medical. There were multiple diagnoses on admission. Among the most frequent diagnoses were major trauma (9.6 per cent of total), intoxications (4.6 per cent) and congenital cardiopathies in the postoperative phase of a corrective or palliative surgery (tetralogy of Fallot (2.8 per cent), ASD (2.7 per cent), etc.) The global mortality rate was 5.8 per cent (268/4646). Severe infections and cardiopathies, mostly congenital, were responsible for almost half the deaths (24.2 per cent each). This description of patients and problems encountered in a paediatric intensive care unit should facilitate planning for personnel training and can be used to establish guidelines for reducing mortality.

Adolescent↗
PubMed2002

Multidisciplinary management of a Jehovah's Witness patient for the removal of a renal cell carcinoma extending into the right atrium.

PURPOSE: To highlight the management of a Jehovah's witness surgical patient presenting for cardiopulmonary bypass (CPB) and deep hypothermic circulatory arrest. CLINICAL FEATURES: A 47-yr-old male, Jehovah's Witness, with renal cell carcinoma was admitted for left radical nephrectomy and excision of tumour thrombus extending into the junction of the inferior vena cava (IVC) and right atrium (RA). The preoperative goals were to maximize red blood cell mass, delineate the extent of tumour extension and develop a surgical plan incorporating blood conservation strategies to minimize blood loss. A midline abdominal incision was made to optimize removal of the non-caval portion of the tumour from the intra-abdominal region. CPB and deep hypothermic circulatory arrest were instituted to aid in removing the tumour from the IVC and RA. Intraoperative blood conservation strategies included the use of acute normovolemic hemodilution, antifibrinolytics, cell salvage, point-of-care monitoring of heparin and protamine blood concentrations, leukocyte-depleting filter, and meticulous surgical techniques. The patient was successfully weaned from CPB and was transported to the cardiothoracic intensive care unit without complication. The patient was discharged home one week after the operation with a hemoglobin of 10.2 g x dL(-1) and a hematocrit of 31.2%. CONCLUSION: Multiple blood conservation techniques were employed to manage this Jehovah's Witness patient through complex cardiac surgery, which was previously denied to him at other institutions. The successful outcome of this patient, while respecting the right to refuse allogeneic blood products, is a result of a multidisciplinary collaboration as well as the application of established blood conservation techniques.

Antifibrinolytic Agents↗