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PubMedDate not supplied

Diagnosis of cochlear Ménière's disease with electrocochleography.

The existence of cochlear Ménière's disease, once considered a variant of classic Ménière's disease but without vertigo, has been questioned due to lack of objective evidence that endolymphatic hydrops is involved with the disease process. Transtympanic electrocochleography (TT ECoG) has emerged as a useful tool for electrophysiologic monitoring of the inner ear, and is especially valuable in assessing endolymphatic hydrops. A retrospective chart review was performed to identify those patients with a diagnosis consistent with cochlear Ménière's disease in order to determine the presence or absence of endolymphatic hydrops using TT ECoG. A total of 7 patients were identified with at least a 2-year follow-up. Using established norms for the summating potential to action potential ratio with click stimulus, 67% of the ears examined demonstrated values consistent with endolymphatic hydrops. Fluctuating aural pressure and tinnitus were present in all patients and medical therapy of diuretics and salt restriction seemed to stabilize or improve the condition in about 80% of the patients. Theoretical considerations are discussed, and a case history of 1 of the study patients is presented to illustrate a typical example of this variant of Ménière's disease.

Adult↗

PubMed2001

Morbidity of second-look surgery in pediatric central nervous system tumors.

The extent of brain tumor resection affects survival. Second-look surgery (resection of residual tumor before radiographic progression) may improve survival by reducing the tumor burden, but the morbidity of the procedure is not known. On chart review of 280 patients with two or more brain tumor operations treated between January 1985 and June 1998, we identified 47 patients with second-look surgery. Lansky and Eastern Cooperative Oncology Group (ECOG) performance scores, as well as perioperative complications were recorded. There were 21 gliomas (6 malignant), 12 medulloblastomas, 3 craniopharyngiomas, 3 ependymomas and 8 miscellaneous tumors. Median time to second surgery was 50 days. Perioperative complications occurred in 45% of patients. There was no significant change in the mean Lansky and ECOG scores 4 and 24 weeks after surgery. Gross total resection (GTR) was achieved in 62% of patients and near total resection (NTR) in 23%, and 15% of patients had subtotal resection. GTR or NTR was achieved in 66% of medulloblastomas and 100% of gliomas. We conclude that second-look surgery by experienced pediatric neurosurgeons has an acceptable morbidity and should be considered in patients with residual tumors.

Brain Neoplasms↗

PubMedDate not supplied

Comparison of the protective efficacy of neurotrophins and antioxidants for vibration-induced trauma.

BACKGROUND: Patients undergoing temporal bone surgery or subjects working with vibrating tools may develop vibration-induced hearing loss (VHL). The aim of this study was to characterize the effects of pretreatment with N-acetylcysteine (NAC) or the neurotrophic factors, brain-derived neurotrophic factor (BDNF) and ciliary neurotrophic factor (CNTF), on VHL in an animal model. METHODS: Trauma to the cochlea was created with a vibrating probe placed on the bone of the external ear canal. BDNF and CNTF(Ax1) were delivered into the cochlea with mini-osmotic pumps. NAC was delivered into the cochlea by round window membrane (RWM) injection, by RWM permeation, or by oral administration. Hearing was evaluated with electrocochleography (ECoG). RESULTS: For control animals, vibration resulted in an average immediate threshold shift of 42 +/- 26 dB. NAC provided no protective benefit in animals subjected to VHL, regardless of the delivery method, with average threshold shifts varying from 38 to 56 dB across groups. NAC injection through the round window membrane was toxic, causing a ECoG threshold shift of >25 dB. In BDNF+CNTF(Ax1)-treated animals, immediate hearing loss was similar to that in control animals. There was a trend of threshold recovery by 1 day after vibration; however, the improvement was not statistically significant, nor was there a significant difference in 1-day thresholds across groups. CONCLUSIONS: Local infusion of BDNF and CNTF(Ax1) may enhance the rate of recovery from VHL, compared to control animals. In contrast, NAC had no effect on VHL, and when delivered by RWM injection, was actually toxic to the inner ear.

Animals↗

PubMed2004

Phase II study of cisplatin and 5-fluorouracil (PF) and mitomycin C, vincristine, cisplatin and 5-fluorouracil (MVPF) in patients with metastatic large bowel cancer: an Eastern Cooperative Oncology Group study (EST 1285).

PURPOSE: To compare the efficacy and the toxicity of cisplatin and 5-fluorouracil (PF) and mitomycin C, vincristine, cisplatin and 5-fluorouracil (MVPF) in patients with metastatic large bowel cancer. PATIENTS AND METHODS: A total of 94 patients with no prior chemotherapy and measurable metastatic large bowel cancer were randomly assigned to one of the two treatment regimens. Eastern Cooperative Oncology Group (ECOG) criteria were used to evaluate response and toxicity. RESULTS: Fifty patients were randomized to PF and 44 to MVPF. Toxicity was evaluable in all patients except one; response was evaluable in 40 and 31, with response rate of 13 and 42%, respectively. Intent-to-treat analysis showed a response rate of 12 and 32%, respectively (p = 0.076), where it was assumed that none of the ineligible or unevaluable patients responded. Median survival for all patients was 9 months, with no difference between PF and MVPF. ECOG Performance Status (0 vs. 1), weight loss (< or =10 vs. >10%) and site of metastatic lesion had statistically significant impact on survival. MVPF was definitely more toxic than PF (p < 0.000005). CONCLUSION: Both treatment regimens showed clinical activity. The MVPF regimen resulted in more responses than PF, no improvement in survival, and more toxicity.

Antineoplastic Combined Chemotherapy Protocols↗

PubMed2004

Development of a cancer pain assessment tool in Korea: a validation study of a Korean version of the brief pain inventory.

OBJECTIVE: The aim of this study was to validate the Korean version of the Brief Pain Inventory (BPI-K), a pain assessment tool that has been validated in several languages. METHODS: The sample consisted of 132 patients in Seoul who had recurrent or metastatic cancer and who expressed pain. The Korean version of the Beck Depression Inventory (BDI-K), the Eastern Cooperative Oncology Group (ECOG) performance status score, the Pain Management Index (PMI), and the PMI-Revised (PMI-R) were used to further validate the BPI-K. RESULTS: Cronbach alphas, computed for the pain interference and pain severity item, were 0.93 and 0.85, respectively. Confirmatory factor analysis of the BPI-K items showed a two-common-factor solution for the BPI-K, consistently demonstrated in other language versions of the BPI. The mean pain interference score was more correlated with the BDI-K scale (r = 0.44) and ECOG (r = 0.39) than the mean pain severity score. Seventy-four percent of the patients in the Seoul sample had inadequate analgesia using the PMI. CONCLUSION: The BPI-K is a valid and useful instrument for assessing cancer pain and pain impact in Korea.

Adolescent↗

PubMed2006

Primary central nervous system lymphoma in an Asian population: a 15-year experience.

BACKGROUND: The aim of this study was to characterize primary central nervous system lymphoma (PCNSL) among Asian patients and to determine their outcomes with different therapeutic modalities. PATIENTS AND METHODS: Between 1990 and 2005, 37 patients with PCNSL were analyzed within 5 different treatment groups: radiotherapy alone (arm A), combined chemoradiation (arm B), chemotherapy alone with methotrexate (MTX) > or = 1 g/m2 (arm C), miscellaneous therapy (arm D), and best supportive care (arm E). RESULTS: The median age at presentation was 59 years, and the majority of patients were male (68%). All patients had aggressive diffuse large B-cell lymphoma. The number of patients in arms A to E were 6, 16, 3, 8 and 4, respectively. The overall median survival was 7.4 months, 54.1 months, not reached, 8.9 months and 0.9 months, respectively. Use of MTX 1-2.5 g/m2 per cycle and an ECOG performance status of 0-2 were each associated with improved survival on univariate analysis (p = 0.022 and p = 0.049, respectively). Compared to radiotherapy alone, use of combined chemo-radiation was associated with a trend towards improved overall median survival (7.4 vs. 54.1 months, p = 0.058). CONCLUSION: The clinical characteristics and treatment outcomes in our Asian patients were comparable to those reported in Western series. Use of MTX 1-2.5 g/m2 per cycle and an ECOG performance status of 0-2 were associated with improved survival.

Adult↗

PubMed1993

Classification of psychotropic drugs based on pharmaco-electrocorticographic studies in vigilance-controlled rats.

The effects of a number of psycho-active drugs on electrocorticographic activity (ECoG) of the rat have been studied. Frontoparietal ECoG was recorded during 6-min periods immediately before drug/vehicle administration and starting at 20 and 45 min after administration. For each 6-min recording time, a mean power spectrum was calculated and smoothed. A quotient of the power at 20 and 45 min after and before drug, respectively, was then calculated. These quotients were used as input for an analysis of variance, followed by a t test and a normalization for the degrees of freedom, resulting in so-called n-profiles. Although each drug has its own characteristic n-profile, n-profiles of drugs belonging to the same clinical class have some characteristics in common. An automated classification system of psychotropic drugs, based on parameters extracted from n-profiles by discriminant analysis, is presented. For the antidepressant drug class the success rate of correct classification of antidepressant drugs is between 53 and 88%, for a neuroleptic drug in the neuroleptic drug class the success rate is 87%, for an anxiolytic drug in the anxiolytic drug class 100% and for a psychostimulant drug in the psychostimulant drug class between 86 and 100%. For a reliable classification of a drug about 10 n-profiles of active doses are needed. Using n-profiles, it appeared also possible to discriminate between antidepressant, neuroleptic, anxiolytic and psychostimulant drugs based on visual judgement. Moreover, visual evaluation of the n-profiles enables 4 subclasses to be recognized within the antidepressant class, 2 subclasses within the neuroleptic and 2 subclasses within the anxiolytic class.

Animals↗

PubMed1996

Mean power spectra from pharmaco-electrocorticographic studies: relative baseline correction and log transformation for a proper analysis of variance to assess drug effects.

The effects of drugs on electrocorticographic activity (ECoG) of the rat are studied in a routine screen. ECoG is recorded for 6-min periods before drug/vehicle administration and starting at 20 and 45 min thereafter. For each period, a mean power spectrum is calculated. Drugs are tested in 25 rats according to a 5 x 5 Latin square design and effects are assessed with analysis of variance. The validity of this assessment depends on assumptions on the chosen statistical model and the distribution of the data. In this study we consider the relative and absolute baseline corrected data. The assumptions appear to be better fulfilled if together with a relative baseline correction a logarithmic transformation is applied to the data.

Analysis of Variance↗

PubMed1992

Platinum/etoposide therapy in non-small cell lung cancer.

Non-small cell lung cancer (NSCLC) is a major health problem in the United States and in many other parts of the world. Identification of systemic therapy that can maintain or improve quality of life and prolong survival is essential because locally advanced disease or distant metastasis is found in the majority of these patients. A variety of combination regimens have produced response rates of 20% or greater in stage IV NSCLC patients in cooperative group trials, including studies conducted within the Eastern Cooperative Oncology Group (ECOG). Although no regimen has emerged as clearly superior, the highest 1-year survival rate (25%) in ECOG trials was observed in EP(etoposide/cisplatin)-treated patients. Subsequently, a randomized trial in which EP was compared to etoposide/carboplatin revealed no significant differences in survival or response rate, and toxicity was slightly less with etoposide/carboplatin. Results from recent phase II trials in which stage III NSCLC patients received preoperative EP and concurrent thoracic irradiation have shown response rates of 65-85%, as well as acceptable toxicity and surgical morbidity and mortality. Future stage IV NSCLC trials should include studies of platinum/etoposide plus new agents. Also a study comparing platinum/etoposide versus supportive care should be considered. The objectives of this study would be to compare survival, quality of life, and cost-effectiveness ratio. The results of recent phase II studies in stage III NSCLC patients suggest that preoperative cisplatin/etoposide and concurrent thoracic irradiation should be considered for evaluation in a phase III trial in stage IIIa NSCLC patients and that this regimen should also be evaluated in stage IIIb patients.

Antineoplastic Combined Chemotherapy Protocols↗

PubMed1989

Effect of hypoxia and catecholamines on the habituation rates of chronically catheterized ovine fetuses.

Integrated electromyographic, electrocortical (ECoG) and electro-ocular activity were recorded in 13 chronically prepared fetal sheep (130-145 days). Fetal movements and the rate of habituation to repeated suffusions of cold saline against the fetal skin were recorded. Experiments were repeated during an intravenous infusion of noradrenaline to the fetus (0.4 microgram/kg estimated fetal weight/min) and during hypoxia induced by altering the oxygen content of the inspired air to the ewe to 9%. Repeated stimulation with cold saline resulted in an increase in fetal movements (p = 0.009). The number of stimuli for habituation was similar in high-voltage and in low-voltage ECoG activity. The rate of fetal habituation was significantly faster during the infusion of noradrenaline compared with control measurements (p = 0.009). During hypoxia, the number of spontaneous fetal movements prior to stimulation decreased (p = 0.002). Habituation rates were also faster during hypoxemia compared with control measurements (p = 0.003). These findings may help to explain the rapid habituation rates seen in some human fetuses in at 'at risk' pregnancies.

Acoustic Stimulation↗

PubMed1985

Effect of morphine on fetal electrocortical activity and breathing movements in fetal sheep.

Morphine (1 mg/kg) given to the lamb fetus near term induces a significant increase in low-voltage high-frequency (LVHF) electrical activity in the brain. This pattern of the electrocorticogram (ECOG) is associated with simultaneous continuous fetal breathing movements of greater amplitude than control. Naloxone prevents and reverses these morphine-induced changes. The observed phenomena suggest that opiate receptors may play a stimulant role in the control of fetal LVHF ECOG and fetal breathing movements.

Animals↗

PubMedDate not supplied

Diagnostic significance of transtympanic electrocochleography in Menière's disease.

Transtympanic electrocochleography (ECoG) was performed on 32 normal ears, 40 ears affected by hair cell damage without any evidence of endolymphatic hydrops (sensory damage) and 44 ears affected by established Menière's disease. The amplitude of the summating potential (SP) and the amplitude of the action potential (AP) were measured at a click stimulus intensity level of 100 dB HL. The SP amplitude was expressed as a percentage of the AP amplitude. In normal ears, the mean SP/AP ratio was 25% (range 10%-63%). In sensory damage, the SP/AP ratio was 13% (range 0%-29%), and in Menière's ears, the SP/AP ratio was 51% (range 29%-89%). In this series, an SP/AP ratio of 29% provided a diagnostic dividing mark between the sensory damage and Menière's-affected ears. Although this precise division was probably fortuitous, it does suggest that ECoG is a useful tool in the differential diagnosis of these two types of cochlear disorders.

Action Potentials↗

PubMed1989

Comparison of tympanic membrane to promontory electrode recordings of electrocochleographic responses in patients with Menière's disease.

The purpose of the present study was to evaluate ECoG recordings obtained simultaneously from a transtympanic electrode and a tympanic membrane electrode in 26 patients with unilateral Meniere's disease. The ECoG recordings were examined quantitatively with regard to absolute amplitude of the summating potential and action potential. Recordings were examined qualitatively in terms of overall waveform quality and ease of component wave identification. All patients demonstrated a clear response with both electrodes. Although the transtympanic electrode resulted in the most robust responses in overall amplitude, the tympanic membrane electrode provided recordings equal to or, in most cases, superior to other noninvasive, extratympanic methods currently available. Furthermore, in our patient population, the likelihood of a positive (upward-going) summating potential was less for the tympanic membrane electrode recordings than for the TT electrode recordings. The major advantages of the TM electrode system are its unique method of stimulus delivery and its ease of application.

Adult↗

PubMed1985

Effect of the standardized Ginseng Extract G115 on the metabolism and electrical activity of the rabbit's brain.

The objective of this original investigation was to study the effect of the standardized Ginseng Extract G115 on the metabolic activity and ECoG of the rabbit's brain. The results showed significant increase of the glucose uptake with simultaneous significant reduction of the lactate, pyruvate and lactate/pyruvate ratio. These findings indicate shift of glucose utilization by the drug from anaerobic to the more economical pathway. G115 was also shown to produce a desynchronizing effect on the electrocorticogram (ECoG) which correlated well with the biochemical findings.

Animals↗

PubMed1984

Phase II study of ifosfamide combined with Mesna uroprotection in advanced non-small-cell lung carcinoma and other solid tumors.

Thirty six patients with advanced solid tumors (24 lung: 3 oat-cell, 14 squamous, 7 adenocarcinomas, 3 soft tissue sarcomas, 6 breast carcinomas; 1 seminoma; 2 ovarian adenocarcinomas) entered a phase II study of high-dose ifosfamide (IF) administered in combination with the uroprotective agent sodium 2-mercapto-ethane-sulfonate (Mesna). Fourteen patients had prior treatment; most patients with lung cancer (22/24) were previously untreated; all had measurable disease. The patients median age was 59 (range 31-74). IF was given at 1.8 g/m2 days 1-5 q 4 weeks. Mesna was given after each IF injection at 0, 4 and 8 h randomly, either i.v. (0.36 g/m2) or orally (0.72 g/m2). Twenty-four patients had greater than or equal to 3 courses of therapy, 9 had 2 courses, and 3 had only 1 course; 129 courses were evaluated for toxicity. Mesna was given orally (17 patients, 57 courses) or i.v. (19 patients, 72 courses). The following side-effect were observed: no gross hematuria, microhematuria (14 courses), transitory mild proteinuria (34 courses), leukopenia grade I-II ECOG (26 courses), anemia grade I ECOG (31 courses), 1 case of pancytopenia, alopecia (31 patients), nausea (moderate, 33 courses; severe, 6 courses), vomiting (moderate, 17 courses; severe, 1 course). Five patients showed a partial response (1 oat-cell carcinoma, 2 with squamous lung cancer, 1 with ovarian carcinoma, 1 with breast carcinoma), 14 showed a minor response (2 patients with oat-cell carcinoma, 2 with lung adenocarcinoma, 5 with squamous lung cancer, 1 with seminoma, 1 with sarcoma, 1 with ovarian carcinoma), and 14 showed progression of disease (7 patients with squamous cell lung cancer, 4 with lung adenocarcinoma, 1 with sarcoma, 2 with breast carcinoma). Considering partial plus minor responses, ifosfamide produced some degree of tumor reduction (PR + MR) in 12/23 (52.1%) lung cancer patients. The data reported support the conclusions that Mesna can prevent high-dose IF bladder toxicity, that IF is active in advanced solid tumors, including lung cancer, and that the IF + Mesna combination is a generally safe treatment procedure.

Adult↗

PubMedDate not supplied

Chemo-immunotherapy of advanced AIDS-related Kaposi's sarcoma.

AIMS AND BACKGROUND: Kaposi's sarcoma (KS) is the most common neoplastic complication of HIV infection and AIDS. Multiple cytotoxic chemotherapy regimens have been used with various response rates. We have evaluated the efficacy and toxicity of low-dose chemotherapy in patients with poor-prognosis AIDS-related KS and the role of interferon alpha (IFN-alpha) in complete responders. METHODS: Twenty-five previously untreated patients with advanced KS received bleomycin (BL) 10 mg/m2 and vinblastine (VB) 6 mg/m2 on days 1 and 15 every two weeks. After six cycles, patients in complete remission received IFN-alpha (3 million U s.c. 3 times/week) combined with antiretroviral therapy. All patients were evaluated for toxicity using the World Health Organization (WHO) toxicity schedule. Both Eastern Cooperative Oncology Group (ECOG) and AIDS Clinical Trials Group (ACTG) response criteria were used to evaluate response and survival. RESULTS: The overall response rate was 84% (95% confidence interval, 51-117%) with six complete remissions (24%) and 15 partial remissions (60%) by ECOG criteria, and 92% (95% confidence interval: 58-128%) with 17 partial remissions (68%) by ACTG criteria. The median duration of response on IFN-alpha treatment was 4.5 months (range, 2-10). The overall median survival duration for all 25 patients was 9 months (range 2-39). Grade 3-4 anemia was observed in five patients and grade 3-4 neutropenia in two patients. No other clinically significant (> or = grade 3) toxicities were observed. CONCLUSIONS: Combination of BL and VB is effective and well tolerated, even if new therapeutic options are developing. This disease remains a challenging problem, so larger studies using the combination of chemotherapy and/or IFN-alpha with antiretroviral treatment are warranted.

Adult↗

PubMedDate not supplied

Concurrent modulation of 5-fluorouracil with methotrexate and L-leucovorin: an effective and moderately toxic regimen for the treatment of advanced colorectal carcinoma. A multicenter phase II study of the Southern Italy Cooperative Oncology Group.

AIMS AND BACKGROUND: Methotrexate (MTX) and leucovorin (LV) can enhance the cytotoxicity of 5-fluorouracil (5FU) by modifying its metabolic pathway inside target cells. Some preclinical studies and clinical trials have suggested that the concurrent or sequential double modulation of 5FU by means of MTX and LV may give a higher activity than single biochemical modulations. The purpose of our phase II study was to assess the activity and toxicity of a biweekly regimen including MTX, levo-LV and 5FU in colorectal cancer patients. METHODS: From July 1994 to May 1997, 100 consecutive patients affected by advanced or metastatic colorectal carcinoma were given MTX, 750 mg/m2 iv (2-h infusion) on day 1, and levo-LV, 250 mg/m2 iv (2-h infusion) followed by 5FU, 800 mg/m2 iv bolus on day 2, every two weeks. Patients were treated until complete response or progressive disease was documented, or for a maximum of 16 courses. RESULTS: Among 97 eligible patients, 5 complete and 25 partial responses were obtained, giving an overall response rate of 31% (95% exact confidence limits, 22-41%). Response rate was significantly higher in patients with a good (ECOG scale 0) than with a poor (ECOG scale 1 or 2) performance status (40% versus 17%, P <0.02). Median time to treatment failure was 27 weeks, median survival time was 63 (95% confidence limits, 54-71) weeks, and 2- and 3-year probability of survival were 34% and 12%, respectively. Performance status was the only pretreatment characteristic significantly affecting the outcome of patients. Indeed, median survival time was 94 weeks for patients with a performance status = 0 and 37 weeks for patients with a performance status > or = 1 (P<0.05). Toxicity of the treatment was low and manageable; grade 3 to 4 leukopenia affected 8% of patients, whereas grade 3 diarrhea and mucositis occurred in 5% and 4%, respectively. CONCLUSIONS: The double biochemical modulation of 5FU by MTX and levo-LV is at least as effective as, and probably more effective than, the single modulation by MTX or by LV. It may therefore represent a therapeutic option for the palliative treatment of patients with advanced colorectal carcinoma.

Adult↗

PubMed1998

Mapping epileptic foci by the dipole tracing method in a brain tumor patient with olfactory seizures: comparison with intraoperative electrocorticograms.

We estimated the position of the epileptic foci in a case of brain tumor with olfactory seizures using the Dipole Tracing Method (DTM) and compared the results with electrocorticograms (ECoGs) recorded during surgical resection. The case was a 24-year-old male. Electroencephalograms (EEG) showed frequent focal spikes in the right temporal area. Magnetic resonance imaging revealed a tumor in the right hippocampus region. We analyzed the spikes using DTM with a CDT-1000 EEG analyzer. The locations of two independent foci were analyzed; one was thought to be in the right hippocampus and the other in the right superior temporal gyrus. When the ECoG was taken, the results were in very close correlation with those of DTM, demonstrating the accuracy of DTM in the estimation of the location of epileptic foci in epileptic seizures with brain lesions.

Adult↗