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PubMed1991

[Clinical experience of expandable metallic stent placement for malignant biliary obstruction].

Expandable metallic stents of modified Gianturco design were used in nine cases of malignant biliary obstruction. Stents were placed through a percutaneous transhepatic approach without any severe complications. Initial patency was obtained seven of nine patients. Of these seven patients, recurrent jaundice was observed in three within four weeks. One patient had recurrent stenosis after four months due to ingrowth of the tumor. Although the expandable metallic stent offers several theoretical advantages over currently available stents, a disadvantage is that tumors may grow through the spaces between the legs of the wire or grow over the stent. We found that multi-modal treatment combined with radiation therapy was indispensable to maintain the patency of the stent in malignant biliary obstruction.

Aged↗
PubMed1991

Relationship between apo[a] isoforms and Lp[a] density in subjects with different apo[a] phenotype: a study before and after a fatty meal.

Plasma Lp[a] levels and apo[a] isoform distribution among lipoproteins isolated by density gradient ultracentrifugation were studied in subjects with one-band or two-band apo[a] phenotypes as assessed by gradient gel electrophoresis before and after an oral fat load. There were no significant differences in the ultracentrifugal profile between fasting plasma and postprandial plasma that was freed of triglyceride-rich particles (TRP). One-band phenotypes exhibited a single symmetrical peak in the density gradient, whereas two-band phenotypes exhibited a multi-modal distribution. Low molecular weight apo[a] isoforms were preferentially associated with low density Lp[a] whereas high molecular weight apo[a] isoforms were found with high density Lp[a] particles. Feeding a high fat meal caused no significant increase in the total plasma level of Lp[a]. However, the isolated TRP contained the apoB-100-apo[a] complex in a quantity that represented only about 1% of its total amount in the fasting plasma. In all cases the apo[a] isoforms present in TRP were also present in the fasting plasma; however, in the two-band apo[a] phenotypes the ratio of the slow over the fast migrating band was in all cases about eightfold higher in TRP than in the fasting plasma. These observations indicate that postprandially a small percentage of apoB-100-apo[a] associates with TRP and suggest that this complex may derive from de novo synthesis rather than from a pre-existing Lp[a] plasma pool. The liver would be the source of the complex due to the presence in the latter of apoB-100.

Adult↗
PubMed1991

[Hemopurification in the management of ARDS complicating multiple organ failure].

In the field of critical care medicine, it has been claimed that ARDS often develops as a part of multiple organ failure (MOF). Since multi-modality therapy is necessary in the management of MOF, it is also mandatory even in the management of ARDS. Among the various therapeutic approaches for patients with MOF, hemopurification is one of the most effective therapeutic tools. Various hemopurification methods such as hemodialysis, peritoneal dialysis, hemoadsorption, hemofiltration and plasma exchange have been applied in the management of MOR. However, our recent experiences suggest that continuous hemofiltration (CHF) and/or continuous hemodiafiltration (CHDF) are safest, most easily performed and effective hemopurification in the management of ARDS/MOF. The efficacy of hemopurification in the management of ARDS is summarized as follows. 1) Removal of humoral mediators and causative substances of ARDS following insults such as sepsis and trauma. 2) Treatment of pulmonary interstitial permeability edema which has been claimed to be one of the most important pathological conditions in ARDS. 3) Removal of excess water given as carrier in IVH solution and accumulating in the body. 4) Immunomodulation which has also been considered to be necessary in the treatment or prevention of ARDS.

Hemofiltration↗
PubMed1978

Update of naltrexone treatment.

To summarize, then, our work with naltrexone in a multi-modality treatment program indicates that it appeals to about 5-10 percent of narcotic addicts--those who conciously want to obtain drug-free status. It does significantly attentuate the effect of narcotics to the extent that they lose their reinforcing properties, and it has minimal side effects. Although we treated a self-selected population, it is noteworthy that about 10 percent of those who remained on naltrexone for more than a week were still opiate free 6 months after cessation of treatment. For some it appeared to be a turning point in their lives. It was the first time in years that they could live in their neighborhood and not be either intoxicated or occupied with the pursuit of narcotics. Our behavioral studies have identified a number of conditioned psychophysiological responses associated with the self-injection ritual. So far, although we have succeeded in extinguishing some of these responses, this has not resulted in an improved clinical outcome. We are currently working on more comprehensive behavioral treatments, but the clinical significance of these conditioned responses is uncertain at present.

Adult↗
PubMed1989

[Electrophysiological studies in siblings of De Sanctis-Cacchione syndrome].

Multi-modality evoked potentials in two cases, who were siblings, of De Sanctis-Cacchione syndrome were reported. The case 1, who was elder sister of the case 2, was a 25-year-old female. And the case 2 was a 23-year-old female. They have the history of consanguinity. They were first noted to have skin erythema on exposure to sunlight, and a diagnosis of xeroderma pigmentosum was made. At the childhood neurological manifestation, such as mental retardation, deafness and muscular weakness developed gradually. The case 2, who was a elder sister, was operated on for squamous cell carcinoma of the eyelid at the age of 20 and 21 years old. Motor conduction velocity obtained from lower limbs were severely reduced and that from upper limbs were moderately delayed. Sensory conduction velocity of median nerve were severely diminished. Auditory brainstem responses (ABR) of the case 1 showed the prolongation in interpeak latency of I-V. ABR of the case 2 could not be obtained. N19 and N13 of short-latency somatosensory evoked potentials (SSEP) to median nerve stimulation with case 2 could not be obtained too. N13-N19 latency of case 1 was remarkably prolonged compared to the normal subjects. Central motor conduction time (CMCT) was studied in case 2 by using the magnetic stimulator. CMCT of case 2 was within the upper limit of normal control. Interpeak latency of I-V in ABR represents the brainstem dysfunction in auditory pathway, and interpeak latency of N13-N19 in SSEP was recognized as central conduction time from medial lemniscus to primary sensory area of cortex. So the prolongation of these interpeak latency in this cases may mean the dysfunction in the central nervous system.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

Biofeedback and stress management strategies.

The concept of stress management was reviewed in this paper. Stress was conceptualised as a perception of inability to cope with its attendant emotional and psychophysiological responses. Management of stress then has to do with altering environmental triggers where possible. Alteration to more realistic mode of perception, adoption of more adaptive means of emotional response as well as the modulation of the body's psychophysiological state through the use of various relaxation techniques would all help to reduce stress and enable the individual to cope with it. The role of biofeedback in promoting the relaxation response as well as training the individual to adapt to better means of coping was discussed. Thirty-three anxious patients who were treated with biofeedback assisted relaxation training were studied for their response on EMG reading and heart rate. Their psychosocial functioning on an experiential index also showed an improvement. It was concluded that whatever techniques are used, a multi-modal approach to stress management is probably the more effective in helping people to cope with the variety of stress faced in life.

Adult↗
PubMed1989

[Documentation of medical images using a laser camera].

For today's and tomorrow's high developed imaging systems CT, MR, DSA, NM, US, DR we need equally highly developed recording equipment to produce high-grade quality "hard copies" at the end of the image transfer chain. For this reason we present a new laser image recording technique with Laser Imager and its operational principle. The Video Imagers (multiformat cameras) used until now are no longer up to date due to their disadvantages for imaging documentation of high-resolution imaging systems. The direct exposure of a single-emulsion-silver-halogenide transparency film with laser light, produces low-noise distortion-free and homogeneous documentation images. The size of the matrix of 4000 x 5000 pixel and 12 bit image depth guarantees the use of the Laser Imager also for future imaging systems with a higher size matrix than is now usual. The modulated accessories such as Multi-Modality Unit (MMU) and Multi-Console Laser Switch (MCLS) guarantees a flexible and more economic use of the Laser Imager.

Copying Processes↗
PubMed1989

[Preliminary results of studying the effectiveness of hemosorption in the complex treatment of children with lupus nephritis].

Hemosorption was employed in multi-modality treatment of 12 children aged 10-15 years with lupus nephritis. Of these, 5 patients suffered from nephritis associated with the nephrotic syndrome (NS), 4 patients had active pronounced nephritis without the NS, and 3 patients presented with latent nephritis. One case was characterized by transitory renal failure in the acute phase while 3 cases by chronic renal failure. Hemosorption produced a beneficial effect on the renal process and on electrolyte balance. The long-term observation over the patients evidences a short-term effect of hemosorption. After the attainment of that effect the further disease course depended on the adequacy of the conservative therapy administered to the patients with lupus nephritis.

Adolescent↗
PubMedDate not supplied

C. parvum clinical protocols: prototypes and summary results in U. S. trials with Wellcome Coparvax.

Clinical investigations utilizing Wellcome C. parvum in cancer therapy number more than one hundred in multiple institutions. Multiple diseases in various stages are being attacked by multi-modality therapy, making the role of immunotherapy very difficult to assess. Fundamental laboratory observations have suggested ways of weaving non-specific with specific immunotherapy, and these with chemotherapy and radiation to yield maximum therapeutic benefit. Current protocols include examples of the critical interactions as well as instructive information on dosing, timing and adjunctive symptomatic therapies. Several protocols will be reviewed, especially where promising clinical results are expected. Important differences between systemic and regional administration are observed.

Clinical Trials as Topic↗
PubMed1986

Adolescence and its discontents: attentional disorders among teenagers and young adults.

Attention deficit disorder (ADD) is the most commonly diagnosed childhood behavioral condition in the United States. This condition has important implications for and influences on adolescent development and adult functioning including emotional and conduct disorders, poor socialization, and school underachievement. In addition it has only been appreciated recently that some symptoms of ADD persist and can be identified among adolescents and young adults. In some situations, ADD may be newly identified during adolescence. Similar to younger children with ADD, a multi-modality approach to the management of adolescents with ADD is recommended.

Adolescent↗
PubMed1979

Influence of varied stimuli on development of motor patterns in the premature infant.

The premature infant is at risk for both mortality and morbidity. His writhing contributes to weight loss, and his extrauterine environment does not contain the multi-modality patterned afferent stimuli that impinge upon the developing brain in utero. Sound is the most effective modality to achieve concurrent decrement in motility along with enhancement of cortical activity. It was anticipated that subjects exposed to 5 minutes of patterned sound 6 times a day would, by 36 weeks gestation, evidence: (a) less gross motor activity, (b) the normal predominance of upper over lower limb activity, and (c) beginning laterality. The sample consisted of 80 males and 73 females whose gestational age at birth was 26--33 weeks. By random assignment 52 subjects were exposed to the routine ambient noise of the isolette and nursery, 50 to a tape recording of their mother's voice, and 51 to an orchestral arrangement of Brahm's Lullaby. Limb activity was measured just prior to discharge by accelerometers worn unilaterally for a 24-hour period on the ankle and wrist prior to transfer to the alternate side for an additional 24 hours. No statistically significant differences were demonstrated among the limb patterns of the 3 groups. Large intragroup variation in gross activity precluded demonstration of between-group differences. The majority of subjects evidenced predominance of upper limb activity and laterality.

Acoustic Stimulation↗
PubMed1982

[A study on 333 patients with adenocarcinoma of the endometrium treated by combined surgery and radiation therapy (author's transl)].

Three hundred and thirty-three consecutive patients with adenocarcinoma of the endometrium treated from 1958 to 1978 by combined surgery and radiation therapy or radiation therapy alone were reviewed. According to the FIGO staging system, there were 204 stage I, 40 stage II, 24 stage III and 20 stage IV. 40 cases of recurrences were also included in this study. The main parameters influencing survival were clinical staging, depth of myometrial invasion, histologic differentiation as well as the possibilities of radical surgery in these patients. Analysis of therapeutic results shows the superiority of pre-operative intra-cavitary irradiation followed by total abdominal hysterectomy and bilateral salpingo-oophorectomy with an 80% actuarial survival at five years in stage I. Primary surgery followed by radiation therapy gives inferior results, particularly in stage II. Treatment by radiation therapy alone should be reserved for inoperable patients after careful evaluation and gives a 35% actuarial survival at five years. The incidence of serious therapeutic complications was 3,6 %. The early diagnosis of endometrial carcinoma by means of systematic endo-uterine explorations in post-menopausal bleeding and the elaboration of combined multi-modality protocol prior to any treatment should lead to a better cure rate for this cancer of increasing incidence.

Adenocarcinoma↗
PubMedDate not supplied

A clinical statistical study of lung cancer patients in Japan with special reference to the staging system of TNM classification: a report from the Japan Joint Committee of Lung Cancer associated with the TNM System of Clinical Classification (UICC).

In 1978, after having conducted clinical field trials, the TNM Committee of Union Internationale Contre le Cancer (UICC) decided on an uniform system for the classification of lung cancer. The Japan Joint Committee of Lung Cancer (JCC) has continued to conduct field studies recommended by UICC, and since then has completed its third series carried out at 149 participating institutions. In this third series, the case records of 4,931 lung cancer patients were submitted for analysis. A clinical staging system of these findings was then set up, arranged in the TNM classification. As a result of this work, some improvements were made in the staging system. And JCC will now propose these changes, given as follows, to UICC for consideration: Occult Cancer: TX N0 M0 Stage I: T1 N0 M0, T2 N0 M0 Stage II: T0 N1 M0, T1 N1 M0, T2 N1 M0 Stage III: T3 N0 M0, T3 N1 M0, Any T N2 M0 Stage IV: Any T, Any N M1 The factors influencing the prognosis of patients with lung cancer (Yoshimura et al., 1982 (b)) (which include age, sex, histological type, modality of treatment and type of clinical staging used) were then re-evaluated. The results of this evaluation suggest an improved 5-year survival rate when using multi-modality treatment.

Aged↗
PubMed1983

[Concept of therapeutic ratio by combination of radiotherapy and chemotherapy].

In combined application of radiation and drugs, the maximum therapeutic ratio should be accomplished by effective combination of the following various means. 1. Effective combination from the aspect of cell kinetics. 2. Application of hypoxic sensitizer or PLDR-inhibitor to cells of the resting phase that are resistant to radiation and chemotherapy. 3. improvement of the method of anti-cancer drug administration. 4. Reasonable planning of the intervals of radiation and chemotherapy. In solid tumors, the proportion of proliferating phase decreases with the increase in the tumor size. Anti-cancer drugs are usually effective to cells of the proliferating phase only, and cells of the resting phase are resistant to radiation. This indicates the absolute necessity of multi-modal treatment including surgical management.

Animals↗
PubMed1978

The place of surgery in the treatment of ovarian cancer.

If the role of surgery has receded somewhat in other areas of gynaecological cancer, the reverse would seem to be true in ovarian cancer. The problem of the scope for increased surgical procedures outside the general run of gynaecological operations is high-lighted by the difficulty in achieving accurate preoperative diagnosis. Carcinoma of the ovary may well be found unexpectedly by the relatively inexperienced surgeon operating for a tumour presumed to be a fibroid uterus. Improvement in the survival of patients treated for cancer is only rarely the result of a single therapeutic advance. Generally it is achieved by the meticulous and individual application of multi-modal therapy. In this context careful and occasionally bold surgery remains a key treatment in the management of ovarian cancer.

Castration↗
PubMed1995

[Current perspectives in the treatment of epidermoid cancer of the esophagus].

Prior to the eighties, most patients with a diagnosis of epidermoid oesophageal cancer only received palliative symptomatic care. To date, most all undergo either surgery or medical treatment or both. Late diagnosis due to lack of clinical signs in the early phases of the disease, and perhaps insufficient attempts at identifying patients at risk who could benefit from systematic screening, is still an important problem although the number of diagnosed cases continues to rise (from 104 in 1985 to 151 in 1989 in Finistere in western France). Two different therapeutic attitudes could improve the prognosis: extensive surgery as proposed by the Japonese with dissection of all invaded lymph nodes whatever the localization and a multimodal approach combining radiochemotherapy and surgery. Although outcome can apparently be improved in certain types of oesophageal cancer, the proposal of aggressive extensive dissection could have an effect on respiratory complications and would not necessarily be adapted to the risk involved in western patients. Certain teams have nevertheless taken this route and will soon report their results. In France two phase II trials combining radiotherapy, chemotherapy (cisplatinum) and surgery have reported encouraging results with complete sterilization in 24% of the cases and 50% survival at 18 months. In our own series of 68 patients, we have obtained 41% sterilization and 56.3% survival at 3 years with the multi-modal protocol. The high number of non-responders to chemotherapy emphasies the importance of maintaining surgical resection whenever possible. The discouraging reports published before 1980 have been contradicted by improvements in outcome achieved over the last decade. Today, all patients with a diagnosis of epidermoid cancer of the oesophagus should benefit from either palliative or curative care based on the latest advances in radiotherapy, chemotherapy and surgery.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1995

[Treatment of breast cancer with ipsilateral supraclavicular node metastases].

During 1954-1977, among 2803 cases of breast cancer 99 (3.5%) had ipsilateral supraclavicular node mestastases. The results of treatment are reported, based on follow-up for more than 10 years. According to the treatment modality, the patients were divided into 4 groups: I. surgery with postoperative adjuvant chemotherapy and radiation therapy; II. radiation and chemotherapy; III. chemotherapy; IV. no treatment. In group I, surgical procedures consisted of segmental mastectomy in 6; simple mastectomy in 7; modified radical mastectomy in 16; standard radical mastectomy in 12, and extended radical mastectomy in 3. The over-all five-year survival rate was 9%. It was 18% (8/44) in group I, but only 5% (1/21) in group II. None survived for 5 years in group III and group IV. The results seem to indicate that more aggressive multi-modality treatment of breast cancer with ipsilateral supraclavicular lymph node metastases is indicated to expect better survival.

Adult↗