Comparing physical activity in individuals with overweight/obesity with and without binge eating disorder.

Objective: Differential participation in physical activity (PA) may partially explain the health discrepancies between individuals with or without binge-eating disorder (BED). Yet, little is known about the PA habits of individuals with overweight/obesity and how those patterns may differ based on BED status. PA patterns and exercise self-efficacy were examined in individuals with overweight/obesity, with and without BED. Design: Ninety-seven participants with overweight/obesity self-reported their PA via the Godin Leisure-Time Questionnaire and the Paffenbarger PA Questionnaire. Exercise self-efficacy was assessed with the Marcus 5-item Exercise Self-Efficacy scale. Based on the Eating Disorder Examination, 27.8% (n = 27) of the participants met BED criteria. Participants were primarily female (n = 75, 77.3%), on average 47.5 years old (standard deviation = 10.4), and predominantly White/Not Hispanic (n = 67, 69.1%) or African-American/Not Hispanic (n = 18, 18.6%). Results: Hierarchical regressions, accounting for significant differences in body mass index between those with and without BED, showed that the Marcus 5-item Exercise Self-Efficacy Scale (but not BED status) was significantly related to PA. BED status also was unrelated to likelihood of reaching Centres for Disease Control PA guidelines, and 44.3% of all participants reported no participation in weekly sports/recreation activities. Conclusions: Both groups participated in relatively little purposeful and moderate/strenuous PA. Exercise self-efficacy may be important to assess and address among treatment seeking individuals with and without BED who struggle with excess weight.

Radical cystectomy for invasive bladder cancer--a local experience.

OBJECTIVES: The aim of this study of patients undergoing cystectomy for invasive transitional cell carcinoma of the bladder was to compare clinical and pathological staging and to review factors that predict survival. PATIENTS: Sixty-three patients (73% male) underwent radical cystectomy between January 1988 and February 1994. The mean age was 61 years (range 33-77 years). RESULTS: Of the patients 14% had clinical and 24% pathological stage T1 disease; figures for T2 disease were 24% and 6%, respectively, for T3 disease 46% and 45%, and for T4 disease 16% and 25%. For T1 and T4 disease the clinical stage predicted the pathological stage in over 80% of cases, and for patients with T3 disease the predictive value of clinical staging was 68%; in no patient with clinical stage T2 disease was this confirmed at cystectomy. The prevalence of tumour infiltration of the lymph glands on histological examination of the cystectomy specimen correlated more closely with pathological stage than with clinical stage. For clinical and pathological staging, respectively, the prevalences were 0% and 0%, for T1, 27% and 0% for T2, 20% and 29% for T3, and 40% and 38% for T4. The overall survival rate (life-table method) was 33% at a median follow-up of 42 months in the surviving patients. No patient with tumour infiltration of the lymph glands survived. Survival also correlated more closely with pathological than with histological stage. For clinical and pathological stage T1 disease the 5-year survival rates were 73% and 91%, respectively; for T2 the rates were 27% and 75%, for T3 32% and 31%, and for T4 28% and 29%. The operative mortality rate was 2% and the rate of recurrence of local disease 10%. CONCLUSIONS: Survival after cystectomy correlates more closely with pathological than with clinical stage of disease. The accuracy of clinical staging in T2 disease is poor. Cystectomy is the standard against which other treatments for bladder cancer must be measured.

Primary chemotherapy for stage 2 testis cancer.

To evaluate the efficacy and toxicity of primary chemotherapy in patients with stage 2 (retroperitoneal lymph node metastases) testis cancer, 20 consecutive patients referred to Groote Schuur Hospital between September 1992 and March 1994 were reviewed. There were 10 patients with non-bulky non-seminomatous germ cell tumour (NSGCT), 5 with bulky NSGCT and 5 with bulky seminoma. The treatment regimen consisted initially of 4 cycles of cisplatin, etoposide and bleomycin. Patients with NSGCT and a residual mass after chemotherapy subsequently underwent retroperitoneal lymph node dissection (RPLND) and those with seminoma underwent a low dose of irradiation to the mass. In 7 (70%) of the 10 patients with non-bulky NSGCT, there was a complete response to chemotherapy and 3 patients underwent limited RPLND. One patient relapsed at follow-up but remains clear of disease after salvage therapy. The survival rate is 100% at a median follow-up of 60 months (range 12-143 months). In 5 patients with bulky NSGCT there was no complete response to chemotherapy. Three have undergone limited RPLND. The survival rate is 52% at a median follow-up of 130 months (range 108-152 months). In 5 patients with bulky seminomas, the survival rate is 100% at a median follow-up of 55 months (range 29-92 months). Toxicity has been modest except for 1 patient who died postoperatively in the early part of the study. Four patients have fathered children after treatment. We conclude that primary chemotherapy is the treatment of choice for patients with stage 2 testis cancer.

Perioperative respiratory complications in patients with asthma.

BACKGROUND: Patients with asthma are thought to be at high risk for pulmonary complications to develop during the perioperative period, and these complications may lead to serious morbidity. Existing medical records were reviewed to determine the frequency of and risk factors for perioperative pulmonary complications in a cohort of residents of Rochester, Minnesota, who had asthma and who underwent anesthesia and surgery at the Mayo Clinic in Rochester. METHODS: Medical records were reviewed for all residents of Rochester, Minnesota, who were initially diagnosed as having definite asthma according to strict criteria from 1 January 1964 through 31 December 1983 who subsequently had at least one surgical procedure involving a general anesthetic or central neuroaxis block at the Mayo Clinic (n = 706). RESULTS: Bronchospasm was documented in the perioperative records of 12 patients (1.7% [exact 95% confidence interval, 0.9 to 3%]). Postoperative respiratory failure developed in one of these patients. Laryngospasm developed in two additional patients during operation. All episodes of bronchospasm and laryngospasm in the immediate perioperative period were treated successfully. No episodes of pneumothorax, pneumonia, or death in the hospital were noted. For univariate analysis, characteristics associated with complications included the recent use of antiasthmatic drugs, recent asthma symptoms, and recent therapy in a medical facility for asthma. Patients in whom complications developed were significantly older at diagnosis and at surgery. CONCLUSIONS: The frequency of perioperative bronchospasm and laryngospasm was surprisingly low in this cohort of persons with asthma. These complications did not lead to severe respiratory outcomes in most patients. The frequency of complications was increased in older patients and in those with active asthma.

Synchronous contralateral adrenal metastasis from renal cell carcinoma: a 7 year survival following resection.

Solitary contralateral adrenal metastasis from a renal cell carcinoma is distinctly unusual but aggressive surgical resection alone can produce long-term survival.

Neo-adjuvant chemotherapy and radical irradiation for locally advanced bladder cancer--a phase 2 study.

Eighteen patients with T3 or T4 bladder cancer were treated with neo-adjuvant chemotherapy and radical irradiation. The tumour response was assessed after two cycles of chemotherapy and two further cycles of chemotherapy were given to patients with responding tumours. Each cycle of chemotherapy consisted of cisplatin (60 mg/m2) as well as methotrexate and vinblastine. After chemotherapy, a complete response (CR) was obtained in four (22%) patients and a partial response in eight (44%) of patients. After irradiation, a complete response was obtained in 12 (67%) patients. Four of the 12 patients who achieved a CR relapsed at a minimum follow-up of 3 years. The 3-year continuously disease-free survival rate (with preserved bladders) is 44%. (95% confidence interval = 21-65%.) Altogether, 11 patients are alive (including three who have undergone salvage cystectomy) for an overall 3-year survival rate which is 61%. This approach to therapy is feasible but the local control rate is unsatisfactory.

Adjuvant chemotherapy for stage I non-seminomatous testicular cancer.

Developments in the treatment of stage I testicular non-seminomatous germ cell tumours have aimed primarily at reducing morbidity since the introduction of retroperitoneal lymph node dissection. Surveillance after orchidectomy, i.e. follow-up alone with chemotherapy only for relapsed disease, was found to be logistically and psychologically taxing for patients. Risk factors for relapse were, however, identified from analyses of tumour histology of the orchidectomy specimen. Between September 1988 and April 1992, 20 patients with clinical stage I testicular non-seminomatous germ cell tumours and a relatively high risk of relapse were entered into a prospective study of adjuvant chemotherapy. The chemotherapy regimen consisted of 2 cycles of cisplatin, etoposide and bleomycin. Each cycle of chemotherapy lasted 3 days. There have been no relapses at a median follow-up of 31 months (range 12-53 months). Acute and late toxicity have been modest. We have found adjuvant chemotherapy to be effective after orchidectomy in patients with stage I disease with adverse prognostic factors for relapse.

Salvage cystectomy after radical irradiation for bladder cancer-prognostic factors and complications.

We have studied 46 patients who underwent salvage cystectomy between March 1981 and June 1992 for persistent or recurrent carcinoma after radical irradiation for bladder carcinoma. The overall 5-year survival rate was 43%. There was a higher 5-year survival rate in patients with an incomplete response compared with those with a complete response to their prior irradiation (50 and 36%), in patients with grades 1 or 2 compared with grade 3 histology (75 and 28%), and in patients with T1 or T2 tumours compared with T3 tumours (59 and 32%). The median interval between commencing irradiation and performing cystectomy was 11 months. In the 25 patients with a prior complete response the median interval was 16 months; this was statistically significantly longer than in the 21 patients with an incomplete response (median interval 7 months). A worsening of tumour grade and category was found in some patients when comparing the findings at cystectomy with those prior to irradiation. This was consistently higher in patients with a prior complete response than in those with an incomplete response. There were 3 deaths and 12 non-fatal major complications due to the prior irradiation or surgery, with a mortality rate of 7% and an overall 5-year complications rate of 35%. Only one of the complications occurred in the 13 patients treated with conventional 2 Gy fractions alone (5 fractions/week). Their overall complication rate was statistically significantly lower than that of the others. Salvage cystectomy is indicated for selected patients with persistent or recurrent disease after radical irradiation for bladder cancer. The expectation of a survival rate similar to that found in patients treated with immediate cystectomy may not be justified.

Chemotherapy, radical irradiation plus salvage cystectomy for bladder cancer--severe late small bowel morbidity.

A proportion of patients with invasive bladder cancer are treated with radical irradiation and salvage cystectomy. The use of neo-adjuvant chemotherapy is being widely investigated. Five patients with invasive bladder cancer at Groote Schuur Hospital have undergone salvage cystectomy after neo-adjuvant chemotherapy and radical irradiation. Two of these patients had severe small bowel morbidity while clear of carcinoma and this was fatal in one patient. In our historical series of 30 patients who had salvage cystectomy after radical irradiation alone, there was only one patient with similar small bowel morbidity. There may be an increase in small bowel morbidity from neo-adjuvant chemotherapy in patients who are treated to clinical tolerance by irradiation and who then require a cystectomy.

Colchicine therapy in primary amyloidosis of the bladder: a case report.

A patient with diffuse localized amyloidosis of the bladder was considered for cystectomy because of intractable gross hematuria. Oral colchicine (2 mg. daily) was commenced and 4 years later the patient was asymptomatic with minimal evidence of amyloidosis cystoscopically.

The treatment of clinically fixed inguinal lymph node metastases from carcinoma of the penis by chemotherapy and surgery.

A 50-year-old patient with carcinoma of the penis was referred for therapy of clinically fixed and ulcerated right inguinal adenopathy and mobile left inguinal adenopathy. He was treated initially by weekly infusions of methotrexate and bleomycin which resulted in clinical mobility and a decrease in size of his right sided adenopathy and re-epitheliazation of the overlying ulcer. A right- and subsequently a left-sided inguinal lymphadenectomy were performed. The patient remained clear of disease at follow-up 44 months after therapy.

Carcinoma of the penis--the Groote Schuur Hospital experience.

The records of 62 patients with carcinoma of the penis seen at Groote Schuur Hospital between 1968 and 1985 were analysed retrospectively. Jackson's staging system was used - 44% of patients were stage 1, 27% stage 2, 19% stage 3 and 10% stage 4. The results of treatment in each stage are outlined. Overall 65% of patients were alive and free of disease at follow-up while 24% died. The overall five-year survival rate was 56%. The management of the inguinal nodes is discussed. Early sentinel node biopsy is recommended, as clinical inguinal node assessment is inaccurate and late detection of inguinal node metastases is associated with a poor prognosis.

Cis-platin combination chemotherapy for non-seminomatous germ-cell tumours of the testis.

Eighteen patients with metastatic non-seminomatous germ-cell tumours (NSGCTs) of the testis were treated with cis-platin combination chemotherapy between 1979 and 1985. Three of the patients received chemotherapy after a staging lymphadenectomy (stage 2 disease) and were free of disease at follow-up. Fifteen patients with stage II disease and adverse prognostic factors or stage III disease received initial chemotherapy followed in 11 cases by surgical exploration. Eleven of these patients were free of disease at a median follow-up of 52 months, 1 was alive at 35 months with a mature teratoma, which is non-progressive, 2 died of their cancer, and 1 died of acute respiratory distress syndrome after surgery. The patients who failed to respond to therapy had associated bulky disease. The overall 5-year survival rate is 81%. Before the introduction of cis-platin there were no survivors among 9 patients with metastatic NSGCTs treated initially with chemotherapy. These findings indicate that the good results reported with cis-platin combination chemotherapy for NSGCTs are reproducible in other populations and centres.

Immunological tolerance induced by in utero injection.

Intrauterine injection of human whole blood into rabbit and rhesus monkey fetuses was found to result in long lasting unresponsiveness to human serum albumin. Intrauterine injection of viable allogeneic bone marrow cells into rabbit fetuses was without any apparent harmful effect and also resulted in permanent unresponsiveness demonstrated by donor red cell survival studies. The implication of these findings in respect of using this approach towards the correction of certain inherited diseases in man is discussed.

Absence of activated murine leukaemia virus in x-irradiated CBA/H-T6crc mice.

CBA/H-T6Crc mice, a substrain that does not normally express demonstrable levels of murine leukaemia virus (MuLV) and has a low natural incidence of leukaemia, were examined for evidence of virus activation at various times following X-irradiation. Although X-irradiation caused a high incidence of leukaemia, no ecotropic, xenotropic or recombinant MuLV was detected by in vitro co-cultivation of bone marrow, spleen and thymus cells from pre-leukaemic and leukaemic animals with selectively permissive cell lines followed by indirect immunofluorescence for MuLV group-specific (gs) antigen. These results, therefore, are not consistent with the hypothesis that endogenous viruses are the universal aetiological agents of leukaemia.

The use of 125I-labelled protein A for the detection of humoral immunity to gross murine leukaemia virus.

A solid-phase radioimmunoassay utilising bind of 125I-labelled protein A to antibodies bound to virus adsorbed onto microtitre plates was shown to be suitable for detection of humoral immunity to Gross murine leukaemia virus (MuLV). The specificity of the reaction was shown by the fact that only homologous or closely related viruses effectively inhibited binding of antibodies to adsorbed virus. With this method a low level of spontaneous humoral immunity was demonstrated in sera from AKR/Crc mice, a strain with high concentrations of endogenous virus, whereas little or no anti-viral activity was found inCBA/H-T6Crc, a subline that does not appear to express MuLV.