Partial cystectomy during radical surgery for nonurological malignancy.

PURPOSE: It is not uncommon for a locally advanced, nonurological malignancy to invade the bladder. Partial cystectomy may be required to ensure complete tumor eradication. To our knowledge the true benefit of this procedure is unknown. MATERIALS AND METHODS: A total of 45 patients underwent partial cystectomy as part of radical surgery for a nonurological malignancy. We retrospectively reviewed these cases to determine which malignancies are prone to invade the bladder, the incidence of malignant invasion, the complication rate and the prognosis after wide en bloc resection. RESULTS: Colorectal adenocarcinoma accounted for the majority of cases. Tumor invaded only 11 bladder specimens (21.5%). Radical surgery was performed with curative intent in 30 patients, of whom 23 had negative surgical margins. At a mean followup of 30.7 months 16 of these 23 patients (69.6%) were free of disease or died of other disease processes. Disease progression and/or cancer related death occurred in 14 of the 15 patients (93.3%) who underwent surgery for palliation and in 16 of the 17 (94.1%) with positive margins at a mean of 21.7 months. Overall disease specific survival in those with malignant invasion was 27.3% compared to 41.2% when the bladder was fixed by a dense fibrous reaction only. No reported complications were related to partial cystectomy at followup. CONCLUSIONS: Advanced primary and recurrent nonurological malignancies often involve the bladder. Partial cystectomy may be necessary due to a dense fibrous reaction or direct tumor extension. While this distinction is made only after formal pathological results are reviewed, wide en bloc resection is necessary to ensure complete excision. When radical surgery is performed with curative intent and negative surgical margins are achieved, patients are likely to experience prolonged disease-free survival.

A profile of health risks among blue-collar workers.

Despite national objectives for extending health promotion programs to blue-collar workers and to small work sites, baseline behavior information for planning such programs is lacking. This study seeks to describe the health risks and norms specific to a population of male, blue-collar gas pipeline workers in remote sites. These workers (n = 395) completed a health risk appraisal and a "health gauge" survey designed to measure nutrition, physical activity, tobacco use, participatory patterns in health-enhancing activities, group norms, and change efforts. Selected behaviors were similar to those of other Texas men (eg, smoking 27% versus 26%) although others were not (eg, smokeless tobacco 18% versus 8%). Multivariate analysis confirmed the relationship of friends' behavior patterns, risk-taking, and interpersonal experience to four lifestyle health behaviors. With 75% or more of workers expressing an interest in various programs, the findings suggest that programming for this population can be successful if tailored to current behaviors and the worksite culture.

Pseudocyesis in organic mood disorders. Six cases.

Pseudocyesis, the delusion of pregnancy, has had an uncertain nosology, primarily because of the concentration on the content of the beliefs and lack of interest in the underlying phenomenology. Six patients with a major mood disorder caused by cerebral dysfunction are presented in this article. The delusion is reviewed with respect to the entities it overlaps, and the clinical manifestations are related to the mood disorders. Although no clear neuroanatomic localization was possible with this group of patients, there may be some association with desomatization caused by parietal lobe dysfunction.

Impact of a restrictive work site smoking policy on smoking behavior, attitudes, and norms.

Three successive cross-sectional surveys were used to measure the impact of a restrictive smoking policy on employee smoking patterns, perceived exposure to environmental tobacco smoke, attitudes about the policy, and smoking-related norms in a large decentralized state agency. No significant change was detected in smoking prevalence, the proportion of smokers attempting to quit, or the total daily consumption of cigarettes by smokers. The daily consumption of cigarettes at work decreased significantly, from 16.9% to 4.9% smoking 15 or more cigarettes per day. The proportion of respondents bothered every day by coworkers' smoke dropped from 21.8% to 3.8%. Following policy implementation, the interaction between smokers and nonsmokers about smoking decreased. The findings suggest that restrictive work site smoking policies are effective at decreasing exposure to environmental tobacco smoke, but not, at least in the short run, at lowering smoking prevalence. Also, the decreased interaction regarding smoking may have the unintended consequence of reducing the perceived pressure on smokers to quit.

Case report of hepatotoxicity associated with maprotiline.

A patient with unipolar affective disorder developed elevations in her liver enzymes shortly after initiation of therapy with maprotiline. The enzyme levels rapidly returned to normal after cessation of the drug with no residual liver disease.