Continuous infusion 5-fluorouracil, etoposide and cis-diamminedichloroplatinum in patients with metastatic carcinoma of unknown primary origin

We conducted a phase II clinical trial of 5-fluorouracil (5 day continuous infusion), cis-diamminedichloroplatinum and etoposide in previously untreated patients with metastatic carcinoma of unknown primary origin. Of the thirty-six evaluable patients (21 adenocarcinoma, 14 undifferentiated carcinoma and 1 squamous cell carcinoma), eight patients responded to this treatment (4 CR, 4 PR). Responses were seen in both soft tissue and visceral disease. Toxicity was significant and included grade III/IV myelosuppression in over 90% of patients treated. Non-hematologic toxicity included nausea/vomiting and stomatitis. Although the remissions obtained in this study appear to be durable (median duration of complete remission greater than 24 months), the regimen does not appear to offer significant advantages over other less toxic and more easily administered cisplatin-based combinations.

The effect of obesity surgery on obesity comorbidity

Obesity is epidemic in the modern world. It is becoming increasingly clear that obesity is a major cause of cardiovascular disease, diabetes, and renal disease, as well as a host of other comorbidities. There are at present no generally effective long-term medical therapies for obesity. Surgical therapy for morbid obesity is not only effective in producing long-term weight loss but is also effective in ameliorating or resolving several of the most significant complications of obesity, including diabetes, hypertension, dyslipidemia, sleep apnea, gastroesophageal reflux disease, degenerative joint disease, venous stasis, pseudotumor cerebri, nonalcoholic steatohepatitis, urinary incontinence, fertility problems, and others. The degree of benefit and the rates of morbidity and mortality of the various surgical procedures vary according to the procedure.

A Clinician’s Approach to Medical Management of Obesity

Obesity is pandemic in the modern world and continues to increase at an alarming rate, with great human and economic consequences. While bariatric surgery has been gaining popularity and acceptance as an effective way to achieve massive weight loss, it remains an option only for the extremely obese. For the millions of overweight and moderately obese individuals, the cornerstone of obesity treatment remains lifestyle and behavioral modifications in diet and physical activity. It is especially important for both primary care providers and subspecialists to be familiar with currently recommended approaches to the medical treatment of obesity, as it is critical that this extremely common, treatable chronic disease be recognized, intervention initiated, and therapy maintained at every appropriate clinical opportunity. Significant medical benefits can be gained even with a relatively small percentage of weight loss.