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We retrospectively evaluated the management of supraglottic carcinoma at our centre during the last 35 years to determine the preferred mode of treatment. A review of the medical records yielded 114 patients with supraglottic T1 and T2 carcinoma who were diagnosed and treated in the Departments of Otolaryngology, Head and Neck Surgery, and Oncology between 1959 and 1993. Of these, 47 (41.2%) had T1 carcinoma (stage I) and 67 (58.8%) T2 (stage II). Treatment varied among radiotherapy, surgery, or combined radiotherapy and surgery. Twelve patients underwent elective neck dissection, one of whom (8.3%) was found to have occult metastases. Local failures were noted in 22 patients (11 T1: 11 T2), three of whom also had neck metastases. All except one T2 patient received radiotherapy. Radiotherapy yielded the best survival rates for T1 disease as combined therapy did for T2. Five-year recurrence rates for T1 patients were 35% for those treated by radiotherapy and 42% for those treated with combined therapy; corresponding figures for T2 patients were 39% and 28%. We suggest that patients with T1 supraglottic carcinoma be managed with radiotherapy and patients with T2 with combined therapy. We believe there is no need for elective neck dissection, especially in T1.

Bioelectrical impedance analysis (BIA) has potential in the area of sports and exercise as a method for evaluating body composition in groups of athletes. BIA probably holds less promise for detecting small changes in percentage fat within an individual. Available data in athletes have indicated an urgent need to control for testing conditions such as hydration, temperature, glycogen stores, and preceding diet and exercise. There are almost no data available for female athletes, but acceptable results have been reported in males when conditions are well controlled. There is, however, a tendency for BIA to overestimate percentage body fat, and more so in African American athletes. BIA is also potentially useful for assessing the hydration status in wrestlers, but it is advisable to use untransformed BIA measurements rather than to convert resistance measurements to body fat because of the questionable hydration status in these athletes. Untransformed results are potentially useful in evaluating the clinical status of athletes at risk for abnormal hydration because of extreme dieting practices.

Between 1950 and 1992, 96 women with squamous cell carcinoma of the larynx were diagnosed and treated in the Department of Otolaryngology and Oncology at Beilinson Medical Center, Israel, and Long Island College Hospital, Brooklyn, New York. Fifty-seven female patients (59%) had glottic carcinoma, 72% of them in stage I. Thirty-eight had supraglottic carcinoma, 68% of them in stages II and III. One patient had stage I subglottic carcinoma. Treatment varied between radiotherapy, surgery, or combined surgery with radiation and/or chemotherapy. The 5-year survival rate was 87%. Although most of the patients had glottic carcinoma in stage I, there was also a high percentage with supraglottic carcinoma, most in advanced stages and with metastases to other regions. The prognosis is not different from that in men. Smoking is an important factor in glottic carcinoma, but not as important as in males.

This study reviews the records of 56 patients with early glottic carcinoma involving the anterior commissure (T1N0M0) who were treated between 1958 and 1988 at Beilinson Medical Center. Five- and 10-year survival rates were 82% and 60%, respectively. Most failures were local (15 patients). In addition, three patients who were treatment failures had neck lesions (regional failure) and one had lung lesions (distant metastases). All 56 patients received irradiation as the only mode of initial treatment. The effectiveness of irradiation for anterior commissure lesions is therefore evaluated. The study supports previous reports suggesting that glottic carcinoma involving the anterior commissure is associated with a high rate of treatment failure.

A review of 48 cases of anaplastic cell carcinoma of the thyroid gland treated in the Department of E.N.T. of Beilinson Medical Center revealed more than 90% of the patients to be over 50 years of age. Twenty-five percent of the patients showed, histologically, areas of transition from differentiated carcinoma (either papillary or follicular) into anaplastic carcinoma. The patients were treated by surgery and/or irradiation and/or chemotherapy. Twenty-seven patients underwent subtotal or total thyroidectomy and 21 patients underwent biopsy or partial thyroidectomy. The survival rate was very poor, two-year survival rate was 28%. Twenty-eight of the patients (58%) died within one year of diagnosis.

Between 1958 and 1983 at Beilinson Medical Center, Petah Tiqva, Israel, 75 patients were diagnosed as having squamous cell carcinoma of the body of the tongue. Of these, 42 were male and 33 female and the average age at the time of diagnosis was 61.6 years. 29.33% were in clinical stage I, 36% in stage II, 26.67% in stage III and 8% in stage IV. Fifteen patients underwent only surgery, nine received only irradiation and 51 received combined treatment. The 5-year survival rate was 68.3% with a significant difference between that for stage I (90%) and stage II (83.7%) and that for stages III and IV (43.07% and 0%, respectively) (P less than 0.001). Among the 24 with recurrence of the malignancy, 20 died despite treatment and four patients died of causes unrelated to the malignancy. From this experience it was concluded that local excision of the tumor should be performed only in stage I patients and that in stage II patients prophylactic treatment of the neck (neck dissection and irradiation) should be undertaken because of the high incidence of occult metastases.

This study evaluated a new technology of bioelectrical-impedance (BI) measurement that makes use of multiple frequencies (5, 50, and 100 kHz) for estimation of extracellular and total body water. In 36 healthy males, resistance and reactance at three frequencies were compared with extra-cellular water (ECW) and total body water (TBW) determined by isotope dilution. ECW was best predicted by resistance measured at 5 kHz, corrected for height and weight (R = 0.930, SEE = 1.94 L) whereas TBW was best predicted by resistance at 100 kHZ and weight (R = 0.947, SEE = 2.64 L). Cross-validation analysis on two randomly selected subsets (n = 18 each) indicated that the prediction equations were reproducible and valid. Thus, BI at dual frequencies is valid for determination of body-water compartments and may be useful in the nutritional assessment of patients in whom body water and hydration is of clinical concern.

The animal model of exercise-induced anorexia was employed in humans to develop a laboratory paradigm for studying the acute effect of exercise on food intake. Each of nine obese and nine nonobese women exercised either strenuously (90 W) or moderately (30 W) on a cycle ergometer for 40 min or rested in the laboratory on each of 3 nonconsecutive days. Intake of a liquefied test meal (1.04 kcal/g) eaten 15 min after exercise was significantly less after the strenuous (620 g) than after the moderate (754 g) exercise in the nonobese women but was no different after the two conditions (532 g after strenuous, 581 g after moderate) in the obese women. Heart rate and energy expenditure were increased in proportion to the exercise by the same amount in both groups. The results demonstrate for the first time that food intake is reduced immediately after strenuous exercise in nonobese women, as it is in animals, and validate the feasibility of this laboratory paradigm.

Controversy regarding defective thermic effect of food (TEF) in obesity might be related to differences among studies in the caloric loads. To clarify further the role of blunted thermogenesis in obesity, responses to the same absolute caloric load (720 kcal) and a relative load, which was 35% of each subject's resting metabolic rate (RMR), were compared in 11 lean (L) and 11 obese (O) men. The relative load was slightly larger for O than L (752 +/- 27 vs 683 +/- 21 kcal; means +/- SEM, NS). TEF, calculated as 3-h postprandial minus fasting RMR, was greater for L than O for both the 720-kcal (69 +/- 4 vs 31 +/- 3 kcal/3 h, p less than 0.01) and relative loads (64 +/- 4 vs 37 +/- 3 kcal/3 h, p less than 0.01). For L, TEF was greater for the 720-kcal load than for the relative load whereas for O, TEF was greater for the relative than for the 720-kcal meal. However, expressed as a percent of the calories ingested, TEF for the absolute and relative meals was identical for each group, in both cases lower for O (4.2 +/- 0.4% vs. 4.7 +/- 0.3%) than for L (9.7 +/- 0.4% vs 9.3 +/- 0.8%); p less than 0.01. These results demonstrate the impact on thermogenesis of the basis on which the meal is dosed and provide further evidence for defective thermogenesis in obesity.

This study validated further the bioelectrical impedance analysis (BIA) method for body composition estimation. At four laboratories densitometrically-determined lean body mass (LBMd) was compared with BIA in 1567 adults (1069 men, 498 women) aged 17-62 y and with 3-56% body fat. Equations for predicting LBMd from resistance measured by BIA, height, weight, and age were obtained for the men and women. Application of each equation to the data from the other labs yielded small reductions in R values and small increases in SEEs. Some regression coefficients differed among labs but these differences were eliminated after adjustment for differences among labs in the subjects' body fatness. All data were pooled to derive fatness-specific equations for predicting LBMd: the resulting R values ranged from 0.907 to 0.952 with SEEs of 1.97-3.03 kg. These results confirm the validity of BIA and indicate that the precision of predicting LBM from impedance can be enhanced by sex- and fatness-specific equations.

The thermic effect of food during incremental cycle ergometer exercise was compared in six normal weight and six obese men (mean +/- SEM 104 +/- 5% and 160 +/- 11% ideal body weight, respectively). Graded exercise tests were performed after a 12-h fast and 60 min after the start of a 910 kcal mixed meal, on separate days. The thermic of food during exercise, which is the fed minus the fasting oxygen consumption (VO2), was significantly greater for the normal than the obese men at submaximal intensities from O (unloaded cycling) to 100 W (p less than 0.05). The mean slope of the regressions of VO2 (ml . min-1) on power output (W), which reflects the rate of increase in energy expended relative to increases in external work performed, did not differ significantly between the fed and fasting conditions for either group, but the mean (+/- SEM) intercept was significantly higher for the normal, but not the obese men, in the fed than the fasting state (599 +/- 53 versus 497 +/- 47 ml O2 . min-1 for the normal men and 819 +/- 126 versus 821 +/- 145 ml O2 . min-1 for the obese men). These results indicate that the thermic effect of food during exercise, which is virtually absent in the obese men, does not increase significantly across submaximal power outputs for the normal men and therefore does not reflect a significant reduction in efficiency.

The accuracy of prediction equations for estimating lean body mass (LBM) from total-body electrical conductivity (TOBEC) was examined by cross-validation. Two samples of adults, aged 18-35 yr, were drawn from separate geographic locations. LBM was determined by densitometry and TOBEC was measured with TOBEC II instrument. LBM and TOBEC were highly correlated in both samples (r = 0.96 and 0.97). Cross-validation of LBM prediction equations was accomplished by exchanging equations and comparing predicted LBM values. There was a mean difference of 0.974 kg LBM between the two equations (p less than 0.0001). Thus, data from 157 subjects were pooled and one equation was developed that incorporated height (cm), sex (males = 0, females = 1), and the zero-, first-, and second-order Fourier coefficients (FC0, FC1, and FC2) of the TOBEC phase value: LBM, kg = -36.410 + (-1.324 X sex) + (0.01185 X (FC1(0.5)xht)) + (12.347 X FC2(0.5)) + (0.0627 X FC0)-(0.9232 X FC2) This equation, developed from 157 subjects, accounted for 96% of the variability in LBM and had a standard error of estimate of 2.17 kg LBM.

The effect of progressive moderate exercise on body weight gain, visceral and muscle protein stores, and thyroid hormone levels during an 8-day refeeding period after 65 h of starvation was studied in 2-month-old male Sprague-Dawley rats. Twenty-four animals were divided into three groups and acclimated for 5 days while being fed with ordinary Purina Chow. After the fasting phase, a group of rats was killed in order to provide base-line information concerning fasting-induced changes in body composition; a sedentary group was fed Purina Chow ad libitum; and a treadmill-exercised group was pair fed with the sedentary rats. During the refeeding phase, the exercised animals regained significantly less weight than the sedentary animals (p less than 0.001), but the two groups did not differ significantly with respect to visceral, muscle, eviscerated carcass, and skin protein. Total body fat content was lower in the exercised than the sedentary group. The thyroid hormone levels were not significantly different for the two refed groups. These results indicate that exercise during refeeding may alter the pattern of body weight gain during refeeding after fasting such that the replenishment of adipose tissue stores is reduced without compromising the restoration and growth of lean tissue.

This study compared three techniques for indirect calorimetric measurement of resting energy expenditure: ventilated canopy, face mask, mouthpiece plus noseclips. A total of 18 healthy men and women underwent all three measurement techniques in three consecutive 20-min measurement periods in a Latin square design. No significant effects were found for either period or method with respect to oxygen consumption, respiratory exchange ratio, and caloric expenditure. Oxygen consumption was (mean +/- SD) 250 +/- 45, 251 +/- 47, and 254 +/- 49 mL/min for hood, mask, and mouthpiece, respectively (ns). The respiratory exchange ratio was lower for the hood (0.809 +/- 0.051) than mask (0.837 +/- 0.043) and mouthpiece (0.847 +/- 0.045) but this difference was not statistically significant (p = 0.07). Calculated caloric expenditure was 1.20 +/- 0.22, 1.21 +/- 0.22, and 1.23 +/- 0.23 kcal/min for hood, mask, and mouthpiece, respectively (ns). Thus, in healthy individuals similar results are obtained by the three methods and the face mask and mouthpiece are acceptable alternatives to the ventilated hood for estimation of resting energy expenditure.

We present a case of atrioventricular (AV) junctional parasystole manifesting with ventricular fusion beats due to the presence of an accessory AV conduction pathway. Ventricular fusion beats are usually impossible in AV junctional parasystole. In the reported case the ventricular fusion occurs because the ectopic AV junctional impulse is conducted through the His bundle, whereas the sinus impulse is conducted to the ventricles through the Kent bundle.