The Painless Stop Smoking Cure

How to Quit Smoking Cigarette

Quit Smoking Magic is the first and Only program of its type that literally can Force You to easily kick the habit in just days even if you have a shoestring budget and absolutely no will power. Benefits: Helps You to successfully quit smoking in as little as just days. Its as easy as taking candy from a Sleeping baby. This system takes just minutes to administer. This system can be done on a shoestring budget. Absolutely no chance of Any negative side effects. Works for almost Everyone 98% success rate thus far. You will never relapse with this program. Theres no Will-power necessary with Quit Smoking Magic. Powerful concept based on Real-life experiences rather than just theories. Quit Smoking Magic Teaches You: How to quit smoking cigarettes super-fast. How to stop your Cravings dead in their tracks. How to Never relapse with this nasty habit. How to avoid spending a ton of Money in your quest for quitting. How to quit smoking Now rather than later. How to Automatically kick this habit even without will-power. How to keep from having withdrawal symptoms and nasty mood swings. How to refrain from having Insomnia after quitting. How to avoid restlessness as well as changes in appetite. Continue reading...

Quit Smoking Magic Summary


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Author: Mike Avery
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Highly Recommended

I usually find books written on this category hard to understand and full of jargon. But the author was capable of presenting advanced techniques in an extremely easy to understand language.

All the modules inside this book are very detailed and explanatory, there is nothing as comprehensive as this guide.

How to Motivate Smokers to Quit

Smoking is associated with a range of diseases, causing a high level of morbidity and mortality. It represents one of the leading causes of preventable death with more than 3 million smokers worldwide dying each year from smoking-related illnesses. Stopping smoking has major health benefits. Smokers who quit before the age of 35 can expect a life expectancy only slightly less than those who have never smoked. Quitting at any age provides both short- and long-term benefits, with those who do so in middle age gaining improvements in health and reducing their excess risk of death. Despite the well-known health consequences of tobacco and the benefits of quitting, a quarter to a third of the adults in industrialized countries continue to smoke 14 . Although a majority of current smokers wish to quit smoking and effective interventions exist 15 , very few request or receive formal smoking cessation interventions. Physicians are in a unique position to intervene yet studies suggest that...

Youth Smoking Cessation

Efforts to help adolescents quit smoking have received relatively little attention. Studies suggest that teenagers who smoke on a daily basis who were unable to quit in the past for an extended period of time who have parents who smoke, particularly mothers, and a number of friends who smoke who do poorly in school and score high on a depression scale are least likely to quit smoking (Burt & Peterson, 1998 Zhu, Sun, Billings, Choi, & Malarcher, 1999). The more risk factors, the less likely adolescents are to quit (Zhu et al., 1999). Reviews of quit-smoking programs for adolescents painted a bleak picture (Burton, 1994 Digiusto, 1994 Sussman, et al., 1999). Retention and recruitment of students were problematic, and end-of-group quit rates were modest. Many studies failed to use appropriate control groups, objective measures of smoking status, and long-term follow-up of graduates (Sussman et al., 1999). Teenage focus groups have provided insight into the nature of smoking cessation...

Adult Smoking Cessation

Of the many nonpharmacological approaches to smoking cessation, here, behavioral approaches are the most germane. They have undergone the most extensive experimental study, are suitable for office and clinic-based physician interventions, and often are used in combination with pharmacological ap proaches to smoking cessation (Fagerstrom, 1988 Hymowitz, 1999). Multi-component behavioral programs, whether in group, individual, or self-help formats, typically include a number of strategies (self-monitoring, stimulus-control procedures, behavioral contracting, alternative behaviors, aversive conditioning, relaxation training, diet and exercise, self-management skill training for relapse prevention, etc.) to motivate smokers, to help them gain control over smoking, and to eliminate smoking systematically from their behavioral repertoire. Once smokers stop smoking, many of the very same behavioral skills that helped them quit smoking are used to help them prevent relapse. Schwartz (1987)...

Characteristics of a sample of smokers and nonsmokers

None of the continuous predictors are correlated with each other, either overall or within the smoking groups. Neither of the categorical predictors is significantly associated with a person's smoking habits (chi-square analysis). In addition, there is no significant association between gender and blood group. White blood cell count and body mass index both differ significantly between the two smoking classes. The white blood cell count is higher in the non-smokers but the body mass index is lower. However, if a correction is applied to the p value for multiple testing the difference in body mass indices becomes insignificant. The mean ages are very similar in the two groups.

Pathology encountered in crack smokers

Corneal Pathology From Smoking Crack

Fatal and non-fatal pulmonary edema (Figure 2.3.1) has been reported in cocaine smokers without obvious cardiac or central nervous system disease.5-8 Some of these patients had resolution of the pulmonary edema without specific treatment and chest radiographs have shown normal cardiac silhouettes. No reports have shown any hemodynamic data from these patients with pulmonary edema. One patient underwent bronchoalveolar lavage and had an elevated protein level (4x normal) suggesting that the edema was due to altered alveolar capillary permeability.7 Bronchial biopsy usually revealed no histologic abnormalities7 or only mild interstitial inflammatory changes .8 Cocaine users who smoked cocaine free base or crack may forcefully blow smoke into another user's mouth to augment the drug's effect. Smokers also prolong the Valsalva maneuver to avoid expiring the precious cocaine smoke. The resulting increased intra-alveolar pressure ruptures the alveolar walls, allowing air to dissect along...

Example of an IPD metaanalysis Postoperative radiotherapy in nonsmallcell lung cancer

Beta Blockers And

Introduction Worldwide, over half a million new cases of lung cancer are diagnosed each year 58 and it is the leading cause of cancer deaths. Surgery is the treatment of choice for non-small-cell lung cancer (NSCLC), and around one fifth of tumours are suitable for potentially curative resection 59 . However, even for patients with apparently completely resected disease, survival rates are disappointing - around 40 per cent at two years. In an effort to improve both local control and survival, the use of adjuvant post-operative radiotherapy (PORT) has been explored. LCSG Lung Cancer Study Group, CAMS Chinese Academy of Medical Sciences, EORTC European Organization for Research and Treatment of Cancer, MRC Medical Research Council, GETCB Groupe d'Etude et de Traitement des Cancers Bronchiques Twenty small-cell patients excluded. LCSG Lung Cancer Study Group, CAMS Chinese Academy of Medical Sciences, EORTC European Organization for Research and Treatment of Cancer, MRC Medical Research...

Poisoning with Nicotine Patches

To evaluate potential adverse effects from inadvertent exposure, three marketed TD nicotine products Nicoderm (drug reservoir and rate-controlling membrane) Nico-tinell (nicotine solution dispersed in cotton gauze between layers of adhesive) and Niconil (nicotine in gel matrix), were administered topically and orally to dogs (133). Topical nicotine doses were 1-2 mg kg 24 h-1 for all products, with plasma con centrations 43 ng mL, or less. Of 12 topical exposures (with Nicotinell and Niconil) 2 were associated with clinical signs (excess salivation or emesis). Oral doses (2.8 mg kg one patch to 13.4 mg kg two patches over 25-57 h), were two- to ninefold higher than the oral doses reported to produce severe toxicity in children, and the higher dose was within the known lethal range for dogs. Oral dosing of Nicotinell and Niconil (two patches per dog) produced vomiting in 2 of 12 exposures. No clinical signs were observed with either topical or oral dosing of Nicoderm. Characteristics...

For Smokers Unwilling to Quit

Intervention efforts will not be successful without sufficient motivation or readiness to quit smoking on the part of the smoker. For the patient who is presently unwilling to quit smoking, recommending entering a smoking cessation programme may be premature and ineffective. The US practice guidelines suggest following the 5 R's motivational intervention as listed in Table 2 15 . The 5 R's for enhancing motiva- Risks The clinician should ask the patient to identify potential negative consequences of tobacco use. The clinician may suggest and highlight those that seem most relevant to the patient. The clinician should emphasize that smoking low-tar low-nicotine cigarettes or use of other forms of tobacco (e.g. smokeless tobacco, cigars, and pipes) will not eliminate these risks. Examples of risks are Environmental risks Increased risk of lung cancer and heart disease in spouses higher rates of smoking by children of smokers increased risk for low birth weight, SIDS, and respiratory...

Actions Of Nicotine On The Brain

The nicotine molecule is shaped like acetycholine (Benowitz, 2001). Nicotine activates certain cholinergic receptors in the brain that would ordinarily be activated by acetylcholine. By activating cholinergic receptors, nicotine enhances the release of neurotransmitters and hormones, including acetylcholine, norepinephrine, dopamine, vasopressin, serotonin, and beta-endorphin. The cholinergic activation leads to behavioral arousal and sympathetic neural activation. The release of specific neurotransmitters has been specifically linked to particular reinforcing effects of nicotine. Enhanced release of dopamine, norepinephrine, and serotonin may be associated with pleasure, mood elavation, and appetite suppression. Release of acetycholine may be associated with improved performance on behavioral tasks and improvement of memory, and the release of beta-endorphin may be associated with the reduction of anxiety and tension (Benowitz, 2001).

Lung Cancer

Changes in the structure of some of the many types of cells that make up the lungs may begin almost immediately upon exposure to carcinogens (cancer-causing substances). Some of the thousands of chemicals contained in tobacco smoke both inhaled directly and released into the air through secondhand smoke are known respiratory carcinogens. Substances such as radon, asbestos, arsenic, uranium, and certain petroleum products also can cause lung cancer. A tumor in one of the bronchi can irritate the lining of the airway and cause a persistent cough, which may cause the tumor to bleed. As it grows, the tumor may block the airway, resulting in repeated bouts of pneumonia or other respiratory infections. A tumor located in the outer part of a lung may not produce any symptoms until it is large enough to press against the chest wall and cause pain. If you experience any of the warning signs of lung cancer (see box), see your doctor as soon as possible. Tests for lung cancer include a chest X...


Nicotine is an alkaloid found in tobacco, and is responsible for its pharmacological effects and addiction. Contact dermatitis from nicotine, considered as rare, has been more frequent since its use in transdermal systems. Irritant dermatitis is mainly encountered, as contact urticaria seems to be rare. Allergic contact dermatitis, sometimes generalized, has been reported, with positive patch testing to nicotine base (10 ethanol or petrolatum). No consequences have been reported in patients who start smoking again after skin sensitization. Bircher AJ, Howald H, Rufli T (1991) Adverse skin reactions to nicotine in a transdermal therapeutic system. Contact Dermatitis 25 230-236 Vincenzi C, Tosti A, Cirone M, Guarrera M, Cusano F (1993) Allergic contact dermatitis from transdermal nicotine systems. Contact Dermatitis 29 104-105

Smoking Cessation

Data on efficacy, safety, and pharmacoeconomics of transdermal (TD) nicotine therapy for smoking cessation up to 1994 were reviewed (86). TD nicotine more than doubled success rates of smoking cessation in motivated subjects smoking 10-15, or more, cigarettes a day. Application site reactions (erythema or burning

Primary Nursing Diagnosis

The treatment of choice for AAA 6 cm or greater in size is surgical repair. When aneurysms are smaller, some controversy exists regarding treatment. Some authorities suggest the smaller aneurysm should just be evaluated frequently by ultrasound examination or CT scan, with surgical intervention only if the aneurysm expands. There is increasing evidence suggesting that beta blockade, particularly propranolol, may decrease the rate of AAA expansion, and blood pressure control as well as smoking cessation is important. Others suggest elective surgical repair regardless of aneurysm size. If the aneurysm is leaking or about to rupture, immediate surgical intervention is required to improve survival rates.

Antecedents to Cultivation Some Case Studies

Root vegetables, where they were available, were excavated from the ground, usually with a digging stick. They were also obtained, for example among the Nabesna people of Alaska, by taking them from the caches of muskrats where the animals stored food ready for the winter. Berries were sometimes preserved in oil but usually were dried simply by laying them out on racks in the sun. Reducing the water content prevents or delays bacterial growth and the action of the enzymes naturally present in the tissue. During the winter, or late autumn when it often rained, food was preserved by being smoked, usually within the family dwelling. Smoking dries out the food and coats it with chemicals that inhibit the invasion of microorganisms that could cause it to go bad. Sometimes meat was also ground up and mixed with grease and berries to help preserve it to produce pemmican, which the buffalo hunters of the plains also often depended on during the winter months. Drying or smoking can preserve...

Addictionsubstance abuse

DSM-IV-TR defines 11 classes of commonly abused substances (see 6.07 Addiction). These include alcohol, amphetamine and amphetamine-like compounds, caffeine, cannabis, hallucinogens, inhalants, nicotine, opioids, phencyclidine, and the class of drugs defined as sedatives, hypnotics, or anxiolytics. Substance dependence is defined as a pattern of repeated self-administration that can result in tolerance, withdrawal, or compulsive drug-taking behavior, and has as a basis an anhedonia, the inability to gain pleasure from normally pleasurable experiences. Tolerance is evident as either a need for increased amount of substance to produce a desired effect, or the diminished effect of the same dose of substance over time. All substances of abuse produce tolerance, but the actual degree of tolerance varies across classes. Withdrawal involves maladaptive physiological changes that occur with declining drug concentrations. These changes tend to be unpleasant and produce cognitive and behavioral...

How To Use Delmars Dental Drug Reference

The scope of drugs covered in this reference includes traditional dental drugs used in the treatment of perio-dontal disease, antibiotic prophylaxis, and pain management with amide local anesthetics, NSAIDs, and opioid analgesics. Also, coverage is provided for other dental related drugs that are given systemically for the treatment of anxiety and other general infections. Coverage also includes cardiovascular drugs, opi-oid analgesics, opioid antagonists, drugs used for smoking cessation programs, and certain other drugs of special interest to dental practitioners.

Discharge And Home Healthcare Guidelines

Use extreme caution not to make the patient feel guilty about the cause of the SAB however, it is important that she be made aware of factors that might contribute to the occurrence of an SAB (such as cigarette smoking alcohol and drug usage exposure to x-rays or environmental teratogens). Preconceptual care should be encouraged, should the patient decide to become pregnant again.

Abstinence Violation Effect AVE

Part of Marlatt and Gordon's 1985 model of the relapse process involving a cognitive-emotional reaction that includes (a) guilt from relapsing and engaging in an undesired behavior (e.g., smoking) after quitting smoking or changing the behavior (e.g., smoking cessation), which is discrepant from the new self-image (e.g., a nonsmoker) and (b) an attribution that the relapse episode was due to personal weakness. This usually results in perceptions of decreased self-efficacy in considering readopting a desired health behavior (Cormier, 2002 Parks, Anderson, & Marlatt, 2001 Shiffman et al., 1996). In addition to smoking, AVE can be experienced among binge eaters (Grilo & Shiffman, 1994) and people with other addictive disorders. See Relapse Prevention.

Risk Factors and Cancer

The increasing knowledge of the process of carcinogenesis induced by chemical agents provides a major basis for cancer control and has unraveled the association between smoking and lung cancer. About 30 of all cancer deaths in the USA are due to the use of tobacco, and this death toll is still increasing reflecting smoking habits among young women since the 1950s.1,15 Smoking causes more than 90 of all cases of lung cancer and is the main cause of cancers of the larynx, mouth, esophagus, bladder, kidney, and pancreas, while about 25 of colon cancer and polyps can be attributed to smoking. Five years after stopping smoking, the risk of cancer decreases to half and to the level of lifelong nonsmokers after 10-15 years. Reducing the epidemic of tobacco smoking is currently the most effective means of cancer prevention.15-17 Occupational factors may account for 5 of all cancer deaths, and these include mostly cancers of the lung, bladder, and bone marrow.1,19 Workplace exposure, the most...

The Hazards of Tobacco

Tobacco use is by far the top avoidable cause of disease, disability, and death in the United States, responsible for nearly one in five deaths. Currently about 50 million adults in this country, mostly men, smoke cigarettes. Although smoking is generally declining, the number of adolescents and young adults who are beginning to smoke is on the rise. Cigarette smoke contains more than 4,000 different chemicals about 200 of them are poisonous, and more than 40 are cancer-causing. Smoking is so dangerous that approximately 400,000 deaths are attributed to smoking-related causes in the United States each year. The health problems caused by smoking are the number one cause of death in men in this country. Most men first experiment with smoking in adolescence because it makes them feel more adult and rebellious. The earlier someone starts smoking, the less likely he is to quit. Experimentation quickly turns into tolerance of and then addiction to nicotine, the habit-forming drug in tobacco...

Properties of arginine vasopressin antidiuretic hormone ADH

Plasma volume contraction cardiovascular volume receptors Fall in arterial blood pressure cardiovascular baroreceptors Hormonal beta-adrenergic stimulation angiotensin II hypothyroidism hypoadrenalism Drugs nicotine barbiturates vincristine Miscellaneous nausea and vomiting hypoglycaemia stress heat

Treatment Options for Major Cancers and Future Directions

Treatment options for lung cancer are determined by the type small cell lung carcinoma (SCLC) or non-small cell lung carcinoma (NSCC), and by stage of the tumor.75 Small cell lung carcinoma, which accounts for approximately 20 of all primary lung cancers and tends to be particularly aggressive, is often widespread by the time of diagnosis and treatment is often limited to chemotherapy and or chest radiation therapy. Representative examples of combination therapies for SCLC are etoposide and cisplatin (EC) etoposide, cisplatin, and vincristine sulfate (ECV)

Neuronal Nicotinic Receptor Agonists

The incidence of smoking is high in patients with schizophrenia, a rate at least three times higher than the general population. In fact, nicotine appears to produce a modest transient improvement in cognitive and sensory deficits in these patients. It has been suggested that smoking in schizophrenia represents an attempt to self-medicate.39 However, these views must be interpreted with caution. Overall, schizophrenic patients have a high degree of comorbid abuse of a variety of substances including nicotine, alcohol, cannabis, cocaine, and amphetamine. Importantly, the rate of substance abuse is higher than in the general population for all of these substances in spite of the fact that such abuse is associated with poorer outcomes, exacerbation of positive symptoms, increased hospitalization, and increased frequency of homelessness. This increased propensity to abuse a variety of substances regardless of consequences suggests that there may be a disregulation of reward systems in...

FSee 708 Kinase Inhibitors for Cancer

Cyclophosphamide, doxorubicin, and vincristine sulfate (CAV) cyclophosphamide, doxorubicin, and etoposide (CAE) etoposide and cisplatin (EP) and cyclophosphamide, etoposide, and vincristine (CEV). Depending on the extent of the disease, non-small cell lung carcinoma can be removed by surgical resection or treated with radiation therapy in combination with chemotherapy (e.g., gemcitabine hydrochloride together with cisplatin and vinorelbine). In addition to the preceding treatment modalities, photodynamic therapy is use for the care of patients with inoperable lung cancer or with distant metastasis. Surgery is the treatment of choice for colorectal cancer and, depending on the stage of the disease, chemotherapy and radiation are used as adjuvant treatment.76 For example, a cocktail of different agents (fluorouracil, leucovorin, and irinotecan) is used for metastatic colorectal cancer. An important advance in the treatment of colorectal cancer has been reported recently with...

Studies in MS and Other Conditions

Aromatherapy has been studied in a few other unrelated conditions. Small studies on older people with dementia have produced mixed results. Inhalation of black pepper extract may decrease the craving for cigarettes. People with a form of baldness called alopecia areata may benefit from scalp massage using a mixture of thyme, rosemary, lavender, and cedar-wood oils.

Trends In Problems Across Time And Space

The appearance of new drugs (or reappearance of old ones in new forms) exposed social groups to agents against which they had no sociocultural protection or immunity that is, the community or nation had no tradition for problem-free, or at least controlled, use of the substance. Users themselves may not have perceived the actual risks associated with the new psychoactive substance. This situation also occurred when the group was familiar with the substance but in a different form. For example, traditions may exist for wine but not beer or distilled alcohol pipe smoking may be subject to customs that do not extend to cigarette smoking.

Gender Ethnicracial And Life Span Considerations

Thromboangiitis obliterans, a causative factor for arterial occlusive disease, typically occurs in male smokers between the ages of 20 and 40. Arterial insufficiency usually occurs in individuals over 50 years of age, and is more common in men than women. PAOD affects 20 of people over 70 years of age in the United States. Ethnicity and race have no known effect on the risk of most arterial occlusive diseases.

Preparation for Quitting

The physician should then provide the patient with some basic didactic information about quitting smoking. (1) Smoking represents an addiction to nicotine. Therefore smoking cessation must be undertaken as seriously as one would approach any other drug addiction. Willpower alone is insufficient. The patient must make quitting smoking his her top priority. (2) The goal should be total tobacco abstinence after the quit date. (3) The patient can expect to experience unpleasant nicotine withdrawal symptoms (e.g. mood disturbance, insomnia, irritability, 3. Anticipate challenges to the planned quit attempt (including nicotine withdrawal symptoms), particularly during the critical first few weeks difficulty concentrating, increased appetite and weight gain). For most individuals, these symptoms peak within a few days of quitting and dissipate within 1 or 2 weeks. (4) The physician can help the patient identify high-risk or dangerous situations. These are events, internal states, or...

Monitoring of the Fetus in a Mother with Graves Disease

Eye symptoms and signs of Graves' hyperthyroidism including excessive watering, pain and irritation as well as chemosis, periorbital oedema, proptosis and ophthalmoplegia may occur before, during or after the onset of hyperthy-roidism and are more common in cigarette smokers. Treatment during pregnancy initially should be symptomatic with topical eye drops and elevation of the head of the bed. Careful monitoring is necessary to check for any signs of optic neuropathy. Oral or intravenous prednisone therapy is indicated in severe congestive ophthalmopathy but should be used sparingly in pregnancy. In line with the Graves' hyperthyroidism, the ophthalmopathy would be expected to improve during gestation.

Efficacy equivalence or noninferiority

Both equivalence and non-inferiority trials have perhaps their greatest role where cure rates are high, but there is a wish to reduce as far as possible the morbidity of treatment without compromizing efficacy (for example, stage I testicular seminoma) or where survival rates are very low, and the aim is to provide the best palliation while again avoiding adverse effects on already low survival rates (for example, poor prognosis small cell lung cancer patients).

How to Motivate Sedentary People to Be More Active

The efficacy of primary care physicians in changing unhealthy lifestyle habits has already been demonstrated in other fields (smoking cessation for example), particularly when they have been adequately trained 21 . With regard to physical activity promotion in a primary care setting, more than 20 original papers 32-51 and ten reviews of the literature have been published 52-61 . There is a fair amount of evidence

Community Health Education

Example The Pawtucket Health Heart Program in Rhode Island is a com-munitywide cardiovascular disease prevention program employing a variety of community-based interventions, targeting worksites, restaurants, schools, grocery stores, individuals, small groups, and the community at large in an effort to reduce the incidence of heart disease through screening, health education, and counseling programs directed toward risk factors such as high blood pressure, elevated cholesterol, cigarette smoking, obesity, and sedentary lifestyle (Hunt et al., 1990 Lasater et al., 1991).

The development of risk assessment 421 Risk and risk perception

Some risks are perceived as being greater than others because they are well publicised. Some risks, though unlikely, are 'dreaded' so that perception of the risk is out of proportion to its real likelihood, e.g. the risk of dying in a plane crash compared with that of dying from cigarette smoking. In some cases greater vulnerability is felt from a risk that people believe they have no control over and, in consequence, are much more sensitive if they are exposed to that risk agent. In addition, there is a perception that there are many risks, each of which needs to be considered and eliminated, and which compete for attention.

Multiplicity and ligand specificity

Which are bioactivated byAOX (orXOR). AOXalso plays an important role in the detoxification of potentially reactive iminium ions that can be generated by P450 or MAO, often from cyclic tertiary amines, e.g., nicotine.40 Menadione, isovanillin, and raloxifene are useful diagnostic inhibitors of AOX.65

Pediatric Asthma Case Study

A 14-year-old African-American female is brought to the pediatrician's office by her mother. She has just started running on her high school track team, but has been complaining to her mother that her running feels different this year. When she ran in middle school she could race longer distances without becoming winded. She now says her chest burns and she is running fewer miles before she has to stop to catch her breath. Her girlfriend told her she could hear her wheezing and she should go to the nurse. The school nurse confirmed her wheezing and notified her mother to come pick her up from school. There is no history of asthma in the family but her parents both smoke cigarettes. The school nurse advised that cigarettes could be contributing to the child's respiratory complaints. At the pediatrician's office her peak flow is 380 L min, which is within 5 of her predicted value for her height and weight. She does complain of coughing at night. Her lung sounds are now clear with no...

Specific Cell Extraction

Generally, the extraction of diseased cells by magnetic particles is based on the chemical difference between healthy and infected cells. Two steps should be considered. The first involves targeting the microspheres to a specific site by applying a magnetic field. Magnetic guidance makes it possible to reach areas that are difficult to access, and its efficacy usually depends on the properties of the carrier, such as particle size and stability in the environment. Secondly, the infected cells are then recognized and immobilized on sensitized particles. Capture yield varies from patient to patient since recognition depends on the properties of tumor cells and their affinity vis-a-vis the antibodies immobilized on the colloidal particles. Hancok 36 , Rembaum 59 and Ugelstad 60 initiated the use of magnetic particles to purify marrow. The method was then extended to other tumors such as the treatment of lymphocytes, leukemia and lung cancer. Using chemotherapy and radiation to cure...

Periodic Health Checkups for

Those at risk Men who smoke or chew tobacco men with poor oral hygiene. Those at risk Men with a family history of high blood pressure, heart disease, kidney disease, or stroke men who are overweight or have diabetes men who smoke or use tobacco products. Those at risk Men with a family history of heart disease men who have diabetes men who smoke or use tobacco products.

Intraarterial Thrombus Formation A

Activation of platelets, e.g., upon contact with collagen of the extracellular matrix after injury to the vascular wall, constitutes the immediate and decisive step in initiating the process of primary hemostasis, i.e., cessation of bleeding. However, in the absence of vascular injury, platelets can be activated as a result of damage to the endothelial cell lining of blood vessels. Among the multiple functions of the endothelium, the production of NO' and prostacyclin plays an important role. Both substances inhibit the tendency of platelets to adhere to the endothelial surface (platelet adhesiveness). Impairment of endothelial function, e.g., due to chronic hypertension, cigarette smoking, chronic elevation of plasma LDL levels or of blood glucose, increases the probability of contact between platelets and endothe-lium. The adhesion process involves GPIB IX, a glycoprotein present in the platelet cell membrane and von Wille-brandfs factor, an endothelial membrane protein. Upon...

Alcohol and Other Drugs

Dependence on alcohol and other drugs, also called addiction, poses a triple threat to the dependent person and to society as a whole. It increases the probability that a person will do something potentially harmful, such as acting in a violent or careless manner. It leads to impaired judgment that affects certain everyday activities, such as driving a car, thereby increasing the risk of injury or death. And it creates chemical imbalances in the brain and the body that increase the risk of illness and death. Nicotine, the drug found in cigarettes and other tobacco products, is extremely addictive.

Epidemiology of Reproductive Toxicology

Antimicrobials, antiemetics, theophylline, caffeine, ethanol, and nicotine. From 15 to 25 of pregnant women report licit drug use (ethanol nicotine), or illicit drug use (marijuana cocaine heroin), or have positive urine drug screens during pregnancy. Analgesics, vitamins, iron, antibiotics, theoph-ylline, and psychotropic medications account for 50 to 80 of all reported toxic ingestions by pregnant women.

Receptor Regulation Of Release

In keeping with the expression of nicotinic ACh receptors by DA neurons (primarily a4B2-subunit-containing Picciotto et al., 1998 Champtiaux et al., 2003), nicotine ACh facilitatory control of somatodendritic DA release has been identified in VTA using microdialysis with a remote, subcutaneous nicotine administration (Rahman et al., 2003), and more directly in a dendrosomal preparation from SN VTA using a 3H DA release assay (Reuben et al., 2000). Although the effect of nicotinic ACh receptor activation on DA cells is typically excitatory, inhibitory effects can also occur by subsequent activation of Ca2+-activated K+ channels (Fiorillo and Williams, 2000). An additional facilitatory regulation of somatodendritic DA release may be offered by endogenous ATP acting at P2 receptors in VTA, according to experiments using microinjection of P2 receptor antagonists and microdialysis (Krugel et al., 2001). Specific P2Yrreceptor immunoreactivity on neurons in VTA suggests, but does not...

Perimenopausal transition

In women with no symptoms of estrogen deficiency but with dysfunctional uterine bleeding who smoke or have other reasons to avoid an oral contraceptive, monthly withdrawal bleeding can be induced with medroxyprogesterone acetate (5 to 10 mg daily for 10 to 14 days per month). II. Menopause occurs at a mean age of 51 years in normal women. Menopause occurring after age 55 is defined as late menopause. The age of menopause is reduced by about two years in women who smoke.

Determining the size of difference to detect in a specific trial

The questionnaires described below are based on those developed by Freedman and Spiegelhalter 8 . They comprise two sections, the first identifying the expected differences in survival, the second attempting to elicit the clinically important differences as well as the factors which affect these values. In describing these questionnaires, the CHART bronchus trial 9 is used as an example. This was a randomized trial comparing conventional radiotherapy with Continuous, Hyperfractionated, Accelerated RadioTherapy (CHART) in the treatment of inoperable non-small cell lung cancer. Conventional radiotherapy was delivered in thirty fractions of 2 Gy, given once a day, Monday to Friday only, over six weeks. CHART was given to a total dose of 54 Gy, given in thirty-six fractions of 1.5 Gy, with three fractions given at 8-hour intervals for twelve consecutive days including weekends. This approach would, it was hoped, improve survival by minimizing the opportunity for tumour repopulation...

Nicotinic acetylcholine receptors nAChRs

NAChRs are homo- or heteropentameric ligand-gated ion channels present in the CNS, peripheral nervous system, and neuromuscular junction. Various subunits can combine to provide a diversity of receptor subtypes with unique brain and neuron-specific distributions.37 Activation of nAChRs mediates calcium influx and neurotransmitter release, again specific to the neuronal subtype (i.e., cortical, hippocampal). Interest in nAChRs comes from observations that they are reduced in AD and that nicotine improves attention in AD patients. Also A 42 can bind to a7 nAChRs and antagonists of this receptor promote neuron survival. Several nAChR agonists have entered the clinic (e.g., ABT-418 14, SIB-1553A 15, GTS-21 16, TC-1734 17). The progress of these agents has been slow due to efficacy issues and side effects, including emesis, motor dysfunction, and hallucinations, although these are reduced in comparison to nicotine due to improved receptor subtype selectivity. The first a4b2 agonist to...

Biological Background

Largest organ of the body, with an average weight of 7 kg in adults. With a surface area of approximately 2 m2, the skin offers a unique and easily accessible body surface across which drugs can be delivered. Transdermal administration is noninvasive, and allows for the attainment of constant plasma levels over extended periods of time. Additionally, the incidence of side effects after transdermal administration may be lower than after oral administration, such as in the case of estradiol.85 Transdermal patches are discreet to wear and were preferred for nicotine replacement therapy over other administration devices (nasal sprays and pulmonary inhalers) that, although equivalent in efficacy, were considered embarrassing to use.86

Indications and Contraindications

The deep-plane technique can be considered for most cases of primary rhytidectomy, except in the unusual situation, when simple skin redundancy is the only concern. It is particularly effective for advanced jowls and heavy nasolabial folds and for patients who smoke or have some other condition that predisposes them to compromised vascularity or infection. Patients with extremely thin skin in whom minor subcutaneous irregularities would be more evident are also better suited for the deep-plane rhytidectomy, as are those who are suceptible to hypertrophic scarring.

Analysis of Cytotoxic Agents in Xenograft Models

Retrospective evaluation of activity of established cytotoxic agents in clinical trials versus preclinical models shows that, in general, activity in xenograft models is predictive of some level of clinical response. Several reports have detailed good correlations between xenograft response and clinical response for rhabdomyosarcoma, colon cancer, lung cancer (particularly small-cell lung cancer), breast cancer, and myeloma.26'52'53 Table 1 shows a partial compilation of data generated in our department examining the activity of numerous standard cytotoxic agents as well as selected novel targeted agents in a variety of xenograft and syngeneic flank tumor models. Both early treatment (ET) and staged tumor (ST) trials are included and it can be seen that in some cases the magnitude of response is quite similar in the two cases (e.g., paclitaxel in the A549 model), while in others there are significant differences in response (e.g., paclitaxel in breast cancer). The data include several...

Practical considerations

This is perhaps the most common type of situation in which even quite small alterations to the allocation ratio can make participation in the trial much easier, the resulting increase in accrual more than compensating for the slight loss in power associated with moving the allocation ratio away from equality. One example involved the trials of continuous, hyperfractionated accelerated radiotherapy (CHART) in head and neck, and also lung cancer described earlier in this chapter 9 . As CHART is given in multiple daily fractions, without breaks for weekends, patients are treated outside of normal hours and this therefore incurs additional staff costs. It is clearly more cost effective to have several patients ready to treat in succession. In the MRC CHART trials, 3 2 randomization was used to increase the number of patients allocated CHART, and therefore increase the chance that participating centres would have several patients to treat simultaneously.

Randomized Phase Ii Designs

One of the reasons causing variation of tumor response rates is the inherent heterogeneity of cancer. For example, it is extremely difficult to evaluate tumor response of patients with prostatic, brain, or pancreatic cancers. On the other hand, for advanced colorectal cancer, advanced non-small-cell lung cancer, or advanced hepatocellular carcinoma, survival can be observed in a relatively short period of time. In such situations, survival rather than tumor response rate may be used as the primary endpoint for ranking and selection in the randomized phase II cancer clinical trials. As a new agent may not exist under which survival function is uniformly higher than those of all others across time, it is not clear how to define the best treatment based on observed survival functions. Liu et al. (1993), under the assumption of the Cox's proportional hazards model, suggested the use of hazard ratios for

Genetic Considerations

Mutations in the SERPINA1 gene cause alpha-1 antitrypsin (AAT) deficiency. The gene (AT1) causes the hereditary form of emphysema. AT1 protects the body from being damaged by the protinase trypsin. AT1 is inherited in an autosomal co-dominant pattern, meaning that two different gene alleles are expressed and both contribute to the development of the trait. The M allele is most common and results in production of normal levels of AT1. People who are homozygous normal have copies of the M allele from both parents. The two variants (S and Z) cause production of low or moderately low amounts of AT1. Persons with the ZZ or SZ genotype will probably develop AT1 deficiency. Persons with an MS or SS genotype usually produce enough alpha-1 antitrypsin to protect the lungs. There is an increased risk of AT1 for those who carry the MZ alleles, particularly if they are smokers. Familial factors predisposing to emphysema in the absence of alpha-1 antitrypsin deficiency are also likely.

Health Care Delivery System

Example The Loma Linda Centers for Health Promotion and the Kaiser Permanente health care systems include health promotion, education, and preventive services. In these systems, participants are diagnosed, treated, and placed in preventive care and health maintenance programs involving dietary changes, weight loss, smoking cessation, periodic screening, exercise, immunization, and other practices that may help restore or maintain health.

What is quality of life

An example of the value an assessment of QL can add was in a randomized trial of cisplatin and vinblastine plus either hydrazine sulphate (HS) or a placebo for patients with advanced non-small cell lung cancer. Herndon et al. 7 reported similar results in terms of survival, response and weight gain. Although patients in the HS group experienced significantly more severe neuropathy this was only one of eighty types of toxicity recorded, and it was therefore felt that this alone did not provide a clear indication of which treatment was better. However, QL analyses revealed worse physical functioning, fatigue, lung-cancer-specific and cancer-specific symptoms for patients in the HS group, and the authors concluded that the QL assessment provided a unique viewpoint from which to compare the treatments.

Complete Medical History

Certain forms of repetitive behavior may influence the present coloration of the teeth, and the likelihood that an improved appearance can be maintained. The dentist must know if the patient is an active drinker of tea, coffee, or colas. These beverages cause a readily correctable form of staining, but they may compromise the maintenance of a whitened smile. Smoking (cigarettes, pipes) and chewing tobacco are much more invasive. The stains follow the microfissures of the tooth structure internally, and may be very difficult to eliminate.

Identifying key symptoms

It may also be important not to focus only on the possible positive aspects of a treatment. Treatment-related adverse effects may also be relevant. For example, in a trial of two thoracic radiotherapy regimens for lung cancer, the key QL outcome might be the duration and severity of dysphagia. In an MRC Lung Cancer Working Party trial 39 , patients with non-small cell lung cancer were asked to complete a daily diary card, and the proportion of patients reporting moderate or severe dysphagia was plotted. This suggested that in terms of dysphagia, the shorter radiotherapy schedule (17 Gy in 2f) affected fewer patients and was transient, whereas the longer radiotherapy schedule affected more patients for longer (Fig. 6.3). Fig. 6.3 Proportion of patients reporting moderate or severe dyspagia on a daily diary card (adapted from MRC Lung Cancer Working Party, 39 ). Sometimes more than one symptom may be important. For instance, patients may present with a complex mixture of symptoms which...

Cardiovascular System

Transient hypertension is noted in nearly 50 of alcoholics undergoing detoxification and is related to quantity of drinking and severity of other withdrawal symptoms. Epidemiological studies have demonstrated that alcohol elevates blood pressure independently of age, body weight, or cigarette smoking (Klatsky, Friedman, & Armstrong, 1986). A 10-year follow-up study found even moderate intake of alcohol (

How many patients are required

For example, the primary aim of the QL aspect of a lung cancer trial might be to compare the difference in the proportion of patients who have relief from their cough at three months. If the standard treatment is expected to give 50 per cent of patients However, this sample size assumes that all patients will be assessable. In many advanced cancers, attrition due to death, even at three months, may have reduced the trial population by 10 or 15 per cent. In addition, the above scenario requires complete information on all patients and indeed all patients to start with a cough otherwise how could relief be assessed The framing of the hypothesis is again important, as, for example, Stephens etal. 43 have suggested redefining 'palliation' as not just improvement, but also prevention (for asymptomatic patients), and control (for patients with minimal symptoms). In this way all patients could be included in the analysis. Nevertheless, the calculated QL sample size must be adjusted by adding...

Clinical evaluation

The majority of patients with COPD will have either a history of cigarette smoking or exposure to second-hand cigarette smoke. Occasionally, patients will develop COPD from occupational exposure. A minority of patients develop emphysema as a result of alpha-1-protease inhibitor deficiency or intravenous drug abuse.

Development of QL questionnaires

The daily diary card (DDC) grew out of the idea that, in chemotherapy for lung cancer, it was felt that the main side effects were known but not their duration or the pattern of severity. Thus, the daily diary card was developed based on previous work in other conditions, such as the assessment of night cough in asthma patients and vaginal bleeding patterns. As patients complete the card each evening it was considered imperative to keep the number of questions to a minimum and for practical reasons to use a four or five point categorical scale. In the first MRC trial to use DDCs the consensus opinion was that the questions should address overall QL, a functional measure (physical activity), the main expected side-effect (nausea and vomiting) and two psychological items (mood and anxiety). These questions were changed in subsequent MRC trials depending on the research question.

Choosing a questionnaire

Several papers have asked patients to complete more than one questionnaire and have then compared the results. The questionnaires compared in this way include the FACT-G and the EORTC QLQ-C30 72 , the FLIC and the EORTC QLQ-C30 73 and three lung-cancer-specific questionnaires, the EORTC, FACT, and LCSS 74 .

Association with Tumors

SCLE is regarded as a facultative paraneoplastic syndrome by some authors, and cases have been described in association with various malignant tumors. In nearly 20 patients described, lung cancer and breast cancer were most frequently found. However, malignant tumors in other organ systems (stomach, liver, uterus, and brain) have been also reported. The patients described did not differ in clinical presentation, histopathologic findings, and serologic profile from other patients with SCLE except for a higher age at onset (Castanet et al. 1995, Ho et al. 2001, Kuhn and Kaufmann 1986, Richardson and Cohen 2000,Trueb andTrueb 1999). First disease manifestation of SCLE in older patients ( 50 years) may possibly indicate the occurrence of the disease as a paraneoplastic syndrome.

History And Overview Of The Problem Early Beginnings

The use of tobacco (Nicotine tobaccum) has been traced to early American civilizations, where it played a prominent role in religious rites and ceremonies. Among the ancient Maya, tobacco smoke was used as solar incense to bring rain during the dry season. Shooting stars were believed to be burning butts cast off by the rain god. The Aztecs employed tobacco (Nicotine rustica) as a power that was used in ceremonial rites as well as chewed as a euphoric agent with lime (Schultes, 1978). The popular weed was not without its detractors. James I of England published a counterblaste to tobacco in 1604, and he arranged a public debate on the effects of tobacco in 1605. Pope Urban III condemned tobacco use in 1642, threatening excommunication of offenders. In Russia, a decree in 1634 punished tobacco users by nose slitting, castration, flogging, and banishment. These harsh measures were abolished by Peter the Great, who took to smoking a pipe in an effort to open a window to the West. It is...

[KLOHnihdeen Pregnancy Category C

Epidural use causes analgesia at presynaptic and postjunctional al-pha-2-adrenergic receptors in the spinal cord due to prevention of pain signal transmission to the brain. tv2, distribution, epidural 19 min elimination 22 hr. Uses Oral, Transdermal Mild to moderate hypertension. A diuretic or other antihypertensive drugs, or both, are often used concomitantly. Non-FDA Approved Uses Alcohol withdrawal, atrial fibrillation, attention deficit hyperactivity disorder, constitutional growth delay in children, cyclosporine-associated nephro-toxicity, diabetic diarrhea, Gilles de la Tourette's syndrome, hyperhidrosis, hypertensive emergencies, mania, menopausal flushing, opiate detoxification, diagnosis of pheochromocy-toma, postherpetic neuralgia, psychosis in schizophrenia, reduce allergen-induced inflammatory reactions in extrinsic asthma, restless leg syndrome, facilitate smoking cessation, ulcerative colitis.

Age Related Macular Degeneration

The main unmet medical need is that there is currently no accepted medical therapy to treat dry AMD. Based on epidemiological studies many cases of dry AMD could be prevented by reducing cigarette smoking for example, almost 30 000 cases of AMD in the UK could be attributed to smoking.23 The role of oxidative stress in disease pathology suggests the advisability of antioxidant, carotenoid, and vitamin supplementation. One difficulty with dry AMD is that, as a largely asymptomatic and slow-developing disease, it is frequently the case that significant morphological damage (RPE cell and photoreceptor death) has occurred before the patient experiences visual deficit and thus is aware of the disease. On the positive side, a therapy that even just significantly slowed AMD progression in an elderly population might be sufficient to mostly preserve visual acuity for the rest of a patient's life.

Therapeutic implications

Lifestyle modifications including implementation of a regular exercise program, reduction of obesity through dietary measures, and avoidance or cessation of cigarette smoking should be implemented to reduce the intensity of a prothrombotic state and the progression of macrovascular disease. Vitamin B6 (1.7 mg per day) and folic acid (400 g of dietary or 200 g of supplemental folic acid per day) in recommended daily allowance (RDA) doses appear to be appropriate particularly because elevated homocysteine (139)

Clinical Practice Guidelines

Physicians have a unique role to play in the anti-smoking arena (Sullivan, 1991). Past reviews (Orleans, 1993), monographs (U.S. Department of Health and Human Services, 1994b), and guidelines (American Psychiatric Association, 1996) underscore the importance of physician intervention on smoking in a variety of medical settings. The Public Health Service-sponsored Clinical Practice Guideline, Treating Tobacco Use and Dependence (Fiore et al., 2000), provides clinical and systems interventions that are intended to increase the likelihood of successful quitting. The major findings and recommendations may be summarized as follows 1. Tobacco dependence is a chronic condition that often requires repeated intervention. However, existent effective treatments can produce long-term or even permanent abstinence. 2. Because effective tobacco dependence treatments are available, every patient who uses tobacco should be offered at least one of these treatments Patients unwilling to try to quit...

Prevention Of Smoking

The prevention of tobacco use in children and adolescents requires a multi-pronged approach that targets the social environment, as well as individual behaviors (Bonnie, 2001 Lantz et al., 2000 Lynch & Bonnie, 1994 U.S. Department of Health and Human Services, 1994a). Individual behavior change strategies include school-based prevention programs, computer-based systems, and peer-based interventions (Lantz et al., 2000). Pediatricians and other health professionals also have an important role to play in preventing smoking initiation (Hymowitz, Schwab, & Eckholdt, 2001). Sussman, Lichtman, Ritt, and Pallonen (1999) reported that average reductions in smoking onset among youth generated by school-based prevention programs was about 6 , with a range of 0 to 11 . Programs that focused on teaching young people resistance skills to deal with social and other influences to smoke were most successful and had a longer lasting impact (Lantz et al., 2000). At the environmental level, mass media...

Protecting Your Lungs

Lung cancer is the leading cause of cancer death among both men and women in the United States. Twice as many men as women die of chronic obstructive pulmonary disease (such as emphysema), and pneumonia is a more common cause of death among men than among women. Lung disease is directly related to specific risk factors such as cigarette smoking and working in occupations that carry risks for developing lung disease. Plastics, wood, metal, and textile workers bakers millers farmers poultry handlers miners grain elevator workers laboratory technicians drug manufacturers dry cleaners and detergent manufacturers are all exposed to airborne agents that can cause occupational asthma, lung cancer, and other respiratory disorders. smoking and avoiding exposure to tobacco smoke are critical to protecting your lungs. Cigarette smoke is the major cause of lung cancer, chronic bronchitis, and emphysema. Exposure to cigarette smoke also increases your risk of respiratory infection, including...

Psychopharmacotherapy General Considerations

There are numerous approaches to smoking cessation and many comprehensive reviews of the literature (e.g., Hymowitz, 1999 Lando, 1993 Leventhal & Cleary, 1980 Schwartz, 1987). Although many approaches to smoking cessation have been successful in the short run, few, if any, have proved satisfactory in the long term. This is true for traditional group and individual counseling programs, hypnosis and acupuncture, self-help stop-smoking strategies, multi-component behavioral interventions, and pharmacological therapies (Hunt & Bespalec, 1974 Hymowitz, 1999 Yudkin et al., 2003). The tendency of smokers to quit, relapse, and quit highlights the cyclic nature of the quitting process and serves as a reminder that as much care and effort must go into helping smokers remain cigarette-free as into helping them stop smoking in the first place.

Betel Areca catechu Piperaceae

Although it is commonly called betel-chewing, this is something of a misnomer as the nut that is used is in fact the seed of the areca palm (Areca catechu), which is mixed with lime and then wrapped in a betel leaf (Piper betle). The nut and leaf also are not really chewed, but are put between the cheek and tongue and left there, as with a coca or tobacco quid. The main psychoactive constituent is arecaidine, which has stimulating effects similar to those of nicotine.

Coca Cocaine Erythroxylum coca Erythroxlyaceae

The coca plant is a bush or shrub that grows to a typical height of about 3 feet (1 m), and the chewing of its leaves is a traditional practice in a wide area extending from Central America throughout the Andes and into the Amazon region. There are fourteen different alkaloids (alkaline, nitrogen-containing organic substances, usually with toxic potential) contained in the leaves of the coca plant with the most famous of course being cocaine (although nicotine is also present in smaller quantities).

Inhibitors of Microtubule Assembly

In addition to the naturally occurring vinca alkaloids (Figure 2), a semisynthetic analog, vinorelbine 4,17,18 has been approved by the US Food and Drug Administration for treatment of nonsmall-cell lung cancer either as a single agent or in combination with cisplatin.19 Further evaluation of the vinca structure-activity relationship (SAR)20-23 has led to the identification of several analogs, including vinflunine 5 and KAR-2 6, that have progressed to advanced preclinical and

Scope of the Metabolic Syndrome Epidemic Prevalence and Risk

MetS is associated with increased risk of cardiovascular disease and also increased risk for the development of its associated risk factors - diabetes and hypertension. The presence of MetS according to the National Cholesterol Education Program (NCEP) definition was prospectively associated with the development of type 2 diabetes20 (see 6.19 Diabetes Syndrome X) and both all-cause and cardiovascular mortality.21 Cardiovascular disease risk has been reported to be increased two- to fivefold in both men and women with MetS (greater in men than in women) when adjusted for age, cholesterol, and tobacco use.22 Some national guidelines for risk factor management include MetS as a factor that can be used to restratify patients into a higher level of risk than would be assumed by simple tallying of traditional risk factors.23

Bacterial vaginosis

Bacterial vaginosis represents a change in vaginal flora characterized by a reduction of lactobacilli and an increase of Gardnerella vaginalis, Mobiluncus species, Mycoplasma hominis, anaerobic gram-negative rods, and Peptostreptococcus species. Risk factors for bacterial vaginosis include multiple or new sexual partners, early age of first coitus, douching, cigarette smoking, and use of an intrauterine contraceptive device.

Classification Antineoplastic miscellaneous

Uses With combination therapy to treat refractory testicular tumors and small cell lung cancer. Non-FDA Approved Uses Alone or in combination to treat acute monocytic leukemia, non-Hodgkin's lymphoma, Hodgkin's disease, AIDS-associated Kaposi's sarcoma, Ewing's sarcoma. Also, choriocarcinoma hepatocellular carcinoma nonsmall cell lung, breast, endometrial, and gastric cancers acute lymphocytic leukemia soft tissue carcinoma rhabdomyo-sarcoma.

Antidiuretic Hormone ADH and Derivatives B

Cimetidine Induced Gynecomastia

ADH, a nonapeptide, released from the posterior pituitary gland promotes reabsorption of water in the kidney. This response is mediated by vasopressin receptors of the V2 subtype. ADH enhances the permeability of collecting duct epithelium for water (but not for electrolytes). As a result, water is drawn from urine into the hyperosmolar inter-stitium of the medulla. Nicotine augments (p. 110) and ethanol decreases ADH release. At concentrations above those required for antidiuresis, ADH stimulates smooth musculature, including that of blood vessels ( vasopressin ). The latter response is mediated by receptors of the V1 subtype. Blood pressure rises coronary vasoconstriction can precipitate angina pectoris. Lypres-sin (8-L-lysine vasopressin) acts like ADH. Other derivatives may display only one of the two actions.

Physiological Effects

Cannabis intoxication commonly heightens the user's sensitivity to external stimuli, thus making colors seem brighter and smells more pungent. It also distorts, sometimes severely, the user's sense of time. The term temporal disintegration (Mathew, Wilson, Humphreys, Lowe, & Weithe, 1993) has been coined to describe this slowing of subjective time after use of marijuana. In addition, at least in low doses, marijuana causes mild euphoria and feelings of relaxation. It is also know to increase appetite. There is some controversy over whether individuals intoxicated with cannabis pose a hazard, as they seem to be attracted to thrill-seeking behavior and are usually subdued. Some people have argued that individuals who smoke marijuana are less likely to drive fast however, reaction time to complex and unforeseen situations is slowed, and muscle strength and hand-eye coordination is decreased. Because it delays reaction time, alters time perception, and for many other reasons, marijuana...

Types of epidemiological studies

In experimental studies the exposure conditions are chosen by the investigator, as in animal studies. If patients are the subjects, this type of study is often referred to as a clinical trial. For ethical reasons, exposure is bound to certain restrictions of which the most important one is that examining potentially toxic substances in humans is prohibited. This implies that potentially adverse effects of food components can only be investigated in non-experimental studies. For example, studying the beneficial effect of adding vitamin A to the diet of smokers in relation to the incidence of lung cancer would be permitted. In contrast, the effect of PCBs in mother's milk on the health of babies can only be evaluated in a non-experimental study design. In experimental studies, two groups of subjects are compared with regard to the outcome variable subjects exposed to the substance under investigation (intervention group), and subjects not exposed (control group). An essential condition...

Pharmacologic Highlights

The nurse's role is one of monitoring and support. Support the patient who is experiencing symptoms from any rhythm disturbance. Maintain the patient's airway, breathing, and circulation. To maximize oxygen available to the myocardium, encourage the patient to rest in bed until the symptoms are treated and subside. Remain with the patient to ensure rest and to allay anxiety. Discuss any potential precipitating factors with the patient. For some patients, strategies to reduce stress or lifestyle changes help limit the incidence of dysrhythmias. Teach the patient to reduce the amount of caffeine intake in the diet. If appropriate, encourage the patient to become involved in an exercise program or a smoking cessation group. Provide emotional support and

Description Surgical Tracheostomy for Face

Cancer of the larynx is more common in men than in women (5 1 ratio) because, heretofore, men have been more likely to smoke cigarettes and drink alcohol, but the incidence in women is rising as more women also smoke and drink. Cancer of the larynx occurs most frequently between the ages of 50 and 70. Women are more likely to get laryngeal cancer between the ages of 50 and 60 and men between the ages of 60 and 70. Laryngeal cancer is 50 more common in African Americans than in whites. HISTORY. Be aware as you interview the patient that hoarseness, shortness of breath, and pain may occur as the patient speaks. Obtain a thorough history of risk factors alcohol or tobacco usage, voice abuse, frequent laryngitis, and family history of laryngeal cancer. Obtain detailed information about the patient's alcohol intake ask about drinks per day, days of abstinence, and patterns of drinking. Ask the patient how many packs of cigarettes he or she has smoked per day for how many years.

Positron Emission Tomography

Whole body positron emission tomography (PET) with 18-F-fluorodeoxyglucose (18-FDG) allows malignant adrenal lesions to be recognized. The contribution of 18-FDG PET has been well evaluated in large studies in relation to lung cancer, and is highly accurate in differentiating benign non-inflammatory lesions from malignant disease. Using 18-FDG PET, these studies have shown a 100 sensitivity and specificity for the diagnosis of malignant adrenal mass when CT or MRI identify enlarged adrenal glands or a focal mass. Recent studies have reported false positive results as a result of 18-FDG uptake by pheochromocytomas and benign adenomas. For the diagnosis of a malignant adrenal tumour, the positive predictive value of 18-FDG PET was 100 and the negative predictive value (NPV) to rule out malignancy was also 100 . Within these study populations, 18-FDG PET also has the ability to detect metastatic lesions in non-enlarged adrenal glands, but its accuracy in this situation has not been fully...

Population Attributable Risk

Example Roughly 135,000 people die each year from lung cancer in the United States. The relative risk of lung cancer in smokers is 10 to 1 one-third of the American population smokes, so 101,000 lung cancer deaths per year are attributable to smoking. Alternatively, there might have been 101,000 fewer deaths if no one smoked.

Three Biological Examples

Rosenberg's last example concerns the units of selection controversy. He uses a strengthened version of an idea about causality that Sober and Lewontin (1982) defended. This is the idea that C is a positive causal factor for bringing about E precisely when C raises the probability of E in at least one background context, and does not lower it in any. For example, smoking is said to be a positive causal factor for lung cancer, if smoking increases some people's chances of getting cancer and does not lower anyone else's. Lewontin and I intended the range of background contexts to be the ones that are actually exemplified in the population. However, Rosenberg expands this set to include background contexts that are merely conceivable. It is no surprise that causal claims that seem to be true turn out to be false under his strengthened criterion. Just imagine a science fiction circumstance in which smoking actually reduces the chance of lung cancer, e.g., by causing physicians to supply a...

Types Of Models Used In Drug Discovery And Development

Model equations can be augmented with expressions accounting for covari-ates such as subject age, sex, weight, disease state, therapy history, and lifestyle (smoker or nonsmoker, IV drug user or not, therapy compliance, and others). If sufficient data exist, the parameters of these augmented models (or a distribution of the parameters consistent with the data) may be determined. Multiple simulations for prospective experiments or trials, with different parameter values generated from the distributions, can then be used to predict a range of outcomes and the related likelihood of each outcome. Such dose-exposure, exposure-response, or dose-response models can be classified as steady state, stochastic, of low to moderate complexity, predictive, and quantitative. A case study is described in Section 22.6.

Evaluation of Patient

Most patients with head and neck cancer have squamous cell carcinoma arising from mucosal surfaces of the head and neck. Most of these patients are more than 40 years of age with a 4 or 5 to 1 male female ratio. The vast majority of these patients relate a history of tobacco use, usually cigarette smoking, and many have a history of alcohol abuse. A patient presenting with a mass in the neck that is nontender and enlarging and who matches the above profile, should be regarded as having cancer until proven otherwise. An orderly stepwise approach should be taken in evaluating these patients. Most physicians treating these patients agree that open biopsy of the neck mass should be delayed until later stages of evaluation.

CIS1 Cytokine Inducible SH2Containing Protein

The CIS1 gene is located in the distal region of mouse chromosome 9, which is linked to Trf, Gnai2, and Col7aI (25). This region shares homology with the short arm of human chromosome 3 (3p21), so that the putative CIS1 locus in human is thought to be 3p21. It is known that the human 3p21 locus is frequently lost or rearranged in renal cell carcinoma and lung cancer (31,32). In view of the function of CIS1 and its tissue distribution, loss of the CIS1 gene may thus constitute one of the mechanisms involved in unregulated cell proliferation.

Clove Syzygium aromaticum Myrtaceae

When the Dutch captured the Moluccas (1605-21), they attempted to prevent further haemor-rhaging of their monopoly by confining clove cultivation to one island. They destroyed perhaps seventy-five percent of clove trees in the Moluccas, significantly reducing genetic diversity. In the late 18th century, the French secretly collected young cloves from the Moluccas and introduced a few trees to their islands in the Indian Ocean. From there, cloves reached Zanzibar, where the Sultan required plantation owners to plant cloves or forfeit their land. Zanzibar then dominated the world clove market, until epidemics of sudden death (a fungal disease of cloves) on Zanzibar in the 20th century. This, combined with ever-increasing demand in Indonesia for clove cigarettes (tobacco plus thirty to forty percent by weight of shredded cloves) has led to the homeland of clove once again becoming the world's largest producer and consumer of cloves.

Initial patient education

Abstinence from alcohol, cigarettes, illicit drugs should be assessed. Information on the safety of commonly used nonprescription drugs, signs and symptoms to be reported should be discussed, as appropriate for gestational age (eg, vaginal bleeding, ruptured membranes, contractions, decreased fetal activity).

Tobacco Nicotiana spp Solanaceae

With the exception of Australia (which has its own indigenous Nicotiana that was chewed by Aborigines), the world ultimately owes its supplies of tobacco to the Americas. The cultural history of tobacco use begins in the remote prehistory of South America. According to current understanding, the lowlands of Patagonia, the Pampas, and Gran Chaco are the probable home of the tobacco plant. The early history of tobacco in South America is obscure, as few, if any, definite archaeological finds have been made. However, it is likely that the indigenous inhabitants of the region began to cultivate tobacco in their gardens several thousand years ago, growing about 12 different species altogether, Nicotiana tabacum and N. rustica being the most common. N. rustica had been taken by 200 ad to North America, where wild tobaccos had been harvested since at least 400 bc N. tabacum probably followed ca. 1000 ad. chemistry of the plant. Tobacco contains the harmala alkaloids harman and norharman, and...

Longitudinal data repeated measures

For each patient, data from a clinical trial are sometimes in the form of repeated assessments over time. In such a trial observations are taken on more than one occasion for each patient over the period of the trial. An example of such data is given in the randomized clinical trial LU19 conducted by the Medical Research Council Lung Cancer Working Party 10 . In this trial the control arm of six cycles of ACE chemotherapy given 3-weekly was compared to the experimental arm of 6 cycles of ACE + G-CSF given 2-weekly. For each patient, clinicians were asked to complete a symptom assessment form before starting treatment and then after each cycle of chemotherapy, 3-weekly for the ACE arm and 2-weekly for the ACE+G-CSF group. In both groups after the completion of chemotherapy (eighteen weeks for the ACE arm, twelve weeks for the ACE + G-CSF arm) reports were to be completed each month up to six months.

Layout of the Autonomic Nervous System

The autonomic nervous system (ANS) carries all efferent impulses from the central nervous system, except for motor innervation of skeletal muscle. The ANS is mainly outside voluntary control and regulates (i) the heart beat, (ii) contraction of smooth muscle, (iii) all exocrine and some endocrine organs, and (iv) some of intermediary metabolism. Afferent sensory fibers run in the same nerve bundles that carry efferents, but only the efferents will be considered here. The ANS is anatomically and functionally divided into two main divisions, the parasympathetic and sympathetic divisions. Structurally, both divisions have preganglionic and post-ganglionic fibers. In both divisions, the neurotransmitter released from the pre-ganglionic presynaptic nerve terminal is acetylcholine (ACh), which acts on post-synaptic, ganglionic nicotinic receptors. These are so called because nicotine can act as an agonist at the receptor sites. The neurotransmitter released from the post-ganglionic...

Otitis Media Introduction

Otitis Media (OM) is an infection of the middle ear most common in infants and toddlers during the winter months. It may be either viral or bacterial. Inflammatory obstruction of the eustachian tube causes accumulation of secretions in the middle ear and negative pressure from lack of ventilation. The negative pressure pulls fluid and microorganisms into the middle ear through the eustachian tube resulting in otitis media with effusion. The illness usually follows a URI or cold. The older child runs a fever, is irritable, and complains of severe earache, while a neonate may be afebrile and appear lethargic. The child may or may not have a purulent discharge from the affected ear. Myringotomy is a surgical procedure performed to equalize the pressure by inserting tubes through the tympanic membrane. The tympanostomy tubes remain in place until they spontaneously fall out. Most children outgrow the tendency for OM by the age of 6. There is a higher incidence in children exposed to...

Transfer across biological membranes

Because only unbound drug (the free fraction) is in equilibrium throughout the body, disposition is affected by binding to or dissolving in cellular constituents. While circulating in blood, drugs may be reversibly bound to several plasma proteins. For example, basic compounds often bind to a1-acid glycoprotein acidic compounds bind to albumin. The extent of plasma protein binding varies among drugs, nicotine is 5 bound whereas the barbiturate, secobarbital, is 50 bound, and the benzodiazepine, diazepam is 96 bound.7 The fraction of drug that is bound is governed by the drug concentration, its affinity for binding sites, and the number of binding sites. At low drug concentrations, the fraction bound is a function of the number of binding sites and the dissociation constant, a measure of binding affinity. When drug concentrations exceed the dissociation constant, concentration also governs the amount of protein binding. Therefore, published protein binding fractions for drugs only...

The Explanation of Singular Occurrences Putnams

I very much doubt that the concept of explanatory relevance means what Putnam requires it to mean in this argument. When scientists discover why smoking causes cancer, they are finding out which ingredients in cigarette smoke are carcinogenic. If smoking causes cancer, this is presumably because the micro-configuration of cigarette smoke is doing the work. If there turn out to be several carcinogenic ingredients and different cigarettes contain different ones, this does not make the molecular inquiry explanatorily irrelevant to the question of why people get cancer. The fact that P is multiply realizable does not mean that P's realizations fail to explain the singular occurrences that P explains. A smoker may not want to hear the gory details, but that does not mean that the details are not explanatory.8

Clinical Presentation

Cough is probably the most common presenting symptom in lung cancer and is related to endobronchial erosion and irritation. Centrally located lesions may result in a change in a chronic cough, hemoptysis, pneumonia. More peripheral tumors may present with chest pain and or cough related to chest wall and pleural involvement. Local extension of lung cancers results is varying presentations and syndromes. Invasion of the recurrent laryngeal nerve may result in hoarseness in up to 8 of cases. Dysphagia may be an indication of esophageal extension and is seen in 1-5 of presentations. Paraveterbral extention with involvement of the sympathetic nerve plexus results in Horner's syndrome (meiosis, ptosis, ipsilateral anhydrosis). Superior vena cava syndrome results from extrinsic compression of the superior vena cava. Patients present with jugular venous distention, edema of the face neck and arms. Paraneoplastic syndromes occur in 10 of patients with lung cancer. Paraneoplastic syndromes...

Goals Of Clinical Trials

This is a randomized, parallel-group trial to demonstrate that the one-year survival of the patients with pretreated advanced (Stage IIIB IV) non-small-cell lung cancer (NSCLC) receiving the oral investigational drug is not inferior to those receiving intravenous (IV) docetaxel.

Probabilistic Explanations

For example, suppose that smoking (P) makes lung cancer (Q) highly probable and that cigarette smoke always contains one of two carcinogenic ingredients (Aj or A2), which are found only in cigarette smoke. It can easily turn out that one of these ingredients is more carcinogenic than the other.15 This means that there can be an important difference between higher-level and lower-level explanations of the same event they may differ in terms of the probabilities that explanans confers on explanandum. To see why, let us add one more detail to the example. Suppose that lung cancer can be realized by one of two types of tumor (B1 or B2) growing in the lungs. Given this, consider an individual who has lung cancer. How are we to explain why this person has that disease One possible reply is to say that the person smoked cigarettes. A second possibility is to say that the cancer occurred because the person inhaled ingredient A1. Putnam's multiple...

The Neurobiology of Substance Dependence

Tolerance, dependence, and addiction are all manifestations of brain changes resulting from chronic substance abuse and involve different brain pathways than those subserving acute drug reinforcement. Acute drug reinforcement appears to share a final common dopaminergic pathway from the ventral tegmental area of the brain to the nucleus accumbens. These acute processes are relatively unimportant for pharmacotherapy of dependence and addiction instead, the neurobiology of changes associated with chronic use forms the basis for rational pharmacotherapy. This translation of neurobiology into effective treatments has been most successful for opioids, with more limited success for alcohol, nicotine, and stimulant dependence. Opioid treatments such as metha-done, levo-alpha-acetyl methadol (LAAM), buprenorphine, and naltrexone act on the same brain structures and processes as addictive opioids, but with protective or normalizing effects. This concept of normalization is critical for...

Therapeutic drug monitoring

The effectiveness of a drug may diminish with continual use. Tolerance denotes a decreased pharmacological responsiveness to a drug. This is demonstrated by several drugs of abuse including ethanol and heroin. The degree of tolerance varies but is never complete. For example, tolerance to the effects of morphine quickly develops, but the user is not totally unresponsive to the pharmacological effects. To compensate for the development of tolerance, the dose is increased. Tolerance may develop slowly, such as in the case of tolerance to the CNS effects of ethanol, or can occur acutely (tachyphylaxis) as in the case of nicotine. In these cases, a correlation may be found between plasma drug concentration and the intensity of response at a given moment, but the relationship is not consistent and varies with time.16

Estimating the size of the treatment effect

Table 9.15 Results of the CHART lung cancer trial at approximately annual intervals during the accrual of patients to the trial from 1992 to 1995, and at the time of reporting of the results of the trial in 1997. Reprinted with permission from Elsevier Science (The Lancet, 2001, 358, 375-81) Table 9.15 Results of the CHART lung cancer trial at approximately annual intervals during the accrual of patients to the trial from 1992 to 1995, and at the time of reporting of the results of the trial in 1997. Reprinted with permission from Elsevier Science (The Lancet, 2001, 358, 375-81) Table 9.16 Estimates of when the CHART lung cancer trial would have stopped using three different approaches to monitoring together with the estimated improvement in 2-year survival Table 9.16 Estimates of when the CHART lung cancer trial would have stopped using three different approaches to monitoring together with the estimated improvement in 2-year survival

Principles Of Developmental Ly Based Psychotherapy

Make the mistake of communicating with the patient in a manner that is inappropriately abstract or basic. For example, some individuals do not have the capacity for verbal expression of emotions. They may operate on a more basic, earlier level where affect spills over immediately into behavior. They stomp and yell and scream when they are angry they cling when they are needy. They commonly don't say, I feel angry or I miss you so much that I think about you all the time. We often put those words in a patient's mouth, yet they really may not be able to abstract affect in that way. If such patients begin to act out aggressively or withdraw after the therapist's vacation, for example, offering them an interpretation like Gee, you must have missed me and are showing me your anger by stubbing out your cigarettes on my couch will go right over their heads. Patients may nod, but if they are operating at a more primitive level, they simply won't get it. It won't be a meaningful intervention...

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