The Painless Stop Smoking Cure

Quit Smoking Magic

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 Overview


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I've really worked on the chapters in this book and can only say that if you put in the time you will never revert back to your old methods.

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

Evidence of benefits from smoking cessation

Many observational epidemiologic studies have investigated the effect of stopping smoking on smoking-related diseases, and there is a wealth of evidence that, not only is tobacco smoking a major risk factor for cardiovascular disease, but also stopping smoking reduces this risk. Grade B However, there is less agreement about the rate at which the risk attenuates after smoking cessation. In the 20 year follow up of the British Doctors Study, for example, excess risk was halved within 2 or 3 years of smoking cessation, and by 10 years the risk had returned to that of a non-smoker (Figure 11.1).6 However, follow up of the cohort men in the British Regional Heart Study indicates that attenuation of risk is much slower, and even men who had given up smoking for more than 10 years still had an increased risk, compared with non-smokers (Figure 11.2).7 Following myocardial infarction (MI), smoking cessation confers substantial benefits and is particularly important. In one observational...

Specialist smoking cessation clinics

Specialist smoking cessation clinics have been shown to deliver effective interventions and can make a useful contribution to the provision of individual interventions, usually by providing regular group treatments. There is some evidence that they can achieve enhanced attendance and abstinence rates as high as 20 or more, but interpretation of their success should take account of the fact that they recruit widely and participants are generally highly motivated to stop, compared with the majority of those expressing an intention to do so. When available, they offer a self-referral and secondary referral service and can provide valuable opportunities for smoking cessation research.31 However, as they are relatively few in number in relation to the huge need for such interventions, their overall contribution will inevitably be small.

Practical aspects of smoking cessation in clinical practice

The essential features of individual smoking cessation interventions in medical practice are to assess in any medical consultation the smoking status of the patient, whether a non-smoker, smoker or ex-smoker advise all smokers about the desirability and importance of stopping smoking because of health hazards, especially those who already have smoking-related diseases assist smokers to stop smoking, particularly those with smoking-related diseases and especially if expressing interest to do so follow up at subsequent consultations to assess the outcome and, if necessary, further assist those trying to stop smoking while encouraging ex-smokers to maintain their non-smoking status.32

Late Phase Ii Clinical Trial Of S1 In Lung Cancer

The objective of this clinical trial was to examine the antitumor activity and toxicity profile of S-1 in patients with stage Illb or IV lung cancer who underwent no treatment prior to the onset of this clinical trial. Sixty-two patients were enrolled in this clinical trial, and 61 patients were treated with S-1. Fifty-nine patients were eligible for the analysis of response and toxicities. S-1 was administered orally at a dose of 40 mg m2, twice daily, i.e., once after breakfast and once after dinner. One course consisted of 28-d consecutive oral administration and of subsequent 14-d withdrawal. This regimen was repeated in four courses unless the disease progressed. Twenty-two patients with stage IIIb lung cancer and 37 patients with stage IV lung cancer were enrolled in this clinical trial. As shown in Table 11, the response rate per protocol set was 22.0 (13 59). As shown in Fig. 15, the median follow-up was 281

Videoassisted Thoracic Surgery for Lung Cancer

The majority of patients with pulmonary carcinoma present with extensive tumor burden that is centrally located. A minority of patients present with asymptomatic, peripheral tumors. Approximately 37 of solitary lung nodules represent primary lung carcinoma. Therefore these lesions require accurate histological diagnosis for effective treatment. The incidence of lung cancer increases with age and smoking habits. Early diagnosis is imperative as patients with solitary, peripheral lung lesions have the best outcomes following proper treatment. Most if not all operations performed through conventional thoracotomy are possible using VATS. Although technically more demanding initially, VATS is a reasonable surgical option for pulmonary carcinoma. Without 10-year survival data, many thoracic surgeons believe that VATS should be limited to patients with stage IA or IB tumors (T1N0 and T2N0, respectively). Stages I and II tumors are confined to lung parenchyma without mediastinal or...

Nicotine replacement therapy NRT

The advent of nicotine chewing gum in the 1970s provided the first specific pharmacologic treatment for smoking cessation. Grade B Subsequent development of transdermal nicotine patches, nicotine nasal sprays, and nicotine oral inhalers has increased the range of products available. The objective in using these nicotine replacement products is to provide a temporary alternative source of nicotine to allay withdrawal symptoms and so enhance the potential for smoking cessation. Large placebo-controlled trials have clearly demonstrated that the use of such products as an adjunct to advice from a health professional can approximately double smoking cessation rates, compared with placebo.21,22 Several systematic reviews of the many trials that have now been conducted with them have confirmed the benefits and shown that all preparations are effective, but the evidence is particularly substantial for nicotine gum and nicotine patches.23,24 Both appear to have similar effectiveness but,...


Although -nicotine is the predominant natural isomer, the occurrence of some d-nicotine makes it of interest to develop enantioselective assays for this compound. A review of nicotine and cotinine assays has been given (42), An early report of an RIA for -nicotine described an immunogen prepared from 6-aminonicotine. This compound was converted to 6-(p-aminobenzamido)nicotine and conjugated to albumin Fig. 4 8b ) by diazotization (43), The enantiomeric purity of the 6-aminonicotine was not discussed, and the synthesis of 6-aminonicotine is reported to cause racemization (44). However, the antiserum eventually obtained showed only 6 cross-reaction with d-nicotine (43). A racemic nicotine analog, ra s-3 - h y d roxy methy 1 - n i coti ne, was converted to the hemisuccinate, which was conjugated to protein to form an immunogen (Fig. 4 8c ). The resulting antiserum was used with tritiated -nicotine as radioligand. With this radioligand the assay was highly selective for -nicotine, with...

Tobacco and Nicotine

Tobacco is one of the most powerful stimulant plants known, and nicotine its active principle is one of the most toxic of all drugs. An average cigar contains enough nicotine to kill several people. When tobacco is smoked, most of the nicotine is destroyed by the heat of burning. (To kill people with a cigar, you'd have to soak the cigar in water till it turned dark, then make people drink the liquid.) Nicotine is so strong and dangerous that the body very quickly develops tolerance to it to protect itself. If a person begins smoking regularly, tolerance to the poisonous effects of nicotine develops in a matter of hours (as compared to days or weeks for heroin and months for alcohol). In the form of cigarettes, tobacco is the most addictive drug known. It is harder to break the habit of smoking cigarettes than it is to stop using heroin or alcohol. Moreover, many people learn to use alcohol and heroin in nonaddictive ways, whereas very few cigarette smokers can avoid becoming addicts....

Lung cancer

Cancer of the lung is the leading cause of cancer-related death in males and the incidence is rising in females. Regrettably it is closely related to tobacco smoking and control in the future depends largely on government measures to reduce tobacco consumption. From a practical point of view, lung cancers are categorized as small or non-small cell cancers. Table 18.2. World Health Organization histologic classification of lung cancer.

Cardiovascular Disease

Der, and genetic background cannot be changed, treated, or modified (16). Others, for example, smoking, high serum cholesterol, high blood pressure, physical inactivity, obesity, and overweight, are under some control by the individual. Smokers have twice the risk of heart disease compared with nonsmokers. Nearly one-fifth of all deaths from cardiovascular diseases (180,000 deaths per year) are attributable to smoking (14). Surveillance data indicate that an estimated 1 million young people become regular smokers each year (14).

The Persistence of Time

An example of interval timing data collected from an adult participant (ALB) diagnosed with attentional-deficit disorder (ADD) using the PI procedure is shown in Figure 1. The top panel illustrates percent maximum response rate for ALB in an unmedicated state (NicPre) plotted as a function of 7-s and 17-s criteria trained using methods reported by Levin et al, 1996, 1998 Rakitin et al., 1998. In this procedure, a blue square presented on a computer monitor is transformed to magenta at the appropriate criterion time during fixed-time training trials. Thereafter, participants are requested to reproduce the temporal criterion for a sequence of test trials for which a distribution of their responses is plotted on a relative time scale immediately following the trial during the inter-trial interval (ITI). This ITI feedback is displayed on the computer monitor and provides the participant with information concerning the relative accuracy and precision of their temporally-controlled...

Understanding the mechanisms of breathlessness Why should we care

A 72-year-old former smoker with end stage obstructive lung disease comes to see her physician for a routine visit. She says she feels much worse as of late. Her last spirometry testing revealed her one second forced expiratory volume to be 600 milliliters, a decline in her lung function brought on by her smoking three packs of cigarettes per day for 50 years. She now must wear oxygen even at rest. Even when she feels her best, she is only able to walk up one flight of stairs before she must stop and catch her breath. However, over the past few weeks she can only go up a few steps at a time.

Obtaining incremental information from diagnostic tests

A 75 year old male presents with a history of exertional chest pain. The patient describes substernal chest pain that he perceives as a pressure sensation occurring when he walks too fast, uphill, or in the cold. It is relieved by rest within a few minutes. On two recent occasions, he tried a friend's nitroglycerin tablets, and obtained even more rapid relief of his symptoms. His symptoms have never occurred at rest. The patient has a history of diabetes mellitus, hypertension, and hypercholes-terolemia. He smokes one pack of cigarettes a day. Several male family members died of coronary artery disease before the age of 60. The patient underwent carotid artery surgery a year ago for treatment of transient ischemic attacks.

Chemical Carcinogenesis by Mixtures Defined and Undefined

While most of this chapter concerns itself with the carcinogenic action of specific chemicals, it is relatively unusual that an individual is exposed to a single carcinogenic agent. Despite this fact, relatively few detailed studies on mixtures of carcinogenic chemicals have been carried out experimentally. The most common environmental mixtures are those seen in tobacco smoke and other combustion products, including engine exhaust and air pollution (Mauderly, 1993). Interactions between chemicals in mixtures may be additive, multiplicative, or inhibitory (Mumtaz et al., 1993). In the examples given above, however, the exact chemical nature of components in tobacco smoke or air pollution is not always known, nor are their amounts determined. Thus, one may be forced to deal with a mixture as if it were a single entity or, if the constituents are known, to treat the effects of the mixture in some empirical way usually related to the most potent component of the mixture. Studies on the...

Age of Cancer Incidence

The fifth section discusses how carcinogens alter the incidence of cancer at different ages. The best data on human cancers come from studies of people who quit smoking at different ages. Longer duration of smoking strongly increases the incidence of lung cancer. Interestingly, among nonsmokers, the acceleration of cancer does not change as individuals grow older, whereas among smokers, the acceleration tends to rise in midlife and then fall later in life. I also discuss incidence data from laboratory studies that apply carcinogens to animals. These studies show remarkably clear relationships between incidence and dose. Dose-response patterns provide clues about how mechanistic perturbations to carcinogenesis shift quantitative patterns of incidence.

Many Roles Many Rewards

The professional rewards of a career in epidemiology are the excitement of discovery and the knowledge that epidemiologic studies can be used to help people improve or maintain their health over time. Epidemiologic research has significantly improved the public's health over the past century. Research results have been used to identify new medicines to treat disease, to educate the public about the health effects of cigarette smoking and inactive lifestyles, and to improve sanitation and water treatment, significantly reducing the burden of infectious disease in heavily populated areas. see also Gene and Environment Population Screening Public Health, Genetic Techniques in Statistical Geneticist.

Preoperative Management Of Specific Problems

The morbidity and mortality of deep vein thrombosis and pulmonary embolism make it mandatory to provide prophylaxis against these catastrophes. Patients at high risk include older individuals, those with previous abdominal surgery, varicose veins, increased antithrombin III levels, history of cigarette smoking, and high platelet counts. The risk is increased in patients older than 40 years who undergo general anesthesia for more than 30 min.

Clinical Significance

Conditions such as abdominal pain, increased intracranial pressure, thyrotoxicosis, and hyperkalemia, which increase vagal tone, may exacerbate the abnormalities of SSS and cause increased symptoms. Drugs such as digoxin, quinidine, procainamide, disopyramide, nicotine, b-adrenergic antagonists, or calcium channel blockers also cause increased symptoms.

Physiology of breathlessness in advanced disease

Understanding not only of the individual pathophysiologic mechanisms responsible for breathing discomfort, but also of the complexity of the physiology of any given patient in whom multiple processes are occurring at once. Patients with lung cancer who develop breathlessness, for example, may have a number of physiologic derangements. Some are irreversible, such as hyperinflation and airflow limitation from underlying COPD, or partially reversible, such as hypoxia and cardiovascular deconditioning. Some, however, may be quite reversible with appropriate treatment. Drainage of a malignant pleural effusion may improve gas exchange, facilitate expansion of the lung, and decrease hyperinflation of the chest wall.

Low penetrancemodifier genes

Polymorphisms in the N-acetyltransferase (NAT2) gene are associated with an altered rate of metabolism of carcinogens, with wild-type alleles producing a rapid acetylator phenotype and homozygosity for combinations of variant alleles resulting in a slow phenotype. It has been shown that there is a statistically significant interaction between acetylator status among BRCA1 carriers and the number of packs of cigarettes they smoke per week, duration of time they had smoked, or age at which they started smoking. This suggests that BRCA1 carriers who smoke are at increased risk of breast cancer if they are slow acetylators (Ambrosone et al., 1996 Rebbeck et al., 1997 Ambrosone et al., 1998).

Breast Cancer and Its Treatment

It is the second leading cause of cancer death among women (representing 15 of all cancer deaths), compared to 25 of cancer deaths from lung cancer (American Cancer Society ACS 2004). Estimated deaths from breast cancer in 2003 were 39,800 for women and 400 for men. Mortality rates for breast cancer declined significantly in recent years, mostly among young women, both white and black, falling 1.4 annually in 1989-1995 and then at a rate of 3.2 annually. Survival for women with breast cancer varies as a function of the stage of the disease at diagnosis. The ACS data show 5-year relative survival rates of 86 for all stages, 97 for local, 78 for regional, and 23 for distant (or metastasized) Breast cancer is the leading type of new cancer among women. The ACS estimated that 211,300 new cases of invasive breast cancer would occur among women and 1300 among men in the United States in 2003 (ACS 2004). New cases of breast cancer represented one third of...

Prothrombotic factors

Several prospective studies have demonstrated an association between fibrinogen and CHD. Increased concentrations are associated with glucose intolerance, cigarette smoking, and hypercholesterolemia. A fibrinogen concentration of > 3.1 g l is associated with relative risks of CHD of 1.6 in men and 2.9 in women.

Interactions between the NMTs Are Common

Other examples of cross talk can be found between cholinergic and monoaminergic systems. For example, applications of nicotine in the vicinity of the axon terminals of noradrenergic neurons facilitate noradre-nergic release and glutamatergic neurotransmission. In addition, GABA, an inhibitory neurotransmitter,

Addiction and dependence

Beyond the health consequences for adults, smoking is a serious threat to young people on several levels. Despite widespread antismoking programs, 14.9 percent of teenagers smoke on a regular basis. Unfortunately, many youth perceive low risk of dangers from smoking and others start smoking tobacco cigarettes after smoking safe marijuana.

Prevalence Of Risk Factors In Patients With Premature

A large study of the prevalence of modifiable risk factors in US men with angiographically documented coronary artery disease before the age of 60 showed that virtually all had one or more risk factors.11 Compared with controls, the frequency of hypertension was 41 v 19 , of diabetes 12 v 1 , of cigarette smoking 67 v 28 , and of a low HDL cholesterol 63 v 19 . However, the frequency of a raised LDL cholesterol was similar in the two groups, 26 v 26 , reflecting the high prevalence of hypercholesterolaemia in the general population.

Factors Such As Charge That Affect Drug Absorption Distribution And Excretion

Charged drugs or other molecules do not readily pass through lipid membranes. However, this often leads to the mistaken conclusion that drugs that are strong acids or bases, i.e., mostly ionized at physiological pH, will not be absorbed from the gut or pass the blood-brain barrier. If a drug is a strong base and has a p a of 9.4, the ratio of ionized to un-ionized will be 100 1 at pH 7.4, but that still means that approximately 1 of the drug is un-ionized and free to go through a lipid membrane. And there is always about 1 that is un-ionized because the equilibrium is virtually instantaneous therefore, the effect of the drug being a strong base or acid is that it decreases the effective concentration available to diffuse across the membrane. This slows the rate of diffusion but not the ultimate amount absorbed given adequate time for absorption. With absorption from the gut, the surface area is quite large and transit time in the small intestine, where most absorption occurs, is...

Fruits And Vegetables

By inducing detoxifying enzymes, or by blocking the carcinogen from reaching target tissue. Tumor promotion may be inhibited by retinol and beta-carotene (green yellow vegetables and fruits), tocopherol (nuts, wheat germ), vitamin C (vegetables, fruits), organosulfur compounds (garlic, onions), curcumin (tumeric, curry), and capsaicin (chili peppers). Covalent DNA binding is inhibited by phenyliso-thiocyanate (broccoli, cabbage), ellagic acid (fruits, nuts, berries), and flavonoids (fruits, vegetables). Biotransformation of potential carcinogens is inhibited by indole-3-carbinol (cruciferous vegetables). Thus, citrus fruit contains carotenoids, but it also contains flavonoids, glucarates, terpenes, and phenolic acids. Does protection require one or more of these plus carotenoids Studies along this line of reasoning are virtually unknown. Perhaps studies of combinations of protectants will yield an answer where studies of single substances haven't. Block et al. (49) compiled an...

Pre Existing Lung Disease

Bronchospasm may occur in asthma, COAD, smokers and in patients with acute respiratory infection. It is commonly precipitated by upper airway irritation either during airway manipulation or if secretions are present. Other causes of wheeze include aspiration, pulmonary oedema, and bronchospasm associated with anaphylaxis. Treatment of bronchospasm will depend on the underlying cause and the severity but should include supplemental oxygen and inhaled bronchodilator therapy.

Decision analysis in the evaluation of specific products

The authors concluded that significant potential benefits in life expectancy in coronary artery disease reduction, combined with the osteoporosis prevention in symptom relief, would point to greater emphasis on postmenopausal estrogen use in appropriate patients. Since the report by Zubialde et al22 hormone replacement therapy has undergone additional study. A growing body of literature suggests that its predicted effects have not been fully realized,23'24 and the results of a recent polymorphism study have further complicated matters.25 It bears repeating here that the reliability of a decision analysis is related directly to the quality of the data on which the analysis is based. The Zubialde analysis was based on the best data of its time, but superior data from clinical trials have since called the findings into question.

Summary of Known Relations between Diet and Cancer

See also Alcohol Disease Risk and Beneficial Effects. Cancer Epidemiology of Gastrointestinal Cancers Other Than Colorectal Cancers Epidemiology of Lung Cancer Effects on Nutritional Status. Dietary Fiber Potential Role in Etiology of Disease. Dietary Surveys. Vegetarian Diets.

Theoretical Bases

Although there is some evidence that covert sensiti-zation may lead to a favorable outcome in patients with addictions and deviant sexual interest a number of theoretical issues remain unresolved, which cast doubt on the presumed theoretical underpinnings of covert sen-sitization. First, although scene presentation in covert sensitization includes aversion relief, the addition of this component to the overall effectiveness of the procedure has not been evaluated. Moreover, Emmelkamp and Walta found that the effects of covert sensitization could better be explained by cognitive factors such as outcome expectancy than by conditioning. In their experimental study, half of the participants (smokers) were led to believe that they participated in an experimental study on the physiological effects of imagining smoking scenes, whereas the other half were informed that they received a bonafide treatment. All participants were treated with covert sensitization. Only the smokers who expected...

The Potential Therapeutic Role of Vitamins

Although vitamins in food, especially vegetables and fruits, have been shown to be beneficial in reducing the incidence of particular types of cancer when included in the diet, the beneficial effects have not always been shown with vitamin and mineral supplements. Some supplements may promote tumor growth, as was seen in a study using -car-otene supplementation in patients with lung cancer. Supplementation increased the rate of tumor recurrence in such patients. See also Cancer Epidemiology and Associations Between Diet and Cancer Epidemiology of Gastrointestinal Cancers Other Than Colorectal Cancers Epidemiology of Lung Cancer Effects on Nutritional Status. Cobalamins. Colon Nutritional Management of Disorders. Diarrheal Diseases. Eating Disorders Anorexia Nervosa. Folic Acid. Nutritional Support Adults, Enteral Adults, Parenteral Infants and Children, Parenteral. Supplementation Dietary Supplements. Vitamin B6. Vitamin D Physiology, Dietary Sources and Requirements. Vitamin E

Carcinogens Produced by Food Processing

Cooking foods in hot oils has also been found to generate a range of carcinogenic chemicals. Many of these are volatile and may therefore represent more of a hazard to the cook than to the food consumer. Thus, cooking with unrefined rapeseed or soya bean oil, which contain significant levels of the polyunsa-turated fatty acid linolenic acid, has been shown to result in the release of aldehydes including formaldehyde, acetaldehyde and acrolein, hydrocarbons including 1,3-butadiene and benzene, and other chemicals. Many of these compounds are mutagenic to bacteria and carcinogenic in animals, and in areas of the world where such cooking practices are common (e.g., China), the incidence of lung cancer in the exposed population is high.

Phase IV cardiac rehabilitation

Phase IV CR is the long-term maintenance of risk factor modification, with long-term follow-up in primary care. For the benefits of physical activity and lifestyle change to be sustained, the available evidence suggests that both need to be maintained (SIGN, 2002). As clinically indicated, referral to specialist clinicians, such as smoking cessation or psychological support, may still be required (DoH, 2000). This stage is likely to be the most informal stage of cardiac rehabilitation, where there is long-term maintenance of individual goals and monitoring of clinical issues and risk factor modification, mainly by the primary healthcare team (BACR, 1995). It is important that the patient is aware of the exact nature of the follow-up system available.

Mechanisms Of Stressrelated Immune Alterations

Stress can also affect immunity indirectly by leading to negative health behaviors that can contribute to alterations in immune functioning. Stress is typically associated with riskier health behaviors, including increased drug alcohol use, increased smoking, poorer sleep, and poorer nutrition. These behaviors can also negatively affect the immune system, although the relationship between individual health risk behaviors and immunity is often not clear. Partial sleep deprivation has been shown to decrease immune functioning in humans and rats, and poor sleep has been hypothesized as one mechanism through which repeated, intrusive thoughts may impact immunity. The immu-nological effects of cigarette smoking, on the other hand, have been particularly mixed, with research reporting decreases, increases, and no change in immune functioning. Some of this variability may be due to differences in the amount of smoking, acute versus chronic effects of smoking, and the timing of sampling in...

Hydrocarbon Carotenoid bCarotene

Fi-Carotene is one of the most widely studied carot-enoids - for both its vitamin A activity and its abundance in fruits and vegetables. Epidemiological studies have often pointed to an abundance of carot-enoids in the diet being protective against many diseases. Diets rich in fruits and vegetables are recommended to reduce the risk of cardiovascular disease and some forms of cancer. However, when fi-carotene is removed from the plant matrix and administered as a supplement, these benefits sometimes disappear. For example, because lung cancer is Carotenoid Cardiovascular disease Cataract Macular degeneration Lung cancer Prostate cancer Carotenoid Cardiovascular disease Cataract Macular degeneration Lung cancer Prostate cancer

In a public health context

Psychoactive drugs differ in their metabolic pathways and mechanisms of action in the human body, the strength of their effects, and the states of mind and feelings they induce. However, the effects of drug use also are highly dependent on the pattern of use and on the set and setting, that is, the expectations of the user and of others who are present and the context of use (Zinberg). Although the psychoactive effect of tobacco may not register in the consciousness of a habituated cigarette smoker, in other circumstances the effect of tobacco use may be so strong that the user is rendered unconscious, as early Spanish observers reported in describing tobacco use among native South Americans (Robicsek).

Addiction as a Modern Governing Image

In popular thinking and often in official definitions addiction has remained a property of the drug for illicit drugs but of the person for alcohol (Christie and Bruun). The inherent addictiveness attributed to illicit drugs is the primary rationale for their prohibition. The extent of the anathema imposed in U.S. cultural politics by labeling a substance as addictive can be gauged from the unanimous testimony of cigarette company executives to the U.S. Congress in 1994 that they did not believe that cigarettes are addictive despite the evidence of their own corporate research (Hilts).

Transmission Across Synapses

The cholinergic receptors present on skeletal muscles and in autonomic ganglia are activated by nicotine and are blocked by the antagonists tubocurarine and hexamethonium. On the other hand, cholinergic receptors on many end organs are activated by muscarine and are blocked by the antagonist atropine. Thus, these receptors are referred to as nicotinic-cholinergic and muscarinic-cholinergic receptors, respectively. Nicotinic-cholinergic ACh, nicotine

CVD profile at different stages of the epidemiologic transition

In the third phase (the age of degenerative and manmade disease), accelerated economic development and increased per capita incomes promote lifestyle changes in diet, physical activity, stress and addictions. A diet rich in calories, saturated fat and salt is accompanied by reduced physical activity through the increased use of mechanized transport and sedentary leisuretime pursuits. The metabolic mismatch leads to obesity, increased blood lipids, diabetes and elevated blood pressure. Tobacco consumption, especially cigarette smoking, starts as a pleasurable pastime and turns into a severe addiction. These factors result in the onset of clinically manifest atherosclerotic vascular disease (CHD, atherosclerotic stroke and peripheral vascular disease) at around 55 years of age. Such patterns first occur in the upper socioeconomic classes, who have disposable income to expend on rich diets, tobacco and transport vehicles. Several countries in South America and Asia currently manifest...

Elicit a Medical History

The patient reports no past medical history. He has not seen a doctor since he was a child and has had no hospitalizations and no history of past surgeries. He reports smoking a half of a pack of cigarettes per day, moderate alcohol use, and occasional drug use, including marijuana and cocaine. He takes no medications except for an over-the-counter multivitamin daily and ibuprofen for the occasional headache and muscle pain. He has no known drug allergies. At the same time that you have been learning the medical history, a nurse has been putting in two large bore IVs and starting intravenous fluids for resuscitation. What next

The Role of Pharmacogenetics in Multifactorial Neoplasia

More than two decades ago, a report indicated that high inducibility of the aromatic hydrocarbon hydroxylation pathway was a significant risk factor for human lung cancer (Kellerman et al., 1973). These studies were performed with human lymphocytes, and it was assumed that changes seen in this peripheral tissue reflected changes in the lung, since a high level of inducibility of AHH in lymphocytes was more frequently observed in lung cancer patients than in patients with other diseases. These results became quite controversial, since others were unable to reproduce these data, but more recent studies in Japan have related a specific mutation in a codon of exon 7 in the cytochrome P-450IA1 gene exhibits a different geno-typic distribution between controls and lung cancer patients, as noted in Table 5.12 (Hayashi et al., 1992). The mutation in the gene is the result of a transition from an adenine residue to that of a guanine, resulting in a change from an isoleucine (Ile) to a valine...

Father son iridium and impact

One evening in 1977, Walter Alvarez brought a small specimen the size of a packet of cigarettes, from the Gubbio section, to his father Luis, the famous Berkeley physicist and Nobel laureate. The geologist son pointed out to his physicist father the sequence in which several centimeters of white limestone were followed by a thin layer of darker clay 2 cm thick, and finally by several centimeters of reddish limestone. Under the magnifying glass, they could see Cretaceous Foraminifera in the white strata, but nothing in the clay. Above this began the Cenozoic layer, and with it the slow resumption of life. Luis Alvarez was holding in his hand a small piece of evidence of the end of the Mesozoic, possibly contemporary with the last dinosaur (Fig. 2.1). In his autobiography,2 he would write how this moment

Friends of Cyber Angel

Cyber-Angel, which she installed on her portable handheld. One such client, Steven, who now volunteers for Cyber-Angel, ceased smoking under Heidi's care and got in the habit of performing stretching exercises on a daily basis as directed by Heidi. Soon, Steven moved out of his group home, altering his diet and daily habits. He found a job at the local supermarket and told Heidi that he would volunteer his time to help others like himself benefit from Cyber-Angel. He was encouraged to register as a fundraising volunteer in order to keep Cyber-Angel active and to perform tasks similar to John's. Steven even became a health activist in his old neighborhood, raising awareness of the adverse effects of smoking among the smokers he had been living with at the group home.

Current global burden of tobacco and future projections

About half of these deaths will be in middle age (35 to 69) rather than old age, and those killed by tobacco in middle age lose, on average, more than 20 years of non-smoker life expectancy.1 Tobacco use is estimated to have caused about 4 million deaths a year, more or less evenly split between developed and developing countries. These numbers reflect smoking patterns several decades ago, and worldwide cigarette consumption has increased substantially over the past half century.2 Currently, about 30 of young adults become persistent smokers, and relatively few quit. The main diseases by which smoking kills people are substantially different in America, where vascular disease and lung cancer predominate 1 in China, where chronic obstructive pulmonary disease causes even more tobacco deaths than lung cancer 3,4 and in India, where almost half the world's tuberculosis deaths take place and the ability of smoking to increase the risk of death from TB may...

Tobacco a risk factor for coronary heart disease

It is well established that prolonged smoking is an important cause of chronic disease. Prolonged smoking causes many diseases in addition to lung cancer, notably other cancers and chronic respiratory and cardiovascular diseases. However, the toll of death and disability from smoking outside the high income countries has yet to be felt. This is because the diseases caused by smoking can take several decades to develop. Even when smoking is common in a population, the damage to health may not yet be visible. The alarming size of the hazards now observable in populations that have been smoking for many decades. Thus in the first 20 years of follow up of the British doctors, cohort (1951-71), smokers had, on average, about a 1-5 to twofold higher death rate at each age, similar to the excess reported in other studies around that time (see Table 10.1). With longer duration of smoking, death rates of smokers have increased substantially so that during the second period of follow up...

Evidence From In Vivo Studies With Humans

A cross-sectional study of smokers (N 30) and nonsmokers (N 30) showed a significant inverse relationship between chromosome aberrations and blood folate status and that smoking and blood folate status are interrelated in their association with chromosome fragility. In this study of ex vivo expressed DNA damage, the cells were cultured in low folate medium and the results may therefore reflect the expression of fragile sites within chromosomes (25). A cross-sectional study on buccal mucosal folate and vitamin B12 and its relation to micronucleus frequency in buccal cells revealed that buccal mu-cosal folate and vitamin B12 are significantly lower in current smokers than in noncurrent smokers (29). Although current smokers in this study were three times more likely to have micronucleated buccal cells, this chromosome damage index was not associated with localized folate and vitamin

Puberty and Adolescence

In adolescence (badanegootyoon) boys have more freedom than girls. A girl's freedom of movement, already limited in childhood, is further restricted in adolescence. Teenage girls are expected to come home directly after school and to keep their parents informed of their whereabouts at all times. If a girl has older brothers, she is expected to obey them as she obeys her parents and to respect their opinions. Meanwhile, a boy regardless of age, is expected to protect his sisters and to guard their honor, which often means fighting with other boys. During adolescence, boys begin to smoke cigarettes and drink alcohol. Since there is no enforced legal drinking age, boys spend a great deal of time drinking with friends in caf s and bars. Increasingly, girls are also beginning to spend time in caf s and bars either with their boyfriends or with a group of girlfriends. However, girls generally frequent bars and caf s where parents, neighbors, or relatives will not see them and, unlike boys,...

TABLE 712 Causes of Gastroesophageal Reflux Disease

Comprehensive treatment of reflux disease involves decreasing acid production in the stomach, enhancing upper tract motility, and eliminating risk factors for the disease. As noted above, mild disease is often treated empirically. H 2 blockers or proton-pump inhibitors are mainstays of therapy. Dosage is titrated for each patient. A prokinetic drug may also greatly decrease symptoms. Simple discharge instructions should be given to all patients thought to be experiencing reflux-related symptoms Avoid agents that exacerbate GERD (ethanol, caffeine, nicotine, chocolate, fatty foods), sleep with the head of the bed elevated (30 ), and avoid eating within 3 h of going to bed at night. Management of Barrett's esophagus includes intensive treatment of the underlying GERD with proton-pump inhibition. Often, laser or photodynamic ablation therapy and surgical treatment are employed as well. Close monitoring for dysplastic changes is essential.

Gender Related Social Groups

For most urban women, their nonkin gender-related social groups are comprised of their friends from high school and college. Until marriage, most young urban women maintain these relationships and consider their friends as confidantes and helpers. After marriage, young women have a difficult time maintaining their friendships because of the double burden of housework and work outside the home. After marriage, women develop friendships with their female neighbors. Female neighbors drink coffee together, smoke cigarettes, and trade gossip. Neighbors also often lend money to one another, baby-sit one another's children for short periods of time, and help each other in preparing feasts.

The nature of tobacco smoking

Tobacco smoking is a complex behavior to which psychologic, social, and pharmacologic factors contribute.14 Its acquisition is almost invariably in adolescence, as the result of desire for experimental rebellious behavior, which is perceived as adult and encouraged by peer group pressure. However, pharmacologic addiction usually then becomes a factor determining persistence of the behavior, making it difficult to stop because of the addictive effects of nicotine and the discomforts associated with withdrawal. Although the balance between psychologic factors and pharmacologic addiction varies from smoker to smoker, there is now increasing awareness of the importance of nicotine addiction in maintaining smoking behavior, and the powerful nature of this addiction has been compared with addiction to heroin or cocaine.15


Phenotyping using caffeine showed no difference in CYP1A2*1F metabolic activity between different genotypes in nonsmokers but a significant difference in smokers homozygous for the A allele compared with the other genotypes in terms of a 1.6-fold increased activity.1-17-1 Unexpectedly, another study demonstrated a lower in vivo activity in patients with colorectal cancer than in healthy controls. 19

Community interventions

Community- or population-based smoking cessation interventions have been implemented in a number of settings. Typically, they involve use of mass media to promote public awareness and education, to encourage health professionals to raise smoking as an issue in consultations with patients, and to offer self-help materials. Evaluation of the effectiveness of such programs is difficult and they are discussed in Chapter 10. Contented smokers Relapsing

Review of cessation studies

Grade A In a comprehensive systematic review of 188 randomized controlled trials of the efficacy of a wide range of interventions aimed at helping people to stop smoking, it was concluded that simple advice, even on one occasion only, given by a doctor in general or family practice or in a hospital clinic to all smokers who consulted, resulted in sustained cessation of about 2 and that additional encouragement and support (additional visits, exhaled CO measurement, letters, etc.) further enhances this effect.28 Whether similar interventions delivered by nurses are equally effective remains uncer-tain,29 although there is evidence that nurse support, subsequent to doctor advice, can enhance the effect of this.30 This comprehensive review25 also endorsed the use of nicotine replacement therapy but concluded that a variety of other smoking cessation interventions - hypnosis, acupuncture, aversion therapy, and pharmacologic agents other than nicotine, which are sometimes advocated - have...

Cns Effects Of Nonbrain Cancer

Certain types of cancers cause brain dysfunction indirectly, causing paraneoplastic brain disorders. It has been estimated that 10 of cancer patients develop such a syndrome. Most commonly associated with small cell lung cancer (SCLC), paraneoplastic brain disorders typically manifest as a diffuse ence-phalomyelitis, including limbic encephalitis, cerebelli-tis, brain stem encephalitis, myelitis, and sensory or autonomic ganglionitis. The cognitive deficits associated with these disorders are of two types. Some patients develop a gradually progressive subcortical dementia that is difficult to distinguish from dementia due to other causes. The second form, paraneoplastic limbic encephalitis, is often characterized by the subacute, progressive onset of anxiety, depression, confusion, hallucinations, recent memory loss, or seizures. The onset of symptoms can precede the diagnosis of cancer even by years. These disorders have an autoimmune pathogenesis and are associated with high titer...

Pathological Characteristics

The pathogenesis of cerebral aneurysms is incompletely understood but is likely complex and multi-factorial involving a congenital predisposition and superimposed environmental factors. Evidence for a congenital component arises from observations of familial cases and the increased incidence ofaneurysms in disorders such as autosomal-dominant polycystic kidney disease, fibromuscular dysplasia, aortic coarc-tation, and connective tissue disorders such as Mar-fan's syndrome and Ehlers-Danlos syndrome. In support of an environmental component, data reveal a clear age-related component (increased incidence with increasing age and rarity of aneurysms in children) and the de novo development and or growth of aneurysms after unilateral carotid occlusion. Additionally, cigarette smoking has been consistently reported to confer predisposition to aneurysmal SAH in large series across different populations. Furthermore, injury to the vessel walls by various insults, such as infection, trauma,...

High density lipoprotein cholesterol

There is an inverse association between HDL cholesterol (or apolipoprotein A1) and ischemic heart disease. An absolute increase corresponding to 0-12mmol l (about 10 of the average value) is associated with about a 15 decrease in the risk of ischemic heart disease at age 604'30 or a 20 decrease with adjustment for the regression dilution bias.30 The effect of alcohol in increasing HDL cholesterol is the major mechanism for the lower risk of heart disease in drinkers.31 The effect of smoking in decreasing HDL cholesterol contributes to the excess risk of heart disease in smokers. The statin cholesterol lowering drugs increase HDL cholesterol relatively little. Certain other cholesterol lowering drugs (such as fibrates and niacin) increase HDL cholesterol more, but even in persons with relatively low HDL cholesterol the overall protective effect of these drugs is smaller because they reduce LDL cholesterol less, and so they should not be preferred to statins.

Lipids as screening tests

Serum cholesterol reduction is important in reducing the risk of ischemic heart disease, but cholesterol and other lipids are poor population screening tests for ischemic heart disease. The reason for the apparent discrepancy is that the screening potential of a factor depends not only on the strength of its relationship with disease, but also on its variation in magnitude across individuals in a community. In the case of lipids, the high average values in western societies place everyone at risk, and the variation between individuals is too small for use in population screening. By analogy, if everybody smoked between 15 and 25 cigarettes per day, cases of lung cancer would not cluster in the minority who smoked 25 cigarettes a day to the extent that those who smoked 15 or 20 could be ignored. Moreover, the Gaussian distribution of serum cholesterol means that many people have values around the average and few have relatively high values, so that most ischemic heart disease events...

Computers and Internet Use Among Seniors

Prochaska, DiClemente, Velicer, and Rossi (1993) used a computer program to individualize self-help materials for community-based adult smokers, although participants did not actually interact with a computer. A questionnaire was administered to determine subjects' readiness to change their smoking behavior, and then they were randomly assigned to one of four study groups. Compared with subjects in the group that received standardized manuals, subjects in the three other groups who were given various forms of summarized versus detailed computerized information and with or without repeated follow-up, regardless of their readiness to change, had significantly higher quit rates after six months and after twelve months. This indicates that detailed information and repeated follow-up was the most helpful in changing smoking behaviors. Schneider, Schwartz, and Fast (1995) developed a computerized, telephone-based, interactive smoking cessation program, using a toll-free call to activate the...

Factors associated with dyspnea

Few studies have examined the factors associated with dyspnea in patients with cancer.11'13'17'19-24 Some of these have found that dyspnea in cancer patients has diverse etiologies, commonly with more than one factor contributing to the breathlessness.17,20 In one study the prevalence of dyspnea was strongly related to the number of risk factors a patient had.11 Most studies have found that lung or pleural involvement with cancer is associated with the presence of dyspnea.11'13'17'19'20 Escalante and associates found that the most common cause of shortness of breath in a group of patients presenting to an emergency room in lung cancer patients was their underlying disease (64 per cent) in breast cancer patients, pleural effusions (31 per cent) and in other cancers, lung metastases (20 per cent).17 Dudgeon and colleagues found that shortness of breath was significantly more common among cancer patients with a history of smoking, asthma, or chronic obstructive pulmonary disease, lung...

Serotonin and drugs of abuse

Regarding other types of drugs of abuse, the 5-HT3 antagonist MDL 72222 has been shown to block place preference conditioning induced in rodents by morphine or nicotine without affecting the preference for amphetamine. It is possible that these effects of 5-HT3 antagonists are associated with the reduction in dopamine release as it is well established that the rewarding effects of many drugs of abuse are due to increased dopaminergic activity in limbic regions. On the strength of the experimental findings, it has been proposed that 5-HT3 antagonists might be useful in treating drug abuse in man. Only appropriate placebo-controlled studies of 5-HT3 antagonists will clarify the therapeutic value of such agents in different types of drug abuse.

Bronchogenic Carcinoma

Luomanen and Watson report that of 676 patients who died of lung cancer, only 2.2 revealed metastases to the colon at autopsy. These were often small, serosal deposits. Metastases may infrequently be seen as focal stenosis, mural rigidity, or annular narrowing260 (Figs. 4-228 through 4-230). Occasionally, they result in large mesenteric masses with infiltration of the bowel wall and fixation and angulation of the bowel and its mucosal folds (Fig. 4-231). In such cases, the findings are indistinguishable from those in widespread intraabdominal metastases from other sources. Rarely, central ulceration may be seen in the submucosal deposits (Fig. 4-232), which may lead to perforation.236,258

Epidemiology in Food and Nutritional Toxicology

Some examples of human epidemiological studies used in food and nutritional toxicology include linking aflatoxin B1 with liver cancer, food colors with allergic reactions, and prevention of lung cancer by carotenoids. Although links or correlations can be obtained by using epidemiological tools, the major disadvantage of epidemiological studies is the variety of things humans are exposed to, making it difficult to isolated effects of a specific substance on a population. Also, variability in population will affect the outcomes of epidemiological studies. Although epide-miological studies have limitations, they often can be used to corroborate the results of animal-based experiments.

Studies on the Role of Exercise Fitness in the Etiology of Coronary Heart Disease

Coronary heart disease (CHD) has a multifactorial etiology, and major 'biological' risk factors include elevated concentrations of blood total and low-density lipoprotein (LDL) cholesterol, reduced concentration of high-density lipoprotein (HDL) cholesterol, high blood pressure, diabetes mellitus, and obesity. In addition, 'behavioral' risk factors for CHD include cigarette smoking, a poor diet, and low levels of physical activity and physical fitness associated with the modern, predominantly sedentary way of living. Among these risk factors, a sedentary lifestyle is by far the most prevalent according to data from both the United States and England (Figure 1).

Molecular epidemiology

Confounding is the effect of a third variable that influences the exposure-disease relationship under study and is very important in epidemiology. The confounder variable is associated with the exposure being studied and is an independent risk factor for the health outcome under analysis. A cohort study on the relation between alcohol intake and risk of lung cancer might find a relative risk. However, people who consume alcohol often smoke (a confounding variable). Smoking is a known risk factor for lung cancer. Confounding variables usually have a stronger effect than the exposure under study. To find the correct relative risk of alcohol on lung cancer, either the study population has to be restricted to nonsmokers or else smokers and nonsmokers have to be separated. Therefore, a corrected estimate of the relative risk can be obtained by calculating a weighted average of the stratum-specific relative risks for smokers and nonsmokers, which usually involves statistical procedures to...

Circadian Disorders

Sleep-wake schedule dictated by the circadian clock. Similar to jet lag, many workers report insomnia during their off hours and hypersomnolence during their work hours. Consequently, alterness and performance suffer on the job and place the worker at greater risk for sleepiness-related accidents. Most workers also complain of additional symptoms including gastrointestinal discomfort and malaise. It is thought that the extreme work shift schedules of workers are largely responsible for two infamous disasters, the grounding of the oil tanker Exxon Valdez in 1989 and the Chernobyl nuclear plant explosion in 1986. In a similar vein, a 1992 study demonstrated that nurses on shiftwork schedules were up to 3 times more likely to misdiagnose and provide improper treatment than their daytime counterparts. Furthermore, a well-documented link exists between shift-work and both gastrointestinal and cardiovascular diseases. Often confounding the treatment of shift-work disorders is the fact that...

Gender and Religion

The shaman carries out procedures that delineate a world set apart he establishes the proper and rule-governed means by which it is entered, and its powers engaged and channeled. For example, the shaman masters the skills of separating, defining, protecting, and offsetting. He creates enclosures, shields, or other barriers that protect the vulnerable, whether persons or places. A shaman may encircle a threatened individual, house, or village with a protective wall of tobacco smoke, woven like a fish fence, and made more powerful by augmentation with power-generating incantations that function to block out invading spells and influences.

Pharmacological management

One study described the use of a continuous intravenous infusion of morphine for severe dyspnea in patients with terminal lung cancer.78 Six of eight patients obtained good relief of their breathlessness, however, carbon dioxide levels rose steadily over the course of the infusion in five of seven patients and seven of eight patients died while receiving morphine infusions.

Impact Of Fish Analysis In Different Research Areas

A small number of studies have addressed the possible effects of lifestyle factors such as smoking, air pollution, and caffeine and alcohol consumption on sperm aneuploidy frequencies. Robbins et al. 22 found a significant association between caffeine and alcohol consumption and increased disomy frequencies for some chromosomes. No significant association was noted for smoking. Two studies found a significant association between smoking and aneuploidy for some chromo-somes, 23,24 but it is difficult to rule out combined lifestyle factors because smokers also consume more caffeine and alcohol than nonsmokers. Our laboratory studied over 600,000 sperm cells from heavy smokers, light smokers, and nonsmokers (all nondrinkers of alcohol) and found a significant increase of disomy only for chromosome 13, but not for chromosome 21, X, or Y. 25,26 Perreault et al. 26 studied seasonal air pollution and found an association between high levels of air pollution and YY disomy in nonsmoking men....

Degradation Turnover and Factors that Induce Increased Requirements for Vitamin C

It remains largely a mystery why some people succumb to classical scurvy after a short period of virtually zero intake, whereas others survive for much longer. It has been speculated that some people may be able to produce all of the enzymes of the vitamin C synthetic pathway, including gulo-nolactone oxidase, which is normally absent from humans. However, this now seems unlikely, and it is more probable that the retention and recycling mechanisms for the vitamin are more efficient in some people than in others. We now know, for example, that smokers have a higher turnover of endogenous vitamin C than non-smokers, presumably because of the free-radical oxidant species in cigarette smoke. People with infections also have increased vitamin C turnover, which is associated with the liberation of pro-oxidant substances (such as hypochlorous acid) that are used by the body to kill bacteria. Some people have isoforms of certain blood proteins such as haptoglobins that are associated with...

The role of dairy products in preventing dental caries

An individual's dietary and social patterns are major contributors to one's oral health. The quality of life can be greatly impacted as a result of poor oral health leaving a negative impact on self-esteem, eating ability, and social functioning (Moynihan, 2005). Several oral diseases can be linked back to poor nutrition, and as teeth deteriorate the conditions are exacerbated. Studies (Johansson et al., 1994, Norlen et al., 1993) have shown edentulous individuals are more apt to have inadequate dietary intake (high carbohydrate, high fat, low nutrient density foods) than dentate individuals. Sugars, specifically sucrose, are recognized as being a major contributor to dental caries' etiology. Other social factors such as alcohol and tobacco use, drug abuse, poor hygiene, and poor nutrition are also cited as being major contributory factors to oral diseases.

Random Flap Pathophysiology

The effect of smoking on random flap necrosis correlates with the amount the patient smokes (13). Smokers using more than one pack per day experience random flap necrosis at three times the rate of lower-level and nonsmokers. Lower-level, for- mer, and nonsmokers have similar risk profiles. If the patient can discontinue smoking 48 h prior to and 7 days after surgery, flap survival is greatly improved (13). Two mechanisms are involved in smoking-related random flap necrosis vasoconstriction by nicotine and tissue hypoxia due to carbon monoxide competing with oxygen for hemoglobin-binding sites (14). o

Free Flap Pathophysiology

Factors found not be related to free flap loss include tobacco use, recipient site (head and neck vs. extremities), indications for surgery (trauma vs. cancer), use in diabetic patients, age of the patient, type of anastomosis (end-to-side vs. end-to-end or running suture vs. interrupted sutures), use of heparin in the vessel irrigating solution, and a wide spectrum of postoperative antithrombotic therapies (dextran or systemic heparin).

Clinical and physiologic outcomes in the coronary population

That include morbidity, mortality, exercise tolerance, and symptoms (see summary below). The evidence is less consistent for the benefit of reduced blood lipids, smoking cessation, psychological wellbeing, social adjustment and functioning, reduction in excess body weight, and a series of physiologic measures.

Policies in the United States

Historically, inhumane animal use has been most common in science fairs. These are extracurricular competitions in which junior- and senior-high-school students exhibit their projects. Humane standards at these fairs have been lacking in the past. In the 1960s and 1970s, the Animal Welfare Institute (AWI) reported on many student projects that treated animals cruelly. Typical were projects that involved failed attempts of surgical procedures on monkeys, rabbits, and other species, guinea pigs who were forced to inhale nicotine fumes until they died, and mice* who were given known toxic agents (such as cleaning fluid) to demonstrate their death. Frequently these teenagers worked in their home basements or garages, and they often won prizes for their efforts. What was particularly troubling was that these students were becoming insensitive to animal suffering and learning all the wrong lessons about how to treat animals from these school-sanctioned activities.

Background Definition

Sunlight exposure is an established independent risk factor for the development of SCC. SCC arises more commonly in the sun-exposed areas, including the head, neck and arms, but also occurs on the buttocks, genitals and perineum.14 Other risk factors for SCC include older age, male sex, Celtic ancestry, increased sensitivity to sun exposure, increased number of precancerous lesions and immunosuppression.4,15,16 Exposure to oral psoralens, arsenic, cigarette smoking, coal-tar products, UVA photochemotherapy and human papilloma virus have been associated with SCC. Genetic disorders that predispose to SCC include epidermodysplasia verruciformis, albinism and xeroderma pigmentosum.

Lung Tumor Collection Processing And Models

Lung Cancer Models Lung cancer models that are representative of human cancers are valuable tools to study tumor progression and discovery of therapeutic targets, provided they represent the tumor genotypically and not just phenotypically. While the significance of tumor suppressors (p53, pRB, p16INK4a) and activated oncogenes, such as K-ras and c-myc, involved in lung cancer is well known (8,9,11), the progression model and order of inactivation or activation mechanisms involving tumor suppressors and oncogenes is poorly recapitulated in current lung cancer models. However, some progress has been made in this nascent field. For example, overexpression of activated H-ras using the calcitonin-calcitonin gene-related peptide (CGRP) promoter induces pulmonary neuroendocrine (NE) cell hyperplasias and thyroid tumors (33). This was surprising, as NE lung cancers such as SCLC typically do not have ras mutations. Recently, Linnoila et al. developed a mouse model of lung NE tumors (34). In...

Environmental Factors in the Etiology of Human Cancer Chemical Agents and Processes

As noted in Chapter 1, the incidence of cancer at various tissue sites in humans varies greatly among countries and even within certain countries. Immigrants and especially their descendants tend to acquire the cancer incidences characteristic of their new habitats. The conclusion has been drawn that a high percentage, perhaps as much as 80 , of the more frequent and statistically important human neoplasms (of the bronchi, stomach, colon, breast, and others) have environmental factors, including lifestyle, as major components of their etiology. This has further led to a general agreement that at least 50 of all human cancers could be avoided if existing etiological knowledge were applied (cf. Tomatis et al., 1997). Differences in the exposure to carcinogenic radiations other than solar ultraviolet (UV) light as the major cause of skin cancer , infectious disease, or hormonal factors do not appear sufficient to explain the geographical differences noted for most of the major cancers....

Gastrooesophageal reflux disease

The majority of reflux responds to lifestyle adjustments and medical treatment. Losing weight, stopping smoking, avoiding spicy foods and alcohol help some people, but most require some form of acid reduction therapy with either H2 antagonists, or PPIs. Surgical intervention is only considered in cases that do not respond to medical therapy, and sometimes when patients request surgery as an alternative to life-long medication. Some patients have only a partial response to high doses of PPIs, and others have relief of the acid-related problems, but still have a large volume of gastric fluid regurgitating into their oro-pharynx.

Change in Attitudes Beliefs and Practices Regarding Gender

Finally, consumerism has changed most areas of Hungarian life, including gender. Mothers are now under pressure from advertisements that use the voice of male doctors or other experts to direct them to purchase disposable diapers, children's vitamins and other supplements, and baby toiletries (Vajda, 1998). The formerly state-run magazine Nok Lapja, which had been filled with articles on work and politics, is now equivalent to any Western women's magazine, including many articles on dieting, fashion, and gossip (Haney, 1994 Toth, 2001 West, 2000). While women are the primary targets of such consumer propaganda, younger, especially well-educated, Hungarian men in certain types of jobs are now also concerned that they smoke the right cigarettes, drink the right alcohol, wear the right clothes, and drive the right car. Just as women are being told that beauty, femininity, health, and popularity are available at a price, men too are confronting a world in which masculinity is only...

Novel Insights From Comparing Tumor Profiling With Clinical Response Correlation Of Patient Outcome With Putative

Clustering can classify tumors into distinct groups. Garber et al. (30) identified clusters based on the similarity of transcriptional profile (30). We also identified clusters using a similar approach as well as on the basis of stable clusters identified by combining clustering methods and bootstrapping of tumor samples (29). With our dataset, we asked whether lung cancer patient outcome correlated with the subclasses of lung adenocarcinomas defined. However, such clusters may or may not correlate with clinical end points. For example, in our dataset, there was no detectable difference in prognosis between the primary lung adenocarcinomas and the metastases to the lung of colonic origin. However, in our dataset (29), the NE C2 adenocarcinomas were associated with a less favorable survival outcome than all other adenocarcinomas (Figs. 3A and 4B). The median survival for C2 tumors was 21 mo compared to 40.5 mo for all non-C2 tumors (p 0.00476). When only stage I tumors were considered,...

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). who smoke.

Optimization Of Liposomal Delivery

They are not cleared rapidly by Kupffer cells in the liver, and yet extravasate and penetrate across tight barriers. BIVs penetrated barriers including the endothelial cell barrier in normal mice and the posterior blood retinal barrier in adult mouse eyes, and diffused throughout large tumors 3 and several layers of smooth muscle cells in pig arteries. We demonstrated efficacy for treatment of non-small-cell lung cancer 3 using BIV DOTAP Chol-p53 DNA-liposome complexes and not by using SUV DOTAP Chol-p53 DNA-liposome complexes. Therefore, morphology of the complexes is essential.

Energy Intake for Patients with Malnutrition

See also Anemia Iron-Deficiency Anemia. Ascorbic Acid Physiology, Dietary Sources and Requirements Deficiency States. Cancer Epidemiology of Gastrointestinal Cancers Other Than Colorectal Cancers Epidemiology of Lung Cancer. Carbohydrates Regulation of Metabolism. Cholesterol Sources, Absorption, Function and Metabolism. Copper. Cytokines. Diabetes Mellitus Etiology and Epidemiology Classification and Chemical Pathology Dietary Management. Fatty Acids Metabolism. Glucose Chemistry and Dietary Sources Metabolism and Maintenance of Blood Glucose Level Glucose Tolerance. Iodine Deficiency Disorders. Iron. Lipids Chemistry and Classification. Magnesium. Malnutrition Secondary, Diagnosis and Management. Nutritional Assessment Anthropometry Biochemical Indices Clinical Examination. Nutritional Support Adults, Enteral Adults, Parenteral. Protein Deficiency. Vitamin A Physiology Deficiency and Interventions. Zinc Deficiency in Developing Countries, Intervention Studies.

[1022Metastatic Large Cell Carcinoma

It has been reported that 9.7 of metastases of pulmonary large-cell carcinoma occur in the gastrointestinal tract and 5.7 in the small intestine, indicating that it is not an uncommon disorder 10 . Its symptoms include gastrointestinal bleeding with anemia. A patient who had undergone resection of a lung cancer a few years earlier underwent double-balloon endoscopy for a thorough examination of gastrointestinal bleeding (Fig. 10.2.5a). Contrast-enhanced radiography showed a mass (Fig. 10.2.5b). Biopsy resulted in a diagnosis of large-cell carcinoma, and the past history suggested metastasis of lung cancer. Partial resection of the small intestine was performed (Fig. 10.2.5c). 10. Ryo H, Sakai H, Ikeda T, et al (1996) Gastrointestinal metastasis from lung cancer. Nihon Kyobu Shikkan Gakkai Zasshi 34 968-972

Clinical Description And Prevalence

The incidence of melanoma is rising faster than all other cancers except lung cancer in women, currently varying between 5 (Western Europe) and 20 (Northern Europe) to over 50 (Queensland, Australia) cases per 100,000 per annum. 1,2 Familial clustering of melanoma was first described by Norris in 1820, 3 but it was not until the second half of the 20th century before others documented the familial occurrence of melanoma. Across several population-based studies, 1-13 of melanoma cases reported the occurrence of melanoma in at least one first-degree relative. 4 Hence, it is commonly accepted that melanoma predisposition is hereditary in 10 of all cases. But even in high-sun-exposure areas such as Queensland, Australia, less than 5 of melanoma probands report two or more first- or second-degree relatives affected with melanoma. 5

Box 102 Causes of dyspnoea due to intrathoracic malignancy

Main indications for bronchial stent Inoperable (patient) or unresectable (stage) lung cancer, following bronchial anastamosis (sleeve or transplant). A pleural effusion is a common complication of primary pulmonary, primary pleural (mesothelioma) and metastatic thoracic disease. It is a major cause of dyspnoea in advanced malignancy, often with the primary site unidentified. The mechanism of the effusion may be due to either obstruction of the pleural drainage or overproduction of fluid from the pleura. In all cases it portends a poor prognosis with a reduced life expectancy, represents advanced malignant disease (e.g. stage IV lung cancer), and is not manageable by surgical resection.5 Mesothelioma, a pleural-based malignancy in which the most common presenting complaints are dyspnoea and chest pain, has a median survival from the time of diagnosis of seven to twelve months.6 Malignant effusions associated with primary lung cancer also have a short survival time and together with...

Carcinogen Dose Response

Lung cancer incidence increases with roughly the fourth or fifth power of the number of years (duration) of cigarette smoking but with only the first or second power of the number of cigarettes smoked per day (dosage). The stronger response to duration than dosage occurs in nearly all studies of carcinogens. Peto (1977) concluded The fact that the exponent of dose rate is so much lower than the exponent of time is one of the most important observations about the induction of carcinomas, and everyone should be familiar with it and slightly puzzled by it First, in examples such as cigarette smoking, the onset of carcinogen exposure does not begin at birth but at some age t0 at which smoking starts, so the duration of exposure is t - t0 t. Cigarette Smoking The classic study of cigarette smoking among British doctors estimated annual lung cancer incidence in the age range 40-79 as I(t) -c(1 +d 6)2T4 5, where c is a constant, d is dosage measured as cigarettes per day, and t t -10 is...

Covert Sensitization

This is a procedure designed to reduce the frequency of an undesirable behavior by pairing it in imagery with an aversive stimulus (e.g., a nauseous scene). Three aspects are important. First, classical conditioning is used by repeatedly pairing the undesirable behavior with the unpleasant scene. Second, escape conditioning is provided through the use of negative reinforcement whereby the reduction in the undesirable behavior is paired with positive feelings when the unpleasant scene is terminated. Third, it is helpful to relax the client first. For example, a therapist might instruct a client to graphically and in detail visualize how nauseous he feels when he sees a pack of cigarettes and then imagine himself feeling much better as he turns away from the cigarettes. This procedure has been used in hypnotic contexts as well as in imagery. The outcome probably depends on the client's ability to visualize, which in turn may be related to hypnotic susceptibility. This procedure was...

Dietary Management

See also Cancer Epidemiology of Lung Cancer. Cystic Fibrosis. Food Intolerance. Malnutrition Primary, Causes Epidemiology and Prevention Secondary, Diagnosis and Management. Nutritional Support Adults, Enteral. Sodium Physiology. Supplementation Role of Micronutrient Supplementation.

Squamous Cell Carcinoma

The most common esophageal tumor is squamous cell carcinoma, which occurs predominantly in the middle and lower thirds of the esophagus. Predisposing conditions are nicotine and alcohol abuse, caustic injuries, achalasia, and the rare Plum-mer-Vinson syndrome (Table 3.7). The cardinal symptom is dy-sphagia, although even pronounced tumors may cause few if any complaints (Table 3.8). Nicotine abuse

Cessation of Carcinogen Exposure

Lung cancer incidence of continuing smokers increases with approximately the fourth or fifth power of the duration of smoking (Doll and Peto 1978). By contrast, incidence among those who quit remains relatively flat after the age of cessation (Doll 1971 Peto 1977 Halpern et al. 1993). In 1977, Richard Peto (1977) stated that the approximately constant incidence rate after smoking ceases is one of the strongest, and hence most useful, observational restrictions on the formulation of multistage models for lung cancer. Peto argued that, in any model, the observed constancy in incidence after smoking has stopped suggests that smoking cannot possibly be acting on the final stage of cancer progression. There could, for example, be a particular gene or pathway that acts as a final barrier in progression and resists the carcinogenic effects of cigarette smoke. In 2001, Julian Peto (2001) reiterated Richard's argument The rapid increase in the lung cancer incidence rate among continuing...

The Anger Episode Model

Models Anger

The medical problems associated with anger are particularly problematic since they often are not linked to anger episodes by patients. Outcomes linked to a stimulus are likely to be those that are close in time. Thus, patients are most likely to see the interpersonal costs of anger. In contrast, many medical anger outcomes are like those associated with cigarette smoking they do not appear for years. Nevertheless, the data show that longer term, persistent anger is associated with hypertension, stroke, myocardial infarction, and cancer. For example, Williams and her associates (2000) completed a large-scale prospective study of the relationship of trait anger to cardiovascular heart disease (CHD). Middle-aged men and women (n 12,986), initially free of coronary disease, were followed for a mean of 53 months. Results indicated that among adults with normal blood pressure, the risk of coronary events increased directly with increasing levels of trait anger. High-anger adults were 2.6

Mechanistic Hypotheses and Comparative Tests

First, cancer incidence rises more rapidly with duration of exposure than with dosage. In terms of lung cancer, incidence rises more rapidly with number of years of smoking than with number of cigarettes smoked per year. Second, lung cancer incidence remains approximately constant after cessation of smoking but rises in continuing smokers.

Other Types of Bioactive Compounds Branched Chain Fatty Acids Lectins Opsonins Analgesics and Antiulcer Compounds

Lectins are proteins that possess binding sites for specific mono- and oligosaccharides. A lectin has been isolated from sea cucumber which exhibited cytotoxicity against mouse cancer cells and human lung cancer cells (Gana and Merca 2002). Opsonins are proteins known to bind to the surface of many kinds of pathogens and tag them as targets for phagocytosis. A new opsonin-like molecule in the coelomic fluid of the sea cucumber H. leucospi-lota has been reported (Xing and Chia 2000). A crude water extract of a Malaysian sea cucumber has been shown to possess analgesic activity with a relatively long duration of action (Yaacob et al. 1994). Anti-ulcerative effects on rat stomach cells have been demonstrated in an aqueous ethanolic extract of Stichopus japonicus body-wall muscle (Migas and Klemenchenko 1990).

The Mthfr Gene Product MTHFR

More recently, Dekou et al. reported that the frequency of the MTHFR 677T allele of the coronary heart disease high-risk town of Dewsbury was significantly higher than in the coronary heart disease low-risk town of Maidstone and was associated with increased total homocysteine plasma concentrations (21). This effect was seen in men but not in women and was not observed for MTHFR 1298A C. Furthermore, a higher susceptibility for malignant lymphoma has been observed in individuals with the combined MTHFR 677CC 1298AA genotype, as well as those with the MTR 2756GG genotype (22). Moreover, the MTHFR 677C T mutation, smoking, and folate status were strong interactive determinants of high-risk adenomas of the colorectum (23). In this study, the risk was particularly high in smokers with low folate and the MTHFR 677CT or the MTHFR 677TT genotype, and in smokers with high folate and the MTHFR 677CC genotype. This risk pattern was also observed for colorectal hyperplastic polyps. Together,...

Case presentation 1

A 40-year-old man, who emigrated from India to Canada 2 years previously, presents with irregular fever and cough for several weeks. He is coughing up thick clear coin-like bits of sputum, sometimes streaked with blood. He had hemoptysis on one occasion. His fever is more marked in the evenings and he has cold sweats at night. He also has marked loss of appetite, and has lost some 10 kg of weight in the past 2 months. He smokes cigarettes but denies drinking alcohol. He works in the construction industry, but has been unable to work for a month.

Lobar And Pulmonary Collapse

The best management of lung cancer is to resect it but if this is not feasible intrinsic endobronchial cancers can be resected with a laser or removed manually with biopsy forceps. Sometimes these blockages are due to extrinsic compression in which cases, if there is a useful distal lumen, a stent can be inserted.

Role Of Cognitivebehavioral Therapy In Primary Care

Psychology's contribution, including advances in cognitive-behavioral therapy, to the prevention, assessment, treatment, and management of acute and chronic illnesses will undoubtedly play a major role in the future development of the profession (Levant et al., 2001). Major advances in assessment and treatment from a cognitive-behavioral perspective will likely lead the way. Health care delivery systems that acknowledge the behavioral and physical causes of disease are rapidly becoming the new framework for health care systems (American Psychological Association Public Policy Office, 2000). The U.S. Department of Health and Human Services (2000) has noted that 8 of the top 10 leading health indicators are behavioral in nature alcohol use, tobacco use, diet, physical activity, suicide, violence, unintentional injuries, and unsafe sex. Psychological problems often manifest themselves in the form of physical symptoms. Patients may therefore seek care for the physical manifestations of a...

Poison Hemlock Conium maculatum

All parts contain conine alkaloids similar in structure and effect to nicotine. Symptoms occur rapidly in 15 min to 1 h and begin with complaints of burning and dryness of the mouth. Tachycardia, triors, diaphoresis, mydriasis, profound muscle weakness, and seizures may develop. In severe cases, ascending paralysis, bradycardia, coma, and death occur. Although most cases are unintentional, there are some case reports of toxicity resulting from the intentional use by patients for a presumed narcotic-like effect.8 Treatment consists of GI decontamination, activated charcoal, and supportive care which may include IV fluids, antidysrhythmics, and anticonvulsants.

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