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. Read more here...

Quit Smoking Magic Summary


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Chromosomal Changes in Lung Cancer

SCLC shows deletions on the short arm of chromosome 3, but this loss has also been observed in non-small-cell lung cancer. Oncogenes regulate normal growth and development, but when activated promote tumour formation. Dominant oncogene mutations are seen in the myc family in SCLC and in the ras family in NSCLC (non-small-cell lung cancer). The myc family encode nuclear phosphoproteins, which bind to DNA and probably have transcriptional regulatory functions. Amplification of c-, N- and L-myc has been detected in SCLC. The ras family of proto-oncogenes consists of H-ras, K-ras and N-ras. These encode related 21-kDa membrane-associated proteins, which probably have a role in trans-duction of growth signals. Ras gene mutations are found in 20-40 of NSCLC, especially adenocarcinomas. They are not seen in SCLC. K-ras mutations in NSCLC tumours is associated with shortened survival. K-ras mutations correlate with smoking in lung adenocarcinoma. This suggests that exposure to the carcinogens...

Smoking Behavior Epidemiology

Recent estimates indicate that approximately 60 million Americans (about 29 of the population) and one third of the world's adult population smoke cigarettes. According to the Centers for Disease Control, over 440,000 deaths per year in the United States are attributable to smoking. Worldwide, an estimated 4 million deaths can be attributed to smoking and use of other tobacco products. During the past few decades, overall rates of smoking prevalence have decreased in Western countries. However, in the 1990s, rates increased for certain groups, including women and high school students. Although prevalence rates for men are four times higher (47 ) than those for women (12 ), rates for men are currently decreasing while rates for women are increasing. Prevalence rates for Native Americans and Caucasians are higher than for African Americans, Latinos, and Asian Americans. Prevalence rates of cigarette smoking and other tobacco use continue to rise for both adolescents and adults in...

Chemistry Of Tobacco Smoke

Individual smoke components, of which more than 50 appear in the vapour phase of fresh mainstream smoke, are considered volatile smoke components whereas all others are considered particulate phase components. The particulate phase contains more than 3500 compounds, and most of the carcinogens. Standardized machine smoking conditions have been used for measurement of cigarette smoke constituents. These conditions are also arbitrary and it is recognized that each smoker may puff in ways that are widely different from the standardized conditions, thereby changing the yield of individual smoke constituents. In addition to nitrogen, oxygen and carbon dioxide, the gas phase contains substantial amounts of carbon monoxide, water, argon, hydrogen, ammonia, nitrogen oxides, hydrogen cyanide, hydrogen sulfide, methane, isoprene, butadiene, formaldehyde, acrolein, pyridine and other compounds. Some major constituents of the particulate phase include nicotine...

Nicotine And Depression

Nicotine exposure is very common throughout the world. Because it readily crosses the blood-brain barrier, it is able to interact with neurochemical systems, for example, binding to acetylcholine (ACh) receptors in the brain and elsewhere (123). Both nicotine use and withdrawal have been associated with depression. Studies suggest an association between chronic nicotine use and depression (124-126). Smokers reported mood-elevating effects of smoking, hypothesized to be either relief of the abstinence syndrome or a brain enhancement effect. Several authors have noted both a greater prevalence of smoking among depressed patients (127,128) and a greater prevalence of depression among smokers (129-131). Also, there appears to be a correlation between a history of depression and the onset of smoking (132,133), greater difficulty in smoking cessation (127,130,131,134-137), and relapse to smoking (134,138). For example, Glassman et al. (135) found that 60 of smokers had a history of major...

Cigarette Smoking

Cigarette smoke yields more than 4000 constituents. These include carbon monoxide, hydrogen cyanide, aldehydes, cadmium, ammonia, nicotine andbenz a anthracene, a potent carcinogen. In addition, there are aromatic hydrocarbons and other toxic substances, which may be tumour initiators, such as benzanthracenes and benzopyrenes. There are suspended water droplets, which vary in size and have central resinous cores. These smoke droplets are absorbed on bronchial walls and propelled on the mucociliary escalator back to the mouth 98 of smoke particles landing in the bronchi are removed by cilia within 24 h. Smaller particles enter alveoli and, if undissolved, are ingested by macrophages and removed to lymphatics. Nicotine makes cigarettes addictive. The faster a cigarette is smoked, the more nicotine is present in the mainstream smoke 85 is absorbed in the lungs and it causes an increase in heart rate, blood pressure and cardiac output. Cigarette smoking may be active or passive. The...

Nicotine abuse

Smoking has been shown to be an important risk factor for ED, whether in the long or short term. The detrimental effects of smoking on sexual function have been shown to be independent of other nicotine related health problems. Long-term cigarette smoking has been shown to be an independent risk factor for arteriogenic impotence 29 . Juenemann et al. suggested that smoking could significantly interfere with the cavernous veno-occlusive mechanism 30 . Smoking cigarettes directly before an intracavernous injection of papaverine significantly reduced the erectile response to the medication 31 .


Nicotine is a pale yellow, highly toxic liquid contained in the leaves of several species of plants. Commercially, nicotine is extracted from dried Nicotiana tabacum leaves and used for making insecticides (nicotine sulfate) or tobacco products (Benowitz, 1998). Nicotine is extremely poisonous and can cause respiratory failure, convulsions, nervous system paralysis, and death if consumed in a single dose of 50 mg or more. Nicotine is typically found in tobacco products such as cigarettes, cigars, snuff, chew, and pipes as well as in insecticides such as Black Leaf (40 percent nicotine sulfate Benowitz, 1998). Most tobacco products, such as cigarettes, contain 10 milligrams or more of nicotine content (American Cancer Society ACS , 1997). However, when smoked, a single cigarette delivers approximately 1 to 3 mg of nicotine, as well as 4,000 other chemicals, to the nose, mouth, and primarily to the lungs, where nicotine is quickly assimilated through cell membranes into the pulmonary...

Lung Cancer

Ever since its introduction, sleeve lobectomy has made an important impact on the surgical treatment of lung cancer. When considering surgical options and prognosis, it is useful to distinguish four anatomic situations (as detailed in Table 16-1) in two groups of patients. The first and classic anatomic situation is a tumor found on bronchoscopy to arise in a lobar bronchus so as to preclude standard lobectomy. The second situation is where a carcinoma extrinsic to the airway may extend to the lobar bronchus. In the third situation, the bronchial margin may be found on frozen section to contain tumor. Finally, the fourth is

Disorders of the Back

Of patients with acute low back pain, only 1.5 develop sciatica (i.e., painful paresthesias and or motor weakness in the distribution of a nerve root). However, the lifetime prevalence of sciatica is 40 , and sciatica afflicts 11 of patients with low back pain that lasts for more than two weeks.9,10 Sciatica is associated with long-distance driving, truck driving, cigarette smoking, and repeated lifting in a twisted posture. It is most common in the fourth and fifth decades of life, and peaks in the fourth decade. Most patients with sciatica, even those with significant neurological abnormalities, recover without surgery.11 Only 5 to 10 of patients with persistent sciatica require surgery.5,12 Despite the incidence and prevalence of low back pain and sciatica, the major factor responsible for its societal impact is disability.12 The National Center for Health Statistics estimates that 5.2 million Americans are disabled with low back pain, of whom 2.6 million are permanently...

Exploration and MRFIT

A prime example of the harm that comes from exploratory analyses that are represented as confirmatory is one of the results from the Multiple Risk Factor Intervention Trial (MRFIT) 3 study. Published in 1982, it was designed to demonstrate that reductions in the risk factors associated with atherosclerotic cardiovascular disease would be translated into reduction in clinical events, e.g., myocardial infarction and stroke. Patients in the intervention group received treatment for elevated blood pressure, joined cigarette smoking cessation programs, reduced their weight, and lowered their serum lipid levels patients in the control group followed their usual accepted standard of living. At the conclusion of the study, the investigators found and reported that there was no difference in clinical outcome between those patients who received risk factor intervention and those who did not.

Characteristics of Stroke

Apart from age, the most important risk factor for CVD is arterial hypertension. Control of severe and moderate, and even mild, hypertension has been shown to reduce stroke occurrence and stroke fatality. Cardiac impairment ranks third, following age and hypertensive disease. At any level of blood pressure, people with cardiac disease, occult or overt, have more than twice the risk of stroke. Other risk factors are cigarette smoking, increased total serum cholesterol, blood hemoglobin concentration, obesity, and use of oral contraceptives.

Clinical Correlations

In contrast to germ-line or inherited mutations, 'sporadic' cancers also can arise when a mutation occurs in a previously normal somatic cell. In this regard, environmental factors are thought to play major roles as mutagens or carcinogenic agents. For example, the relationship between tobacco smoke and lung cancer is well documented (Henderson et al., 1991). Anilines used in rubber tyre production are linked to the development of bladder cancer, while exposure to solar ultraviolet rays can cause melanoma (Case et al., 1993 Armstrong et al., 1997). Hundreds of chemical carcinogens that exist in food and products in daily use can either directly or through the production of secondary metabolites irreversibly alter a normal cell's DNA. So-called 'lifestyle' factors can also play a role. A link has been made between consumption of a diet high in animal fats and prostate cancer (Tzonou

Social Skills and Daily Living

Modeling by in vivo demonstration is widely used as part of social skills training. Video modeling is the staple of many standard programs. It has been the primary component in a diverse range of training programs, from teaching young, isolated children to overcome their shyness, to providing alternatives to social behavior related to drug abuse, aggression, and other illicit or unhealthy activity. For example, films of age-appropriate students coping with social pressure to smoke cigarettes have been effective in programs at junior high schools. It may be noted that the programs with greatest effectiveness are those that illustrate adaptive coping (resisting coercion without destroying friendships), not negative consequences (early, gruesome death by cancer).

Historical perspective

At the incidence of lung cancer among British doctors. This study established a link between smoking and the development of small cell (oat cell) carcinoma of the lung. Further work undertaken by Doll and Hill has identified that the risk of dying from lung cancer is 32 times higher in heavy smokers compared with non-smokers (Horton-Taylor, 2001). A laboratory experiment, undertaken in 1915, proved for the first time that it was possible to develop cancer as a direct result of exposure to a chemical - coal tar. It was applied directly to the skin of a rabbit, resulting in the development of skin cancer (Yarbro, 2000a). In 1896 a German physicist, Roentgen, identified the use of radiation (X-rays) as a diagnostic tool. Further work looking at the use of radiation resulted in it being used as a new treatment for cancer by the close of the nineteenth century. However, within 7 years of Roentgen discovering the use of X-rays as a diagnostic tool, a causal link between exposure to...

Interaction Transactional Theories and Research

Although some theoretical perspectives have focused on stress as a stimulus and others have focused on stress as a response, most modern conceptualizations of stress can be considered interactive or transac-tional in nature. Transactional theories incorporate the importance of both stressors and stress responses in explaining the linkage between stress and illness or disease. Additionally, transactional theories of stress suggest that stress responses can serve as new stressors that elicit more intense stress responses. For example, if an individual responds to interpersonal conflict (a stressor) by drinking alcohol and smoking cigarettes (an acute behavioral stress response), these behavioral responses may become new stressors that warrant additional stress responses. Thus transactional theories of stress incorporate components of stress stimuli and responses that operate upon one another in a cyclic fash

Mechanisms of action

Nicotine acts on nicotinic cholinergic receptors in autonomic ganglia and at the neuromuscular junction as well as within the CNS. In low doses it is excitatory but in higher doses it inhibits these receptors. It also increases central nervous system 5HT and dopamine release, particularly in the striatum and nucleus accumbens.

Colorectal Cancer Incidences and Mortalities

Colorectal cancer is one of the most frequent malignant tumors with a still increasing incidence in Western countries (Parkin et al. 2005). In the United States, this disease accounts for 10 of all cancers, and is currently the second and third leading cause of cancer-related death of men and women, respectively (both sexes combined, 10 ) (Jemal et al. 2006). In Europe, colorectal cancer was the second most common cancer both in terms of incidence (376,400 cases, 13 ) and mortality (203,700 deaths, 12 ) in 2004 (Boyle and Ferlay 2005). In Germany, colorectal cancer was also listed among the 20 most frequent causes for cancer deaths in 2003, with 18 in men, second after lung cancer, and with 11 in women, following breast and lung cancer (www. It was calculated that about 5 million people in Germany, or 6 of the popu

Nonbiogenic Toxic Substances Metals

Some of the toxic effects of these metals involve hematopathies, neuropathies, nephropathies, and carcinogenesis attributed to lead pulmonary edema, nausea, vomiting, abdominal pain, prostate, and lung cancer attributed to cadmium neuropathies, teratogenesis, and mutagenesis attributed to mercury and both central nervous system (CNS) and peripheral nervouos system (PNS) pathologies, including muscle weakness and loss of sensory perception, attributed to arsenic.47

Summary of the Basic Chemistry Relevant to Our Global Ecosystem

(4) The interior zones - the core and the mantle - at high temperature interact very little with the surface, although here and there and now and then there is input to the surface from volcanoes and sea-floor black smokers . The surface also receives dust and debris from extra-terrestrial bodies and more rarely from more sizeable meteorites.

Primary Prevention Of Allergy

It is well established that exposure to tobacco smoke in infancy and early childhood is associated with an increased risk for respiratory infections and wheezing, as well as for sensitisation to inhalant allergens50. Other measures, like efforts to reduce the levels ofindoor allergens like house dust mites and pets have largely been disappointing51 Recent studies even suggest that the contrary may be true, i.e. that exposure to allergens during infancy may reduce the prevalence of allergic asthma in school children 52.

Targeting the Initiation of Wnt Signaling at the Cell Membrane

Activation of canonical Wnt signaling involves binding of Wnt ligands to frizzled receptors and LRP-5 6 co-receptors. This can be antagonized by the endogenous inhibitors of Wnt signaling sFRPs, WIF-1, and Dkk. Overexpression of Dkk-3 has been demonstrated to inhibit growth of lung cancer cells and invasion and motility of osteosarcoma cells (152,153). The expression of Dkk-1, which is a transcriptional target of p53, has been shown to be induced upon treatment of cancer cells with chemotherapeutic agents, and re-expression of Dkk-1 in cells lacking endogenous Dkk-1 sensitized these to chemotherapy (154). These data suggest a potential of Dkk proteins as adjuvants for chemotherapy. To directly target Wnt signaling an antibody against Wnt-1 has been utilized (155). This Wnt-1 antibody inhibited P-catenin-mediated signaling, induced apoptosis in human breast and lung cancer cells, sarcoma and mesothelioma cells, and suppressed growth of xenografted tumors in mice. The apoptotic effect...

The Need For Dna Repair

Many different types of DNA base changes have been observed following oxidative stress, and these lesions are widely considered as instigators of cancer, development, ageing and neurological disorders (for review, see Wiseman and Halliwell, 1996). The endogenous attack on DNA by ROS generates a low steady-state level of DNA adducts that have been detected in the DNA of human cells (Dizdaroglu, 1991). Over 100 oxidative base modifications in DNA have been detected in human cells (Wiseman and Halliwell, 1996). The best known and most widely studied is 8-hydroxyguanosine (8-oxoG). Oxidative DNA damage accumulates in cancerous tissues and is thought to contribute to carcinogenesis. For example, higher levels of oxidative base damage were observed in lung cancer tissue compared with surrounding normal tissue and a ninefold

Targeting PCatenin Tcf Transcription

Oncolytic viruses selectively lyse malignant cells by cytopathic effects (182). The major advantage of this strategy is the amplification of the virus at the site of the tumor. Brunori and coworkers engineered an oncolytic adenovirus that selectively replicates in cells with aberrantly high P-catenin expression (183). This adenovirus expresses the viral E1B and E2 genes from promoters controlled by b-catenin Tcf. The Tcf-E1B and Tcf-E2 promoters were found to be active in many cell lines with activated Wnt signaling. Viruses with Tcf-dependent regulation of E2 expression replicated efficiently in SW480 colon cancer cells, but showed a significantly reduced replication in H1299 lung cancer cells and WI38 normal fibroblasts. As a proof of concept, the authors introduced a stable P-catenin mutant into normal WI38 fibroblasts, which rendered these cells permissive for virus replication. Another oncolytic virus with Tcf-binding sites integrated into the promoters of the E1A, E1B, E2, and...

Directed Neurological Examination Cranial Nerve Ix

Both sides of the pharynx should be examined for both the afferent and efferent limbs of the reflex by touching one side first and then the other, while watching for symmetry of pharyngeal movement. The normal reflex response varies, and it may be reduced in the elderly or in smokers. Asymmetry of the reflex is the feature most indicative of pathology.

Preoperative Evaluation

As with all patients, a thorough medical history to assess the risk of anesthesia, a propensity for bleeding, and the use of both prescribed anticoagulants as well as herbal supplements which may influence clotting ability is necessary 47 . It is important to establish a social history with emphasis on tobacco use and exposure as well as environmental exposures that may contribute to nasal irritation. A complete review of systems with attention to endocrine disorders such as diabetes, immunologic disorders such as HIV and y-globulin deficiencies, as well as systemic disorders such as Wegener's granulomatosis provides significant diagnostic information.

Directacting Cholinomimetics

Direct-acting cholinomimetics are drugs that act directly by stimulating cholinergic receptors. These drugs are divided into drugs that stimulate muscarinic (M-cholinoreceptors) or nicotinic (N-cholinoreceptors) receptors. Drugs whose efficacy is primarily connected to stimulation of muscarinic receptors, including choline esters, i.e. acetylcholine and its structural analogues, which are methacholine, carbacholine, betanechol, and natural alkaloids muscarine and pilocarpine. Drugs whose action is based on stimulation of nicotinic receptors include the alkaloids nicotine and lobeline.

Natural nicotinic alkaloids

Nicotine Nicotine, 1-methyl-2-(3-piridyl)pirrolidine (13.1.27), is an alkaloid that is isolated from the plant Nicotiana (Nicotiana tabacum, Nicotiana rustica, and others) and can be synthesized in various ways 33-36 . In particular, it is proposed to proceed from nicotinic acid ethyl ester, which is condensed with N-methylpyrrolidone, giving 1-methyl-2-nicotinoyl pyrrolidone-2 (13.1.23). Acidic hydrolysis of this compound leads to an opening of the pyrrolidine ring giving the intermediate (13.1.24), which under the reaction conditions is decarboxylated to the -aminoketone (13.1.25). The carbonyl group is reduced to an alcohol and the resulting product (13.1.26) undergoes dehydration to nicotine (13.1.27).

The principle of intentiontotreat

Example 7.1 Surgery compared to radiotherapy in operable lung cancer Consider a (hypothetical) trial comparing surgery and radiotherapy in the treatment of operable lung cancer. Assume that a total of 200 patients were randomised to one of these two groups as shown in Figure 7.1.

Why do we need systematic reviews of observational studies

The randomised controlled trial is the principal research design in the evaluation of medical interventions. Aetiological hypotheses, however, cannot generally be tested in randomised experiments. For example, does breathing other people's tobacco smoke promote the development of lung cancer, drinking coffee cause coronary heart disease, and eating a diet rich in unsaturated fat induce breast cancer Studies of such 'menaces of daily life'2 employ observational designs, or examine the presumed biological mechanisms in the laboratory. In these situations the risks involved are generally small, but once a large proportion of the population is exposed, the potential public health impact of these associations, if they are causal, can be striking.

Coronary Artery Disease and Mortality from All Cardiac Causes

The risk of thoracic irradiation should be considered in the context of other cardiovascular risk fac-tors,but information on the prevalence of risk factors in comparison populations is generally lacking. One report that did assess other risk factors 26 demonstrated that patients experiencing an MI also had a higher frequency of elevated cholesterol, tobacco use and obesity than the US population as a whole. In

Interpreting a computer output unmatched casecontrol study

Table 3.5 Exposure to passive smoking among female lung cancer cases and controls in four studies. 7 Lung cancer cases Controls Table 3.5 Exposure to passive smoking among female lung cancer cases and controls in four studies. 7 with three dummy variables as described in Chapter 2. This is known as a fixed effects analysis. Chapter 5 gives a further discussion on the use of dummy variables in cases such as these. The program gives the option of getting the output as the log odds (the regression coefficients) or the odds ratio. The main result is that lung cancer and passive smoking are associated with an odds ratio of 1.198, with 95 CI 0.858 to 1.672. The pseudo R2 which is automatically given by STATA is difficult to interpret and should not be quoted. It is printed automatically and illustrates one of the hazards of reading routine output.

Hypnosis As A Psychotherapeutic Technique

There is evidence that the addition of hypnotic suggestion to behavioral treatment plans provides some advantage in treating habit disorders. Hypnotic suggestions that alter perceptions can be especially useful in these treatments. For individuals trying to quit smoking, hypnotic suggestions to increase the aversiveness of smoking and minimize withdrawal symptoms can be incorporated into a standard smoking cessation protocol. Similarly, treatment for obesity can incorporate suggestions for aversive reactions to unhealthy foods and an enhanced sense of control over eating behaviors. Augmenting treatment with hypnotic suggestions can also increase confidence in the ability to achieve one's goals and can lead to greater compliance with the selected treatment program. Meta-analytic studies suggest that the effects of treatments for obesity and pain (among other conditions) may be enhanced by the inclusion of hypnosis.

Table 1 The Hill criteria for inferring causation Hill 1965

Particular histological type of this cancer), then it is more likely to be causal. There are exceptions, however (e.g. smoking causing bronchitis, lung cancer, pancreatic cancer) Temporality A cause should not only precede the outcome (disease), but also be compatible with its latency period Whereas causality can be conclusively established between a particular exposure as an entity and a particular disease as an entity, it is not possible to conclusively establish such a link between an individual exposure and a particular disease of a certain individual, e.g. smoking and development of lung cancer. It is possible, however, to

Stephen A Shiver Brian W Loggie Scope and Epidemiology

Gastric cancer takes on a much more prominent role when considered on a world-wide scale. It continues to be among the leading causes of cancer related deaths, surpassed only recently by lung cancer. Marked geographic variation is the rule. Countries of the Far East have the highest incidence. In Japan, the disease accounts for 40-50 of cancer related deaths. The lowest incidence occurs in the Middle East, United States, and Canada. The European continent appears to have an intermediate risk.3 Pathological differences also exist based on geography. The intestinal type (as compared to the diffuse type) of gastric cancer appears to predominate in those regions with high incidence whereas the diffuse type predominates in areas where the incidence is low, such as the United States. This trend has practical importance because the diffuse type is generally associated with a more aggressive course and subsequently a poorer prognosis.3

Policies and legislation

Laws, treaties, policies and regulations have played important roles in the prevention and control of disease. Only governments can legislate for health warnings on cigarettes, introduce mandatory food standards and labelling, crack down on smuggling, set a pro-health tax policy , or implement national transport policy. Often governments are the main providers of health care they decide how funding is allocated, from prevention programmes to treatment, research, and training. The first international convention that relates specifically to cardiovascular disease is the WHO Framework Convention on Tobacco Control. It was adopted without dissent by the World Health Assembly in Geneva in May 2003, and is currently in the process of ratification. Once 40 countries have ratified the Convention, it will come into effect as a legally binding treaty among those countries. The Convention includes clauses on advertising bans, smoke-free areas, health warnings, taxation, smoking cessation and...

General Characteristics

The IBD are more frequent among whites than blacks, but Crohn's disease is increasing among black populations of the United States and Britain. Ulcerative colitis and especially Crohn's disease are much more common among Jews of the United States, Britain, and Sweden than among other groups. Ulcerative colitis and Crohn's disease occur among all ethnic groups, including Maoris, Arabs, and probably the Chinese, albeit infrequently. There is a scarcity of cigarette smokers among ulcerative colitis patients, and ex-smokers apparently have an increased vulnerability to it. By contrast, there is an excess of smokers in Crohn's disease populations. This intriguing observation, however, has yet to be explained.

Male Sexual Dysfunction Male Erectile Disorder

Previous estimates of ED complaints in clinical samples have indicated that from 36 to 48 of men who present for treatment in sex clinics have a primary diagnosis of male erectile disorder (Ackerman & Carey, 1995). Current estimates of clinical prevalence are missing, and may be important in describing the change in treatment for erectile dysfunction from sex therapy to pharmacology. Physiologically-based risk factors for ED include older age, alcohol use, nicotine use, and a sedentary lifestyle (Acker-man & Carey, 1995 Tengs & Osgood, 2001). Psychological risk factors include mental disorders and acute emotional states, particularly anxiety and depression (Barlow, 1986 Masters & Johnson, 1970 Wincze & Carey, 1991).

Geneenvironment Interactions

Polymorphisms in the CYP1A1 gene have been extensively studied, although there is still disagreement as to whether these have functional consequences for the activity or inducibility of the enzyme. Two of these are the Msp1 polymorphism (loss gain of a restriction site) and an exon 7 polymorphism that results in the coding for valine in place of isoleucine (Perera and Weinstein, 2000). One study has found that US smokers with the exon 7 variant allele had higher levels of DNA adducts in their white blood cells than smokers with the normal allele (Perera and Weinstein, 2000). Newborn babies with the CYP1A1 Mspl restriction site had higher levels of adducts in placenta and cord blood than those without it (Whyatt et al., 2000). Polymorphisms in other CYP genes may also be important but have been less well studied. A number of polymorphisms in Phase II metabolizing enzymes are also of interest. The null genotype of GSTM1 (in which glutathione S-transferase p.1 is absent) is associated...

Marijuana Related Problems

The types of problems associated with regular marijuana use have also been well documented. Heavy use has been linked to impairment in memory, concentration, motivation, health, interpersonal relationships, employment, and school performance, as well as lower participation in conventional roles of adulthood, history of psychiatric symptoms and hospitalizations, and participation in deviant activities. These problems appear related to frequency and duration of use. Regarding health issues, chronic use clearly increases the risk of respiratory problems (e.g., bronchitis). Of note, marijuana smoke has more carcinogens than tobacco smoke, yet direct links to lung cancer have not yet been observed. Marijuana impacts many other physical systems (e.g., cardiovascular, reproductive, endocrine, immunological, neurobiological). However, the clinical significance of effects across these systems is generally not considered robust, although much more research is needed to provide definitive...

CSF1 and Tumor Cell Invasion

Carcinoma) when compared to normal littermates, which is reversed by CSF-1 treatment (37). Crossing CSF-1(op) mice with a transgenic mouse susceptible to mammary cancer prevented macrophage accumulation in mammary tumors. In the macrophage-deficient mice, the incidence and initial rates of growth of primary tumors were not different from those seen in normal mice, but the rate of tumor progression was slowed and metastatic ability was almost completely abrogated when compared with mice that contained normal numbers of macrophages. Overexpression of CSF-1 in wild-type mice also accelerated tumor progression and increased rates of metastasis (17). Another study has shown that CSF-1 promotes tissue invasion by enhancing ECM-degrading pro-teinase MMP-2 production by lung cancer cells (38). In some instances, malignant cells coexpress CSF-1 and CSF-1R, raising the possibility of autocrine growth control by CSF-1 in the development of these malignancies (39).

Negative Affect Hypothesis

Examination of the relation between hostility and lifestyle factors, Musante et al. (1992) found some support for this alternative hypothesis. Increased hostility was related to poorer health habits, including consumption of a less healthy diet (increased fat and sugar consumption accompanied by decreased fiber intake) and a greater tendency to smoke cigarettes. Data from the cardia Study support these conclusions as well, with hostility being associated with higher frequency of smoking cigarettes and marijuana as well as consumption of a higher number of calories (Scherwitz et al., 1992). Finally, prospective links between measures of hostility taken during the undergraduate years and health behaviors in adulthood have provided additional evidence for this hypothesis. Data from the UNC Alumni Heart Study showed that high hostility during young adulthood was associated with increased smoking and consumption of alcohol and a high-fat diet, obesity, and low social support at midlife...

Random vs fixed effects

Suppose we wish to include a variable in a model that covers differing groups of individuals. It could be a generic description, such as smokers or non-smokers or it could be quite specific, such as patients treated by Doctor A or Doctor B. The conventional method of allowing for categorical variables is to fit dummy variables as described in Chapter 2. This is known as a fixed-effect model, because the effect of being in a particular group is assumed fixed, and represented by a fixed population parameter. Thus smoking will decrease lung function by a certain amount on average. Being cared for by Doctor A may also affect your lung function, particularly if you are asthmatic. However, Doctor A's effect is of no interest to the world at large, in fact is only so much extra noise in the study. However, the effect of smoking is of interest generally. The main difference between a fixed and a random effect model depends on the intention of the analysis. If the study were repeated, would...

Bcgspirulina Combination For Cancer Immune Therapy

A post operative immune therapy for cancer has been conducted using the cell-wall skeleton of BCG (BCG-CWS) in patients with lung cancer after surgical resection in the hospital of Osaka Medical Center for Cancer for 10 years. In a typical study of patients with lung cancer, significant high 5-year survival with good QOL was observed compared to a historical control in the same hospital.31'32 BCG-CWS acts as a potent adjuvant for induction of tumor-specific cytotoxic T lymphocytes (CTL), a potent effector for tumor cells. Thus, the mechanism of this adjuvant for induction of antitumor immunity has been investigated in our research group.

Nicotinic Hypofunction

Patients with schizophrenia are notoriously heavy smokers, which lead researchers to examine the cholinergic system of the brain. Smoking may be a form of self-medication since gating deficits are temporarily restored by stimulation of the nicotine receptor, specifically the a7-nicotinic receptor (Adler et al., 1998). There is an abnormal expression of a7 -nicotinic receptors in the hippocampus of postmortem brain from schizophrenia patients. While this was originally believed to be simply a consequence of heavy smoking, it is now being revisited as an inherited vulnerability factor since linkage studies have found a dinucleotide polymorphism at chromosome 15q13-14, the site of the a7-nicotinic receptor (Freedman et al., 1997).

Markers Of Early Response The Example Of p53 Mutations

There is growing interest in the study of the relationship among carcinogenic exposures, the risk of cancer at specific sites and mutation spectra in relevant cancer genes (i.e. oncogenes and tumour-suppressor genes). One current theory is that specific carcinogens or carcinogenic mixtures (such as tobacco smoke) would leave a fingerprint (characteristic mutation spectrum) in relevant cancer genes. Many in vitro and in vivo experimental studies have been conducted to elucidate carcinogenic mechanisms, with particular reference to mutation spectra in cancer genes. The fact that mutagens do not act randomly was already noted 30 years ago by Benzer, and then in a classical series of papers by Miller on the lacl gene, regarding mutational specificity in bacteria (see, for example, Coulondre et al., 1977 Miller et al., 1979). Denissenko et al. (1996, 1997, 1998) published some of the most interesting recent studies. They showed a strong and selective formation of adducts by the PAH...

Epidemiology Of Tobacco And Cancer

How do we know that smoking causes cancer The strongest evidence comes from prospective epidemiolo-gical studies. The prospective study design is powerful. Individuals are asked questions about their lifestyle and other factors, then followed for long periods of time. Cancer deaths are recorded and relative risks are determined with respect to the answers given on the questionnaires. Therefore, the answers cannot be influenced by disease state, bias and many other confounding factors. Large studies of this type conclusively demonstrate that all three main types of lung cancer - squamous cell, small cell and adenocarcinoma -- are caused mainly by tobacco smoking (IARC, 1986 Shopland, 1995 Blot and Fraumeni, 1996). These studies have consistently demonstrated a dose--response relationship between numbers of cigarettes consumed daily and relative risk of lung cancer. These data, which are based on over 20 million person Case-control epidemiological studies ask questions of people with...

Chemoprevention Of Tobaccorelated Cancer

Avoidance of tobacco products is clearly the best way to prevent tobacco-related cancers. Smoking cessation programmes have enjoyed some success in this regard, particularly with the advent of the nicotine patch. Political pressure, especially related to the potentially harmful effects of environmental tobacco smoke, has also had an impact on decreasing smoking. However, approximately 25 of the adult population in the USA continues to smoke, and many of these people are addicted to nicotine. For the addicted smoker who has failed smoking cessation, and for the ex-smoker, chemoprevention may be a way to reduce the risk for cancer (Hecht, 1998b). Chemopreven-tion involves administration of a non-toxic agent capable of blocking or reversing any of the steps illustrated in Chemoprevention of lung cancer and other tobacco-related cancers in humans is attractive because epidemio-logical studies have consistently demonstrated a protective effect of vegetables and fruits against these cancers...

Cancer Surveillance and Monitoring at the Workplace

Cancer surveillance at the workplace has been explored, e.g., for bladder cancer among people exposed to 2-napthylamine and to benzidine, and for lung cancer among workers exposed to asbestos. Chest X-rays, cytology and urinalysis have been proposed (Schulte et al., 1990). Urine cytology has good sensitivity and specificity for invasive bladder cancer, but no survival advantage has been demonstrated. Also, chest X-rays and cytological examination of sputum has not reduced mortality from lung cancer significantly. Judgments on the value of screening depend also on the intensity of exposure it may be more justified in small groups exposed to high levels of carcinogens than among large groups exposed to low levels.

Molecular Monitoring Of Human Cancers In Blood And Prognostic Implications

Molecular analysis of aberrant p15 methylation in blood may possibly enable disease monitoring and risk assessment.12 p15 methylation may play a role in cancer progression in addition to leukemogenesis52 and aberrant p15 methylation appears to have important prognostic implications. The median survival time of patients with acute leukemia with p15 methylation at diagnosis was notably reduced as compared with those carrying unmethylated p15 alleles.12 This molecular approach may be applied to many other tumor suppressor genes, DNA repair genes, or metastasis suppressor genes, which are methylated in different tumor types. For example, DAPK hypermethylation has been associated with shortened survival in patients with lung cancer.18 RASSF1A and APC hypermethylation in blood of patients with breast cancer has also been associated with reduced survival.53 Moreover, the MSP analysis of plasma samples may potentially be applied for risk assessment and early detection of human cancers. p15...

Methylation Profiling Of Tumor Cells And Tumor Dna In Other Body Fluids From Patients With Cancer

With diagnostic, prognostic, and therapeutic implications, tumor DNA has been detected in plasma, serum, and other body fluids from patients with tumors initiating in virtually all organs, including peritoneal fluid from patients with ovarian cancer, bronchial alveolar lavage fluid from patients with lung cancer, bone marrow aspirates, urine, prostatic fluid, cerebrospinal fluid, gastric biliary juice, and stool sam- Lung cancer ples from patients with a variety of cancers (Table 14.2).2 Epigenetic alterations occur early in primary neoplasia, and promoter hypermethylation is an early phenomenon in premalignant or morphologically benign lesions. Many research groups have analyzed epigenetic markers in body fluids of patients with cancer as compared with healthy individuals. Tumor-associated methylated DNA was detected in exfoliated tumor cells isolated from body fluids (Table 14.2).62 Thus far, DNA hyperm-ethylation has been found in body fluids from patients with different cancer...

Putative role in specific pain syndromes

Of inflammatory hyperalgesia (see 5, 71 ) the channel is present in peripheral terminals where it appears to be acutely modulated by inflammatory mediators 69, 70 , its modulation is blocked by compounds that attenuate inflammatory hyperalgesia 72 and channel density is increased in the presence of persistent inflammation 12, 14, 15, 73 . NaV1.8 is also present in the peripheral terminals of TG afferents innervating all oral and craniofacial structures studied to date. Specifically, there is preliminary data suggesting this channel is present in the terminals of pulpal afferents 74 and there is compelling evidence suggesting the channel underlies spike initiation in both corneal 68 and meningeal 75 afferents. While it is very likely that this channel is modulated by inflammatory mediators, such modulation has yet to be demonstrated. Furthermore, it has yet to be determined whether persistent inflammation of a specific oral or craniofacial structure results in an increase in the...

Treatment Of The Decubitus Ulcer Patient

Inadequate nutritional supplementation is often a vexing problem with the individual with a decubitus ulcer. This is especially the case with elderly patients, patients with chronic, systemic illness or significant infection, multisystem trauma, malignancy, involuntary weight loss, obesity, or depression. Additional factors such as cigarette smoking, substance abuse, and absence of social support have also been demonstrated to promote impaired nutrition for healing in clinical settings (9). Similar to burns, a hypermetabolic, potentially catabolic state occurs in association with decubitus ulcers (10). Adequate nutritional intake is imperative to provide the necessary calories for the increased metabolic demand of this condition. For these reasons, the maintenance of an optimal nutritional status is an important clinical goal in treating the patient with a decubitus ulcer.

Lung Injury Following Lung Resection Epidemiology

Surgery and the development of ALI ARDS.72 78 However, men over the age of 60 years, especially when undergoing lung resection for lung cancer, form a high risk group.73 Furthermore, no correlation has been found between the side of resection and the development of ALI ARDS, but the risk increases progressively with more extensive resections.73 75 79 ALI may present up to 7 days after surgery,73 77 but most patients present between 1 and 3 days postoperatively.75 76 Excessive perioperative administration of crystalloid may precipitate respiratory failure,74 77 although recently the perceived role of fluid overload has diminished.75 76 The high protein content of the alveolar oedema fluid and the frequent delay in presentation suggest that perioperative fluid overload is not the primary cause of post-pulmonary resection lung injury. The differential diagnosis includes lower respiratory tract infection and cardiogenic pulmonary oedema (fig 15.3 ). Both can be investigated in the...

Metaphors and Similes

Walt Kelly's Pogo said that, Words are for people who can't read pictures. But words can be used to create pictures in our minds. Consider the following. Tobacco causes the deaths of 400,000 Americans each year. Big number. To be more specific, in the United States more than 1000 persons die each day of the effects of tobacco use. This has a little more punch. But try this word picture The loss of life in the U.S. due to tobacco use is the equivalent of three jumbo jets crashing each day. For me, this image has vivid impact Metaphors and similes enrich our writing, and the chief way we go wrong is mixing our images

The Hyperthyroid Diet

Stay away from caffeine, alcohol, and cigarettes, all of which may stimulate your heart. You may want to take vitamin supplements as well. (Vitamins A, D, and E are stored in body fat and can be lost through excretion if you are thyrotoxic or hyperthyroid.) When you are in balance again, you will need to cut down on your fat and calcium intake.

Results and Complications

Postoperatively, velopharyngeal insufficiency has been rare. One case following aggressive UPPP is known to have occurred and resolved with partial suture release. Clinical success also occurred. This is similar to maxillofacial surgery where velopharyn-geal insufficiency is rare even following UPPP. As with UPPP, transient symptoms of mild nasopha-ryngeal reflux may occur immediately postoperatively. Dysphagia may occur for several weeks postoperatively. Increased pharyngeal volume, UPPP effects, or other factors may decrease afferent triggering of swallow or may decrease bolus pressures and contribute to delayed pharyngeal clearance. As with all palatopha-ryngoplasty techniques, sensation of globus, muco-cilliary dysfunction, dry throat, excessive salivation, and increased aspiration may occur. In isolated palatal advancement, these complaints seem to be rare and less common than with traditional UPPP tech-nques. Rarely, palatal flap necrosis and a subsequent oronasal fistula may...

Niacin and Nicotinic Acid

Nicotinic acid deficiency was found to be the causative agent of pellagra in 1937, yet the name was changed to niacin in order to prevent confusion with the tobacco derivative, nicotine. Niacin includes both nicotinic acid and nicotinamide, which form the metabolically active nicotinamide adenine dinucleotide (NAD) and NAD phosphate (NADP), an end product of tryptophan metabolism. More than 200 enzymes are dependent on NAD and NADP to carry out oxidation and reduction reactions, and these enzymes are involved in the synthesis and breakdown of all carbohydrates, lipids, and amino acids. Although niacin is endogenously produced in humans, exogenous intake is required to prevent deficiency. Niacin is found in meats, liver, fish, legumes, peanuts, enriched bread, coffee, and tea.

Molecular Genetic Findings

Investigations into the genetic-basis HNSCCs have resulted in a general molecular progression model for these neoplasms (Figure 10) (Califano et al., 1996 Sidransky, 1997). This model resembles those developed by similar means for bladder cancer and non-small cell lung cancer (Sidransky et al., 1992 Minna et al., 1997) more than it corresponds to the colorectal cancer mutation paradigm (Fearon and Vogelstein, 1990). Whether this general progression model will hold true for all squamous cell

Risk Factors for Development of the Disease

Cigarette smoking has consistently been identified as a risk factor for developing pancreatic cancer (Table 11.3). Up to 25 of all cases of pancreatic cancer may be attributable to cigarette smoking. The mechanism for this increase in risk is unknown, but laboratory animals exposed to carcinogens in cigarette smoke have shown susceptibility to developing pancreatic tumors. Recent increases in pancreatic cancer rates among women have followed increased rates of smoking by women.

Table 113 Risk factors for developing pancreatic cancer Environmental Factors

Definite Cigarette smoking Possible Excess dietary fats Chronic pancreatitis has been associated with an increased risk for pancreatic cancer. However, most patients with pancreatitis never develop pancreatic cancer. Some studies suggest that the association of pancreatic cancer with pancreatitis is likely due to other associated risk factors such as cigarette smoking. In rare cases, some patients with familial forms of chronic pancreatitis are at high risk for developing cancer. Other than smoking cessation and a diet that is high in fresh fruits, vegetables, fiber and low in fat, there are no specific guidelines for preventing cancer of the pancreas.

Papilloma of the Bronchus

Papillomas are classified into solitary or multiple. The solitary lesions are rare, presenting in middle-aged smokers as a central tumour. It grows as a wart-like lesion into the bronchial lumen and consists of nonkeratinizing squamous epithelium. Papillomatosis is seen in children. HPV (human papillomavirus) types 6 and 11 can be identified in both solitary and multiple tumours. One-third show carcinoma in situ or invasive carcinoma and thus papillomas require at a minimum close follow-up.

Carcinoma of Lung Epidemiology

The lung is the commonest site of cancer worldwide and is in first place in all areas of Europe and North America. Lung cancer appears to be rising in incidence by 70 in women and 30 in men (Travis et al., 1995). In the USA the largest percentage increases in age-adjusted rates are for small-cell carcinoma and adeno-carcinoma (60 each) with a smaller change for the latter tumour (14 ). In the EEC, lung cancer accounts for 21 of all cancer deaths in men and the corresponding figure for women is 4 . This latter figure is increasing and worldwide lung cancer is the fifth most frequent cancer in women. This is due to the social acceptability of smoking, the targetting of women in tobacco advertisements and appetite suppression caused by cigarettes. A decline in incidence in all cell types is predicted soon Tobacco is associated with most of the major histolo-gical types of lung cancer. The increase in lung cancer risk according to the number of cigarettes smoked appears stronger for...

In Humans And Animal Models

Bronchogenic carcinoma is the most important type of human lung carcinoma. Tobacco smoking is a high risk factor for the disease. The developmental pathway of the two major varieties of bronchogenic carcinomas, non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC), has been investigated in humans and animal models. It is hypothesized (McDowell, 1987) that regiospecific stem cells in renewing lung tissues, thought to retain many aspects of those during embryonic lung development, are the targets for initiation during multistage lung carcinogenesis. In the adult bronchial epithelium, the cells which divide are mucous cells and basal cells and PNECs. Mucous cells (McDowell, 1987) and basal cells (Nasiell et al., 1987) are therefore considered to be the major stem cells for NSCLC in humans. The role of PNECs in the development of SCLC in humans and other species is still poorly understood (McDowell, 1987 Sunday et al., 1995 Van Lommel et al., 1999 Linnoila et al., 2000a)....

Different Environmental Possibilities

Now we must return to difficulties, inherent in our description of the approach of the ecosystem to a cyclic state, which we have mentioned several times but glossed over in order to show the major way the surface ecosystem has evolved. The difficulties arise from the character of two inputs to this system (1) light, which does not penetrate deeply into water so that photosynthesis and oxygen production cease below about 50 m in the sea which can be more than 10,000 m deep and (2) from the bottom of the sea there is considerable constant input of reduced sulfide minerals from the black smokers of the crust. These two factors produce gradients of chemicals and redox conditions made uncertain by mixing so that the degree of aerobic character differs at different sea depths and in different places (see Section 1.12). However, the real difficulty for the approach to a cyclic state is that the flow from the oxidised surface is down towards the reduced crust of an enormous capacity so that...

Alveolar Type Ii Cell Tumors

A greater understanding of the developmental pathway and the location and regulation of stem cells in the adult lung is important for several reasons. Heroic modern medical treatment enables improved survival of premature humans but also incurs a risk of chronic lung injury. Improved knowledge of stem cells is prerequisite for future interventions to speed lung maturation or to support regeneration of lung tissue damaged due to premature birth. Similarly, phenotypic changes in the epithelium, such as mucous cell hyperplasia, are hallmarks of common lung diseases including asthma, chronic bronchitis, and cystic fibrosis. A better understanding of cell lineages and the regulation of cell pheno-type may lead to potentially beneficial therapies. Lung cancer is the world's most prevalent lethal cancer. Stem cells probably are at greatest risk of malignant transformation. Thus, identification of lung stem cells and their modification during multistage carcinogenesis may form the basis for...

MiRNAs and Their Potential Involvement in Diseases

The miR-17-92 cluster is often overexpressed in tumor samples from B-cell lymphomas (68) and human lung cancer cell lines when compared to normal cell lines (69). These studies revealed that the miR-17-92 cluster can act as a potential human oncogene. The targets for this miRNA cluster, as predicted by using TargetScan (57), include tumor-suppressor genes, suggesting that miR-17-92 overexpression can downregulate expression of these suppressor genes, and favor tumorigenesis (69). suggesting that let-7 may also regulate RAS expression in human. This is supported by an association between let-7 downregulation and an increased expression of RAS protein (71), further implicating the loss of let-7-regulated RAS expression during the development of lung cancer. Altered expression of a protein component of the miRNA-guided RNA silencing pathway may have a global impact on the expression of genes regulated by miRNAs. Indeed, a decreased expression of the RNase III Dicer was observed in...

Risk Factors for Stroke

Knowledge of stroke risk factors has advanced substantially during the past several decades and exceeds that of many other major neurological diseases. Important stroke risk factors include advanced age, systolic hypertension, diabetes mellitus, hypercholesterolemia, carotid artery stenosis, IIAs, cigarette smoking, lack of exercise, cardiovascular disease, atrial fibrillation, and left ventricular hypertrophy (LVH) on electrocardiography (ECG). y , y Based on epidemiological data, a risk profile table can be used to estimate a person's 10-year probability of stroke occurrence. y Stroke rates increase dramatically with age. About two thirds of all strokes occur after the age of 65. In the Framingham study the mean age of stroke patients was 65.4 years for men and 66.1 years for women. y As the population ages, the burden of stroke becomes greater. Hypertension is the most significant modifiable risk factor for stroke, and stroke incidence is proportional to the level of the blood...

Scope of Problem Incidence and Mortality

Lung cancer (LC) is the most important unsolved problem in surgical oncology. 180,000 Americans will develop LC in the year 2000 160,000 will die. Treatment of the disease has limited effectiveness only 14 of patients attain five-year survival. LC is the number one cause of cancer mortality in the U.S. in both men and women. LC is also the main cause of cancer mortality in Western Europe, and its incidence is rapidly increasing in Third World nations. Global annual mortality will exceed three million during the next century. There has been very little improvement in survival during the past 20 years. LC is unique in that its cause is known. It is theoretically preventable, by the single measure of primary prevention of cigarette smoking. Unfortunately, the issue is complicated by the fact that the etiologic agent is highly addictive, and is aggressively marketed by a rich and deeply entrenched industry, which is protected by powerful legal and political allies. Furthermore, it is a...

Cell Types and Tumor Biology

Cell type characterization by pathologists is important in the determination of prognosis and treatment. Bronchogenic carcinomas account for more than 95 of all primary lung malignancies. These tumors can be separated according to biologic behavior into two major categories, small cell lung cancer (SCLC) comprising about 20 of bronchogenic carcinomas and nonsmall cell lung cancer (NSCLC) approximately 80 . Using modern pathologic techniques of immunohistochemistry and electron microscopy, precise differentiation should be possible in almost all cases.

Clinical Presentation

The most important item in clinical evaluation is the history of smoking. LC is uncommon in the never-smoker. It is not sufficient to ask if the patient smokes. We must ask if he has ever smoked. Because more than half of all smokers in the U.S. have now quit, LC is now actually more frequent in ex-smokers. Patients who have

Table 123 NSCLC resections City of Hope Cancer Center 19871996

Once staging studies have demonstrated that the patient is a candidate for surgical resection, the next important consideration is whether the patient has physiological reserves sufficient to sustain the requisite loss of pulmonary function. A major problem in treating LC lies in the fact that cigarette smoking causes multiple other diseases that may complicate the surgical treatment of the lung neoplasm. Chronic obstructive lung disease (COPD) is almost always present and may be severe enough to preclude lobectomy or pneumonectomy. Cigarette smoking is also a major risk factor for carotid and coronary artery disease. Basic workup consists of a careful history and physical examination with particular attention to exercise capacity, sputum production, and history of asthma and COPD. Pulmonary function studies (PFTs) and arterial blood gas determination are critical. Chronic hypercarbia or hypoxemia severe enough to require oxygen supplementation are contraindications to major pulmonary...


Strong evidence exists that these neurological syndromes result from attacks by humoral and cellular arms of the immune system. Some patients with paraneoplastic encephalomyelitis with small cell lung cancer harbor high titers of IgG antibodies against a set of 35- to 40-kd proteins that are selectively expressed in the nuclei of neurons throughout the human nervous system and in all small cell lung cancers, some neuroblastomas, and medulloblastomas.y y '49 These antibodies, designated as anti-Hu, are present in higher concentrations in the CSF than in the serum, suggesting that their synthesis likely occurs within the central nervous system. y The antibodies can be detected within the neuronal nuclei of patients with paraneoplastic encephalomyelitis. A correlation between sites of accumulation and those areas most affected by the paraneoplastic syndrome is observed. y Although there is a high correlation between the presence of high titers of anti-Hu...

Paraneoplastic Cerebellar Degeneration

This entity, the most common paraneoplastic syndrome affecting the brain, may complicate any malignant tumor but is most commonly associated with lung cancer, particularly small cell lung cancer, and gynecological cancers, including endometrial, fallopian, ovarian, and breast cancer and lymphoma.

Paraneoplastic Retinal Degeneration or Cancer Associated Retinopathy

Binding antigens that are both a photoreceptor cell-specific protein and a protein expressed by small cell lung cancer. y Pathologically, widespread degeneration of the outer retinal layers with relative preservation of the other retinal layers occurs. This syndrome is usually associated with small cell lung cancer but is also observed with other tumors, including melanoma and cervical cancer. The distinctive clinical triad consists of photosensitivity, ring scotomatous visual field loss, and attenuated caliber of retinal arterioles. y

Motor Neuron Diseases

An illness similar to motor neuron disease manifested as spinal cord or anterior horn cell disease has been linked with cancer. Motor neuronopathy with loss of anterior horn cells can occur as part of a paraneoplastic syndrome. In addition, a motor neuronopathy with multifocal conduction blocks can be seen. Patients with predominant motor neuron involvement may have the anti-Hu antibody, and patients with motor neuron disease and cancer may have resolution of their neurological symptoms congruent with successful treatment of their cancer. Patients in whom motor neuron disease is a fragment of a widespread encephalomyelitis syndrome should be examined for anti-Hu antibodies and, if positive, suspected of harboring small cell lung cancer. An association between motor neuron disease and non-Hodgkin's lymphoma, infrequently with a paraproteinemia, has also been observed. y Subacute motor neuronopathy can develop with Hodgkin's disease and is characterized by subacute progressive painless...

Neuromuscular Junction and Muscle Disorders

LEMS is either associated with malignancy, most commonly small cell lung cancer, or with other autoimmune disorders, including thyroid disease, pernicious anemia, vitiligo, and type I diabetes mellitus. General fatigue commonly precedes weakness. Gait dysfunction usually follows weakness on standing. Autonomic dysfunction, commonly cholinergic and involving nicotinic and muscarinic synapses, produces xerostomia and erectile failure. Orthostatic hypotension is not usually a feature. Although sluggish pupillary responses may occur, ocular symptoms are rare. Repetitive or sustained contraction can improve the lower extremity proximal muscle weakness. The combination of proximal muscle weakness and hyporeflexia are hallmarks of this disease. Neurophysiological studies help confirm the diagnosis. The weakened muscles exhibit reduced amplitude compound motor action potential (CMAP) with facilitation characterized by a twofold increase in CMAP after rapid stimulation at 20 to 50 Hz....

Neuroendocrine Tumors

There is only one published study on these tumors in the trachea.38 This could be due to its rarity, but it may also be due to misclassification as an atypical carcinoid or large cell carcinoma. The data and descriptions that follow are mainly from pulmonary LCNECs. The patient ages range from 35 to 75 years, and the tumor occurs mostly in cigarette smokers.39

Incidence And Epidemiologic Associations

Modified Dukes Staging

Colorectal cancer ranks third behind prostate and lung cancer in men and behind breast and lung cancer in women as the most common malignancy in the United States. It is the second leading cause of cancer deaths, accounting for approximately 10 of deaths from cancer. An estimated 130,000 patients will be newly diagnosed with bowel cancer in 1999, and 57,000 deaths will occur.1 The probability of colorectal

Bronchial Sleeve Resection

The large variety of potential indications for endobronchial stent placement are listed in Table 40-2. The majority of patients requiring tracheobronchial stents have malignant disease, most commonly bronchogenic carcinoma. A patient with an unresectable lung cancer and endobronchial tumor producing central airway obstruction may receive rapid and satisfying palliation by laser or core-out of the endobronchial disease. However, this requires patent distal airways and is not feasible when a tumor also produces obstruction at the Primary airway tumor Squamous cell Adenoid cystic Carcinoid Mucoepidermoid Miscellaneous Lung cancer Patients with locally advanced lung cancer may also exhibit significant extrinsic compression of the airway, with or without concomitant endoluminal tumor. These patients may require urgent stenting to stabilize the airway while the primary tumor and bulky mediastinal lymph nodes are treated with systemic therapy or radiation. However, many times, these patients...

Vitamin E and the Heart

A number of recent studies have attempted to determine whether taking vitamin E supplements lowers the risk of atherosclerotic heart disease and heart attacks by inhibiting low-density lipoprotein (LDL, the bad type of cholesterol). In the early 1990s, three studies found no correlation between the naturally occurring level of vitamin E in the blood and heart attacks or cardiovascular deaths. In a randomized, double-blind study, a relatively low dose of vitamin E was tested for lung cancer prevention effects. No effect on cardiovascular mortality was found.

Methylation Profiling Of Circulating Tumor Dna In Plasma And Serum From Patients With Cancer

In patients with lung cancer, APC hypermethylation was commonly detected in plasma or serum by quantitative real-time methylation-specific PCR (MSP).40 DNA methylation was also found in plasma or serum from patients with colorectal cancer, liver cancer, or esophageal cancer.29344142 Circulating tumor DNA was detectable in plasma or serum of patients with bladder cancer, renal cell carcinoma, or prostate

Drugs That Stimulate or Block Sympathetic and Parasympathetic Postganglionic Neurons

Nicotine is another drug that can stimulate postgan-glionic neurons in the same manner as acetylcholine because the membranes of these neurons all contain the nicotinic type of acetylcholine receptor. Therefore, drugs that cause autonomic effects by stimulating postgan-glionic neurons are called nicotinic drugs. Some other drugs, such as methacholine, have both nicotinic and muscarinic actions, whereas pilocarpine has only mus-carinic actions. Nicotine excites both the sympathetic and parasympathetic postganglionic neurons at the same time, resulting in strong sympathetic vasoconstriction in the abdominal organs and limbs but at the same time resulting in parasympathetic effects such as increased gastrointestinal activity and, sometimes, slowing of the heart.

Geriatric dermatology

Geriatric Changes

Although the entire body changes slowly with advancing years, aging of the skin is readily visible and readily noticed by both men and women. If the sale of cosmetics (e.g., moisturizing creams, age spot removers, wrinkle creams, wigs, hair dyes for men and women) is any sign, it would seem obvious that the constant search for the elixir of youth is mainly directed toward maintaining a youthful-looking skin. Consider the interest in retinoic acid (Retin-A, Renova), a-hydroxy acids, chemical peels, botulism toxin, microdermabrasion, and laser skin resurfacing for wrinkles and aging skin. The two most important skin-care strategies to avoid signs of aging are to protect the skin from ultraviolet light and avoid exposure to tobacco smoke.

Types of cardiovascular disease

Types Cardiovascular Diseases

Disease of the blood vessels supplying the heart muscle. Major risk factors High blood pressure, high blood cholesterol, tobacco use, unhealthy diet, physical inactivity, diabetes, advancing age, inherited (genetic) disposition. Other risk factors Poverty, low educational status, poor mental health (depression), inflammation and blood clotting disorders. brain. This may result from either blockage (ischaemic stroke) or rupture of a blood vessel (haemorrhagic stroke). Risk factors High blood pressure, atrial fibrillation (a heart rhythm disorder), high blood cholesterol, tobacco use, unhealthy diet, physical inactivity, diabetes, and advancing age.

Incidence of Somatostatin Receptors in Human Tumors

Colony Forming Ells

Using the RT-PCR and immunohistochemical method, demonstrated subtypes sst1, 2 and 3 in both tumoral and nontumoral epithelial cells, whereas sst4 was expressed preferentially in malignant epithelial cells and sst5 was absent. The lung cancers mainly express sst2 (68 of samples examined immunohistochemically). The incidence of other subtypes are scarcer.27 Interestingly, the sst2 expression is not limited to small cell lung cancer (SCLC), which originates from the neuroendocrine cells of bronchial epithelium, but can be revealed also in nonSCLC. Recently, a functional sst2 was found in a nonSCLC cell line, Calu-6.28 Since melanocytes are known to derive from the neural crest, melanoma is also considered as a neuroendocrine cancer. The high incidence of sst receptors was found in these tumors by means of RT-PCR. Ninety-six of samples expressed sst1, 83 sst2, 61 sst3, 57 sst4 whereas only 9 sst5.29 The immunohistochemical findings are roughly similar.30 However, the data on functional...

New Trends in Prospect Summary and Conclusion

Squamous cell carcinoma accounts for 50 of all primary tracheal malignancies. It occurs predominantly in male smokers between the ages of 45 and 80 years, more often in the distal one-third of the trachea, and presents as an exophytic and usually ulcerated mass obstructing the lumen. Many develop another primary carcinoma in the larynx or lung. Squamous cell carcinoma of the trachea has an aggressive behavior characterized by early invasion into the adjacent mediastinal structures and metastasis to mediastinal and cervical lymph nodes. Metastasis to lung, liver, and bone is a presentation of late stage disease. Tracheomedi-astinal and tracheo-esophageal fistulae are late complications of advanced stage tracheal carcinoma.

Physiologic Peculiarities of Specific Pulmonary Abnormalities

Pulmonary Vascular Constriction

Chronic infection, caused by inhaling smoke or other substances that irritate the bronchi and bronchioles. The chronic infection seriously deranges the normal protective mechanisms of the airways, including partial paralysis of the cilia of the respiratory epithelium, an effect caused by nicotine. As a result, mucus cannot be moved easily out of the passageways. Also, stimulation

Ganglioblocking Substances

Ganglioblockers are those compounds that selectively act on nerve transmission in the auto-nomic ganglia. (Theoretically, ganglioblockers can stop all autonomic activity in the organism). These drugs are classified as depolarizing and antidepolarizing ganglioblockers. Depolarizing ganglioblockers such as nicotine initially stimulate postganglionic receptors, and then they block subsequent activation of the receptor, thus preventing repolarization of the postsynaptic membrane. The pharmacological effects of nicotine are very diverse and largely depend on the dose, exposition, and physiological condition of the individual.

Subacute Radiation Pneumonitis

Subacute pneumonitis is a pneumonopathy that usually occurs 1-3 months after the completion of radiation. It is well described in the adult literature after the treatment of lung cancer 5, 6,109 , but little of the data from such studies are relevant to modern pediatric cancer therapies. Pneumonitis can occur unexpectedly, with little or no warning. Because of this, many attempts have been made to identify clinical risk factors. The factors that influence risk include total lung radiation dose, irradiated lung volume exceeding 20 Gy vs 25 Gy vs 30 Gy, mean lung dose, fractionation of radiotherapy, daily fraction size, performance status, pre-treatment pulmonary function, gender, low pre-treatment blood oxygen and high C-reactive protein 44,54,59,68,110,112,123 .

Genetics of Restless Legs Syndrome

Although clinical observations suggest that RLS may be associated with emotional distress, psychosocial dysfunction, and depression, several large-scale epidemiological studies (1,2,7) were undertaken to systematically identify the significant correlates with RLS. Berger et al. (7) performed a large-scale cross-section survey with face-to-face interviews and physical examinations of 4310 participants in the Study of Health in Pomerania in northeastern Germany. The overall prevalence rate of RLS was 10.6 however, it increased with age, and women were twice as often affected as men. In addition, the risk of RLS increased gradually with women with more children. Thus, these epidemiological variables were implicated as important environmental factors for RLS. The 1996 Kentucky Behavioral Risk Factor Surveillance Survey collected data on the frequency of those experiencing RLS, self-rated general and mental health status, demographic, and behavioral risk factors, by telephone interviews...

Isolated Clinic Hypertension White Coat Hypertension

Because patients with isolated clinic hypertension have presumably less risk for cardiovascular complications than essential hypertensive patients, there is a question about whether treatment is necessary in this group. Additionally, there have been some reports that anti-hypertensive treatments are less effective in decreasing blood pressures observed in isolated clinic hypertensive patients (Fitscha and Meisner, 1993 Pickering et al., 1994). Therefore, in order to make optimal treatment recommendations, it is important for the physician to distinguish isolated clinic hypertensive patients from those with established hypertension. Unfortunately, there are few guidelines that will assist a physician in making this distinction. For example, although it is known that more women than men exhibit isolated clinic hypertension (Myers and Reeves, 1995 Pickering et al., 1988), this information is not very useful for determining the appropriate diagnosis when examining a new hypertensive...

Special Physiologic Problems in Submarines

Second, poisonous gases on occasion escape into the atmosphere of the submarine and must be controlled rapidly. For instance, during several weeks' submergence, cigarette smoking by the crew can liberate enough carbon monoxide, if not removed rapidly, to cause carbon monoxide poisoning. And, on occasion, even freon gas has been found to diffuse out of refrigeration systems in sufficient quantity to cause toxicity.

Formulation Of Aetiological Hypotheses

According to the rule of difference, when both a particular set of factors and the incidence of a particular cancer differ between two populations, one or more of these factors will likely contribute to the occurrence of the disease. When the difference in incidence is large, in relative terms, and only one or two factors form the differentiating set, then the hypothesis is more likely to be correct, and vice versa. Thus, the relatively high incidence of Kaposi sarcoma among homosexual men in the United States in the early 1980s indicated that sexual preference was involved in the occurrence of the disease, since few other, if any, characteristics distinguish homosexual from heterosexual men. Also, the lower incidence of cervical cancer among nuns points to sexual activity as an important causal factor, since nuns differ from other women with respect to only a few characteristics and practices. By contrast, the usually higher incidence of lung cancer in large cities cannot be...

Assertiveness Training

Recent AT research has focused on reducing anxiety in psychiatric patients, providing stress management training, using AT in school settings to reduce aggressive behavior, enhancing social skills training, developing sex education programs, and increasing self-confidence in college students. Assertiveness training is also being used in Behavioral Health and Behavioral Medicine programs for lowering blood pressure, smoking cessation, and anger control.

Trks And The Regulation Of Cancer Growth

The regulation of cell number during development or in cancer growth reflects a balance of signals that promote proliferation or differentiation and survival or apoptosis. Neurotrophin activation of Trks helps to determine this balance during development and oncogenesis. Thus in cancer Trks can be helpful or hurtful biological modifiers and positive or negative prognostic indicators. Trk activities have been described in diverse cancers arising from many tissues including medullary thyroid carcinoma (McGregor et al., 1999), Wilms' tumor (Donovan et al., 1994 Eggert et al., 2001), glioblastoma multiforme (Singer et al., 1999), lung cancer (Ricci et al., 2001), pancreatic cancer (Schneider et al., 2001), melanoma (Innominato et al., 2001), leukemia (Eguchi et al., 1999), breast cancer (Descamps et al., 1998) and Ewing's sarcoma (Nogueira et al., 1997) (Table 1). A review of well described Trk activities in prostate cancer, medulloblastoma and neuroblastoma serves to demonstrate the...

Computerized Psychological And Behavioral Assessment

Computer-assistant programs include software that assists clinicians in collecting client data and or making diagnostic decisions. For example, researchers have designed computerized behavior observation systems to facilitate naturalistic and analog observation of individuals. Expert systems are computer-assistant programs that include algorithm structures that are designed to simulate diagnostic-decision making. For example, one group of researchers created a smoking cessation expert system that analyzed assessment data, integrated the information, and made individualized recommendations for treatment strategies in a short report. Case formulation software helps clinicians organize important variables operating in a client's life and assists the clinician in developing hypotheses about client functioning. Stephen Haynes and his colleagues have developed a computer program that helps clinicians identify target behavior problems, the effects of those problems, and the causal variables...

Risk factor tobacco

Heavy smokers with hypertension benefit most from stopping. British medical journal, 1998, 317 962-963 (editorial). Cole CW, Hill GB, Farzad E, Bouchard A, Moher D, Rody K, Shea B. Cigarette smoking and peripheral arterial occlusive disease. Surgery, 1993, 114(4) 753-756 discussion, 756-757. Smoking and urology male fertility and sexuality dysfunctions. Cigarettes what the warning label doesn't tell you the first comprehensive guide to the health consequences of smoking. New York. The American Council on Science and Health, 1996, Chapter 11 95-100. International Consultation on Environmental Tobacco Smoke (ETS) and Child Health, 11-14 January 1999. Geneva, WHO, 1999 (WH0 NCD TFI 99.10). Smokers don't know the risks of heart attack Ayanian JZ, Cleary PD. Perceived risks of heart disease and cancer among cigarette smokers. Journal of the American Medical Association, 1999, 281 1019-1021. National Cancer Institute. Health effects of exposure to...

Risks of androgen therapy

Testosterone is a physiologic stimulus for erythro-poiesis. Men with hypogonadism have lower hemoglobin levels than age-matched controls, and T therapy can restore their hemoglobin levels to the normal range. The mild anemia prevalent in elderly men has been postulated to be due to declining T levels 208 . Although a rise in the hematocrit is generally beneficial for patients with anemia, elevation above the normal range may have grave consequences, particularly in the elderly 209 . The risk of hemoconcentration and of resulting thrombosis is greater if the patient also has a condition that may itself be associated with an increase in the hematocrit, such as smokers, men with chronic obstructive pulmonary disease, and congestive heart failure. Some cases of thrombosis of various arteries have been reported in literature. T injections appear to be associated with a greater risk of polycythemia than topical preparations. Dobs etal. 198 compared a transdermal non-scrotal T patch with...

Mechanisms Of Tumour Induction

The mechanisms by which tobacco causes cancer can best be illustrated by considering the relationship between cigarette smoking and lung cancer, because it is here that the most information is available. The overall framework for discussing this information is illustrated in Figure 4 (Hecht, 1999). Carcinogens form the link between nicotine addiction and cancer. Nicotine addiction is the reason why people continue to smoke. While nicotine itself is not considered to be carcinogenic, each cigarette contains a mixture of carcinogens, including a small dose of PAHs and NNK among other lung carcinogens, tumour promoters and co-carcinogens (Hecht, 1999). Carcinogens such as NNK and PAHs require metabolic activation, that is, they must be enzymatically transformed by the host into reactive intermediates, in order to exert their carcinogenic effects. There are competing detoxification pathways which result in harmless excretion of the carcinogen. The balance between metabolic activation and...

Epidemiological Studies Evaluating Cancer Causation

When an exposure is fairly common (e.g. smoking, sunlight, poverty, even prevalence of HBV carriers), ecological studies should be able to reveal the effects of these exposures. Thus, following the increase in tobacco consumption, the incidence of lung cancer increased sharply over time skin melanoma is more common in geographic latitudes with more sunshine exposure stomach cancer is generally more common in low-income social strata and the incidence of primary liver cancer is higher in populations with higher prevalence of HBV (Tomatis, 1990). As a corollary, the inability of ecological studies to demonstrate an association between a widespread exposure that has rapidly increased over time (e.g. extremely low-frequency In analytical epidemiological studies, there are several ways through which an association, or lack thereof, is assessed, but the most common measure is the relative risk. A value equal to 1 implies that the exposure under study does not affect the incidence of the...

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