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Pharmacotherapy of nicotine addiction

The acute effects of smoking (calmness, alertness, increased concentration) can be positively reinforcing, whereas nicotine withdrawal symptoms (depressed mood, insomnia, irritability, anxiety, poor concentration, weight gain) are negatively reinforcing.49 Pharmacotherapy is an integral part of the treatment of nicotine dependence but is most effective with concurrent behavioral therapy. Both nicotine-replacement therapies and bupropion (Zyban ) double long-term smoking cessation rates and have, therefore, been recommended as first-line therapy by the Agency for Healthcare Research and Quality. Nicotine-replacement therapies (Food and Drug Administration (FDA)-approved), include 2- or 4-mg nicotine polacrilex gum, the nicotine patch, nicotine nasal spray, and the nicotine inhaler.49 The choice of therapy can be tailored individually, depending on patient preference, side effects, or the presence of other medical conditions. Sustained-release bupropion is an antidepressant...

Cigarette smoking and lung disease

A history of smoking is associated with more than a three times increase in post-operative lung problems. Even stopping smoking for a short period of time reduces this risk substantially. In the long term, smoking is a major risk factor for global lung diseases, such as asthma and chronic lung disease. Reduced lung function is associated with an increase in post-operative lung problems, and may necessitate post-operative ventilation. In severe lung disease, weaning the patient from mechanical ventilation can be prolonged.

Lung cancer prevention and screening

Lung cancer is the most common cancer in men. In women, it is the third most common cancer, but the most common cancer cause of death. It is estimated to have caused more than 65 700 deaths in women in the USA in 2002.2 In the UK, lung cancer accounts for one out of 6.5 deaths from cancer - more than 30 000 in 1996.6,16 Because women have recently been smoking cigarettes in greater numbers, quitting in smaller numbers, and smoking for 30 years or more, the incidence of lung cancer in women may continue to grow. In the UK, the incidence of lung cancer for women between 1971 and 1996 has increased by 9 , while it declined by 28 in men.6 During the past two decades, there has been little improvement in survival almost half of those with diagnosed lung cancer are dead within one year.7 Thus, prevention is important. However, methods of screening have not been promising or effective.

Cigarette smoking

Some 90 of PAD patients are smokers or recent ex-smokers (Mikhailidis, 2000). Smoking is a major risk factor in lower limb atherosclerosis progression and moderate cigarette smoking (15 cigarettes a day) almost doubles the risk of developing PAD, as compared to non-smokers, and the risk may increase in relation to the number of cigarettes smoked (Hughson et al., 1978 Kannel & McGee, 1985). Studies show a four- to nine-fold increased risk of PAD in patients smoking in excess of 20 cigarettes per day, as compared to non-smokers (Hughson et al., As smoking tobacco increases the risk of intermittent claudication and contributes to its progression (Krupski, 1991), stopping smoking could prevent patients from progressing towards critical limb ischaemia and is probably the most important action a claudicant can take.

Natural History Target of Screening

Considerations such as the above contain epi-demiologic and public health policy implications as they highlight the distinction in benefits from colorectal screening that may apply to a single individual patient vs the strategic allocation of resources for colon cancer prevention in a population at large. In this context, the benefit harms ratio of screening asymptomatic populations is a critical concern. In colon screening, unlike screening for breast or lung cancer, the target lesion for detection is merely a benign precursor, rather than an actual frank his-tological malignancy and the intervention becomes cancer prevention rather than cancer detection. Thus, it is even more critical to obtain a careful balance of variables such as risk, resource cost and testing interval (Fig. 2).

General Therapeutic Measures

Of smoking cessation programmes and antidepressant therapy, if necessary. Lipid-lowering drugs are especially indicated, with the use of HMG-CoA reductase inhibitors. Statins not only decrease cholesterol levels but also exert pleiotropic effects on the vascular wall limiting the inflammatory process within the plaques 1, 13 . Plaque regression with lipid-lowering therapy has been reported in both the aorta and carotids. An LDL cholesterol level less than 100 mg dl should be attained. The incidence of cardiac event may be minimized by appropriate control of heart rate and blood pressure. Diabetic patients should be adequately treated and monitored. Haemoglobin A1c should be less than 7 . Dietary supplementation of vitamin B12 and folic acid should be prescribed, especially in patients with hyperhomocysteinemia 25 . Exercise decreases LDL cholesterol and all patients should maintain a regular exercise regimen. Lastly, the use of anti-platelet drugs may reduce the risk of fatal and...

Solitary Pulmonary Nodule

Adenocarcinoma is commonly peripheral and represents about 30 of the total number of lung cancer cases. Its incidence is rising especially in females. Adenocarcinoma frequently presents as an incidental finding on x-ray. The other major histological types of lung cancer tend to have central localization and are as follows

Data Expression And Analysis

Characteristics that we might want to study may be measured in a variety of ways. Observed data may be dichotomous, categorical, or continuous. If data can take only one of two values, they are defined as dichotomous. Returning to our smoking and lung cancer example, we could describe smoking in terms of the dichotomous variables ever or never smoked. Categorical observations have values that fit into categories. For example, we might characterize race or ethnicity using a categorical variable. Some data categories describe ascending levels of intensity or severity. For example, we could describe smoking history as none, light, moderate, and heavy. When categorical data are ordered in this way, they are ordinal. Finally, data may be measured on a continuous scale. Again, referring to our smoking example, we could measure smoking in terms of the number of cigarettes consumed. At analysis, continuous data may be transformed into categorical data (but not vice versa). Once we have...

Dietary factors that may increase risk

Alcohol has been associated with cancer of the mouth, pharynx, larynx, breast, esophagus, cervix, and liver. Women should limit intake of alcohol to no more than one drink per day (360 ml beer, 150 ml wine, 30 ml 100-proof spirits). Women who are at high risk for breast cancer may consider not drinking any alcohol. The combination of alcohol and tobacco use increases risk far more than either one alone. Randomized clinical trails have shown that high-dose beta-carotene supplements increase the risk of lung cancer in smokers. Rather than taking supplements, people should be encouraged to eat naturally occurring sources of beta-carotene in the form of fruits and vegetables.

Substance Abuse Section I Identify A Suspected Substance Abuser 11 General

Alcohol and drug abuse, commonly called substance abuse, is an ever increasing problem in the military services as well as in the civilian sector. Substance abuse is not limited to narcotics addition. It can also include abuse of food, solvents, alcohol, aspirin, drugs, and nicotine (figure 1-1).

Peripheral Vascular Disease Lower Limb

Catheter angiography is useful to diagnose vasculitic conditions such as thromboangiitis obliterans (Buerger disease). This condition classically affects small and medium-size arteries and veins of the lower limbs in young smokers with a typical angiographic appearance. In patients with blue digit syndrome, catheter angiography may show the source of emboli, typically atherosclerotic plaques in the aorta or iliac arteries. However, CT or other noninvasive modalities are preferred for the initial evaluation in blue digit syndrome, because the catheter-based modalities carry the risk of further atheroemboli.

Arthropathies see Arthritis Arthus reaction see Immune complex

Calculations of the worldwide health burden from occupational and environmental exposure to asbestos suggest a projected 5-10 million cancers, with 30 000 in Australia alone (two thirds lung cancer, one third mesothelioma). Because of this and because there are now safe and economic alternatives, an international ban on all mining and use of asbestos has been recommended. lung cancer Lung cancer follows heavy exposure and the risk is enhanced 8-fold by concomitant cigarette smoking.

What are the physical consequences

People with diabetes have a higher risk of developing certain health problems, or complications, and this risk is particularly high for people who are overweight, who smoke or who are not physically active. However, it is important to remember that you will not inevitably develop complications simply because you have diabetes. Careful research has shown that the better your blood glucose control, the less likely you are to experience complications. Knowing this helps many people to work harder at controlling their diabetes when they're tempted to let things slide a little. Along with good diabetic control, giving up (or not starting) smoking can reduce your chances of developing complications. Smoking and diabetes definitely do not mix. All of the possible complications are more common in people who smoke, and anyone who has already developed any of the associated problems should stop smoking

The Disease Should Be an Important Health Problem

As the most common male cancer in Europe and the United States, and second only to lung cancer in terms of male cancer deaths, there is little doubt that prostate cancer represents a significant public health burden in Western countries 2 . In the U.S. alone, an estimated 220,900 new prostate cancer cases were diagnosed in 2003, with 28,900 deaths attributable to the disease 3 .Although a dramatic increase has been observed in the number of men diagnosed with localized disease as a consequence of PSA testing, those with advanced prostate cancer continue to present a significant burden to the community, developing metastatic disease at a rate of 8 per year, and reaching 40 at 5 years. These metastases predominately affect the skeleton, causing high levels of morbidity and hospitalization, and necessitating expensive palliation. In addition, the use of hormone manipulation in the form of androgen suppression to treat advanced disease causes iatrogenic morbidity by reducing bone density...

Clinical Use Of Cb1 Antagonists Sr 141716

The selective CB1 antagonist SR 141716 (rimonabant or Acomplia Sanofi-Synthelabo), when administered to marijuana smokers, caused weight loss in overweight and obese subjects without causing adverse side effects (118). Based on this and the promising studies on animals (reviewed previously), SR 141716 has been used in randomized, double-blind clinical trials to determine its efficacy in treating obesity and related metabolic complications. Several Phase III clinical trials named RIO (Rimonabant In Obesity) were initiated starting in 2001 and included more than 6600 overweight or obese patients with or without comorbidities who were given SR141716 (5 or 20 mg) or placebo for up to 2 yr (119 - 121). All subjects were on a calorie-restricted diet and underwent a run-in period of diet alone prior to being randomized to drug or placebo conditions.

Studies in Seventh Day Adventists

Sites combined was 54 when the general California population was used but this changed to 82 when the comparison with non-smokers was made. When the mortality experience of SDA physicians for the years 1914 to 1971 was compared with the mortality experience of physician graduates of the University of Southern California (USC), the SMRs were similar for all cancer sites combined (58 for SDA physicians, 52 for USC physicians). For colorectal cancer, the SDA physician SMR was actually considerably higher than the USC SMR (90 vs. 44). A further follow-up of this population was completed through 1976 and Standardized Mortality Ratios were reported comparing age-adjusted mortality rates in California SDAs to the U.S. white population.21 SMRs were reduced, in particular in males, for most cancer sites (Figure 4.9) and were substantially and significantly reduced for colorectal cancer and lung cancer. However, SMRs were not significantly reduced for breast cancer, prostate cancer, or the...

Vascular Risk Factor Modification in Peripheral Arterial Disease

The literature suggests that cigarette smoking, hypertension, dyslipidemia, and diabetes mellitus are important factors in the development of PAD, and these will be addressed in turn (Table 6.2). A key risk factor for PAD is platelet aggregation along with other hemorheological factors such as increased plasma fibrinogen and decreased fibrinolysis. Currently an area of interest that is being explored is that of the contribution of inflammation to PAD. The high white blood count (WBC) contributes vascular risk to the patient with PAD (Belch et al., 1999) as does increased oxidative stress. Of the above, however, platelet activation and release in the patient with PAD has been well documented and has led to the evidence-based use of antiplatelet agents in PAD.

Prostate Cancer Risk Reduction by Dietary Modification

Preventive medicine is currently a topical issue. Cardiovascular disease is a well-known example. The identification of atherosclerosis as one of the causative mechanisms of cardiovascular disease has resulted in important lifestyle modifications in diet, tobacco use, and exercise. This has led to a significant decrease in the incidence of heart disease in many countries. Prostate cancer potentially represents an ideal target for chemoprevention because of its long latency. Although the use of new biological strategies is being examined in the context of primary prevention and progression of prostate cancer, it has been suggested that nutrition may also have a role. However, does the weight of

New Adventist Health Study

When meat and poultry intake were evaluated in regard to lung cancer risk, the relative risks were somewhat elevated, though not significantly so. More noteworthy was the protective association between fruit and green salad intake and lung cancer risk. After taking into account smoking history, lung cancer risk was decreased 74 in those who frequently consumed fruit and a significant dose-response relationship was found.30 Prostate cancer risk bore a similar relationship to meat intake in that risk appeared to be somewhat elevated in the highest consumption categories (daily intake), yet the elevated risks were not as substantial (or statistically significant) as the protective associations seen with consumption of certain vegetables and fruits. In the prostate cancer analysis, a relative risk of 0.53 was noted for frequent consumption of beans, lentils, or peas and a relative risk of 0.60 was noted for frequent tomato con-sumption.31

D SDA Studies Outside the US Denmark Netherlands and Norway

In Norway, 7253 SDAs were followed between 1961 and 1986 and monitored for cancer diagnoses. The Standardized Incidence Ratios (SIR) were divided into two groups those under 75 years of age and those greater than 75 years of age. Only the SIR for lung cancer in those less

Analysis Interpretation

The difference experienced by vegetarians compared with non-vegetarians appeared to be moderated by gender. Males appeared to enjoy a stronger degree of protection from cancer mortality incidence than females. For example, four out of six studies (67 ) that evaluated col-orectal cancer risk by gender revealed lower SMRs for males than females. For lung cancer, six out of six (100 ) SMRs were lower in males and for all cancer sites combined, six out of six studies (100 ) showed lower SMRs in males than females. Overall, the protective association with vegetarianism seems most pronounced for colon, stomach, and lung cancer and less pronounced for ovarian, pancreatic, and the lymphatic hematopoietic cancers.

Preoperative Planning

The patient's medical status must be evaluated preopera-tively, and all documented preoperative measures to prevent peri-operative ischaemia need to be taken. Initiation of -blockers and platelet inhibitors is particularly important, as are smoking cessation and the implementation of preoperative optimal regulation of blood pressure and blood glucose. Also, the use of statins seems to be associated with reduced peri-operative mortality in major non-cardiac surgery, probably due to their anti-inflammatory, plaque-stabilizing effects 57, 65 . The information should be clear and understandable, in order for the patient to give his or her informed consent to the procedure. In addition to the patient's right to information, good preoperative information reduces preoperative anxiety, thereby decreasing stimulation of the sympathetic nerve system. Preoperative anxiety, cigarette smoking and other stimulation of the sympathetic nervous system, in addition to the surgical trauma, lead to an...

Plasma Coagulation Factor Tests

A variety of medications can interfere with the results of the activated partial thromboplastin time. An increased or prolonged APTT time is associated with salicylates such as aspirin. A decreased or shortened APTT time is associated with the use of digitalis, tetracyclines, antihistamines, and nicotine.

Fruits and Vegetables

The term vegetarian implies a lifestyle characterized by a diet rich in vegetable intake. A recent review based on 206 human epidemiologic studies and 22 animal studies concluded that fruits and vegetables were effective in the prevention of several forms of cancer including stomach, esophagus, lung, oral cavity, pharynx, endometrium, pancreas, and colon.62 Twenty cohort studies (perhaps offering the strongest type of evidence) were reviewed and indicated that fruit and vegetable consumption afforded protection against lung cancer across all studies reviewed. The 174 case-control studies that were reviewed indicated that there was convincing evidence for a protective role for fruits and vegetables for cancer of the lung, stomach, and esophagus and probable evidence for protection against cancer of the oral cavity and pharynx, colon, breast, pancreas, and bladder. In this review, prostate cancer was the one form of cancer not found to be associated with fruit and vegetable consumption....

Comorbidity with other psychiatric disorders

Alcoholism is complicated by the fact that, particularly in women, it is often accompanied by other psychiatric disorders therefore, a holistic approach is required for treatment. Comorbid conditions include tobacco use, drug abuse, major depression, anxiety disorders, bulimia nervosa, and antisocial personality disorder (ASPD).4 Alcohol problems predict the subsequent use of tran-quilizing drugs in older women.5 Severe alcoholism, impulsivity, and suicidal tendencies also tend to coexist but are more likely to group in men.6 ASPD and antisocial symptoms are more prominent in male alcoholics, whereas in women alcoholism is often associated with anxiety (particularly social phobia) and affective disorders.4 Major depression is much more common in women than in men, and many studies have shown that antecedent depression is a risk factor for problem drinking. In women, there is a strong relationship between depression and smoking depressed individuals are more likely to smoke and are...

And Endovascular Surgery

Patients treated with endovascular procedures need the same preoperative optimization of medical treatment, smoking cessation, etc. as those undergoing conventional open surgery, for lowest peri- and postoperative morbidity and mortality, but more so for the long-term results.

Alternative Explanations for Low Cancer Risk in Vegetarians

Smoking The reduction in cancer mortality (and incidence) in vegetarians appears to be stronger in men than women and the possibility that differences in alcohol and tobacco consumption in vegetarians vs. non-vegetarians must be considered as an explanation for this finding. The use of tobacco, generally lower in vegetarian populations,12 is clearly related to cancer risk. A recent review indicated that 38 of cancer deaths among males in the U.S. could be attributed to cigarette smoking, while among women, 23 of all cancer deaths are due to cigarettes.63 These estimates do not include the impact of cigar, pipe, or smokeless tobacco, nor do they include the influence of environmental tobacco smoke. Cancer sites that have been associated with cigarette smoking include lung, oral cavity, esophagus, larynx, bladder, pancreas, kidney, and cervix. Recent data have suggested that colon cancer may be associated with cigarette smoking (but only after a long latency period).64-65 The more...

Recent Recommendations on Vitamins and Chronic Disease Prevention

American Heart Association (176) Vitamin or mineral substitutes are not a substitute for a balanced, nutritious diet that limits excess calories, saturated fat, trans fat, and dietary cholesterol. Scientific evidence does not suggest that consuming antioxidant vitamins can eliminate the need to reduce blood pressure, lower blood cholesterol level, or stop smoking.

Medical consequences of longterm alcoholism Harmful effects

The principal harmful effects of heavy drinking include liver pathology (hepaptitis, hepatoma, cirrhosis), neurological complications, and cancers of the mouth, larynx, oesophagus, and breast. Medical sequelae are likely to start to present in middle age in those alcoholics and smokers who started drinking and smoking in their youth. The multiple harmful effects of cigarette consumption are well known and will not be discussed further here. However, the effects of alcohol and cigarette smoking are synergistic in the development of oral, laryngeal, pharyngeal, and esophageal cancers.

Cardiovascular Risk Factors and Peripheral Arterial Disease

A 62-year-old man with intermittent claudication was referred for vascular risk factor modification. He had no history of myocardial infarction (MI) or stroke. He was smoking 20 cigarettes day. His family history was negative for premature vascular events. He was not taking any medication. He was advised to start aspirin 75 mg day, but he stopped taking these tablets because of stomach discomfort. The patient's total cholesterol was 228 mg dl (5.9 mmol l). His blood pressure required treatment with amlodipine and a thiazide diuretic. The patient eventually stopped smoking after referral to the smoking cessation clinic in our hospital.

Chemotherapy in Prostate Cancer

Prostate cancer is now most frequently diagnosed malignancy and the second leading cause of cancer-related death 1 . Death rates have increased over the past 20 years and mortality may approach that of lung cancer within 15 years 2 . For patients with advanced disease, the response rate to hormonal therapy is about 80 , but this is not durable, and all patients will eventually develop hormone-refractory prostate cancer (HRPC) 3 . Chemotherapy has been shown to have palliative benefit in symptomatic HRPC, but has not yet been demonstrated to prolong survival. Median life expectancy for patients with HRPC is only 12 to 18 months, underscoring the urgent need for new therapeutic approaches 4 .

Damage to Genes Germline vs Somatic Mutations Error Corrections Consequences

Damage to genes may result from exposure to mutagens such as pesticides, tobacco smoke, and radiation, or they may occur randomly during DNA synthesis and cell division. As described in chapter 2, cells have built-in damage-control and repair systems, so the damage is usually repaired or the cell is destroyed by apoptosis. The damage control system, unfortunately, is not 100 percent foolproof. The genes coding for the repair enzymes may themselves be mutated. Mutations can also occur at the level of the small proteins that regulate transcription and translation, or those that transduce signals from the cell surface to the genes in the nucleus. It is important to remember that mutations occur both in somatic cells and germ cells, and that some result in cancer.

Bypass to the Popliteal Artery

A 62-year-old overweight postal worker presented with complaints of cramps in his right calf. He stated that this reproducible pain occurred each time he walked 50 yards and resolved upon sitting down. He denied tissue loss or rest pain. His past medical history was significant for hypertension, hypercholesterolemia and tobacco use, as well as coronary revascularization.

Studies Relating Very Low Meat Intake To Longevity

Fraser96 recently reported that, among Californian Seventh-Day Adventists, vegetarians were substantially more likely to have never smoked cigarettes or used alcohol, and to have no prevalent chronic disease. To account for potential confounding by these factors, ever-smokers, alcohol users, and subjects with history of coronary heart disease, stroke, and cancer were excluded from the previously unpublished analysis of Seventh-Day Adventists given in this chapter. adjustment ever-smokers, alcohol users, those with baseline chronic disease excluded from analysis multivariate adjustment ever-smokers, alcohol users, those with baseline chronic illness excluded from analysis ** Adjusted for age, sex, physical activity, body mass index by multivariate adjustment ever-smokers, alcohol users, and those A common criticism of studies that have linked very low meat intake to better health outcome is that vegetarians are likely to exhibit a number of other positive prognostic factors.96,106 Some...

Living Will May Not Be Enough In An Emergency

A retired Los Angeles bus driver, suffering from lung cancer, drew up a living will to avoid life-sustaining technology that would prolong his life and suffering. Then one morning, while preparing breakfast, he felt a sudden intense pain in his back and cried out. Paramedics, called on the scene by his wife, began a massive resuscitation effort when they found no pulse. (They passed a line in a vein in his arm and a tube through his mouth into his lungs.) A DNR order in the living will did not hold, because living wills do not apply during emergencies that are in or out of the hospital. (Emergency teams are required to act first, lest crucial time to save a person's life be lost. This is what the bus driver's daughter was told when she complained that her dad had a living will specifying no massive resuscitation.) The paramedics rushed the man to the hospital, Emergency room staff drew a blood sample, attached wires and hooked him up to a respirator, and sent him to an intensive care...

Herbal preparations black cohosh

Overdose can result in bradycardia, nausea, vomiting, and CNS disturbance. Studies of black cohosh generally have not been blinded, enrolled more than a small number of patients, or examined duration of use beyond six months. Black cohosh is not to be confused with blue cohosh, which has nicotine properties and is potentially toxic, or with white cohosh. The American College of Obstetricians and Gynecologists (ACOG) indicates that black cohosh may be helpful for women with vasomotor symptoms but recommends that its use be limited to less than six months' duration, since little is known of its potential for adverse effects.71

Cardiac and Pulmonary Complications

In addition, many elderly vascular surgery patients have a degree of underlying pulmonary disease. Therefore, postoperative respiratory complications are exceedingly common after major vascular surgery. Predisposing patient risk factors that may give rise to respiratory problems include advancing age, cigarette smoking, and the presence of chronic obstructive pulmonary disease. Predisposing procedure-

Chapter Summary continued

Bronchogenic carcinoma is the leading cause of cancer deaths among both men and women. Major risk factors are cigarette smoking, occupational exposures, and air pollution. Histologic types include adenocarcinoma, bronchioloalveolar carcinoma, squamous-cell carcinoma, small-cell carcinoma, and large-cell carcinoma. Other tumors of importance include bronchial carcinoids, metastatic carcinoma to the lung, and laryngeal squamous cell carcinoma.

General Discussion

In approximately 50 of patients with community-acquired pneumonia (CAP), an etiologic diagnosis cannot be made. The common known causes of CAP are bacteria, viruses, and atypical pathogens. The ATS guidelines recommend treatment of patients based on severity of disease and comorbid conditions. Streptococcus pneumoniae is the most likely pathogen for all groups, and treatment must include coverage for that organism in all patients. In elderly and chronically ill patients, those with COPD, and even smokers without COPD, coverage must include gram-negative bacteria. Aspiration pneumonia should be considered in those with impaired consciousness or altered swallowing reflexes. About 5 of patients with CAP have Pseudomonas aeruginosa identified in their respiratory tract. In the United States, 5 to 35 of pneumococci are now penicillin resistant. Most are intermediate-level resistant and are seen more in immune-compromised and or chronically ill patients, especially if these patients have...

Morbidity and Mortality Associated With Obesity

Obesity is common and is associated with increased rates of mortality and morbidity. The effect of obesity on mortality risk has been addressed by a large number of studies over the past 20 yr. There are unfortunately a number of important methodological issues that have made it difficult to establish a clear relationship between these variables. For example, smokers weigh less than nonsmokers but have increased mortality related to their smoking, not their reduced weight. People with undiagnosed cancer may lose weight and have an increased risk of mortality that, again, is not related to their reduced weight. In an effort to correct for these factors, many modern studies exclude smokers and first 2- to 5-yr mortality (this period begins when BMI weight is first measured) when looking at the effects of obesity on mortality. When this has been done, there remain some questions about whether mortality rates are increased in overweight individuals (BMI 25-30), but it is clear that...

Assessing Weight History

The pattern of weight change over time in an individual patient often gives important clues as to likely causes of weight gain, past successes and challenges in weight loss, and the reasons that the person is seeking assistance with their weight at this time. Asking questions about the history of weight gain including maximum lifetime weight, factors that were associated with periods of weight gain, and previous periods of weight loss with a focus on events that precipitated previous weight-loss attempts and relevant events associated with the termination of previous attempts at weight loss can be very revealing. One way to get at this information efficiently is to have patients draw a graph of their own weight over time (46). In this manner, triggers for weight gain such as pregnancy, smoking cessation, introduction of a new medication, depression, or a musculoskeletal injury can be identified and the clinician can help the patient see the con-

Cerebrovascular disease

Since risk factors differ somewhat for the two major stroke types, proper diagnosis is quite important. Haemorrhagic strokes are due to ruptured blood vessels on the brain surface (subarachnoid haemorrhage) and in the brain substance (intracerebral haemorrhage). Ischaemic strokes are due to blockage of blood vessels by thrombosis in the brain blood vessels, emboli to the brain from the heart or elsewhere, or blockage of blood vessels outside the brain (most notably the carotid arteries). All studies of alcohol and stroke are complicated by the complex and disparate relations of both stroke and alcohol to other CV conditions. Age, cigarette smoking and HTN are important risk factors for both major stroke types. Several CV conditions predispose to cardio-embolic ischaemic stroke these include mitral valvular disease, CHD, cardiomyopathy and atrial fibrillation. Anticoagulant therapy, often employed in CV problems, increases the risk of haemorrhagic stroke....

Prevention of coronary heart disease in women

Case 1 a 62-year-old woman comes to you as a new patient. She has no complaints but needs preventive care. She smokes one pack of cigarettes per day and is on no medications. She does no regular physical exercise and has a desk job. She has no chronic medical problems. Her blood pressure is 150 90 mmHg, and she has a body mass index (BMI) of 38 kg m2 and a waist-to-hip ratio of 1.2. There are no other physical exam abnormalities. You order fasting screening labs, which show total cholesterol of 265 mg dl (6.9 mmol l), low-density lipoprotein (LDL) 180 mg dl (4.7 mmol l), high-density lipoprotein (HDL) 25mg dl (0.65mmol l), triglycerides 300mg dl (3.4mmol l), and glucose 180 mg dl. Case 2 a 65-year-old woman presents for new patient evaluation after a recent hospitalization for an inferior myocardial infarction (MI). She was treated acutely with angioplasty and stent placement in the right coronary artery. She also has a 30 left anterior descending coronary artery lesion and a 20...

Risk factors for atherosclerosis

There are three classes of risk factor for atherosclerosis. Causal risk factors are those where evidence supports a direct cause-and-effect role. These risk factors include nicotine use, high blood pressure, elevated serum cholesterol or LDL, low HDL, and high plasma glucose.

Lipid Differences Between Omnivores And Vegetarian Or Vegans

Lung Cancer 1-14 cigarettes 15 cigarettes *Two tailed p < 0.05, **p < 0.01. Categories nonsmoker, pipe or cigars only 1-14 cigarettes day, > 15 cigarettes day, ***includes current cigarette smokers, (8 men and 13 women). **** The 33 women who smoked pipe or cigar only were included in the category 1-14 cigarettes day along with the 13 women who did not declare how much they smoked. Adapted from Key, T.J.A., Thorogood, M., Appleby, P.N., and Burr, M.I. Dietary habits and mortality in 11,000 vegetarians and health conscious people results of a 17-year follow up. BMJ, 313, 775, 1996. With permission from the BMJ Publishing Group.40

Obstructive Hydrocephalus

The syndrome is seen in middle-aged males who are usually morbidly obese, smokers, and hypertensive. It is due to a number of causes, mainly obesity, pharyngeal malformations, drugs, and alcohol. Patients present cyclical periods of hypoventilation and apnea sometimes lasting minutes, which cause anoxia, arrhythmias, and lack of normal sleep. Results in poor physical well-being during the day, mood changes, and work and family problems.

F Treatment for Central Nervous System Depressant Abuse

For thousands of years, people have used stimulants. The most common stimulants are the nicotine in tobacco products and the caffeine in coffee, tea, and some cola beverages. Central nervous system depressants such as those in paragraph 4-3 of this lesson slow down the action of the body's central nervous system while central nervous system stimulants speed up the body's system. Examples of central nervous system stimulants include cocaine and amphetamines. Common amphetamines include Dexedrine , Benzedrine , and Methedrine .

Specific Discussion

The chest x-ray shows dense bilateral pleural plaques and diaphragmatic calcification characteristic of asbestos-related disease. Pleural plaques, malignant mesothelioma, asbestosis, and lung cancer occur after a long latency period. Asbestos-related pleural effusions are often bloody, exudative, and difficult to differentiate from those caused by trauma, neoplasm, or thromboembolic disease. Diagnosis is based on history of occupational exposure and exclusion of other causes. Chronic bronchitis is a clinical diagnosis, and the chest radiograph and clinical picture are not suggestive of CHF. Empyema presents as a pleural effusion or a loculated pleural-based opacity and not with diffuse bilateral calcification.

Management of Patients with Carotid Bifurcation Disease

A 72-year-old white male was referred for evaluation and management following the finding of an asymptomatic carotid bruit, picked up on routine physical examination by his primary-care physician. The patient was asymptomatic with respect to ocular or hemispheric ischaemic events. His risk factors included a 30-year history of smoking one pack of cigarettes a day, which he quit a year ago. He had hypertension that was controlled well by two drugs. He had no history of coronary artery disease, diabetes mellitus, or symptoms of peripheral vascular disease. On physical examination, his temporal pulses were equal. His carotid pulses were full and equal, but there was a loud bruit over the right carotid bifurcation. His femoral, popliteal, dorsalis paedis and posterior tibial pulses were normally palpable bilaterally.

Molecular Biology of Kidney Cancer

Kidney cancer, more commonly known as renal cell carcinoma,is the sixth leading cause of cancer death in the United States 1 . It currently accounts for approximately 3 of all adult malignancies 1 .In 2001,32,000 cases of renal cell carcinoma in the United States were documented. Of these 32,000 cases, approximately 40 will die of the disease 1 . Renal cell carcinoma is more common in males than in females, with approximately a 2 1 ratio. It typically affects patients between the ages of 50 and 70 but may occur in younger individuals, especially those who suffer from familial syndromes 2-5 . The number one risk factor for the disease is cigarette smoking. Other risk factors include obesity and hypertension, which are thought to be particular risk factors for females who develop renal cell carcinoma 3-5 . Occupational exposures such as leather finishing products and asbestos have also been associated with the development of renal cell carcinoma 6,7 .Also an increased incidence has been...

Nutritional prevention

A summary of risk factors for osteoporosis is shown in Table 14.1. Sedentary lifestyle and or immobility (those confined to bed or wheelchair), low body weight, cigarette smoking, and excessive alcohol consumption all influence bone mass negatively. Behavioral measures that decrease the risk of bone loss include eliminating both tobacco use and excessive consumption of alcohol and caffeine.4 Maintaining estrogen levels in women is important. Measurement of bone density should be considered in patients who present with risk factors. Whether risk factors alone should be the reason to institute preventive measures is not well proven.

The answers are 303d 304g 305b 306h 307a

(Kutty, 3 e, pp 762-765.) Most patients with CML have the Philadelphia chromosome t(9,22) and the bcr abl fusion protein. Mucosa-associated lymphoid tissue (MALT) tumor has been shown to be secondary to H. pylori. Squamous cell carcinomas of the anus, penis, and cervix have been linked to human papillomavirus (HPV). Hepatitis B and C and hemochro-matosis are the major risk factors for hepatocellular carcinoma. Other risk factors include aflatoxin exposure and being from the Far East or Africa (high-incidence areas). Cigarette smoking is the most consistently observed risk factor for pancreatic cancer. Schistosomiasis is associated with squamous cell carcinoma of the bladder. Patients with BRCA1 gene on chromosome 17 present with breast cancer at a young age with a family history of breast or ovarian cancer. Vinyl chloride exposure is a risk factor for hemangiosarcoma of the liver. Patients with colonic polyps are at risk for developing colon cancer. Villous adenomas are more likely to...

Items 738 through 741

A 52-year-old woman presents to your office for her annual gynecological examination. She stopped menstruating about 6 mo ago and is getting some hot flashes. Her history reveals that she drinks one glass of wine per day and smokes about 10 cigarettes per day. She does not exercise much and is overweight. Her most important risk factor for developing osteoporosis is

The Constitutive and Induced Defenses of Plants

In comparison, because of the commercial and medical interest in nicotine, its precise biosynthetic and induction pathways in Nicotiana ssp. are well understood, as is its exact mode of toxicity on animals of all kinds, which is why it is a favorite for ecological studies (Baldwin and Preston 1999 Baldwin et al. 2001). The same level of certainty cannot be applied to most putative defensive compounds produced by trees, especially if reliably analyzing them is problematic as with phenolics, or if they appear to have little if any effect on the herbivores of interest (Haukioja 2005). Transformation approaches are therefore invaluable for studying the role of the genes associated with the defensive pathways of trees.

Achievement of optimum health status

This is perhaps one of the most challenging aspects of pre-assessing vascular patients. It is, first of all, necessary to assess the risk factors a high percentage of these patients are, or have been, heavy smokers, diabetic, suffer from hypertension, raised cholesterol, ischaemic heart disease (IHD) and lead a sedentary lifestyle. Thus achieving optimum health status can be quite difficult. Health education and advice should be offered with the availability of a wide range of leaflets and opportunity for referral to services, such as smoking cessation if available.

Metastatic Carcinoma To The Liver

Chronic gallbladder disease, diabetes mellitus, chronic pancreatitis, cigarette smoking, diets high in meat and fat, and occupational exposure to carcinogens are predisposing factors. Carries a poor prognosis (85 are already locally invasive or metastatic at the time of diagnosis) associated with a mutation in the Ki-ras oncogene. Tumor complications include splenic vein obstruction, splenomegaly, portal hypertension, and hypercoagulability. p.232

Diseasespecific Guidelines

In the U.S., cancer is the second leading cause of death after cardiovascular disease and is responsible for one out of four deaths. Existing scientific evidence suggests that about one third of the 5,000,000 cancer deaths that occur in the U.S. each year are due to dietary and life-style factors, and another third can be blamed on cigarette smoking. The evidence also indicates that, although genetics is a factor in the development of cancer, behavioral factors such as cigarette smoking, dietary choices, and physical activity can modify the risk of cancer at all stages of its development.103 A recent report commissioned by the World Cancer Research Fund and The efficacy of beta-carotene as a chemo-preventive agent was tested in several large clinical trials. Results from two of these trials revealed that individuals at high risk for developing lung cancer (heavy smokers and asbestos workers) who use high-dose supplemental beta-carotene had an increased relative risk (18-23 ) for...

Diabetes complications

Cardiovascular disease remains the major cause of morbidity and mortality for all patients with diabetes. Women with diabetes are five times more likely to develop coronary artery disease than women without diabetes.33 The protective effect of female gender against cardiovascular disease before menopause is not true for any woman with diabetes. Presentation of heart disease may be atypical in the woman with diabetes. Fatigue, decreased exercise tolerance, or dyspepsia may be anginal equivalent symptoms in the woman with diabetes.34 Routine evaluation with exercise stress testing may have up to a 54 false-positive rate in women, so other cardiac evaluations, such as a stress nuclear perfusion study or stress echo, may be necessary. Small-vessel disease is common in diabetes therefore, revascularization procedures may be more difficult in women with diabetes. Risk-factor modification, including smoking cessation, aspirin use, blood pressure control (with consideration of an...

Peripheral Arterial Disease

Peripheral arterial disease continues to be underdiagnosed. In one comprehensive review (19), 6979 patients either older than 70 years, or 50-69 years old with a history of cigarette smoking or diabetes, were evaluated. Only 49 of the patients with a prior diagnosis of peripheral arterial disease were identified by the physicians treating them and 45 of patients diagnosed with peripheral arterial disease in this study had gone previously undetected. Smoking is the most powerful modifiable risk factor for peripheral disease intermittent claudication is three times more common in smokers than nonsmokers. The severity of the disease increases with the number of cigarettes smoked. Cessation of smoking has been reported to cause significant reductions in rest pain, MI, cardiac deaths, and overall 10-year survival (36). Stop smoking

Ceramide and cell senescence

Several clues exist as to the specific mechanisms by which ceramide may mediate the regulation of lifespan. A key phenotype of senescent cells is the lack of response to mitogens. Investigations into this particular facet of cell senescence led to the discovery that lack of mitogenic response is mediated through inhibition of phospholipase D (PLD). Senescent HDF showed ceramide-dependent inability to activate PLD, resulting in lack of PKC activation which in turn mediates the transcriptional response to mitogens. Treatment of quiescent young HDF with exogenous ceramide mimicked the inactivation of PLD and its sequelae observed in senescent HDF 82, 83, 96 . Other investigation has demonstrated that ceramide inhibits telomerase activity in a lung cancer cell line via inactivation of c-Myc 82 . This inactivation partially involves increased ubiquitylation and subsequent proteolytic degradation, as do some stress responsive events, as discussed above 82 . Current investigation focuses on...

Screening for Abdominal Aortic Aneurysm

Recent studies in the U.K. have shown that a screening program would indeed fulfill these expectations, observing a reduction in the AAA rupture rate by 50 . Other groups suggest a screening program would have a greater diagnostic yield and hence prove more cost-effective if only the specific, high-risk populations were targeted, such as elderly male smokers. Whatever the proposal, it would certainly appear that a timely ultrasound examination may be beneficial in the early management of AAA, but a large multicenter trial is needed to obtain

PostMI Risk Stratification and Management

Modification of coronary risk factors is essential for effective secondary prevention, and the positive effects of risk-reduction efforts have been documented (Table 7). Smoking cessation may be the single most effective means of reducing mortality after acute MI, since smoking doubles the recurrence rate of acute MI and the risk of death. The risk declines rapidly within three years of stopping, approaching that of acute MI survivors who never smoked.

Symptoms And Pathology

This stage is usually associated with headache, anorexia, nausea and vomiting, chills, fever, aches and pains, malaise, and a tender liver. There may also be fatigue and an upper respiratory flu-like infection. Those patients who smoke may develop a distaste for tobacco.

Differential Screen for Induced Target Genes

P21 was also reported to interact with caspase 3, a cysteine protease known to be an important regulator in cell death signaling (Suzuki et al., 1999). In one report, caspase 3 was shown to be cleaved by p21, activating its enzymatic activity, and thereby allowing the conversion of the human lung cancer cell line A549 from a growth-arrested state to an apoptotic one (Zhang et al., 1999). In the other case, the binding of procas-pase 3 to p21 inhibited caspase 3 activity (Suzuki et al., 1999). A binding domain for this procaspase was identified at the N terminus of

The Map Kinase Pathway

JNK modulates the activity of nuclear RARs. In non-small cell lung carcinoma (NSCLC) cells, activation of JNK may be at the basis of the resistance to the action of retinoids (Lee et al., 1999). Activation of JNK contributes to RAR dysfunction by phosphorylating RARa and inducing degradation through the ubiquitin-proteasomal pathway. Interestingly, mice that develop lung cancer from activation of a latent K-ras oncogene have high intratumoral JNK activity, low RARa levels, and are resistant to treatment with RAR ligands. JNK inhibition in a human lung cancer cell line enhances RARa levels, ligand-induced activity of RXR-RAR dimers, and growth inhibition by atRA (Srinivas et al., 2005). In spite of these data, the major target of JNK activity seems to be the RXR moiety of the RAR RXR complex. Overexpression and UV activation of JNK1 and JNK2 hyperphosphorylate mouse RXRa. This inducible hyperphosphorylation involves Ser61 and Ser75 as well as Thr87 in the B region and Ser265 in the...

Inflammatory Abdominal Aortic Aneurysms

Definition of the inflammatory AAA depends on the presence of a triad of factors a thickened aneurysmal wall, marked perianeurysmal retroperitoneal fibrosis, and dense adhesions involving adjacent abdominal viscera to the aneurysm. These aneurysms comprise 5 to 10 of all AAAs, and the typical patient is a male in his sixth decade. Females are rarely affected by the disease (male-to-female ratio of 20 1). Interestingly, the average age at diagnosis is about 10 years younger than those patients presenting with noninflammatory aortic aneurysms. Postulated risk factors that are specific for the development of inflammatory AAA include cigarette smoking and a genetic predisposition. A more convincing theory regarding inflammatory AAA development is that it is the result of a specific inflammatory process. This process is responsible for both inflammatory and noninflammatory AAAs, and thus we are not to consider the two pathologies as distinct pathological entities rather, the former is an...

HPVE7 Viral Oncoproteins and p16INK4ACyclin DRb Pathway

There is substantial genetic evidence that only one component in the p16INK4A cyclinD Rb pathway needs to be inactivated for neoplastic clonal expansion 32,33 . Evidence from studies in lung cancer suggests that there are important phenotypic differences between cells that have inactive Rb but active p16 function, as compared to cells with active Rb and inactive p16 32,34 . For example, Rb undergoes mutational inactivation in the genesis of 90 of small cell lung cancers, whereas in non-small-cell lung cancer, the preferential target is p16. In many SCCs that do not reveal viral involvement, the p16iNK4A cyclinD Rb pathway is commonly disrupted through mutation, deletion, or hyperme-thylation of the p16 gene, resulting in reduced or absent p16 expression 35,36 . Data from functional studies in mice suggest that overexpression of the polycomb group (PcG) gene BMI-1 can provide a further alternative mechanism to downregulate p16 37 . In contrast, where the Rb protein is functionally...

Drugs Approved by FDA for Other Uses Than Weight Loss

Bupropion is a norepinephrine and dopamine reuptake inhibitor that is approved for the treatment of depression and for smoking cessation. Gadde et al. reported a clinical trial in which 50 obese subjects were randomized to bupropion or placebo for 8 wk with a blinded extension for responders to 24 wk. The dose of bupropion was increased to maximum of 200 mg twice daily in conjunction with a calorie-restricted diet. At 8 weeks, 18 subjects in the bupropion group lost 6.2 3.1 of body weight compared with 1.6 2.9 for the 13 subjects in the placebo group ( p< 0.0001). After 24 wk, the 14 respond-

Naturally Occurring Repellent And Insecticidal Chemicals

These compounds are insecticidal at low concentrations and frequently toxic to vertebrates. Their mode of action varies, but many affect acetylcholine receptors in the nervous system (e.g., nicotine) or membrane sodium channels of nerves (e.g., veratrin). Insecticidal examples include nicotine (Nicotinia spp.), anabasine (Anabasis aphylla), veratrin (Schoenocaulon officinale), and ryanodine (Ryania speciosa). Physostigmine, which served as the model compound for the development of the carbamate insecticides, is an alkaloid isolated from the calabar bean (Physostigma venenosum) (Stedman and Barger, 1925). Although these chemicals are not volatile, they may be used as repellents by burning plant material, either on a fire or in a mosquito coil to create an insecticidal smoke that repels the insects through direct toxicity. Alkaloids are found in large quantities in many members of the Berberidaceae, Fabaceae, Solanaceae, and Ranunculaceae families, all of which are used extensively as...

Answers and Case Discussion

This 39-year-old man had the significant risk factors of a family history of cardiovascular disease, cigarette smoking, and hypertension. Although vomiting, diaphoresis, and shortness of breath were not present, his history is still compatible with AMI. The physical examination is not helpful in this instance and neither confirms nor denies the possibility of AMI. As always, the first steps to be taken should be those that are necessary to protect the patient's life should an adverse event such as ventricular fibrillation occur. Therefore, starting an IV, monitoring the patient, and starting O2 are the first steps.

Venous Ulcers Associated with Deep Venous Insufficiency

A 46-year-old female schoolteacher and non-smoker presented with an ulcer on the medial side of the ankle. The ulcer had persisted for the past year despite compressive dressings at a hospital wound care center. Ulcers in the same general area had occurred intermittently in the past but had healed with local wound care and dressings. The ulcer was very painful, particularly with dependency of the leg (7 10 over a visual analogue scale) and frequently at night. The patient had made a habit of elevating her legs during the day whenever feasible, and to sleep with her legs elevated on a pillow at night. She had been using a nonsteroidal anti-inflammatory drug once or twice a day at work for pain relief, but lately a narcotic prescribed by her physician was required for sleep at night. Even so, on some nights, she had to walk off the pain for twenty to thirty minutes before she could fall asleep.

Is it dangerous to take oral contraceptives

Like all medicines, birth control pills may cause serious problems in certain persons (see next pages), The most serious problems related to the pill are blood clots in the heart, lungs, or brain (see stroke, p. 327). This occurs most often in women over 35 who smoke tobacco. However, the chance of getting dangerous clots is higher when women get pregnant than when they take the pill. But for some women, both pregnancy and taking birth control pills have a higher risk. These women should use other methods of family planning.

A Iliofemoral Venous Thrombosis

A 72-year-old man was admitted in the late evening because of a turgid, white, painful left leg. Over the course of 4 months, he had lost 8 kg of weight (from 82 to 74 kg) his height was 175 cm. There were general symptoms, such as tiredness, slight nausea, lack of appetite and increasing apathy. Over the last 12 h, he had been increasingly confused and aggressive. He had been bedridden for 3 weeks but had refused to see a doctor. There was no history of psychiatric disease, focal cerebrovascular events, ischaemic heart disease, hypertension, intermittent claudication, or venous insufficiency. He had been smoking about 20 cigarettes a day since he was 14 years old, and for many years he had had slight functional dyspnoea, but otherwise no pulmonary symptoms. Stools had been light yellow to grey white for the last week. His renal function had never been examined, and it had not been noticed whether he had passed urine in the last 24 h. Diazepam was the only medication. The history was...

Characterization of tumors with single and multiple p53 mutations

The physical and functional separation of p53 alleles also provides an assay to monitor intra-tumor WT p53 delivery by viral vectors for cancer gene therapy approaches to treat brain, head and neck, ovarian, and lung cancer 38, 106, 195, 199, 214 . Specific primers can be used to amplify the mRNA obtained from endogenous p53 alleles or the virally encoded WT cDNA to estimate the contribution of viral WT p53 mRNA in tumor samples.

Postoperative Management

Careful postoperative management is essential for a successful outcome. The patient's vital signs and vascularity of the area should be monitored continuously. The room should be warm, as cooling can lead to cold-induced vasospasm. In addition, the patient should be left in a quiet room with limited visitations, to avoid stress-induced vasospasm. Cigarette smoking by the patients and visitors is strictly forbidden, as nicotine is a potent inducer of vasospasm. Finally, cold drinks, as well as those with caffeine are restricted.

Evidence For Lung Restoration By Vitamin A

There have been two published clinical studies that tested the effectiveness of RA in restoring airway tissue of former cigarette smokers (Kurie et al., 2003 Mao et al., 2002). In one of the studies, a high dose of RA (100 mg person day) was effective in reducing the degree of tracheal metaplasia (Kurie et al., 2003), but a lower dose of RA (20 mg person day) showed no benefit for those with emphysema (Mao et al., 2002). Although the different outcomes of the studies may have been due to dose of RA, the precise reason is not known.

Pharmacotherapy For Vascular Dementia Vd

Once VD has been identified, thorough review should be made of the patient's medical conditions. The clinician should review with the patient and caregiver any risk factors that exist for stroke, and outline a treatment plan to control or eliminate these conditions. Cigarette smoking should be eliminated, and attention to diet and exercise regimens should be encouraged. Blood pressure control should not become overaggressive, as this may place the patient at increased risk of more brain damage from hypoperfusion. In fact, maintenance of a slightly increased blood pressure may be beneficial for cognition in VD patients 256,257 . The use of aspirin 258 and reduction of plasma lipids may also have a role as preventive measures 259 .

Pharmacological Treatment

A limited number of medications are currently available in the pediatric age group for use as adjuncts to behavioral management. Sibutramine (Meridia) is currently available for the treatment of adolescents 16 yr of age or older. Sibutramine is a norepinephrine and serotonin reuptake inhibiter and has side effects that include hypertension, tachycardia, dry mouth, headache, constipation, and insomnia. When used in conjunction with a group-based behavioral therapy, sibutramine plus behavioral therapy led to a more rapid decline in BMI than behavioral therapy alone (91). Sibutramine should not be administered in conjunction with monoamine oxidase inhibitors or other serotonin reuptake inhibitors. Another pharmaceutical alternative is orlistat (Xenical). Orlistat binds gut lipase and prevents hydrolysis of dietary fats into free fatty acids and monoacylglycerols. Its side effects, which often lead to discontinuation of the medication, include flatulence, diarrhea, steatorrrhea, and...

Squamous Intraepithelial Neoplasia Vulvar Intraepithelial Neoplasia

Unrelated to HPV, differentiated VIN, is discussed below. Usual VIN has a wide variety of clinical appearances and may appear as red, white, dark, flat, raised, or ulcerated lesions. Lesions may be multifocal or confluent. These HPV-related lesions are more common and more often recurrent in patients with immune suppression, or who smoke cigarettes. Terminology is variable, and encountered terminologies may include the three-tiered VIN 1,2,3, or the two-tiered low- and high-grade squamous intraepithelial lesion. Whether VIN 1 exists or is actually the same as a reactive lesion or condyloma is controversial, and recently the International Society for the Study of Vulvovaginal Disease (ISSVD) has adopted a terminology that only includes VIN as a high-grade lesion (see below). Histologically, VIN may have a warty or basaloid configuration (52). Warty lesions have a prominent HPV cytopathic effect with koilocytosis, but are distinguished from condyloma acuminatum by the degree of...

The answers are 402e 403a 404b Wallace 14e pp 811 814 Health belief model the likelihood of taking a health action is

The answers are 413-b,f,h, 414-c,d,e, 415-c,h. (Wallace, 14 e, p 824. Fauci, 14 e full text , pp 563, 568, 605-609.) Moderate alcohol consumption appears to be a risk factor also for breast cancer. Tobacco use is also associated with cancer of the lip, oral cavity, pharynx, pancreas, larynx, bladder, and kidney.

Problems That Occur During Sleep

Inherited differences in the shape of the upper airways, and diminished elastic content of the tissues with age. Allergies, infection, respiratory irritants, and smoking can cause swelling of these tissues. Alcohol and some drugs can cause the muscles of the throat to relax. Lying on the back can cause the tongue and other throat tissue to be pulled back by gravity. Large tonsils and adenoids may constrict the size of the throat. Nasal congestion may force more mouth breathing. Even depression, stress, or anxiety can cause changes in blood flow to the nose, causing swelling.

Protein Differences Between Omnivores And Vegetarians Or Vegans

A varied diet based on plant proteins is adequate, yielding growth and body maintenance results equivalent to a diet based on meat protein.39 The lower incidence of obesity, constipation, lung cancer, hypertension, coronary artery disease, type 2 diabetes, gallstones, reduced risk of breast cancer, diverticular disease, colon cancer, calcium kidney stones, and osteoporosis appear to be obvious advantages particularly of the well balanced vegan diet for the elderly.3,39,40 Key et al.,40 (Table 11.1) show the protective effect of daily fresh fruit intake in ischemic heart disease, cerebrovascular disease, and lung cancer, and daily raw salad protection for ischemic heart disease. They also presented a higher incidence of breast cancer in the vegetarian women, but the confidence interval was broad. The smokers in their study population demonstrated a higher rate of ischemic heart disease, cerebrovascular disease, and, of course, lung cancer, to emphasize the disease problems associated...

The answer is a Fauci 14e pp 14511455 Massive lifethreatening hemoptysis is 100 cc of blood in 24 h The most common

Cause for nonmassive hemoptysis (< 30 cc day) in smokers and nonsmoking patients with a normal chest radiograph is bronchitis. Chronic bronchitis is characterized by excessive secretions manifested by a productive cough, often purulent or bloody, for 3 mo or more for 2 consecutive years in the absence of any other disease to explain the symptoms. Patients are often obese and cyanotic (blue bloater). The mnemonic is BBB Bronchitis Blue Bloater. 117. The answer is a. (Fauci, 14 e, pp 1451-1455.) COPD is defined as a condition where there is chronic obstruction to airflow due to chronic bronchitis or emphysema. An exacerbation of COPD occurs when the patient develops the acute onset of marked dyspnea and tachypnea requiring the use of accessory muscles that is unresponsive to medications. a antitrypsin deficiency should be suspected in nonsmokers who present with COPD of the lung bases in their fifties without any predisposing history, such as occupational exposure to support the...

Aortofemoral Graft Infection

A 66-year-old man, an ex-smoker with hypertension and hypercholesterolemia, had undergone a Dacron bifurcated aortic graft and bilateral ureteric stents for an inflammatory aortic aneurysm with ureteric obstruction at another hospital 4 years previously. The left limb of the graft had been anastomosed to the common femoral artery and the right limb to the common iliac bifurcation. Postoperatively he had suffered a mild groin wound infection, which had healed with antibiotics. At follow-up he complained of left calf and thigh claudication. On examination, he appeared generally well with a midline abdominal scar and a left vertical groin scar. He had good right femoral pulse but an absent left femoral pulse.

Primary and secondary prevention

Primary prevention focuses on reducing risk factors for stroke. The six most important factors are hypertension, atrial fibrillation, history of recent MI, diabetes, cigarette smoking, and alcohol abuse.Weightreduction in obese people and control of hyperlipidemia can reduce the risk of stroke (Table 13.2). Dietary and lifestyle changes have been shown to reduce risk of stroke. A low-salt, low-fat diet, control of hyperlipidemia, reduction of obesity, and exercise may reduce the risk of a first stroke. Reducing or quitting cigarette smoking is important. Once a woman stops smoking, her risk of stroke returns to that of a non-smoker within three to five years.22

Reducing the Stigma Associated with Schizophrenia

Modern communication technology, however, also offers the possibility of reducing stigma. Since the unsuccessful anti-stigma campaigns of the postwar period, public education methods and techniques for health promotion have improved dramatically. ''Social marketing'' campaigns have been used successfully to advance a variety of causes including AIDS prevention, family planning, smoking cessation and reducing infant mortality. Effectiveness is increased by ''audience segmentation partitioning a mass audience into sub-audiences that are relatively homogeneous and devising promotional strategies and messages that are more relevant and acceptable to those target groups 1 .

Mechanisms For Protection Against Emphysema By Vitamin A

Anti-inflammatory properties are also evident in a vitamin A-deficient model (Fig. 1). When weanling rats are deprived of dietary vitamin A for 6 weeks, lung inflammation occurs in certain areas of the lung, while emphysema occurs in other areas of the same lung (Baybutt et al., 2000). Thus, without vitamin A lung inflammation increases. The increased presence of pulmonary inflammation and emphysema in cigarette smokers may be related to vitamin A status.

Obstetrics and Gynecology

The answer is b. (Cunningham, 20 e, pp 746-751, 755-757, 765-767.) Placenta previa and abruptio placenta are the two most common causes of third-trimester bleeding. Placenta previa is abnormal implantation of placenta near or at the cervical os, and may be total, partial, marginal, or low-lying. Risk factors for placenta previa include advanced maternal age, multiparity, smoking history, and prior cesarean section. Patients present at 30 wk gestation with painless vaginal bleeding. There is no fetal distress. Vaginal examination is contraindicated and sonogram is required to make the diagnosis. Abruptio placentae is premature separation of a normally implanted placenta. Patients present with painful (unremitting abdominal and back pain) vaginal bleeding and there is fetal distress. Risk factors for abruptio placentae include advanced maternal age, multiparity, diabetes, hypertension, tobacco use, alcohol use, and cocaine use. Placenta accreta is a placenta that adheres to the...

Erectile Dysfunction due to Aortic Disease

Risk factors consisted of mild hypertension controlled by an angiotensin converting enzyme (ACE) inhibitor, cigarette smoking (discontinued 1 month previously), and a history of an infrarenal abdominal aortic aneurysm diagnosed 8 months before. Ultrasound had measured an abdominal component 3.6 cm in diameter compared with a suprarenal aortic diameter of 3 cm.

Xylocaine Infiltration For Marsupialization

A 20-year-old G3P0030 obese female comes to your office for a routine gynecologic exam. She is single, but is currently sexually active. She has a history of five sexual partners in the past, and became sexually active at age 15. She has had three first-trimester voluntary pregnancy terminations. She uses Depo-Provera for birth control, and reports occasionally using condoms as well. She was treated for chlamydia last year, but denies any prior history of abnormal Pap smears. The patient denies use of any illicit drugs, but admits to smoking about one pack of cigarettes a day. Her physical exam is normal. However, 3 weeks later you receive the results of her Pap smear, which indicates a high-grade squamous intraepithelial lesion. A 50-year-old G3P3 with a history of fibroids comes to see you complaining of menometrorrhagia. Her LMP was 5 weeks ago and so heavy that she could not leave the house, fearing she would bleed through her clothes. She also complains of occasional hot flushes...

Neoplasia and Blood Disorders

A 55-year-old man has lung cancer in the right middle lobe. Which paraneoplastic syndrome is associated with GHRH secretion and lung cancer 98. A 45-year-old white man with a limited small cell lung cancer presents to the emergency room of a local hospital and exhibits agitation and confusion, ataxia, nystagmus, peripheral sensory loss, and generalized weakness. The most likely etiology of this disorder is 101. A 66-year-old white woman with a known history of small cell lung cancer comes to your office because of engorgement of her neck veins on the right side and over her chest wall. She also has cyanosis of the extremities, facial edema, and difficulty with her mentation. Her diagnosis is most likely c. Lung cancer

Chronic Critical Limb Ischemia

An 85-year-old male with a history of diabetes, hypertension, hypercholesterolemia, coronary artery bypass, and active tobacco use presented with a gangrenous right first toe. The patient stated that he had no history of trauma to the area, and complained of rest pain in the foot. The patient had been in otherwise good health since his coronary artery bypass 12 years ago. On physical examination, the patient was in no physical distress. The patient had a well-healed median sternotomy scar. Auscultation of the heart revealed a regular rate without any murmurs. He was obese. Abdominal examination revealed no palpable masses. The patient had bilateral femoral and popliteal pulses but no pedal pulses. The patient had bilateral, well-healed scars from the greater saphenous vein harvest sites. The right gangrenous toe was dry without any evidence of infection.

Categories Of Commonly Abused Substances

Drug abuse is not limited to one particular group of individuals. The majority of Americans is vastly overmedicated in one way or another, which is most likely due to the belief that there is a pharmacologic remedy for every problem. The list of commonly abused substances can be extremely long, ranging from caffeine and tobacco (nicotine) to over-the-counter sleep medications. We will limit this lesson to abused substances that fall into four major categories depressants, stimulants, narcotics, and hallucinogens. (4) Nicotine. Nicotine is a mild stimulant found in tobacco. NICOTINE

Hyaline Membrane Disease

ID CC A 36-year-old female nonsmoker visits her family doctor because she has become increasingly short of breath (dyspnea) her symptoms first appeared only during exercise but now occur even when she is at rest. Discussion Pollutants, cigarette smoke, and infections increase PMNs and macrophages in the lung and thus produce a number of proteolytic enzymes. Damage to lung tissue due to these enzymes is controlled by the globulin a,-antitrypsin, which inhibits trypsin, neutrophil, elastase, and collagenase. A deficiency of this enzyme causes excessive lung tissue destruction and panacinar emphysema (cigarette smoking is associated with the centrilobular type). Patients may also develop liver damage.

A score of 07 is mild BPH 819 is moderate BPH and 2035 is severe BPH

The answer is b. (Fauci, 14 e, p 1544.) IgA nephropathy (Berger's) is the most commonly encountered form of focal glomerulonephritis worldwide, and patients will often have microhematuria. It may follow an upper respiratory tract infection or physical exertion. Bladder cancer is a common cause of asymptomatic microhematuria but is usually found in patients over the age of 50. Risk factors for bladder neoplasia include aniline, rubber, other organic solvents, industrial dyes, and tobacco use. Minimal change disease almost always presents with severe proteinuria, and erythrocyte casts are not seen in rhabdomyolysis. Patients with Alport syndrome have the nephritic syndrome and hearing loss. 254-255. The answers are 254-b, 255-c. (Fauci, 14 e, pp 592-596.) Ninety-five percent of tumors of the kidney are renal cell carcinomas. Patients present with hematuria and the presence of an abdominal mass. Causal factors have been implicated in the development of renal cell carcinoma, but...

Technique Used To Maximize Compliance With Allocated Regimen

In a study of the cause of lung cancer, patients who had the disease were matched with controls by age, sex, place of residence, and social class. The frequency of cigarette smoking was then compared in the two groups. What type of study was this The incidence rate of lung cancer is 120 100,000 person-years for smokers and 10 100,000 person-years for nonsmokers. The prevalence of smoking is 20 in the community. 22. What is the relative risk of developing lung cancer for smokers compared with nonsmokers 23. What percentage of lung cancer can be attributed to smoking 24. If the prevalence of smoking in the community was decreased to 10 , the excess incidence rate of lung cancer that could be averted in that community would be An investigator is designing a randomized, double-blind, placebo-controlled clinical trial to see whether vitamin E will prevent lung cancer. b. Incidence of lung cancer A research team wishes to investigate a possible association between smokeless tobacco and...

Items 548 through 549

A 50-year-old man presents to a health center for routine care. His last visit was 5 years ago and he has no complaints. He has been smoking 1 pack of cigarettes a day since he was 15 years old. When counseled about his smoking, he says he has no intention to quit and feels fine. He drinks two alcoholic beverages per week. Records show that his blood cholesterol is 235 mg dL, with a HDL level of 40 mg dL and a LDL level of 140 mg dL. The patient has no family history of coronary artery disease (CAD). His height is 5 ft, 10 in and he weighs 170 lbs. His blood pressure is 110 75 mm Hg. a. Refer him to classes for smoking cessation and reassess progress in 2 wk c. Prescribe nicotine replacement therapy and reassess progress in 2 wk

Decreased arousal andor plateau

Lifestyle changes are critical and should include moderation of alcohol intake, exercise, smoking cessation, weight loss, and stress management. Medications that can be discontinued or reduced in dosages should be changed (Table 5.7). Additionally, just as psychotropic agents can significantly reduce

Ovarian Steroid Secretion Data

At baseline, all subjects were interviewed regarding their menstrual history, pregnancies, past and present contraceptive use, sexual activity, use of cigarettes and alcohol. During the baseline study cycle, all women underwent a complete physical examination including height and weight measurement. Blood and urine specimens were collected during all study menstrual cycles.

Emphysema And Vitamin A

CIGARETTE SMOKING, VITAMIN A DEFICIENCY, AND THE DEVELOPMENT OF EMPHYSEMA The overwhelming majority of cases of emphysema have been linked to cigarette smoking. Because vitamin A deficiency induces emphysema (Baybutt et al., 2000), the emphysema resulting from cigarette smoke could be the consequence of a localized vitamin A deficiency of the lungs. In support of this hypothesis, there is evidence that cigarette smoking leads to vitamin A deficiency. Edes and Gysbers (1993) reported that feeding rats benzopyrene, a constituent in cigarette smoke, depleted the vitamin A content of the lungs and liver. As previously noted, vitamin A-deficient lungs produce areas of emphysema (Baybutt et al., 2000). Therefore, the emphysema incurred from cigarette smoke could be the consequence of a localized vitamin A deficiency in the lungs. Further support for this hypothesis is reported in a study by Li et al. (2003) in which rats were exposed to cigarette smoke from 20 nonfiltered commercial...

Cigarette Crusher

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