1/9. harm reduction--a treatment approach for resistant smokers with tobacco-related symptoms.Smokers with chronic obstructive pulmonary disease (COPD) appear to represent a hard-core group, and this presents a dilemma for chest physicians. A reduction in cigarette smoking benefits health, and nicotine replacement therapy (NRT) can aid smoking reduction. Hence we studied the efficacy of nicotine gum in helping hard-core smokers with severe COPD to quit. Seventeen smokers with severe COPD (FEV(1) 38-47% of predicted normal) who smoked >30 cigarettes/day but were unable to quit were encouraged to reduce their smoking as much as possible by using 4-mg nicotine gum. Five gradually reduced their daily tobacco consumption and, 18 months after starting NRT, were smoking an average of 6 cigarettes/day while still using nicotine gum. Compared to baseline, their respiratory symptoms had improved, and both FEV(1) and FVC had increased. There was no improvement in pulmonary function in the group of smokers who did not reduce their cigarette consumption. No adverse events relating to nicotine occurred among the patients who used NRT to reduce their smoking. We propose that this reduction approach should be considered for patients with respiratory disease who are unable or unwilling to stop smoking.- - - - - - - - - - ranking = 1keywords = tobacco (Clic here for more details about this article) |
2/9. A case series of nicotine nasal spray in the treatment of tobacco dependence among patients with schizophrenia.A retrospective case series of 12 smokers with schizophrenia or schizoaffective disorder who had not successfully quit smoking with previous treatments for tobacco dependence were treated with nicotine nasal spray. All but one patient (92 percent) tolerated the nasal spray well, and nine (75 percent) used it at maximal doses for prolonged periods. After treatment five patients (42 percent) were abstinent from smoking for more than 90 days, and four patients (33 percent) substantially reduced the amount that they smoked. Ten patients (83 percent) used the spray in combination with other medications, and all received psychosocial support. nicotine nasal spray was found to be well tolerated.- - - - - - - - - - ranking = 1keywords = tobacco (Clic here for more details about this article) |
3/9. Successes and failures of the teachable moment: smoking cessation in cancer patients.BACKGROUND: Successful cancer treatment can be significantly compromised by continued tobacco use. Because motivation and interest in smoking cessation increase after cancer diagnosis, a window of opportunity exists during which healthcare providers can intervene and assist in the quitting process. methods: The authors conducted a comprehensive literature review to discuss 1) the benefits of smoking cessation in cancer patients, 2) current knowledge regarding smoking cessation interventions targeted to cancer patients, and 3) treatment models and state-of the-art guidelines for intervention with cancer patients who smoke. The authors present clinical cases to illustrate the challenging nature of smoking cessation treatment for cancer patients. RESULTS: Continued smoking after cancer diagnosis has substantial adverse effects on treatment effectiveness, overall survival, risk of second primary malignancies, and quality of life. Although some encouraging results have been demonstrated with smoking cessation interventions targeted to cancer patients, few empirical studies of such interventions have been conducted. A range of intervention components and state-of-the-art cessation guidelines are available that can be readily applied to cancer patients. Case illustrations highlight the crucial role of healthcare providers in promoting smoking cessation, the harmful impact of nicotine addiction manifested in delayed and failed reconstructive procedures, and unique problems encountered in treating patients who have particular difficulty quitting. CONCLUSIONS: Despite the importance of stopping smoking for all cancer patients, the diagnosis of cancer is underused as a teachable moment for smoking cessation. More research is needed to empirically test cessation interventions for cancer patients, and attention must be given to complex and unique issues when tailoring cessation treatment to these individuals.- - - - - - - - - - ranking = 0.2keywords = tobacco (Clic here for more details about this article) |
4/9. Yellow forelock--a new neuro-ophthalmological sign.We examined a middle-aged man with a prominent yellow forelock who complained of loss of vision in both eyes. He smoked his pipe avidly and drank a little Bourbon whisky daily. The nicotine content of the forelock (21.7 ng/mg) was 10 times that of the hair on his occiput (2.23 ng/mg). A yellow forelock when associated with isolated painless visual loss suggests tobacco amblyopia.- - - - - - - - - - ranking = 0.2keywords = tobacco (Clic here for more details about this article) |
5/9. Tobacco addiction as a psychiatric disease.Tobacco is the most widely used addictive substance in the world. Since the Surgeon General's 1964 report, medicine has sought out the genesis of tobacco addiction (TA) and has evolved methods of treatment and prevention. psychiatry was slower than other medical specialties to acknowledge TA as a legitimate area for psychiatric intervention, probably because the many psychiatrists who were smokers identified with their smoking patients. Since 1980, the American Psychiatric association has recognized nicotine dependence and nicotine withdrawal as diagnostic entities. The complications of TA are in the province of other medical specialists, but psychiatrists have unique tools for treating addictive disorders. This paper describes some of the addictive qualities of tobacco, and presents illustrative cases of successful treatment of TA using hypnosis. It describes an effective cooperative community program under medical aegis, focusing on education, therapy, and prevention, which has resulted in the virtual disappearance of tobacco consumption in hospitals and schools in the community. By sharing their expertise in the treatment of individual patients, and the design of effective community programs that include education, prevention, and treatment, psychiatrists will be active leaders in the medical community's program to reduce tobacco addiction.- - - - - - - - - - ranking = 0.8keywords = tobacco (Clic here for more details about this article) |
6/9. Psychiatric aspects of head and neck cancer surgery.Psychiatric problems of patients with head and neck cancer include reactions to disfiguring illness and treatment; adjustment to alterations of speech, eating, and other functions, including sex; changes in body image; alcohol and tobacco addiction; pain; organic brain syndromes; and dealing with terminal illness. Although speech is often compromised, head and neck patients can communicate and psychiatric work is possible. The consultation-liaison psychiatrist can provide considerable assistance by utilizing psychodynamic, behavioral, and pharmacologic modes of treatment and by working with family members and staff.- - - - - - - - - - ranking = 0.2keywords = tobacco (Clic here for more details about this article) |
7/9. thromboangiitis obliterans (Buerger's disease) and smokeless tobacco.thromboangiitis obliterans, a distinct clinical and pathologic entity characterized by segmental inflammatory and proliferative lesions of the tunica media of small arteries and veins, has been reported frequently in men who have a history of heavy cigarette smoking. We report a case of thromboangiitis obliterans in a 38-year-old man that was clearly associated with the use of smokeless (chewing) tobacco. In addition to a physical history and examination and laboratory evaluation, a biopsy of the skin and deep subcutaneous tissue of the patient's left thigh was performed, and this revealed occlusion of 2 large dermal blood vessels by a highly organized thrombus. A regimen of nifedipine and antiplatelet therapy, plus complete abstinence from tobacco, resulted in resolution of the patient's symptoms and pain. Our findings may be of particular importance in view of the increasing popularity of smokeless tobacco and the complications which may result from its use.- - - - - - - - - - ranking = 1.4keywords = tobacco (Clic here for more details about this article) |
8/9. Focal oral warty dyskeratoma.A 49-year-old white man developed focal oral warty dyskeratoma, which is a solitary, elevated nodule with a keratotic umbilicated center. The term "focal oral warty dyskeratoma" was suggested to distinguish these lesions from the histologically similar oral lesions found in Darier's disease. This paper reviews previously published reports of the lesion and presents an additional case. The average age of patients was 52.2 years, and a slight male predilection was noted. In almost all cases, the lesion was found in tissue overlying bone, with the maxillary alveolar ridge and palate being the most common locations. When the side of involvement was given, all lesions were noted to be on the left side. No evidence of a viral presence was seen with light or electron microscopic study, but the possibility of chronic irritation, such as tobacco usage, exists as an etiologic agent.- - - - - - - - - - ranking = 0.2keywords = tobacco (Clic here for more details about this article) |
9/9. Extensive salivary contamination due to concurrent use of chewing tobacco during I-131 radioablative therapy.Although multiple authors have reported on various causes of external I-131 contamination after administration of radioiodine, to the authors' knowledge there have been no reported cases of external contamination from salivary secretions due to expectoration of chewing tobacco. A case of extensive I-131 contamination of a hospital room, furniture, and plumbing due to indiscriminate use of chewing tobacco during an inpatient I-131 radioablative therapy is presented.- - - - - - - - - - ranking = 1.2keywords = tobacco (Clic here for more details about this article) |