August 8, 2006, 0:11 AM CT

more effective smoking cessation

Results of a new imaging study, supported in part by the National Institute on Drug Abuse (NIDA), National Institutes of Health, show that the nicotine received in just a few puffs of a cigarette can exert a force powerful enough to drive an individual to continue smoking. Scientists observed that the amount of nicotine contained in just one puff of a cigarette can occupy about 30 percent of the brain's most common type of nicotine receptors, while three puffs of a cigarette can occupy about 70 percent of these receptors. When nearly all of the receptors are occupied (as a result of smoking at least 2 and one-half cigarettes), the smoker becomes satiated, or satisfied, for a time. Soon, however, this level of satiation wears off, driving the smoker to continue smoking throughout the day to satisfy cigarette cravings.

"Imaging studies such as this can add immensely to our understanding of addiction and drug abuse," says Elias A. Zerhouni, M.D., Director of the National Institutes of Health. "These findings suggest that drug therapies or vaccines for smoking cessation need to be extremely potent to compete with nicotine, which binds so readily to these receptors."

The study is reported in the August 2006 issue of the Archives of General Psychiatry.

"This study illustrates the powerfully addictive impact of even small amounts of nicotine. Every time a smoker draws a puff from a cigarette, they inhale numerous toxic chemicals that promote the formation of lung cancer, and contribute in a significant way to death and disability worldwide," says NIDA Director Dr. Nora D. Volkow. "Eventhough a number of smokers endorse a desire to quit, very few are able to do so on their own, and fewer than half are able to quit long-term even with comprehensive therapy. This study helps explain why".........

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August 1, 2006, 11:04 PM CT

Emphysema Patients Might Benefit From Surgery

The latest results from the landmark National Emphysema Treatment Trial (NETT) confirm and extend earlier findings that selected patients with advanced emphysema predominately in the upper area of the lung may benefit from surgery and the benefits are still apparent with two more years of follow-up. The newly published findings from the largest study of bilateral lung volume reduction surgery (LVRS) to treat severe emphysema also confirm that patients with upper-lobe emphysema and poor exercise capacity before surgery are more likely to have improved survival in comparison to similar patients treated with medical treatment without surgery. Surgery might also provide some symptom relief in patients with emphysema in the upper lung area but who had good exercise capacity previous to surgery; however, survival rates did not improve in this group.

NETT scientists describe the effects of LVRS after following 1218 patients for an average of 4.3 years, two years longer than the primary results reported in 2003. The earlier findings led to Medicare coverage of LVRS for patients meeting criteria based on the study results. NETT began in 1996 as a cooperative effort between the National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health and the Centers for Medicare & Medicaid Services. Both are agencies of the U.S. Department of Health and Human Services.........

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July 25, 2006, 6:30 AM CT

Take a deep breath

Ventilation treatment burst into the public consciousness more than 60 years ago with the "iron lung" and the polio epidemic. Mechanical ventilation has come a long way since then and is used today with patients who cannot breathe on their own because of trauma, lung injuries and chronic lung disease.

But ventilation demands a delicate balance between over inflating and under inflating the lungs, either of which can lead to further injury. Scientists have observed that pumping too much air overdistends the lung, leading to ventilator-induced lung injury (VILI).

Doctors currently use small amounts of air (low tidal volume) to protect against VILI. But low tidal volumes can lead to progressive closure of the lungs' air cells, called alveoli, reducing the lung's ability to exchange gases. One way to reverse closure of the alveoli is to periodically give a more robust puff of air, known as deep inflation.

A new study in the online edition of the American Journal of Physiology-Lung Cellular and Molecular Physiology shows that low tidal volume combined with periodic deep inflation provides the best balance between keeping the lung open and preventing VILI in mice. And, using mice, these scientists have demonstrated for the first time that eventhough deep inflation is necessary, it can be overdone.........

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July 17, 2006, 5:13 AM CT

Children who live with smokers

Children are particularly vulnerable to the effects of secondhand smoking, both because they are small and still growing and because they're often a "captive audience" for tobacco smoke. Now, scientists identify another problem: a greater risk for respiratory complications during outpatient surgical procedures.

Dwight Jones, MD, of Children's Hospital Boston and Neil Bhattacharyya, MD, from Brigham and Women's Hospital followed 405 children, 168 of whom came from households with smokers. The children were having day surgical procedures at Children's, ranging from drainage of middle-ear fluid to circumcision to hernia repair. All had general anesthesia and received oxygen through a face mask.

Children who lived with smokers had a higher occurence rate of respiratory problems that may occur during surgery than those from nonsmoking households: excessive mucus secretion (38 percent vs. 8 percent), breath-holding (15 percent vs. 6 percent), constriction of the larynx or bronchial tubes that potentially could impair breathing (29 percent vs. 5 percent), and actual airway obstruction (29 percent vs. 11 percent). Respiratory problems were similarly increased in the recovery room, but to a lesser extent.

"It was in the wakeup period in the operating room that they did the worst," says Jones, a pediatric otolaryngologist at Children's. "We had a harder time waking up children coming out from anesthesia because of choking, gagging and secretions".........

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July 14, 2006, 5:14 AM CT

High-tech Medical Devices

The International Modern Hospital Show 2006 is being held from July 12 to 14 in Tokyo (Tokyo Big Sight), where nearly 400 companies have gathered to showcase the latest in healthcare-related technology. The theme of the show is "Reliable Health, Medical Treatment, and Care - Aiming for High Quality Service," a theme whose success evidently depends on high technology. Below are photos (via Impress Watch) and explanations of a few of the devices appearing at the show. Despite appearances, these fellows are here to help.

The first photo shows a patient simulator developed by IMI Corporation and Paramount Bed Co., Ltd., a system consisting of a monitor connected to a sensor-laden mannequin whose physiology changes realistically as per the therapy it receives. Great for training future medical professionals. Great for your haunted house, too.........

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June 30, 2006, 0:12 AM CT

Light Cigarette Smokers Less Likely To Quit

People who smoke low-tar and low-nicotine, or "light" cigarettes thinking they will reduce their health risks may actually be less likely to kick the habit, as per research conducted by University of Pittsburgh and Harvard University. As such, light cigarette smokers increase their lifetime risk of a variety of smoking-related diseases suggests the study published online by the American Journal of Public Health.

The analysis, conducted by Hilary Tindle, M.D., M.P.H., assistant professor of medicine, University of Pittsburgh School of Medicine, while she was based at Harvard Medical School, found that of 12,285 self-reported smokers, those who used light cigarettes were about 50 percent less likely to quit smoking than those who smoked non-light cigarettes. Smoking light cigarettes was associated with reduced odds of quitting for all age groups, but this effect increased with progressing age, peaking in adults age 65 and older, who were 76 percent less likely to quit than their counterparts who smoked non-light cigarettes.

Additionally, Dr. Tindle and her collaborators, who included Saul Shiffman, Ph.D., professor of psychology at the University of Pittsburgh, found that more than a third (37 percent) of the self-reported smokers said they used light cigarettes to reduce their health risks. The majority of these light cigarette smokers were female, Caucasian and highly educated. The responses were obtained as part of the 2000 National Health Interview Survey, an ongoing household survey of the U.S. population conducted by the United States Census Bureau for the National Center for Health Statistics.........

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June 24, 2006, 11:48 PM CT

Role of Environment in Women's Smoking

Scientists have long known that reasons for smoking include social pressure and other environmental factors, as well as genetic factors based on results of prior twin studies. Now a more comprehensive study of twins by scientists at the University of Southern California (USC) has provided a better understanding of these complex influences. They found that women are far more likely than men to start smoking because of environmental factors, whereas genetic factors appear to play a larger role in influencing men to start smoking.

However, the study, which appears in the current issue of the journal Cancer Epidemiology, Biomarkers and Prevention, found no differences between the sexes in factors correlation to continued smoking, which appeared to be strongly influenced by genetics. The study, entitled "Gender Differences In Determinants of Smoking Initiation and Persistence in California Twins," looked at factors that influenced twins to start smoking and to continue smoking.

With regard to starting smoking, there was a significant difference between men and women, said Ann Hamilton, assistant professor of preventive medicine at the Keck School of Medicine of USC and lead author on the study. "Heritability, which reflects factors correlation to genetic effects, was stronger in men; however, among men who communicated with each other at least weekly, the heritable effect was reduced. This may indicate that the heritable effect in men could be overestimated or able to be affected by environmental factors."........

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June 21, 2006, 10:08 PM CT

Comparison Of Nicotine Lozenges And Patches

A smoking-cessation study comparing the effectiveness of nicotine patches and lozenges is under way at the Medical College of Georgia.

Participants, who must be at least age 18 and smoke at least 10 cigarettes per day, will receive a 12-week supply of either replacement treatment as well as five counseling sessions.

Nicotine patches and lozenges are designed to reduce withdrawal symptoms but their effectiveness has not been compared, says Darlene Gibson, research nurse. "There are some people in whom lozenges are thought to work better because they need that immediate gratification, rather than just the constant release of patches," she says.

"The harmful effects from smoking tobacco products are well-known," says Dr. Daron G. Ferris, director of the MCG Gynecologic Cancer Prevention Center and a principal investigator. "However, kicking the habit can be challenging for a number of smokers. Nicotine replacement helps ease withdrawal symptoms when stopping cigarettes".

Participants will receive a smoking-reduction regimen with a targeted stop date after which they'll be randomized to get either patches or lozenges. They'll be followed for 27 weeks. Five free counseling sessions will help participants look at their lifestyle, why they smoke and ways to break the habit.........

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June 19, 2006, 9:24 PM CT

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June 15, 2006, 10:32 PM CT

Lung Retransplants From Living Donors Improve Survival

A team of scientists at Washington University School of Medicine in St. Louis has found that using lobes of lungs from living donors improves the chances of short-term survival for children who require a second lung transplant.

Their findings are reported in the recent issue of the Journal of Thoracic and Cardiovascular Surgery.

Scientists compared the outcomes of lung retransplants in 39 children from 1991 to 2004, including 13 patients who had lung retransplants using lobes from living donors and 26 patients who received lung retransplants using whole lungs from deceased donors.

Living-donor lung retransplantation involves removing a lower lobe, or about one-third of a lung, from each of two healthy adult donors and transplanting the lobes as replacement lungs into a child.

Established in 1990, the lung transplant program at Washington University School of Medicine and St. Louis Children's Hospital was the first freestanding pediatric lung transplant program in the United States. To date, the Washington University Medical Center haccording toformed the most pediatric lung transplants worldwide.

All children who received lung retransplants also had their initial lung transplants at St. Louis Children's Hospital. The majority of children needed second transplants because of bronchiolitis obliterans syndrome, a progressive decrease of pulmonary function that develops in nearly half of pediatric lung recipients within five years. The remainder had primary graft dysfunction, where the lungs don't work effectively after transplant. Eventhough some patients survive these conditions, in a number of instances, the only therapy is retransplantation.........

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