Time course of cigarette withdrawal symptoms while using nicotine gum

Ratings of withdrawal symptoms were provided at weekly intervals by 147 smokers clinic clients who managed complete abstinence for 4 weeks. The ratings followed a similar temporal pattern regardless of amount of nicotine gum used. Irritability, depression, difficulty concentrating and restlessness peaked in the 1st week or two and returned to baseline by week 4. Hunger was more persistent. Craving was reported to be the most troublesome withdrawal symptom at first, although by the 4th week hunger was cited almost as often. Across all subjects, evenings were cited most often as the worst time of day for craving but among heavier smokers and those who used more nicotine gum mornings were considered worst.

Detection of testicular torsion by magnetic resonance imaging in a rat model

Testicular torsion is one of the most common pediatric urological emergencies. Incorrect or delayed diagnosis contributes significantly to morbidity. We previously have shown that magnetic resonance displays scrotal contents with great detail using hydrogen concentration weighted and T2 weighted images. Sprague-Dawley rats underwent either unilateral 720-degree testicular torsion or a sham procedure. Magnetic resonance images were obtained at intervals with a 3 or 5-inch surface coil. Scans after surgical torsion showed a characteristic spiral distortion of the fascial planes of the spermatic cord, not seen in the sham animals, as well as a decrease in testicular size with prolonged torsion.

A wire-sheath system for MR-guided biopsy and drainage: laboratory studies and experience in 10 patients

On the basis of laboratory experiments, we devised a wire-sheath system for MR-guided biopsy and drainage and then evaluated that system in 10 patients. The localizing system consisted of a 20-gauge plastic sheath into which a stainless-steel alloy wire had been inserted. In laboratory studies, we compared this wire-sheath assembly with other materials to determine its optimal visualization on MR images. We then used the same wire-sheath system to perform 16 procedures (in 10 patients), including six biopsies, five diagnostic fluid aspirations, and five catheter drainages of infected and noninfected fluid collections. The laboratory results showed that the wire-sheath assembly cast a 7-mm artifact, was visualized well on all pulse sequences, and was safe within the magnet (minimal attraction). The assembly was visualized well in each patient and provided adequate localization. MR-guided biopsy and drainage can be performed with high-resolution detail by using this wire-sheath system. Potential uses of this system include (1) treatment of lesions that can be seen on MR images only (or that can be seen to significantly better advantage on MR images than on sonograms or CT scans), and (2) treatment of patients in whom avoidance of the radiation delivered by CT is imperative.

Long-term use of nicotine chewing gum. Occurrence, determinants, and effect on weight gain

Among 538 clients of a Smokers Clinic who were treated with 2-mg nicotine chewing gum, 34 (6.3%) were still using the gum at one-year follow-up. This group represented 25% of lapse-free abstainers. At one-year follow-up, long-term gum users were using an average of 6.8 pieces of gum per day. Long-term gum users were similar to treatment failures in cigarette consumption and tobacco dependence, while "gum-free" successes were significantly lighter and less-dependent smokers. Long-term gum users used more gum during the four weeks of treatment than treatment failures, who in turn used more than the gum-free successes. It is suggested that for many the long-term use of gum was an essential ingredient of their success. Long-term gum users gained significantly less weight than other long-term treatment successes.

District programme to reduce smoking: can sustained intervention by general practitioners affect prevalence?

A total of 101 general practitioners in 27 practices in inner London took part in a quasi-experimental study designed to examine whether a brief intervention applied to all smokers seen by general practitioners and sustained on a continuous basis could in time have a cumulative effect and reduce the prevalence of smoking among their patients. Of 21 practices approached in our local district (Camberwell), seven were willing to undertake brief intervention with support from the smokers' clinic (SBI), four opted for intervention without support (BI), and six acted as usual care controls. A further 10 out of 12 practices approached in South Hammersmith provided an unselected group of usual care controls. A series of six cross-sectional surveys were conducted over a three-year period. Each survey consisted of all adult patients attending to see a doctor during a defined two-week period, sample sizes averaging just over 9000 per survey. The estimated decline in self-reported smoking prevalence over the 30-month period following the start of intervention was 5.5% (from 36.4% to 30.9%) in the SBI group compared with 2.1% for BI and 2.8% and 3.0% in the two usual care control groups, the decline in the SBI group being significantly greater than in the other groups which did not differ significantly between each other. These interim results provide encouraging evidence that brief intervention by general practitioners with support and back-up from a local smokers' clinic can, when sustained on a continuous basis, reach sufficient smokers to reduce smoking prevalence in their practice populations. However, firm conclusions must await longer periods of observation now that the other Camberwell practices have adopted the SBI procedures.

MR imaging of brain contusions: a comparative study with CT

Ninety-eight brain contusions in 17 patients served as a data base for a comparative study of MR and CT for defining brain contusions. MR was the more sensitive technique, detecting 98% of the brain contusions compared with only 56% by CT. CT was slightly better for showing hemorrhagic components, documenting 77% of hemorrhages compared with 71% for MR. The appearance of the contusions on MR was variable, depending on the T1- and T2-weighting of the images and the constituents of the contusions, such as edema, hemorrhage, and encephalomalacia. On MR, hemorrhagic components appeared as high signal on T1-weighted images and as either low or high signal on T2-weighted images, depending on the age of the hemorrhage. The approximate ages of hemorrhagic contusions were often suggested by their appearance on T1- and T2-weighted images. CT is very effective for evaluating acute head trauma, but MR is recommended for documenting brain contusions during the subacute and chronic stages of head injuries.

Inflatable surface coil for MR imaging of the prostate

An inflatable surface coil for transrectal magnetic resonance imaging of the prostate was designed. The coil was tested during imaging of an insulated saline phantom and of the prostates of four patients. Phantom images were comparable to those obtained with commercial coils of similar size. High spatial resolution and excellent contrast were noted in coronal images of the prostates. Use of this coil could substantially improve studies of the prostate and cervix.

Craniopagus twins: neuroradiological findings (CT, angiography, MRI)

A pair of craniopagus twins was examined with CT, angiography and MRI, to preoperatively assess their cerebral anatomy and blood flow. Angiography revealed a common venous sinus and a venous cross-flow from one brain to the other. This common sinus was also identified in magnetic resonance images. The significance of accurately evaluating the veins and sinuses in craniopagus twins is stressed.

Cerebral palsy in a macaque monkey

Magnetic resonance imaging was used to document brain lesions symptomatic of cerebral palsy in the macaque monkey exhibiting poor motor control and periodic episodes of ocular nystagmus and convulsive twitching. Neuroanatomic deficits most likely resulted from hemorrhage or ischemic infarction at or near the time of birth. Extreme maternal dependency and retarded behavioral development were documented at 3 and 12 months of age. Both social and motor behavior improved significantly when observed at 30 months of age after therapy.

Fibrous metaphyseal defects--determination of their origin and natural history using a radiomorphological study

The radiomorphological appearance of fibrous metaphyseal defects (FMDs) is demonstrated by long-term follow-up studies. A characteristic radiomorphological course rather than a typical single appearance can be established. These findings correlate well with the duration of these tumor-like lesions; therefore, the radiological findings allow conclusions to be made about the age of a fibrous metaphyseal defect. In addition, the characteristic locations of FMDs will be explained in respect of their origins at insertions of tendons and ligaments.

[Analysis of errors in imaging diagnosis of varicocele. Duplex sonography, plate thermography and phlebography]

Comparative investigations were done by duplex sonography, thermography and phlebography in 142 patients with 158 varicoceles. Verification of clinical varicoceles (130/158) was performed by duplex sonography in all cases and by thermography in 93%. Measurement errors were due to dorsally located varicoceles near the radix of the penis (3/130) and by small, two-sided varicoceles (6/130). Small subclinical varicoceles (28/158) were detected by real-time sonography in 89%, by Doppler sonography in 64%, and by thermography in 53%. In three patients with normal real-time sonography, subclinical varicoceles were found by Doppler sonography alone. The combination of both sonographic methods is highly sensitive for the detection of subclinical varicoceles and should be done in all cases without therapeutic results.

District programme to reduce smoking: effect of clinic supported brief intervention by general practitioners

By encouraging and supporting general practitioners to undertake brief intervention on a routine basis smokers' clinics could reach many more smokers than are willing to attend for intensive treatment. In a study with 101 general practitioners from 27 practices 4445 cigarette smokers received brief intervention with the support of a smokers' clinic, brief intervention without such support, or the general practitioners' usual care. At one year follow up the numbers of smokers who reported that they were no longer smoking cigarettes were 51 (13%), 63 (9%), and 263 (8%), respectively (p less than 0.005). After an adjustment was made for those cases not validated by urine cotinine concentrations the respective success rates were 8%, 5%, and 5%. Use of nicotine chewing gum was associated with higher self reported success rates. General practitioners providing supported brief intervention encouraged not only more smokers to use the gum but also more effective use; gum users in this group reported a success rate of 27% at one year. Compliance by the general practitioners in recording smoking state averaged 45%, and significantly higher success rates were reported by patients whose smoking state had been recorded. Brief intervention by general practitioners with the support of a smokers' clinic thus significantly enhanced success rates based on self reports. Better results might be obtained if general practitioners' compliance with the procedure could be improved and if they encouraged more of their patients to try nicotine gum. Collaboration of this kind between a smokers' clinic and local general practitioners could deliver effective help to many more smokers than are likely to be affected if the two continue to work separately.

[Sonography in cervical lymph node metastases]

The value of high resolution real time sonography for the detection of cervical lymph-node metastases in head and neck cancers was assessed in 118 histological proven cases. The accuracy of sonography (89%) proved to be superior to palpation (80%). In 9 patients a thrombosis of the internal jugular vein was detected. The ability of sonography to detect tumorous infiltration of the arterial vessel wall is discussed in 12 patients. Regarding possible artefacts, sonography is the only imaging modality which can solve this problem. Sonography should be performed preoperatively in all patients with malignant head and neck tumors for cervical lymph-node staging.

Breath-holding endurance as a predictor of success in smoking cessation

A pretreatment test of breath-holding endurance predicted end-of-treatment outcome in 56 Smokers Clinic clients (r = .44; p less than .001). The cut off points derived by discriminant analysis were 32 seconds for men and 20 seconds for women, which correctly classified 78.6% of cases. The breath-holding test might sample the type of endurance necessary to withstand the discomfort associated with cigarette withdrawal and may also be relevant to success in quitting other addictive behaviours. However, alternative explanations are possible and more data are needed.

[Sonographic anatomy of the neck and its importance in lymph node staging of head and neck cancer]

Our experience with sonography of the neck (about 1,500 examinations) indicates that most of the structures that are of therapeutic importance can be demonstrated by ultrasound. The cervical nerves, however, cannot be differentiated sonographically from perivascular fat because there is insufficient impedance difference presented by the myelin sheaths. The typical sonographic anatomy of the anterior and lateral cervical muscles, of the major vessels, the thyroid and parathyroid and salivary glands has been analysed. The structures that can be shown by sonography have been related to dissections of the neck.

Time course of cigarette withdrawal symptoms during four weeks of treatment with nicotine chewing gum

Ratings of withdrawal symptoms were obtained from 52 Smokers Clinic clients who abstained throughout a four week group treatment programme involving use of nicotine chewing gum. Mean ratings of irritability, depression, hunger, restlessness, and inability to concentrate were significantly higher in the first week of abstinence than at baseline, although only a minority of smokers experienced severe withdrawal symptoms. Disturbance of mood and concentration returned to baseline within four weeks while increases in hunger persisted. The average amount of time spent with the urge to smoke started to decline early in treatment, but the average strength of urges and overall difficulty not smoking did not decline until the fourth week. At the end of treatment 35% were still experiencing strong urges to smoke and 23% reported finding it difficult keeping themselves from smoking. The findings have practical implications for preparing smokers for cessation with the aid of nicotine gum.

[Computerized tomography in the acute diagnosis of spinal injuries]

Additional to conventional x-ray examinations, high-resolution CT has a greater impact on the diagnostic evaluation of severe spine injuries. It allows exact judgment of the condition of vertebral arch, articular processes, joints and spinal axis and therefore a better delineation of the stability or instability of spinal fractures. Intraspinal fracture of spinal stenosis and intra or paraspinal soft tissues lesions are much more easily detected. For this reasons CT-evaluation of severe spinal traumata permits earlier, much more precise and in many cases successful therapy.

Which smokers report most relief from craving when using nicotine chewing gum?

Seventy-seven smoker clinic clients who managed at least 2 weeks of smoking abstinence while chewing 2 mg nicotine gum reported the degree to which the gum reduced their craving for cigarette, their daily gum consumption and the extent of urges to smoke despite the gum. Greatest relief from craving by the gum was reported by smokers with higher pre-abstinence expired-air carbon monoxide (CO) concentrations and higher "stimulant" and "dependent" scores on a smoking motivation questionnaire but not greater usual daily cigarette consumption. Gum consumption correlated positively with expired-air CO, usual daily cigarette consumption, and "stimulant" and "dependent" smoking scores. Despite the gum, urges to smoke and difficulty not smoking were reported and the severity of these was associated with "indulgent", "stimulant" and "dependent" smoking scores but not CO or usual daily cigarette consumption. The results are discussed in terms of the possible role of pharmacological and non-pharmacological factors in craving.

Enhancing the impact of groups: an evaluation of two group formats for smokers

The effects of two different group formats constituting part of an otherwise identical smoking cessation programme were evaluated. Each group format was in use for one full calendar year. One hundred and thirty-two smokers were treated in 14 'therapist-oriented' (T-O) groups run in traditional didactic style and 138 in 14 'group-oriented' (G-O) groups, where the primary emphasis was on group resources (group support, group pressure and spontaneous modelling of coping responses). G-O groups were significantly more successful. The two types of groups did not differ in the number of clients who succeeded in stopping smoking just after the first meeting, i.e. before the difference in group formats could have any impact; but in the G-O groups more of those who failed initially persisted in trying and succeeded later in the course. Independently of the format, larger groups were more successful and in addition there was significant variation between single groups regardless of both format and size. Group processes seem to play an important role in smoking cessation and the way in which a group is structured can affect outcome.

[Ultrasound diagnosis of branchiogenic neck cysts]

16 operatively and histologically proven branchiogenic cysts were evaluated sonographically and the contents of some of them were analysed by microscopy and chemistry. The echographic appearance of all cysts depended on the frequency of the scanheads and ranged from cystic (3.0 MHz) via semi-solid (5.0 MHz) to solid (7.5 MHz). This frequency-related sonographic pattern is caused by the high amount of cholesterin contained in these cysts and permits diagnosis of a branchiogenic cyst.

[Sonography in salivary calculi--indications and status]

In 23 patients with sialolithiasis the value of real time sonography was investigated. The calculi were correctly diagnosed in 91% of the patients. 3 of 4 calculi could be localized in the main duct of the salivary gland. Because of the high accuracy and the possibility to detect non opaque stones, sonography should be performed, if on plain film the localisation of the calculi is questionable, before sialography is done. In sonolithotrypsy, sonography can be used to document the extraglandular localisation of intraductal calculi.

[Value of ultrasound study in lymphomas of the neck]

In order to determine the value of high resolution ultrasonic procedures in the diagnosis of lymphomas of the neck, a comparative study of palpation, sonography and the surgical findings was undertaken. 42 patients were studied and 210 criteria evaluated. The error incidence was found to be 23.8% for palpation, 4.8% for the sonography and 1% for the combination of the two methods. The suprasonic procedure can detect a lymphoma from 5 mm. on, whereas palpation is only possible upward of 15 mm. Therefore, high resolution sonography enables a more precise evaluation and diagnosis of lymphomas of the neck. It facilitates the locating of the lymphomas during surgery and also allows the differentiation to the large vessels of the neck preoperatively. Thus, sonography of the neck is of high informative value there is no physical inconvenience or stress for the patient, and it is easy and quick to administer.

[Mediastinal CT-staging of bronchial carcinomas]

Forty-three patients with proven bronchogenic carcinoma were evaluated with computed tomography (CT) to search for mediastinal and broncho-pulmonary nodal metastases. Definitive staging was achieved by thoracotomy (34 patients) and mediastinoscopy or transbronchial nodal sampling (9 patients). Three parameters of lymph node appearance on CT were studied to improve the sensitivity and specificity of CT in detecting malignancy in bronchogenic carcinoma: 1) node size, 2) node location and 3) border regularity and definition. 762 clearly defined nodes were studied by CT - 391 metastatic and 371 non metastatic. The most useful CT parameters were node size over 10 mm, and node location, which results in a sensitivity of 80% and a specificity of 88%. A combination of all 3 CT parameters increased sensitivity to 82% and specificity to 90%. These results show clearly, that size is not the only relevant CT-parameter in successful preoperative identification of mediastinal nodal metastases.

[Role of computed tomography in malignant tumors of the oral cavity and pharynx]

The CT findings of 22 patients with histologically verified malignant tumors of the oral cavity and pharynx were evaluated to demonstrate the value of CT. Comparison with conventional radiological methods was made. In 16 patients an attempt was made to define tumor expansion and 6 patients were examined after surgery and radiation therapy with regard to tumor recurrence. In the first group we found tumors of different stages: in advanced cancer it was evident that with CT it is possible to describe tumor expansion very exactly and its relationship to surrounding structures, as well as the invasion of the intracranial space or spinal cord. In malignomas of the tongue and mouth floor measurements of size by CT were very precise, as proved by surgery. Our results in the first group of patients show, that CT has a great influence on therapeutic management and is also very important for clinical staging of these malignomas. In the second patient group it is shown that by CT differentiation between postoperative changes and recurrent tumor is as difficult as it is in other organs. Based on the postoperative examination, appropriate follow-up is necessary.

[Computerized tomography in middle ear diagnosis--a comparison with conventional methods]

Due to important improvement in detail resolution and the excellent contrast resolution, in the newest computed tomography (CT) units, normal and pathologic structures of the inner and middle ear can be visualized. The clinical value of CT in comparison to standard X-rays and tomography is prospectively evaluated on the basis of 50 patient examinations. Today CT is unsurpassed in the diagnosis of cholesteatomas and glomus tumors and is superior to all other imaging techniques. Chronic inflammatory diseases of the middle ear can be evaluated in most cases on the basis of standard X-rays and tomography. CT's importance is primarily complementary, except for preoperative cases. Fractures should be visualized first on standard X-rays. If questionable complications are involved (e.g., tympanic or intracranial hematomas), CT should be the next step. Conventional tomograms are not necessary.

[Real-time sonography in breast diagnosis. Indication and value]

With improvement in ultrasound technique, sonography is gaining increasing importance in the evaluation of breast lesions. The following conclusions are drawn on the basis of experience in the use of real-time sonography in 200 patients. Palpable masses are most suitable for examination by sonography, whereas the diagnostic yield in diffuse breast disease is relatively low. The most important task is the differentiation between benign cystic and solid masses. Differential diagnosis of solid tumours may be difficult or even impossible and biopsy should not be carried out solely on the basis of a sonographic examination. Palpation and mammography must still be considered as basic methods of examination, which may be successfully complemented by sonography.

[Age-dependent changes in the intestinal contents of blowfly maggots--a study method in the framework of forensic determination of the time of death]

Maggots of the forensically important blowfly species Calliphora vicina were reared under three different temperature conditions. They were fed food containing insoluable contrast medium. Subsequent radiological examinations proved that the maggots stopped eating immediately upon attaining their maximum length. During the course of their subsequent development, the anterior intestine always remains empty. The evaluation of intestinal filling in blowfly maggots represents an efficient method of determining larval age in establishing time of death.

[Reduction of radiation dose by the use of carbon fiber cassettes]

A new type of radiographic cassette, reinforced by PEEK-CFK is discussed. The amount of reduction of radiation dose by this cassette was evaluated by means of an experimental physical and clinical trial. Dose reduction may reach 30% depending on the type of examination and the organ studied. An increase of contrast of the radiographs could not be verified. This type of cassette can be recommended for routine clinical use.

Detection of intestinal diverticula by double-contrast small bowel enema: differentiation from other intestinal diverticula

This report documents the roentgenographic diagnosis of diverticula in the jejunum and ileum. The experience has been gained from 7 Meckel's and 8 other diverticula shown by the small bowel enema in 400 patients. Diverticulum detection rate by this technique approaches the incidence in autopsy series. Differentiation between Meckel's, acquired, and pseudodiverticula by means of specific radiologic criteria is discussed.

[Localizing instrument for fine needle puncture of non-palpable changes in the breast]

A simple device for localisation of non-palpable lesions of the breast has been developed. It consists of two metal grids which facilitate mammographic fine needle puncture and preoperative marking of small lesions. The instrument is easy to handle and can be used at any mammographic unit without special adjustments.

[Value of computer tomography of the small pelvis for the early diagnosis of local recurrence after surgery of rectal cancer]

The value of pelvic computed tomography (CT) in the detection of local recurrence following radical operation for rectal cancer was assessed in a prospective study on 15 patients. A positive CT finding was checked in every instance by a second-look operation (11 cases). Tumour tissue in the pelvis was found in 9 patients, whereas in 2 patients the positive CT finding was proven to be false. 5 out of 9 cases with recurrent tumour underwent radical surgery. In the 4 cases with a negative CT finding no recurrence has developed after a median observation time of 34 months. Pelvic CT is a useful and reliable method of detecting pelvic recurrence before it becomes clinically obvious. However, the method does not allow certain prediction of whether or not the recurrence will be radically operable.

[Mondor's disease of the female breast]

This report is based on eight patients with Mondor's syndrome. Its main clinical findings is linear retraction of breast skin probably due to thrombophlebitis or lymphangitis. The final diagnosis of Mondor's syndrome implies exclusion of breast cancer by mammography. A differential diagnosis of this entity is discussed.

[CT in relapsing rectal carcinomas (author's transl)]

In 12-15% of rectal carcinomas a relapse appears during the first two years. Until now, early radiological diagnosis by means of conventional methods was extremely difficult and subject to high and negative error rates. Computerized tomography--in comparison to conventional radiological methods--allows early recognition of these tumour relapses and finds excellent use for purposes of radiological post-operative management.