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Study objective: To demonstrate the efficacy, safety, and appropriate mode of instillation of tale for sclerosis in treatment of malignant pleural effusions (MPEs). Design: A prospective, randomized trial was designed [...]

Background: Since nicotine gum was introduced in the 1980s, nicotine replacement therapy has become the most widely used pharmacological smoking cessation treatment. Some smokers prefer acute oral forms, but many smokers reject chewing gum. We tested the safety and efficacy of a new nicotine polacrilex lozenge for smoking cessation. Methods: Double-blind, placebo-controlled, randomized clinical trial with parallel arms testing 2- and 4-mg nicotine lozenges. Smokers (n=1818) were assigned to a lozenge dose on the basis of nicotine dependence, assessed by time to the first cigarette of the day. Low-dependence smokers were randomized to receive the 2-mg nicotine (n=459) or placebo (n=458) lozenge; high-dependence smokers, the 4-mg nicotine (n=450) or placebo (n=451) lozenge. We assessed abstinence at 6, 12, 24, and 52 weeks and analyzed craving and withdrawal symptoms. Results: Treatment with the nicotine lozenge resulted in significantly greater 28-day abstinence at 6 weeks, for the 2-mg (46.0% vs 29.7%; odds ratio [OR], 2.10; 95% confidence interval [CI], 1.59-2.79; P Conclusion: The nicotine lozenge is a safe and effective new treatment for smoking cessation in low- and high-dependence smokers.

Recommendations for classifying regional lymph node stations for lung cancer staging have been adopted by the American joint committee on Cancer (AJCC) and the Union Internationale Contre le Cancer. The [...]

Study objective: This study was designed to examine the extent of smoking cessation prior to thoracotomy for resection of a pulmonary malignancy and the recidivism rate. Design: Prospective, longitudinal study. [...]

Byline: Masayuki Haniuda, Seiki Hasegawa, Takeshi Shiraishi, Carolyn M. Dresler, Joel D. Cooper, G.Alexander Patterson Abstract: The degree of lung allograft inflation during harvest and storage may affect posttransplantation function. High volume ventilation causes pulmonary vascular injury and increased pulmonary capillary permeability. However, the effect of lung inflation on pulmonary capillary permeability after hypothermic flush and storage is unknown. The current study was designed to examine the effects of hyperinflation and hypoinflation during preservation on pulmonary vascular permeability. Methods: An isolated, ex vivo rabbit lung gravimetric model without the confounding effects of reperfusion was used to determine post pulmonary capillary filtration coefficient (K.sub.f). New Zealand White rabbits (2.75 to 3.15 kg) were intubated and the lungs ventilated with room air (tidal volume 25 ml). After sternotomy and heparinization, the pulmonary artery was flushed with low potassium dextran-1% glucose solution (200 ml). The heart-lung block was then excised. Two studies were conducted. For measurement of changes in airway pressure and lung volume during preservation, lungs were inflated to one of four storage volumes (12, 25, 40, 55 ml) with room air, 100% O.sub.2, or 100% N.sub.2 and stored at 10[degrees] C in a sealed container filled with saline solution. During preservation, lung volume and airway pressure were measured at 3, 6, 12, and 24 hours. In the K.sub.f study, lungs were inflated with 100% O.sub.2, 50% O.sub.2 (with 50% N.sub.2), or room air and preserved. After 24 hours of preservation at 10[degrees] C, the heart-lung block was suspended from a strain-gauge force transducer and the lungs were ventilated with room air. The pulmonary artery was connected to a reservoir of hetastarch solution (6% hetastarch with 0.9% saline solution). Lung weight gain, airway pressure, pulmonary artery pressure, and left atrial pressure were measured continuously. After a brief flush with hetastarch solution, the reservoir was then elevated to achieve 1.0 to 1.5 mm Hg increments in pulmonary artery pressure. Results: The slope of subsequent steady-state lung weight gain was used to determine the K.sub.f. The current study demonstrated the following: (1) changes in lung volume and airway pressure during storage increased with intraalveolar O.sub.2 concentration, (2) irrespective of inflation, fraction of inspired oxygen, hyperinflation during lung preservation increased the K.sub.f in a volume-dependent fashion; (3) K.sub.f was increased in lungs stored hypoinflated with room air; and (4) at any inflation volume, the K.sub.f was significantly increased with 100% O.sub.2 inflation after 24 hours of preservation. Conclusion: These results suggest that storage at high lung volume or high inspired oxygen fraction increases pulmonary capillary permeability. (J Thorac Cardiovasc Surg 1996;112:85-93) Article History: Received 10 October 1995; Accepted 21 November 1995 Article Note: (footnote) [star] From the Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Mo., [star][star] Supported by National Institutes of Health grant 1 R01 HL41281., a Address for reprints: G. Alexander Patterson, MD, Professor of Surgery, Division of Cardiothoracic Surgery, Suite 3108, Queeny Tower, One Barnes Hospital Plaza, St. Louis, MO 63110., aa 0022-5223/96 $5.00 + 0, acents 12/1/70791

Patients who undergo surgical excision of the entire pancreas with denervation (removal of the nerve supply) of the intestine suffer severe metabolic changes. These include acute intestinal disorders (diarrhea and malabsorption) and a chronic state of diabetes due to lack of insulin and glucagon, the major hormones that regulate glucose metabolism. Following surgery, acute diarrhea and weight loss must be controlled. These patients have increased caloric needs, but this condition is not completely explained by the loss of fat in the stools. There is little information available on the metabolic characteristics of patients who have undergone total pancreatectomy, or the usefulness of medical treatment. A prospective evaluation was undertaken of 49 patients who underwent total pancreatectomy; 31 percent of these patients were followed for more than four years. The most frequent indication for surgery was cancer of the pancreas (31 of 49 patients). All the patients suffered severe, debilitating diarrhea following surgery; in most of them, this problem abated within 3 to 12 months, however, 10 percent of the patients continued to have diarrhea. Deficiencies in fat-soluble vitamins, magnesium and trace elements were prevented by administering supplements. The diabetes caused by pancreatectomy differs from spontaneously occurring adult-onset diabetes in that there is an absence of insulin and glucagon, and hypoglycemic episodes (of low blood sugar) frequently occur. This can be improved with intense home blood sugar monitoring. No patient in the study developed diabetic vascular (blood vessel) disease. Within months of surgery all patients were able to return to normal activities. In the patients who were followed for more than five years, there was an unusual frequency of liver disease and osteopenia, or decreased bone density, with diminished bone mineral content. (Consumer Summary produced by Reliance Medical Information, Inc.)

To the Editor: The recent article by Werebe and colleagues (January 1999)l concerning the systemic distribution of talc was a fascinating and timely study. This group has a very large [...]