Bupropion and naltrexone for smoking cessation: A double-blind randomized placebo-controlled clinical trial.

Combination of non-nicotine pharmacotherapies has been underexamined for cigarette smoking cessation. A randomized, double-blind, parallel-group double-dummy study evaluated two medications, bupropion (BUP) and naltrexone (NTX), in treatment-seeking cigarette smokers (N = 121) over a 7-week treatment intervention with 6-month follow-up. Smokers were randomized to either BUP (300 mg/day) + placebo (PBO) or BUP (300 mg/day) + NTX (50 mg/day). The primary outcome was biochemically verified (saliva cotinine, carbon monoxide) 7-day, point-prevalence abstinence. BUP + NTX was associated with significantly higher point-prevalence abstinence rates after 7-weeks of treatment (BUP + NTX, 54.1%; BUP + PBO, 33.3%), P = 0.0210, but not at 6-month follow-up (BUP + NTX, 27.9%; BUP + PBO, 15.0%), P = 0.09. Continuous abstinence rates did not differ, P = 0.0740 (BUP + NTX, 26.2%; BUP + PBO, 13.3%). Those receiving BUP + NTX reported reduced nicotine withdrawal, P = 0.0364. The BUP + NTX combination was associated with elevated rates of some side effects, but with no significant difference in retention between the groups.

Effects of long-term treatment with proton pump inhibitors in gastro-oesophageal reflux disease on the histological findings in the lower oesophagus.

BACKGROUND: The application of hyperplasia of the basal cell layer and elongation of the papillae in the squamous epithelium of the distal oesophagus, as histological criteria for the diagnosis of gastro-oesophageal reflux disease (GORD), continues to be controversial. An unanswered question is whether these changes may regress under long-term treatment with proton pump inhibitors (PPI). This fact prompted us to investigate the effect of PPI treatment on the histological changes observed in the lower oesophagus. METHODS: 295 patients with endoscopically confirmed erosive GORD were investigated by endoscopy/biopsy prior to and during the course of a 12-month PPI treatment regimen (8 weeks acute treatment with 30 mg lansoprazole/day followed by long-term treatment with 15 or 30 mg lansoprazole or 20 mg omeprazole/day). The parameters studied were the frequency of ulcers and erosions and the hyperplasia of the basal cell layer and elongation of the papillae prior to treatment and on day 56 (D56), after 6 months (M6) and after 12 months (M12) of treatment. RESULTS: In the various treatment groups, the results showed no statistically significant differences. Ulcers and erosions (prior to treatment 21% and 31%, respectively) were detected statistically significantly less frequently under PPI treatment (ulcers, D56: 1%, M6 and M12, 0%; erosions, D56: 2%, M6: 4%, M12, 3%). While high-grade hyperplasia of the basal cell layer and elongation of the papillae was found in 51% of the cases prior to treatment, the corresponding figures were only 3% (D56, M6) and 2% (M12). In contrast, the percentage of cases with normal oesophageal epithelium increased from 8% before treatment to 55% (D56), 66% (M6) and 63% (M12). CONCLUSIONS: Our study shows not only that erosions and ulcers heal under PPI treatment, but also that hyperplasia of the basal cell layer and elongation of papillae in the squamous epithelium of the oesophageal mucosa may normalize, and are thus presumably not 'normal physiological variants'.

Smoking cessation in women with cardiac risk: a comparative study of two theoretically based therapies.

This gender-specific research study compares the relative effectiveness of two theory-based interventions targeting women who smoke. Women with coronary artery disease (CAD; n = 53) or CAD risk factors (n = 107) were randomly assigned to either coping-skills Relapse Prevention (RP) treatment or an educational/supportive treatment based on Health Belief Model (HBM) principles. RP was comparable, but not superior to HBM treatment, as indicated by the lack of differential smoking outcomes at 3 and 6 months. RP was more effective than HBM for women with low self-efficacy, as predicted. The presence of a smoking-related disease had a substantial effect on smoking status, in that the odds of being abstinent at 6 months were 2.2 times greater for non-diagnosed women when compared with CAD women. These findings indicate that more potent relapse prevention interventions are needed to increase cessation rates in women who smoke, especially those with established heart disease.

Context modulates effects of nicotine abstinence on human cooperative responding.

The effects of ad libitum smoking, abstinence, and 0-, 2-, and 4-mg nicotine gum on human cooperative responding were examined. Participants were provided the opportunity to respond cooperatively or independently to episodes initiated by a computer-simulated other person. Participants could also initiate episodes that ostensibly provided the other person the opportunity to respond cooperatively or independently of the participant. Working cooperatively added points to both the participant's and other person's counters. Working independently added points only to the participant's counter. Results demonstrated that abstinence decreased cooperative responses during episodes initiated by the computer-stimulated other person. Relative to abstinence and placebo gum conditions, ad libitum smoking and administration of 2- and 4-mg nicotine gum increased these cooperative responses. No gender differences were observed. The number of cooperative episodes initiated by the participants was not affected significantly by the smoking or gum conditions. Nicotine increased reports of vigor and decreased abstinence-engendered reports of depression, anger, confusion, and tension. The difference in the effects of nicotine abstinence on the 2 classes of cooperative responding demonstrates that the social contingency mediates the behavioral effects of abstinence.

Changes in Helicobacter pylori-induced gastritis in the antrum and corpus during 12 months of treatment with omeprazole and lansoprazole in patients with gastro-oesophageal reflux disease.

BACKGROUND: Several studies have shown that treatment with omeprazole leads to aggravation of Helicobacter pylori gastritis in the corpus. Whether this also applies to lansoprazole, and whether, in comparison with omeprazole, there are differences in therapy-induced gastritis parameter changes remains unclear. METHODS: In 111 patients infected with H. pylori and with gastro-oesophageal reflux disease we investigated the gastritis parameters in antral and corpus mucosa before and after 2, 6 and 12 months of treatment with 15 or 30 mg lansoprazole or 20 mg omeprazole/day. RESULTS: In all groups the different treatments had a similar effect: in both regions of the stomach, suppression or partial elimination of H. pylori was seen. However, improvement in the inflammation was observed only in the antrum, while in the corpus most gastritis parameters worsened significantly. There was no increase in intestinal metaplasia or atrophy. CONCLUSION: In common with omeprazole, lansoprazole aggravates the gastritis parameters in the corpus but improves them in the antrum. Treatment with proton pump inhibitors does not result in any increase in the incidence of atrophy/intestinal metaplasia. However, as gastritis predominating in the corpus seems to be associated with an elevated carcinogenic risk, consideration should be given to prophylactic H. pylori eradication therapy before initiating proton pump inhibitor treatment.

Gastric polyps as precancerous lesions.

Gastric polyps cover a wide range of possible diagnoses. Endoscopically, the nature of the lesions can be diagnosed with a high level of probability. Nevertheless, histopathological diagnosis remains mandatory. The macroscopic appearance of gastric polyps is described together with underlying histopathological diagnoses, which are determinative for subsequent treatment.

War-related changes in cigarette smoking: a survey study of health professionals in Sarajevo.

This study reports on a survey of smoking behaviors among 39 healthcare professionals in Sarajevo, Bosnia-Herzogovina. The hypothesis that cigarette smoking would decrease as a result of an 800% price increase was not supported. Cultural, pharmacological, and psychological reasons that may have contributed to the present findings are discussed.

Contingent reinforcement for reduced carbon monoxide levels in methadone maintenance patients.

Five cigarette smoking methadone maintenance patients (MMP) participated in a within-subjects (A-B-A-B) study involving repeated application of carbon monoxide (CO)-contingent payments for reductions in smoke intake. To replicate and extend findings from an earlier study in non-drug-abusing smokers (Stitzer & Bigelow, 1982), we used the same contingent reinforcement procedure that involved the delivery of a monetary payment ($5) for CO readings which were 50% or less than the average value of readings obtained during the prior noncontingency period. Although four of the five subjects earned the contingent payment on at least three of the eight occasions, the overall effect of the intervention on CO level was nonsignificant. Daily smoking records revealed significantly lower rates during the first contingency intervention for the group as a whole. Significant correlations between CO and the time interval since smoking prior to CO measurement were found. The rather modest intervention effects suggest that important parameters be considered when designing contingency management procedures to reduce cigarette smoking in this difficult population of drug abusers.

The effects of high and low doses of methadone on cigarette smoking.

The effect of methadone dose on the cigarette smoking of five methadone maintenance subjects was studied in a clinical setting. Following a two-week baseline period, daily doses of methadone were either increased (50-80 mg) or decreased (80-50 mg) every two weeks according to an A-B-A-B study design. Continuous self-monitoring was used to collect data on natural smoking behavior, and expired air carbon monoxide (CO) levels were measured at each clinic visit. The predicted methadone dose-related changes in smoking were found in three of the five subjects. Fine-grained analysis of self-monitoring records showed that the proportion of total daily smoking was highest within 4 h after taking methadone for three subjects. CO levels were not significantly associated with smoking rate. The results further support and extend previous reports that methadone may produce dose-related increases in smoking. No reactive effects of self-monitoring were observed, and compliance with this procedure was extremely high, supporting the usefulness of this method for assessing natural smoking behavior in this population.

Treatment session frequency and smoking cessation.

In a retrospective program evaluation analysis, we compared abstinence rates in 78 smokers participating in a 2-, 3-, or 6-week clinic-based behavioral-pharmacological smoking cessation program. The three treatment formats consisted of six sessions that varied in session frequency. Retention and end-of-treatment smoking cessation rates were best in the medium-frequency (3-week) and high-frequency (2-week) treatment session formats. One-year follow-up abstinence rates were highest in the medium-frequency format, and lowest in the high-frequency format. A significant patient-treatment interaction effect was found for pretreatment smoking rate. Individuals with lower pretreatment smoking rates benefited most with respect to end-of-treatment cessation rates from the medium- and high-frequency treatment session format. However, this effect was not significant at the 1-year follow-up. The need for prospective research and patient-to-treatment matching implications in smoking cessation programs are discussed.

A proposed revision of the Fagerstrom Tolerance Questionnaire.

This article presents the results of initial testing of a revised version of the Fagerstrom Tolerance Questionnaire (TQ). Revisions were designed to improve the psychometric properties of the TQ. Four diverse samples of cigarette smokers completed the 10-item Revised Tolerance Questionnaire (RTQ), and responses were subjected to psychometric and factor analyses. Substantial improvement in internal consistency was obtained as compared to prior studies of the TQ. In addition, the results of factor analysis indicate that a substantial amount of covariation among the 10 items can be accounted for by a single common factor. Thus, unlike the TQ, the RTQ appears to be measuring a unidimensional construct. Also, preliminary data on temporal stability are positive. With respect to validity, the RTQ correlated moderately with the TQ and outperformed the TQ in predicting expired alveolar carbon monoxide. Finally, suggestions for further establishing the validity of the RTQ are offered.

Cognitive and affective responses to successful coping during smoking cessation.

Based on Marlatt's relapse model, this study examined the previously unexplored role of cognitive and affective responses that follow successful coping experiences during smoking cessation. Twenty-six smokers completed self-report measures of attribution, efficacy, and affect in response to smoking cessation behaviors during treatment and at 2-, 4-, and 8-week follow-ups. Subjects abstinent at 3-month follow-up were more likely to attribute their successful quitting behaviors to more internal, stable, and controllable factors, and they reported enhanced self-efficacy, compared with smokers. Differences in affective responses to successful coping by quitters and smokers were not significant. Implications of the findings with respect to relapse theory and relapse prevention treatment are discussed.

A critical review of the Reasons for Smoking Scale.

The present article reviews studies bearing on the psychometric characteristics and clinical utility of the Reasons for Smoking Scale (RFS). It is concluded that the instrument possesses adequate psychometric properties such as a stable factor structure, internal consistency, and temporal stability. However, the supportive results of validity studies are weak and inconsistent. Moreover, the instrument appears to possess little clinical utility. Consequently, there exists little empirical evidence to justify its widespread use in clinical practice.

A fine-grained analysis of the role of self-efficacy in self-initiated attempts to quit smoking.

The relation between self-efficacy ratings and smoking behavior was explored among 36 people who were trying to quit smoking on their own. Ss self-monitored high-risk situations, coping efforts to withstand the temptation to smoke, and self-efficacy in coping with similar temptations for 4 weeks after quitting. Self-efficacy ratings were significantly related to the outcome of these situations, with Ss reporting higher efficacy ratings after situations in which they did not smoke as opposed to those in which they did smoke. Self-efficacy was predictive of smoking outcome, but there was considerable intersubject variability in the strength of the relation between efficacy and smoking behavior. Both efficacy and previous smoking behavior predicted smoking outcome equally well, however.

Transcardiac serotonin concentration is increased in selected patients with limiting angina and complex coronary lesion morphology.

Serotonin is released by activated platelets and may act as a mediator to initiate or sustain certain unstable syndromes of ischemic heart disease in humans. To determine whether or not serotonin concentration increases across the coronary bed in patients with severe, limiting angina, we measured central aortic and coronary sinus serotonin concentrations by a sensitive radioenzymatic assay in 39 patients with coronary artery disease and 13 patients with minimal or no coronary artery lesions as detected by arteriography. Although no difference existed in the mean aortic or coronary sinus serotonin concentrations between these two groups, elevated coronary sinus serotonin concentrations were detected in 23% of those with coronary artery disease. The coronary sinus and aortic serotonin concentration difference was greater in patients with significant coronary artery disease (0.6 +/- 6.62 ng/ml) compared with patients without significant coronary artery disease (-5.6 +/- 10.32 ng/ml) (mean +/- SD) (p less than 0.05). Further analysis revealed that patients with eccentric, irregular coronary artery lesions or intraluminal filling defects had a significantly elevated coronary sinus and aortic serotonin difference (3.1 +/- 5.54 ng/ml) compared with those with smooth concentric lesions (-1.9 +/- 6.61 ng/ml) (p less than 0.02). These data suggest that serotonin is released into the coronary circulation of some patients with coronary artery disease, especially those with frequent angina and complex coronary lesions. Although serotonin may be released in some patients with coronary artery disease, the specific pathophysiologic role of serotonin in the development or perpetuation of certain coronary syndromes in humans remains to be determined.

[Idiopathic familial erythrocytosis. Report on a family with autosomal dominant inheritance]. / Idiopathische familiäre Polyglobulie. Beobachtung einer Familie mit autosomal dominantem Erbgang.

An autosomal erythrocytosis, inherited as a dominant, occurred in seven members of a family. The propositus was first diagnosed as having erythrocytosis at 26 years of age. He had headaches and marked plethora. Polycythaemia vera and secondary erythrocytosis of known cause were excluded. Erythropoietin level was not elevated. Two of his three children were also found to have erythrocytosis. As in this family, the disease is characterized in middle age by hypertension, cardiovascular and thromboembolic phenomena, as well as abnormal bleeding. For over eight years the propositus has been successfully treated with repeated venous blood lettings.