[Nicotine dependence therapy: medical counselling and other non pharmacological interventions]. / Strategie terapeutiche per la disassuefazione da fumo di sigarette: il counselling e gli interventi non farmacologici.

Cigarette smoking and nicotine dependence represent a complex disease. In the treatment program design the combination of non pharmacological and pharmacological therapy, the concurrence of physicians and other health professionals has been demonstrated the most successful therapeutic approach. This article reviews the main evidence based non pharmacological interventions. Social support request, self-monitoring and smoking behaviour modification are cornerstones of the preparation to quit. Post cessation counselling is mainly focused on problem solving activities. The complementary use of exercise and relaxation training is also evaluated.

[Clinical evaluation of smokers]. / La valutazione clinica del fumatore.

The number of patients who continue to smoke after a major cardiac event is high. More and more often the patients ask the cardiologist to help them quitting smoking. In the last few years the rapid developments in the neuropharmacological field set up the bases for a more effective and evidence based treatment of nicotine dependence. Thus a number of reviews, guidelines and original articles has been published in internal medicine, cardiology and pneumology journals and their main purpose was to increase as much as possible the number of physicians able to set up a "specialistic" nicotine dependence treatment. The aim of this article is instead to review the stages of the smoker clinical evaluation in a "specialistic" environment and to translate them in practical tips ready to be used in the cardiological daily practice. Three issues are specifically reviewed: motivation to quit, degree of nicotine dependence and the role of mood disturbances.

Usefulness of transdermal clonidine in hypertensive patients undergoing minor surgical operations.

Transdermal clonidine (TTSC) treatment was evaluated in 29 patients with mild to moderate hypertension scheduled for minor surgery. Two weeks before the scheduled operation, patients underwent 24-h ambulatory blood-pressure monitoring (ABPM) to evaluate the efficacy of previous oral antihypertensive treatment, which was then substituted with TTSC, 0.1 mg/day. After 1 week, the efficacy of TTSC was clinically assessed, and the dose increased to 0.2 mg/day if needed. ABPM was repeated 2 days before the scheduled operation and 2 days after surgery. The 24-h blood pressure (BP) and heart rate (HR) profiles were smoothed by Fourier analysis. Three patients withdrew for adverse events and one for inefficacy after dose adjustment, TTSC being effective in the remaining 25 patients. Two patients who completed treatment lacked postsurgical ABPM recording. In the 23 patients with all ABPM recordings, average 24-h BP and HR obtained preoperatively during TTSC treatment were slightly reduced compared with values recorded during previous oral therapy. BP changes after surgery were negligible, whereas HR showed a moderate increase. Minor adverse events occurred in four (14%) of 29 patients. Our results demonstrate that TTSC provides adequate BP control in patients with mild to moderate hypertension undergoing minor surgery.

Right ventricular dysplasia: radioisotopic angiography.

To evaluate if regional wall motion (RWM) abnormalities detected at rest in patients with high presumption of right ventricular dysplasia (RVD) are confirmed by stress test and could be considered of diagnostic value in the clinical setting of the disease, 12 patients underwent first-pass radionuclide angiography (RA) at rest and during exercise. The mean global right ventricular ejection fraction (EF) was 29.83 +/- 7.91 at rest; during exercise, we found a non-significant increase (32.16 +/- 9.8, P greater than 0.05). Six segments with systo-diastolic dyskinesis, three segments with diastolic dyskinesis, and 10 segments with akinesis at rest confirmed the same degrees of dysfunction during exercise. Eight of the 15 hypokinetic segments at rest showed normal function during exercise; the remaining seven confirmed the same degree of dysfunction during exercise. We conclude that various degrees of RWM abnormalities are found in all patients with RVD; hypokinetic dysfunction has to be confirmed by exercise. RWM abnormalities are not specific for RVD, and clinical and electrophysiological data should be combined to obtain as much evidence as possible for diagnosis.