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Results for “virtual intervention”

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At least 937 records · Page 52Linked to original sources

PubMed2007

Virtual bronchoscopic navigation system shortens the examination time--feasibility study of virtual bronchoscopic navigation system.

Computed tomography (CT)-guided transbronchial biopsy (TBB) using an ultrathin bronchoscope with simulation by virtual bronchoscopy (VB) is effective for diagnosing small peripheral pulmonary lesions. However, we occasionally lose the proper bronchi to the lesion when a bronchoscope is inserted into peripheral bronchi with severe rotation. To overcome this problem, the virtual bronchoscopic navigation system that can display real-time VB images during TBB procedures in comparison with actual bronchi has been developed. We evaluated the usefulness of the virtual bronchoscopic navigation system for CT-guided TBB using an ultrathin bronchoscope (navigation method) to diagnose small peripheral pulmonary lesions, and compared the results to those with previous method that uses VB images in a simulation (simulation method). We performed CT-guided TBB using an ultrathin bronchoscope for 69 patients with 71 small peripheral pulmonary lesions (mean diameter, 13.7 mm) between November 2002 and November 2005 with the navigation method. CT-guided TBB with the navigation method was performed safely without any serious complications for all patients. Mean time to the initial scan, time to the first biopsy and total examination time were 5.3, 8.5 and 24.5 min, respectively. Fifty lesions (70%) were diagnosed by this procedure. Compared to simulation method, diagnostic sensitivity was higher in the navigation method, but the difference was not significant. However, the time to the first biopsy and total examination time were significantly shorter in the navigation method than in the simulation method (p<0.05). In summary, the virtual bronchoscopic navigation system was safely used, effective for diagnosing small peripheral pulmonary lesions, and useful for shortening the examination time of CT-guided TBB using an ultrathin bronchoscope.

Aged↗

PubMed1991

Efficacy of 24-hour ambulatory blood pressure monitoring in children.

OBJECTIVES: To determine whether the use of an ambulatory blood pressure monitor (ABPM) is feasible and gives accurate readings in children, and to provide data on normal daily blood pressures (BPs) and BP patterns in children. DESIGN: Cohort. SUBJECTS: Ninety-nine healthy fifth-grade students. INTERVENTIONS: Students wore an ABPM for 24 hours while recording their activities in diaries. Before and after the study period, each subject had three BPs simultaneously measured with the ABPM and a mercury manometer to assess the accuracy of the ABPM. An activity scale was retrospectively applied to diary entries to help explain the variety of BP patterns noted during data analysis. RESULTS: Systolic BPs obtained with the ABPM at the beginning and end of the study were slightly higher than those obtained with a mercury manometer; diastolic BPs were virtually identical. A circadian pattern of BPs was noted: mean systolic and diastolic BPs were higher during the day than at night. The BP patterns ranged from "hypoactive" (little baseline variation) to "hyperactive" (wide fluctuations with spikes to elevated BP ranges) during various activities. In general, higher BPs were noted at times of increased activity or emotional levels. CONCLUSIONS: Ambulatory BP monitoring was well tolerated, and measurements were reproducible and accurate. The variety of BP measurements noted at different activity levels indicate that a child's activity should be considered during data analysis. As further experience is gained, the ABPM should prove helpful in diagnosis and management of hypertension in children.

Ambulatory Care↗

PubMedDate not supplied

Primary mediastinal yolk sac tumor in a 66-year-old woman.

OBJECTIVE: To report a rare case of nonseminomatous extragonadal germ cell tumor in a 66-year-old female with primary yolk sac tumor of the mediastinum. CLINICAL PRESENTATION AND INTERVENTION: A 66-year-old female was admitted to our hospital with a history of chest pain for 1 month. Computerized tomography of the thorax showed a left paracardiac mass adjacent to the aortic arch, left main pulmonary artery and pericardium. Total surgical excision could not be performed, but several biopsies which were taken through a thoracotomy revealed yolk sac tumor of the mediastinum. Systemic chemotherapy was started, but no response was observed and the patient died after one course of chemotherapy. CONCLUSION: Nonteratomatous mediastinal germ cell tumors are virtually nonexistent in women. To our knowledge, this is the oldest female patient with a primary mediastinal germ cell tumor. Chemotherapy was not effective especially in an old patient. We suggest surgery should be considered as primary treatment modality if diagnosis is made at an early stage.

Aged↗

PubMed2001

Physical abuse of women before, during, and after pregnancy.

CONTEXT: Clinicians who care for new mothers and infants need information concerning postpartum physical abuse of women as a foundation on which to develop appropriate clinical screening and intervention procedures. However, no previous population-based studies have been conducted of postpartum physical abuse. OBJECTIVES: To examine patterns of physical abuse before, during, and after pregnancy in a representative statewide sample of North Carolina women. DESIGN, SETTING, AND PARTICIPANTS: Survey of participants in the North Carolina Pregnancy Risk Assessment Monitoring System (NC PRAMS). Of the 3542 women invited to participate in NC PRAMS between July 1, 1997, and December 31, 1998, 75% (n = 2648) responded. MAIN OUTCOME MEASURES: Prevalence of physical abuse during the 12 months before pregnancy, during pregnancy, and after infant delivery; injuries and medical interventions resulting from postpartum abuse; and patterns of abuse over time in relation to sociodemographic characteristics and use of well-baby care. RESULTS: The prevalence of abuse before pregnancy was 6.9% (95% confidence interval [CI], 5.6%-8.2%) compared with 6.1% (95% CI, 4.8%-7.4%) during pregnancy and 3.2% (95% CI, 2.3%-4.1%) during a mean postpartum period of 3.6 months. Abuse during a previous period was strongly predictive of later abuse. Most women who were abused after pregnancy (77%) were injured, but only 23% received medical treatment for their injuries. Virtually all abused and nonabused women used well-baby care; private physicians were the most common source of care. The mean number of well-baby care visits did not differ significantly by maternal patterns of abuse. CONCLUSION: Since well-baby care use is similar for abused and nonabused mothers, pediatric practices may be important settings for screening women for violence.

Adolescent↗

PubMed2004

Pharmacological strategies for kidney function preservation: are there differences by ethnicity?

The prevalence of chronic kidney disease (CKD) is on the rise in all ethnic groups. This is because of the increased prevalence of obesity, diabetes mellitus, the metabolic syndrome, and the inadequate control of elevated blood pressure and other cardiovascular-renal risk factors, especially in ethnic minority populations. The implications of the aforementioned trends in risk factor prevalence and control are profound. Moreover, these trends negatively impact patient quality of life and place an enormous financial burden on the health care system for the provision of care to patients with CKD, end-stage renal disease (ESRD), and/or cardiovascular disease (CVD). Thus, it is of utmost importance to devise strategies that prevent kidney disease and delay progressive loss of kidney function in persons with CKD. Proven strategies include pharmacological interventions that lower blood pressure to less than target levels (<130/80 mm Hg), attainment of optimal glycemic control (Hb A1c <7%), and reducing urinary protein excretion. It is also possible, although yet unproven, that correction of anemia and aggressive treatment of dyslipidemia may forestall the loss of kidney function. In general, ethnic minorities are underrepresented in most large trials. Recently, a few outcome clinical trials in blacks have reinforced the lessons of kidney function preservation already learned in nonblack populations. That is, the reversible risk factors for CKD appear to be virtually identical and, at least in nondiabetic CKD, pharmacological targeting of the renin-angiotensin-aldosterone system (RAAS) with angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers preserves kidney function better than non-RAAS blood pressure-lowering regimens, especially when significant proteinuria exists. Although more CKD studies in ethnic minorities are needed, until they become available, the best available evidence from the existing clinical trial database should be applied to minorities with CKD-even when specific data are not available for a specific racial or ethnic group. Why this approach? First, there are no known unique risk factors for kidney disease in any ethnic group. Second, poor control of reversible risk factors for CKD is universal, particularly in blacks and other ethnic minorities. Thus, it is logical to predict that more efficient use of strategies proven to forestall loss of kidney function will reduce the excess of CKD and ESRD in ethnic minorities relative to non-minority populations. However, medical-based strategies alone are probably not enough. The global epidemic of obesity will fuel the growing population of persons, especially among ethnic minorities, with diabetes, the main cause of CKD, ESRD, and CVD. The obesity and diabetes epidemics are unlikely to abate without innovative and ultimately effective public health approaches.

Clinical Trials as Topic↗

PubMed1996

The effect of combined treatment with dextran 40 and acetylsalicylic acid on patency in severely traumatized small veins and arteries: an experimental study in the rabbit.

The effects of pharmacologic intervention on the fates of severely traumatized small veins and arteries have been studied in a rabbit model. Controls were given bolus doses of saline and a group treated with a combination of dextran 40 and acetylsalicylic acid starting prior to traumatization and continuing until postoperative day 5. Relative to controls, bleeding times in the treated group were significantly lengthened in arteries but not in veins, and venous patency significantly improved throughout the interval ending 2 weeks postoperatively. Arterial patency was at first highly improved but by 2 weeks, occlusion was virtually 100 percent. Since some of the occlusions took place more than a week after traumatization, the effects of antithrombotic agents on patency may need to be evaluated over considerably longer time periods than has previously been the rule.

Animals↗

PubMed1977

Death-producing hemoptysis in tuberculosis.

Massive hemoptysis in patients with tuberculosis is reported infrequently and then virtually always in association with cavitary disease or aspergilloma. In contrast, we describe herein five cases characterized by hemoptysis on admission, bilateral pulmonary disease, samples of sputum positive for acid-fast bacilli by Ziehl-Neelsen stain, and no obvious cavitary disease. In each, hemoptysis subsided and then suddenly recurred in prodigious amounts, leading to death, probably from asyphyxiation. In patients hospitalized with tuberculous hemoptysis of any amount, with or without an obvious cavity, aggressive diagnostic evaluation, including bronchoscopic examination, may define the site of bleeding, thus permitting rapid surgical intervention if the hemoptysis increases.

Adult↗

PubMed2006

Computers in medicine. Virtual rehabilitation: dream or reality?

Coronary heart disease is the number one cause of death for men and women in the United States and internationally. Identification of persons at risk for cardiovascular disease and reduction of cardiovascular risk factors are key factors in managing this tremendous societal burden. The internet holds great promise in helping to identify and manage persons at high risk of a cardiac or vascular event. The Internet has the capability to assess risk and provide support for cardiovascular risk reduction for large numbers of persons in a cost effective and time efficient manner. The purpose of this report is to describe important advances in the use of the Internet in identifying persons at risk for a cardiovascular event and in the Internet's ability to provide interventions designed to reduce this risk.

Cardiovascular Diseases↗

PubMed2005

Laser needle guide for the sonic flashlight.

We have extended the real-time tomographic reflection display of the Sonic Flashlight to a laser guidance system that aims to improve safety and accuracy of needle insertion, especially for deep procedures. This guidance system is fundamentally different from others currently available. Two low-intensity lasers are mounted on opposite sides of a needle aimed parallel to the needle. The needle is placed against a notch in the Sonic Flashlight mirror such that the laser beams reflect off the mirror to create bright red spots on the flat panel display. Due to diffuse reflection from these spots, the virtual image created by the flat panel display contains the spots, identifying the projected destination of the needle at its actual location in the tissue. We have implemented our design and validated its performance, identifying several areas for potential improvement.

Equipment Design↗

PubMed2005

Impact of virtual tumor resection and computer-assisted risk analysis on operation planning and intraoperative strategy in major hepatic resection.

HYPOTHESIS: Currently, standard planning for hepatic resection is based on the schematic description of the functional anatomy of the liver according to Couinaud, and on the evaluation of 2-dimensional computed tomographic imaging of the liver. Recent developments in image-based computer assistance allow patients' individual functional liver anatomy to be computed from mathematical analysis of standard multidetector computed tomographic scans. An intended resection can be performed virtually under realistic anatomic conditions, and the influence of different resection planes on blood supply and drainage within the remaining liver parenchyma can be calculated by a computer-assisted risk analysis. We evaluated the impact of computer-assisted risk analysis on operation planning for major hepatectomies, in particular on extent of resection or need for vascular reconstruction. DESIGN: Prospective cohort study. SETTING: Academic tertiary care referral center. PATIENTS: Twenty-five consecutive patients admitted to the hospital for major hepatectomy, of whom 4 had tumors deemed unresectable by both methods. INTERVENTIONS: Two-dimensional computed tomography was used to calculate the volume of the future liver remnant with the intended resection line manually determined, and then the volume of the future liver remnant was calculated again by computer-assisted risk analysis as the remaining liver volume not being devascularized but having both portal venous blood supply and hepatic venous drainage. MAIN OUTCOME MEASURES: The difference between the remaining functional liver volumes calculated by the 2 methods. RESULTS: The deviation between liver volumes determined by 2-dimensional computed tomography and by computer-assisted risk analysis was less than 20% in 14 of 21 patients, between 20% and 30% in 3, between 30% and 40% in 2, and 41% and 43% in 1 patient each. The most extensive deviations were found in extended left hepatectomy or when left hepatectomy was combined with additional wedge resection in the right lobe. In 7 cases, all with a deviation greater than 20%, the results of computer-assisted risk analysis led to a change of operation planning with regard to the extent of resection (n = 3) or the need for vascular reconstruction (n = 4), although in 1 of these cases resection was not performed because of peritoneal carcinomatosis. CONCLUSIONS: Image-based computer assistance allows for areas at risk for devascularization or venous congestion to be identified and precisely calculated before resection. In selected cases with small liver remnants, operation planning may be improved substantially by preoperative computer-assisted risk analysis.

Adult↗

PubMed1998

Effect of a garlic oil preparation on serum lipoproteins and cholesterol metabolism: a randomized controlled trial.

CONTEXT: Garlic-containing drugs have been used in the treatment of hypercholesterolemia even though their efficacy is not generally established. Little is known about the mechanisms of action of the possible effects on cholesterol in humans. OBJECTIVE: To estimate the hypocholesterolemic effect of garlic oil and to investigate the possible mechanism of action. DESIGN: Double-blind, randomized, placebo-controlled trial. SETTING: Outpatient lipid clinic. PATIENTS: We investigated 25 patients (mean age, 58 years) with moderate hypercholesterolemia. INTERVENTION: Steam-distilled garlic oil preparation (5 mg twice a day) vs placebo each for 12 weeks with wash-out periods of 4 weeks. MAIN OUTCOME MEASURES: Serum lipoprotein concentrations, cholesterol absorption, and cholesterol synthesis. RESULTS: Baseline lipoprotein profiles were (mean [SD]): total cholesterol, 7.53 (0.75) mmol/L (291 [29] mg/dL); low-density lipoprotein cholesterol (LDL-C), 5.35 (0.78) mmol/L (207 [30] mg/dL); high-density lipoprotein cholesterol (HDL-C), 1.50 (0.41) mmol/L (58 [16] mg/dL); and triglycerides, 1.45 (0.73) mmol/L (127 [64] mg/ dL). Lipoprotein levels were virtually unchanged at the end of both treatment periods (mean difference [95% confidence interval]): total cholesterol, 0.085 (-0.201 to 0.372) mmol/L (3.3 [-7.8 to 14.4] mg/dL), P=.54; LDL-C, 0.001 (-0.242 to 0.245) mmol/L (0.04 [-9.4 to 9.5] mg/dL), P=.99; HDL-C, 0.050 (-0.028 to 0.128) mmol/L (1.9 [-1.1 to 4.9] mg/dL), P=.20; triglycerides, 0.047 (-0.229 to 0.135) mmol/L (4.2 [-20.3 to 12.0]) mg/dL, P=.60. Cholesterol absorption (37.5% [10.5%] vs 38.3% [10.7%0], P=.58), cholesterol synthesis (12.7 [6.5] vs 13.4 [6.6] mg/kg of body weight per day, P=.64), mevalonic acid excretion (192 [66] vs 187 [66] microg/d, P=.78), and changes in the ratio of lathosterol to cholesterol in serum (4.4% [24.3%] vs 10.6% [21.1%], P=.62) were not different in garlic and placebo treatment. CONCLUSIONS: The commercial garlic oil preparation investigated had no influence on serum lipoproteins, cholesterol absorption, or cholesterol synthesis. Garlic therapy for treatment of hypercholesterolemia cannot be recommended on the basis of this study.

Adult↗

PubMed2004

Prevention of colorectal cancer through the use of COX-2 selective inhibitors.

Colorectal cancer is a major cause of morbidity and mortality accounting for an estimated 550,000 deaths annually worldwide. Colonic neoplasia develops in a stepwise fashion progressing from normal mucosa to adenomatous polyps to carcinoma, a process that takes years, thereby providing a prime opportunity for intervention. Although early detection by fecal occult blood testing and sigmoidoscopy can decrease the risk of cancer-related death by 20-30%, most persons never undergo appropriate screening. Population-based studies have previously determined that long-term ingestion of aspirin or other nonsteroidal antiinflammatory drugs (NSAIDs) leads to a 40-50% reduction in mortality. from colorectal cancer. These observational studies fueled subsequent mechanistic investigations that led to the identification of a molecular target, cyclooxygenase-2 (COX-2). COX-2 has tumor-promoting properties. Expression of COX-2 is virtually undetectable in normal intestinal mucosa, but is increased in approximately 50% of colonic adenomas and in 90% of colorectal carcinomas. Experimental studies in mice have revealed that genetic ablation or pharmacologic inhibition of COX-2 attenuates the number and size of intestinal polyps that develop in animals harboring a mutation in Apc, which confers an increased risk for intestinal neoplasia. Recent clinical studies using specific COX-2 inhibitors have shown that these compounds can: (1) reduce intestinal polyp burden in patients with familial adenomatous polyposis; (2) prevent the occurrence and/ or recurrence of colorectal adenomas and cancers; and (3) negatively regulate angiogenesis in colorectal cancer liver metastases. Compared to nonselective NSAIDs, COX-2 specific inhibitors cause substantially fewer gastrointestinal side effects. These findings indicate that a widely used and relatively safe class of drugs may represent a viable and effective anticancer strategy for a disease that causes over a half-million deaths per year.

Animals↗

PubMed2006

Effect of supine knee position on obstructive sleep apnea.

We previously reported a case of a middle-aged man whose obstructive sleep apnea (OSA) was virtually eliminated when he slept in the supine "knees up" position. In this study, we attempt to replicate this phenomenon in a group of volunteers with previously diagnosed OSA. Results indicated no significant improvement in OSA when sleeping supine knees up. Examination of distribution of within subjects' change [calculated as Respiratory Disturbance Index (RDI) in the "knees down" position vs RDI in the knees up position] indicated a trend for improvement in the latter (p=0.12, two-tailed probability). These results suggest that knee position is unlikely to be a robust intervention for OSA though they allow for the possibility that some patients may have a moderation of their condition by such a manipulation.

Female↗

PubMed1993

Oral and contact dissolution of gallstones.

The appropriate selection of patients for treatment with oral ursodeoxycholic acid (UDCA)--a drug that has virtually no side effects--results in about 50% of patients experiencing safe dissolution of gallstones within 2 years. Eligible patients have small (less than 20 mm in diameter) radiolucent gallstones in a gallbladder visualized by oral cholecystography (OCG); ideal candidates are thin women who have gallstones that are less than 15 mm in diameter, floating when observed by OCG, or of low density on computed tomographic (CT) scanning. Contact dissolution with methyl tert-butyl ether (MTBE) is rapid, effective more often than UDCA, and safe but requires the expertise of an interventional radiologist. Any size and number of cholesterol gallstones that are not CT-dense will be dissolved by MTBE, leaving at most only insoluble debris that is clinically innocuous. Although gallstones recur after dissolution by UDCA or MTBE in 50% of patients within 5 years, recurrent gallstones are usually asymptomatic and/or can probably be dissolved. We conclude that oral or contact dissolution provides an alternative treatment to cholecystectomy for about 30% of patients with symptomatic gallstones.

Administration, Oral↗

PubMed1999

Morphologic spectrum of Ebstein's malformation: revisitation relative to surgical repair.

OBJECTIVE: Our aim was to elucidate the morphologic spectrum of Ebstein's malformation of the tricuspid valve with regard to diagnosis and the feasibility of surgical repair, in the light of the currently favored reconstructive techniques. METHODS: We examined 23 autopsied hearts. Taking the displacement of the septal and mural leaflets of the abnormal tricuspid valve as our diagnostic criterion, we focused subsequently on the location of the distorted valvular orifice and the attachment and formation of the anterosuperior leaflet. We also assessed the dimensions of the components of the right ventricle relative to the plane of the displaced valvular orifice. RESULTS: In all hearts, the septal and mural leaflets were hinged at various points within the inlet of the right ventricle. In many cases, however, these leaflets were virtually absent. The plane of the effective tricuspid valvular orifice was displaced anterosuperiorly to varying degrees. In the most severe forms, the valvular mechanism took the form of a 1-leaflet valve. The length of the functional right ventricle when compared with the left ventricle ranged proportionally from 0.6 to 1. 1 (mean, 0.9). CONCLUSIONS: Ebstein's malformation is much more than simple "downward displacement" of the leaflets. In essence, the valvular orifice is formed within the ventricular cavity at the junction of the atrialized inlet and functional ventricular components. When surgical intervention becomes necessary, it is essential to make a detailed assessment of both valvular and ventricular abnormalities.

Adolescent↗

PubMed1979

Cancer of the breast. Staging methods, primary treatment options and end results.

A totally satisfying concept of treatment is not easy to formulate from the complex and often conflicting results of local therapeutic interventions for breast cancer. It seems evident that clinically occult cancer is often beyond the pale of both resection and irradiation at primary treatment, particularly when cancer is found in regional lymph nodes. Despite all combinations of local treatment, the ultimate risk of failure correlates more closely with the stage of the disease at the time of treatment than with the particular form of treatment. Thus the extent of disease must be considered the major, perhaps the ultimate determinant of prognosis. Because, under controlled conditions, several therapeutic alternatives have appeared to provide virtually identical end results in terms of survival and ultimate dissemination of the disease, the adequacy of control within the field of treatment may, in fact, be the most meaningful end result of local treatment. The experience that has accumulated with treatment of breast cancer supports the thesis that removal of the breast accomplishes all that can be achieved in terms of curing the disease, and wider treatment with surgery or irradiation serves only to improve the prospects for local control. Halsted demonstrated this principle with his radical mastectomy and it still seems to be the case. This fact provides further impetus for detecting and treating cancer while it is still localized to the breast. With these generalizations in mind some empirical observations can be added. An anatomic fact is that multiple microscopic foci of cancer that are not evident clinically are often present in the mammary parenchyma. Undisturbed, at least some, and perhaps eventually all, of these foci of cancer progress to become clinical cancers. Thorough removal of the entire breast (the entire mammary parenchyma) eliminates this particular hazard and, one may presume, terminates the disease if it is still limited to the breast. Removal of the underlying pectoralis major muscle provides additional margin around the tissues primarily involved, but sacrific of the muscle is apparently needless unless it is directly invaded by cancer. Microscopic metastases are also often present in regional lymph nodes without being clinically detectable and, left untreated, have the capacity to enlarge and become clinically apparent. Routine wide removal of regional lymph nodes improves the control of cancer at these sites when metastases are present, but whether it improves the chances for cure is doubtful. The fact is that approximately 25 per cent of patients with axillary metastases enjoy prolonged survival free of recurrence, some remaining well even after thirty years (Adair et al., 1974). Whether they would survive as well without removal of the metastases is uncertain. Desease-free survival is highest if metastases are removed while still microscopic, but this phenomenon may simply reflect treatment at an earlier phase in the evolution of the disease...

Bone and Bones↗

PubMed1988

Mothers' concepts of childhood diarrhea in rural Pakistan: what ORT program planners should know.

Diarrhea is the leading cause of infant and child death in Pakistan. Appropriately, the development of oral rehydration therapy (ORT) programs has become a major priority of the Pakistan Ministry of Health and of international funding agencies. Paradoxically, however, there is virtually no published anthropological literature on diarrhea-related traditional health beliefs and practices among the rural and illiterate people who make up 90% of the nation's population. The study reported on here focuses on these matters and suggests important implications for the multimillion-dollar ORT programs currently being launched. Mothers' ethnomedical models of diarrheal disease and concepts of appropriate treatment are discussed, as are practical problems relating to the effective implementation of ORT in such a setting. The results underline the need for anthropological studies as an adjunct to health interventions involving behavioral modification.

Adult↗

PubMed1988

Tobacco addiction as a psychiatric disease.

Tobacco is the most widely used addictive substance in the world. Since the Surgeon General's 1964 report, medicine has sought out the genesis of tobacco addiction (TA) and has evolved methods of treatment and prevention. Psychiatry was slower than other medical specialties to acknowledge TA as a legitimate area for psychiatric intervention, probably because the many psychiatrists who were smokers identified with their smoking patients. Since 1980, the American Psychiatric Association has recognized nicotine dependence and nicotine withdrawal as diagnostic entities. The complications of TA are in the province of other medical specialists, but psychiatrists have unique tools for treating addictive disorders. This paper describes some of the addictive qualities of tobacco, and presents illustrative cases of successful treatment of TA using hypnosis. It describes an effective cooperative community program under medical aegis, focusing on education, therapy, and prevention, which has resulted in the virtual disappearance of tobacco consumption in hospitals and schools in the community. By sharing their expertise in the treatment of individual patients, and the design of effective community programs that include education, prevention, and treatment, psychiatrists will be active leaders in the medical community's program to reduce tobacco addiction.

Adult↗