Another Reason To Quit Smoking

CIGARETTES may contain traces of pigs' blood, an Australian academic says with a warning that religious groups could find its undisclosed presence "very offensive".

University of Sydney Professor in Public Health Simon Chapman points to recent Dutch research which identified 185 different industrial uses of a pig - including the use of its haemoglobin in cigarette filters.

Prof Chapman said the research offered an insight into the otherwise secretive world of cigarette manufacture, and it was likely to raise concerns for devout Muslims and Jews.

Religious texts at the core of both of these faiths specifically ban the consumption of pork.

"I think that there would be some particularly devout groups who would find the idea that there were pig products in cigarettes to be very offensive," Prof Chapman said today.

"The Jewish community certainly takes these matters extremely seriously and the Islamic community certainly do as well, as would many vegetarians.

"It just puts into hard relief the problem that the tobacco industry is not required to declare the ingredients of cigarettes ... they say 'that's our business' and a trade secret."

The Dutch research found pig haemoglobin - a blood protein - was being used to make cigarette filters more effective at trapping harmful chemicals before they could enter a smoker's lungs.

Prof Chapman said while tobacco companies had moved voluntarily list the contents of their products on their websites, they also noted undisclosed "processing aids ... that are not significantly present in, and do not functionally affect, the finished product".

This catch-all term hid from public view an array of chemicals and other substances used in the making of tobacco products, he said.

At least one cigarette brand sold in Greece was confirmed as using pig haemoglobin in its processes, Prof Chapman said, and the status of smokes sold was unknown.

"If you're a smoker and you're of Islamic or Jewish faith then you'd probably would want to know and there is no way of finding out," Prof Chapman said.

The Sydney office of British American Tobacco Australia was contacted by AAP.

A spokeswoman said a comment would be provided although it was not immediately available.

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Case Study 1

material obtain from:

http://www.upstate.edu/cdb/grossanat/hnsmgrp3ans.shtml

Case Study 1

A young man was taken to the emergency room with a knife wound in the right side of the
neck. The blade pierced the skin and the sternocleidomastoid muscle in a horizontal
plane at a point approximately 4 cm directly posterior to the angle of the mandible. Bleed-
ing from the wound was not substantial. Compresses were applied to the area, the bleed-
ing came under control, the skin was stitched and the patient was allowed to go home.

When he returned to have the stitches removed one week later, the following symptoms
were observed: his tongue deviated markedly to the right upon protrusion; the floor of the
mouth on the right side was relaxed and lengthened; the hyoid bone was tilted slightly from
the horizontal plane, the right side being higher than the left; a generalized weakness of
the infrahyoid muscles was present on the right side of the neck.

There was no sensory loss from the tongue or from the skin of the neck. Taste sensation
from the tongue was normal. The function of the sternocleidomastoid and platysma
muscles was unimpaired. After one year, function was restored to the tongue and associ-
ated structures.

QUESTIONS / PROBLEMS

1. Did the knife enter the posterior triangle of the neck?

No. It pierced the SCM directly and did not enter one of the major named triangles of the
neck. The SCM divides the anterior from the posterior triangle, etc., etc., but is not "in"
either triangle.

2. Damage to what structure would account for the symptoms described above?

Damage to the right hypoglossal nerve can account for all of the symptoms. As described
below, this nerve not only is motor to most tongue muscles, but it also carries fibers from
C 1 (and sometimes C 2) that supply the geniohyoid, superior belly of the omohyoid and
the thyrohyoid muscles. Recall, however, that the C 1 fibers are only traveling with the
hypoglossal nerve and strictu sensu are not part of it. Nevertheless, they probably would
have been cut or injured along with the hypoglossal fibers.

3. Why did the tongue deviate to the injured side?

On the right side, the denervated muscles do not have the same strength as the muscles
on the left (unaffected) side; hence, the muscles on the left overpower/override the right
muscles and the tip of the protruded tongue deviates to the weakened right side. The
tongue can be protruded in the midline only when the muscles on both sides work
together. The tongue is protruded solely by the muscles on the intact side; therefore,
when one hypoglossal nerve is severed or damaged, the protruded tongue deviates to the
paralyzed or weakened side.

4. What caused the problems with the hyoid bone and the infrahyoid muscles? Why were
the latter not totally denervated?

The problems relating to the position of the hyoid bone resulted from the fact that
C 1 fibers were running with the hypoglossal nerve. These fibers supply the geniohyoid
(a suprahyoid muscle) and two infrahyoid muscles, the superior belly of the omohyoid
and the thyrohyoid. The geniohyoid pulls the hyoid bone forward, shortens the floor of
the mouth, elevates the hyoid bone and helps to open the jaw. The floor of the mouth on
the right side was relaxed and lengthened because of the injury sustained by the nerve
to the geniohyoid. The thyrohyoid and omohyoid depress the hyoid bonee and the thyroid
cartilage during swallowing and speaking. Since the nerve supply to 2/4 infrahyoids were
damaged and the nerve supply to only 1/4 suprahyoids was injured, the right suprahyoids
were stronger than the righ infrahyoids and tended to elevate the right side of the hyoid
bone.

5. Account for the fact that only minimal bleeding occured from the site of the wound.

The knife did not penetrate sufficiently deep to sever either the internal or external carotid
arteries which lie medial (deep) to the hypoglossal nerve.

6. Describe the relationships of cranial nerves IX, X, XI and XII to the arteries and other
landmark structures in the neck.

The relationships of cranial nerves IX-XII, the carotid arteries and other structures in the
neck are of considerable importance. The glossopharyngeal nerve (IX) and the pharyngeal
branches of the vagus (X) lie lateral to the internal carotid and medial to the external carotid
arteries. The superior laryngeal nerve (from vagus) lies medial to both arteries. The main trunk of the vagus descends posterior to the internal and common carotid arteries. The
accessory nerve (XI) crosses the posterior triangle of the neck diagonally from the jugular
foramen to the anterior border of the trapezius muscle. The hypoglossal nerve (XII) is the
most superficial of the cranial nerves in this area. It descends from the hypoglossal canal,
hooks around the occipital artery and lies superficial to the internal and external carotid
arteries.
(REFER TO THE DIAGRAMS THAT FOLLOW)

7. Why do you think that the patient recovered use of the affected structures in this
particular case?

The nerve was not completely severed. The supra- and infrahyoids displayed weakness but
not paralysis, hence not all of the C 1 fibers were severed.

For additional information, refer to:
Netter plates: 24, 27, 29, 63, 65, 122, 123.
Snell, pages: 645-652, 656, 673, 681, 684, 709, 786, 801-802.

On the diagram above, label structures 1 - 4, and then complete the chart below concerning
vagal innervation of the larynx.

	Name	Component Fibers	Function(s)	Symptoms Produced by a Lesion of this Structure
1	Superior Laryngeal Nerve	somatic motor; somatic sensory; special sensory; preganglionic parasympa- thetic; (postganglionic sympathetic)	Forms an external and an internal branch; this is the parent nerve of 2 and 3 (see below)	All of those listed for 2 and 3 below since this is the PARENT nerve.
2	Internal Layngeal Nerve	somatic sensory; special sensory; preganglionic parasympathetic; (post- ganglionic sympathetic)	Supplies region from epiglottis down to vocal cords	No cough reflex; lack of sensation above vocal cords; no glandular secretions released by mucosal glands from epiglottis to vocal cords, i.e. region above vocal cords
3	External Laryngeal Nerve	somatic motor; somatic sensory; (postganglionic sympathetic)	Regulates the cricothyroid muscle	Hoarseness or a very low- pitched voice; vocal cords cannot be lengthened/ AD-ducted
4	Recurrent Laryngeal Nerve/ Inferior Laryngeal Nerve	somatic motor; somatic sensory; preganglionic parasympathetics; (postganglionic sympathetics)	Motor to ALL instrinsic muscles of larynx (NOT cricothyroid, however); sensory to mucous mem- brane below vocal folds; stimulates/regulates glandular secretion from mucosal glands below vocal folds	Vocal Fold cannot be AB-ducted on side of lesion; folds come to rest halfway between ab- and ad-ducted; speech and breathing may be impaired, especially if the nerve is only partially bisected

TELL ME DOCTOR...

There are eleven rather typical complaints given below. Using what you have learned about
the cranial nerves, indicate which nerve (or nerves) you think has been compromised. Be
specific and be prepared to pinpoint the site of the lesion if possible.

1. "The reason why I did not leave the house sooner once the fire broke out was because
I could not smell the smoke."

Cr. I, olfactory

2. "I can't feel anything over my right cheek, lower lip or most of my tongue and my mouth
is almost totally dry."

Lesion might have been at or very near foramen ovale. The designation "almost or extremely
dry" usually accompanies complaints about the malfunctioning of the parotid; the description
"slightly dry or partially dry" usually goes along with impairment of the submandibular and/or
sublingual glands, with the parotid intact and functioning. Of course, if the lesion had been
bilateral even more spectacular symptoms would have been reported.

3. "I can no longer close my eye tightly or whistle a tune."

Cr. VII, motor supply to orbicularis oculi (temporal and zygomatic branches), orbicularis oris
(buccal branches) and buccinator (buccal branches).

4. "I seem to have a lot of difficulty turning my head now and I think that there is a big
difference in the contour of my neck."

Cr. XI, spinal accessory; motor supply to sternocleidomastoid and trapezius muscles.

5. "I keep having dizzy spells and feeling sick to my stomach (Cr. VIII, vestibulocochlear
nerve). Yesterday I lost my balance as I was walking down the street. The muscles on the right
side of my face don't seem to be working right (Cr. VII, facial nerve). I can barely taste my food
(Cr. VII, chorda tympani, special sensory), my mouth is rather dry (Cr. VII, chorda tympani,
parasympathetic, submandibular ganglion) and my right eye is very dry. I seem to be making
almost no tears in that eye (Cr. VII, parasympathetic, greater petrosal nerve, ptergopalatine
ganglion, zygomaticotemporal nerve to lacrimal nerve)."

Lesion might have been at level of internal acoustic meatus.

6. "I know that you said my ear was infected, but why am I so sick to my stomach? I
seem to be coughing a lot but I don't think that I have a cold."

Cr. X, Vagus nerve, auricular branch.

7. "Last night I didn't dry my hair after I took a shower and went to bed with wet hair. I
woke up in the middle of the night because I felt so cold. Then, I decided to go to the
bathroom, and when I looked in the mirror I noticed that the corner of my mouth was
drooping and that I was drooling."

Sounds like Bell's palsy; Cr. VII, especially the motor, buccal and marginal/mandibular
branches to the orbicularis oris.

8. "After I had that lump removed from the right side of my chin, the right corner of my
mouth began to droop and the right side of my neck developed all these baggy folds."

Cr. VII, marginal and cervical branches to orbicularis oris and platysma muscles.

9. "Ever since that accident, I find that the dentist can drill my lower teeth and I don't
feel a thing!"

Cr. V 3, inferior alveolar nerve, sensory to lower teeth and gums.

10. "My right pupil isn't the same size as my left. In fact, it doesn't change its size; it is
always dilated."

Cr. III, parasympathetic, ciliary ganglion, nerve to sphincter pupillae.

11. "Ever since I suffered that blow on the side of my head, I have double vision. It causes
no end of trouble for me as I am going down the stairs."

Cr. IV, superior oblique.

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Appropriate Patients for Hormonal Therapy

Hormonal treatments for breast cancer are used for women who:

• Are at high risk, but have not had breast cancer
• Had non-invasive breast cancer (DCIS) and want to reduce the risk of recurrence and a new breast cancer
• Have hormone receptor-positive breast cancer that appears to have been completely removed by surgery (Hormonal therapy is used as adjuvant therapy to get rid of any remaining breast cancer cells. It may be used alone or in combination with chemotherapy.)
• Have invasive breast cancer and need to shrink a large tumor before surgery or radiation
• Have cancer that remains after surgery or cancer that has recurred (come back)
• Have advanced disease

Hormone drugs are only effective in women whose cancer has the estrogen or progesterone receptor. Every breast cancer is tested for these receptors and your physician will share these results with you. If the cancer is negative for both these receptors, you will not benefit from the treatment.

notes from: http://www.fccc.edu/cancer/types/breast/treatment/hormonal/index.html

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Hormonal Therapy

Hormonal therapy is one of the major modalities of medical treatment for cancer. It involves the manipulation of the endocrine system through exogenous administration of specific hormones, particularly steroid hormones, or drugs which inhibit the production or activity of such homones (hormone antagonists). Because steroid hormones are powerful drivers of gene expression in certain cancer cells, changing the levels or activity of certain hormones can cause certain cancers to cease growing, or even undergo cell death.

Hormonal therapy is used for several types of cancers derived from hormonally responsive tissues, including the breast, prostate, endometrium, and adrenal cortex. Hormonal therapy may also be used in the treatment of paraneoplastic syndromes or to ameliorate certain cancer- and chemotherapy-associated symptoms, such as anorexia. Perhaps the most familiar example of hormonal therapy in oncology is the use of the selective estrogen-response modulator tamoxifen for the treatment of breast cancer, although another class of hormonal agents, aromatase inhibitors, now have an expanding role in that disease.

information obtain and edited from: wikipedia.com

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Carotid Sinus Massage

Definition

Carotid sinus massage involves rubbing the large part of the arterial wall at the point where the common carotid artery, located in the neck, divides into its two main branches.

Purpose

Sinus, in this case, means an area in a blood vessel that is bigger than the rest of the vessel. This is a normal dilation of the vessel. Located in the neck just below the angle of the jaw, the carotid sinus sits above the point where the carotid artery divides into its two main branches. Rubbing the carotid sinus stimulates an area in the artery wall that contains nerve endings. These nerves respond to changes in blood pressure and are capable of slowing the heart rate. The response to this simple procedure often slows a rapid heart rate (for example, atrial flutter or atrial tachycardia) and can provide important diagnostic information to the physician.

Description

The patient will be asked to lie down, with the neck fully extended and the head turned away from the side being massaged. While watching an electrocardiogram monitor, the doctor will gently touch the carotid sinus. If there is no change in the heart rate on the monitor, the pressure is applied more firmly with a gentle rotating motion. After massaging one side of the neck, the massage will be repeated on the other side. Both sides of the neck are never massaged at the same time.

Preparation

No special preparation is needed for carotid sinus massage.

Aftercare

No aftercare is required.

Risks

The physician must be sure there is no evidence of blockage in the carotid artery before performing the procedure. Massage in a blocked area might cause a clot to break loose and cause a stroke.

Normal results

Carotid sinus massage will slow the heart rate during episodes of atrial flutter

source from: http://www.healthline.com/galecontent/carotid-sinus-massage

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Listen to Your Heart

Go on this website to play and learn some interactive application on subjects like ECG or heart anatomy.

http://www.skillstat.com/learn.htm

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