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Johan Hansson Gunnar Wagenius: For providing some of the clinical angles. Erik Borg and Berit Engstrm: Your spirits hover across this work. Dan Bagger-Sjbck, Jan Wersll, Richard Kuylenstierna: For initially believing in me, hiring me, continuing hiring me, supporting me and then finally educating me. Lars Lundman, Lennart Mendel and Georgios Papatziamos: For biking with me, lunching with me and sharing some of my interests in matters small and big. All my colleagues at the department of otorhinolaryngology, past and present for making the department an interesting and pleasant place to work. My family: for endless support these years, having shared all the doubts and hardships and having made all the sacrifices. The management of symptoms experienced by patients receiving cytotoxic chemotherapy influences their quality of life during treatment Richardson et al, 1988 ; . A wealth of empirical evidence indicates that detailed and specific knowledge of patients' experiences is vital to effective side-effects management Richardson, 1995; Burish and Tope, 1992; Hill, 1992; Given, 1991; Dodd, 1988 ; . Different approaches to symptom assessment may be adopted, varying from unstructured communication between patients and health professionals to the use of documentation such as checklists or diaries. Health professionals who administer chemotherapy may argue that they `assess' patients in the communication that occurs during treatment. However, research indicates that health professionals do not accurately perceive the extent of chemotherapyrelated problems suffered by the individual patient, particularly less `visible' problems such as nausea Holmes and Eburn, 1989 ; . This may partly be explained by evidence which suggests that communication in cancer care is characterised by avoidance of patients' expression of their concerns and poor appreciation of patients' needs Wilkinson, 1991 ; . Health professionals may not routinely detect and monitor the concerns of individuals who have cancer, and a poor level of facilitative communication and distancing and blocking tactics are common Dennison, 1995 ; . Therefore, poor clinical practice may be due in part to the lack of a routine and systematic approach to the assessment of patients' symptoms Are you currently on any other therapy contraceptives, methadone, anti-depressants, etc. ; ? ! Yes ! No There are known drug interactions between a variety of drugs, and even herb-drug interactions. These can worsen side effects and or cause one or both therapies to be less effective. For example, some protease inhibitors can decrease the level of ethinyl-estradiol chemical in oral contraceptives ; , making them less effective. If you decide to take therapy, take all the medications, vitamins, supplements and or alternative therapies that you're taking to your next doctor's appointment. Whenever you add or change a therapy or supplement, be sure to talk with all your health practitioners and pharmacist ; to make sure these products may be taken together safely.

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Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN 37232; LINCO Research, St. Charles, MO 63304; Department of Medicine, Yale University, New Haven, CT 06520; and Vaccine Research Center, National Institutes of Health, Bethesda, MD 20892 Received for publication June 23, 2005. Accepted for publication September 29, 2005. The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked advertisement in accordance with 18 U.S.C. Section 1734 solely to indicate this fact and torsemide Stella P: A phase II evaluation of gleevec imatinib mesylate IND#61135, NSC #716051 ; in the treatment of persistent or recurrent epithelial ovarian or primary peritoneal carcinoma. GOG. Stella P: Phase II study of topotecan and paclitaxel followed by high-dose thoracic radiation therapy with concomitant cisplatin etoposide and amifostine in limited-stage small cell lung cancer. NCCTG. Stella P: Cyclophosphamide and doxorubicin CA ; 4 versus 6 cycles ; versus paclitaxel 12 weeks versus 18 weeks ; as adjuvant therapy for women with node-negative breast cancer: A 2x2 factorial phase III randomized study. NCCTG. Stella P: A phase II study of oxaliplatin and capecitabine in patients with measurable metastatic adenocarcinoma of the esophagus, gastroesophageal junction, and gastric cardia. NCCTG. Stella P: Phase II trial of encapsulized ginger as a treatment for chemotherapy-induced nausea and vomiting. UMCC. Stella P: A prospective observational biologic study of asymptomatic patients with monoclonal gammopathy and plasma proliferative disorders. SWOG. Stella P: Randomized phase III trial of cisplatin and irinotecan NSC-616348 ; versus cisplatin and etoposide in patients with extensive stage small cell lung cancer. NCCTG. Stella P: A randomized phase II trial of PS-341 and gemcitabine in patients with metastatic pancreatic adenocarcinoma. NCCTG. Stella P: Phase II evaluation of carboplatin, paclitaxel and gemcitabine followed by concurrent cisplatin and radiation therapy in patients with locally advanced or recurrent urothelial malignancy. SWOG.

INTRODUCTION Venom of the predatory marine gastropods of the genus Conus cone snails ; contain a unique array of peptides whose pharmaceutical potential remains largely unexploited 1 ; . These peptides have been classified based on their pharmacological target and structure 2, 3 ; . One important class, the -conotoxins, utilise a four-loop framework to selectively inhibit "N-type" voltage-sensitive calcium channels VSCCs ; found in the central and peripheral nervous systems of vertebrates 4 ; . Neurotransmitter release from preganglionic parasympathetic neurons has been found to be resistant to inhibition by a range of selective calcium channel antagonists of L-, N-, P Q-, R- and T-type calcium channels 5 8 ; . recently discovered -conotoxin from Conus catus CVID ; is highly selective for N-type over P Q-type VSCCs 9 ; and shows potent analgesic activity in rats 10 ; . In the present study, we investigated the effects of CVID on autonomic neurotransmission using conventional intracellular microelectrode recording techniques. -Conotoxin CVID was found to be a potent inhibitor of neurally-evoked transmitter release from the intact preganglionic cholinergic nerves innervating the rat submandibular ganglia, whereas -conotoxin MVIIA had no effect. The orientation and nature of the residues in loop 2 of -conotoxins has been shown to be crucial for selective binding to the N-type VSCC 11-15 ; . Since the only sequence difference in loop 2 between CVID and MVIIA is at position 10, we investigated the importance of this position for -conotoxin structure and ability to block neurotransmitter release from preganglionic parasympathetic neurons. Inhibition of preganglionic transmitter release was favoured in -conotoxins with a Lys at position 10 and trandolapril.

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