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Urinary Tobacco Alkaloid Measurement in Patients Having Thromboangiitis Obliterans/In reply

To the Editor. The recent Residents' Clinic by Geske et al1 points out the difficulties of diagnosing thromboangiitis obliterans (TAO or Buerger disease) when the patient admits past smoking but denies current tobacco use.1 Denial and rationalization are common features of tobacco dependence, and an objective measure of tobacco use is critical in such circumstances. The tobacco alkaloids nicotine and cotinine can be measured in blood and urine and are biomarkers of nicotine exposure. Serum cotinine, with an elimination half-life of 18 to 20 hours, is able to detect nicotine use after 2 to 3 days of abstinence. However, elevated levels of both nicotine and cotinine are also common after use ...

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