History Of Heavy Cigarette Smoking Research Articles

Pulmonary Langerhans cell histiocytosis in adults: A case report.

BACKGROUNDLangerhans cell histiocytosis (LCH) is a rare disease of unknown aetiology. While it may affect any organ of the body, few cases of solitary lung involvement are published in the literature. Here, we report a rare case of pulmonary LCH (PLCH) in an adult.CASE SUMMARYA 52-year-old male presented to hospital in July 2018 with complaints of progressively worsening cough with sputum, breathlessness, easy fatigability, and loss of appetite since 2016, and a 32-year history of heavy cigarette smoking (average 30 cigarettes/d). Physical examination showed only weakened breathing sounds and wheezing during lung auscultation. Chest computed tomography (CT) showed irregular micronodules and multiple thin-walled small holes. Respiratory function tests showed a slight decrease. Ultrasonic cardiogram showed mild tricuspid regurgitation and no pulmonary hypertension. Fibreoptic bronchoscopy was performed with transbronchial biopsies from the basal segment of right lower lobe. LCH was confirmed by immunohistochemistry. The final diagnosis was PLCH without extra-pulmonary involvement. We suggested smoking cessation treatment. A 3-mo follow-up chest CT scan showed clear absorption of the nodule and thin-walled small holes. The symptoms of cough and phlegm had improved markedly and appetite had improved. There was no obvious dyspnoea.CONCLUSIONImaging manifestations of nodules, cavitating nodules, and thick-walled or thin-walled cysts prompted suspicion of PLCH and lung biopsy for diagnosis.

Surgical treatment for thoracoabdominal intra-aortic thrombus with multiple infarctions: a case report

BackgroundMobile intra-aortic thrombus without atherosclerosis, aneurysm, or congenital coagulopathy is very rare, and there are few reports especially in young or middle-aged patients. Furthermore, there are presently no established guidelines or common strategies for the treatment of mobile intra-aortic thrombus.In this case report, we describe the first case of intra-aortic thrombus caused by secondary erythrocytosis and describe the recommended treatment strategy for intra-aortic thrombus.Case presentationWe report a case of an independent 40-year-old Asian man with a current history of heavy cigarette smoking who had sudden onset of abdominal and lumbar pain. Contrast-enhanced computed tomography revealed partial renal and splenic infarction, and he was transferred to our hospital. He also had a large mural thrombus in his thoracoabdominal aorta. Blood analysis on admission showed a hemoglobin level of 19.4 g/dL and hematocrit of 54.3 %; his international normalized ratio of prothrombin time, fibrin degradation products, and activated partial thromboplastin time levels were 1.02, 2.8 μg/ml, and 26.9 seconds respectively. We could find no abnormalities in protein C and protein S activity levels. Lupus anticoagulant and anti-cardiolipin antibody were both negative. He had no past medical history of arrhythmia and we found no signs of an arrhythmic event during admission.We promptly started anticoagulant therapy, but as the thrombus seemed at high risk of causing further critical infarction, we performed emergency aortic thrombectomy using partial extracorporeal circulation. To prevent dissemination of the thrombus during extracorporeal circulation, we first clamped his proximal and distal aorta on either side of the thrombus just before initiating extracorporeal circulation.After the aortotomy we removed a 14-cm length of intra-aortic thrombus without residual lesion. He was discharged from our hospital 20 days after surgery. From the results of his blood analysis, we considered the only cause of this thrombus was secondary erythrocytosis, which was probably induced by his current heavy cigarette smoking.ConclusionWe are the first to report such a thrombosis caused by secondary erythrocytosis and conclude that once the diagnosis of intra-aortic thrombus with systemic embolism is clear, emergency surgical removal of such a thrombus must be considered to prevent further embolic complications.

Cribriform adenocarcinoma of the lung: clinicopathologic, immunohistochemical, and molecular analysis of 15 cases of a distinctive morphologic subtype of lung adenocarcinoma

Lung adenocarcinoma is characterized by marked heterogeneity and may be composed of an admixture of histologic growth patterns, including acinar, papillary, solid, and lepidic (bronchioloalveolar). Tumors displaying a prominent or predominant cribriform architecture are rare and most often confused for metastases from other organs. We report the clinical, histologic, immunohistochemical, and molecular features in 15 primary lung adenocarcinomas with a predominant cribriform histology. All patients were adults between 30 and 80 years of age (median: 64), and all but one reported a history of heavy cigarette smoking. All cases showed a predominant (>70%) cribriform architecture that resembled a variety of tumors arising in other organs, including breast, prostate, ovary, pancreas, uterus, colon, and thyroid. Immunohistochemical stains showed a phenotype consistent with a primary lung tumor (ie, TTF1+/CK7+), with negative results for other markers. Molecular analysis in six cases showed that none harbored an EGFR-activating mutation. KRAS mutation was detected in one case, and an ALK1 and ROS1 gene rearrangement were each detected in an additional two cases. Cribriform adenocarcinomas of the lung represent a distinctive histologic subtype of lung cancer that may be morphologically difficult to differentiate from metastases with a predominant cribriform architecture.

Auricular composite chondrocutaneous grafts in the repair of nasal alar rim defects.

Dear Editor: An 82-year-old man presented with a grayish-black papule on the right ala of the nose that had been there for 3 to 4 years, and which bled occasionally. Physical examination revealed that the size of the papule was 0.5×0.5 cm. The patient had no family history of skin cancer; he had a history of heavy cigarette smoking. We suspected basal cell carcinoma and performed a 2-mm punch biopsy. The results of the pathologic examination of the specimen confirmed the diagnosis of basal cell carcinoma. Before the surgery, we ensured that he stopped cigarette smoking to allow better survival of the graft. The tumor was widely excised with a 2-mm surgical margin, resulting in a 0.9×0.8 cm full-thickness defect (Fig. 1A). The defect was reconstructed by using a composite chondrocutaneous graft harvested from the antitragus of the right ear (Fig. 1B). The graft was prepared in such a way that it was approximately 20% larger than the defect in order to compensate for the natural contraction of the graft. The donor site was closed primarily, and after hemostasis of the recipient bed, the defect was repaired with the composite skin graft (Fig. 1C). To lower the metabolic demand, an ice pack was applied to the recipient site postoperatively for surface cooling. At a 5-month postoperative follow-up, desirable aesthetic and functional results were observed (Fig. 2). The patient agreed publication of his case. Fig. 1 (A) Full-thickness defect of the nasal ala after tumor excision. (B) Composite graft designed over the donor site. (C) The defect covered with the auricular chondrocutaneous composite graft. Fig. 2 Symmetric alar rims with excellent match of color and contour observed at a 5-month follow-up. Auricular composite grafting is relatively simple, and can be performed in a single surgical session for the repair of all 3 layers of the nasal ala. The donor tissue provides mechanical stability to the repaired ala for preventing collapse on inhalation1, as well as acceptable color and contour match. In addition, the donor site can be easily repaired without noticeable scarring. One drawback of the composite graft is that it cannot be used for defects >2 cm, because of its high metabolic demand. Moreover, the procedure is less reliable than either the local or regional flap techniques2,3, and can only be used on healthy recipient sites3. Smoking increases the risk of postoperative ischemia, which can result in poor wound healing or tissue necrosis1. In smokers, like our patient, other reconstructive methods or complete cessation of smoking should be considered. Several procedures have been introduced to increase the survival of composite chondrocutaneous grafts and overcome graft failure. With regard to postoperative procedures, cooling can be used to lower the metabolic demands of the graft4. Hyperbaric oxygen can also be supplied to enhance fibroblast replication, which increases collagen formation and neovascularization5. Finally, scarification with a thin needle (20~26 gauge) coupled with heparin injections can be used for decongestion of the graft1. In conclusion, we successfully reconstructed a full-thickness defect on the free margin of the nasal alar rim with a composite chondrocutaneous graft from the patient. We believe that reconstructive surgeons can give preference to this technique when reconstructing nasal alar defects, especially small defects. In addition, surgeons should consider the use of appropriate postoperative methods to increase graft survival.

Isolated knee monoarthritis heralding resectable non-small-cell lung cancer. A paraneoplastic syndrome not previously described

Objective:To describe isolated knee monoarthritis as a paraneoplastic syndrome heralding non-small cell lung cancer (NSCLC), and to discuss its clinical characteristics.Methods:Clinical records of all consecutive, new outpatients with isolated knee...

Sclerosing Rhabdomyosarcoma: A Rare Variant With Predilection for the Head and Neck

Sclerosing rhabdomyosarcoma is a newly described variant of rhabdomyosarcoma with a predilection for the head and neck. Little has been written on the topic, because of the scarcity of the disease and its recent recognition as a distinct entity. The present report describes the fifth confirmed case of sclerosing rhabdomyosarcoma and is the first report in the otolaryngology literature. Case report. The authors have reported the case of a 66-year-old woman with a 35-year history of heavy cigarette smoking and daily alcohol consumption and a 2-month history of progressive dysphagia and dysarthria secondary to an enlarging tongue mass. Urgent tracheotomy was performed for impending respiratory embarrassment. Direct laryngoscopy revealed a bulky, exophytic mass involving the base of tongue. Specimens were obtained and submitted for analysis. Initial frozen-section analysis of the specimens favored carcinoma, although subsequent immunohistochemical analysis disproved this. The diagnosis of sclerosing rhabdomyosarcoma was based on microscopic appearance and patterns of gene expression, including the expression of desmin and myogenin. A search of the literature revealed only four confirmed cases of sclerosing rhabdomyosarcoma. With the inclusion of the oropharyngeal tumor in the present report, three of the five confirmed cases have occurred in the head and neck. Sclerosing rhabdomyosarcoma is a rare variant of rhabdomyosarcoma that has a predilection for the head and neck. The clinical presentation may mimic carcinoma. The otolaryngologist-head and neck surgeon must be familiar with this disease entity.

Respiratory bronchiolitis-associated interstitial lung disease: radiologic features with clinical and pathologic correlation.

The purpose of this work was to describe the radiographic and CT findings in patients with respiratory bronchiolitis-associated interstitial lung disease (RB-ILD) and to correlate them with clinical, physiologic, and pathologic features. RB-ILD was proved pathologically in all 21 patients. Sixteen (76%) patients were current smokers, and five (24%) patients were ex-smokers. The mean cigarette consumption was 38.7 pack-years. Chest radiographs and CT scans were semiquantitatively analyzed and correlated with clinical findings, physiologic measures, and a pathologic score of disease extent. The major radiographic findings were bronchial wall thickening in 16 patients (76%) and ground-glass opacity in 12 patients (57%). The predominant initial CT findings were central bronchial wall thickening (proximal to subsegmental bronchi) in 19 patients (90%), peripheral bronchial wall thickening (distal to subsegmental bronchi) in 18 patients (86%), centrilobular nodules in 15 patients (71%), and ground-glass opacity in 14 patients (67%), None of these CT findings had a significant zonal predominance. Other findings were upper lung predominant centrilobular emphysema (57%) and patchy areas of hypoattenuation (38%) with a lower lung predominance. Radiologic findings were similar in both current and ex-smokers. The amount of ground-glass opacity correlated inversely with arterial oxygen saturation ( r = -0.67, p = 0.04), and the areas of hypoattenuation correlated with alveolar-arterial oxygen gradient ( r = 0.56, p = 0.04). The extent of centrilobular nodules correlated with the extent of macrophages in respiratory bronchioles ( r = 0.53, p = 0.03) and with chronic inflammation of respiratory bronchioles ( r = 0.57, p = 0.02). The extent of ground-glass opacity correlated with the amount of macrophage accumulation in the alveoli and alveolar ducts ( r = 0.56, p < 0.01 and r = 0.54, p = 0.04, respectively). At follow-up CT after steroid treatment and smoking cessation, in nine patients, the extent of bronchial wall thickening, centrilobular nodules, and ground-glass opacity had decreased, but the areas of hypoattenuation had increased (p < 0.05). The CT findings of RB-ILD are centrilobular nodules, ground-glass opacity, and air trapping. These radiologic features, in patients with a history of heavy cigarette smoking, may differentiate RB-ILD from other interstitial lung diseases.

The epidemiology and clinical management of chronic obstructive pulmonary disease in Singapore.

The epidemiology and clinical management of chronic obstructive pulmonary disease in Singapore.

Illness as Failure: Blaming Patients

At fifty, everyone has the face he deserves. --George Orwell Thy rebuke hath broken my heart; I am full of heaviness: I looked for some to have pity on me, but there was no man, neither found I any to comfort me. They gave me gall to eat: and when I was thirsty they gave me vinegar to drink. --Prayer Book Washington, a fifty-eight-year-old man with a long history of heavy cigarette smoking and alcohol consumption, presented to the emergency room with weight loss and severe difficulty swallowing. A battery of diagnostic tests quickly disclosed that he was suffering from advanced cancer of the esophagus. Once this conclusion had been reached, more than one member of the health care team could not help remarking that Washington had brought it on himself, through decades of abusing his health. When one physician heard other members of the team express this attitude, she became indignant and accused the others of the victim. Mr. Washington has suffered enough already, and what little remains of his life will be even worse, she said. don't you stop worrying about who is to blame, and instead focus your energies on taking good care of your patient? Should we roundly condemn victim blaming in all cases, and devote our full attention to every patient, without regard to the role their own choices may have played in generating their afflictions? Or might there come a point at which the link between patients' choices and their afflictions appears so strong that it diminishes the strength of their claims on our resources, our ministrations, and perhaps even our sympathy? Why and How We Blame Patients The phenomenon of assigning moral blame for illness is far from new. The Bible often describes illness as the wages of sin, and the Book of Leviticus repeatedly links bodily affliction with ritual impurity. In recent times, epidemiological research has transformed venerable moral vices such as sloth, gluttony, intemperance, and fornication into medical risk factors--sedentary lifestyle, obesity, alcoholism, and unsafe sex. Implicit throughout is a causal association between habit and health, according to which the afflicted may be regarded as the instigators of their own bodily misfortune. As our biological and epidemiological understanding continues to advance, more and more illness becomes explainable in terms of risk factors. The progressive elucidation of avoidable risk factors, in turn, strengthens the case for treating patients themselves as the cause of their diseases.[1] Once we admit that patients bear some degree of responsibility for their afflictions, the circle of blame is limited only by our understanding of pathology and epidemiology. To the obvious example of cigarette smoking one could add a host of other hazardous conditions and behaviors for which patients might be blamed: alcohol and drug abuse (increasing the risk of cirrhosis, heart disease, and AIDS), failure to wear seat belts (injury or fatality in a motor vehicle accident), obesity (diabetes and cardiovascular disease), sedentary lifestyle (cardiovascular disease), and multiple sex partners and unprotected sex (AIDS, other venereal diseases, and cervical cancer). The list of hazardous choices extends even further, to include avoidance of marriage (singles of both sexes tend not to be as healthy as their married counterparts), nulliparity (women who have never had children suffer an increased risk of breast and endometrial cancer), and even failure to find satisfying work (people who like their jobs tend to be healthier than people who don't). To blame people for the health habits they adopt, two factors in addition to the link between habit and health must be taken into account. First, individuals must genuinely choose to adopt those habits, and their failure to relinquish them must also be a matter of personal choice. Second, individuals must understand that what they are doing is hazardous. …

Neuroendocrine, immunologic, and microvascular systems interactions in rheumatoid arthritis: physiopathogenetic and therapeutic perspectives

Objective: To review the “core” systems interactions in rheumatoid arthritis (RA): neuroendocrine, immunologic, and microvascular, and to interpret an integrated physiopathogenesis of the disease, beginning at a preclinical phase of risk factors to the later stages of manifest clinical inflammation. Methods: Publications on stress reactions, serum hormonal levels, biological mediators of inflammation and vascular alterations in RA during its preclinical phase, course of active disease, including pregnancy, and hormonal therapy of active disease were retrieved. In addition, experimental reports on biological models of the disease were considered. Levels of adrenal and gonadal steroids (ie, glucocorticosteroids [GCS], dehydroepiandrosterone [DHEA], its sulfate [DHEAS], estradiol [EZ], and testosterone [T]), as well as prolactin (PRL) and other hormones, biological mediators, vascular endothelial system (VES) interactions with hormones, and immunologic mediators of inflammation in RA, were reviewed and interpreted. Results: Women with premenopausal onset of RA not previously treated with GCS had lower basal serum levels of adrenal androgens, that is, DHEA or DHEAS, both before and after onset of clinical disease, compared with controls. Risk factors, including hormonal, immunologic, and hereditary indicators, were found to be uniformly present many years before clinical onset in such younger women, as compared with a frequency of circa 15% in matched controls. Also, a history of heavy cigarette smoking significantly predicted the onset of RA in perimenopousal women, and in men, suggesting that vascular endothelial alterations predispose to the disease. In the same prospective study, 1 or more of 4 risk factors were present an average of 12 years before clinical onset of disease in 83% of male RA cases versus 26% in matched controls (ie, sensitivity of 83% and specificity of 74%). Early RA patients may have lower serum cortisol levels than normal controls, and less than expected for the degree of ongoing inflammation, as wel as having upregulated PRL levels. Conclusions: Among persons genetically prone to RA, the “core” systems are hypothesized to become “remodeled” during a long preclinical phase as a result of chronic imbalances in their interactive homeostasis. This hypothesis needs to be critically assessed in further studies of such physiological precursors of disease as well as stressors in the development and course of RA. Optimal hormonal management of biological mediators of RA is also a priority challenge for disease control in the future. Relevance: Evidence indicates that men and women who are susceptible topremenopausal onset of RA can each be identified long before their clinical onsets of disease, and that productive research in primary preventions is an achievable objective. Disease prevention objectives are central in the public health strategy of the National Arthritis Action Plan and of the US Public Health Service “Healthy People 2000” (and 2010 proposed). Success in such prevention goals can be expected to significantly reduce the enormous burden of this common disease, which affects all segments of the population.

Predictors of smoking relapse after noncardiac surgery. Study of Perioperative Ischemia (SPI) Research Group.

We studied 235 smokers who were admitted for major noncardiac surgery and who survived hospitalization to determine the frequency and predictors of smoking relapse 1 year after hospitalization. We analyzed data collected prospectively from the Study of Perioperative Ischemia. We determined smoking status by self-report. At 12 months posthospitalization, 142 (76%) of the 186 surviving patients had resumed smoking. Significant independent predictors of relapse at 12 months were a history of alcohol abuse and a history of heavy cigarette smoking (P less than 0.01 and P less than 0.05, respectively). Since smokers commonly undergo surgery, the perioperative period provides a valuable window of opportunity for smoking cessation interventions designed to decrease the high rate of smoking relapse after surgery.

Comparative epidemiology of cancer between the united states and japan. A second look

Vital statistics were examined for the years 1955 through 1985 for Japanese natives and United States whites to elucidate changes in cancer mortality and related antecedent patterns of life-style in these two populations. Results show that lung cancer rates are rapidly accelerating among Japanese males as a consequence of their prior history of heavy cigarette smoking. Oropharyngeal cancer rates are also rising in Japan paralleling increases in alcohol and tobacco utilization. As the Japanese life-style and diet continue to become more "westernized," the rates of malignancies of the breast, ovary, corpus uteri, prostate, pancreas, and colon also continue to rise. Nevertheless, the mortality patterns of certain malignancies, viz., laryngeal, esophageal, and urinary bladder cancer, are discrepant with their established risk factor associations, suggesting the existence of other differences in risk factor exposure between the two countries. Epidemiologists and health educators need to develop innovative international programs of investigation and health promotion with preventive impact on common malignancies associated with risk factors of life-style.

Thermoactivated Price-Label Fume Intolerance

REACTIVE airway disease has been reported to occur with increased frequency among meat wrappers. Prolonged exposure to pyrolysates of polyvinyl chloride (PVC) soft-wrap films was initially implicated in the cause of this occupational disorder. 1 Severe asthma developed in a meat cutter after repeated occupational exposure to fumes of thermoactivated price-label adhesives. Report of a Case A 43-year-old man with a history of heavy cigarette smoking (45 cartons annually) was employed as a meat cutter for 25 years. He was asymptomatic until 1968 when he noted recurrent episodes of chest tightness and productive cough. Initially, these attacks developed only at work and appeared to be closely related to exposure to fumes of PVC meat-wrap film generated when the PVC resin was cut by the hot wire of the meat-wrapping console. His symptoms intensified at the end of the work week, decreased on weekends, and were virtually absent during vacation. In

Respiratory Distress Syndrome in the Adult After Cardiopulmonary Bypass

Fifteen episodes of the adult respiratory distress syndrome occurred in 14 patients after cardiopulmonary bypass. The clinical course was characterized by tachypnea, hyperventilation, and progressive hypoxemia developing postoperatively after a symptom-free period. Recovery occurred after institution of respiratory support and administration of steroids, diuretics, and antibiotics. There were no deaths. Prolonged cardiopulmonary bypass time, a history of heavy cigarette smoking, and a tendency to develop cardiocirculatory failure postoperatively was present more frequently in these patients as compared to a control group of ten who experienced an uneventful recovery. Early recognition of the adult respiratory distress syndrome by serial monitoring of arterial blood gases and aggressive management of hypoxemia and bronchopulmonary infections are thought to be important factors in survival.