Male Smoker Research Articles

Tension Pneumothorax as the Presentation of Pulmonary Langerhans Histiocytosis

A 36 year old male smoker presented to the emergency department with shortness of breath. A chest x-ray showed a tension pneumothorax. Chest tube was placed urgently. CT scan showed upper lobe predominant cystic lung lesions. Biopsy confirmed the diagnosis of pulmonary Langerhans Histiocytosis.

Exploring socio-contextual factors associated with male smoker's intention to quit smoking.

BackgroundPrograms to encourage smokers to quit smoking tobacco have been implemented worldwide and are generally viewed as an effective public health intervention program. However, few studies have examined the social factors that influence a smoker’s intention to quit smoking. This study investigated the socio-contextual factors that are associated with the intention to quit smoking among male smokers in South Korea.MethodsData were obtained from a 2014 nationally representative panel that examined the influences of mass media on the health of the Korean population. Members of this panel were recruited using a mixed-method sampling and a combination of random digit dial and address-based sampling designs. Survey questions were based on those used in previous studies that assessed the effects of social context, including mass media and social capital, on health. Multivariate logistic regression analyses of the answers of 313 male smokers were undertaken.ResultsMale smokers who participated in community-based activities were 2.45 times more likely to intend to quit smoking compared to male smokers in general (95 % confidence interval [CI]: 1.25–6.82). In addition, male smokers who participated in informal social gathering networks were 2.38 times more likely to intend to quit smoking compared to male smokers in general (95 % CI: 1.11–5.10). Moreover, male smokers with high smartphone use were 1.93 times more likely than smokers with low smartphone use to intend to quit smoking within one year (95 % CI: 1.07–3.46).ConclusionsA supportive environment that enables male smokers to access beneficial health information and that encourages them to quit smoking is necessary for a stop-smoking program to be effective. The result of this study contribute to establishing a new smoking control policy by identifying socio-contextual factors related to the intention to quit smoking.

Video-assisted thoracic surgery micro pneumonectomy, a new approach.

Video-assisted thoracic surgery (VATS) pneumonectomy is normally limited due to the difficulty to remove the whole lung via the utility incision. We present our technique of VATS pneumonectomy, this we call micropneumonectomy. A 75-year-old male current smoker with a right hilar mass, invading both upper and lower lobe bronchi to segmental level on CT scan and PET scan, pathology from CT guided biopsy showed squamous cell carcinoma. The patient had a mediastinoscopy just prior to pneumonectomy, primarily to remove station 7 lymph nodes and to mobilize the carina to facilitate the VATS pneumonectomy. Smooth postoperative course, and patient was fit for discharge two and half days post operatively. Our technique showed an effective way of doing pneumonectomy via VATS technique, which expands the use of VATS technique into pneumonectomies, with three intercostals incisions smaller than 5 mm, in addition to a single sub-xiphoid incision which can take 12 mm instruments.

Correlation of high resolution CT patterns with pulmonary function tests in patients with interstitial lung diseases

BackgroundInterstitial lung diseases (ILDs) refer to a broad category of lung diseases characterized by exertional dyspnea, different interstitial patterns on high resolution computed tomography (HRCT), and abnormal pulmonary functions. The aim of this studyThis is to correlate the radiological pattern and extent of involvement of ILDs with pulmonary function tests and verify the radiological functional relationship. Patients and methodsThis is a prospective descriptive study which was conducted upon 44 patients aged ⩾18years, who were diagnosed to have interstitial lung diseases (ILDs), all of them were admitted to Chest Department, Assiut University Hospitals between June 2014 and May 2015. They were classified into three groups according to the predominant pattern on HRCT: Group I: Fibrotic pattern including reticular pattern and/or honeycombing, Group II: Ground glass pattern, Group III: Nodular pattern. Pulmonary function tests including; forced spirometry, total lung capacity (TLC), residual volume (RV) and diffusing capacity for carbon monoxide (DlCO) also O2 saturation via pulse oximetry were done for all patients. ResultsIn this study 44 patients with ILDs were included, their mean age was 45.7years, most of them were male (63.6%) and non smoker (59.1%) with mean SpO2 87.8%. the most frequent HRCT pattern was the fibrotic one including reticular and honey combing (45.5%) followed by ground glass pattern (36%) and the least frequent one was the nodular pattern (18.2%). There was significant positive correlation between TLC and DLCO in fibrotic pattern (P value=0.000), while no correlation could be detected between them in the other two patterns. Moreover, there was a significant positive correlation between DLCO and SpO2 in all different patterns (P value=0.000). ConclusionHRCT patterns and degree of lung involvement of ILDs correlate with pulmonary function parameters. Lung volumes are lower in fibrotic lesion regardless the degree of lung involvement, while DLCO among different patterns were dependent upon the degree of lung involvement. Restrictive pulmonary dysfunction correlate with gas exchange in fibrotic pattern while in ground glass one, gas exchange is independent on lung volumes.

A 42 year male presenting with swelling in both parotid regions

A 42 years old male smoker presented with swelling in both parotid regions, 3.5x2.5cm in left & and about 2.5x1.5 cm in right, for 8 months with no pain, fever, dysphagia, dyspnoea, epistaxis or any ear problem. After all necessary investigations, including MRI and FNA, it was diagnosed as Warthin tumor. Warthin`s tumour is a benign tumour of salivary glands affecting mostly parotid gland. Smokers and older individuals are at greater risk of developing Warthin`s tumour. FNA has good accuracy for diagnosing this type of tumour though some literatures show risk of developing sialocutaneous fistula. MRI possesses high specificity and sensitivity for warthin`s tumour. From different available treatment options we chose local excision.Bangladesh Med J. 2015 May; 44 (2): 109-111

TCTAP C-052 Ostial Lcx Thrombus Following LMCA Bifurcation Stenting

### Patient initials or identifier number f2015 ### Relevant clinical history and physical exam 45year old male patient, hypertensive, non-diabetic and smoker 6 months back admitted for NSTMI, then CAG showedDistal LMCA. Bifurcationlesion with Medina 1, 1, 1. Then LMCA to LAD stenting with

The effect of the amiodarone-warfarin interaction on anticoagulation quality in a single, high-quality anticoagulation center.

Clinical trials have reported a low time in therapeutic range (TTR) in patients with atrial fibrillation treated with both warfarin andamiodarone. These trials included centers and countries with both high and low TTRs. What is the impact of amiodarone on the TTR in a single, high-quality anticoagulation clinic? TTR was assessed in amiodarone and nonamiodarone-treated patients from a University anticoagulation clinic. Baseline characteristics between patients ever-taking or never-taking amiodarone were similar, except more amiodarone patients were smokers (19.5 vs. 6.1%, P = 0.0031). The TTR calculated from 8901international normalized ratios (INRs) in 249 nonamiodarone patients with a mean follow-up of 34 ± 20 months (mean INR 36 ± 18) was 66 ± 16.6% compared with 61.3 ± 16.2% (P = 0.111) from 1455 INRs in 41 amiodarone-treated patients with a mean follow-up of 28 ± 20 months (mean INR 35 ± 22). Factors associated with a low TTR were male sex (P = 0.0013), smoker (P = 0.0048), and amiodarone use (P = 0.0374). A second on-treatment analysis, in which the TTR was calculated only during amiodarone therapy, resulted in similar findings; however, amiodarone did not emerge as a predictor of a low TTR. In 11 patients, the TTR prior to amiodarone (54.5 ± 22.2%) was not significantly different in the first 3 months (54.6 ± 33.4%) or after 3 months (67.2 ± 33.7%) of amiodarone. In a single high-quality anticoagulation center, anticoagulation quality, as measured by the TTR, can be comparable in amiodarone and nonamiodarone-treated patients.

Carcinoma epidermoide de laringe sincrónico con carcinoma medular de tiroides. Presentación de un caso

Synchronous tumours are defined as those presenting within 6 months subsequent to the diagnosis of the primary tumour. We present a case of invasive laryngeal carcinoma in a 65 year old male smoker who underwent radical laryngectomy with bilateral cervical dissection and hemi-thyroidectomy due to suspicion of tumour invasion. There are a few case reports of laryngeal carcinoma synchronous with thyroid carcinoma, the majority being papillary thyroid carcinoma in males aged between 47 and 62. We present a case of invasive squamous cell laryngeal carcinoma synchronous with thyroid medullary carcinoma and cervical lymph glands positive for metastases from epidermoide carcinoma.

Lung Transfer Factor in Middle Aged Asymptomatic Male Smokers of a City from West India: A Cross-Sectional Study.

Smoking is an increasingly popular indulgence in India. Assessment by routine spirometry falls short of direct functional parameter like Diffusion Lung Capacity (DLC), also known as lung transfer factor (LTF). To measure LTF amongst middle aged male smokers and to study various correlates for it. Total of 45 asymptomatic male current smokers were enrolled for this cross-sectional study conducted at pulmonary function testing lab of Physiology Department of our college. Smoking history was evaluated and smoking index was defined by product of number smoked per day and years smoked. We used instrument Ultima PFX of Medgraphic Company. After pre syringe calibration LTF was measured by Methane mixture using protocols of ATS. Parameters measured were Dlco-uncorrected, corrected and normalized to VA (alveolar volume). Results were compared for statistical significance and significance was set as p <0.05. In case group of 45(25 bidi and 20 cigarette smokers) mean age was 30 years, mean duration was 8 years, mean smoking index was 60. We found small insignificant decline in actual LTF values than predicted which was not significantly different between bidi and cigarette smokers. Duration, age and intensity of smoking were negatively and significantly correlated with LTF value while anthropometric parameters were not. Smoking adversely affects LTF in young asymptomatic current male smoker that further declines with severity of smoking and with duration regardless of type of smoking. With years to come, these alterations can largely be prevented by smoking cessation, at least theoretically.

A rare case of Propionibacterium species causing lung abscess

Propionibacterium species are a part of the normal microbial flora of the body and are usually found as contaminants of blood culture. Here, we report a case of Propionibacterium spp. causing lung abscess in a 69-year-old male smoker, alcoholic and diabetic. After taking treatment for about 1 year, he was referred to the Government Medical College, Thiruvananthapuram where Propionibacterium species , sensitive to Penicillin was isolated from his sputum repeatedly. He recovered completely after 6 weeks of oral Penicillin therapy.

Primary Hepatoid Adenocarcinoma of the Lung

ABSTRACT Hepatoid adenocarcinoma lung (HAL) is an extremely rare type of extrahepatic adenocarcinoma with morphological similarity to hepatocellular carcinoma. We report a case of 59 years male smoker who presented with anorexia, weight loss and cough. Chest X-ray revealed a homogenous opacity in the left upper and mid zone. Computed tomography (CT) chest showed a left upper lobe mass with enlarged hilar lymph nodes. Serum alpha fetoprotein (AFP) was normal. Guided fine needle aspiration cytology (FNAC) of the mass revealed a few atypical cells. Endobronchial biopsy showed sheets of polygonal cells with coarsely clumped chromatin, eosinophilic nucleoli and abundant eosinophilic to clear cytoplasm. The neoplastic cells were positive for hepatocyte-1, Carcinogenic embryonic antigen (CEA), Cytokeratin 7 (CK-7) and cytoplasmic positivity for thyroid transcription factor (TTF-1). After 3 months, the tumor had grown significantly. Due to its aggressive behavior, early and accurate diagnosis is necessary. How to cite this article Vellaisamy G, Rout P, Crasta J, Devaraj U. Primary Hepatoid Adenocarcinoma of the Lung. J Postgrad Med Edu Res 2016;50(2):103-106.

Bronchogenic Carcinoma with Cardiac Invasion Simulating Acute Myocardial Infarction.

Cardiac metastases in bronchogenic carcinoma may occur due to retrograde lymphatic spread or by hematogenous dissemination of tumour cells, but direct invasion of heart by adjacent malignant lung mass is very uncommon. Pericardium is frequently involved in direct cardiac invasion by adjacent lung cancer. Pericardial effusion, pericarditis, and tamponade are common and life threatening presentation in such cases. But direct invasion of myocardium and endocardium is very uncommon. Left atrial endocardium is most commonly involved in such cases due to anatomical contiguity with pulmonary hilum through pulmonary veins, and in most cases left atrial involvement is asymptomatic. But myocardial compression and invasion by adjacent lung mass may result in myocardial ischemia and may present with retrosternal, oppressive chest pain which clinically may simulate with the acute myocardial infarction (AMI). As a result, it leads to misdiagnosis and delayed diagnosis of lung cancer. Here we report a case of non-small-cell carcinoma of right lung which was presented with asymptomatic invasion in left atrium and retrosternal chest pain simulating AMI due to myocardial compression by adjacent lung mass, in a seventy-four-year-old male smoker.

Fine Needle Aspiration Cytology in Warthin's Tumor: A Diagnostic tool

Warthin’s tumor, also known as papillary cystadenoma lymphomatosum or adenolymphoma, is the second most common benign tumor of the salivary glands. It is commonly seen in lower lobe of the parotid gland and affects mainly male in sixth or seventh decades of life. Studies have shown that there is a close association between Warthin’s tumor and cigarette smoking. Preoperative fine needle aspiration cytology (FNAC) of a parotid mass plays a pivotal role in differentiating neoplastic from inflammatory lesion as well as management of patients. We report a case of a 70 year old male chronic smoker who presented with painless swelling in the parotid region bilaterally.

Transitional cell carcinoma: A rare development in congenital ureteropelvic junction obstruction kidney.

A 54-year-old male chronic smoker presented with hematuria 13 years after being diagnosed with an asymptomatic left non-functioning kidney secondary to congenital ureteropelvic junction obstruction. On evaluation, he was diagnosed with renal collecting system mass occupying the lower pole region, for which radical nephroureterectomy with bladder cuff excision and nodal dissection was carried out. Histopathology revealed upper tract transitional cell carcinoma.

Radiation-induced KRAS G12V mutant lung adenocarcinoma in a never smoker

Abstract The molecular profile of radiation-induced cancers remains poorly understood. This case report describes a 59-year-old male never smoker with a distant history of Hodgkin's lymphoma treated with mantle radiation who decades later develops primary lung adenocarcinoma within the prior radiation portal. Genomic profiling of the cancer demonstrated a KRAS G12V mutation. We briefly review the clinical entity of radiation-induced second malignancies and KRAS mutant lung adenocarcinoma. Although to date there is no standard molecularly targeted therapy available for KRAS mutant lung cancer, prior reports of activating EGFR mutations in a proportion of radiation-induced lung cancers suggest that a variety of genomic alterations may occur in these secondary malignancies. Given the potential to identify other molecularly defined subsets of lung cancer for which specific therapies exist, routine molecular profiling of these cases seems reasonable.

0533: Liver dysfunction in chronic heart failure: prevalence, characteristics and prognostic significance: Moroccan profile

Background Abnormal liver function tests are common in ambulatory chronic heart failure but characterization and importance of liver dysfunction are poorly defined. The aim of this study was to evaluate the incidence of liver dysfuction in ambulatory patients diagnosed with chronic heart failure in order to establish a correlation with the risk factors, evolution and prognosis. Methods 1613 consecutive ambulatory patients with chronic heart failure were enrolled from 2006 to 2013 and registered in the therapeutic unit of chronic heart failure. Clinical, echocardiographic and biological data were investigated. In only 358 HF patients, liver function was determined by aspartate and alanine aminotransferase (AST, ALT). We divided our population into three groups: group 1 with elevated ALT>45 UI/l, group 2 with elevated AST >45 UI/l and group 3 with normal liver enzymes. Results Liver dysfunction was present in 13.68%. Mean serum levels of ALT and AST were 98.44 UI/l and 88.43 UI/l respectively. Liver dysfunction was associated with male sex (p=0.019), dyslipidemia, smoker and coronary heart disease (p=0.004). Compared with a normal liver function, those with dysfunction had a higher heart rate and more cardiac right and left decompensation. Also Transaminases elevated were associated with more tricuspid regurgitation (p Conclusions Liver dysfunction is frequent in chronic heart failure. Patients with heart failure and abnormal liver function had less optimized traitment with more hospitalizations for cardiac decompensation

Calcified nodule as a cause of myocardial infarction with non-obstructive coronary artery disease

Introduction: In patients presenting with myocardial infarction (MI), angiography most often reveals obstructive coronary artery disease (cAD) but 5-20% of patients with MI have non- obstructive cAD (MINOcA) at angiography. calcified nodule has been identified as a cause of MI with obstructive cAD but to date has not been reported as a cause of MINOcA. Intravascular ultrasound (IVUs) may find an underlying cause of MINOcA but has limited sensitivity for calcified nodule. We report a case of calcified nodule in a patient with MINOcA diagnosed by optical coherence tomography (Oct). case report: the patient was a 60-year-old male former smoker with cAD risk factors who presented with one hour of mid-sternal chest pain. troponin peaked at 1.28 ng/ml. Electrocardiogram of the patient was normal. coronary angiography showed minimal luminal irregularities. the patient underwent intracoronary Oct. On Oct, thrombus was identified overlying a calcified plaque with protrusion into the right coronary artery lumen. the appearance was characteristic of calcified nodule. cardiac MrI scan showed hypokinesis in the basal inferoseptal and basal anterior walls without late gadolinium enhancement. the patient was treated with dual antiplatelet therapy (aspirin and clopidogrel) and a high intensity statin. conclusion: these combined clinical, Oct and cMr findings confirm that calcified nodule is a cause of MINOcA and underscore the utility of intracoronary imaging to determine the pathophysiology of MINOcA. Even without intracoronary imaging, plaque disruption (e.g. plaque rupture, erosion, or calcified nodule) should be considered in cases of MINOcA based on prevalence of at least 35-40% in prior studies.

Pulmonary Histiocytosis - Important to Recognize Pulmonary Hypertension as its Important Complication in Early Course of Disease

A 45 year old male smoker presented with progressive shortness of breath for last 6 months. There was no significant past medical history. Physical examination and all blood tests were normal. Chest X-ray showed non-specific interstitial infiltrates bilaterally. High resolution CT scan was consistent with reticulo-nodular and cystic changes in upper and middle lobes and ground glass appearance in posterior basal lobes of lungs. There was mix obstructive and restrictive pattern on pulmonary function tests. Surgical Lung biopsy was taken which confirmed Pulmonary Langerhans cell histiocytosis. Patient was advised to stop smoking and started on medical management. Unfortunately patient lost follow up and presented again with worsening symptoms and clinical signs of right sided heart failure. Echocardiography and right heart catheterization was performed which showed severe pulmonary hypertension. Patient was started on treatment for pulmonary hypertension which made little symptomatic improvement but his symptoms got worsen over time and is now being considered for lung transplantation. Learning points/conclusion: Pulmonary function tests may be of normal, obstructive, restrictive or mixed pattern as is the case with our patient. But reduction in Diffusing capacity of Lung for Carbon Monoxide (DLCO) is the most common and earliest abnormality. Pulmonary hypertension is a common and under recognized complication due to direct vasculopathy (arterioles but predominantly venules) and can occur at any time during course of disease as it may or may not co-relate with lung function abnormalities and severity of parenchymal involvement. Investigations for pulmonary hypertension should be done early to prevent unnecessary delay in management.

Bioequivalence of Two Different Nicotine Chewing Gum Formulations of Two Different Strengths (2 mg and 4 mg) in Indian Healthy Adult Human Male Smoker Subjects

Nicotine Mint Flavored Chewing Gums are used to aid smokers wishing to quit or reduce prior to quitting. The aim of these two studies was to determine the bioequivalence of two test and two reference formulations of Nicotine 2 mg and 4 mg Mint Flavored Chewing Gum. Both of these two studies were single dose, randomized, 2-period, 2‑sequence, laboratory-blinded, crossover design conducted in two different set of 54 healthy adult Indian male subjects each under fasting conditions with a washout period of 8 days (for 2 mg study) and 9 days (for 4 mg study). Study formulations were administered after a 10-hour overnight fast. Blood samples for pharmacokinetic profiling were taken post-dose up to 24 hours. Safety was evaluated through the assessment of adverse events, and laboratory tests. Plasma concentrations of Nicotine were determined with a validated LC-MS/MS method. Bioequivalence between the products was determined by calculating 90% confidence intervals (90% CI) for the ratio of Cmax and AUC0-t values for the test and reference products, using logarithmic transformed data. The 90% CI of Nicotine were 93.71-113.45, 89.95-112.68 and 92.90-115.98 for Cmax, AUC0-t and AUC0-∞ respectively for Nicotine 2 mg Mint Flavored Chewing Gum study. The 90% CI of Nicotine were 88.68-102.76, 91.48-109.00 and 91.14-111.66 for Cmax, AUC0-t and AUC0-∞ respectively for Nicotine 4 mg Mint Flavored Chewing Gum study. Since the 90% CI for Cmax and AUC0-t were within the 80-125% interval, it was concluded that the two test and two reference formulations of Nicotine 2 mg and 4 mg Mint Flavored Chewing Gum are bioequivalent in their rate and extent of absorption.

IgM Multiple Myeloma Presenting As Hyperviscosity Syndrome with Isolated Skin Manifestation

Background:Immunoglobulin M-producing multiple myeloma (IgM MM) accounts for less than 1% of all myeloma cases. Because the disorder is rare,its clinical characteristics and long-term prognosis remain unknown. Hyperviscosity occurs from pathologic changes of either cellular or protein fractions of the blood such as are found in MM (particularly IgA and IgG3) and other diseases.Case PresentationA 65-year-old male smoker presented to emergency room (ER) with headache, dizziness, shortness of breath, symmetrical finger pain, nose bleeds, and blood in stool. On lab work hemoglobin was 7.9 gm/dl. Review of the peripheral blood smear showed atypical lymphocytes. CT chest showed left axillary and supraclavicular lymphdenopathy. Serum protein was 13 gm/dl, Serum protein electrophoresis showed a monoclonal IgM kappa gammopathy with UIEP confirming the bence jones proteinuria. A bone marrow biopsy showed about 80% cellularity with diffuse and solid neoplastic plasma cell infiltrates that were CD138+, CD20- and CD3-. Flow cytometric analysis of the bone marrow aspirate demonstrated a small fraction of clonal plasma cell population that were CD38+, CD138+, CD45-, and CD56-, Fluorescent in Situ Hybridization confirmed neoplastic plasma cells with kappa light chain restriction, and cyclinD1-. On examination, the patient had a erythematous skin changes and edematous bilateral symmetrical finger findings.Discussion:MM with IgM gammaglobulin is a rather distinct subtype of MM displaying clinical and pathologic features of both MM and WM. The clinical presentation of WM is similar to that of MM except that organomegaly is common in WM but is uncommon in MM and lytic bone disease and renal disease are uncommon in WM but are common in MM.The criteria for diagnosis of IgM myeloma (and its differentiation from WM) requires the presence of either lytic bone lesions and/or evidence of the t(11;14) translocation. It is also characterized by negative CD20, D56 and CD117 phenotype. All the reported cases of IgM myeloma had been treated with melphalan and prednisolone with suboptimal results. Some patients were treated with VAD (vincristine, adriamycin and dexamethasone) regimen, others with CTD protocol. The results were similar to the MP regimen. Radiotherapy was mainly used as palliative measure.Conclusion:Our case suggests that IgM multiple myeloma can presents as hyperviscosity syndrome with isolated skin manifestation and may have unique clinical characteristics. DisclosuresNo relevant conflicts of interest to declare.