Positive Smoking History Research Articles

Early donor management increases the retrieval rate of hearts for transplantation in marginal donors†

Organ donations continue to fall, failing to meet the clinical requirements for heart transplantation. Furthermore, the pathophysiology of brain stem death including hormonal and inflammatory changes may lead to significant donor heart injury. Early donor management may potentially alleviate these changes and therefore increase the number of available hearts for transplantation. We aimed to investigate whether early management of borderline donors can increase the heart retrieval rate. Between September 2011 and February 2013, we performed early donor management of 26 potential heart donors in the intensive care units of the respective donor hospitals. At the time of referral donors were considered as borderline based on high-dose inotrope requirements, history of hypertension and cardiopulmonary resuscitation. Our management protocol included insertion of a pulmonary artery catheter and performance of cardiac output studies, weaning noradrenaline and commencing arginine vasopressin, and administration of tri-iodothyronine, methylprednisolone and insulin. Our primary end-point was donor heart acceptance, depending collectively on the results of cardiac output studies, cardiac contractility and coronary artery patency at the time of retrieval operation. We retrieved 14 (56%) borderline hearts after donor management (Group A) with a 30-day survival rate of 86%. Twelve (44%) organs were declined due to poor heart function (n=8; 66.7%; P<0.001) and/or palpable coronary artery disease (n=4; 33.3%; P=0.018) (Group B). The mean age of Groups A and B was 42.77 and 47.78 years, respectively (P=0.19). Most of the female donors, i.e. 10 (83%), were declined, and only 4 (27%) were accepted (P=0.005). Majority of patients in both groups (Group A: 71.4%; n=10; and Group B: 66.7%; n=8) were on high-dose noradrenaline (>0.08 μg kg(-1) min(-2)) at the time of donor offer. Group A had a mean cardiac output of 6.29 and 3.09 l/min for Group B (P=0.01). A positive smoking history was present in 28.6% (n=4) and 33.5% (n=4) in Groups A and B, respectively (P=0.793). Cardiopulmonary resuscitation was performed on 3 (21.4%) patients in Group A and 2 (16.7%) in Group B (P=0.759). A history of hypertension was present in 7.1% (n=1) of the Group A and 33.3% (n=4) of the Group B donors. In our study, we were able to retrieve more than half of the potential heart donors as a result of early active donor management without impacting on the post-transplant recipient outcome. Early active donor management may assist in increasing the number of heart transplantations, thus warranting further investigation.

Abstract MP29: Patient Characteristics And Outcomes Associated With In-hospital Onset Of Acute Decompensated Heart Failure

Introduction: There has been little focus on hospitalized acute decompensated heart failure (ADHF) that develops after admission, which may occur because of comorbid conditions, over-administration of fluid or post-surgical complications. Aims: To compare patient characteristics, case fatality, and hospital length of stay (LOS) associated with ADHF that develops after hospital admission as compared to those with ADHF at admission. Methods: Hospitalizations with possible ADHF were sampled, based on HF ICD codes, among those aged &gt; 55 years from the four communities of the Atherosclerosis Risk in Communities Study (2005-2010). Medical records were abstracted with events classified by physician panel or computer classified. Case fatality was obtained through the National Death Index. We identified 4,503 (unweighted) events with definite/probable ADHF, after excluding those with unknown time of decompensation (n=81), hospital transfers (n=102), and race other than black or white (n=118). Demographic and clinical characteristics were compared by ADHF onset (at/after admission). Logistic regression was used to evaluate the association of ADHF onset with in-hospital mortality, and 28-days and one-year mortality, adjusted for demographics and comorbidity. Linear regression was used to evaluate the association of ADHF onset with log-transformed hospital LOS, adjusted for demographics. All analyses were weighted to account for the stratified sampling design. Results: Of 21,052 (weighted) ADHF events, 7.4% (n=1561) developed ADHF after admission. Patients with ADHF occurring after admission were older (mean: 79 vs. 75 years), and more likely white and female. Those with ADHF at admission were more likely to have a positive smoking history, COPD, and to be on dialysis. Presence of diabetes, hypertension and coronary artery disease were not significantly different between groups. In hospital mortality (16.5% vs. 6.3%; OR= 2.7, 95% CI=1.9-3.8) and 28-day mortality (23.9% vs. 10.1%; OR= 2.4, 95% CI=1.7-3.4) was higher among those who developed ADHF after admission. One-year case fatality was similar (39.4% vs. 33.6%; OR= 1.2, 95% CI=0.9-1.6). Unadjusted mean LOS was longer for those with ADHF occurring after admission (12.8 days, 95% CI=11.8-13.8) than those with ADHF at admission (7.2 days, 95% CI=6.8-7.6). The adjusted and geometric mean LOS was 1.3 days (95% CI=1.2-1.4) longer for those who developed ADHF after admission. Conclusion: Although patients with ADHF onset after admission were slightly older, differences in comorbidity do not indicate an easily identifiable subgroup for closer in-hospital monitoring. Development of ADHF after admission was associated with an alarmingly high early case fatality and longer hospital LOS compared to those with ADHF at hospital admission.

CYP1A1 Ile462Val Polymorphism as a Risk Factor in Cervical Cancer Development in the Polish Population

Background and objectiveThere are inconsistent data of the cytochrome P450 1A1 (CYP1A1) Ile462Val (rs1048943) single nuclear polymorphism (SNP) as a genetic susceptibility factor for cervical cancer in various populations. Moreover, little is known about the interaction of this SNP with other risk factors, including contraceptive use, postmenopausal status, parity, and tobacco smoking.MethodsPolymerase chain reaction-restriction fragment length polymorphism was used to study the prevalence of the CYP1A1 Ile462Val SNP in women with cervical cancer (n = 456) and controls (n = 495).ResultsLogistic regression analysis adjusting for age, parity, oral contraceptive use, tobacco smoking, and menopausal status demonstrated that that the CYP1A1 Ile/Val polymorphism was not associated with an increased risk of cervical cancer in all patients. The adjusted odds ratio (OR) for patients with the Ile/Val genotype vs. Ile/Ile genotype was 1.539 (95 % confidence interval [CI] 0.932–2.541, p = 0.091). However, an increase in cervical cancer risk was seen among patients with a positive history of tobacco smoking and parity. The adjusted OR for positive history of tobacco smoking with the Ile/Val vs. Ile/Ile genotypes was 2.978 (95 % CI 1.382–6.418, p = 0.0052). The adjusted OR for parity with the Ile/Val vs. Ile/Ile genotype was 1.739 (95 % CI 1.006–3.009, p = 0.0472).ConclusionOur genetic study suggests that the CYP1A1 Ile462Val SNP may be a risk factor for cervical cancer among patients with a positive history of tobacco smoking and parity.

SERUM ANTIBODY ANALYSIS FOLLOWING HEPATITIS B VACCINATION FOR OCCUPATIONAL RISK ASSESSMENT AMONG DENTAL STUDENTS

Abstract: Background &amp; Objectives: Hepatitis B is the most important infectious occupational disease for the health care workers. Dental surgeons are frequently in contact with blood and saliva and hence are at high risk for Hepatitis B Virus (HBV) exposure. HBV infection is a major public health problem in India, as there are 45 million estimated carriers. Immunization against HBV reduces the risk of transmission of HBV to dental personnel and from dental personnel to patients. The present study was aimed to evaluate the serum levels of anti-HBs in vaccinated dental health care workers. Methods: In this study, estimation of serum levels of Anti- HBs in 40 dental students vaccinated against HBV was done. Data was obtained regarding vaccination data, age, sex, weight, height and smoking history. Anti-HBs level was evaluated two years after the 1st dose of vaccination. Low responders were given booster vaccination and post booster anti HBs assay was done. Results: The study included 110 hepatitis B vaccinated dental students. Out of 110 students only 40 students had documented history of complete vaccination and volunteered to be a part of the study. Among these 40 students, three students (7.5%) had less than 100 IU/L anti–HBs level and 37 students (92.5%) had more than 100 IU/L anti–HBs level. Anti- HBS level above 100 IU/L is identified to be protective. Following booster vaccination, low responders showed anti -HBs titre more than 100 IU/L. Conclusion: In this study majority dental students had desirable immune response to the HBV vaccine. Male gender and positive smoking history could have attributed to low anti-HBs titre in subjects who had inadequate levels in our study. Hence, all Health Care Workers, in particular dental surgeons with contributory factors like smoking habit, male gender should undergo periodic assessment of anti-HBs titre.

Male Breast Cancer and Hyperestrogenemia: A Thirteen-Year Review.

BackgroundMale breast cancer (MBC) is a very rare malignancy and accounts for 0.1% of all male cancers. MBC has not been studied as extensively as its female counterpart. Certain clinical and pathological risk factors like smoking history, age at onset, family history of cancer, obesity, ethnicity, estrogen/progesterone receptor status and BRCA gene mutation status have all been studied well in the female breast cancer (FBC) patients and the clinical trial evidence from these studies is then extrapolated to treat and manage patients with MBC. One such area of interest is high levels of estrogen and its relationship with MBC. In our retrospect research study we aim to find an association between MBC and high levels of circulating estrogen at the time of diagnosis.MethodsA 13-year retrospective review of the male breast cases at University of Florida College of Medicine’s Tumor Registry was conducted. Data regarding certain clinic-pathological risk factors and MBC were collected and reviewed. Main surrogate indicators for elevated estrogen were examined, namely, low HDL (< 40 mg/dL), low albumin (< 4 g/dL) and high BMI (> 25). Presence of any one of these surrogates was seen as an indirect marker for high estrogen level. For cancer staging, the American Joint Committee on Cancer (AJCC) staging system was used. Stages 0-2 were grouped together as they are less extensive compared to stages 3-4 (also grouped together) which represent extensive disease. Univariate analysis was conducted using STATA 13 to do Fischer’s exact test as cross-tables showed cell counts of five or less. The main comparison was that between extensive MBC (stages 3-4) and non-extensive breast cancer (stages 0-2).ResultsBetween January 2000 and November 2013, we found a total of 2,129 cases of breast cancer patients at our institute. Out of these 2,113 (99.24%) were female and 16 (0.75%) were men. Four MBC patients were excluded because their complete charts could not be found in the medical records department. Six (50%) patients had one indicator, four (33%) patients had two indicators and one (8.3%) patient had all three. Eleven (91.6%) patients had precursors suggestive of hyperestrogenemia. Only one (8.33%) patient did not have any surrogate marker indicator of high estrogen levels. Two (16%) were black and 10 (83.33%) were white. Mean age was 61.75. Five (41%) had a first degree relative with a malignancy. Laterality was nine (75%) in the left breast, three (35%) in right breast. Eight (66.6%) found a mass on physical exam. Five (41.6%) had a positive smoking history. One patient had no data in the chart. Remaining all 11 (91.6%) had non-TNBC. One patient did not have complete documentation. Five (41.6%) had mastectomy, six (50%) received RT, four (33.3%) received chemotherapy and another four received hormone therapy. In terms of stage, four (33.3%) had stage 4, two (16.6%) stage 3B, two (16.6%) stage 2B, two (16.6%) stage 2A, one (8.33%) had stage 1C and one had stage 0. HDL data were available in seven (58.3%) with mean of 37, albumin in 10 (83.3%) with mean of 3.61, BMI in 11 (91.66%) patients with a mean of 33.30. Within subgroups, two patients were black and 10 white. Both black patients had LE disease (stage 0-2). Of the white patients, four (40%) had limited disease while six (60%) had extensive breast cancer. Family history assumed a similar distribution as three (60%) of patients with negative family history for cancer had limited disease and two (40%) had extensive one, same numbers applied for family-history-positive population. Three (60%) of patients with limited disease smoker and two (40%) did not. As for laterality, a total of nine patients had left-sided breast cancer, of whom five had had limited disease and four fell into the extensive disease category. The hormonal status for most patients were HER/NEU negative (seven out of 10 patients, two patients did not have this information on file), ER positive (11 out of 12) and PR positive (8 out of 12). Estrogen status: Low HDL was seen in three out of seven patients, low albumin in four out of 10 and obese BMI in nine out of 11. Finally, 11 out of 12 patients had at least one indicator of high estrogen. No significant change in prevalence of these markers was seen when comparing patients with limited and extensive disease.ConclusionNone of the aforementioned variables assumed statistical significance between the two subgroups. Results, however, show that as a whole, 11 out of the 12 patients had at least one indicator of high estrogen. Our results point in the direction that elevated estrogen is probably associated with MBC. Further meta-analysis of similar studies can be helpful to explain the dynamics of this association. Our statistical analysis was limited due to the small sample size, which is due to the extreme rarity of the disease.

Risk Factors Predicting Mortality in Patients with Lung Abscess in a Public Tertiary Care Center in Karachi, Pakistan

Lung abscess is a commonly encountered entity in South-East Asia but not much data regarding its outcome is available. The objective of this study was to identify the factors associated with increased mortality in patients diagnosed with lung abscess in a tertiary care center of Karachi, Pakistan. A retrospective case analysis was performed via hospital records, on patients admitted with lung abscess between January 2009 and January 2011 at the largest state-owned tertiary care centre in Karachi, Pakistan. Out of the 41 patients hospitalized, 17 could not survive and were evaluated for clinical, radiological and microbiological factors to determine association with heightened mortality. Mortality due to lung abscess stood at 41.4% (17 of 41 cases). Adult male patients were found to have higher mortality with 13 out of 17 (43%) dead patients being male. A majority (21/41, 51.2%) of the cases belonged to the 41-60 year old age group. Highest mortality was seen in patients<20 years of age (3/4, 75%). Patients with blood sugar levels of >200 mg/dL (56%) succumb to disease. Patients with a positive history of smoking, diabetes mellitus, and alcohol intake expressed mortality rates of 44%, 56%, and 50% respectively; while 29.4% of the mortalities were positive for Pseudomonas aeruginosa on sputum culture. A significant association was found with elevated mortality and low haemoglobin levels at time of admission; mortality was 58% (p=0.005) in patients with Hb less than or equal to 10 mg/dL. The risk factors involved with heightened mortality included male gender and history of smoking, diabetes and alcohol intake. High blood sugar levels and detection of Pseudomonas aeruginosa on sputum cultures were also implicated. Anemia (Hb level less than or equal to 10 mg/dl) was statistically significant predictive factor for increased mortality.

Severe Cognitive Dysfunction and Occupational Extremely Low Frequency Magnetic Field Exposure among Elderly Mexican Americans

AimsThis report is the first study of the possible relationship between extremely low frequency (50–60 Hz, ELF) magnetic field (MF) exposure and severe cognitive dysfunction. Earlier studies investigated the relationships between MF occupational exposure and Alzheimer’s disease (AD) or dementia. These studies had mixed results, depending upon whether the diagnosis of AD or dementia was performed by experts and upon the methodology used to classify MF exposure.Study DesignPopulation-based case-control.Place and Duration of StudyNeurology and Preventive Medicine, Keck School of Medicine, University of Southern California, 2 years.MethodologyThe study population consisted of 3050 Mexican Americans, aged 65+, enrolled in Phase 1 of the Hispanic Established Population for the Epidemiologic Study of the Elderly (H-EPESE) study. Mini-Mental State Exam (MMSE) results, primary occupational history, and other data were collected. Severe cognitive dysfunction was defined as an MMSE score below 10. The MF exposure methodology developed and used in earlier studies was used.ResultsUnivariate odds ratios (OR) were 3.4 (P< .03; 95% CI: 1.3–8.9) for high and 1.7 (P=.27; 95% CI: 0.7–4.1) for medium or high (M/H) MF occupations. In multivariate main effects models, the results were similar. When interaction terms were allowed in the models, the interactions between M/H or high occupational MF exposure and smoking history or age group were statistically significant, depending upon whether two (65–74, 75+) or three (65–74, 75–84, 85+) age groups were considered, respectively. When the analyses were limited to subjects aged 75+, the interactions between M/H or high MF occupations and a positive smoking history were statistically significant.ConclusionThe results of this study indicate that working in an occupation with high or M/H MF exposure may increase the risk of severe cognitive dysfunction. Smoking and older age may increase the deleterious effect of MF exposure.

Ankilozan spondilitli hastaların solunum fonksiyonlarının egzersiz kapasitesi ve yaşam kalitesi ile ilişkisi

Ankylosing spondylitis causes restrictive respiratory disorder by limiting the expansion of the chest because of the costosternal and costovertebral joints. Our study is planned to evaluate the respiratory functions of the ankylosing spondylitis patients who have a high rate of pulmonary involvement, and to compare the results with the exercise capacity and life quality of these patients. There were 27 (18 male, 9 female) Norvegian patients who came to Turkey and had ankylosing spondylitis diagnose according to Modified New York criterias, to have a routine physical therapy and rehabilitation programme with an average age of 50.6 ± 6.6 years. The patients' clinical histories were taken. Pulmonary function tests were performed with spirometry and pulmonary muscle strength was measured with mouth pressure measure. 6 minute walk test was performed to determine exercise capacity and Short Form-36 Life Quality Questionairre was used to evaluate life quality of the patients. The patients had 18.85 ± 10.64 average diagnose duration and the expected FEV1 value of the patients was 3.75 ± 0.88 L/sec, FEV1/FVC ratio was 80.44 ± 6.42, MIP was 62.96 ± 20.61 and MEP was 80.22 ± 21.12. 40.7% of the patients had positive smoking history while 14.8 % had dyspnea and 11.1% had symptoms of caughing-sputum. Walking distance was 595.50 ± 83.20 metre. Life quality category scores were 42.82 ± 16.78 minimally, 83.58 ± 23.06 maximally. Pulmonary function and pulmonary muscle strength values were similar in smoking and non-smoking patients. But in smoking patients, physical function and social function categories of quality of life survey scores were found lower than non-smoking patients. Respiratory and other parameters were high related to high standarts in treatment and following and exercise habit of the patients in Norway. Accordingly, it is thought that an appropriate medical treatment and exercise as a lifestyle habits of the patients reduce the negative effects of ankylosing spondylitis on respiratory system.

Endovascular Management of Critical Limb Ischemia in Renal Transplant Patients

End-stage renal disease is a significant negative predictor of limb salvage and patient survival in patients with limb ischemia, but little is known of the overall effects of renal transplantation. Endovascular management may be less morbid than open surgery, but technical success and durability in these patients is not well established. All patients with functioning renal transplants and critical limb ischemia (CLI) treated with endovascular techniques between 2003 and 2010 were retrospectively reviewed for limb salvage, reintervention, pre- and postprocedure creatinine, and estimated glomerular filtration rate (eGFR), and overall survival. Contralateral common femoral access, low-profile techniques, and isosmolar contrast were standard for all interventions. Endovascular interventions were performed on 57 limbs in 28 patients with renal transplants. Mean age was 54 years, 78% were male, 85% were diabetic, 100% were hypertensive, and 64% had a positive smoking history. All patients were treated for CLI. Treated regions included 16 iliac, 19 superficial femoral, 16 popliteal, and 12 tibial arteries, as well as 1 bypass graft with initial technical success of 100% and 0% 30-day mortality. Of all lesions, 43% required reintervention during the follow-up period, the majority in the first year. There was no significant change in eGFR or creatinine comparing pre- and post-angiogram value. Limb salvage and 1-year survival were 83% and 82%, respectively. Endovascular management of CLI in renal transplant patients results in good technical success and can be accomplished without a measurable change in transplant kidney function, although it requires repeat interventions. Endovascular therapy is a reasonable first-line treatment option for this high-risk group.

Effects of diabetes and smoking on lumbar spinal surgery outcomes

Smoking and diabetes have long been considered risk factors for poor surgical outcome. However, the precise role of smoking and diabetes in the development of poor outcome in lumbar spinal surgery remains ambiguous. This study was undertaken to determine the effects of diabetes and smoking specifically on lumbar spinal surgery outcomes. A retrospective cohort study studied 902 patients who underwent lumbar spinal surgery at the Royal Melbourne Hospital, Australia, between 2001 and 2005, inclusively. Four groups were formed: control; diabetic; positive smoking history; and diabetic and positive smoking history. Multivariate analysis was used to analyse the likelihood of developing complications with a history of diabetes and/or smoking. Our findings indicate that diabetes was significantly associated with an increased risk of developing complications. Patients in the diabetic groups were also significantly older and had a longer length of stay than the other patients (p<0.05 for all significant findings). We conclude that diabetes does increase the risk of poor outcome following lumbar spinal surgery. However, we found no association between a positive smoking history and an increased rate of poor outcome.

Prognostic Significance of Hyoid Bone Invasion in Advanced Base of Tongue Carcinoma Treated by Chemoradiation

Objectives: Examine the prognostic influence of hyoid bone invasion in advanced base of tongue squamous cell carcinoma (BOTSCC) treated with chemoradiation. Methods: We retrospectively reviewed pre-treatment imaging (computed tomography/magnetic resonance imaging) for the presence or absence of hyoid bone invasion in patients with advanced (T3 or T4a) BOTSCC treated with chemoradiation from January 2001 to January 2011 at our tertiary academic medical center. We compared patients with hyoid bone invasion to those without based on the following metrics: 1-year, 2-year and 5-year disease-free survival (DFS), disease-specific survival, and overall survival. Results: 13 out of 40 patients had hyoid invasion present on pretreatment imaging. Average follow up was 43 months (range: 19-96 months). Patients with hyoid bone invasion were found to have lower percentages in all survival metrics measured compared to patients without, respectively, with statistical significance achieved in the following: 1-year DFS: 53.9% vs. 84.6% ( P = 0.04), 2-year DFS: 36.4% vs. 80.0% ( P = 0.01) and 5-year DFS: 22.2% vs. 62.5% ( P = 0.05). Patients with hyoid bone invasion were also found to have lower percentages in DFS compared to patients without hyoid bone invasion the following subgroups: T4a BOTSCC, N stage 2 only, and positive smoking history. A multivariate analysis did not find hyoid bone invasion as a statistically significant independent variable. Conclusions: Hyoid bone invasion by BOTSCC may indicate a poorer prognosis despite treatment. Hyoid bone invasion may be a possible indication for the intensification of radiation therapy or the addition of chemotherapy, may encourage the consideration of primary surgery, and/or may increase the degree of post-treatment surveillance monitoring and imaging.

897 IMPACT OF SMOKING STATUS ON BLADDER RECURRENCE FOLLOWING RADICAL NEPHROURETERECTOMY IN PATIENTS WITH UPPER TRACT UROTHELIAL CARCINOMA

You have accessJournal of UrologyUrothelial Cancer: Upper Tract Tumors (II)1 Apr 2013897 IMPACT OF SMOKING STATUS ON BLADDER RECURRENCE FOLLOWING RADICAL NEPHROURETERECTOMY IN PATIENTS WITH UPPER TRACT UROTHELIAL CARCINOMA Masayuki Hagiwara, Eiji Kikuchi, Nobuyuki Tanaka, Kazuhiro Matsumoto, Hiroki Ide, Akira Miyajima, Ken Nakagawa, Takeshi Masuda, So Nakamura, and Mototsugu Oya Masayuki HagiwaraMasayuki Hagiwara Tokyo, Japan More articles by this author , Eiji KikuchiEiji Kikuchi Tokyo, Japan More articles by this author , Nobuyuki TanakaNobuyuki Tanaka Tokyo, Japan More articles by this author , Kazuhiro MatsumotoKazuhiro Matsumoto Tokyo, Japan More articles by this author , Hiroki IdeHiroki Ide Tokyo, Japan More articles by this author , Akira MiyajimaAkira Miyajima Tokyo, Japan More articles by this author , Ken NakagawaKen Nakagawa Tokyo, Japan More articles by this author , Takeshi MasudaTakeshi Masuda Saitama, Japan More articles by this author , So NakamuraSo Nakamura Tokyo, Japan More articles by this author , and Mototsugu OyaMototsugu Oya Tokyo, Japan More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.470AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Although smoking status has a significant impact on outcome in patients with bladder cancer, its role in the outcome of upper tract urothelial cancer (UTUC) has not yet been fully evaluated. The aims of the present study were to identify independent risk factors of subsequent bladder recurrence in a large series of patients with UTUC and to investigate the possible influence of smoking status on subsequent bladder recurrence after surgery. METHODS We identified a study population of 313 consecutive patients treated with nephroureterectomy for UTUC at our 3 institutions between 1994 and 2010.ü@The associations between the subsequent bladder recurrence and the clinicopathological parameters, including smoking status, were analyzed. RESULTS There were 97 (31.0%) current smokers, 63 (20.1%) ex-smokers, and 153 (48.9%) non-smokers. While we combined ex-smokers and current smokers and classified them as having a positive history of smoking, this group had a significantly higher incidence of high grade tumors compared with non-smokers (P=0.018). During follow-up, bladder recurrence developed in 156 patients (49.8%); 63 current smokers, 34 ex-smokers, 59 non-smokers.ü@The 3-year bladder recurrence-free survival (BRFS) rates were 32.5% in the positive smoking group and 59.9% in non-smokers (P<0.001). Multivariate analysis showed that male gender (P=0.010, HR=1.83) and a positive smoking history (P=0.028, HR=1.50) were independent risk factors for subsequent bladder recurrence. In a subgroup of patients with a positive history of smoking, the 3-year BRFS rate in patient with ≥50 pack-years (14.0%) and those who smoked ≥40 cigarettes per day (6.4%) were significantly lower compared to their counterparts (35.6% and 33.3%, respectively). Multivariate analysis revealed that the number of pack-years ≥50 (P=0.019, HR=1.63) and number of cigarettes per day ≥40 (P=0.011, HR=1.82) were independent risk factors for bladder recurrence in patients with a positive smoking history. CONCLUSIONS A history of smoking and male gender were independent risk factors for subsequent bladder recurrence following nephroureterectomy, and UTUC patients who smoked a large number of cigarettes or long history of smoking had a higher incidence of bladder recurrence. More attention should be paid to the association between smoking status and a worse oncological outcome, such as bladder recurrence, in UTUC patients. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e370-e371 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Masayuki Hagiwara Tokyo, Japan More articles by this author Eiji Kikuchi Tokyo, Japan More articles by this author Nobuyuki Tanaka Tokyo, Japan More articles by this author Kazuhiro Matsumoto Tokyo, Japan More articles by this author Hiroki Ide Tokyo, Japan More articles by this author Akira Miyajima Tokyo, Japan More articles by this author Ken Nakagawa Tokyo, Japan More articles by this author Takeshi Masuda Saitama, Japan More articles by this author So Nakamura Tokyo, Japan More articles by this author Mototsugu Oya Tokyo, Japan More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Abstract P388: Association of Clinical Characteristics and Cardiopulmonary Risk Factors with Aortic and Pulmonary Arterial Enlargement by Magnetic Resonance

Purpose: To determine the association of clinical characteristics and cardiopulmonary risk factors with aortic and main pulmonary artery (MPA) enlargement by cardiovascular magnetic resonance (CMR). Methods: 1794 Framingham Offspring cohort members (65±9 y, 844 M) underwent axial 2D black-blood T2-weighted thoracoabdominal CMR. MPA and ascending (ASC) and descending (DSC) thoracic aortic diameters were measured at MPA-bifurcation level, abdominal (ABD) aortic diameter at 5 mm above renal artery origins. We assessed relationship of arterial diameters to height (HT) and body surface area (BSA) using Pearson correlation and determined sex-specific 90th percentile cutpoints (p90) for ASC, DSC, ABD, and MPA in a referent group free of obesity (BMI≥30), emphysema, myocardial infarction, heart failure, and any history of hypertension (HTN) or smoking. For the overall study sample, multivariable logistic regression was used to determine the association of high (≥p90) vessel diameters with the above risk factors and age, sex and pack-years smoked. Results: 370 Offspring (157 M) met referent-group criteria. In men neither HT nor BSA correlated with aortic diameter. In women DSC, ABD and MPA correlated with HT and BSA (r=0.14 - 0.25, all p≤0.045), but BSA-indexation gave inverse correlations with HT and BSA (all p&lt;0.0001); HT-indexation gave inverse correlations with HT (all p≤0.045). Thus we used unindexed p90 cutpoints of (M,W): ASC=34.9, 31.8mm; DTA=25.3, 22.7mm; ABD=20.0, 17.3mm; MPA=26.6, 24.2mm. Prevalence of and MV-adjusted odds ratios for high diameter are in the Table (N=1794). Obesity was globally and most strongly associated with overall vessel enlargement. ABD enlargement was associated with total pack-years, but not with positive smoking history. Conclusions: ABD enlargement was slightly more prevalent in women. In both sexes MPA and general aortic enlargement are associated with greater age and obesity, but smoking (as pack years) was associated with ABD enlargement only and HTN with the thoracic aorta only.

English

The epidemiologic evidence linking COPD and cardiovascular morbidity and mortality is strong. Even after adjustments for traditional cardiovascular risk factors such as serum total cholesterol Hypertension, obesity and smoking, patients with COPD have a two- to threefold increase in the Risk of cardiovascular events including death. We concluded that more severe the stage of COPD more is the risk of cardiovascular morbidity & mortality. Stable COPD patients are 1.5 (males) & 1.4 (females) times at risk to develop cardiovascular disease as compared to the general population. Among the established risk factors studied: - Age> 60 yrs, Positive Smoking History, Left Ventricular Hypertrophy, and Body Mass Index > 30 Kg/M2 are found in a statistical significant correlation with progressively worsening stages of COPD.A positive but statistically insignificant correlation was demonstrable between the family history of cardiovascular disease in first degree relatives of Stable COPD patients, and increasing cardiovascular morbidity & mortality. In stable COPD patients, Systemic hypertension with resultant Left ventricular Hypertrophy predisposes the patient to an increased risk of Myocardial infarction & correspondingly increased CVS morbidity & mortality. Progressively decreasing FEV1, decreasing FVC, decreasing FEV1/FVC ratio, have a statistically significant correlation to cardiovascular mortality & morbidity. Se CRP levels provide an accurate indicator for assessment of severity of cardiovascular morbidity & mortality in Stable COPD patients. Significant correlations were demonstrated between the treatment that patient requires for stability & cardiovascular disease. Patients on Home Oxygen therapy, oral steroids & bronchodilators despite being Stable COPD should be under closer surveillance for cardiovascular complications. Cardiovascular disease is an important but underrated cause of COPD morbidity & mortality .Hence should be addressed to improve overall disease outcome.

Impact of Smoking Status on Bladder Tumor Recurrence After Radical Nephroureterectomy for Upper Tract Urothelial Carcinoma

Although smoking status has a significant association with clinical features in patients with bladder cancer, there are few reports of the impact of smoking on the clinical outcome of upper tract urothelial cancer. We investigated the possible influence of smoking status on bladder tumor recurrence after radical nephroureterectomy. We identified a study population of 245 consecutive patients treated surgically for upper tract urothelial cancer at our 3 institutions between 1994 and 2010. We analyzed associations between subsequent bladder tumor recurrence and patient clinicopathological parameters, including smoking status. The 3-year bladder tumor recurrence-free survival rate was 32.6% in current smokers, 37.6% in former smokers and 61.7% in nonsmokers. Multivariate analysis revealed that male gender (HR 1.90, 95% CI 1.15-3.16, p = 0.013) and smoking status (former vs none HR 1.77, 95% CI 1.07-2.93, p = 0.027 and current vs none HR 1.58, 95% CI 1.03-2.42, p = 0.035) were independent risk factors for subsequent bladder tumor recurrence. Also, of patients with a positive smoking history those with 50 pack-years or greater showed a significantly higher incidence of bladder tumor recurrence after radical nephroureterectomy (HR 2.00, p = 0.003). Positive smoking history and male gender were independent risk factors for bladder tumor recurrence after radical nephroureterectomy. A larger number of cigarettes smoked may increase the incidence of bladder tumor recurrence in patients with upper tract urothelial cancer.

Can we predict sputum eosinophilia from clinical assessment in patients referred to an adult asthma clinic?

There is overwhelming evidence that asthma guidelines aimed at reducing airway inflammation are superior to those based on clinical symptoms alone. This involves targeting eosinophilic inflammation with inhaled corticosteroids. Because induced sputum is not readily available, our study set out to investigate whether the collective or singular use of routine asthma investigations can predict sputum eosinophilia. Eighty patients underwent skin prick testing, blood tests (IgE, full blood count), spirometry, exhaled fraction nitric oxide (FeNO), PD15 to hypertonic saline, and induced sputum testing at first assessment. A predictive model for sputum eosinophilia (defined as ≥3% eosinophils) was sought using routinely available tests. Fifty-four subjects underwent both induced sputum and FeNO testing. Seventeen (30%) revealed eosinophilic inflammation, nine (16%) neutrophilic, four (7%) mixed granulocytic and 26 (46%) paucigranulocytic. Positive predictors for sputum eosinophilia included low forced expiratory volume in 1 s (FEV(1))% predicted, raised serum eosinophil, positive smoking history, Polynesian ethnicity and negative asthma family history. There was a non-statistically significant trend for FeNO predicting sputum eosinophilia. The best combination of predictors was low FEV(1)% predicted, raised serum eosinophil, positive smoking history and negative family history of asthma. This study demonstrates that the serum eosinophil count and FEV(1) combined with aspects of a clinical history may provide a simple and practical alternative to assessment of airway (sputum) eosinophilia in the clinical setting. A full blood count can be performed at a substantially lesser cost and with greater accessibility than induced sputum. We feel the time has come for the clinical utility of the serum eosinophil count to be revisited.

Macrovascular Disease in the Elderly with Type 1 Diabetes

Macrovascular disease (MVD) is a major complication of type 1 diabetes mellitus. However, accurate data on the prevalence and impact of macrovascular disease in the elderly with type 1 diabetes is lacking. This is despite life expectancy increasing in this population. Using data from over 400 general practices in the UK, the prevalence of macrovascular disease and factors associated with it were identified in elderly (over 65years) patients with type 1 diabetes for the year 2008.In this population, there was high prevalence of macrovascular disease(39.5%). Patients with macrovascular disease were significantly older, had a longer duration of diabetes, a positive history of smoking and higher HbA1cvalues. Our analysis demonstrates a high burden of macrovascular disease in elderly patients with type 1 diabetes. We need to explore how best to address this disease in this population.

TNBC vs. Non-TNBC: A Five-Year Retrospective Review of Differences in Mean Age, Family History, Smoking History and Stage at Diagnosis at an Inner City University Program.

BackgroundIn recent years, breast cancer has been classified on the basis of estrogen or progesterone receptor (ER/PR) status and whether the human epidermal growth factor 2 receptor (HER2/neu) protein is overexpressed. Based on this system, breast cancer is broadly divided into the triple negative breast cancer (TNBC) and the non-TNBC subtypes. TNBC is a subtype of breast cancer, notable for its propensity to metastasize early and display a comparatively more aggressive course than its non-TNBC counterpart. Certain clinico-pathologic and demographic risk factors have been associated with breast cancer. In this study, we aim to compare mean age, ethnicity, family history, tobacco use and stage at presentation between TNBC and non-TNBC subtypes at our inner city university program.MethodsWe reviewed data in our tumor registry between January 2000 and December 2005 with particular attention to mean age, race, family history, tobacco use and stage at presentation. We found a total of 445 patients with various subtypes of breast cancers. We included only those patients in whom the status of both ER/PR and the status of Her2/neu protein overexpression were recorded. Our strict selection criteria lead to an exclusion of about 103 patients. Out of the remaining 342 patients, 39 were TNBC and 303 were non-TNBC.ResultsMean age of onset for TNBC vs. non-TNBC patients was 59.87 ± 15.67 years vs. 60.09 ± 13.98 years respectively (P = 0.9272). In terms of ethnicity, TNBC vs. non-TNBC patients had the following racial backgrounds: black, 58.97% vs. 39.27%; white, 35.90% vs. 57.76%; Chinese, 2.56% vs. 0.99%; others, 2.57% vs. 1.98% respectively (P = 0.004, OR = 2.755). Comparisons with respect to a history of tobacco abuse for TNBC vs. non-TNBC patients revealed a positive smoking history in 20.51% vs. 27.72% whereas there was no former or current smoking history in 71.79% vs. 61.72% respectively (P = 0.4385). Comparison of family history of a breast cancer in TNBC vs. non-TNBC patients showed that positive family history of breast cancer was seen in 30.77% vs. 33.33%, no family history of cancer was seen in 51.28% vs. 51.82% and unknown 17.95% vs. 14.85% (P = 0.8384). Pathologic stage at the time of diagnosis for TNBC vs. non-TNBC patients was as follows: stage 0, 15.79% vs. 11.37% (P = 0.4332); stage 1, 34.21% vs. 30.98% (P = 0.6890); stage 2, 28.98% vs. 37.25% (P = 0.3205); stage 3, 18.42% vs. 17.25% (P = 0.0.8591); and stage 4, 3.63% vs. 3.14% (P = 0.8651). Analysis using Chi-square test revealed χ2 value of 0.855.ConclusionOur results add to the growing body of evidence pertaining to the association of certain demographic and clinico-pathologic characteristics in women with breast cancer. We found that in our patient population, there is a significant ethnic predisposition for the two types of breast cancers that we studied. African Americans were more likely to have TNBC compared to the higher frequency of non-TNBC in white females. We did not find a significant difference in mean age, cigarette smoking, family history and stage at diagnosis between the TNBC and non-TNBC breast cancer patients. These findings are all consistent with the previously published research studies.

Donor smoking reduces recipient survival after lung transplant

This study investigated whether lung transplantation from donors with a positive smoking history was associated with increased morbidity and mortality in recipients. Data were analysed from 2181 lung transplant waiting-list...

Tuberculosis of the Breast: A Case Report

INTRODUCTION: Tuberculosis of the breast is a rare condition, with an incidence ranging from 0. 1% to 0.52% even in countries where the case rate of tuberculosis is high1. It affects virtually only women, particularly those aged 20 to 50 years, and occurs more commonly in blacks than in whites. Similar to the skeletal muscle and spleen, breast tissue seems to be resistant to Mycobacterium tuberculosis, which may justify the low incidence of disease in these sites2. Microbiologic and histopathologic tests are the gold standard for diagnosis of breast tuberculosis, by identifying acid-fast bacilli (AFB) and granuloma with caseation necrosis and histiocytic inflammatory infiltration, respectively4. We report a case of breast tuberculosis in a female patient. CASE REPORT: A 76-year old female patient sought the breast disorder service due to the appearance of a red patch and increased volume of the left breast for two months. She had no fever and reported drainage of purulent secretion with fistulous orifices. On physical examination, the patient presented with a bloodstained area measuring 6x6cm at the junction of the upper quadrants of the left breast, with fistulizing and necrotic areas surrounding the main lesion. The patient was gravida 0, para 0 and had a positive history of smoking, hypertension and Alzheimer’s disease. History of alcoholism and diabetes was negative. Chest tomography was normal and PPD test was negative. Histopathologic analysis of the lesion showed a chronic granulomatous inflammatory process, with foci of necrosis, although not caseous necrosis. Cephalexin, ciprofloxacin and anti-inflammatory drugs had been administered to the patient but treatment was unsuccessful. The option was a therapeutic test for tuberculosis, since clinical presentation of the lesion was suggestive of tuberculosis. Antituberculous therapy was begun with ethambutol, 275mg/d; rifampin, 150mg/d; and isoniazid, 75mg/d, 3 pills daily. There was a good clinical response with resolution of the breast lesion and complete wound healing. At one-year follow-up, the patient remains well and has no further lesions or complaints. DISCUSSION: Despite being a rare infection, tuberculosis of the breast should always be considered in patients presenting with a palpable breast lump or fistulizing inflammatory process, who test negative for malignancy. Histopathologic evaluation is essential for diagnostic confirmation. Furthermore, in the absence of a histologic diagnosis, a therapeutic test may be necessary, as occurred in the present case.