Current smokers develop more posterior myocardial infarctions probably due to increased tendency to thrombosis

This investigation was carried out to determine whether smokers developed smaller infarcts as assessed by peak enzyme levels and also to what extent smoking could modify infarct localization. The study included 753 patients, of whom 351 had no history of previous coronary heart disease (CHD) (angina pectoris and/or myocardial infarction (MI)). The investigation was designed as an exposed (smoking) versus non-exposed (non-smoking) cohort study. Outcome was infarct size, posterior versus non-posterior MI and non-Q-wave versus Q-wave infarcts. In the total cohort of patients, 312 (41%) were smokers, the corresponding number in the restricted cohort of patients without a previous CHD (CHD-0-pts) was 169 (48%). Smokers were younger than non-smokers, and more of them were males. It was found that infarct size was similar in smokers and in non-smokers (crude and adjusted effects). Crude effects showed that smokers developed significantly more posterior infarcts than non-smokers; odds ratio (OR) for developing a posterior MI was 1.95 (2p < 0.001) (all patients) and 2.34 (2P < 0.001) (CHD-0-pts), respectively. After adjusting for confounders (logistic regression model), OR in the two groups was 1.24 (2p = 0.256) and 1.95 (2p = 0.01), respectively. The study shows that current smokers were younger, and indicates that in those without a previous CHD, significantly more of them developed a posterior MI.     

STRESS AND AROUSAL CIRCADIAN RHYTHMS IN SMOKERS AND NON-SMOKERS WORKING DAY AND NIGHT SHIFTS

Twenty smokers and twenty non-smokers completed a brief Mood State Questionnaire every 2 hours, over one day shift and one night shift. The subjects comprised male police officers and factory workers, aged 23–57 years. Cigarette smokers reported significantly higher stress levels than non-smokers on both day and night shifts (p<0.05). This confirms previous findings that smokers are often more stressed than non-smokers. Stress levels varied over time within each shift (p<0.001), but the circadian patterns did not differ between smokers and non-smokers. Thus smoking did not alter circadian mood rhythms, nor did it facilitate stress control. Self-rated levels of arousal showed the archetypal inverted-U pattern over time in both smokers and non-smokers. There was no difference in mean arousal levels between subgroups, indicating that cigarettes did not lead to greater alertness. The shift×time interaction was significant for both stress (p<0.001) and arousal (p<0.003), indicating different circadian rhythms during the day shift and the night shift. Finally, while smokers consumed slightly more cigarettes during the night shift than day shift (22.3, 19.4 respectively, p<0.05), mean stress and arousal levels did not differ between shifts. The implications of these findings for smoking behaviour are discussed. © 1997 by John Wiley & Sons, Ltd.     

Correlation between epicardial fat and cigarette smoking: CT imaging in patients with metabolic syndrome

Background. The aim of our study was to assess the relationship between cigarette smoking and epicardial fat in a cohort of patients with metabolic syndrome (MetS) at risk for coronary artery disease. Methods. We studied, in primary prevention, 54 subjects diagnosed with MetS. According to their smoking habits, the subjects were divided into two groups: smokers and non-smokers. Besides anthropometric characterization and screening laboratory tests, the subjects had a multidetector computerized tomography scan, which allowed epicardial fat quantification and calcium score (CS) evaluation. Results. Compared with non-smokers, smokers showed older age (61.6 ± 1.8 vs 56.8 ± 1.2 yrs; p < 0.05). Also, the smokers displayed increased epicardial fat volume (138 [123; 150] vs 101[79; 130] ml; p < 0.01) as well as higher CS (94 [3; 301.5] vs 0 [0;10.2]; p < 0.001), in comparison with non-smokers. Notably, CS was positively correlated with smoking habit (r_s 0.469; p < 0.01), epicardial fat (r_s 0.377; p < 0.01), age (r_s 0.502; p < 0.001) and uric acid (r_s 0.498; p < 0.01). Accordingly, the associations between both CS or epicardial fat and cigarette smoking were still maintained after adjustment for age (r 0.317; p < 0.05; r 0.427; p < 0.01). Finally, multiple regression analysis showed that smoke was the variable that best predicted CS (R² 0.131; β 0.362; p < 0.05) and epicardial fat (R² 0.177; β 0.453; p = 0.01). Conclusions. Our findings suggest that, in subjects with MetS, cigarette smoking is an independent predictor of increased epicardial fat volume and higher CS.     

The effect of smoking cessation on quality of life after lung cancer surgery

Objective: This study aimed to evaluate the effect of smoking status on quality of life (QoL) after non-small-cell lung cancer surgery with the European Organisation for Research and Treatment of Cancer (EORTC) QoL Questionnaire-C30 and LC13. Methods: QoL was prospectively recorded in 70 consecutive patients undergoing lobectomy or pneumonectomy. Questionnaires were administered preoperatively and 1, 3, 6 and 12 months postoperatively (MPO). Results: Of all patients analysed, nine (13%) were non-smokers, 20 (29%) former smokers, six (8%) recent quitters and 35 (50%) current smokers. All four groups had comparable patients’ characteristics and preoperative QoL scores, with exception of non-smokers who had significantly lower physical functioning, role functioning, cognitive functioning and a higher thoracic pain burden. In non-smokers, all QoL scores returned to baseline 3 months after surgery. Former smokers complained of a significant 3-month decrease in physical functioning (3 MPO, p = 0.01) and a 12-month decrease in role functioning (12 MPO, p = 0.01). Former smokers complained of a significant increase in dyspnoea (6 MPO, p = 0.001) during the first 6 months after surgery. Recent quitters had a longer impairment in physical functioning (6 MPO, p = 0.01) and a 3-month burden of dyspnoea (3 MPO, p = 0.02). In current smokers, no return to baseline in physical (12 MPO, p = 0.01), role (12 MPO, p = 0.01) and social functioning (12 MPO, p = 0.02) and a persistent increase in dyspnoea (12 MPO, p = 0.04) were reported. Current smokers also complained of increased thoracic pain (12 MPO, p = 0.02). Except non-smokers, all patients complained of fatigue the first 3 months after surgery. Conclusions: Smoking cessation is beneficial at any time point to lung cancer surgery and current smoking at the time of surgery is associated with a poor postoperative QoL.     

Smoking is associated with worse outcomes in patients with prostate cancer treated by radical radiotherapy

OBJECTIVE: To investigate the effect of smoking on the outcome in a cohort of men treated for localized prostate cancer at one institution with a uniform protocol of radical external beam radiotherapy (EBRT). PATIENTS AND METHODS: The study was a retrospective review of 434 patients with cT1-T4 N0m0 prostate cancer treated with curative intent with EBRT (66 Gy in 33 fractions) between 1990 and 1999. Univariate and multivariate Cox regression analyses were used to estimate the risk associated with smoking on biochemical failure (American Society for Therapeutic Radiology and Oncology definition), local failure, distant failure, overall and disease-specific survival. RESULTS: The median follow-up was 70.3 months. A smoking history was obtained in 96% of cases; 16.8% were current smokers, 54.4% previous smokers and 28.8% non-smokers. Current smokers presented at a younger median age, by 3.6 years (P = 0.06). There were no differences in clinical T stage, Gleason score or prostate-specific antigen level amongst the three patient groups. Smoking conferred a higher risk of developing metastatic disease in both current smokers (hazard ratio 5.24; 95% confidence interval 1.75-15.72) and previous smokers (2.90, 1.09-7.67). There were also increases in risk, although not quite significant, for biochemical failure (1.49, 0.88-2.40) and overall survival (1.72, 0.94-3.15). CONCLUSIONS: After curative treatment with EBRT, a history of smoking was associated with a greater risk of developing metastatic disease. Smoking status was not associated with worse disease on presentation.     

The effect of smoking on survival in lung carcinoma patients with brain metastasis: a systematic review and meta-analysis

The effects of smoking on survival in BM patients have yet to be reviewed and meta-analysed. However, previous studies have shown that smokers had a greater risk of dying from lung cancer compared to non-smokers. This meta-analysis, therefore, aimed to analyse the effects of cigarette smoking on overall survival (OS) and progression-free survival (PFS) in lung cancer BM patients. PubMed, Embase, Web of Science, Cochrane and Google Scholar were searched for comparative studies regarding the effects of smoking on incidence and survival in brain metastases patients up to December 2020. Three independent reviewers extracted overall survival (OS) and progression-free survival data (PFS). Random-effects models were used to pool multivariate-adjusted hazard ratios (HR). Out of 1890 studies, fifteen studies with a total of 2915 patients met our inclusion criteria. Amongst lung carcinoma BM patients, those who were smokers (ever or yes) had a worse overall survival (HR: 1.34, 95% CI 1.13, 1.60, I2: 72.1%, p-heterogeneity?<?0.001) than those who were non-smokers (never or no). A subgroup analysis showed the association to remain significant in the ever/never subgroup (HR: 1.34, 95% CI 1.11, 1.63) but not in the yes/no smoking subgroup (HR: 1.30, 95% CI 0.44, 3.88). This difference between the two subgroups was not statistically significant (p?=?0.91). Amongst lung carcinoma BM patients, smoking was associated with a worse OS and PFS. Future studies examining BMs should report survival data stratified by uniform smoking status definitions.

     

Association of Chronic Obstructive Pulmonary Disease and Smoking Status With Bone Density and Vertebral Fractures in Male Lung Cancer Screening Participants

We studied the vertebral fracture prevalence on low‐dose chest computed tomography (CT) in male lung cancer screening participants and the association of fractures and bone density with chronic obstructive pulmonary disease (COPD) and smoking. 1140 male current and former smokers with ≥16.5 packyears from the NELSON lung cancer screening trial were included. Age, body mass index, and smoking status were registered. CT scans and pulmonary function tests were obtained on the same day. On CT, vertebral fractures and bone density were measured. The cohort had a mean age of 62.5 years (standard deviation 5.2) old; 531 (46.6%) had quit smoking; and 437 (38.3%) had COPD. Of the group, 100 (8.8%) participants had a vertebral fracture. Fracture prevalence was higher in current compared to former smokers (11.3% versus 5.8%, p = 0.001), but similar in participants with COPD compared to those without (9.6% versus 8.3%, p = 0.430). The multivariable adjusted odds ratio for fracture presence was 1.79 (95% CI: 1.13–2.84) in current smokers and 1.08 (95% CI: 0.69–1.67) in COPD participants. Bone density was lower in current compared to former smokers (103.2HU versus 108.7HU, p = 0.006) and in participants with COPD compared to those without [100.7 Hounsfield Units (HU) versus 108.9HU, p < 0.001]. In multivariate analysis, smoking status and COPD status were independently associated with bone density, corrected for age and body mass index. In conclusion, our study shows that lung cancer screening participants have a substantial vertebral fracture burden. Fractures are more common in current smokers, who also have lower bone density. We could not confirm that COPD is independently associated with vertebral fractures. © 2014 American Society for Bone and Mineral Research.     

Increased nitric oxide metabolites in exhaled breath condensate after exposure to tobacco smoke

BACKGROUND: Cigarette smoking reduces the level of exhaled nitric oxide (NO) in healthy subjects, although the mechanism is unclear. NO is a highly reactive molecule which can be oxidised or complexed with other biomolecules, depending on the microenvironment. The stable oxidation end products of NO metabolism are nitrite and nitrate. This study investigated the effect of smoking on NO metabolites in exhaled breath condensate. METHODS: Fifteen healthy current smokers were recruited together with 14 healthy non-smokers. Measurement of exhaled NO, lung function, and collection of exhaled breath condensate were performed. Nitrite, nitrite + nitrate, S-nitrosothiols, and nitrotyrosine levels were measured. The effect of inhaling two cigarettes in smokers was also evaluated. The mean level of exhaled NO in smokers was significantly lower than in non-smokers (4.3 (0.3) ppb v 5.5 (0.5) ppb, p<0.05). RESULTS: There was no difference in the levels of nitrite, nitrite + nitrate, S-nitrosothiols, and nitrotyrosine in the exhaled breath condensate at the baseline visit between smokers and non-smokers. After smoking, nitrite + nitrate levels were significantly but transiently increased (from 20.2 (2.8) microM to 29.8 (3.4) microM, p<0.05). There was no significant change in the levels of exhaled NO, nitrite, S-nitrosothiols, or nitrotyrosine 30 and 90 minutes after smoking. CONCLUSIONS: These findings suggest that acute smoking can increase the level of nitrate, but not nitrite, S-nitrosothiols, or nitrotyrosine in breath condensate. The deleterious effect of oxidant radicals induced by smoking may contribute to the epithelial damage of airways seen in smokers.     

Job stress and health profiles of smokers,ex-smokers and non-smokers

This article provides an empirical perspective on the relationship between work stress and job satisfaction for physical well-being in a senior police population when physical factors such as smoking are considered. The subjects were 533 superintending police officers, predominantly male ( > 97 per cent), from Great Britain. Forty-two per cent of senior police officers were non-smokers (N = 220) and an almost equal proportion, 40 per cent (N = 209), were ex-smokers, the remaining 18 per cent (N = 93) being regular smokers (12 per cent smoking in excess of 10 cigarettes per day). The Occupational Stress Indicator was used as the measure of overall stress levels and its components. Mean scores of smokers, ex-smokers and non-smokers on the OSI were compared using univariate F-tests and discriminant function analysis. Smokers per se were inclined to exhibit higher job stress scores than either ex-smokers or non-smokers and report the worst physical health scores. The non-smokers yielded the greatest level of work satisfaction and psychological well-being in contrast to the ex-smokers, who were most distressed psychologically and least satisfied with their work. Group profiles were not statistically different from each other with the exception of the physical health and one ‘coping’ subscale. Job-related pressure was predictive of lack of job satisfaction (F)1,432) = 40.09, p < 0.001) and both physical and mental ill-health F(4,461) = 41.05, p < 0.001 and F(4,454) = 69.76, p < 0.001 respectively) across the groups of non-smokers, ex-smokers and the three smoking groups. There was no evidence of a direct relationship between smoking behaviour and job satisfaction, physical and mental health. A comparison showed the average number of days off from work to be lowest for non-smokers (M 2.37, SD 8.25) followed by ex-smokers (M 3.4, SD 15.91) and then smokers (M 4.94, SD 17.33). The variance of these groups increased but the mean differences did not reach statistical significance (F(2,519) = 1.24, p > 0.05). The results of this study argue for tentative links between stress, smoking, absenteeism and other health factors in this senior police occupational sample. They also lend support for the utility of a generalized measure of stress components in medical and occupational settings.     

Relationships Between Intestinal Calcium Absorption,Serum Vitamin D Metabolites and Smoking in Postmenopausal Women

Smoking has been associated with low bone density, fractures and poor intestinal calcium absorption. Calcium absorption is a critical factor in calcium balance in postmenopausal women but the mechanisms causing decreased absorption efficiency in postmenopausal smokers are controversial and poorly defined. We performed a cross-sectional study of 405 postmenopausal women attending a clinic for the management of osteoporosis to compare intestinal calcium absorption efficiency, serum vitamin D metabolites and parathyroid hormone levels in postmenopausal women who had never smoked, who were smokers previously or who were current smokers, to examine the relationships between these variables in smokers. Two hundred and fifty-two of the women had never smoked, 79 had smoked previously and 74 were current smokers. The hourly fractional rate of calcium absorption was similar in non-smokers and those who had previously smoked. Radiocalcium absorption was less in the 74 smokers compared with the 331 non-smokers [0.60 (0.29 SD) vs 0.71 (0.27); p= 0.004], as were serum calcitriol (p<0.001) and parathyroid hormone (PTH) (p<0.01). There was no difference in the relationship between calcium absorption and serum calcitriol between smokers (r= 0.38) and non-smokers (r= 0.28); hence the impaired calcium absorption in the smokers was almost entirely attributable to suppression of the PTH–calcitriol endocrine axis. In postmenopausal women smoking is associated with a reduction in calcium absorption efficiency due to suppression of the PTH–calcitriol axis. This impairment of calcium absorption could lead to accelerated bone loss and limit the usefulness of dietary calcium supplementation. Received: 21 May 2001 / Accepted: 4 September 2001     

Identification of current smokers among renal transplant recipients.

BACKGROUND: In renal transplant recipients, smoking is associated with a high burden of cardiovascular disease and a higher risk of graft loss. Surprisingly, the results of measurement of cotinine serum level, the gold standard for the detection of active smoking, have not been confronted with self-reported smoking history in this group. The aim of our study was to identify and characterize the smoking group of renal transplant recipients. METHODS: Cotinine serum level was measured and all patients were asked to fill out an anonymous questionnaire on smoking history. RESULTS: Out of 233 renal transplant recipients, 106 (45%) reported to be lifetime and current non-smokers: cotinine serum level was below detection limit in all; among the 127 renal transplant recipients (55%) with a lifetime history of smoking, cotinine level was diagnostic of current smoking in 32 (25%). Only 21 of the current smokers (66%) declared to the nephrologist that they had continued smoking whereas 11 (34%) claimed to be non-smokers. Current smokers were younger (P=0.01) than former smokers. CONCLUSION: The identification of current smokers among renal transplant recipients should start with questioning about lifetime history of smoking and if positive, measurement of cotinine serum level. Indeed up to 34% of current smokers do not acknowledge they are active smokers and would otherwise not offer to participate in programmes to stop smoking.     

Relationships Between Risk Factors and Fractures Differ by Type of Fracture: A Population-Based Study of 12192 Perimenopausal Women

Relationship between selected factors and fractures according to type of fracture were retrospectively examined in 12192 women aged 47–56 years responding to the baseline postal enquiry of the Kuopio Osteoporosis Study, Finland, in 1989. A total of 1358 women reported fractures sustained during the previous 9.4 years, i.e. at ages 38–57 years. The incidence of fractures per 1000 person-years was 17.2 after menopause and 9.5 before (p < 0.0001). The adjusted fracture risk was elevated in smokers versus non-smokers (OR: 1.5; (95%CI = 1.3–1.9) and in those with chronic health disorders versus the healthy (OR = 1.3; 95% CI 1.1–1.5). Long-term work disability was associated with fractures independently of health disorders (OR = 1.3; 95% CI 1.1–1.6). Anthropometric measures were not associated with the overall fracture risk. Menopause was strongly and linearly related to wrist fracture but not to ankle fracture. A 1 SD increase in body mass index decreased the risk of wrist fracture by 21% (p = 0.0001) but increased that of ankle fracture by 24% (p = 0.002). Smoking was related to ankle fracture (OR = 2.2; 95% CI 1.6–3.2) but not to wrist fracture (OR = 0.9; 95% CI 0.6–1.4). Health disorders were more markedly associated with fractures other than those of the wrist or ankle. Relationships between several risk factors and pre- and perimenopausal fractures vary by type of fracture. This may affect, for example, the comparability of studies with varying fracture profiles.     

The Association of Warthin Tumor with Salivary Ductal Inclusions in Intra and Periparotid Lymph Nodes

A predominant theory of the much debated histogenesis of Warthin tumor (WT) is that it arises from heterotopic salivary ductal inclusions (SDI) in parotid lymph nodes (LN). If this were the case, we might expect to see an increased number of SDI in the lymph nodes of patients with WT compared to controls. To test this, we compared the prevalence of SDI in patients with WT versus those with pleomorphic adenoma (PA). Cases of WT and PA were retrieved from the case files of the Department of Pathology at the QEII Health Science Centre, Halifax, NS, Canada. We then compared the prevalence of SDI in parotid LN between patients diagnosed with WT versus PA. 46 WT and 52 PA met our inclusion criteria. WT was significantly associated with an older age at surgery (62.5 years vs 50.2 years, p = 0.001). 71.7 % of WT and 32.7 % of PA had inclusions in any LN. The presence of inclusion is a significant predictor for WT versus PA (p = 0.019). Where smoking status was available, 92.5 % of WT patients were smokers/ex-smokers, versus. 55.1 % of PA (p = 0.034 for current smokers). Among PA, 44 % of smokers had inclusions compared with 22.7 % of non-smokers. SDIs are more frequent in parotid LN from patients with WT than PA. The high proportion of smokers among WT patients is consistent with prior studies. The results support the hypothesis that WT arises from SDIs. Individuals with more SDIs may be predisposed to WT.     

Characteristics of patients at risk for perioperative myocardial infarction after infrainguinal bypass surgery: An exploratory study

Patients requiring infrainguinal bypass surgery often have diffuse atherosclerotic disease, and perioperative myocardial infarction (MI) is a potentially lethal complication that is not uncommon in these patients. To establish additional clinical characteristics that might be useful in identifying patients who require more extensive cardiac evaluation, we conducted an exploratory case-control study comparing 22 patients who had a perioperative MI following elective infrainguinal bypass surgery with 191 control subjects whose bypasses were uneventful. In addition to previously recognized risk factors (e.g., history of angina or prior MI), we examined the association of perioperative MI with (1) results of common preoperative laboratory tests and ECG, (2) preoperative use of certain medications, and (3) intraoperative factors that might be anticipated prior to surgery (e.g., duration of surgery or type of anesthesia). Perioperative MI was associated not only with a history of angina, prior MI, or coronary artery disease but also with the need for certain cardiac medications, higher white blood cell (WBC) counts, ST-segment depression, left bundle branch block, and lengthy surgical procedures. Multiple logistic regression analysis identified the following factors as being independently associated with perioperative MI: preoperative antiarrhythmic agents (odds ratio [OR]=26.4,p 0.006), nitrates (OR=8.4,p=0.006), calcium channel blockers (OR=5.5,p=0.04), and aspirin (OR=6.8,p <0.01) and ST-segment depression (OR=11.8,p=0.01), WBC count (OR=1.27/1000,p=0.005), and duration of surgery (OR=2.2/hr,p=0.0001). In patients undergoing infrainguinal bypass surgery, perioperative MI is associated not only with a history of previous cardiac events and ECG evidence of ischemia but also with regular use of certain cardiac medications, higher WBC counts, and longer surgical procedures. Incorporation of these variables into current methods of risk assessment might improve their predictive value sufficiently to provide an objective, inexpensive means of distinguishing patients who warrant extensive preoperative cardiac evaluation from those who do not.We are indebted to Maryann Barry, RN, for helping to collect the preoperative ECG reports and to Timothy Heeren, PhD, Boston University School of Public Health, for advice regarding statistical analysis.     

Depression After Coronary Heart Disease Events

Objective - To study the prevalence of depression at least 6 months after various coronary heart disease (CHD) events (bypass grafting, coronary angioplasty, myocardial infarction, myocardial ischaemia without infarction) and the associations between depression and clinical variables. Design - In the course of the study 414 (284 males, 130 females) patients younger than 71 years (mean age for men 60.9 years and for women 63.6 years) were interviewed and examined. Smoking habits, body mass index, lipid levels and diabetic status were recorded. The New York Heart Association (NYHA) class was assessed. Depression was screened using a self-rated depression scale. Results - In the four diagnostic categories, one-sixth of the patients (14-19%) suffered from depression. Depression was associated with smoking (OR 1.7, 95% CI 1.2; 2.4) and poor NYHA class (OR 1.9, 95% CI 1.4; 2.6). Conclusion - Depression is common after CHD events, and is associated with smoking and poor NYHA class. The identification and treatment of depression should be one of the elements in the rehabilitation of cardiac patients.     

Cigarette smoking and the haemodynamic response to tracheal intubation

This study investigated the effects of smoking and gender on the haemodynamic response after tracheal intubation. Patients were assigned to one of four groups: female non-smokers, female smokers, male non-smokers and male smokers. After tracheal intubation, the highest mean (SD) increase in heart rate (30 (18) %) and rate–pressure product (40 (29) %) was seen in male smokers. The increases in heart rate and rate–pressure product in male smokers were significantly greater than those in female non-smokers, p < 0.05. The increase in rate–pressure product was significantly greater in male smokers than in male non-smokers, p = 0.022.     

Prevalence of and risk factors for nocturia: Analysis of a health screening program

BACKGROUND: We examined the prevalence of and risk factors for nocturia in Kurashiki city and the surrounding area, a rural area in Japan. MATERIALS AND METHODS: We collected data on 6517 individuals (4568 men and 1949 women) who participated in a multiphasic health screening. We analyzed the relationships between nocturia assessed by a questionnaire (voiding twice or more during night) and other variables including age, hypertension, cardiovascular disease, cerebrovascular disease, chronic obstructive pulmonary disease, diabetes mellitus (DM), chronic renal failure, benign prostatic hyperplasia (BPH), smoking habit and alcohol intake. RESULTS: Overall, 1856 individuals (28.5%) answered that they arose to urinate at least twice during the night. This rate increased with age from 16.5% in individuals younger than 50 to 60.0% in those older than 69. Logistic regression analysis revealed that cohorts of subjects 50-59, 60-69, and 70 years old or over had, respectively, 1.75, 3.35, and 6.21 times the prevalence of nocturia of the 49 years or younger cohort. Hypertension (odds ratio [OR] 1.64) and DM (OR 1.70) were other independent positive risk factors for nocturia. On the other hand, current smokers who smoked 20 or more cigarettes per day were less likely to have nocturia than non-smokers (OR 0.72). In male individuals, BPH was another independent positive risk factor (OR 1.35). Gender was not associated with nocturia. CONCLUSIONS: Although population bias is an important limitation to this study, nocturia is associated with various factors suggesting that multiple approaches are needed to the treatment of patients with nocturia.     

Is it justified to refuse breast reduction to smokers?

INTRODUCTION AND AIMS: There are several studies in the literature suggesting that smoking increases the complication rate in various plastic surgery operations. We did a study on 402 patients to see the effect of smoking on breast reduction. The objective was to raise the controversial issue of whether breast reduction could be refused to smokers who fail to stop smoking in the peri-operative period. MATERIALS AND METHODS: The records of patients who had undergone breast reductions between April 1999 and May 2004 at the Leicester Royal Infirmary, Leicester were reviewed retrospectively for age, body mass index, smoking habits and wound-related complications. RESULTS: A total of 764 breast reductions were performed in 402 patients during this period. Twenty-eight per cent (112) of these patients were smokers. The mean age was 33.9 (range 19-68)+9.5 years in smokers and 34.4 (range 16-73)+10.6 years in non-smokers. About 90% of patients had bilateral breast reductions. Wound-related complications were seen in 35% of smokers as against 13% of non-smokers, P value<0.001. Overall, smokers had a 2.3 x higher chance of developing a complication. The probability of a smoker developing wound infection was 3.3 x more in comparison to a non-smoker. Smokers were also three times more likely to develop T-junction necrosis. CONCLUSION: Smoking increases the complication rate of breast reduction significantly. Hence, patients must be strongly encouraged to quit smoking before surgery and abstain until the wound has completely healed. Stoppage of smoking in the peri-operative period should be adopted as an essential eligibility criterion for breast reduction.     

膀胱癌与吸烟及烟草烟雾环境暴露的关系

目的 探讨吸烟及烟草烟雾环境(ETS)暴露与膀胱癌发病风险的关系.方法 2005年10月至2009年3月期间进行了一项病例对照研究,病例组为124例初次诊断为膀胱癌的患者,对照组为227例非肿瘤、非泌尿系统疾病的住院患者.使用Logistic回归分析计算吸烟对膀胱癌发生的比数比(OR)及95%可信区间(95%CI).结果 吸烟者易患膀胱癌的风险是终生不吸烟者的1.867倍,男性吸烟者的相对危险度是终生不吸烟者的2.648倍,对于已戒烟的男性相对危险度是终生不吸烟者的2.019倍.不吸烟者在未成年期暴露于烟草烟雾环境易患膀胱癌的风险是无暴露者的2.068倍,而对于成年后暴露于烟草烟雾环境的发病风险与无暴露者差异无统计学意义(P＞0.05).结论 吸烟是膀胱癌发病的危险因素之一;已戒烟者膀胱癌发生的危险度低于现行吸烟者;戒烟有利于降低吸烟者易患膀胱癌的风险.在未成年期长期暴露于烟草烟雾环境中,膀胱癌的发病风险显著增加;而成年人暴露于烟草烟雾环境中,是否能增加膀胱癌的发病风险并不确定.     

Effects of passive and active smoking on induction of anaesthesia

It is said that cigarette smokers suffer stormy induction ofanaesthesia; although plausible, this is unsubstantiated. Wehave studied the incidence of adverse events during induction,together with peripheral oxygen saturation (Sp_o2), in activeand passive smokers, and in non-smokers. During induction, bothactive and passive smokers had a higher incidence of adverseevents than non-smokers (P<0.01 and P<0.05, respectively).Irrespective of smoking status, those suffering adverse eventshad greater concentrations of carboxyhaemoglobin and sufferedmore oxygen desaturation than those not suffering such events.Although we were unable to demonstrate a direct link betweensmoking status and oxygen desaturation during induction, ourstudy gives a firmer basis for exhorting patients not only tostop smoking before anaesthesia but also to avoid passive smoking.