The Role of Smoking Cessation in the Prevention of Coronary Artery Disease

Smoking (tobacco addiction) is the most significant of the modifiable cardiovascular risk factors. Mistakenly described as a “habit” or “behavioral choice,” the onset of tobacco addiction quickly follows the acquisition of an ability to inhale cigarette smoke and is reflected in a transformation of neurophysiologic function and nicotine-receptor density. Thereafter, comfort and a degree of neurophysiologic “equanimity” require the regular administration of nicotine. Smokers inhale thousands of other chemicals, many of which play critical roles in the initiation and accentuation of atherosclerosis by influencing vasomotor activity, vascular dysfunction, oxidation of lipids, atheroma development, and thrombosis. Smoking cessation is a priority in the management of any patient with cardiovascular disease. The benefits of cessation accrue rapidly in such patients and have a pronounced effect on the likelihood of disease progression, hospital readmission, and mortality. All physicians must be familiar with the principles of cessation practice and be able to initiate smoking cessation attempts.     

The development of the New South Wales Service for the Treatment and Rehabilitation of Torture and Trauma Survivors (STARTTS): the first year

Many immigrants to Australia are refugees, some of whom have experienced acute stress and trauma, including torture, prior to or during their escape from their home countries. In response to a growing recognition that the health care services may not be meeting the needs of these people the NSW Department of Health funded the establishment of a community-based rehabilitation service for traumatised refugees. This paper provides an overview of the recent history of the service, some of the organisational and staffing issues faced during its first year, some characteristics of the first 200 clients, principles of treatment, clinical, nosological and therapeutic issues and relationships with other agencies.     

Cerebral perfusion imaging with technetium-99m HMPAO following cerebral trauma. Initial experience

Thirteen patients with cerebral trauma were studied for cerebral perfusion by the use of Tc-99m HMPAO scanning. CT imaging was performed on nine patients. Because of their clinical condition, four patients were scanned only in the planar mode to help establish the diagnosis of brain death. Other indications for study included gunshot wound and blunt or sharp object trauma with or without skull fracture. In all cases, HMPAO scans showed defects with a quality equivalent to or greater than that demonstrated by CT. Our initial results suggest that HMPAO may predict the degree of permanent damage and which patients may develop post-traumatic headache. A diagnosis of brain death can be established without the withdrawal of medical therapy.     

Pleomorphic fibroma of the eyelid

· Background: This report describes the pathology of an unusual variant of fibroma of the eyelid. The soft ovoid tumour was excised from the centre of the left lower lid in an 84-year-old patient had been growing slowly for several years. · Methods: The tumour was studied by conventional histology, immunohistochemistry and electron microscopy. · Results: The tumour was formed by fibroblasts of spindle and multinucleate type, and the collagenous stroma contained mast cells and blood vessels which exhibited minor inflammatory changes. With the immunohistochemical methods the only positive marker was for vimentin. · Conclusion: On morphological grounds it was possible to distinguish this extremely rare tumour from other mesenchymal tumours. The presence of distinctive multinucleate giant cells makes the term pleomorphic fibroma an appropriate name for this type of lesion. Received: 25 May 1997 Revised version received: 8 September 1997 Accepted: 15 September 1997     

Mechanisms of hemorrhage in dengue without circulatory collapse.

To characterize the molecular basis for the hemostatic defects of dengue infections, a study was conducted in Bangkok, Thailand. Febrile children (n = 68) hospitalized with suspected dengue were enrolled before their clinical syndromes were classified as either dengue fever (DF) or dengue hemorrhagic fever (DHF). Hospital course and outcome were recorded; blood was obtained during the febrile illness (S1), after defervescence (S2), and 1 month after onset of disease (S4). Patients were classified as DF (n = 21) and DHF grades 1, 2, and 3; (DHF1, n = 8; DHF2, n = 30; and DHF3, n = 9). All had marked thrombocytopenia. Bleeding scores were assigned on the basis of bleeding site. Although there was no correlation between bleeding scores and pleural effusion index (a measure of vascular leakage) or bleeding scores and platelet counts, there was a correlation between pleural effusion index and platelet counts. Bleeding scores did not correlate with hemostatic data. Activated partial thromboplastin time was prolonged, with trends toward decreased fibrinogen and increased levels of prothrombin fragment F1.2 in the acute-phase samples. However, no factor level was dramatically decreased. We conclude that most patients with DF or DHF, even without overt hemorrhage, have consumptive coagulopathy. Nevertheless, hemorrhage in dengue without circulatory collapse is most likely due to activation of platelets rather than coagulopathy, which is well compensated. Our data suggest that vascular alteration may be the principal factor involved in the association of thrombocytopenia and hemorrhage with disease severity.