Cigarette smoking continues to be the single, most preventable cause of death and disability in the United States. For individuals who have cancer, continuing to smoke negatively impacts their treatment, survival, and risk for second primary tumors. This review of behavioral and pharmacological approaches to smoking cessation focuses on the recent comprehensive review of cessation interventions by the Agency for Health Care Policy and Research (AHCPR), as well as on new developments in the field. An intervention model is outlined that provides oncologists with a brief and easily implemented method of systematically treating patients who smoke. By assessing patient smoking status, advising smoking patients to quit, and proactively assisting their patients in quitting, oncologists can significantly influence patient health and fulfill their professional and ethical responsibility to address this life-threatening behavior.

Behavior Therapy↗

PubMedDate not supplied

Selective non-operative management of pseudoaneurysms and arteriovenous fistulae complicating femoral artery catheterization.

Femoral arterial pseudoaneurysms or arteriovenous fistulae may sometimes complicate percutaneous femoral artery catheterization procedures. Most surgeons recommend prompt operative repair because of the unfavorable natural history of pseudoaneurysms or arteriovenous fistulae secondary to violent or accidental arterial trauma. However, the natural history of catheterization-induced pseudoaneurysms and arteriovenous fistulae has not been well documented. Accordingly, we prospectively studied the natural history of 22 pseudoaneurysms, 8 arteriovenous fistulae, and 3 combined lesions, identified by duplex scan in 32 patients following trans-femoral cardiac, peripheral vascular, or vascular access arterial catheterization procedures. Angiographic procedures were performed with the use of 5-8F introducer sheaths. A femoral artery complication was significantly more likely to result from coronary balloon angioplasty (9/304; 3.0%) than from diagnostic cardiac catheterization (21/2476; 0.8%) (p less than 0.003; chi square). Fourteen patients (13 pseudoaneurysms, 1 combined pseudoaneurysm/fistulae) underwent surgical repair. Pain and/or enlarging hematoma resulted in repair within two days of the diagnosis in 8 patients. The need for chronic anticoagulation prompted elective repair in 2 patients. A pseudoaneurysm was repaired in one patient five days following catheterization when it became painful. In three stable patients, asymptomatic pseudoaneurysms were repaired electively during another surgical procedure. There were no operative deaths. One patients (7%) developed a wound infection postoperatively. Eighteen patients (19 arterial lesions: 9 pseudoaneurysms, 8 arteriovenous fistulae, 2 combined pseudoaneurysms/arteriovenous fistulae) with improving symptoms and stable physical signs were followed by serial clinical evaluation and duplex scans. Seventeen of 19 (89%) of these lesions resolved spontaneously within 5-90 days (mean 30.7 days).(ABSTRACT TRUNCATED AT 250 WORDS)

Aneurysm↗

PubMedDate not supplied

Renal allograft platelet activating factor synthesis during acute cellular rejection.

The aim of this study was to characterize the synthesis and metabolism of platelet activating factor (PAF, 1-0-alkyl-2-0 acetyl-sn3-phosphorylcholine) by renal tissue undergoing acute cellular allograft rejection in the canine model. Kidneys were transplanted into outbred mongrel dogs and allowed to reject without immunosuppressive therapy. Five days after transplantation, all kidneys were non-functional and the tissue was assayed for the capacity to produce various molecular species of PAF and lyso-PAF using physical-chemical (GC/MS), immunologic (RIA) and biologic (platelet aggregation) assays. Renal cortical tissue obtained from rejecting allografts produced more PAF than control tissue by the following factors (GC/MS): 18-fold for C16:0 PAF; 3-fold for Lyso-C16:0 PAF; 2-fold for C18:1 PAF; and 6-fold for C18:0 PAF. The control tissue to which comparisons were made was renal cortex obtained from the native contralateral kidney. Increases in the production of various molecular species of PAF were also observed with renal medullary tissue undergoing acute rejection, although the magnitude of change was less dramatic than with renal cortex. The predominant PAF metabolite produced both by normal and allograft tissue was C16:0 Lyso-PAF. The increased PAF production by renal allograft tissue undergoing rejection was mainly attributable to C16:0 PAF and C16:0 Lyso-PAF, but increased production of both C18:0-PAF and of C18: 1-PAF was also detected. Increased renal allograft PAF production was also confirmed with a competitive binding immunoassay specific for PAF. In addition, when PAF-like material was isolated and purified from renal allograft incubation media and added to washed canine platelets, an intense aggregation response was observed that was abolished with prior alkaline methanolysis of the isolated material. Aggregation responses of similar magnitude were not obtained with PAF-like material isolated from native (non-rejection) renal tissue. In other experiment, incubation media obtained from rejecting renal allografts was found to contain factor which catalyzed hydrolysis of exogenous PAF to Lyso- PAF at twice the rate induced by media obtained from normal renal tissue. In conclusion, this study has identified dramatic increases in production of the biologically active molecular species of PAF by renal allograft tissue undergoing untreated cellular rejection. High levels of biologically inactive Lyso-PAF were also detected, and renal allograft tissue elaborates a factor which catalyzes rapid hydrolysis of PAF.

Animals↗

PubMedDate not supplied

Improved renal function after renal artery revascularization.

An experience with 20 patients with renovascular hypertension and renal insufficiency secondary to renal artery stenosis is presented. The mean follow-up was 29 months. Eighteen patients had atherosclerotic renal artery stenosis and two patients had transplant renal artery stenosis. The mean preoperative blood pressure of 162 +/- 5 mmHg decreased significantly to 105 +/- 2 mm Hg (p less than 0.001). The serum creatinine also decreased from a mean preoperative level of 4.7 +/- 0.7 mg/dl to a mean postoperative level of 2.3 +/- 0.3 mg/dl (p less than 0.001). Similarly, the creatinine clearance improved from a mean preoperative level of 28 +/- 2 ml /min to a mean postoperative level of 45 +/- 8 ml/min (p less than 0.03). Four patients (20%) with improved renal function died from 4 days to 15 months postoperatively. Two patients (10%) have progressed to end stage renal disease. These findings demonstrate that renal revascularization is clearly beneficial in the short-term and long-term improvement of renal function.

Adult↗

PubMedDate not supplied

Importance of bidirectional arterial flow in dialysis fistula construction.

The normal direction of blood flow in end of cephalic vein to side of radial artery arteriovenous dialysis fistulas in the wrist was antegrade in the proximal arterial limb and retrograde through the distal arterial limb. There were no instances of arterial insufficiency in the hand due to a steal phenomenon. These findings support the surgical construction of end of vein to side of artery fistulas.

Arteriovenous Shunt, Surgical↗