Matthew A. Steliga

Epidemiology of Lung Cancer: Smoking, Secondhand Smoke, and Genetics

The link between smoking and development of lung cancer has been demonstrated, not only for smokers but also for those exposed to secondhand smoke. Despite the obvious carcinogenic effects of tobacco smoking, not all smokers develop lung cancer, and conversely some nonsmokers can develop lung cancer in the absence of other environmental risk factors. A multitude of genetic factors are beginning to be explored that interact with environmental exposure to alter the risk of developing this deadly disease. By more fully appreciating the complex interrelationship between genetics and other risks the development of lung cancer can be more completely understood.

Lobectomy for Pulmonary Vein Occlusion Secondary to Radiofrequency Ablation

Pulmonary Vein Occlusion After RF Ablation.  Pulmonary vein stenosis, a recognized complication of transcatheter radiofrequency ablation in the left atrium, is often asymptomatic. Significant stenosis is commonly treated with percutaneous balloon dilation with or without stenting. We encountered a case of complete pulmonary vein occlusion that caused lobar thrombosis, pleuritic pain, and persistent cough. Imaging studies revealed virtually no perfusion to the affected lobe. A lobectomy was performed, resolving the persistent cough and pain. Pulmonary vein occlusion should be suspected in patients who present with pulmonary symptoms after having undergone ablative procedures for atrial fibrillation. This condition may necessitate surgical intervention if interventions such as balloon dilation or stenting are not possible or are ineffective. (J Cardiovasc Electrophysiol, Vol. 21, pp. 1055‐1058, September 2010)

Do HIV-infected non-small cell lung cancer patients receive guidance-concordant care?

Background:The incidence of lung cancer cases among HIV-infected individuals is increasing with time. It is unclear whether HIV-infected individuals receive the same care for lung cancer as immunocompetent patients because of comorbidities, the potential for interaction between antiretroviral agents and cancer chemotherapy, and concerns regarding complications related to treatment or infection. Objectives:The objective of this study was to assess the effect of HIV infection on receipt of guidance-concordant care, and its impact on overall survival among non–small cell lung cancer Medicare beneficiaries. Design:The study design was a matched case-control design where each HIV patient was matched by age group, sex, race, and lung cancer stage at diagnosis with 20 controls randomly selected among those who were not HIV infected. Subjects:The patients included in this study were Medicare beneficiaries diagnosed with non–small cell lung cancer between 1998 and 2007, who qualified for Medicare on the basis of age and were 65 years of age or older at the time of lung cancer diagnosis. HIV infection status was based on Medicare claims data. A total of 174 HIV cases and 3480 controls were included in the analysis. Measures:Odds ratios for receiving guidance-concordant care and hazard ratios for overall survival were estimated. Results:HIV infection was not independently associated with the receipt of guidance-concordant care. Among stage I/II patients, median survival times were 26 and 43 months, respectively, for those with and without HIV infection (odds ratio=1.48, P=0.021). Conclusions:HIV infection was not associated with receipt of guidance-concordant care but reduced survival in early-stage patients.

Hyalinizing Clear Cell Carcinoma of the LungCase Report and Review of the Literature

Objectives Hyalinizing clear cell carcinoma (HCCC) is common in head and neck sites but extremely rare in the lung. This case report describes an HCCC in the lung of a 54-year-old female patient. Methods We summarize the histomorphologic, immunophenotypic, and molecular features for our and three previously reported HCCCs of the lung with emphasis on potential diagnostic pitfalls. Results Sections of a well-circumscribed 3.5-cm lung mass were characterized by a bronchocentric tumor growing in sheets, nests, and cords in a background of hyalinized stroma. Tumor cell appearance was clear to eosinophilic, lacking significant pleomorphism or mitotic activity. By immunohistochemistry, the tumor cells were strongly positive with antibodies to pan-keratin, p63, and CK5/6 while negative for CK7, CK20, thyroid transcription factor 1, napsin A, chromogranin, and synaptophysin. Next-generation sequencing demonstrated an EWSR1-ATF1 fusion transcript. Conclusions Awareness of key morphologic features of pulmonary HCCC is crucial for the recognition of this rare entity in the lung. Ancillary studies, including immunohistochemistry and molecular testing, are essential for the distinction from its mimics.

Clinical practice and the tobacco epidemic: relevance of a global public health problem in the clinical setting

Defining the problem It is estimated that by the year 2030, 8.3 million deaths worldwide will be attributed to tobacco-induced diseases, representing 10% of deaths globally [1]. In developed economies, tobacco use is the leading cause of preventable death, with lung cancer killing far more men and women than any other form of cancer [2,101]. The link between tobacco and lung cancer was suggested in 1939 by DeBakey and Ochsner [3]. It is well established that smoking leads to lung cancer, and a recent review of the global literature has established a relative risk for lung cancer from tobacco ranging from 15 to 30 [4]. Death is perhaps the most easily quantified outcome of the tobacco epidemic, but is hardly the complete picture. Disability due to cancer, cardiovascular disease and chronic obstructive pulmonary disease is widespread but harder to measure. Direct and indirect healthcare costs for treating victims of tobacco addiction in the USA alone have been estimated to be in the range of US

Surgical treatment of pulmonary metastases from osteosarcoma in pediatric and adolescent patients.

96 billion per year in health costs, and an equal amount in lost productivity. Perhaps the most striking aspect of the tobacco epidemic is not merely the number of deaths or cost, but the fact that millions of deaths and immeasurable disability due to tobacco use are preventable. Widespread consequences in addition to developing lung cancer Lung cancer due to smoking is the most well-known negative aspect of the tobacco epidemic and also the most obvious direct cause–effect relationship. It is not a difficult concept to understand that decades of direct exposure of carcinogens to the airways can lead to malignancy. Unfortunately, the impact of tobacco use is much more widespread in the human body than merely the direct effect of the carcinogens bathing the surface of the airways. Tobacco use leads to the circulation of carcinogens throughout the body and has been linked to increased risk of breast, bladder, colorectal and other malignancies. Other than leading to cancer, tobacco use has been linked to negative health consequences in nearly every organ system. Tobacco use is a major risk factor for developing cardiovascular and cerebro vascular disease. Smokers with diabetes have increased insulin resistance, poorer glucose control and more complications from diabetes. Wound healing is greatly impaired in smokers owing to vasospasm from nicotine, circulating levels of carbon monoxide and other circulating toxins. This is well recognized in the surgical community, and plastic surgeons often decline elective cosmetic surgery in active smokers, citing poorer healing and increased complication

Thoracic Anesthesia and Cross Field Ventilation for Tracheobronchial Injuries: A Challenge for Anesthesiologists

Osteosarcoma is the most common primary bone malignancy in the United States, comprising approximately 56% of the primary bone tumors.1,2 Most patients present with local disease; their treatment is outlined in greater detail elsewhere in this book. However, 10–20% of patients diagnosed with osteosarcoma will have radiographic evidence of synchronous isolated pulmonary metastases at the time of initial presentation. Of the patients without synchronous pulmonary metastases, 40–55% will develop metachronous pulmonary metastases.3–5

Smoking Cessation in Clinical Practice: How to Get Patients to Stop

Tracheobronchial injuries are rare but life threatening sequel of blunt chest trauma. Due to the difficult nature of these injuries and the demanding attributes of the involved surgery, the anesthesiologist faces tough challenges while securing the airway, controlling oxygenation, undertaking one-lung ventilation, maintaining anesthesia during tracheal reconstruction, and gaining adequate postoperative pain control. Amongst the few techniques that can be used with tracheobronchial injuries, cross field ventilation is a remotely described and rarely used technique, especially in injuries around the carina. We effectively applied cross field ventilation in both our cases and the outcome was excellent.

Tobacco Control and Primary Prevention

Tobacco use is an etiologic agent for many diseases treated by cardiac, vascular, and thoracic surgeons and contributes to increased perioperative complications and long-term risk. Smoking cessation may be challenging for patients and can be frustrating for clinicians. Lack of familiarity and pessimistic views toward cessation methods lead to underuse by physicians. Evidence-supported measures that increase chances of cessation include direct physician advice, approved pharmacotherapy, structured counseling, and a follow-up plan. Approved pharmacotherapy consists of varenicline, bupropion, or nicotine replacement therapy in the form of long-acting patches and short-acting forms of nicotine such as gum, lozenges, prescription nasal spray, or prescription inhaler. Direct physician advice is critical and strengthened when combined with more in-depth counseling from a specialist who may have more expertise and time. Integrating assessment and referral to counseling services into a clinical workflow can deliver resources in an efficient manner with the goal of providing the best available resources to all patients.

Successful Treatment of Esophageal Necrosis Secondary to Acute Type B Aortic Dissection

Abstract Tobacco is the single greatest contributor to development of lung cancer. Nearly all societies across the globe are afflicted with the tobacco epidemic, and smoking rates are rising for certain populations. Successful tobacco control is typically implemented not as a single measure but as part of a comprehensive, multifaceted approach using several concepts; the impact of one measure on smoking rates can be difficult to distill when several are implemented in combination. However, a concerted multifaceted effort using evidence-based strategies can alter the future course of the tobacco epidemic, with the potential to save millions of lives. The World Health Organization Framework Convention on Tobacco Control provides a global tobacco-control strategy, including monitor tobacco use and prevention policies; protect people from tobacco smoke; offer to help quit tobacco use; warn about the dangers of tobacco; enforce bans on tobacco advertising; and, raise taxes as a tobacco control measure.