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Nicotine dependence phenotype and lung cancer risk.

A behavioral phenotype that characterizes nicotine dependence, the time to first cigarette after waking, is hypothesized to increase the risk of lung cancer.

METHODS: A case-control study of histologically confirmed lung cancer was conducted. The current analysis included 4775 lung cancer cases and 2835 controls who were regular cigarette smokers.

RESULTS: Compared with subjects who smoked their first cigarette > 60 minutes after waking, the pack-years-adjusted odds ratio was 1.31 (95% confidence interval [95% CI], 1.11-1.54) for subjects who smoked 31 minutes to 60 minutes after waking and 1.79 (95% CI, 1.56-2.07) for subjects who smoked within 30 minutes of waking. The risk estimates were similar when smoking was modeled as total years, smoking status (current vs former), number of cigarettes smoked per day, years since quitting, and excess odds ratio. The findings were consistent for all histologic types of lung cancer.

CONCLUSIONS: The findings of the current study indicate that a specific nicotine dependence phenotype that is associated with the amount of smoke uptake per cigarette is independently associated with lung cancer risk. These findings may help to identify high-risk individuals who would benefit from targeted interventions. Cancer 2011;. © 2011 American Cancer Society.

Lung cancer with venous thrombo-embolism: clinical characteristics.

Lung cancer is the most common malignancy diagnosed in patients with venous thrombo-embolism (VTE). Aim: To investigate clinical, biological, radiological features and survival of lung cancer patients with VTE.

Methods: Retrospective case-control study investigating biologic, clinical course and survival of 25 patients lung cancers with VTE (Group M) and 50 lung cancers without VTE (group T).

Results: The frequency of the VTE was 5.88% with 2.58% pulmonary embolism (PE). The mean age was 58 years ± 9.8 in group M and 57.9 years ± 9.6 in group T. No significant difference concerning medical or surgical history for both groups was found. The dyspnea and chest pain were at equal frequency (63.6%). Regarding the clinical probability of the PE, it was no significant differences between the two groups. A rate of D-dimer > 0.7μg/l was more frequent among group M (75% vs 20%; p = 0.054). The most common histological type was nonsmall cell lung cancer (88%). A stage IV was significantly more frequent in group M (86.4% vs. 52.3%; p = 0.007). The mean period of survival in Group M was 10.6 ± 1.2 month and 20.2 + 1.8 month in group T; p = 0.38.

Conclusion: The VTE associated to lung cancer is under diagnosed. Prospective studies are needed to establish more adapted scores.

Prevalence of pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension in the United States.

The prevalence of pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH) in the US is largely unknown. Prior research has estimated PAH prevalence in Europe at ∼15-52 per million.

Methods: Using a privately insured claims database (1999-2007) for the under age 65 population and a Medicare claims database for the 65+ population, and following the current clinical classification of PH, CTEPH patients were identified as having:

  • ≥2 claims for pulmonary hypertension (PH) [ICD-9-CM: 416.0, 416.8];
  • ≥1 claim for pulmonary embolism (PE) ≤12 months prior or 1 month after the initial PH claim (index date).

PAH patients were identified:

  • ≥2 claims for primary PH [416.0]; no left heart disease, lung diseases, CTEPH,
  • or miscellaneous PH diagnoses ≤12 months prior or 1 month after the index date.

Both cohorts were required to have ≥1 claim for right heart catheterization ≤6 months prior to any PH claim, or ≥1 claim for echocardiogram ≤6 months prior to a specialist-diagnosed PH claim. Age- and gender-standardized prevalence rates per million individuals (PMI) were calculated using appropriate population weights.

Results: Prevalence rates (95% CI) of CTEPH were estimated at 63 (34-91) PMI among the privately insured (<65), and 1007 (904-1111) PMI among the Medicare population (≥65). The corresponding estimates for PAH were 109 (71-146) PMI among the <65 population, and 451 (384-519) PMI for Medicare. Limitations: Identification of PAH and CTEPH patients in administrative claims data is challenging, due to lack of specific ICD-9-CM codes for the conditions and risk of misdiagnosis.

Conclusions: Prevalence rates of CTEPH and PAH increase with age, and are higher among women. The increased risk of PE may explain the sharp age gradient for CTEPH prevalence. The estimated US prevalence of PAH is higher than existing estimates.

Scintigraphy for Pulmonary Embolism: Too Old to Rock 'n' Roll, Too Young to Die?

J Nucl Med. 2011 Jul 27;
Authors: Sostman HD, Pistolesi M

Cardiac CT for the assessment of chest pain: Imaging techniques and clinical results.

Immediate and efficient risk stratification and management of patients with acute chest pain in the emergency department is challenging. Traditional management of these patients includes serial ECG, laboratory tests and further on radionuclide perfusion imaging or ECG treadmill testing.

Due to the advances of multi-detector CT technology, dedicated coronary CT angiography provides the potential to rapidly and reliably diagnose or exclude acute coronary artery disease. Life-threatening causes of chest pain, such as aortic dissection and pulmonary embolism can simultaneously be assessed with a single scan, sometimes referred to as "triple rule out" scan. With appropriate patient selection, cardiac CT can accurately diagnose heart disease or other sources of chest pain, markedly decrease health care costs, and reliably predict clinical outcomes.

This article reviews imaging techniques and clinical results for CT been used to evaluate patients with chest pain entering the emergency department.

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