Chronic and acute effects of cigarette smoking on skin blood flow

Factors Associated With Perioperative Hospital Acquired Pressure Injury in Patients Undergoing Spine Surgery in the Prone Position: A Prospective Observational Study

BACKGROUND

Hospital acquired pressure injury (HAPI) is associated with poor clinical outcomes and high medical costs. Patients undergoing surgery in the prone position are particularly vulnerable to perioperative HAPI. This prospective observational study investigated the factors associated with HAPI in patients undergoing elective spine surgery in the prone position.

METHODS

Two hundred eighty-seven patients undergoing elective spine surgery participated in this study. Demographics, perioperative vital signs, laboratory findings, surgical data, and intraoperative data were prospectively recorded. The sites and stages of HAPI were investigated on postoperative day 2. The stages of HAPI were evaluated using the pressure injury staging system of the National Pressure Ulcer Advisory Panel.

RESULTS

Perioperative HAPI was observed in 71 (24.7%) patients (stage 1, 40; stage 2, 31). The most frequent site (number) of HAPI was the upper extremities (33), followed by the chest (32), lower extremities (20), face (18), pelvis (10), and abdomen (9). In multivariate analysis, the duration of prone positioning per hour (odds ratio [95% confidence interval], 1.48 [1.25-1.74]; P <0.001) and intraoperative pH ≤7.35 (1.98 [1.05-3.76]; P =0.036) were associated with perioperative HAPI.

CONCLUSIONS

The incidence of perioperative HAPI was 24.7% in patients undergoing elective spine surgery in the prone position. Long duration of prone positioning and intraoperative acidosis were associated with increased development of perioperative HAPI.

Difference of body surface temperature in stable chronic obstructive pulmonary disease patients with different degree of airflow limitation

BACKGROUND

This study aimed to investigate the changes of body surface temperature of stable chronic obstructive pulmonary disease (COPD) patients and explore its clinical significance for the progression of COPD.

OBJECTIVES

The aim of this study was to explore the correlation between body surface temperature and disease severity in COPD patients.

METHODS

From May 2015 to May 2016, the patients who were diagnosed as COPD at stable phase (n = 148) were enrolled in this study. The subjects in control group (n = 49) were healthy people. The patients' general condition modified Medical Research Council (mMRC) dyspnea scale and the COPD assessment test (CAT) score were recorded, and pulmonary function of patients was determined. Back average temperature measurement was made using a thermal infrared imager (DT-9875, CEM, China).

RESULTS

Patients in the COPD group had significantly lower mean temperatures of the back than those in the control group. The mean temperature of the back presented a decreased tendency with the aggravation of airflow limitation. Correlation analysis revealed that in the COPD group, the back temperature was negatively correlated with smoking index and mMRC score. FEV1%, FVC% and FEV1/FVC were positively correlated with pulmonary function. Smoking showed a tendency to lower the back temperature of COPD patients.

CONCLUSIONS

This study preliminarily suggested that the body surface temperature of COPD patients decreased compared with that of healthy people, which may be associated with the dysfunction of autonomic nerve, increased basal metabolic rate, metabolic syndrome and peripheral nerve injury in COPD patients.

Work-related risk factors for ulnar nerve entrapment in the Northern Finland Birth Cohort of 1966

Ulnar nerve entrapment (UNE) is the second most common entrapment neuropathy in the upper extremity. The aetiology of UNE is multifactorial and is still not fully understood. The aim of the study was to identify occupational risk factors for UNE and to determine whether smoking modifies the effects of work-related factors on UNE. The study population consisted of the Northern Finland Birth Cohort of 1966 (NFBC1966). In total, 6325 individuals active in working life participated at baseline in 1997. Occupational risk factors were evaluated by a questionnaire at baseline. The data on hospitalizations due to UNE were obtained from the Care Register for Health Care between 1997 and 2018. The incidence rate of hospitalization due to UNE was 47.6 cases per 100,000 person-years. After adjusting for confounders, entrepreneurs (Hazard ratio (HR) = 3.68, 95% CI 1.20–11.27), smokers (HR = 2.51, 95% CI 1.43–4.41), workers exposed to temperature changes (HR = 1.72, 95% CI 1.00–2.93), workers with physically demanding jobs (HR = 3.02, 95% CI 1.39–6.58), and workers exposed to hand vibration (HR = 1.94, 95% CI 1.00–3.77) were at an increased risk of hospitalization for UNE. Exposure to work requiring arm elevation increased the risk of hospitalization due to UNE among smokers (HR = 2.62, 95% CI 1.13–6.07), but not among non-smokers. Work-related exposure to vibration and temperature changes, and physically demanding work increase the risk of hospitalization for UNE. Smoking may potentiate the adverse effects of work-related factors on UNE.

Wearable Laser Doppler Flowmetry Sensor: A Feasibility Study with Smoker and Non-Smoker Volunteers

Novel, non-invasive wearable laser Doppler flowmetry (LDF) devices measure real-time blood circulation of the left middle fingertip and the topside of the wrist of the left hand. The LDF signals are simultaneously recorded for fingertip and wrist. The amplitude of blood flow signals and wavelet analysis of the signal are used for the analysis of blood perfusion parameters. The aim of this pilot study is to validate the accuracy of blood circulation measurements recorded by one such non-invasive wearable LDF device for healthy young non-smokers and smokers. This study reveals a higher level of blood perfusion in the non-smoker group compared to the smoker group and vice-versa for the variation of pulse frequency. This result can be useful to assess the sensitivity of the wearable LDF sensor in determining the effect of nicotine for smokers as compared to non-smokers and also the blood microcirculation in smokers with different pathologies.

Holistic dermatology: An evidence-based review of modifiable lifestyle factor associations with dermatologic disorders

BACKGROUND

Holistic dermatology focuses on treating the human body as a whole and implementing lifestyle changes to enhance the treatment and prognosis of skin disease. Understanding the interplay between modifiable lifestyle factors and patients' dermatologic health will help physicians better inform patients on self-care methods to mitigate the burden of their skin disease(s).

OBJECTIVE

To review the current scientific literature on the relationship between modifiable lifestyle factors and the dermatologic outcome of skin disorders.

METHODS

A systematic literature search on PubMed, Cochrane, and Web of Science was conducted to identify research articles examining the relationship between dermatology and 6 major categories of modifiable lifestyle factors: diet, sleep, exercise, stress, alcohol, and smoking.

RESULTS

A substantial amount of evidence supports the relationship between modifiable lifestyle factors and dermatologic outcomes. There were the most studies on diet, stress, alcohol, and smoking, but all lifestyle factors were supported by some degree of scientific evidence.

CONCLUSION

All modifiable lifestyle factors explored in this review play a critical role in modulating the onset and progression of skin disease. We anticipate more research studies in the future and an increasing integration of holistic dermatology into patient care.

Smoking is associated with ulnar nerve entrapment: a birth cohort study

Ulnar nerve entrapment is the second most common compression neuropathy of the upper extremity. It has been associated with smoking in cross-sectional studies. Our aim was to study whether smoking is associated with ulnar nerve entrapment. The study population consisted of the Northern Finland Birth Cohort 1966 participants, who attended the 31-year follow-up in 1997 (N = 8,716). Information on smoking, body mass index (BMI), long-term illnesses, and socio-economic status were recorded at baseline in 1997. Data on hospitalizations due to ulnar nerve entrapment neuropathies was obtained from the Care Register for Health Care, 1997-2016. Hazard ratios (HR) with 95% confidence intervals (CI) and population attributable risk (PAR) were calculated adjusted for gender, BMI and socio-economic status. 66 patients were diagnosed with ulnar nerve entrapment in the follow-up 1997-2016. Before the age of 31 years, smoking ≤10 pack years associated with more than doubled (HR = 2.57, 95% CI = 1.29-5.15) and smoking >10 pack years with more than five-folded (HR = 5.61, 95% CI = 2.80-11.23) risk for ulnar nerve entrapment compared to non-smokers in the adjusted analyses. Adjusted PAR for smoking (reference of no smoking) was 53.6%. In our study, smoking associated with increased risk for ulnar nerve entrapment, accounting for considerable proportion of increased risk.

Introduction to skin aging

Cutaneous science has seen considerable development in the last 25 years, in part due to the Omics revolution, and the appreciation that this organ is hardwired into the body's key neuro-immuno-endocrine axes. Moreover, there is greater appreciation of how stratification of skin disorders will permit more targeted and more effective treatments. Against this has been how the remarkable extension in the average human life-span, though in the West at least, this parallels worrying increases in lifestyle-associated conditions like diabetes, skin cancer etc. These demographic trends bring greater urgency to finding clinical solutions for numerous age-related deficits in skin function caused by extrinsic and intrinsic factors. Mechanisms for aging skin include the actions of reactive oxygen species (ROS), mtDNA mutations, and telomere shortening, as well as hormonal changes. We have also significantly improved our understanding of how to harness the skin's considerable regenerative capacity e.g., via its remarkable investment of stem cell subpopulations. In this way we hope to develop new strategies to selectively target the skin's capacity to undergo optimal wound repair and regeneration. Here, the unsung hero of the skin regenerative power may be the humble hair follicle, replete with its compliment of epithelial, mesenchymal, neural and other stem cells. This review introduces the topic of human skin aging, with a focus on how maintenance of function in this complex multi-cell type organ is key for retaining quality of life into old age.

The impact of smoking on neurosurgical outcomes

Cigarette smoking is a common health risk behavior among the general adult population, and is the leading preventable cause of morbidity and mortality in the US. The surgical literature shows that active tobacco smoking is a major risk factor for perioperative morbidity and complications, and that preoperative smoking cessation is an effective measure to lower these risks associated with active smoking. However, few studies have examined the effects of smoking and perioperative complications following neurosurgical procedures. The goal of this review was to highlight the scientific data that do exist regarding the impact of smoking on neurosurgical outcomes, to promote awareness of the need for further work in the specific neurosurgical context, and to suggest ways that neurosurgeons can promote smoking cessation in their patients and lead efforts nationally to emphasize the importance of preoperative smoking cessation. This review indicates that there is limited but good evidence that smoking is associated with higher rates of perioperative complications following neurosurgical intervention. Specific research is needed to understand the effects of smoking and perioperative complications. Neurosurgeons should encourage preoperative smoking cessation as part of their clinical practice to mitigate perioperative morbidity associated with active smoking.

Telangiectasia macularis multiplex acquisita: a new entity in Chinese populations and an analysis of associated factors

BACKGROUND

  Telangiectasia macularis multiplex acquisita (TMMA) is a rarely documented entity with distinctive clinical manifestation. Most patients are middle-aged adults. It may be associated with other diseases such as hepatitis, diabetes, or cardiovascular diseases.

OBJECTIVES

  To assess the clinical presentation of TMMA and its association to other systemic diseases, especially the correlation to liver disease, in Taiwan.

METHODS

  We identified and retrospectively analyzed clinical criteria-matched and skin biopsy-proven patients from 2002 to 2010 at a single medical center. The clinical criteria for diagnosis of TMMA included: (i) crops of telangiectasia superimposed on erythematous macules symmetrically on bilateral upper arms, possibly extending to the forearms, shoulders, V-shaped area of the anterior chest, back or thighs; (ii) no mucosal or systemic involvement; (iii) not associated with autoimmune diseases, such as lupus erythematosus, dermatomyositis or systemic scleroderma that may induce cutaneous telangiectasia; and (iv) no ataxia or unsteady gait.

RESULTS

  Twenty-five patients were enrolled in this study. The male-to-female ratio was 19:6. The age of onset was variable, mostly between the third to sixth decades. The V-shaped area of the anterior chest was commonly involved (68%), in addition to the arms (100%). Viral hepatitis was diagnosed in 56.5% of the patients (13/23); 38.9% (7/18) and 50% (9/18) of the patients had diabetes and hypertension, respectively. In addition, 64.7% of the patients (11/17) had dyslipidemia. The pathological reports of most cases showed only mild perivascular lymphocytic infiltration with or without telangiectasia.

CONCLUSIONS

  TMMA should be assigned to a distinct entity with unique clinical manifestation. It has not been well recognized and mostly misdiagnosed as other diseases with telangiectasia. It is important to evaluate the complete liver function tests when TMMA is suspected.

Cigarette smoking: a risk factor for postoperative morbidity and 1-year mortality following craniotomy for tumor resection

Object

Identifying risk factors for surgical morbidity and mortality might improve the safety and efficacy of neurosurgical intervention. Cigarette smoking is a relatively common practice and is associated with several adverse health outcomes. The authors examined the relationship between smoking and intraoperative blood loss, postoperative outcomes, and survival following craniotomy for tumor resection.

Methods

A consecutive population of patients undergoing craniotomy for tumor resection between 2006 and 2009 was identified. Using multivariable models and Cox proportional hazard regression analysis, the authors assessed the relation between smoking and operative outcomes including blood loss, complication rates, hospital length of stay, 30-day mortality, and 1-year survival among patients who underwent craniotomy for tumor resection.

Results

A total of 453 patients were included in this study: 237 patients never smoked, 54 quit smoking for at least 1 year, and 162 were current smokers. Current smoking status was an independent risk factor for higher intraoperative blood loss, complication risk, and lower 1-year survival following intervention relative to patients who never smoked. Patients who quit smoking had significantly higher mean blood loss, but did not carry a higher risk for other outcomes such as postoperative complications and 1-year mortality compared with patients who never smoked.

Conclusions

Current cigarette smoking is associated with poor surgical outcome and lower 1-year survival after undergoing craniotomy for tumor resection. However, quitting smoking and implementing strict smoking cessation programs may help mitigate these risks. Future research might investigate mechanisms underlying these associations.

The determinants of periorbital skin ageing in participants of a melanoma case-control study in the U.K

BACKGROUND

Skin ageing is said to be caused by multiple factors. The relationship with sun exposure is of particular interest because the detrimental cutaneous effects of the sun may be a strong motivator to sun protection. We report a study of skin ageing in participants of an epidemiological study of melanoma.

OBJECTIVES

To determine the predictors of periorbital cutaneous ageing and whether it could be used as an objective marker of sun exposure.

METHODS

Photographs of the periorbital skin in 1341 participants were graded for wrinkles, degree of vascularity and blotchy pigmentation and the resultant data assessed in relation to reported sun exposure, sunscreen use, body mass index (BMI), smoking and the melanocortin 1 receptor (MC1R) gene status. Data were analysed using proportional odds regression.

RESULTS

Wrinkling was associated with age and heavy smoking. Use of higher sun-protection factor sunscreen was protective (P = 0·01). Age, male sex, MC1R variants ('r', P=0·01; 'R', P=0·02), higher reported daily sun exposure (P=0·02), increased BMI (P=0·01) and smoking (P=0·02) were risk factors for hypervascularity. Blotchy pigmentation was associated with age, male sex, higher education and higher weekday sun exposure (P=0·03). More frequent sunscreen use (P=0·02) and MC1R variants ('r', P=0·03; 'R', P=0·001) were protective.

CONCLUSIONS

Periorbital wrinkling is a poor biomarker of reported sun exposure. Vascularity is a better biomarker as is blotchy pigmentation, the latter in darker-skinned individuals. In summary, male sex, sun exposure, smoking, obesity and MC1R variants were associated with measures of cutaneous ageing. Sunscreen use showed some evidence of being protective.

ASSESSMENT OF PROXIMAL INTERPHALANGEAL JOINTS IN PATIENTS WITH OSTEOARTHRITIS VIA LASER DOPPLER PERFUSION IMAGING

The study aims to determine whether the LDPI technique can provide an objective indication of synovial hyperaemia associated with inflamed finger joints. In addition, it hopes to obtain more information about the influence of pain and stiffness on the cutaneous blood flow and assess whether skin perfusion can be used as an index to evaluate these clinical parameters of Osteoarthritis.

Except for the deformed joint, the red laser source (λ = 632.8 nm, visible red) failed to detect any hyperaemic areas associated with joint inflammation in patients with Osteoarthritis (OA). Measurements taken over the PIP joints of both groups have shown a good repeatability for all between-day measurements. However, the variation in between-day perfusion of the OA group is greater compared to the normal control. For majority of the subjects, perfusion in the adjacent skin tends to be lower and fluctuate less than that in their PIP joints. The study also indicates some correlation between the blood perfusion with pain and stiffness of the finger joints.

Overall, the present finding suggests that a longer wavelength near-infrared laser have considerable potential for this form of imaging and that LDI can offer a convenient means of rapidly assessing an inflamed joint non-invasively. Further clinical studies in these areas are warranted.

The impact of chronic smoking on rectal mucosal blood flow

BACKGROUND

Chronic smoking adversely affects peripheral vasculature. The aim of the present study was to investigate the effect of chronic cigarette smoking on rectal microvascular blood flow.

METHODS

Rectal mucosal blood flow (MBF) was measured in 80 subjects (44 smokers and 36 non-smokers). The MBF was measured in the four quadrants of the rectum by laser Doppler flowmetry.

RESULTS

Rectal perfusion was found to be significantly lower in posterior midline compared to the other sites. In chronic smokers the observed MBF measured at the posterior and ventral sites was significantly lower compared to non-smokers (P = 0.04 and P = 0.03, respectively).

CONCLUSIONS

Our results suggest that rectal mucosal blood flow is reduced in chronic smokers.

Cigarette Smoking and Cutaneous Damage in Systemic Lupus Erythematosus: Table 1

Objective.

To evaluate the association between cigarette smoking and cutaneous damage in systemic lupus erythematosus (SLE).

Methods.

Our study was performed in SLE clinic registry cohort patients, all of whom fulfilled revised American College of Rheumatology criteria for SLE; patients are followed prospectively with annual assessments that include collection of demographic variables, smoking history, disease activity (SLE Disease Activity Index version 2000, SLEDAI-2K), medications, and damage scores (Systemic Lupus International Collaborating Clinics/ACR Damage Index). Cumulative cutaneous damage scores were used for the primary analyses. Logistic and logit regression models were performed to examine potential associations between current smoking and cutaneous damage, controlling for age, sex, race, lupus disease duration, antimalarial or immunosuppressant use, and anti-DNA and anti-SSA antibody status.

Results.

Of our sample (N = 276), 92% were women and 73.7% were Caucasian; the mean age was 45.1 years, mean disease duration 13.5 years, and 17.5% were current smokers. In the regression analyses, current cigarette smoking was associated with total cutaneous damage (OR 2.73, 95% CI 1.10, 6.81) and with scarring (OR 4.70, 95 CI 1.04, 21.2). In additional analyses, current smoking was also associated with active lupus rash (OR 6.18, 95% CI 1.63, 23.3).

Conclusions.

Current cigarette smoking may be associated with cutaneous damage and active lupus rash in SLE, suggesting another reason to emphasize smoking cessation in patients with SLE.

Does rectal mucosal blood flow affect the outcome of transanal advancement flap repair?

INTRODUCTION

Transanal advancement flap repair provides a useful tool for the treatment of high transsphincteric fistulas. Recent studies indicate that transanal advancement flap repair fails in one of every three patients. Until now no definite risk factors for failure have been identified. A previous pilot study, conducted in our own institution, revealed a significant decrease in rectal mucosal blood flow after creation of the advancement flap. We postulated that impaired blood flow might result in breakdown of the distal part of the flap. This study was designed to evaluate the effect of rectal mucosal blood flow on the outcome of transanal advancement flap repair.

METHODS

Between August 2004 and June 2007 a series of 54 patients with a high transsphincteric fistula underwent transanal advancement flap repair. The present series comprised 34 males and 20 females. Median age at the time of repair was 45 (range, 25-68) years. Rectal mucosal blood flow was determined by laser Doppler flowmetry before and after creation of the flap. The flow was expressed in arbitrary units.

RESULTS

Transanal advancement flap repair was successful in 34 patients (63%). Median healing time was 2.2 months. Median mucosal blood flow before and after transanal advancement flap repair was 145 arbitrary units and 94 arbitrary units, respectively. This decrease was statistically significant. In a comparison of patients with and patients without a successful repair, no differences were found in mucosal blood flow before and after creation of the flap (146 vs. 138 arbitrary units and 83 vs. 104 arbitrary units).

CONCLUSION

Rectal mucosal blood flow does not affect the outcome of transanal advancement flap repair.

[Effect of cigarette smoking on skin perfusion of the hand]

BACKGROUND

Cigarette consumption leads to postoperative wound healing disturbances by impairing skin circulation.

MATERIALS AND METHODS

Fourteen nonsmokers and 44 smokers were investigated and classified according to age (<40 and >40 years) and duration of cigarette consumption. Circulation at the tip of the middle finger was measured in both groups under standard conditions with laser Doppler imaging.

RESULTS

There was a reduction in skin blood circulation of 24% in smokers (young 39%, older 11%, P=0.001) and 30% in nonsmokers (young 35%, older 18%, P=0.019). With longer duration of cigarette consumption, the effect grew weaker (<10 years 25%, 11-30 years 18%, >30 years 15%). There was no correlation between the number of cigarettes consumed per day and impaired circulation.

CONCLUSION

Younger subjects react to cigarette consumption with a stronger reduction in circulation. In elective surgery, especially in young smokers we recommend a 6- to 8-week nicotine abstinence prior to surgical intervention.

Risk reduction: Perioperative smoking intervention

Smoking is a well-known risk factor for perioperative complications. Smokers experience an increased incidence of respiratory complications during anaesthesia and an increased risk of postoperative cardiopulmonary complications, infections and impaired wound healing. Smokers have a greater risk of postoperative intensive care admission. Even passive smoking is associated with increased risk at operation. Preoperative smoking intervention 6-8 weeks before surgery can reduce the complications risk significantly. Four weeks of abstinence from smoking seems to improve wound healing. An intensive, individual approach to smoking intervention results in a significantly better postoperative outcome. Future research should focus upon the effect of a shorter period of preoperative smoking cessation. All smokers admitted for surgery should be informed of the increased risk, recommended preoperative smoking cessation, and offered a smoking intervention programme whenever possible.

Digital Skin Blood Flow as an Indicator for Intravascular Injection of Epinephrine-Containing Simulated Epidural Test Dose in Sevoflurane-Anesthetized Adults

I designed this study to determine the efficacy of heart rate (HR), systolic blood pressure (SBP), and digital skin blood flow (DSBF) in detecting intravascular injection after a simulated epidural test dose containing 15 mug of epinephrine in sevoflurane-anesthetized adults. In addition, the testing threshold using DSBF was derived. Eighty patients were randomized to receive either 0.5 minimum alveolar anesthetic concentration (MAC) sevoflurane or 1.0 MAC sevoflurane and nitrous oxide in oxygen (n = 40 for each sevoflurane concentration). Each group of patients was further randomized to receive either 3 mL of 1.5% lidocaine containing 15 mug of epinephrine IV or 3 mL of saline IV (n = 20 each). HR, SBP, and DSBF were monitored for 5 min after injection. By using the HR (positive if >or=10 bpm increase) and SBP (positive if >or=15 mm Hg increase) criteria, a positive response rate to epinephrine was 95% for both variables during 0.5 MAC and 90% during 1.0 MAC sevoflurane anesthesia. Injection of the test dose resulted in peak DSBF decrease by 87% +/- 8% and 81% +/- 12% at 52 +/- 10 and 53 +/- 13 s in the sevoflurane 0.5 and 1.0 MAC groups, respectively. Positive DSBF criterion, as determined from peak increases during saline administration, was a decrease in DSBF >or=15%. Using this value, the sensitivity, specificity, positive predictive value, and negative predictive value were 100% in both sevoflurane groups. In conclusion, DSBF was superior to conventional hemodynamic criteria for detection of an intravascular injection of epidural test dose.

IMPLICATIONS

This study examined the efficacy of digital skin blood flow to detect an intravascular injection of an epinephrine-containing epidural test dose. This new variable when measured with a laser Doppler flowmeter was superior to conventional hemodynamic criteria during sevoflurane anesthesia.

Effect of smoking and sun on the aging skin

Smoking and ultraviolet radiation are known to have a detrimental effect on human skin. Important characteristics of the aging skin are elastosis and telangiectasia. The purpose of the study was to assess the relative importance of age per se, and the detrimental effects caused by sun exposure and smoking on the development of cutaneous elastosis and telangiectasia in a well-defined group of individuals. We made use of 966 individuals who participated in a case-control study to investigate environmental and genetic risk factors for skin cancer. Exposure measurements for sunlight and smoking were collected and the amount of elastosis and telangiectasia in the face and neck was recorded according to a four-graded score varying from none to severe. Relative risks were estimated using exposure odds ratios from cross-tabulation and logistic regression. Multivariate logistic regression was used to adjust for potential confounders. Among both sexes a strong association was observed between increasing age, sun exposure, and amount of elastosis. The association between increasing age, sun exposure, and amount of telangiectasia was strong among men, but less apparent among women. Smoking was also associated with elastosis among both sexes, and with telangiectasia predominantly among men. Intrinsic differences between men and women (e.g., hormones) or behavior differences (e.g., more frequent use of creams and cosmetics among women) could account for this apparent difference in the occurrence of telangiectasia. In contrast to elastosis, telangiectasia may not be a good marker of the aging skin, specifically not in women.

Association between tobacco use and metastatic neck disease

OBJECTIVES/HYPOTHESIS

Tobacco has multiple effects on connective tissues that might affect tumor behavior. This study examined the association between tobacco use and tumor behavior (lymphatic metastasis and extracapsular spread) in head and neck cancers.

STUDY DESIGN

Chart audit.

METHODS

Medical records of patients from the Department of Otolaryngology, University of Pittsburgh Medical Center (Pittsburgh, PA) with oral cavity, pharyngeal, and laryngeal cancers who underwent neck dissection were reviewed focusing on their tobacco use habits, as well as the clinical and pathological criteria of primary tumors and cervical lymph nodes. Univariate and multivariate analyses were performed to study the significance between pathological and tobacco use variables.

RESULTS

The study included 171 patients. Both univariate and multivariate analyses revealed significant associations between tobacco use and pathological findings. Cervical metastasis was observed in 100% of tobacco users and 54% of nonusers (P <.0001). Extracapsular spread was observed in 100% of tobacco users and 19% of nonusers (P <.0001). Tobacco use was independently associated with pathological nodal stage in multivariate analysis. Former users and light users of tobacco were not at reduced risk of cervical metastasis or extracapsular spread.

CONCLUSIONS

The study demonstrates that tobacco use is a possible risk factor for cervical metastasis and extracapsular spread, which may be helpful information in planning therapy for patients with clinically staged node-negative necks.

Complications of postmastectomy breast reconstructions in smokers, ex-smokers, and nonsmokers

Smoking results in impaired wound healing and poor surgical results. In this retrospective study, we compared outcomes in 155 smokers, 76 ex-smokers, and 517 nonsmokers who received postmastectomy breast reconstructions during a 10-year period. Ex-smokers were defined as those who had quit smoking at least 3 weeks before surgery. Transverse rectus abdominis musculocutaneous (TRAM) flap surgery was performed significantly less often in smokers (24.5 percent) than in ex-smokers (30.3 percent) or nonsmokers (39.1 percent) (p < 0.001). Tissue expansion followed by implant was performed in 112 smokers (72.3 percent), 50 (65.8 percent) ex-smokers, and 304 nonsmokers (58.8 percent) (p = 0.002). The overall complication rate in smokers was 39.4 percent, compared with 25 percent in ex-smokers and 25.9 percent in nonsmokers, which is statistically significant (p = 0.002). Mastectomy flap necrosis developed in 12 smokers (7.7 percent), 2 ex-smokers (2.6 percent), and 8 nonsmokers (1.5 percent) (p < 0.001). Among patients receiving TR4AM flaps, fat necrosis developed in 10 smokers (26.3 percent), 2 ex-smokers (8.7 percent), and 17 nonsmokers (8.4 percent). Abdominal wall necrosis was more common in smokers (7.9 percent) than in ex-smokers (4.3 percent) or nonsmokers (1.0 percent). In this large series, tissue expansion was performed more often in smokers than was autogenous reconstruction. Complications were significantly more frequent in smokers. Mastectomy flap necrosis was significantly more frequent in smokers, regardless of the type of reconstruction. Breast reconstruction should be done with caution in smokers. Ex-smokers had complication rates similar to those of nonsmokers. Smokers undergoing reconstruction should be strongly urged to stop smoking at least 3 weeks before their surgery.

Cigarette smoking-associated elastotic changes in the skin

BACKGROUND

Clinical features of the skin in persons who smoke include increased wrinkling, gauntness, and discoloration that has been termed smoker's face. The histologic changes in the sun-exposed skin of these patients have not been previously elucidated.

OBJECTIVE

The purpose of this study was to assess the amount of elastosis in the sun-exposed skin of smokers and nonsmokers.

METHODS

We evaluated the skin from the forehead and cheeks of 17 smokers and 14 nonsmokers for the presence of elastosis. With the use of a computer-generated analysis of tissue sections at 4 different levels, the amount of elastotic material was expressed as an average percent of the field staining for elastic tissue. Patients were also evaluated for the presence of other malignancies, arsenic and radiation exposure, and previous skin cancers.

RESULTS

There was a significantly greater amount of elastosis (P < .05) in the skin of patients who smoked compared with those patients who did not. No significant differences were found between the 2 groups with regard to the other parameters evaluated.

CONCLUSION

Cigarette smoking is associated with an increase in elastosis, which may contribute to the clinical features of "smoker's face."

Evaluation of skin blood flow by laser Doppler flowmetry

Laser Doppler flowmetry is an excellent noninvasive technique for the measurement of cutaneous microcirculation. The list of applications of laser Doppler flowmetry in dermatology is long. It can be applied to monitor inflammation caused by various drugs, chemicals, and allergens related to blood flow. To measure certain inflammatory reactions a combination of other bioengineering measurements is desirable. Flaps can be monitored, and burn depth measured by laser Doppler flowmetry. Through blood flow measurement, the pathophysiology of various skin diseases can be verified and certain treatments can be partially monitored. Although it is not as directly applicable to daily clinical practice, except in a few cases, laser Doppler flowmetry is a very useful technique in various kinds of dermatologic research.

Cutaneous blood flow abnormalities in hypertriglyceridemia

An accelerated atherosclerosis, in particular of the coronary arteries, was documented in hypertriglyceridemia. The objective of the present study was to assess the cutaneous dynamic blood flow in hypertriglyceridemia, utilizing the optical noninvasive method of laser Doppler flowmetry. The cutaneous blood flow on the forearms was measured during the postischemic reactive hyperemia test in treated and non-treated patients with hypertriglyceridemia and healthy control subjects. The subjects were 32 patients with hypertriglyceridemia--15 untreated and 17 following 6-9 months of bezafibrate treatment--and 27 healthy control subjects. In untreated patients with hypertriglyceridemia, the peak flow was significantly lower than in both the treated group (p < 0.005) and control group (p < 0.02). Similarly, the area under the response-time curve of the untreated patients with hypertriglyceridemia was smaller (p < 0.01 and p < 0.05, respectively). These parameters were similar in the treated group and the control group. The reaction was faster in the treated group, as compared to the other two groups (p < 0.001). The control group exhibited a longer time to decay than the treated group (p < 0.01). Postischemic reactive hyperemia tests in patients with hypertriglyceridemia reveal cutaneous microcirculatory changes in the forearm. These changes may arise from several mechanisms, including functional abnormalities of the endothelium or vascular smooth muscle, or structural changes in the blood vessels that limit vasodilatation. These changes are reversible, and corrected when reducing the triglyceride levels, but other abnormalities are then present, suggesting a permanent damage. These dynamic measurements of cutaneous blood flow are sensitive indicators of atherogenesis, and can be employed for the evaluation of microvascular involvement and follow-up of patients with hypertriglyceridemia.

Cutaneous blood flow in gestational hypertension and normal pregnancy

A laser Doppler flowmeter was used to assess skin blood flow changes in three groups of young subjects: women with gestational hypertension, healthy pregnant women, and healthy non-pregnant women. Responses to four vasoactive stimuli were studied: isometric and cognitive activities, cutaneous post ischemic reactive hyperemia, and local heating. The first two stimuli are vasoconstrictive and were performed on the fingertip, whereas the latter two are vasodilative and were performed on the forearm. The most prominent differences were observed in the isometric test, where the expected decrease, which was indeed registered in non-pregnant women, was almost absent in the healthy pregnant group. The gestational hypertension group had a greater decrease in blood flow than normal pregnancy, but lesser than non-pregnant control subjects. We conclude that although normal pregnancy modifies the response of the skin microvasculature to some vasoactive stimuli, gestational hypertension pushes that response back toward the non-pregnancy state.