The development of Crohn's disease (CD) is related to an interaction of genetic and environmental factors, with tobacco smoking being one of the most commonly studied environmental factors. In 1998, the Vienna classification was created to define CD by using three accepted clinical variables: age at diagnosis, disease behavior, and disease location. In this qualitative systematic review, articles examining the relationship between smoking and CD, using variables outlined in the Vienna classification, were identified utilizing multiple health databases. Current smoking was found to be associated with late-onset CD (> or =40 years old) and current smokers were more likely to progress to stricturing or penetrating type CD than were nonsmoking patients. Conflicting evidence exists regarding the relationship between smoking with respect to CD disease location. The Vienna classification is an important tool in permitting comparisons and predicting clinical course among CD cases, especially when smoking status is taken into account.
An ever-increasing array of chemotherapeutic agents is being used in the treatment of solid organ or hematologic malignancies. The success of many of these agents has led to an increasing survival of patients with cancer. However, many of these agents, particularly anthracyclines and trastuzumab, are associated with the development of cardiotoxicity. The current standard for the evaluation of chemotherapy-associated cardiotoxicity typically involves the use of serial measurements of left ventricular (LV) function by echocardiogram (Echo) and radionuclide ventriculogram (MUGA). Unfortunately, this time-honored method offers low sensitivity to the early prediction or detection of cardiac events. Frequently, by the time cardiotoxicity is detected, significant LV dysfunction has occurred and ultimately this may not respond to standard cardioprotective treatment. Cardiac biomarkers, troponin I and B-type natriuretic peptide, may allow a more accurate and timely monitoring strategy. The current data and a summarized understanding of how to utilize cardiac biomarkers for the prevention and early detection of cardiac dysfunction during chemotherapy are presented.
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