Abstract

In this issue, two cases are reported in which a vasculitic (Buerger disease) and a thrombotic (Hughes syndrome) condition interact with cigarette smoking with detrimental results. Despite the strong association with many diseases, the debate on the health impact of cigarettes rages on. First described by Felix von Winiwarter¹ in 1879 and subsequently elucidated by Leo Buerger² in 1908, Buerger disease (BD) is a fascinating condition that causes transmural inflammation and occlusion of small and medium vessels. As a disease with a proclivity for affecting individuals in their primes of life, the true cost of BD is often underestimated. These are people who, more often than not, are addicted to nicotine, and possibly to other drugs, and are unlikely to have medical insurance. The treatment of BD is symptomatic, with NSAIDs, oral anticoagulants, and prostanoids playing important roles in slowing the progress of the disease and preventing amputations; however, cigarette smoking must be discontinued.³ The use of vasodilators and/or sympathectomy have been disappointing. Revascularization interventions have similarly had poor results.⁴ Multiple amputations and loss of economic and personal autonomy is the expected result in the patient who continues to smoke.