Factors determining ICD implantation in drug therapy patients after termination of antiarrythmics versus implantable defibrillators trial

Because of a significant survival benefit in the defibrillator arm of the Antiarrhythmics versus Implantable Defibrillator (AVID) Trial, patients in the antiarrhythmic drug (AAD) arm were advised to undergo ICD implantation. Despite this recommendation, ICD implantation in AAD patients was variable, with a large number of patients not undergoing ICD implantation. Patients were grouped by those who had been on AAD < 1 year (n = 111) and those on AAD > 1 year (n = 223). Multiple clinical and socioeconomic factors were evaluated to identify those who might be associated with a decision to implant an ICD. The primary reason for patients not undergoing ICD implantation was collected, as well as reasons for a delayed implantation, occurring later than 3 months from study termination. Of 111 patients on AAD for less than 1 year, 53 received an ICD within 3 months compared to 40/223 patients on AAD for more than 1 year (P < 0.001). Patient refusal was the most common reason to not implant an ICD in patients on drug < 1 year; physician recommendation against implantation was the most common in patients on drug > 1 year. Multivariate analysis showed ICD recipients on AAD < 1 year were more likely to be working and have a history of myocardial infarction (MI), while those on AAD > 1 year were more likely to be working, have a history of MI and ventricular fibrillation, and less likely to have experienced syncope, as compared to those who did not get an ICD. Having private insurance may have played a role in younger patients receiving an ICD.     

Ancillary studies in clinical trials

BACKGROUND: Randomized clinical trials offer unique opportunities for testing questions of relevance to nursing through the mechanism of ancillary studies. APPROACH: A review of the strategies to prepare and negotiate an ancillary study through a randomized clinical trial structure is offered. RESULTS: Several steps are required that are unique to the ancillary studies arena. These steps involve (a) accessing the main trial; (b) obtaining approval; (c) funding; and (d) publication. There are hurdles and strategies to address them. DISCUSSION: Collaboration and compromise are the keys to success in the conduct of an ancillary study of scientific merit. The cost-effectiveness, excellent collaboration, and the opportunity to further develop one's research skills and research program in a highly scientific interdisciplinary environment are well worth the effort.     

Ongoing and planned clinical trials of anti-arrhythmic drugs: an update

Anti-arrhythmic drug therapy is frequently used for the control of ventricular arrhythmias in the setting of heart disease. These agents have been used in many randomised clinical trials in an attempt to demonstrate improved survival. However, most studies have been disappointing, showing little or no improvement in survival, and, in some cases, deterioration. This report reviews ongoing clinical trials designed to evaluate survival in specific patient populations.     

Lymphoma cells in cerebrospinal fluid confirmed by chromosome analysis

Two cases of malignant lymphoma are reported, in which lymphoma cells were undergoing cell division in the cerebrospinal fluid. In each case it was possible to perform chromosome counts and karyotype analyses, and in this way to establish that a neoplastic clone was present.     

The histogenesis of small cell carcinoma of the prostate. An immunohistochemical study

Small cell carcinomas of the prostate are rare. A few reported cases have manifested morphologic and functional neuroendocrine characteristics, and it has been suggested that these tumors are derived from the argentaffinic/argyrophilic cells normally present in the prostate. The authors have recently studied three cases of primary prostatic small cell carcinoma in which the small cell component developed during the course of progression of "regular" prostatic adenocarcinoma, and reflected a terminal aggressive phase of the disease. Immunoperoxidase staining for prostate-specific acid phosphatase (PSAP) showed positivity in the adenocarcinoma but absence in the small cell component of each tumor. The association of small cell carcinoma with prostatic adenocarcinoma indicates that in considering the histogenesis of prostatic small cell carcinoma, a specific neuroendocrine cell of origin need not be implicated.