Primary Prevention of Sudden Cardiac Death: Can We Afford the Cost of Cardioverter-Defibrillators? Data from the Search-MI Registry-Italian Sub-study

Background: Large randomized trials show that in appropriately selected patients with left ventricular dysfunction, implantable cardioverter-defibrillators (ICDs) can improve overall survival at 2–5 years. Since direct implementation of the criteria used in the MADIT II and SCD-HeFT will lead to a marked rise in ICD implants, there is a growing fear that increased use of ICDs may cause a dramatic burden to health care systems. The ICD has traditionally been seen as an expensive form of treatment, which is difficult to accept at the first look. This is mainly due to the nonlinear character of the ICD investment, characterized by high initial expenditure, followed by a deferred pay-off in terms of clinical benefits. Cost-effectiveness analysis may help provide a different perspective on the problem of ICD cost, as may estimation of the daily cost of ICD treatment, assuming a time horizon of 5–7 years—a particularly interesting subject for further registry studies.
Methods and Results: Based on real expenditure data from 2002 to 2005, as recorded in the Search-MI Registry-Italian Sub-study of patients implanted on MADIT II indications, we estimated the daily costs associated with the device and leads. Over a 5–7 year time horizon, the average daily cost was estimated to be €4.60–€6.70. Translation of these figures into U.S. market conditions suggests a daily cost of around $7.90–$11.40.
Conclusions: These findings appear useful to help evaluate the affordability of ICD in comparison with other therapeutic options in a context of limited available economic resources.     

''Organoid'' thymoma: a well-differentiated variant with distinctive clinicopathological features

The present paper describes the clinical, histological and immunohistochemical features of five cases of 'organoid' thymoma. The histological hallmark of this lesion is the prominent and diffuse 'organoid' pattern, defined by the presence of several areas of medullary differentiation. These areas, which are strictly reminiscent of the medullary area of the normal thymus, are scattered within a neoplastic tissue resembling the thymus cortex, the overall appearance mimicking that of normal thymus. All cases shared common clinical features; they were non-invasive or minimally invasive tumours arising in young or middle-aged female patients. Although the incidence of 'organoid' thymoma is low (5.2% in our series), our morphological, immunohistochemical and clinical data suggest that this peculiar tumour may represent a well-differentiated variant of thymoma, with low-grade aggressiveness and a distinct clinicopathological profile.     

Hospital versus population controls in a retrospective study on diet and stomach cancer

The aim of the present study is to evaluate drawbacks and advantagesof the choice of hospital versus population controls in a casecontrol study on diet and cancer through the analysis of a retrospectivestudy on diet and gastric cancer (GC) conducted in Forli, Italy,involving 232 cases, 430 population controls and 252 hospitalizedcontrols. The present paper reports the comparison of resultson diet and GC risk obtained using the 2 types of controls.Population controls tended, in general, to eat all kinds offoods slightly more frequently (bread, pasta, cold cuts, freshfish, seasoned cheeses, legumes, garlic, onions and preservedfruits), with the exception of cooked vegetables, which werereported less frequently by population than by hospital controls.ORs for specific foods adjusted for confounders and other foodswere consistent in the separate models including populationand hospital controls respectively for all food groups, withthe exception of cooked vegetables which represented a protectivefactor only when hospital controls were considered (high consumers,population controls: adjusted, OR=0.9, trend p value 0.54; highconsumers, hospital controls, adjusted OR=0.5, trend p value<0.01). Hospital controls were slightly less often currentsmokers (22.6 versus 30.0%) and more often regular wine drinkers(57.5 versus 47.8%) compared with population controls, but noneof these variables was associated with GC risk. The main resultsin this study were consistent using both types of controls,nevertheless the distribution of some dietary variables notrelated to the disease under study differed between the 2 controlgroups, suggesting some caution in the use of hospital controlswhen studying diseases other than GC.     

Protein A Reactivity of Lymphocytes from Some Patients with Chronic Lymphocytic Leukaemia Mediated by an Interaction with the F(ab')2 Region of Surface Immunoglobulin

Peripheral blood lymphocytes (PBL) from 15 of 38 patients with chronic lymphocytic leukaemia (CLL) were capable of forming rosettes with human erythrocytes coated with staphylococcal protein A (SpA-HRBC). PEL from seven patients also showed a marked proliferafive response after stimulation with Staphylocccus aureus bacteria strain Cowan I (Cowan Staph). The SpA-rosetling of CLL cells was inhibited by incubation with F(ab')₂ fragments of anli-immimoglobuiin (Ig) antibodies. In addition, incubation with these fragments inhibited the proliferative response of leukacmie B cells to Cowan Staph. The Cowan-Siaph-induced proliferation of CLL cells was also impaired by the addition of normal human IgG and human IgG F(ab')₂ fragments to the cultures, whereas non-immune rabbit IgG was not inhibitory, The inhibitory activity of human IgG F(ab')₂ fragments was retained hy a SpA-Sepharose column, and it was found in the material recovered from the same column by acid elution. These data indicate thai an interaction between SpA and a structure located in the F(ab')₂ region of surface Ig of different classes is responsible for either SpA-binding or the Cowan-Staph-induced proliferate response of PBL from some patients with CLL.     

PLASMA INSULIN DISAPPEARANCE CURVE AFTER INTRAVENOUS INSULIN INJECTION IN HUMAN HYPERTHYROIDISM

The disappearance curves of plasma insulin after intravenous injection of unlabelled pork insulin was studied in nine young female hyperthyroid subjects with Graves' disease and eleven young female normal subjects, who served as controls. Comparison of the curves by analysis of variance did not reveal statistical differences between them (F obtained = 2.8, F F 0.05 = 4.41), implying that there was no significant differences in the transference of injected insulin from plasma to the extra-vascular space between hyper- and euthyroid subjects. The results may suggest that the metabolism of insulin is not appreciably affected in hyperthyroidism.