Positron emission tomography/computed tomography introduction in the clinical management of patients with suspected recurrence of ovarian cancer: a cost-effectiveness analysis

Aim of this study was to evaluate the economic impact of the introduction of positron emission tomography/computed tomography (PET/CT) in the early detection of recurrent ovarian cancer through a cost-effectiveness analysis of different diagnostic strategies. Thirty-two consecutive patients with suspected ovarian cancer recurrence, studied by both contrast enhanced abdominal CT and PET/CT, were retrospectively included in the study. Three different diagnostic strategies were evaluated and compared: (1) CT only or baseline strategy; (2) PET/CT for negative CT or strategy A; (3) PET/CT for All or strategy B. For each one, expected costs, avoided surgery and incremental cost-effectiveness ratio (ICER) were calculated to identify the most cost-effective strategy. The number of positive patients increased from baseline strategy (20/32) to strategy A and B (30/32 and 29/32 respectively). Positron emission tomography/computed tomography reoriented physician choice in 31% and 62% of patients (strategies A and B respectively). Strategy A is dominated by strategy B, which is more expensive (2909€ vs. 2958€), but also more effective (3 cases of surgery avoided) and presents an ICER of 226.77€ per surgery avoided (range: 49.50–433.00€). Positron emission tomography/computed tomography introduction in this population is cost-effective and allowed to redirect the clinical management of patients towards more appropriate therapeutic choices.     

Fourier Analysis in Patients with Different Pacing Modes

The purpose of this study was to evaluate the usefulness of phase analysis in detecting the altered activation sequence induced by different pacing modes. Radionuclide ventriculography and planar gated blood pool scintigraphy were performed at rest in 56 patients with different pacemakers. This method permitted us to localize the pacemaker impulse site in the right ventricle and its diffusion in the heart. In patients with VVI pacemaker, this technique showed an evident asynchronism of contraction and relaxation of each ventricle and the standard deviation of phase angle (sigma), calculated by computer, is greater during pacing than sinus rhythm for left (LV) and right (RV) ventricles (LV sigma: 17 degrees +/- 4 vs 11 degrees +/- 3, less than 0.001; RV sigma: 31 degrees +/- 7 vs 14 degrees +/- 4, P less than 0.001). In the patients with VVI rate responsive pacemakers, the LV sigma changed from 18.5 +/- 3 under pacing to 11 degrees +/- 3 in sinus rhythm, P less than 0.001, while the RV sigma changed from 30 degrees +/- 8 to 14 degrees +/- 4, P less than 0.001. Instead in the patients with DDD pacemakers, the LV sigma changed from 15.5 degrees +/- 2 under pacing to 11 degrees +/- 3 in sinus rhythm, P less than 0.05, while the RV sigma changed from 29.1 degrees +/- 6 to 14 degrees +/- 4, P less than 0.001.(ABSTRACT TRUNCATED AT 250 WORDS)     

Evidence for biventricular involvement in acromegaly: a Doppler echocardiographic study

To investigate left and right ventricular involvement in acromegaly,20 patients were studied by Doppler echocardiography. Nine ofthem had systemic hypertension. Right ventricular free wallthickness was significantly increased in acromegalic patients(8 ± 2 vs 4 ± 1 mm; P <0.001). Left ventricularmass index was augmented both in the whole group and in thesubgroup of normotensive acromegalics, as compared with normals(134 ± 33 and 115 ± 20 vs 80 ± 18 g.m^–2,.P <0.01). Ejection phase indices were normal in the patientgroup, while impaired left and right ventricular diastolic fillingwas found. In fact, isovolumic relaxation time was prolonged(118 ± 21 vs 78 ± 12 ms; P <0.001), ratio ofearly to late mitral (0. ± 0.3 vs 1.8±0.5 P<0.001)and tricuspid (1.0±0.2 vs 1.4±0.3 P<0.001 flowvelocities were significantly decreased as compared with controls.Superior vena cava flowmetry was also abnormal showing a markeddecrease of diastolic filling wave and, consequently, of theratio between peak diastolic and peak systolic flow velocity.No significant differences observed between normotensive andhypertensive acromegalics, except for left ventricular massindex (115 ± 20 vs 156 ± 31 g.m^–2; P <0.01).These findings indicate that abnormal diastolic filling patternsof transmitral, transtricuspid, and superior vena cava flowmetrysuggesting ‘impaired relaxation’ associated withincreased left and right ventricular mass, frequently occurin acromegaly.     

Platelet Aggregability in Patients with a VVI Pacemaker

Several studies have suggested an increased incidence of thromboembolic events in patients with VVI pacemaker (VVI patients); furthermore, other authors have demonstrated that a treatment with anticoagulants or antiplatelet drugs may be effective in reducing thromboembolic events, thus suggesting an increased formation of platelet thrombi in these patients. In this respect, platelet aggregability was investigated in ten VVI patients and ten age– and sex–matched subjects. β–thromboglobulin (β–Tg) and platelet factor 4 (PF4) plasma levels were determined as weJJ as platelet aggregation induced by ADP, collagen, epinephrine, and arachidonic acid. Plasma β–Tg JeveJs were increased in the patient group (86 ± 24 vs 24 ± 13 ng/mL; P < 0.001) in presence of normal PF4 values (14 ± 11 vs 13 ± 6 ng/mL; NS). Aggregation curves showed abnormal values of maximal amplitude, slope, and lag time. In particular, maximal amplitude was significantJy higher in VVI patients as compared with controls (ADP P < 0.01, collagen P < 0.001, adrenaline P < 0.01, arachidonic acid P < 0.05). These findings strongly suggest an increase of platelet activity in VVI patients.