Cost of surgical intervention for reconstructive therapy of HIV-associated facial lipoatrophy.

This study aims to assess direct cost of reconstructive interventions with facial fillers for treatment of HIV (human immunodeficiency virus)-associated facial lipoatrophy (FLA). Evaluation was performed on data from patients enrolled in one arm of a comparative study of immediate versus delayed reconstructive treatment of facial lipoatrophy. Median costs were standardized for efficacy, estimated using data reported by physicians and patient reported outcomes. The variations of the results were evaluated with a sensitivity analysis. Evaluation was performed on 66 patients characterized by significant differences in terms of severity of FLA. Total cost resulted of €140,416.15, with a median cost per patient of €2126.04 (interquartile range [IQR]: 1599-2822). Taking into consideration severity of disease, median costs were €1641.67 (IQR: 1326.67-2126.04) and 2557.12 (IQR: 1939.34-2872.04) (P = 0.0) respectively for patients with low and high severity scores at baseline. Significant differences in term of cost-effectiveness ratios were also found between patients with different severity of FLA, and sensitivity analysis showed that these ratios increase with higher severity scores at baseline and vary widely depending on the costs of filler. Although these results cannot be considered representative because of important limitations, the present study suggests the severity of disease as an important determinant of costs.

Evaluation of p,p'-DDE, p,p'-DDT and polychlorobiphenyls (PCBs) levels in samples of human milk from Rome, Florence and the surrounding areas.

Sixty-five samples of human milk obtained from individual donors living in Rome and surrounding areas between 1982 and 1984, and 28 samples from Florence and surrounding areas obtained during 1985 were analyzed for residues of p,p'-DDE, p,p'-DDT and PCBs. Levels of p,p'-DDE were between 5 and 126 ppb (micrograms/kg of milk), with an average value of 45 ppb (median 34). Levels of p,p'-DDT ranged from 1 to 79 ppb, with an average value of 10 ppb (median 7). PCBs were found at levels ranging from 7 to 304 ppb, with an average value of 74 ppb (median 66). As to the p,p'-DDT, when compared to the data previously obtained in Italy during 1975-77, the present findings show a decrease of the average value and a lower incidence of samples with higher values. These effects are less pronounced for the p,p'-DDE. No relevant variation was observed in the levels of PCBs in comparison with the data obtained in Italy during 1981-82.

Selective, on-column extraction of organochlorine pesticide residues from milk.

A rapid procedure has been developed that allows a single-step, selective extraction of organochlorine pesticide (OCP) residues from milk on solid-matrix disposable columns by means of acetonitrile-saturated light petroleum. Recovery experiments were carried out on homogenized milk (3.6% fat content) spiked with an ethanolic solution of nine OCPs, viz., HCB, alpha-HCH, beta-HCH, gamma-HCH, heptachlor epoxide, dieldrin, endrin, p,p'-DDE and p,p'-DDT, at levels ranging from 0.002 mg/kg for alpha-HCH to 0.008 mg/kg for p,p'-DDT. Average recoveries of four replicates were 77% for HCB and almost quantitative (94-113%) for the other pesticides, with relative standard deviations from 2.9 to 7.3%. Coextracted fatty material amounted to about 5 mg/ml of milk before the clean-up. The described procedure also showed a satisfactory performance with milk powder. The extraction procedure requires about 60 min. The main advantages are that emulsions do not occur, several samples can be run in parallel by a single operator, reusable glassware is not needed and simple operations are required.