Comparison of deep wound infection rates using a synthetic dural substitute (neuro-patch) or pericranium graft for dural closure: a clinical review of 1 year.

OBJECTIVE: The need to repair dural defects has prompted the use of dura mater substitutes. Many synthetic materials have been used for dural closure. Neuro-Patch (B. Braun Médical S.A., Boulogne, France) is a nonabsorbable microporous fleece composed of polyester urethane that has been approved for human use by the European Union since 1995. To the best of our knowledge, no clinical series with Neuro-Patch have been published thus far, particularly with regard to septic complications. The aim of our study was to compare the safety of Neuro-Patch with that of pericranium graft with regard to postoperative wound infections. METHODS: This is a retrospective study of 1 year's experience including all patients who underwent dural plasty with a Neuro-Patch (n = 61) or pericranium graft (n = 63). The follow-up period was at least 12 months after surgery. Before wound infection rates in the two groups were compared, factors suspected of being risks for neurosurgical site infection were evaluated. RESULTS: Patient characteristics (mean age, neurological diagnosis), surgical procedures, prophylactic antibiotics, and risk factors for surgical infections (including duration of surgery, emergency, contaminated operations, and external cerebrospinal fluid drainage) were similar in the Neuro-Patch and pericranium groups. Deep wound infection rates in the Neuro-Patch and pericranium groups were 15 and 5%, respectively (P = 0.06), and cerebrospinal fluid leaks were significantly more frequent in the Neuro-Patch group (13 versus 1.6%, P < 0.05). CONCLUSION: The results of our investigations show that Neuro-Patch raised the risk of wound infection, as do foreign materials implanted in the body. Synthetic dural grafts should be reserved for when autologous grafts are not sufficient or possible. An extensive prospective multicenter randomized trial is needed to confirm our results.

[Treatment of malignant non-Hodgkin's lymphoma. Economic impact of rituximab (Mabthera) versus conventional chemotherapy]. / Traitement des lymphomes malins non hodgkiniens. Répercussions économiques de l'utilisation du rituximab (Mabthera) versus chimiothérapies conventionnelles.

The monoclonal antibody rituximab, targeted against the CD20 antigen, has shown efficacy in patients with follicular lymphoma who relapse or fail to response to conventional chemotherapy. We evaluated the economic impact of using rituximab for the treatment of non-Hodgkin's lymphoma (NLH) in comparison with conventional chemotherapy protocols (CHOP or CHVP). In this retrospective study conducted between 1998 and 2000, the direct costs of treating inpatients with NHL rituximab (n=20) or CHOP/CHVP (n=17) were compared. Results, including costs of administering chemotherapy and adverse events, showed that the average cost per patient was comparable for the two strategies (9700 euro for rituximab, versus 8487 euro for conventional chemotherapy). In the rituximab group, the cost was mostly due to drug purchases. In the conventional chemotherapy group, outlays were related to drug-induced toxicity and longer hospital stay. Our results were similar to others described in the literature. Prospective studies are nevertheless needed for confirmation. For first-line treatement, the difference in the cost-effectiveness-ratio between rituximab and conventional drugs might be smaller, but sound data are not yet available.