Cement Loaded With High-Dose Gentamicin and Clindamycin Reduces the Risk of Subsequent Infection After One-Stage Hip or Knee Arthroplasty Exchange for Periprosthetic Infection: A Preliminary Study.

BACKGROUND: The use of antibiotic-loaded acrylic cement for treating periprosthetic joint infections remains controversial. We hypothesized that the raw rate of surgical site infection (SSI) is lower after using cement loaded with high-dose gentamicin and clindamycin than after using cement loaded with standard-dose gentamicin for implant fixation during 1-stage hip and knee revision arthroplasty for infection. METHODS: One hundred seventy-one continuous patients operated by 2 experienced surgeons during a 2-year period were included in the study. All patients were followed for 24 months. The primary endpoint was the raw rate of SSI after 2 years of follow-up time. RESULTS: The raw rate of SSI after 2 years of follow-up time was significantly lower in the study group (13%) than in the control group (26%) (P = .03) with an odds ratio of 0.42 (P = .03). These SSIs were new infections rather than a recurrence/persistence of the initial infection. CONCLUSION: The cement used in the study group significantly reduced the risk of SSI relative to the cement used in the control group. Routine use of this high-dose dual antibiotic-loaded cement can be considered during 1-stage knee or hip revision arthroplasty for infection.

Silicone ring tourniquet or pneumatic cuff tourniquet for total knee arthroplasty.

PURPOSE: The goal of the present study was to evaluate the potential advantages of a silicon ring tourniquet in comparison to the conventional pneumatic cuff tourniquet. The tested hypothesis was that the calculated blood loss will be decreased after use of the silicone ring tourniquet. METHODS: The study was monocentric and mixed retrospective and prospective evaluation of prospectively collected data. Inclusion criterion was implantation of a total knee arthroplasty. The retrospective control group involved 39 patients operated on with a pneumatic cuff tourniquet. The prospective study group involved 33 patients operated on with a silicone ring tourniquet. All patients were followed for three months. Primary criterion was the calculated blood loss (OSTHEO formula). Secondary criteria were pain on third post-op day, need for allogenic transfusion, haemoglobin drop, delay of discharge, and occurrence of complications. RESULTS: The mean calculated blood loss was 901 ml in the study group and 989 ml in the control group (NS). There was no significant difference in pain evaluation and haemoglobin drop between the two groups. There was a non significant decrease of allogeneic transfusion and length of stay in the study group. There was a significant decrease of complication rate in the study group, and especially for skin complications. CONCLUSIONS: The tested hypothesis was not confirmed: there was no significant change in the calculated blood loss. No bias was identified in complication analysis. The decreased rate of skin complication might be a positive influence of the silicone ring tourniquet.

Pharmacokinetics of therapeutic monoclonal antibodies used in oncology.

This review presents the clinical pharmacokinetics of the marketed therapeutic monoclonal antibodies used in oncology. Aspects regarding absorption, tissue distribution, elimination as well as factors influencing pharmacokinetics, pharmacodynamics and kinetic interactions are also discussed.

The effect of rifampin on the pharmacokinetics of vinorelbine in the micropig.

BACKGROUND: Vinorelbine has been shown to be metabolised by CYP3A4 in vitro. To evaluate the impact of CYP3A in the disposition of vinorelbine in vivo, we compared the kinetics of the alkaloid given intravenously alone and combined with rifampin, a potent CYP3A inducer, in the micropig. ANIMALS AND METHODS: Four healthy Yucatan micropigs, about 20 kg, received a first infusion of vinorelbine (0.5 mg/kg). During the next week they were injected rifampin (600 mg daily) and a second vinorelbine infusion (0.5 mg/kg) on the 7th day of rifampin dosing. Serum concentrations of vinorelbine and rifampin were measured by high performance liquid chromatography. RESULTS: The mean peak concentrations of vinorelbine were 274.2 ng/ml (Standard Deviation or SD: 90) and 458 ng/ml (SD: 448), the mean areas under the serum concentration-time curve were 8,344 ng.min.ml-1 (SD: 2,604) and 14,093 ng/ml.min-1 (SD: 10,000) and the total clearances were 1.146 l/min (SD: 0.333) and 1.003 l/min (SD: 0.714) when the Catharanthus alkaloid was given alone or was combined with rifampin, respectively. CONCLUSION: We did not observe an increase in vinorelbine elimination by rifampin related to a CYP3A induction in an animal model physiologically close to humans. Although the number of animals was small, these results suggest that CYP3A metabolism constitutes a minor pathway of elimination of intravenous vinorelbine in the micropig.