"Recommendations for periprosthetic joint infections (PJI) prevention: the European Knee Associates (EKA)-International Committee American Association of Hip and Knee Surgeons (AAHKS)-Arthroplasty Society in Asia (ASIA) survey of members".

PURPOSE: Periprosthetic joint infections (PJIs) represent a devastating consequence of total joint arthroplasty. The European Knee Associates (EKA), the American Association of Hip and Knee Surgeons (AAHKS) International Committee, and the Arthroplasty Society in Asia (ASIA) board members were interested in quantifying differences in arthroplasty surgeons' use of various PJI prevention measures to provide clinical recommendations to reduce PJI incidence. METHODS: A prospective Microsoft Forms online survey was distributed among EKA, AAHKS International Committee, and ASIA members and their affiliated arthroplasty surgeons. The survey consisted of 20 single and multiple response questions focused on PJI prevention strategies at three perioperative periods: preoperatively, intraoperatively, and postoperatively. RESULTS: Three hundred and ninety-four arthroplasty surgeons from 6 different continents completed the survey. Preoperative: (A) PJI Risk Stratification: 40.6% routinely set thresholds (e.g., BMI, HgbA1C) to be met to qualify for surgery, 36.5% only review past medical history; 9.1% use machine learning to personalize PJI risk; (B) BMI limit: 36% no limit; 15.4% BMI < 35; 30.9% BMI < 40; 17.2% BMI < 45; (C) Nutritional status: 55.3% do not screen; among those who screen their patients (44.7%), albumin is the single most used marker (86.3%); (D) Hyperglycemia/Diabetes: 83.3% check this comorbidity; 88.1% use HgbA1C as single best screening test; (E) MRSA nasal colonization: 63.7% do not test; 28.9% test all patients; 7.4% test selectively. Intraoperative: (A) Antibiotic prophylaxis in high-risk patients: 43.4% use single antibiotic for 24 h; 21.3% use double antibiotic for 24 h; 14.2% use single/double antibiotic for 7 days postoperatively; (B) Skin-cleansing: 68.7% at home (45.6% chlorhexidine sponge; 11.9% clippers); (C) Intraoperative skin disinfection: 46.9% single chlorhexidine; 25% double chlorhexidine-povidone-iodine;15.4% single povidone-iodine; (D) Tranexamic acid (TXA) to reduce bleeding/SSI: 96% yes (51% double IV dose, 35.2% single IV dose, 23.6% intra-articular injection); (E) Surgical suction drain: 52% do not use drains; 19.7% use a drain < 24 h; (F) Intra-articular lavage: 64.9% use only saline; 28.1% use dilute povidone-iodine; (G) Antibiotic local delivery to prevent PJI: 82.4% use antibiotic-added cement. Postoperative: (A) Routine monitoring of PJI serologic markers: 42% only in symptomatic patients; 34.2% do not; 20.8% in all patients; (B) Serologic markers to rule in/out PJI: 95.9% CRP; 71% SEDRATE; 60.6% WBC; (C) Synovial fluid test to rule in/out PJI: 79.6% culture/sensitivity; 69.5% WBC count; 31.4% CRP. CONCLUSIONS: This survey demonstrated that notable differences still exist in the application of PJI preventive measures across different geographic areas: Optimizing the patient preoperatively and applying multimodal intraoperative strategies represent newer, clinically relevant steps in the effort to reduce the burden of PJI. More uniform guidelines still need to be produced from international scientific societies in order facilitate a more comprehensive approach to this devastating complication. LEVEL OF EVIDENCE: IV.

Lumbar nerve root compression caused by herniated intradiscal gas: description of a clinical case with recurrence.

The authors report a rare case of recurrence of lumbar nerve root compression caused by herniated intradiscal gas treated surgically with resolution of pain symptoms. They describe the possible causes of the formation of gaseous material reported in the literature. They believe that to avoid recurrence it is important to associated removal of the hernia with complete emptying of the disc and resection of the posterior longitudinal ligament.

Randomized study with the pineal hormone melatonin versus supportive care alone in advanced nonsmall cell lung cancer resistant to a first-line chemotherapy containing cisplatin.

At present, there is no effective medical therapy in metastatic nonsmall cell (NSC) lung cancer patients who progressed under a first-line chemotherapy containing cisplatin. Since recent data have demonstrated the antineoplastic properties and the lack of toxicity of the pineal hormone melatonin (MLT), a randomized study was designed to evaluate the influence of an MLT treatment (10 mg/day orally at 7.00 p.m.) on the survival time at 1 year from the progression under chemotherapy in respect to supportive care alone in a group of metastatic NSC lung cancer patients, who did not respond to a first-line chemotherapy containing cisplatin. The study includes 63 consecutive metastatic NSC lung cancer patients, who were randomized to receive MLT (n = 31) or supportive care alone (n = 32). The percentage of both stabilizations of disease and survival at 1 year was significantly higher in patients treated with MLT than in those treated only with supportive care. No drug-related toxicity was seen in patients treated with MLT, who, on the contrary, showed a significant improvement in performance status. This randomized study shows that the pineal hormone MLT may be successfully administered to prolong the survival time in metastatic NSC lung cancer patients who progressed under a first-line chemotherapy with cisplatin, for whom no other effective therapy is available up to now.

5-Fluorouracil and dipyridamole in metastatic breast cancer: a pilot study.

In an attempt to increase the clinical activity of 5-fluorouracil (5-FU) by blocking the thymidine salvage pathway, 15 patients with refractory metastatic breast cancer (MBC) were treated with oral dipyridamole (D): 75 mg p.o. q.i.d. and 5-FU: 400 mg/m2 i.v. by bolus for 5 consecutive days, every 28 days. All the patients were pretreated with 5-FU and an anthracycline-based regimen. Toxicity was minimal, with 8 patients experiencing a D-related moderate headache. Although no objective responses were seen, two patients with 5-FU refractory disease showed tumor shrinkage. A different D schedule and the addition of folinic acid (FA) to 5-FU might provide better results and deserves further evaluation.

[Personal experience in 121 cases of palliative operations in abdominal oncological surgery]. / La nostra esperienza su 121 casi di interventi palliativi in chirurgia oncologica addominale.

The Authors analyse 121 cases of patients affected by abdominal malignant tumors, who underwent a palliative operation. Although the number of the examinated cases is small, it appears clear that the longest survival requires, when possible, the removal of most of the malignant tissue. This seems to be in accordance with the results reported by the literature.

[Chemotherapeutic results in 62 cases of breast cancer in conjunction with several clinical variables]. / Risultati della chemioterapia del cancro mammario in funzione di alcune variabili cliniche.

Alkylating drugs, alkylating drugs + antimetabolites, and alkylating drugs + antimetabolites + Vinblastine were used to treat 62 patients. The results were assessed in terms of Karnofsky's classes and related to the following parameters: age, free interval, menopausal status, results of prior endocrine management, site of dominant metastases, length of survival. 44 failures (71%) and 18 objective responses (29%) were noted. A mean survival of 17.3 months was noted for the entire series. Subjects who failed to respond survived an average of 14 months, as opposed to 25.5 months for the responders. This difference was just significant. No relation could be shown between the results and the other parameters, whereas that between the results and the length of survival was highly significant. It is clear that the variables considered cannot be relied upon in predicting the outcome of chemotherapeutical management. If the latter is effective, however, survival will almost certainly be prolonged.

[Treatment of advanced breast cancer with alkylating agents]. / Trattamento con alchilanti del carcinoma mammario in fase avanzata]

The results obtained in 26 patients suffering from metastatic cancer of the breast no longer sensitive to hormone treatment are reported. The patients were treated with ciclophosphamide (CTX) (500 mg i.v.) once a week and triethylenethiophosphamide (20-30 mg i.m.) (TSPA) every 4 weeks associated with cyclophosphamide as follows: CTX--CTX--CTX--CTX+TSPA. 9 objective regressions (34.6%) were observed. Those with objective regression lived 28 months on average (SD 23.45) and those without lived on average 11.41 months (SD 9.89). The difference is statistically significant. Side effects of various types were observed in 7 patients (27%).

[Combination of antimetabolites and alkylating agents in the treatment of advanced breast cancer]. / L'associazione di antimetaboliti ed alchilanti nel trattamento del cancro mammario in fase avanzata

An association of 5-fluoruracyl (or methotrexate) and cyclophosphamide was used in the treatment of 20 cases of hormone-resistant breast cancer. Five objective regressions were obtained. Mean survival here was 28.25 (S.D. 2.87) months, as opposed to 12.75 (S.D. 6.93) months in the remainder. Side-effects of various kinds were noted in 9 patients.

[Combination antimetabolite-alkylating agent-vinblastine in the treatment of advanced breast cancer]. / L'associazione antimetabolita-alchilante-veleno del fuso nel trattamento del cancro mammario in fase avanzata

The results obtained in 14 patients suffering from hormone-resistant metastatic breast cancer treated with the following association: methotrexate (5-fluorouracyl in case of methotrexate intolerance), cyclophosphamide, vinblastin administered i.v. once every 10-13 days, are reported. 4 objective regression (29%) were observed but survival did not very appreciably differing therapy. In 9 cases (65%) intolerance of various types was observed but in 8 these signs regressed in a short time and the therapy was resumed.