Descriptive analysis of the economic costs of periprosthetic joint infection of the knee for the public health system of Andalusia.

This study offers a descriptive analysis of the economic costs of Periprosthetic joint infection (PJI) of the knee for the public health system of Andalusia (Spain) The data are based on consecutive patients with PJI treated in our Bone and Joint Infection Unit between January 2005 and January 2010. The total cost for all patients with knee PJI was 4,151,843 $ (3,202,841 €), i.e., a mean cost per patient of 52,555 $ (40,542 €). The mean cost per patient was 24,980 $ (19,270.80 €) for patients with early PJI and rose to 78,111 $ (60,257 €) for those with late PJI. The main cost was for the hospital stay and the specific in-hospital care received, followed by the cost of the surgical procedure.

Safety analysis of high dose (>6 mg/kg/day) daptomycin in patients with concomitant statin therapy.

There is a paucity of data regarding efficacy and safety of concomitant therapy of daptomycin and statins, so we reviewed patients that concomitantly received daptomycin and statins to identify any potential increase in toxicity in our cohort. This retrospective study included all patients that received >6 mg/kg/day of daptomycin along with statins and had efficacy and safety data. Patients on high dose (>6 mg/kg/day) daptomycin therapy that did not received statins served as controls. One hundred four patients were included. Median daptomycin dose was 7.8 mg/kg/day (range 6.5-10.8 mg/kg/day), for a mean duration of therapy of 17 days (range 10-51 days). Thirty-six patients received daptomycin and statins and 68 received only daptomycin. Muscular toxicity defined as CPK levels>1000 UI/L (2.5 times upper normal limit, range of determination 200-400 UI/L) was equally distributed between both groups (3/36, 8% vs 7/68, 10%; p=0.746). Despite biochemical toxicity, we did not find clinical toxicity and daptomycin treatment was completed in all cases. We did not find predictors of increased CPK during daptomycin therapy. Based on our data, concomitant administration of daptomycin and statins is safe and is not associated with an increased risk of rhabdomyolysis.

[Bidimensional-ultrasound guided-craniotomy in the excision of supratentorial brain tumours]. / Craneotomía guiada por ultrasonografía bidimensional para exéresis de tumor cerebral supratentorial.

OBJECTIVES: With this 1-year retrospective study we aimed to analyze our experience on the utilization of real-time bidimensional (2-D) ultrasonography as an aid for the localization of deep-seated supratentorial brain tumours. MATERIAL AND METHODS: During the year 2006 we performed 2-D ultrasonographic localization studies in patients undergoing excision of subcortical supratentorial brain tumours whose nature was pathologically proven. The ultrasound machines utilized were 2410 A ultrasounds HP and Phillips HDI 3500 ATL. To check gross anatomical structures we used a 3 MHz probe and then a 5 MHz sound to define the brain tumour characteristics. Coronal and sagittal cuts were obtained during parietal or temporal craniotomies, and axial and sagittal slices in the case of frontal masses. After brain tumour removal and after a thorough irrigation with saline, new image acquisitions were performed to confirm the completeness of tumour excision. The amount of removed tumour was also verified by a post-contrast computerized tomography (CT) scan performed after the surgery. RESULTS: The study group was composed by 30 patients with ages comprised between 28 and 82 years. The time required for tumour localization was 17.5 (+/- 1.9) min. The lesions were approached though 8 temporal, 7 parieto-occipital, 8 parietal, 2 fronto-parietal and 5 temporo-parietal craniotomies. Mean depth of the lesions was 5.3 (+/- 1.6) cm. The histopathologic diagnosis was 17 high-grade gliomas, 3 low-grade astrocytomas, 8 metastatic lesions and 2 oligo-astrocytomas. High-grade gliomas were more echogenic than low-grade tumours and than oedema. No residual tumour was detected at the end of the surgery except in two cases in which a tumoral rest was left due to the proximity of the lesion to eloquent cerebral areas. Postoperative CT scans confirmed the completeness of tumour removal in the patients of the study as assessed by intraoperative ultrasounds. CONCLUSIONS: Real-time 2-D ultrasonography affords an adequate image quality for performing guided-craniotomy in supratentorial brain tumours, as it allows for a safe and accurate localization of the lesions. Its use is mainly indicated in the removal of tumours located in, or close to, important anatomical and functional brain areas and to depict the presence of tumour rests after surgical removal of cerebral neoplasms.

Craneotomía guiada por ultrasonografía bidimensional para exéresis de tumorcerebral supratentorial / Bidimensional-ultrasound guided-craniotomy in the excision of supratentorial brain tumours

Objetivos: El objetivo de este estudio descriptivo es presentar nuestra experiencia clínica durante un año sobre la utilización de la ultrasonografía bidimensional (2-D) en tiempo-real para la exéresis de tumor supratentorial de localización cerebral profunda. Material y métodos: Durante el año 2006 realizamos craneotomía guiada por ultrasonografía 2-D en pacientes sometidos a cirugía para exéresis de tumor supratentorial, confirmado por anatomía patológica y de localización subcortical. Para la realización de la ultrasonografía se utilizaron los modelos de ultrasonidos M 2410 A ultrasounds HP y Phillips HDI 3500 ATL. Se utilizó en primer lugar un transductor de 3Mhz para localizar estructuras anatómicas, seguido de un transductor de 5MHz para la identificación del tumor cerebral. Se consiguieron cortes en el plano sagital y coronal durante la craneotomía parietal o temporal y en el plano axial y sagital en la craneotomía frontal. Tras la exéresis del tumor, se realizó una nueva ultrasonografía tras irrigar la cavidad con suero salino para la visualización de remanentes tumorales. Se realizó una tomografía computarizada (TC) craneal postoperatoria para verificar la exéresis total del tumor. Resultados: Se incluyeron en el estudio 30 pacientes de edades comprendidas entre 28 y 82 años. El tiempo requerido para la localización de la lesión fue de 17,5 (±1,9) min. Se realizaron 8 craneotomías temporales, 7 parietooccipitales, 8 parietales, 2 frontoparietales y 5 parietotemporales. La lesión fue localizada a una profundidad media de 5,3 (±1,6) cm. El estudio histológico reveló 17 gliomas de alto grado, 3 gliomas de bajo grado, 8 lesiones metastásicas y 2 oligoastrocitomas. Los gliomas de alto grado mostraron mayor ecogenidad que los gliomas de bajo grado y el edema cerebral. No se detectaron restos del tumor al final de la cirugía, excepto en dos pacientes debido a la proximidad a áreas elocuentes del cerebro. La TC craneal postoperatoria confirmó la exéresis total del tumor en los pacientes incluidos en el estudio. Conclusiones: La ultrasonografía 2-D en tiempo-real proporciona una imagen de calidad aceptable para la realización de craneotomía guiada para exéresis de tumores supratentoriales, ya que permite su localización de manera fiable y segura, sobre todo de tumores localizados en zonas del cerebro con gran importancia anatómica y funcional, así como identificar restos de tumor una vez finalizada la cirugía (AU)

Objectives: With this 1-year retrospective study we aimed to analyze our experience on the utilization of real-time bidimensional (2-D) ultrasonography as an aid for the localization of deep-seated supratentorial brain tumours. Material and methods: During the year 2006 we performed 2-D ultrasonographic localization studies in patients undergoing excision of subcortical supratentorial brain tumours whose nature was pathologically proven. The ultrasound machines utilized were 2410 A ultrasounds HP and Phillips HDI 3500 ATL. To check gross anatomical structures we used a 3MHz probe and then a 5MHz sound to define the brain tumour characteristics. Coronal and sagittal cuts were obtained during parietal or temporal craniotomies, and axial and sagittal slices in the case of frontal masses. After brain tumour removal and after a thorough irrigation with saline, new image acquisitions were performed to confirm the completeness of tumour excision. The amount of removed tumour was also verified by a post-contrast computerized tomography (CT) scan performed after the surgery. Results: The study group was composed by 30 patients with ages comprised between 28 and 82 years. The time required for tumour localization was 17.5 (±1.9)min. The lesions were approached though 8 temporal, 7 parieto-occipital, 8 parietal, 2 fronto-parietal and 5 temporo-parietal craniotomies. Mean depth of the lesions was 5.3 (±1.6)cm. The histopathologic diagnosis was 17 high-grade gliomas, 3 low-grade astrocitomas, 8 metastatic lesions and 2 oligo-astrocytomas. Highgrade gliomas were more echogenic than low-grade tumours and than oedema. No residual tumour was detected at the end of the surgery except in two cases in which a tumoral rest was left due to the proximity of the lesion to eloquent cerebral areas. Postoperative CT scans confirmed the completeness of tumour removal in the patients of the study as assessed by intraoperative ultrasounds. Conclusions: Real-time 2-D ultrasonography affords an adequate image quality for performing guided-craniotomy in supratentorial brain tumours, as it allows for a safe and accurate localization of the lesions. Its use is mainly indicated in the removal of tumours located in, or close to, important anatomical and functional brain areas and to depict the presence of tumour rests after surgical removal of cerebral neoplasms (AU)