Rivaroxaban is as efficient and safe as bemiparin as thromboprophylaxis in knee arthroscopy

Purpose

The aim of this study is to compare effectiveness and safety profile of rivaroxaban with bemiparin in 3-week extended prophylaxis after knee arthroscopy.

Methods

Four hundred and sixty-seven patients were included in this review divided in two groups. One followed prophylaxis with rivaroxaban and the other one with bemiparin. All patients were interviewed and explored at 1 and 3 months postoperatively, looking for symptomatic signs of deep-vein thrombosis (DVT). In case of suspicion, diagnostic tests were performed. Collected data were age, sex, gender, diagnosis, time with ischemia, body mass index, concomitant diseases, concomitant therapy, DVT signs, treatment satisfaction, minor and major complications, treatment adherence and tolerability.

Results

No thromboembolic events were observed in any of the groups. In one case treated with rivaroxaban, the drug had to be withdrawn due to epistaxis.

Conclusions

Our study showed that extended prophylaxis with 10 mg of rivaroxaban once daily for 3 weeks resulted as effective as bemiparin in knee arthroscopy thromboprophylaxis.

Level of evidence

IV.     

When to start: as soon as possible

Debate regarding “When to start” antiretroviral (ARV) therapy has raged since the introduction of zidovudine in 1987. Based on the entry criteria for the original Burroughs Wellcome (002) study, the field has been anchored to “CD4 counts” as the prime metric to indicate ARV treatment initiation for asymptomatic HIV‐positive individuals. The pendulum has swung back and forth, based mostly on the efficacy and toxicity of available regimens. In today's world, several factors have converged that compel us to initiate therapy as soon as possible: (i) The biology of viral replication (1 to 10 billion viruses/day) screams that we should be starting early. (ii) Resultant inflammation from unchecked replication is associated with earlier onset of multiple co‐morbid conditions. (iii) The medications available today are more efficacious and less toxic than in years past. (iv) Clinical trials have demonstrated benefit for all but the highest CD4 strata (>450 to 500 cells/µL). (v) Some cohort studies have demonstrated clear benefit of ARV therapy at any CD4 count, and almost all cohort studies have demonstrated no detrimental effects of early treatment. (vi) In addition to the demonstrated and inferred benefits to the individual patient, we now have a public health benefit of earlier intervention: treatment is prevention. Finally, from a practical/common sense perspective, we are talking about life‐long therapy. Whether we start at a CD4 count of 732 or 493/µL, the patient will be on therapy for over 40 to 50 years! There does not seem to be much benefit in waiting, and there is likely to be significant long‐term harm. Treat early!     

Percutaneous dilatational tracheostomy is as safe as open tracheostomy

Although percutaneous dilatational tracheostomy (PDT) has been advocated as an alternative to open tracheostomy (OT) its relative safety has been questioned repeatedly. This study prospectively compared the safety and complications of PDT and OT. Ninety-four patients underwent PDT and 252 patients underwent OT at this institution from December 1998 through April 2000 with the choice of procedure left to the operator. OT was performed in the operating room whereas PDT was performed in intensive care units (ICUs). PDT was performed by surgeons and medical intensivists under a strict institutional policy and procedure governing patient selection and conduct of the procedure. Complications were defined as bleeding, loss of airway, hypotension, hypoxia, tracheostomy tube malposition, subcutaneous emphysema, infection, and conversion of PDT to OT. All patients survived the operation. PDT and OT had similar complication rates: 2.1 per cent for PDT versus 2.8 per cent for OT (P = not significant). Postoperative bleeding, which was the most frequent complication, occurred in one PDT patient and four OT patients. One PDT patient required conversion to OT as a result of extensive tracheal fibrosis. Subcutaneous emphysema, soft-tissue infection, and a malpositioned tracheostomy tube were the remaining complications in the OT patients. We conclude that the complication rates of PDT and OT are comparable. The choice of PDT or OT should be dictated by the surgeon's training and experience, the patient's condition, neck anatomy, and stability for transfer to the operating room.     

Percutaneous acrylic vertebroplasty as a treatment of vertebral angioma as well as painful and debilitating diseases

Although vertebral hemangiomas are regarded as stable vascular malformations, a number of them progresses and may cause complications involving the cord or the nerve roots. In order to prevent this evolution, vertebral consolidation can be achieved with the percutaneous injection of acrylic cement into the angiomatous vertebra. The preventive effect of this procedure is often combined with relief from vertebral pain. This observation allowed extending the scope of application of this method to other painful spinal lesions such as osteoporosis and certain types of tumors.     

Minimally invasive surgery: only as good as the picture

BACKGROUND: In minimally invasive surgery, there is increased reliance on real-time 2-dimensional images. The fibre-optic light lead is one of the most frequently damaged elements of the 'imaging chain', leading to a poor quality picture. METHODS: Light leads with a honeycomb projection were connected to a light source and the resulting beam directed at a sheet of paper. Darkened sectors with diminished or absent light transmission were recorded. RESULTS: All suitable light leads in routine use were examined. A mean of 22.2% (SD 7.8%) of the projection had diminished or absent light transmission. CONCLUSION: Sub-optimal endoscopic equipment was in routine use.     

Statistics as support tool and not as a decision tool

The use of statistics in medical articles has risen a lot during the last decades, however it is used in a thoughtless manner in many instances. Today, Statistics is the only tool that allows the medical researcher to obtain results and benefits from those studies the relationships of which can not be interpreted from a determinist perspective, because it is a branch of applied mathematics objective of which is to manage and quantify the uncertainty of the available information, to support decision taking. The objective of this article is to review the basic statistical concepts that every doctor should know to be able to perform and/or detect quality research, as well as to underline the most frequent errors committed when interpreting statistical results. We review the general concepts about data synthesis and differentiation of the different types of measurements, hypothesis testing and errors that can be committed doing it, the real meaning of the "p" value, differentiation between statistically significant and clinically relevant results, the importance of confidence intervals as a measure of significance and clinical relevance, the confusion generated between two concepts that are different as standard deviation and standard error, and the criteria that govern the selection of the adequate statistical tests to evaluate relationships between variables.     

A renal biopsy yields sight as well as insight.

A 34-year-old woman presented with periorbital oedema and progressivevisual loss. Periorbital oedema was first observed 2 weeks beforeadmission, particularly in the mornings. Visual loss started5 days prior to admission. The patient was born in Thailand.She had a renal disease of unknown origin in 1974 and was treatedfor malaria     

Targeted bone remodeling involves BMU steering as well as activation

Microdamage removal is an important function of bone remodeling. Experiments have repeatedly shown that remodeling of cortical bone by Basic Multicellular Units (BMUs) is initiated in response to microdamage, and this has become known as “targeted remodeling”. This paper considers the possibility that microdamage is not only able to activate new BMUs, but may also attract or “steer” existing BMUs as they continue to tunnel through the bone matrix. An initial analysis of the relationship of between mean microcrack length and BMU resorption space density in cortical bone indicates that BMUs have an effective area about 40 times greater than their actual cross-section. Interpreting this as evidence that the osteoclasts in a tunneling BMU are able to sense and steer toward microdamage, a model is developed for “BMU steering” based on the hypothesis that osteoclasts are guided not only in the principal stress direction, as proposed by Burger et al. (Burger, E.H., Klein-Nulend, J., Smit, T.H. Strain-derived canalicular fluid flow regulates osteoclast activity in a remodelling osteon–a proposal. J. Biomech 36 (2003) 1453–1459), but also toward microdamage, depending on its proximity.