Intrarenal pressure with hand-pump or pressurized-bag irrigation: randomized clinical trial at retrograde intrarenal surgery.

Kimball AB, Jemec GBE, Sayed CJ, Kirby JS, Prens E, Ingram JR et al.

Lancet 2024;  403: 2504-2519.

These two RCTs included over 1000 patients randomized to different doses of bimekizumab for up to 48 months. Responder rates were superior in those who received bimekizumab in both trials over placebo (I – 48 versus 29 per cent, P=0.006; II – 52 versus 32 per cent, P=0.0032). Side effects were infrequent.

Comment: At last, a meaningful treatment compared with surgery. Now for the direct comparison?

Mueller C, Kehl V, Dimpel R, Blankenstein C, Egert-Schwender SE, Strudthoff J, Lock JF et al, for the IOWISI Study Group.

JAMA Surg. 2024;159: 484-492.

This three armed RCT included 689 patients randomized to saline, polyhexanide or no wound irrigation. Respective wound infection rates were 12.5, 10.6 and 12.8 per cent. Compared to controls, polyhexanide did not reduce infection rates: hazard rate 1.23, 95 per cent confidence interval 0.64 to 2.36.

Comment: Wound irrigation remains controversial, and unproven.

Cihoric M, Kehlet H, Lauritsen ML, Højlund J, Kanstrup K, Kärnsund S et al.  

Br J Surg 2024; 111: znae130.

A single dose of dexamethasone given at the start of emergency laparotomy reduced the mean C-reactive protein level after 24h from  220 to 170 mg/l, P=0.015. It also reduced postoperative major complications (27 versus 45 per cent, P=0.032) and 90-day mortality (7 versus 23 per cent, P=0.023).

Comment: Is there enough evidence yet for this to be the standard of care?

Read comment onRead author response