Stereotactic Aspiration and Antibiotic Treatment Combined with Hyperbaric Oxygen Therapy in the Management of Bacterial Brain Abscesses

Neurosurgery ◽  
2005 ◽  
Vol 57 (6) ◽  
pp. 1140-1146 ◽  
Author(s):  
Murat Kutlay ◽  
Ahmet Çolak ◽  
Şenol Yıldız ◽  
Nusret Demircan ◽  
Osman Niyazi Akın
Keyword(s):  
Brain Abscess ◽  
Antibiotic Treatment ◽  
Hyperbaric Oxygen ◽  
Surgical Techniques ◽  
Adjunctive Treatment ◽  
Stereotactic Aspiration ◽  
Systemic Antibiotic Therapy ◽  
Number Of Patients ◽  
Brain Abscesses

Abstract OBJECTIVE: Despite advances in surgical techniques in the management of the brain abscess, long-term antibiotics are as crucial to cure as the initial surgical procedure itself. This study was designed to evaluate the effect of adjuvant hyperbaric oxygen (HBO) therapy on the duration of antibiotic treatment. METHODS: Between 1999 and 2004, 13 patients with bacterial brain abscesses treated with stereotactic aspiration combined with HBO and systemic antibiotic therapy. Patients younger than 18 years of age were excluded from this study. Postoperatively, all patients were given a 4-week course of intravenous antibiotics. Additionally, patients received hyperbaric oxygen (HBO, 100% O2 at 2.5 ATA for 60 min) twice daily for five consecutive days, and an additional treatment (100% O2 at 2.5 ATA for 60 min daily) was given for 25 days. RESULTS: There were eight male and five female patients. Their ages ranged between 18 and 71 years, with a mean of 43.9 years. The average duration of follow-up was 9.5 months (range, 8–13 mo). This treatment modality allowed infection control and healing for all 13 patients with 0% recurrence rate. HBO treatment was tolerated well, and there were no adverse effects of pressurization. At the end of the follow-up period, 12 patients had a good outcome: nine are without sequelae, and three have a mild hemiparesis but are capable of self-care. One patient has a moderate hemiparesis. CONCLUSION: Although the number of patients is small, this series represents the largest reported group of brain abscess patients treated with stereotactic aspiration combined with antibiotic and HBO therapy. Our preliminary results indicate that the length of time on antibiotics can be shortened with the use of HBO as an adjunctive treatment.

STEREOTACTIC ASPIRATION AND ANTIBIOTIC TREATMENT COMBINED WITH HYPERBARIC OXYGEN THERAPY IN THE MANAGEMENT OF BACTERIAL BRAIN ABSCESSES

Neurosurgery ◽  
2008 ◽  
Vol 62 (suppl_2) ◽  
pp. 1140-1145 ◽  
Author(s):  
Murat Kutlay ◽  
Ahmet Çolak ◽  
Şenol Yıldız ◽  
Nusret Demircan ◽  
Osman Niyazi Akın
Keyword(s):  
Antibiotic Treatment ◽  
Hyperbaric Oxygen ◽  
Hyperbaric Oxygen Therapy ◽  
Oxygen Therapy ◽  
Stereotactic Aspiration ◽  
Brain Abscesses

scholarly journals 288. Follow-Up Blood Cultures in Gram-Negative Bacteremia: How Do They Impact Outcomes

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S144-S144
Author(s):  
Azza Elamin ◽  
Faisal Khan ◽  
Ali Abunayla ◽  
Rajasekhar Jagarlamudi ◽  
aditee Dash
Keyword(s):  
Clinical Outcomes ◽  
Antibiotic Treatment ◽  
Readmission Rate ◽  
Blood Cultures ◽  
Categorical Variables ◽  
Gram Negative ◽  
Number Of Patients ◽  
Significant Difference ◽  
The Impact

Abstract Background As opposed to Staphylococcus. aureus bacteremia, there are no guidelines to recommend repeating blood cultures in Gram-negative bacilli bacteremia (GNB). Several studies have questioned the utility of follow-up blood cultures (FUBCs) in GNB, but the impact of this practice on clinical outcomes is not fully understood. Our aim was to study the practice of obtaining FUBCs in GNB at our institution and to assess it’s impact on clinical outcomes. Methods We conducted a retrospective, single-center study of adult patients, ≥ 18 years of age admitted with GNB between January 2017 and December 2018. We aimed to compare clinical outcomes in those with and without FUBCs. Data collected included demographics, comorbidities, presumed source of bacteremia and need for intensive care unit (ICU) admission. Presence of fever, hypotension /shock and white blood cell (WBC) count on the day of FUBC was recorded. The primary objective was to compare 30-day mortality between the two groups. Secondary objectives were to compare differences in 30-day readmission rate, hospital length of stay (LOS) and duration of antibiotic treatment. Mean and standard deviation were used for continuous variables, frequency and proportion were used for categorical variables. P-value < 0.05 was defined as statistically significant. Results 482 patients were included, and of these, 321 (67%) had FUBCs. 96% of FUBCs were negative and 2.8% had persistent bacteremia. There was no significant difference in 30-day mortality between those with and without FUBCs (2.9% and 2.7% respectively), or in 30-day readmission rate (21.4% and 23.4% respectively). In patients with FUBCs compared to those without FUBCs, hospital LOS was longer (7 days vs 5 days, P < 0.001), and mean duration of antibiotic treatment was longer (14 days vs 11 days, P < 0.001). A higher number of patients with FUBCs needed ICU care compared to those without FUBCs (41.4% and 25.5% respectively, P < 0.001) Microbiology of index blood culture in those with and without FUBCs Outcomes in those with and without FUBCs FUBCs characteristics Conclusion Obtaining FUBCs in GNB had no impact on 30-day mortality or 30-day readmission rate. It was associated with longer LOS and antibiotic duration. Our findings suggest that FUBCs in GNB are low yield and may not be recommended in all patients. Prospective studies are needed to further examine the utility of this practice in GNB. Disclosures All Authors: No reported disclosures

scholarly journals Brain Abscess Caused by Nocardia: Case Report and Literature Review

2020 ◽  
Author(s):  
Guilherme Finger ◽  
Maria Eduarda Conte Gripa ◽  
Tiago Paczko Bozko Cecchini ◽  
Tobias Ludwig do Nascimento
Keyword(s):  
Case Report ◽  
Antibiotic Therapy ◽  
Brain Abscess ◽  
Clinical Signs ◽  
Occipital Lobe ◽  
High Morbidity ◽  
Rare Clinical Entity ◽  
Brain Abscesses

AbstractNocardia brain abscess is a rare clinical entity, accounting for 2% of all brain abscesses, associated with high morbidity and a mortality rate 3 times higher than brain abscesses caused by other bacteria. Proper investigation and treatment, characterized by a long-term antibiotic therapy, play an important role on the outcome of the patient. The authors describe a case of a patient without neurological comorbidities who developed clinical signs of right occipital lobe impairment and seizures, whose investigation demonstrated brain abscess caused by Nocardia spp. The patient was treated surgically followed by antibiotic therapy with a great outcome after 1 year of follow-up.

scholarly journals Remeex® System Effectiveness in Male Patients with Stress Urinary Incontinence

2021 ◽  
Vol 10 (10) ◽  
pp. 2121
Author(s):  
Gerardo-Alfonso Márquez-Sánchez ◽  
Bárbara-Yolanda Padilla-Fernández ◽  
Miguel Perán-Teruel ◽  
Pedro Navalón-Verdejo ◽  
Sebastián Valverde-Martínez ◽  
...  
Keyword(s):  
Urinary Incontinence ◽  
Stress Urinary Incontinence ◽  
Surgical Techniques ◽  
High Survival ◽  
Complication Rates ◽  
Exact Test ◽  
Number Of Patients ◽  
Male Stress Urinary Incontinence ◽  
Group B

Background: When conservative management fails, patients with stress urinary incontinence (SUI) are considered for surgical treatment. Simpler, more economical and less invasive surgical techniques, such as the Remeex® system, have been developed. Objectives: To analyze the objective effectiveness of the Remeex® system in the treatment of male stress urinary incontinence. To study survival and complication rates of the Remeex® system in male SUI patients. Materials and methods: Prospective observational study between July 2015 and May 2020. Group A (n = 7; GA) patients with mild SUI. Group B (n = 22; GB) patients with moderate SUI. Group C (n = 18; GC) patients with severe SUI. Effectiveness was assessed by the number of patients achieving complete and partial dryness. Complete dryness was defined as patients using 0–1 safety pads per day; partial dryness as a >50% reduction in the number of pads used. Results were analyzed using descriptive statistics, Student’s t-test. Chi2, Fisher’s exact test, ANOVA, and multivariate analysis. Significance was set at p < 0.05. Results: Mean age 69.76 years, mean follow-up 33.52 months. Objective effectiveness was observed in 89.36% of patients with incontinence. The effectiveness was 85.71% in GA, 90.91% in GB and 88.89% in GC. There were no significant differences among groups (p = 1.0000). 34.04% of patients with an implant required at least one readjustment, while 66.00% did not require any. There were no significant differences among groups (p = 0.113) Chi2 = 4.352. 95.74% of implants remained in place by the end of follow-up. We observed complications in 17.02% of patients. Conclusions: Remeex® system is an effective and safe method for male stress urinary incontinence treatment, regardless of the severity of the incontinence, with high survival and low complication and removal rates. System readjustments are required in one-third of the cases.

scholarly journals Tuberculous brain abscess in a patient with AIDS: case report and literature review

2003 ◽  
Vol 45 (2) ◽  
pp. 111-114 ◽  
Author(s):  
José E. Vidal ◽  
Sérgio Cimerman ◽  
Paula R. Marques da Silva ◽  
Jaques Sztajnbok ◽  
João F.G.S. Coelho ◽  
...  
Keyword(s):  
Brain Abscess ◽  
Surgical Excision ◽  
Toxoplasmic Encephalitis ◽  
Surgical Approaches ◽  
Aids Patients ◽  
Stereotactic Aspiration ◽  
Antituberculous Treatment ◽  
Brain Abscesses ◽  
Tuberculous Brain Abscess ◽  
Tomography Scan

Tuberculous brain abscesses in AIDS patients are considered rare with only eight cases reported in the literature. We describe the case of a 34-year-old woman with AIDS and previous toxoplasmic encephalitis who was admitted due to headache and seizures. A brain computed tomography scan disclosed a frontal hypodense lesion with a contrast ring enhancement. Brain abscess was suspected and she underwent a lesion puncture through a trepanation. The material extracted was purulent and the acid-fast smear was markedly positive. Timely medical and surgical approaches allowed a good outcome. Tuberculous abscesses should be considered in the differential diagnosis of focal brain lesions in AIDS patients. Surgical excision or stereotactic aspiration, and antituberculous treatment are the mainstay in the management of these uncommon lesions.

Integrated Approach to Construction and Maintenance of Prosthetic Arteriovenous Access for Hemodialysis

Vascular ◽  
2004 ◽  
Vol 12 (4) ◽  
pp. 243-255 ◽  
Author(s):  
David Shemesh ◽  
Oded Olsha ◽  
Daniel Berelowitz ◽  
Ibrahim Zaghal ◽  
Charles Z. Zigelman ◽  
...  
Keyword(s):  
Surgical Techniques ◽  
Integrated Approach ◽  
Preoperative Imaging ◽  
Secondary Patency ◽  
Dialysis Access ◽  
Expanded Polytetrafluoroethylene ◽  
Number Of Patients ◽  
Arteriovenous Access ◽  
The Creation

Autogenous arteriovenous access is the preferred access for hemodialysis patients with end-stage renal disease but is not feasible in a significant number of patients. The creation of a prosthetic arteriovenous access (PAVA) for hemodialysis using expanded polytetrafluoroethylene is technically simple and the short-term results are usually good, but the PAVA's 1-year patency rate is low (less than 60% in many centers). We have developed an integrated approach for the creation and maintenance of PAVAs, under the direction of a dedicated vascular access surgeon, involving preoperative imaging, anesthetic and surgical techniques, and a postoperative graft surveillance program, to improve patency rates. The design used was a prospective nonrandomized study. Between January 1, 1999, and December 31, 2001, 158 PAVAs were created (36.8% of the 419 fistulae created during this period). High-resolution duplex ultrasonography was added to careful clinical assessment in planning and follow-up of the dialysis access. The preferred method of PAVA creation was the forearm loop using tapered 4 to 7 mm stretch expanded polytetrafluoroethylene. After surgery, patients entered a program of close follow-up and regular graft surveillance and maintenance. Prophylactic surgical revisions and endovascular interventions were performed routinely according to ultrasonography findings to prevent thrombosis. Thrombolysis and thrombectomy were performed without delay when the PAVA thrombosed, minimizing the use of central venous access and salvaging the central veins. No patients were excluded from the study. One-, 2-, and 3-year assisted primary patency rates (including patients without occlusion but who were judged to require prophylactic revision) were 65%, 54.1%, and 48.8%, respectively. With surveillance-directed surgical revisions and endovascular treatment before or after occlusion, the 1-, 2-, and 3-year secondary patency rates (functional patency) were 91.4%, 84.3%, and 78.5%. Of the 158 grafts, 110 never occluded during the study period. There were 155 interventions in 74 PAVAs: 30 surgical revisions, 63 prophylactic endovascular procedures, and 52 instances of thrombolytic therapy combined with percutaneous transluminal angioplasty. The use of prosthetic arteriovenous access for hemodialysis, when autogenous arteriovenous access is not feasible, can still be associated with excellent long-term patency, in spite of previously published poor results, as long as good planning, close follow-up, and aggressive intervention (when indicated) are carried out.

scholarly journals Hyperbaric oxygen therapy as an adjunctive treatment for descending necrotizing mediastinitis: about 6 cases

2020 ◽  
Vol 7 (11) ◽  
pp. 3647
Author(s):  
Zribi Hazem ◽  
Ammar Abdulrehamen ◽  
Abdelkabir Amina ◽  
Ben Ayed Ahmed ◽  
Touil Ameny ◽  
...  
Keyword(s):  
Adjuvant Therapy ◽  
Antibiotic Treatment ◽  
Hyperbaric Oxygen ◽  
Hyperbaric Oxygen Therapy ◽  
Oxygen Therapy ◽  
Descriptive Study ◽  
Clinical Results ◽  
Adjunctive Treatment ◽  
Therapy Sessions ◽  
Objective Study

Background: The objective study was to evaluate the use and the effectiveness of hyperbaric oxygen therapy as an adjuvant therapy in 6 cases of descending necrotizing mediastinitis.Methods: This is a retrospective descriptive study, performed between 2010 and 2019. Hyperbaric oxygen therapy was indicated in difficult clinical management cases despite surgery and antibiotic therapy.Results: Six patients had oxygen therapy sessions in addition to antibiotic treatment and surgery. There was marked clinical and radiological improvement in 5 cases. Only one patient died in a septic shock.Conclusions: Hyperbaric oxygen therapy, as adjuvant therapy to surgery and antibiotic treatment, can increase survival and provide good clinical results.

Direct surgical repair of spondylolysis in athletes: indications, techniques, and outcomes

2011 ◽  
Vol 31 (5) ◽  
pp. E9 ◽  
Author(s):  
Doniel Drazin ◽  
Ali Shirzadi ◽  
Sunil Jeswani ◽  
Harry Ching ◽  
Jack Rosner ◽  
...  
Keyword(s):  
Back Pain ◽  
Surgical Techniques ◽  
Young Athlete ◽  
Axial Loading ◽  
Fracture Repair ◽  
Common Symptom ◽  
Disc Disease ◽  
Number Of Patients ◽  
Few Data

Object Athletes present with back pain as a common symptom. Various sports involve repetitive hyperextension of the spine along with axial loading and appear to predispose athletes to the spinal pathology spondylolysis. Many athletes with acute back pain require nonsurgical treatment methods; however, persistent recurrent back pain may indicate degenerative disc disease or spondylolysis. Young athletes have a greater incidence of spondylolysis. Surgical solutions are many, and yet there are relatively few data in the literature on both the techniques and outcomes of spondylolytic repair in athletes. In this study, the authors undertook a review of the surgical techniques and outcomes in the treatment of symptomatic spondylolysis in athletes. Methods A systematic review of the MEDLINE and PubMed databases was performed using the following key words to identify articles published between 1950 and 2011: “spondylolysis,” “pars fracture,” “repair,” “athlete,” and/or “sport.” Papers on both athletes and nonathletes were included in the review. Articles were read for data on methodology (retrospective vs prospective), type of treatment, number of patients, mean patient age, and mean follow-up. Results Eighteen articles were included in the review. Eighty-four athletes and 279 nonathletes with a mean age of 20 and 21 years, respectively, composed the population under review. Most of the fractures occurred at L-5 in both patient groups, specifically 96% and 92%, respectively. The average follow-up period was 26 months for athletes and 86 months for nonathletes. According to the modified Henderson criteria, 84% (71 of 84) of the athletes returned to their sports activities. The time intervals until their return ranged from 5 to 12 months. Conclusions For a young athlete with a symptomatic pars defect, any of the described techniques of repair would probably produce acceptable results. An appropriate preoperative workup is important. The ideal candidate is younger than 20 years with minimal or no listhesis and no degenerative changes of the disc. Limited participation in sports can be expected from 5 to 12 months postoperatively.

Multiple abscesses of the brain

1981 ◽  
Vol 54 (1) ◽  
pp. 93-97 ◽  
Author(s):  
Arthur I. Kobrine ◽  
David O. Davis ◽  
Hugo V. Rizzoli
Keyword(s):  
Antibiotic Treatment ◽  
Content Type ◽  
Life Threatening ◽  
Brain Abscesses ◽  
Systemic Antibiotics ◽  
The Brain ◽  
Fine Print

✓ A case of multiple brain abscesses is presented. The patient was treated with systemic antibiotics; one of the lesions acutely increased in size, became life-threatening, and was surgically removed. The patient continued with antibiotic treatment, and the remaining brain abscesses completely disappeared. Recent follow-up review almost 2 years after diagnosis demonstrated no evidence of recurrence.

scholarly journals Endoscopic treatment of brain abscess

2021 ◽  
Vol 12 ◽  
pp. 36
Author(s):  
Mohamed Elmallawany ◽  
Ahmed Ashry ◽  
Mohamed F. Alsawy
Keyword(s):  
Brain Abscess ◽  
Intraoperative Ultrasound ◽  
Chronic Otitis Media ◽  
Related Complication ◽  
Bleeding Point ◽  
Freehand Technique ◽  
History Of ◽  
Brain Abscesses ◽  
Congenital Cyanotic Heart Disease

Background: Treatment of brain abscess is still a subject of controversy. The main treatment is surgical, although medical therapy alone can be used for selected cases. The treatment of choice is aspiration, which may be performed with the aid of an endoscope or by freehand technique, with or without stereotactic or intraoperative ultrasound guidance. Excision is valuable in some cases. We are reporting our results of endoscopic approach in 12 patients. Methods: This study included 12 patients of brain abscesses treated between January 2015 and January 2018. All the cases except those with small abscesses (<3.0 cm in diameter) were included in the study. Rigid endoscope was used. Follow-up CT scan was done in all cases within 7 and 30 days after surgery. Follow-up periods ranged between 3 and 6 months. Results: There were 11 patients with a history of chronic otitis media and one patient who suffered from congenital cyanotic heart disease. Glasgow Coma Score (GCS) was 5 in one patient, 13 in two cases, and 14–15 in 9 cases. There were one cerebellar, six temporal, and five frontal abscesses. All the patients recovered completely except one who died (GCS 5). There was no procedure-related complication. Hospital stay ranged from 14 to 45 days with an average of 28 days. The endoscopy aided visualization of multiloculations and septation in eight patients which allowed the opening of the septations and complete evacuation. Conclusion: Endoscopic aspiration is safe, easy, and represents an effective way of treatment of brain abscess through proper visualization. It can be used for ensuring the complete aspiration of contents, control of any bleeding point, and also for multiloculated abscess to identify and open the septations which may not be possible in stereotactic or any other guided aspirations.

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