Analysis and management of brain abscess; a ten year hospital based study.

AIM: To study clinical, microbiological and radiological profile of pyogenic brain abscess patients along with modes of treatment and their outcome. MATERIAL AND METHODS: This retrospective as well as prospective study included One hundred and fourteen patients of Brain Abscess who were admitted and evaluated in the Department of Neurosurgery over a period of ten years .This study had a retrospective component from Oct 2001 to May 2009 in which eighty six patients were included and a prospective component from June 2009 to Oct 2011 which included twenty eight patients. Patients were managed medically including intravenous antibiotics and surgical management including single burr hole and total resection with open craniotomy or craniectomy. To evaluate abscess size after aspiration, CT or MR imaging was performed [~ 24 hours after aspiration] and as and when demanded by worsening of the clinical condition or no response to medical and surgical treatment. RESULTS: It was observed that majority of the patients in our study were males numbering 83(72.8%) where as there were only 31 females (27.2%). It was observed that among the underlying factors CSOM predominated with 57 patients ie (50%).

Outcome of the surgical treatment of bullous lung disease: a prospective study.

BACKGROUND: This study aimed at evaluating the outcome of surgery for bullous lung disease by comparing the preoperative and postoperative subjective dyspnea score, pulmonary function and clinical features. MATERIALS AND METHODS: This prospective study was conducted from May 2009 to October 2011, on 54 patients operated for bullous lung disease. Follow-up at 3-6 months consisted of taking a comprehensive history, physical examination, radiological work-up, and evaluation of changes in subjective dyspnea score, arterial blood gas analysis (ABG), and pulmonary function test (PFT). After comparison with preoperative values, the student's paired t-test was used to calculate the statistical significance. RESULTS: With approximately 21.6 cases per year, the most common underlying lung pathology was primary bullous lung disease, followed by COPD. The most common presenting complaint was spontaneous pneumothorax in tall young adults in their fourth decade of life with a history of smoking. Bullectomy, with or without decortication, was done for all cases. Improvement in mean PaO2 (arterial partial pressure of oxygen), SaO2 (arterial oxygen saturation) and PaCO2 (arterial partial pressure of carbon dioxide) was seen in most cases but was statistically insignificant. Improvement in mean FEV1 (forced expiratory volume in 1st second), FVC (forced vital capacity) and FEV1 / FVC was statistically significant, with FEV1 being the most reliable indicator of postoperative progress. Improvement in subjective dyspnea score was statistically significant and showed an inverse correlation with FEV1. Those with diffuse pulmonary parenchymal involvement had poorer baseline values and less significant postoperative improvement. Complications occurred more commonly in those with diffuse disease. Mortality was seen exclusively in those with diffuse disease. CONCLUSION: We conclude that surgery is required for bullous lung disease more frequently in our community since we have a high number of young patients with primary bullous lung disease and localized parenchymal involvement and these patients have a good surgical outcome. Potentially fatal complications like pneumothorax and recurrent infections can therefore be prevented in them. Those with underlying diffuse disease and severely decreased FEV1 (especially below 1 L) also benefit from surgery but require careful patient selection.