Aspiration versus excision: a single center experience of forty-seven patients with brain abscess over 10 years.

The efficacies of two different surgical approaches, aspiration and excision, were investigated for the management of large solitary encapsulated pyogenic brain abscess located in superficial non-eloquent areas, and the impact on length of hospital stay, duration of postoperative antibiotic use, improvement in neurological status, and morbidity and mortality were compared. This retrospective study at Sher-i-Kashmir Institute of Medical Sciences included 47 patients with pyogenic brain abscess from a total of 114 patients evaluated in the Department of Neurosurgery over a period of 10 years from October 2001 to October 2011. Comparisons were made between aspiration and excision in terms of duration of antibiotic use, length of hospital stay, and overall treatment cost. Aspiration was performed in 29 patients (61.7%), of whom 7 patients needed second aspiration, and 18 patients underwent excision (38.3%) of the abscess capsule. The mean duration of antibiotic use in the excision group was significantly shorter at 2.7 weeks (standard deviation [SD]±1.1) compared to the aspiration group at 3.8 weeks (SD±1.3) (p=0.006). Similarly, mean length of hospital stay was significantly shorter in the excision group at 18.1 days (SD±7.7) compared to the aspiration group at 24.9 days (SD±6.6) (p=0.002). In addition, significantly earlier improvement in neurological function (p=0.025) and significantly lower rate of re-surgery (p=0.0238) were found in the excision group compared to the aspiration group. Excision is better than aspiration as far as duration of antibiotic use, length of hospital stay, and overall cost of treatment is concerned, with no significant difference in morbidity and mortality.

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.