[Cerebral abscess. Clinical review of 26 cases]. / Abscesos cerebrales. Revisión clínica de 26 casos.

BACKGROUND: The introduction of new diagnostic and therapeutic techniques has changed the clinical attitude and consequences of brain abscesses (BA). OBJECTIVE: To analyse clinical-radiological features, therapy, prognostic factors and evolution of BA in our institution. MATERIALS AND METHODS: Retrospective study of all clinical records of patients diagnosed with BA from 1982 to 1992. RESULTS: Twenty-six patients with a mean age of 46.2 years were selected. The incidence was 2.6 patients/10,000 admission/year. Among 17 patients (65%) some extraprenchymatous infectious focus was found, which was located at the otorhynolaryngeal area in twelve patients. Mean duration of symptoms was 12.9 days, headache being the most common of them (69%). With CT 18 patients had a single mass, eight patients multiple masses, and 21 patients a ring enhancement when the contrast material was introduced. The causative organism was recovered from 15 patients. The organism recovered more frequently were Streptococcus spp, Enterobacteriaceae and Staphylococcus aureus. Twenty patients (77%) underwent surgical therapy, which consisted in ablation (12) or drainage (8). All patients received antibiotics for a mean of 37 days: the most frequent antibiotic combination used was penicillin+chloramphenicol. Six patients died (23%) and 7 remained with sequelae. Although statistically non-significant, the acute presentation was associated with a higher mortality rate, and the use of dexamethasone was associated with a lower mortality rate (p = 0.053 and 0.062, respectively). CONCLUSIONS: BA is associated with a high mortality rate and a high sequelae rate despite appropriate diagnostic and therapeutic measures. ORL infection is the most frequent predisposing factor. The use of dexamethasone is not associated with a higher mortality rate.

[Fever and recurrent bacteremia as presentation form of secondary aortoenteric fistula]. / Fiebre y bacteriemia recurrente como forma de presentación de una fístula aortoentérica secundaria.

Secondary aortoenteric fistula is a rare complication, although very severe, of aortic revascularization surgery. The major cause is usually infection of the prosthetic material, which may happen short or long after the intervention. The most frequent forms of presentation are digestive hemorrhage, abdominal pain or unpleasantness, shock or other symptoms associated to the compression of adjacent structures. However, as in the present case, symptoms of systemic infection may be the only manifestation, with absence of local signs. This is why a high degree of clinical suspicion is needed. The most useful complementary techniques are computerized tomography, oral endoscopy and, probably, magnetic resonance, along with gammagraphy of indium-marked leukocytes. Therapy must combine long-term systemic antibiotherapy and resection of all infected material, with reconstruction of the vascular continuity following a route far away from the infected area.

[Spinal epidural abscess. 8 years' experience]. / Absceso epidural espinal. Experiencia de ocho años.

We present four cases of spinal epidural abscess diagnosed in Clinica Puerta de Hierro between 1982 and 1990. In three cases the localization was thoracic and in one it was lumbar. Fever and vertebral pain were the more constant clinical symptoms. Lumbar punction showed findings in Cerebro-Spinal Fluid compatible with a parameningeal inflammation focus in the three cases it was performed. Diagnosis was established with myelography or Computerized Axial Tomography. Treatment in two cases was laminectomy and systemic antibiotics: and only antibiotics in the other two cases. Evolution was favorable in the patients who underwent surgery, but the patients treated conservatively had a fatal outcome.