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PubMed1986

Covert splenic abscess: a continuing challenge.

Although splenic abscess is a rare cause of intra-abdominal sepsis, the mortality rate remains high especially in patients with silent or covert lesions. The clinical presentation and course of five patients with overt splenic abscess and seven patients with covert splenic abscess seen during a thirty year period were analyzed. Average age of patients with overt lesions was 44.5 years. Direct extension from a contiguous source, hematogenous spread from a distant site (metastatic) and trauma comprised the known etiologies. Clinical features of localized left upper quadrant sepsis were commonly present but only one patient exhibited multiple organ failure. The clinical diagnosis was established preoperatively in four patients (80%) and all underwent splenectomy without mortality. All resected spleens contained solitary abscesses. In contrast, patients with covert lesions tended to be older (average age 56.1 years), uniformly exhibited multiple organ failure and rarely demonstrated local clinical findings of left upper quadrant sepsis. Trauma was a less common etiology than metastatic infection and direct extension. Four patients died without operation. Three patients underwent exploration for unrelated reasons, but the diagnosis of splenic abscess was made intraoperatively in only one patient. Mortality among patients with covert lesions was 86%. Multiple splenic abscesses were demonstrated in all patients with covert lesions. Splenic abscess presents as a spectrum of clinical disease. Solitary lesions can be readily diagnosed and treated by splenectomy. Multiple abscesses are usually covert, associated with multiple organ failure and highly lethal. The role of splenectomy in patients with covert lesions remains unknown.

Abscess↗

PubMed1986

Brain abscess. A study of 45 consecutive cases.

Clinical features, findings of diagnostic studies, results of therapy, and prognostic factors were analyzed in 45 patients with brain abscesses. The number of patients diagnosed yearly has increased since CT scanning became available, but despite the enhanced sensitivity, the time from either onset of symptoms or hospital admission until initiation of therapy was not decreased and there was no dramatic effect upon morbidity or mortality in this series. Infections of paranasal sinuses, ears, lungs, and odontogenic foci were predisposing factors in approximately 70% of cases. Single abscesses, present in 75% of patients, were distributed equally in both hemispheres, with more than half in the frontal and parietal lobes. Common signs and symptoms included headache, fever, chills, seizures, nausea, vomiting, altered sensorium, nuchal rigidity, and localizing neurologic signs. Blood cultures were positive in 11%. Lumbar puncture rarely provided data from which a diagnosis could be established; CSF cultures were positive in only 7% of patients, and there was a 15% temporally associated incidence of brain herniation and death. Diagnostic information was most readily obtained using imaging techniques such as CT and 99mTc scanning, and arteriography was invasive and of no added value. CT scans are however, often initially negative in patients presenting with clinical signs of meningitis presumably following rupture of an abscess into the subarachnoid space, and the average time for changes to appear on CT scan is 9 days. It is, therefore, recommended that when the clinical assessment suggests the possibility of brain abscess the patient be treated empirically with antibiotics and that lumbar puncture be performed only after thoughtful assessment of the risk-to-benefit ratio for each patient. Causative organisms were isolated from more than 80% of abscesses despite prior antibiotic treatment; more than half grew a single pathogen, most commonly streptococci. Anaerobic and microaerophilic bacteria accounted for 62% of all isolates, and were the only organisms in 33% of patients. Computerized tomographic scans in 30 patients showed "ring-enhancing" lesions, nodular enhancement, or areas of low attenuation. Complete resolution of abscesses on CT scans rarely occurred during hospitalization and took as long as 5 months. Decrease in the size of abscesses on CT scan correlated well with clinical improvement and was seen within a week when abscesses were excised, but was often not obvious for 6 to 8 weeks if antibiotics were used alone.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗

PubMed1979

Pancreatic abscess.

Compared with the general hospital population of patients with pancreatitis, patients with biliary tract or peptic ulcer disease have de novo pancreatic abscesses develop more commonly than patients with alcoholic pancreatitis. The apparent greater predisposition of the patient with biliary tract or peptic ulcer disease to infection does not seem to be due so much to these patients having potential sources of infection, such as an infected biliary tract or leaking ulcer, as to the fact that many patients with alcoholism and hemorrhagic pancreatitis never survive the fluid loss phase of pancreatitis long enough to have a secondary infection and abscess. The mortality associated with the development of de novo pancreatic abscesses is higher in patients with biliary disease, peptic ulcer or idiopathic pancreatitis in comparison with those patients with alcoholic pancreatitis. Some complications of pancreatic abscesses, such as renal failure, may be avoided through appropriate management of fluid losses during the hemorrhagic phase of pancreatitis preceding absecess formation. Good medical management and aggressive use of newer diagnostic and therapeutic modalities may reduce the mortality and complications of pancreatic abscess. Prompt drainage of an abscess once identified is essential to survival. Proximal colostomy or ileostomy is indicated in the patient with a colonic fistula. Large particulate chunks of necrotic pancreas are not easily evacuated through Penrose, cigarette or sump drains. Marsupialization of the abscess may be considered in patients with this type of abscess.

Abscess↗

PubMed1984

Extraperitoneal versus transperitoneal drainage of the intra-abdominal abscess.

Controversy as to whether the intra-abdominal abscess should be drained extraperitoneally or through formal laparotomy still rages. Arguments for a transperitoneal approach include no need to identify specific locus preoperatively and uniform drainage of all abscesses, especially any otherwise unrecognized pus collection. Proponents for the extraperitoneal route stress failure to contaminate previously uninvolved peritoneal spaces and more reliable avoidance of injury to intestine, predisposing to subsequent intestinal fistula. To resolve this impasse, a prospective study of each method was based upon a schedule of previously randomized treatment options. After 32 months of study, 60 patients had been enrolled without obvious differences between treatment groups with respect to demographic features, preoperative definition and locus of infection, precipitating cause of sepsis, associated diseases, responsible bacteria and antibiotic therapy. With the transperitoneal approach, five patients had hollow viscus injury, while seven eventually had an intestinal fistula develop, causing major problems in four. Despite no obvious intestinal injury with the extraperitoneal route, two transient intestinal fistulas did occur. Seven patients drained transperitoneally had additional abscesses discovered, yet another operation was required to drain at least one complicating abscess in seven of this same group. With the extraperitoneal route, only two patients needed reoperation to drain another abscess. Although there were more deaths and complications in the group drained transperitoneally, morbidity (47 per cent) and mortality (7 per cent) were not significantly different statistically. Such data refute the professed superiority of a transperitoneal approach to intra-abdominal abscess drainage, both from need to reoperative for second abscess as well as incidence of latter intestinal fistula. Best results were noted with abscess identification through computerized tomography followed by extraperitoneal drainage.

Abdomen↗

PubMed1993

Valve ring abscess associated with infective endocarditis: echocardiographic features and clinical observations.

The presence of a valve ring abscess in patients with infective endocarditis adds appreciably to the expected rates of morbidity and mortality. From January 1989 to October 1991, a total of 43 consecutive patients with infective endocarditis seen at National Taiwan University Hospital were enrolled in this study. There were 30 men and 13 women, ranging in age from 14 to 75 years (mean +/- SD 38.5 +/- 15.0 years). The presence of infective endocarditis was documented by surgery in 26 patients and was based on a clinical diagnosis in the remaining 17 patients. A valve ring abscess was detected in five patients, either by transthoracic or transesophageal echocardiography, and all were confirmed at surgery. Aortic valve endocarditis was more frequently found in patients with valve ring abscesses (100% vs 31.6%, p < 0.01), and the infecting organism was most often Staphylococcus aureus (60.0% vs 15.8%, p < 0.05). The proportion of urgent operations was also higher in the group with abscesses (80.0% vs 23.7%, p < 0.05). The hospital mortality was 40.0% in patients with abscesses and 5.3% in patients without abscesses, but the difference did not reach significance (p = 0.056). Transthoracic echocardiography identified valve ring abscesses in the first three patients, but transesophageal echocardiography was more useful in detecting abscesses located in the posterior aspect of the aortic root in the other two patients, in which the lesion was overlooked or only suspected by the transthoracic approach.(ABSTRACT TRUNCATED AT 250 WORDS)

Abscess↗

PubMed1993

[Criteria of indication of puncture of amebic liver abscesses. 228 patients].

To clarify the therapeutic role of US-guided in the treatment of amebic liver abscess, three different approach to amebic liver abscess were tested in 228 patients (187 males and 31 females) along 3 years. In a west african endemic area (in Abidjan). All cases were correctly diagnosed by clinical and sonographic findings, and by the pus after percutaneous or chirurgical drainage. The three modes of therapy utilized segregated three distinct group. The first group consisted of 80 patients who were treated medically by metromidazole and ampicillin administered orally. In them, 33 patients have noncollected abscess with a diameter ranged from 2.3 to 12.7 cm (mean 6.6 cm), 23 patients have a collected abscess with a diameter less than 10 cm ranged from 4.1 to 9.7 cm (mean 7.1 cm), 24 patients have a collected abscess with a diameter equal or exceeding 10 cm ranged from 10 to 22.5 cm (mean 14.3 cm). In the second group, there were 124 patients, and they were treated with combined US-guided percutaneous evacuation and medical therapy. In them, 22 patients have a collected abscess with a diameter less than 10 cm ranged from 4.9 to 9.5 cm (mean 7.4 cm), and 102 patients have a collected abscess with a diameter equal or greater than 10 cm (measured 10 cm to 27.5, mean 15.3). There were twenty four patients in the last group, they were treated by open chirurgical drainage because they have an abdominal ruptured abscess. The results with each form of therapy were assessed clinically and by abdominal ultrasound.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed1993

Outcome at three to five years of primary closure of perianal and pilonidal abscess. A randomised, double-blind clinical trial with a complete three-year followup of one compared with four days' treatment with ampicillin and metronidazole.

OBJECTIVE: To evaluate the long term results after primary closure of perianal abscess and pilonidal sinus. DESIGN: Follow up by questionnaire and study of casenotes. SETTING: University hospital and district hospital. SUBJECTS: 88 Patients who had previously been in a prospective random control trial of two regimens of antibiotic treatment (ampicillin and metronidazole for one compared with four days) before incision, curettage, and primary closure of perianal abscess or pilonidal sinus. MAIN OUTCOME MEASURES: Recurrence rate and outcome. RESULTS: 32 Patients had perianal abscesses of which 31 (97%) healed primarily (95% confidence interval [CI] 84 to 100%) with 4 recurrences (13%, 95% CI 2 to 24%). 56 Patients had pilonidal sinuses or abscesses of which 46 (82%) healed primarily (95% CI 70 to 91%) with 14 recurrences (30%, 95% CI 16 to 40%). There were no significant differences between the two antibiotic regimens. The mean followup was 53 months. Two patients had died, both had had perianal abscesses. Pilonidal sinuses tended to recur during the first year, whereas pilonidal abscesses recurred after a lapse of two years or more. Half the patients who had had previous operations for the same complications, compared with a third who were being operated on for the first time. CONCLUSIONS: A one day course of ampicillin and metronidazole is not associated with any more complications than a four day course. Perianal abscesses respond well to primary closure, but management of pilonidal abscesses and sinuses is more difficult.

Abscess↗

PubMed1993

Gas-containing liver abscesses: assessment by ultrasound (US) and computed tomography (CT).

Single gas-containing pyogenic liver abscesses in 11 patients were studied by ultrasound and computed tomography (CT). On ultrasound, all abscesses were predominantly echogenic compared to the normal liver parenchyma. The gas collections appeared as hyperreflective areas arranged in clusters associated with acoustic shadowing and ring-down artifacts. Ten abscesses (90%) had ill-defined margins on ultrasound, causing underestimation of their sizes in these patients. All abscesses were shown to be multiloculated and had clearly defined borders on CT, not appreciated or mistaken for multiplicity of abscesses on ultrasound. Ultrasound may be inadequate in the evaluation of gas-containing liver abscesses, as they have complex echotexture in addition to ring-down artifacts, acoustic shadows and poorly-defined margins; leading to underestimation of abscess size, difficulty in identifying loculations and erroneous interpretation of multiplicity of abscess cavities.

Adult↗

PubMed1993

[Tuberculous liver abscesses as the form of presentation of human immunodeficiency virus infection].

In patients infected by the human immunodeficiency virus (HIV), it has been observed and increase in the incidence of extrapulmonary tuberculosis. Recently, the presence of abdominal tuberculous abscesses has been described as a manifestation of this form of tuberculous disease. However, hepatic abscesses by Mycobacterium tuberculosis are rare among patients infected by the HIV. In the literature, just two patients with this type of abscesses have been described as a form of presentation of the infection by the HIV. In this paper, we present the case of one patient with positive serology to the HIV and two tuberculous abscesses at the hepatic level as part of a disseminated tuberculosis. The main symptoms were fever and lumbar pain. We established the mycobacterial etiology of the abscesses using Ziehl-Neelsen's tinction and culture in Löwenstein's medium of the sample isolated from the abscesses. Abscess drainage under echographic control, in addition to antituberculous chemotherapy, resulted in a quick recovery of the patient, with disappearance of such abscesses as demonstrated by the ultrasonic study performed at three months.

AIDS-Related Opportunistic Infections↗

PubMed1995

[Imaging of peri-anal and perirectal abscesses and fistulae using endoluminal ultrasound diagnosis].

Endoluminal sonography was performed in 31 patients with suspected perianal or perirectal abscesses or fistulas. Patients with unequivocal clinical findings underwent surgical treatment without preceding sonography. The aim of the sonographical examination was to identify the abscesses, their topographical location, and the internal opening of the fistulas. These results were compared with operative findings. An abscess was diagnosed in 22 patients and could be confirmed by surgery in 21. In one patient a hypoechogenic scar resulting from previous surgery was erroneously interpreted as an intersphincteric abscess. The remaining 9 patients suffered from a fistula without abscess. In all 21 abscesses the sonographic examination showed the correct topographical location. There were 5 perianal, 8 intersphincteric and 8 ischiorectal abscesses. The operation demonstrated the internal opening of the fistula in 17 of 35 cases. Only 9 of these 17 openings (53%) had been identified by preoperative ultrasonography. The endoluminal sonography is a good method to find a perianal or perirectal abscess and to show the topographical location. It should be performed in all cases with an obscure preoperative clinical situation.

Abscess↗

PubMed1977

Comparison of 131I-tetracycline and 67Ga-citrate as abscess localizing agents.

Previous studies have shown that radiolabeled tetracyclines tend to accumulate in infarcts and necrotic tumors. These results suggested that radiolabeled tetracyclines might also accumulate in necrotic abscesses or areas of inflammation. In order to develop a better abscess scanning agent, we compared the efficiency of 131I-tetracycline with 67Ga-citrate in labeling experimentally induced staphylococcal aureus abscesses in rats 24 and 72 hours after injection. In addition to evaluating 131I-tetracycline as an abscess scanning agent, we hoped to obtain data which might clarify the controversy regarding early versus late gallium scanning in suspected infection. 131I-tetracycline was chosen over 99mTc-tetracycline because the longer half-life of 131I would allow 72 hour imaging. Absolute concentrations of gallium in the abscess contents and in the surrounding areas of inflammation were significantly greater than the concentration of 131I-tetracycline at both 24 and 72 hours. With the exception of blood, muscle, and bone, the abscess-to-tissue activity ratios for gallium and 131I-tetracycline were similar; however, the ratio of gallium activity in the inflammed tissue to other tissues was greater than that of 131I-tetracycline for every tissue examined at both time periods. The data suggest that 131I-tetracycline has little potential as a general abscess scanning agent. The gallium tissue concentrations and tissue ratios suggest that abscesses which can be imaged at 72 hours can probably be imaged at 24 hours, thus allowing earlier initiation of appropriate therapy. Because of the higher lesion-to-blood ratio at 72 hours, a 72-hour scan would appear to be indicated before a scan is interpreted as normal.

Abscess↗

PubMed1997

[A case of tuberculous abscess in the chest wall close to the thickening pleural lesion following tuberculous pleuritis].

A 33-year-old woman with a history of right tuberculous pleuritis was successfully treated in December 1992 by administration of anti-tuberculous drugs, she demonstrated residual localized pleural thickening on chest computed tomography (CT) and gradually developed a subcutaneous mass in the right chest which became apparent in March 1993. In September, chest CT revealed a periocostal abscess in the right anterior chest wall close to the localized pleural thickening. The patient was diagnosed with tuberculous abscess in the right chest wall on confirmation of acid-fast bacilli in a needle aspiration material of the abscess, and was referred to our hospital. Anti-tuberculous chemotherapy was continued but the chest abscess grew, so on January 28, 1994 she underwent a resection of the abscess, the third costal cartilage and bone, and the parietal pleural lesion connected to the abscess. Histopathological examination showed that the abscess and parietal pleural lesion were compatible with tuberculosis, i.e. both lesions consisted of caseous necrosis and epitheloid cell granuloma, but acid-fast bacilli were not demonstrated in both lesions. After one year of postoperative anti-tuberculous chemotherapy, she was followed without any therapy for 3 years and there has been no recurrence to date. When a localized thickening pleural lesion remains after tuberculous pleuritis, complication of tuberculous abscess in the chest wall should be considered.

Abscess↗

PubMed1997

[Pyogenic hepatic abscess. Review of 59 cases and experience with imipenem].

OBJECTIVES: To study the different etiopathogenic, microbiological, clinical, evolutive, and therapeutic aspects in patients with pyogenic liver abscesses, with a special emphasis in the usefulness of imipenem-cilastatin therapy. MATERIALS AND METHODS: The clinical records of 59 patients with liver abscesses (45 single abscess and 14 multiple abscesses) diagnosed at our institution in the last eleven years were studied. RESULTS: The most common predisposing conditions included biliary (35.6%) and colon (15.3%) diseases, and abdominal trauma (15.3%). The microorganisms responsible for these abscesses included E. coli, Bacteroides spp., and different streptococci. CT and/or abdominal echography were the diagnostic techniques most commonly used. Twenty-three patients were treated with percutaneous drainage and antibiotics, 22 with surgical drainage and antibiotics, 6 with both types of drainage and antibiotics, and 8 exclusively with antibiotics. Twenty-three patients received imipenem (1 g/IV/8 h) and 29 other antibiotics. Twelve patients died and 9 required admission at the ICU. With regard to patients treated with imipenem, 17 (73.9%) cured, 3 of them (one single abscess and two multiple abscesses) without drainage. Two patients treated with imipenem (8.7%) and 4 treated with other antibiotics (13.8%) relapsed. CONCLUSIONS: Imipenem can be a useful antibiotic in association with percutaneous or surgical drainage for the treatment of pyogenic liver abscesses.

Adolescent↗

PubMed1998

Biochemical and ribotypic comparison of Actinomyces pyogenes and A pyogenes-like organisms from liver abscesses, ruminal wall, and ruminal contents of cattle.

OBJECTIVE: To isolate Actinomyces pyogenes and A pyogenes-like (APL) organisms from the ruminal wall and ruminal contents of cattle and compare them with isolates from liver abscesses from the same animals, using ribosomal DNA restriction fragment length polymorphism analysis or ribotyping. PROCEDURE: Specimens of liver abscesses, ruminal walls, and ruminal contents were collected from 59 cattle at slaughter. All beta-hemolytic, pinpoint colonies that were gram positive, pleomorphic rod-shaped, and catalase negative, and that hydrolyzed casein and gelatin were presumptively identified as A pyogenes and were characterized biochemically, using an identification kit. The isolates that resembled A pyogenes but fermented mannitol or raffinose, or both, were called APL organisms. Isolates from the ruminal wall and ruminal contents were compared with liver abscess isolates from the same animal by use of ribotyping. RESULTS: Actinomyces pyogenes and APL organisms were isolated more frequently from the ruminal wall than from ruminal contents. Ruminal isolates of A pyogenes and APL had biochemical characteristics similar to those of the isolates from liver abscesses. Among 6 sets of isolates (4 A pyogenes and 2 APL), 2 isolates from liver abscesses had ribopatterns identical to the corresponding ruminal wall isolates. Also, the APL organisms isolated from the ruminal content matched with the corresponding liver abscess isolates for both sets of specimens tested. CONCLUSIONS: The ruminal wall may be the niche for A pyogenes and APL organisms in the rumen. The genetic similarity, on the basis of ribotyping among isolates from liver abscesses, the ruminal wall, and ruminal contents of the same animal suggests that A pyogenes and APL organisms that cause liver abscesses originate from the rumen.

Abscess↗

PubMed1997

[Ultrasonography of amebic liver abscesses. Proposal of a new classification].

The different classifications used for amebic liver abscesses seem to be usually without direct therapeutic benefit. Echographic assessment was used to propose a new classification of amebic liver abscesses. This report is a prospective study conducted over 3 years and concerning 118 patients involved by 119 amebic liver abscesses. They were 109 males and 9 females aged from 13 to 68 years (mean, 36 years). All cases were correctly diagnosed by clinical and ultrasound findings, aspect of the pus, course under treatment and rarely by serologic examinations (3 patients). Patients were followed up with clinical and sonographic examinations as requested. Our classification was based on the initial echographic examination findings, the therapeutic indications and the type of healing obtained. In total, 93 abscesses (80, 67%) were treated by medical therapy alone and 26 cases (21, 84%) by combined US-guided evacuation and medical therapy. In the 119 abscesses, 112 (94, 11%) completely recovered with reconstitution of a normal liver parenchyma. In the remaining 7 cases (5, 88%) the abscesses persisted for several months (12 to 36 months). Our study suggests that ultrasonographic features of amebic liver abscesses can be segregated in three forms: noncollected form which needs to be treated by medical therapy alone, collected form which can be treated medically or by association with US-guided evacuation, and the healing forms. This classification appears to us to be simple but very precise, reliable and useful especially for therapeutic indications of amebic liver abscesses.

Adult↗

PubMed1976

Tissue distribution of 203 Pb-acetate: comparison with 67 Ga-citrate as an abscess-localizing agent.

Since 203Pb-acetate accumulates in necrotic tumor tissue, the possibility was raised that it might also accumulate in other necrotic tissue such as abscess. We first studied the tissue distribution and excretion of 203Pb-acetate in control rats at 4, 24, 48, 72, and 96 hr. An enterohepatic circulation for lead is suggested. We then compared the uptakes of 203Pb-acetate and 67Ga-citrate in experimental abscesses in rats. The mean gallium accumulation in the abscess was 10 times that of lead at 24 hr and 12 times that of lead at 72 hr. The abscess-to-tissue ratios were greater for gallium for every tissue examined, although the abscessed areas were clearly visualized by scanning at 24 and 72 hr with both agents. With the exception of blood, abscess-to-tissue ratios for 67Ga at 24 hr were higher than or equal to those at 72 hr. However, the 67Ga ratios for the inflamed tissue surrounding the abscess to muscle and blood were higher at 72 hr than at 24 hr, which suggests that inflammation without abscess might be better identified by gallium scanning at 72 hr.

Abscess↗

PubMed1998

[Brain abscess. Clinicomicrobiologic study and prognostic analysis of 59 cases].

INTRODUCTION: Clinical, microbiological, therapeutic and prognostic characteristics of brain abscesses were analyzed as well as the influence of CT in their evolution. MATERIALS AND METHODS: Retrospective study of 59 patients with the diagnosis of brain abscess of bacterial source before (group A) and after (group B) the introduction of CT (25 and 34 patients, respectively). RESULTS: The most common symptom was headache (76.3%) and the most common abnormality in physical examination was a decrease in the level of consciousness (61%) and this abnormality was associated with a higher mortality rate (13% versus 41.6%; p < 0.05) and also a higher proportion of neurologic sequelae (50% versus 85.7%; p < 0.05). The diagnosis was obtained earlier in group B. The hematogenous source predominated (32.2%); an adjacent source was identified in 28.8% and an apparent source was not recognized in 27.2% (40% in group A versus 17.6% in group B). Anaerobic and microaerophilic streptococci were the bacteria recovered most frequently. Gram-negative aerobic bacteria were the most common in otogenic abscesses. The use of corticosteroids had no influence upon mortality, but it was associated with a lower percentage of neurological sequelae (40% versus 14%; p < 0.05). The introduction of CT decreased mortality (40% in group A versus 23.5% in group B, although this difference was not significant) and also sequelae (86.6% in group A versus 57.6% in group B; p < 0.05). Leaving apart cases of bacterial endocarditis, in which death was due to the underlying heart disease and a systemic sepsis picture, mortality attributed to brain abscess was 20.3%. CONCLUSIONS: The introduction of CT has meant a significant breakthrough for the diagnosis, treatment and follow-up of these patients and has contributed to improvement in survival. In our series, the diagnosis of brain abscess was obtained earlier and the number of brain abscesses with no apparent source has decreased since the introduction of CT. Moreover, CT sensitivity is really good for locating multiple abscesses. Overall, the prognosis of these patients has improved since the introduction of this technique. Nevertheless, brain abscess is still associated with a relevant morbi-mortality rate.

Adrenal Cortex Hormones↗

PubMed1998

[Cardiac abscess in infectious endocarditis. A multicenter study apropos of 233 cases. The Working Group on Valvulopathy of the French Society of Cardiology].

The aim of this retrospective multicenter study was to determine present characteristics of infectious endocarditis complicated by abscess and to identifying predictive factors of mortality. The files of 233 patients with infectious endocarditis complicated by perivalvular abscesses between January 1989 and December 1993 were analysed. Two hundred and thirteen patients underwent medico-surgical treatment (175 aortic and 38 mitral abscesses) and 20 patients underwent medical treatment alone (17 aortic and 3 mitral abscesses). The abscess was observed on native valves in 156 cases and valve prostheses in 77 cases. The causative organism was identified in 69% of cases : the commonest organism was the staphylococcus. The diagnostic sensitivity of transthoracic and transoesophageal echocardiography was 36 and 80% respectively. The operative mortality at one month was 16%. Patients over 65 years of age, staphylococcal infection, renal failure and fistulisation of the abscess, were identified as independent predictive factors of mortality at one month. The survival rate three months after surgery was 75 +/- 10% and 59 +/- 11% at 27 months. An age over 65, staphylococcal infection, uncontrolled infection, circumferential abscess and fistulisation were independent predictive factors of global mortality (the first month and after). The mortality rate in unoperated patients was 40%: cardiac failure and fistulisation of the abscess detected by echocardiography were predictive factors of mortality on univariate analysis.

Abscess↗