[Postoperative recurrence of subdural empyema]. / Recidiva de empiema subdural postquirúrgico.

We present a case of recurrent subdural post-surgical empyema by Proprionibacterium acnes after a first drained empyema in which no microbiological diagnosis was reached. P. acnes is a gram-positive anaerobic organism which is part of the saprophytic flora of the skin and others parts of the body. However, it can cause infections, as in the central nervous system, especially post-surgical infections in which can be the second more frequent organism after Staphylococcus aureus. P. acnes grows slowly and shows better growth in liquid anaerobic media. It is usually resistant to metronidazol and sensitive to penicillin. In postoperative central nervous system infections we must take into account the possibility of this organism, process the sample properly and keep touch with the Microbiology Department.

Recidiva de empiema subdural postquirúrgico / Postoperative recurrence of subdural empyema

Se presenta un caso de recidiva de infección postquirúrgica en forma de empiema subdural por Proprionibacterium acnes tras un primer empiemadrenado en el que no se llegó al diagnóstico microbiológico. P acnes es un microorganismo gram positivo, anaerobio, que forma parte de la flora saprófita de la piel y de otras zonas del organismo. Sin embargo puede producir infecciones, entre otras localizaciones, en el sistema nervioso central (SNC), especialmente infecciones postquirúrgicas en las que puede llegar a ser el segundo germen en frecuencia después de Staphylococcusaureus. Es de crecimiento lento y suele crecer mejor en medios anaeróbicos líquidos. Suele ser resistente almetronidazol y sensible a penicilinas. En las infecciones postquirúrgicas del sistema nervioso central hay que tener en cuenta la posibilidad de este microorganismo, procesar las muestras de forma adecuada y mantenernos en contacto con el Servicio de Microbiología (AU)

We present a case of recurrent subdural postsurgical empyema by Proprionibacterium acnes after a first drained empyema in which no microbiological diagnosis was reached. P. acnes is a grampositive anaerobic organism which is part of the saprophytic flora of the skin and others parts of the body. However, it can cause infections, as in the central nervous system, especially postsurgical infections in which can be the second more frequent organism after Staphylococcus aureus. P. acnes grows slowly and shows better growth in liquid anaerobic media. It is usually resistant to metronidazol and sensitive to penicillin. In postoperative central nervous system infections we must take into account the possi- bility of this organism, process the sample properly and keep touch with the Microbiology Department (AU)

[Postsurgical meningitis. Differential characteristics of aseptic postsurgical meningitis]. / Meningitis postquirúrgica. Características diferenciales de la meningitis aséptica post-quirúrgica.

BACKGROUND: Postsurgical meningitis is a rare complication that is accompanied by an increase of hospital stay and high mortality. Some of these cases are not due to a true infection but due to an aseptic inflammation of the meninges denominated aseptic postsurgical meningitis (APSM). Proper identification of these cases would allow better use of antimicrobial drugs. METHODS: A retrospective study of patients with postsurgical meningitis in a universitary hospital for 14 years. We describe the clinical characteristics of patients with postsurgical bacterial meningitis (PBM) compared to those of patients with APSM. RESULTS: During the studied period 35 patients (71%) with PBM and 14 patients (29%) with (APSM) were identified. The mean age of patients with PBM was similar to that of patients with APSM. There was a male predominance in the group of PBM (71%) compared with patients with APSM (36%, p = 0.020). Patients with intracranial hemorrhage tended to present more cases of APSM (64%) than of PBM (34%, p = 0.055). Patients undergoing posterior fossa craniotomy (p = 0.092) and those receiving steroids (p = 0.051) showed a greater tendency to suffer APSM. It was also noted a trend towards present PBM in patients who had suffered an infection in the previous month (p = 0.072). There were seven patients with PBM (20%) with a cell count above 5000 cells/mm3 in CSF, values not found in any patients with APSM. No differences were detected in the glycorrachia and proteinorrachia between the two groups. The most common bacteria isolated were coagulase negative Staphylococcus and S. aureus. In 5 patients (14%) non fermenting gram-negative bacillus (Pseudomonas aeruginosa and Acinetobacter spp) were isolated. There were no deaths attributed to any type of postsurgical meningitis. CONCLUSION: Patients admitted for brain haemorrhage, undergoing posterior fossa surgery or receiving steroids tend to develop APSM. A CSF cell count above 5000 cells / mm3 strongly suggests MBP.

Meningitis postquirúrgica. Características diferenciales de la meningitis asépticapost-quirúrgica / Postsurgical meningitis. Differential characteristics of aseptic postsurgical meningitis

complicación infrecuente que se acompaña de unincremento de la estancia hospitalaria y de una elevadamortalidad. Algunos de estos casos no son debidos a unaverdadera infección sino a una inflamación aséptica delas meninges denominada meningitis aséptica post-quirúrgica(MAPQ). La adecuada identificación de estoscasos permitiría una mejor utilización de los fármacosantimicrobianos.Material y métodos. Estudio retrospectivo de lospacientes con meningitis postquirúrgica en un hospitalterciario durante 14 años comparando las característicasclínicas de los pacientes con meningitis bacterianapostquirúrgica (MBP) frente a las de pacientes conMAPQResultados. Durante el período analizado se identificaron35 pacientes (71%) con MBP y 14 pacientes (29%)con MAPQ. La edad media de los pacientes con MBPfue similar a la de los pacientes con MAPQ. Hubo predominiode varones en el grupo de MBP (71%) en relacióncon los pacientes con MAPQ (36%, p=0,020). Laproporción de pacientes con hemorragia intracranealtendió a ser más frecuente en pacientes que posteriormentedesarrollaron MAPQ (9 pacientes, 64 %) que enlos pacientes con MBP (12 casos, 34%, p=0,055). Lospacientes sometidos a craneotomía posterior (p=0,092)y los que recibían tratamiento esteroideo (p=0,051)mostraron una mayor tendencia a padecer MAPQ.Siete pacientes MBP (20%) presentaron un recuentocelular superior a 5000 células/mm3 en el LCR, cifrano encontrada en ningún caso de MAPQ. No se detectarondiferencias en la glucorraquia y proteinorraquiaentre ambos grupos. La bacterias más frecuentementeaisladas fueron Staphylococcus coagulasa negativa y S.aureus. En 5 pacientes (14%) se aislaron bacilos gramnegativosno fermentadores (Pseudomonas aeruginosa yAcinetobacter spp). No hubo ningún fallecimiento atribuidoa meningitis postquirúrgica. (..) (AU)

Background. Postsurgical meningitis is a rare complicationthat is accompanied by an increase of hospitalstay and high mortality. Some of these cases are not dueto a true infection but due to an aseptic inflammation ofthe meninges denominated aseptic postsurgical meningitis(APSM). Proper identification of these cases wouldallow better use of antimicrobial drugs.Methods. A retrospective study of patients withpostsurgical meningitis in a universitary hospital for14 years. We describe the clinical characteristics ofpatients with postsurgical bacterial meningitis (PBM)compared to those of patients with APSM.Results. During the studied period 35 patients (71%)with PBM and 14 patients (29%) with (APSM) wereidentified. The mean age of patients with PBM wassimilar to that of patients with APSM. There was a malepredominance in the group of PBM (71%) comparedwith patients with APSM (36%, p = 0.020). Patientswith intracranial hemorrhage tended to present morecases of APSM (64%) than of PBM (34%, p = 0.055).Patients undergoing posterior fossa craniotomy (p =0.092) and those receiving steroids (p = 0.051) showeda greater tendency to suffer APSM. It was also noted (...) (AU)

Tratamiento quirúrgico: técnicas, indicaciones, resultados y complicaciones / Surgical treatment: techniques, indications, results and complications

En el momento actual, el tratamiento electivo de la acromegalia consiste en la resección quirúrgica del adenoma productor de hormona del crecimiento con conservación de la función hipofisaria. La mayoría de los casos son intervenidos mediante un abordaje transesfenoidal, que puede ser sublabial o intranasal. El endoscopio puede mejorar la visión de algunos aspectos de la resección quirúrgica realizada con un microscopio y es útil como adyuvante de la microcirugía. La resección quirúrgica de un adenoma con técnica endoscópica exclusiva puede presentar serias limitaciones en los campos quirúrgicos con hemorragia, lo que añade riesgo y en ningún caso mejora los resultados endocrinológicos que ofrece la microcirugía. Estos resultados guardan relación con el tamaño del tumor y los criterios de curación utilizados, así como con el tiempo de evolución postoperatoria. En general se puede esperar una remisión de la enfermedad en más del 90% de los casos intervenidos por tumores < 1 cm de diámetro, pero también se puede obtener la remisión de la enfermedad en al menos un 15% de los casos con adenomas invasivos. El porcentaje de complicaciones es bajo, con insuficiencia de la función hipofisara secundaria al acto quirúrgico en alrededor del 1% de los casos (AU)

Transsphenoidal microsurgery remains the most valid and widely used method of treating acromegaly. This procedure that has been proved relatively safe, achieves selective adenomectomy in a great number of cases and a successful outcome in about 90% of patients with microadenomas. Pituitary insuficiency surgically realated in less than 1% of the cases. 90% of all pituitary adenomas can be treated via the transphenoidal approach using different entry sites: sublabial, pernasal, endonasal. The use of endoscopes is very helpful for better visualization within the sphenoid sinus, especially within the sella, but does not seem to improve the final endocrinological results. Acurate endocrinological diagnosis and early surgical treatment lead to prevent tumor growth and possible focal or general invasion. An other surgical point, is the the prevention of the possibility of pituitary apoplexy rare but life threatening (AU)