Abscesos piógenos encefálicos. Nuestra experiencia en 60 casos consecutivos
Pyogenic brain abscesses: experience with 60 consecutive cases
M. Ortega-Martínez
, J.M. Cabezudo, I. Fernández-Portales, L. Gómez-Perals, J.A. Rodríguez-Sánchez, L. García-Yagüe, L.F. Porras, L.M. Lorenzana, F. Ugarriza, M. Pineda-Palomo, L.M. Bernal-García
Servicio de Neurocirugía. Hospital Regional Universitario Infanta Cristina. Badajoz
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Fernández-Portales, L. Gómez-Perals, J.A. Rodríguez-Sánchez, L. García-Yagüe, L.F. Porras, L.M. Lorenzana, F. Ugarriza, M. Pineda-Palomo, L.M. Bernal-García" "autores" => array:11 [ 0 => array:3 [ "nombre" => "M." "apellidos" => "Ortega-Martínez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "J.M." "apellidos" => "Cabezudo" ] 2 => array:2 [ "nombre" => "I." "apellidos" => "Fernández-Portales" ] 3 => array:2 [ "nombre" => "L." "apellidos" => "Gómez-Perals" ] 4 => array:2 [ "nombre" => "J.A." "apellidos" => "Rodríguez-Sánchez" ] 5 => array:2 [ "nombre" => "L." "apellidos" => "García-Yagüe" ] 6 => array:2 [ "nombre" => "L.F." "apellidos" => "Porras" ] 7 => array:2 [ "nombre" => "L.M." "apellidos" => "Lorenzana" ] 8 => array:2 [ "nombre" => "F." "apellidos" => "Ugarriza" ] 9 => array:2 [ "nombre" => "M." "apellidos" => "Pineda-Palomo" ] 10 => array:2 [ "nombre" => "L.M." "apellidos" => "Bernal-García" ] ] "afiliaciones" => array:1 [ 0 => array:1 [ "entidad" => "Servicio de Neurocirugía. Hospital Regional Universitario Infanta Cristina. Badajoz" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Correspondencia postal: Servicio de Neurocirugía. Hospital Universitario Infanta Cristina. Avda de Elvas S/N. Badajoz." ] ] ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Pyogenic brain abscesses: experience with 60 consecutive cases" ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2005-01-07" "fechaAceptado" => "2005-03-04" "PalabrasClave" => array:2 [ "es" => array:2 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec159138" "palabras" => array:4 [ 0 => "Abscesos cerebrales" 1 => "Escisión" 2 => "Infección intracraneal" 3 => "Punción-aspiración" ] ] 1 => array:4 [ "clase" => "abr" "titulo" => "Abreviaturas" "identificador" => "xpalclavsec159140" "palabras" => array:6 [ 0 => "BGN" 1 => "GOS" 2 => "LCR" 3 => "SNC" 4 => "TC" 5 => "VSG" ] ] ] "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Key words" "identificador" => "xpalclavsec159139" "palabras" => array:4 [ 0 => "Brain abscess" 1 => "Drainage-aspiration" 2 => "Excision" 3 => "Intracranial infection" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span class="elsevierStyleSectionTitle">Introducción</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">El absceso cerebral es un proceso supurativo focal en el parénquima cerebral que todavía presenta una elevada mortalidad. El resultado está altamente relacionado con un tratamiento precoz y adecuado. Para valorar dicho tratamiento revisamos los abscesos cerebrales tratados en nuestro Servicio en los últimos 14 años</p> <span class="elsevierStyleSectionTitle">Material y métodos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Presentamos una revisión de los 60 pacientes con diagnóstico de absceso cerebral piógeno tratados en el Servicio de Neurocirugía del Hospital Infanta Cristina entre Enero de 1990 y Febrero de 2004, prestando atención a la epidemiología, clínica, etiología, microbiología, tratamiento y resultado final.</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">La relación hombre/mujer es 5.6/1, con una edad media de 47 años; el origen de la infección más frecuente es el hematógeno, seguido de las infecciones contiguas, con un 22% de abscesos de origen desconocido; los gérmenes más frecuentes son los cocos Gram positivos (44%), con una importante presencia de gérmenes anaerobios (40%); en un 39% de los casos las infecciones son mixtas; las modalidades de tratamiento fueron la punción de los abscesos para aspiración-drenaje, la cirugía abierta, con o sin resección capsular, y el tratamiento médico exclusivo. 52 pacientes (86.7%) curaron sin secuelas y 4 (6,7%) fallecieron. Aunque los resultados de ambos tipos de tratamiento quirúrgico son similares, el drenaje del absceso requirió en un 20% de los casos un segundo proceder quirúrgico, mientras que la craneotomía lo precisó sólo en el 10%; la estancia media en nuestro hospital fue mucho menor en los abscesos tratados mediante drenaje que en los tratados mediante cirugía abierta (13 vs 26 días); la mortalidad fue mayor en pacientes con bajo nivel de conciencia al ingreso y en mayores de 70 años.</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Consideramos que la menor estancia media del drenaje del absceso, unido a su alta eficacia y su baja morbilidad, hacen aconsejable su uso como tratamiento de primera elección.</p>" ] "en" => array:2 [ "titulo" => "Summary" "resumen" => "<span class="elsevierStyleSectionTitle">Introduction</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Brain abscess is a focal suppurative process in the brain parenchyma that still carries high mortality rates. Outcome is closely related with a correct and early management. In order to evaluate this management we have reviewed the brain abscesses treated in our Department during the last 14 years.</p> <span class="elsevierStyleSectionTitle">Material and Methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">The authors present a retrospective series of 60 consecutive patients with pyogenic brain abscess treated between January of 1990 and February of 2004 paying attention to the epidemiology, etiology, clinical data, microbiology, treatment modalities and outcome</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">The male to female rate was 5.6 to 1. The average age was 47 years. Hematogenous spread was most frequent, followed by contiguous spread. In 22% of the cases, the origin was unknown. Regarding the causative pathogens, Gram positive cocci are the most frequent (44%), with a 40% incidence of anaerobics. A mixed infection occurred in 39% of the abscesses. Three modalities of treatment were used: non surgical, catheter drainage-aspiration and surgical excision. Outcome was excellent in 52 patients (86.7%) and 4 patients (6.7%) died. Although outcome was similar in both surgical modalities, drainage-aspiration required a second procedure in 20% of the cases while this was necessary in only 10% of the patients with abscess excision. Length of admission was shorter in the drainageaspiration group than in the excision group (13 and 26 days respectively). Mortality was higher in patients with low level of consciousness and age over 70 years.</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">The shorter admission time associated with drainage-aspiration of brain abscesses together with its high efficacy and low morbidity suggests that drainageaspiration should be used as the first mode of treatment.</p>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">Ortega-Martínez, M.; Cabezudo, J.M.; Fernández-Portales, I.; Gómez-Perals, L.; Rodríguez-Sánchez, J.A.; García-Yagüe, L.; Porras, L.F.; Lorenzana, L.M.; Ugarriza, F.; Pineda-Palomo, M.; Bernal-García, L.M.: Abscesos piógenos encefálicos. Nuestra experiencia en 60 casos consecutivos. Neurocirugía 2006; 17: 23–33.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "Bibliografía" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:29 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Absceso cerebral. Estudio clínico microbiológico y análisis pronóstico de 59 casos" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "A. Blanco García" 1 => "E. García Vázquez" 2 => "N. Benito" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Rev Clin Esp" "fecha" => "1998" "volumen" => "198" "paginaInicial" => "413" "paginaFinal" => "419" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9737147" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib2" "etiqueta" => "2." 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| año/Mes | Html | Total | |
|---|---|---|---|
| 2023 Junio | 1 | 0 | 1 |
| 2023 Marzo | 2 | 2 | 4 |
| 2019 Enero | 1 | 2 | 3 |
| 2018 Febrero | 14 | 5 | 19 |
| 2018 Enero | 14 | 36 | 50 |
| 2017 Diciembre | 13 | 16 | 29 |
| 2017 Noviembre | 39 | 11 | 50 |
| 2017 Octubre | 7 | 8 | 15 |
| 2017 Septiembre | 12 | 8 | 20 |
| 2017 Agosto | 9 | 4 | 13 |
| 2017 Julio | 10 | 12 | 22 |
| 2017 Junio | 28 | 4 | 32 |
| 2017 Mayo | 21 | 10 | 31 |
| 2017 Abril | 11 | 8 | 19 |
| 2017 Marzo | 9 | 6 | 15 |
| 2017 Febrero | 6 | 1 | 7 |
| 2017 Enero | 9 | 3 | 12 |
| 2016 Diciembre | 19 | 15 | 34 |
| 2016 Noviembre | 17 | 10 | 27 |
| 2016 Octubre | 26 | 7 | 33 |
| 2016 Septiembre | 37 | 16 | 53 |
| 2016 Agosto | 43 | 20 | 63 |
| 2016 Julio | 22 | 10 | 32 |
| 2015 Diciembre | 2 | 0 | 2 |
| 2015 Julio | 2 | 5 | 7 |
| 2015 Junio | 23 | 7 | 30 |
| 2015 Mayo | 26 | 15 | 41 |
| 2015 Abril | 29 | 9 | 38 |
| 2015 Marzo | 19 | 17 | 36 |
| 2015 Febrero | 7 | 14 | 21 |
| 2015 Enero | 26 | 14 | 40 |
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| 2014 Noviembre | 11 | 15 | 26 |
| 2014 Octubre | 23 | 16 | 39 |
| 2014 Septiembre | 17 | 15 | 32 |
| 2014 Agosto | 20 | 9 | 29 |
| 2014 Julio | 18 | 13 | 31 |
| 2014 Junio | 31 | 16 | 47 |
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| 2014 Abril | 26 | 11 | 37 |
| 2014 Marzo | 32 | 18 | 50 |
| 2014 Febrero | 22 | 15 | 37 |
| 2014 Enero | 31 | 10 | 41 |
| 2013 Diciembre | 26 | 12 | 38 |
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| 2013 Octubre | 27 | 14 | 41 |
| 2013 Septiembre | 31 | 14 | 45 |
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