Trends in the management of XXXX : a review of 102 cases over 17 years.

@entity1 @entity16 @entity299 @entity867 @entity1173
The records of 102 @entity1 with brain abscesses treated over 17 years were analyzed. In recent years, cardiac and pulmonary causes were less frequent, the abscesses were smaller, and fewer @entity1 were in poor @entity16 . There has been no significant change in the type or number of infective organisms or in the number of abscesses during the study period. Computed tomographic brain scanning was the most important factor in reducing the mortality rate from 41% to 4%. The @entity1 were grouped according to the treatment received: excision (n = 46), @entity1173 (n = 33), or nonsurgical therapy (n = 17). @entity1 treated nonsurgically were more likely to have smaller abscesses and multiple lesions than were @entity1 in the other two groups. There were no significant differences in the morbidity or mortality rates between treatment groups. @entity1 whose abscesses were excised had a significantly shorter course of antibiotics than the other @entity1 . Organisms were identified in 85% of the cultures from surgical specimens. The use of preoperative antibiotics was significantly associated with sterile cultures; 30% of @entity1 who received antibiotics preoperatively had sterile cultures, compared with only 4% of @entity1 who did not receive such treatment. The mortality rate among all treated @entity1 (the diagnosis of @entity867 was missed in 6 @entity1 before computed tomographic scanning became routine) was significantly related to the initial neurological grade and the size of the lesion but not to age, sex, or the number of abscesses. Four of the 8 treated @entity1 who died had @entity299 ; an aggressive surgical approach is recommended for such @entity1 .(ABSTRACT TRUNCATED AT 250 WORDS)
