PubMed · 13566361
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J BROMOWICZ. [Subdural abscess].. https://pubmed.ncbi.nlm.nih.gov/13566361/
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CASE REPORT: We report a case of an intramedullary spinal cord abscess (ISCA) in a 14-month-old child. This case demonstrates clinical and radiological features and emphasizes the importance of early diagnosis and treatment. Early surgical intervention and adjuvant antibiotic therapy have been shown to improve the clinical outcome. Successful outcome depends on early diagnosis and aggressive management. DISCUSSION: Spinal intramedullary abscess is a rare neurosurgical entity. They can hardly be distinguished from neoplasms. Hart described the first case in 1830. Since then, approximately 70 cases have been reported. An acute spinal intramedullary abscess may present as a cord syndrome with back pain and fever, contrasting with chronic spinal intramedullary abscess, which tends to have a less specific symptomatology.
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BACKGROUND: Although ventral hernia repair is increasingly performed laparoscopically, complication rates with this procedure are not well characterized. For this reason, we performed a prospective study comparing early outcomes after laparoscopic and open ventral hernia repairs. METHODS: We identified all the patients undergoing ventral (including incisional) hernia repair at a single tertiary care center between September 1, 1999 and July 1, 2001 (overall n = 257). To increase the homogeneity of the sample, we excluded umbilical hernia repairs, parastomal hernia repairs, nonelective procedures, procedures not involving mesh, and repairs performed concurrently with another surgical procedure. Postoperative complications (in-hospital or within 30-days) were assessed prospectively according to standardized definitions by trained nurse clinicians. RESULTS: Of the 136 ventral hernia repairs that met the study criteria, 65 (48%) were laparoscopic repairs (including 3 conversions to open surgery) and 71 (52%) were open repairs. The patients in the laparoscopic group were more likely to have undergone a prior (failed) ventral hernia repair (40% vs 27%; p = 0.14), but other patient characteristics were similar between the two groups. Overall, fewer complications were experienced by patients undergoing laparoscopic repair (8% vs 21%; p = 0.03). The higher complication rate in the open ventral hernia repair group came from wound infections (8%) and postoperative ileus (4%), neither of which was observed in the patients who underwent laparoscopic repair. The laparoscopic group had longer operating room times (2.2 vs 1.7 h; p = 0.001), and there was a nonsignificant trend toward shorter hospital stays with laparoscopic repair (1.1 vs 1.5 days; p = 0.10). CONCLUSIONS: The patients undergoing laparoscopic repair had fewer postoperative complications than those receiving open repair. Wound infections and postoperative ileus accounted for the higher complication rates in the open ventral hernia repair group. Otherwise, these groups were very similar. Long-term studies assessing hernia recurrence rates will be required to help determine the optimal approach to ventral hernia repair.