ACUTE POST-SURGICAL MENINGITIS

Acute Post-Surgical Meningitis Occurred Over A Six-Week Period

Abstract

Bacterial meningitis, a world-wide disease, has to be reviewed periodically because the specific micro-organisms responsible for the infection vary with time, geography and patient age. To determine its incidence and clinical features in Taiwan, we reviewed the microbiological records for cerebrospinal fluid (CSF) and blood cultures, and the medical records of patients with bacterial meningitis admitted between 1981 and mid-1998. Bacterial micro-organisms were demonstrated in the CSF and/or blood in 395 patients with 418 episodes of bacterial meningitis. Streptococcus species were the most common causative micro-organism group, at 23.21% of all episodes. Its prevalence rate significantly decreased from the first 7 years of study (41.9%) to the last 10.5 years (19.2%). However, Klebsiella meningitis and Staphylococcal meningitis were more frequently noted after 1987.

Post Surgical Meningitis

Introduction

This study aims at analyzing the outcomes of transsphenoidal surgery in 35 patients of Cushing's disease (CD), the highest number of patients seen during 11 years from one center in Iran. Materials and Methods: Retrospective data from case records of all patients were retrieved. The diagnosis of CD was based on clinical presentation, hormone studies, adrenal and pituitary imaging, and thoracic imaging as and when considered appropriate. Age, sex, clinical parameters, laboratory investigations, intra-operative findings, post-operative complications, duration of hospital stay and follow up observations were evaluated using appropriate statistical methods. Results: Of 35 patients, 26 were female and 9 male with a mean age of 28±10 years. The most frequent presenting symptom had been obesity (57%) which was present for 30±29 months. Four patients had macroadenoma and the other 31 (86%) had microadenoma. All patients were operated by transsphenoidal route; there were no intra-operative complications. Two patients had temporary CSF rhinorrhea and 9 had temporary diabetes insipidus in the post-operative period without any need for surgical intervention.

Materials and Methods

The medical records of all patients who underwent TSS in our hospital were reviewed. This is a sequential case series study of Cushing's disease, operated by transsphenoidal route in our hospital. Most of the patients were admitted to the endocrine ward of the Taleghani Hospital for clinical and appropriate investigation. All had detailed history and clinical examination, and evaluation of serum cortisol levels from samples taken morning, afternoon and following overnight dexamethason. Patients were selected for surgical intervention when findings of their evaluations corresponded to one of the following three groups:

1) typical hormonal findings for Cushing's disease i.e. high basal serum and 24hour urine cortisol, no cortisol suppressibility to low dose dexamethason suppression test (LDDST) but good suppression after high dose dexamethason suppression test (HDDST) and normal or, high serum ACTH; normal or bilateral adrenal hyperplasia on abdominal computed tomography; micro or macroadenoma in pituitary imaging.

2) endocrine evaluation typical for Cushing's disease, as above; adrenal computed tomography normal or bilateral adrenal hyperplasia; no positive finding in pituitary neuro imaging.

3) patients whose endocrine evaluations were not definitive for Cushing's disease but had findings of a micro or macroadenoma in their pituitary neuro ...