A Case of Community-acquired Bacteremic Empyema Caused by Kocuria kristinae.

Kocuria kristinae, part of the normal flora of the skin and oral mucosa, is seldom reported as a human pathogen; infection is mostly associated with immunocompromised patients in healthcare facilities. Here, we describe the first case of bacteremic empyema caused by K. kristinae acquired from the community. K. kristinae was isolated from pleural effusion and two sets of peripheral blood samples drawn from two different sites. The empyema resolved after the insertion of a chest tube and intravenous administration of piperacillin-tazobactam and levofloxacin.

Monitoring Therapeutic Response in a Case of Extrapulmonary Tuberculosis by Serial F-18 FDG PET/CT.

Due to the low yield of AFB smear and culture in extrapulmonary tuberculosis, therapeutic responses of patients with extrapulmonary tuberculosis are usually monitored clinically and/or radiographically. Such monitoring techniques, however, are not enough to provide effective diagnosis if a remnant lesion exists after treatment. Tuberculosis presents hypermetabolic activity on F-18 fluorodeoxyglucose positron emission tomography/computed tomography (F-18 FDG PET/CT) scanning. Reported herein is a case of extrapulmonary tuberculosis where the therapeutic response was assessed via serial F-18 FDG PET/CT scanning, which was useful for detecting the extent of extrapulmonary tuberculosis and for estimating the patient's therapeutic response.

Comparison of natural and Dumon airway stents for the management of benign tracheobronchial stenoses.

OBJECTIVE AND BACKGROUND: To investigate the utility and safety of the 'Natural stent', a newly designed silicone airway stent, the authors compared clinical outcomes and complications in patients who underwent silicone airway stenting for the management of benign airway stenosis. METHODS: The medical records of 94 patients requiring the placement of 100 airway stents (43 Dumon and 57 Natural) were retrospectively reviewed in a tertiary referral hospital. RESULTS: Post-tuberculous stenosis was the leading indication for airway stenting (74%), followed by post-intubation stenosis (21%). After intervention, dyspnoea improved in patients who underwent Dumon (90%) and Natural (86%) stenting. After stabilizing dyspnoea, stents could be successfully removed in half of the patients who underwent Dumon (54%) or Natural (49%) stenting. During a 42-month follow-up period, complication rates were similar in patients who underwent Dumon or Natural stenting. CONCLUSION: Natural airway stent was as effective and safe as Dumon stent for the management of benign tracheobronchial stenoses.

The role of endoscopic surgery for completely obstructive endobronchial benign tumor.

BACKGROUND: The improving techniques of therapeutic bronchoscopy have been replacing conventional surgery for resecting endobronchial benign tumor. However, there could be some limitation for performing bronchoscopic intervention for the patients with complete bronchial obstruction. To evaluate the role of endoscopic surgery for completely obstructive endobronchial benign tumor, we retrospectively reviewed the medical records of 7 patients who underwent bronchoscopic resection due to completely obstructive benign tumor. METHODS: Rigid bronchoscopy was performed under general anesthesia. After the stalk of tumor was identified with using a 1 mm biopsy forceps as a probe, a Nd-YAG laser was used to coagulate the stalk of tumor. The tumor was then removed. RESULTS: Bronchoscopic resection was successful in 6 out of 7 patients. The histological diagnoses were 3 leiomyomas, 3 harmatomas and 1 lipoma. There was no mortality in our study. Pneumomediastinum developed in 1 patient, and this patient was treated with 3 days of oxygen therapy. In 5 out of the 6 successful patients, there was no recurrence for a median of 35 months. In 1 patient, leiomyoma recurred after 17 months, and this was treated by pneumonectomy. CONCLUSIONS: Endoscopic surgery could be applied to the patients with completely obstructive endobronchial benign tumor.

Rigid bronchoscopic intervention in patients with respiratory failure caused by malignant central airway obstruction.

INTRODUCTION: Bronchoscopic intervention in patients with malignant central airway obstruction provides initial palliation and stabilization of the airway, allowing the possibility of other effective therapeutic modalities, such as surgery, radiation, or chemotherapy. In critically ill patients, however, the only studies of bronchoscopic intervention are relatively small series. METHODS: To describe the advantages and limitations of rigid bronchoscopic intervention in critically ill patients, we reviewed the medical records of 36 patients (26 men; median age, 62 years; range, 29 to 76 years) who underwent emergency airway intervention for malignant central airway obstruction. RESULTS: Dyspnea was relieved in 34 of 36 patients (94.4%). After the airway was widened, additional definitive therapeutic modalities were used for 21 of 34 patients (61.8%). Patients who underwent additional definitive therapy after bronchoscopic intervention survived longer (median, 38.2 months; range 1.7 to 57.0 months) than those who did not (median, 6.2 months; range, 0.1 to 33.7 months; p < 0.001). CONCLUSIONS: These data show that rigid bronchoscopic intervention in critically ill patients with malignant central airway obstruction may be temporarily life-saving and, in some patients, may serve as a "bridge" to allow time for additional therapies for longer survival.