[A Case of Bacteremia Which Followed a Urinary Tract Infection by Oligella urethralis].

An 82-year-old bedridden man with sequelae from a cerebral infarction was admitted to a welfare institution for the elderly. He developed a high fever and hematuria and was prescribed levofloxacin for the treatment of a suspected urinary tract infection. Although his condition improved, the symptoms subsequently recurred; therefore, levofloxacin was again administered. He remained febrile and was admitted to a hospital due to recalcitrant urinary tract infection. Immediately after admission, he developed ischuria and pyuria. Urine and blood cultures at admission indicated the presence of levofloxacin-resistant Oligella urethralis (O. urethralis). He recovered with ceftriaxone medication. To our knowledge, this is the first report of bacteremia associated with a urinary tract infection caused by O. urethralis in Japan.

Pleural metastasis of thyroid carcinoma diagnosed by thoracoscopy under local anesthesia.

A 79-year-old male patient with no symptoms was referred to us with incidentally detected pleural effusion and nodules. He had previously been diagnosed with papillary thyroid carcinoma (PTC) and had undergone left subtotal thyroidectomy 12 years before his referral. Four years after the operation, he experienced a relapse limited to the cervical lymph node and was treated with neck dissection. He experienced no further recurrence until his referral. Thoracoscopy was performed under local anesthesia to confirm the diagnosis because thoracentesis was precluded by the small quantity of pleural effusion and the nodules. Many vivid red pleural masses were evident as was a small amount of bloody pleural effusion. The patient was diagnosed with pleural metastasis of PTC, which has a poor prognosis. Because of this poor prognosis, prompt diagnosis is essential. Thoracoscopy under local anesthesia can allow the prompt diagnosis of cases in which safe thoracentesis would be difficult.

[A case of meningeal carcinomatosis from lung cancer successfully treated with aggressive multimodal therapy].

A 44-year-old man was admitted to our hospital because of brain metastasis and intrapulmonary exacerbation of lung adenocarcinoma. Systemic chemotherapy (PAC + CBDCA) was administered, but neurological symptoms (muscle weakness of limbs and disorientation) appeared. Lumbar puncture and enhanced MRI of lumber vertebrae revealed meningeal carcinomatosis. MTX 20 mg/week (+ Ara-C 40 mg/week) was injected into the meningeal space. There was a clear improvement in the neurological symptoms, but it did not last long. Meningeal injection was performed 7 times. Whole-brain and whole-marrow radiation along with systemic chemotherapy gave a marked improvement in the symptoms and in the metastatic shadow on the chest CT scan.

[Pseudotumor by asymptomatic pulmonary infarction diagnosed by video-assisted thoracic surgery].

Two cases of asymptomatic pulmonary infarction were diagnosed by open lung biopsy with video-assisted thoracic surgery (VATS). Case 1: A pulmonary nodule in right S8b was pointed out in a 62-year-old man undergoing hemodialysis on chest x-ray film and CT. Case 2: A 50-year-old woman had undergone left mastectomy for mammary cancer 3 years previously and total hip replacement 1 year before. Chest X-ray film and CT revealed a pulmonary nodule in the left lower lung field and it was suspected to be metastasis of the mammary cancer. Both cases underwent open lung biopsy by VATS, and asymptomatic pulmonary infarction was revealed. When chest X-ray film shows a nodule in the lower-peripheral lung field in patients with risk factors, pulmonary infarction should be considered.

Tracheal stenosis caused by retrosternal dislocation of the right clavicle.

A 17-year-old woman was admitted to our institution because of tracheal stenosis. She had undergone tracheostomy after a traffic accident, but the stenosis had persisted. Chest computed tomography showed retrosternal dislocation of the right sternoclavicular joint and compression of the trachea by the medial head of the right clavicle. To relieve the tracheal compression, 3 cm of the medial head of the clavicle was resected. The dyspnea disappeared completely, allowing closure of the tracheostomy. Posterior dislocation of the sternoclavicular joint and tracheal stenosis due to compression by the dislocated clavicle is rare.