Chronic Pasteurella Multocida Bronchitis Diagnosed 3 Years After Onset of Symptoms.

We report a case of chronic infection with Pasteurella multocida in the lower respiratory tract in a man with a cat. A 77-year-old man presented with recurrent hemoptysis accompanied by bronchiectasis and an opacity in the left lung on chest computed tomography. Although the patient was seropositive for Mycobacterium avium complex, repeated sputum cultures were negative for any specific pathogen. Three years later, he was referred to our hospital for hemoptysis with enhanced opacity in the lower lobe of the left lung. Culture of bronchial lavage fluid obtained via bronchoscopy was positive for P. multocida. The patient was treated with amoxicillin-clavulanic acid for 14 days and was instructed to avoid close contact with his cat. His symptoms and chest imaging findings improved and have not recurred during more than 1 1/2 years of follow up. P. multocida can cause chronic lower respiratory infections.

Eosinophilic granulomatosis with polyangiitis after treatment with dupilumab.

Eosinophilic granulomatosis with polyangiitis (EGPA) in association with the use of asthma medications has been reported. We report the first Asian case of EGPA developed after dupilumab administration in a 77-year-old Japanese woman and discuss the association between dupilumab and EGPA.

Anesthetic Management in Tracheal Dilatation for Severe Tracheal Stenosis.

We report the anesthetic management of a 65-year-old woman with recurrent, severe tracheal stenosis who underwent tracheal dilatation. She had visited the Department of Respiratory Medicine at our hospital for respiratory distress approximately 20 years ago, and had undergone laser ablation under local anesthesia. Because of recurrence and aggravation of respiratory distress, she now presented at the Department of Thoracic Surgery, and was scheduled for surgery. Percutaneous cardiopulmonary support was prepared, and she was sedated with midazolam and dexmedetomidine. Under bronchoscopic guidance, a 5-mm intubation tube was placed directly above the stenosis site. Laser ablation (by argon plasma coagulation) and balloon dilatation were performed, and the tube was replaced with one with a larger diameter, which was subsequently replaced with another with an even larger diameter. Ultimately, a 7-mm tube was placed beyond the stenosis site, and the operation was completed. After restoration of spontaneous respiration and consciousness, the patient was extubated in the operating room and returned to the intensive care unit. In anesthetic management of patients with tracheal stenosis, treatment of hypoxia is important. In this case, we collaborated with the attending physician, clinical engineers, and operating room nurses throughout, and consequently, were able to perform the operation safely.

[Usefulness of additional dexmedetomidine administration in postoperative pain management after the scoliosis surgery].

BACKGROUND: As scoliosis surgery in children is a large invasive surgery, postoperative pain control is difficult. METHODS: We examined the difference of the analgesic effect between patients with and without DEX administration using the intravenous patient controlled analgesia (IV-PCA) of fentanyl after the scoliosis surgery in 18 patients. RESULTS: The frequency of PCA bolus administration in the period with DEX administration was significantly less compared with the period without DEX. There were no effects on circulatory condition and level of consciousness in all patients during DEX administration. And the starting times for drinking water and oral feeding were prolonged in a patients receiving a large amount of continuous fentanyl infusion. It is highly probable that effects of fentanyl such as inhibition of gastrointestinal motility and nausea and/or vomiting are contributory. CONCLUSIONS: The amount of fentanyl required for postoperative analgesia was decreased by combining DEX. In addition, it is thought that side effects of fentanyl are reduced in low dose fentanyl administration cases. As a result, it may bring early postoperative recovery. The IV-PCA using fentanyl with DEX may be useful for postoperative analgesia in scoliosis surgery. We will recommend using DEX (0.25 microg x kg(-1) x hr(-1)) together with fentanyl (0.5 microg x kg(-1) x hr(-1)) for this purpose.