An unusual case of empyema

SummaryAbscess formation and empyema are serious sequelae of pneumonia. Colonisation of the pleural fluid occurs most frequently by aerobic organisms or mixed aerobic and anaerobic species including: Streptococcus pneumoniae, Streptococcus milleri, Bacteroides species and anaerobic fusobacteria. Actinomyces, Eikenella corrodens and Nocardia species are a rarely reported combination of anaerobic organisms resulting in empyema, especially in the Northern hemisphere. A 65-year-old man presented in a severely debilitated state with poor dentition and features of severe pneumonia. His past medical history included diabetes mellitus, peripheral vascular disease and cerebrovascular events. CT scan revealed consolidation, empyema and abscess formation. The patient was initially managed with intravenous dicloxacillin and metronidazole and a diagnostic aspirate was followed by chest drain insertion. Microscopy results showed Nocardia and antimicrobial therapy was altered to co-trimoxazole and ticarcillin/clavulanate. After additional nutritional support the patient was fit for video assisted thoracoscopy and decortication. Further culture results confirmed the growth of Actinomyces species and Eikenella corrodens and the therapy was modified to co-trimoxazole and benzylpenicillin. Pneumonia and empyema due solely to anaerobic organisms is rare but should be suspected if clinical onset is insidious. Anaerobic culture of specimens is indispensable to the rapid choice of appropriate antibiotic

Continuing professional development:introducing the ERS International Certificate in Respiratory Sleep Medicine

Certification of specialists in respiratory sleep medicine for the purposes of continuing professional developmen

LABORATORY INVESTIGATIONS IN SUPPORT OF FLUID BED FLUORIDE VOLATILITY PROCESSES. PART IV. THE FLUID BED FLUORINATION OF Usub3sub 3Osub8sub 8

In one of the processes under development, the uranium and plutonium content of a spent reactor fuel of the Dresden type would be fluorinated in a fluid-bed reactor to produce the volatile uranium and plutonium hexafluorides. The study of the fluorination of U/sub 3/O/sub 8/ was undertaken because it is the major product obtained in an oxidative decladding step that is being proposed for the removal of uranium and plutonium from stainless steel-clad and Zircaloy- clad fuel elements. The study Will also provide data needed for the development of apparatus and procedures for future work with mixtures of uranosic oxide and plutoniam dioxide. Experiments were performed to determine the optimum reaction conditions for the conversion of U/sub 3/O/sub 8/ to uranium hexafluoride and for minimizing the elutriation of unreacted U/sub 3/O/sub 8/ from the fluid bed. Elutriation of U/sub 3/O/sub 8/ from the fluid bed was minimized when a fluid bed height of 8 in. of 120 mesh alumina, a fluorinating gas phase containing 20 vol% fluorine, and a reaction temperature of 500 deg C were employed. Conversion of greater than 99% of the U/sub 3/O/sub 8/ to uranium hexafluoride was obtained when the feeding-fluorination period, in w,hich the U/sub 3/O/sub 8/ powder was fed into the fluid bed and the major part of the fluorination was accomplished by reacting the oxide with 20 vol % fluorine, was followed by a recycle-fluorination period of 5 hr at 500 deg C with 100% fluorine. Kinetic data for the fluorination of U/sub 3/O/sub 8/, obtained by means of a thermobalance, are reported for the temperature range from 300 to 400 deg C. The data were treated by the diminishing-sphere model. Experimental results are also presented for the oxidative decladding of stainless steelclad and Zircaloy-clad uranium dioxide pellets. (auth

Sleep HERMES: a European training project for respiratory sleep medicine

[No abstract available