Rupture of the diaphragm mostly occurs following major trauma. We report a case of delayed presentation of traumatic diaphragmatic hernia on the left side in a 44-year-old male who presented two weeks after a minor blunt trauma. Left kidney and intestinals coils were found to herniate through the diaphragmatic tear. This case demonstrates the importance of considering the diagnosis in all cases of blunt trauma of the trunk. It also illustrates the rare possibility of herniation of kidney through the diaphragmatic tear.

Nowadays, endobronchial tuberculosis is of rare occurrence. This article presents three such cases. All of them presented as unresolved pneumonia with collapse-consolidation in chest X-ray. All the three patients were sputum smear negative for acid fast bacilli. Diagnosis was possible only with fiberoptic bronchoscopy and bronchial biopsy.

BACKGROUND Empyema thoracis refers to accumulation of pus in the pleural space. The pathogenic organisms isolated in cases of empyema depend on prior antibiotic use and route of infection i.e. whether infection arises as a complication of pneumonia or following oesophageal surgery. It also depends on the age of the patient and presence of co-morbid illness. MATERIALS AND METHODSIt is a descriptive study. It was designed to investigate the bacterial isolates of thoracic empyema and to find out the anti biogram pattern of the isolated organisms in a tertiary care hospital over one-year period. In this study, bacteriological spectrum was analysed in 50 empyema cases. Samples of pleural fluid were sent for bacterial culture (Aerobic) and for Gram's stain as well as for cytologic studies and mycobacterial and fungal smears and cultures, also if clinically indicated Cartridge Based Nucleic Acid Amplification test (CBNAAT). Patients with tubercular empyema were excluded. RESULTS24 cases were culture positive. Among the 24 culture positive cases, Streptococcus pneumoniae was the commonest bacterium isolated followed by Staphylococcus aureus. A strong inverse correlation was found between prior antibiotic use with chance of culture positivity. In present study Gram-positive organisms were found to be most sensitive to Vancomycin, Linezolid and some are sensitive to Clindamycin, Ciprofloxacin, Levofloxacin and Co-amoxyclav. Gram negative organisms were mostly sensitive to Ceftriaxone, Cefoperazone, Cefepime, Piperacillin-Tazobactam, Meropenem and Colistin. All the strains of Pseudomonas aeruginosa were sensitive to Amikacin. Resistance to Co-amoxyclav was noted in many strains of the Gram negative organisms except Klebsiella. CONCLUSIONGram positive organisms were the commonest organisms isolated in our study. This study also supports the view that prior antibiotic use reduces the chances of detecting the micro-organism through culture and determination of sensitivity.

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