The average prescribed dose of fluticasone was 80% of that for beclomethasone, even though fluticasone is at least twice as potent as beclomethasone. Similar findings were observed when the general practitioners responded to the case histories. The high doses of fluticasone prescribed may be due to a failure to appreciate that fluticasone is twice as potent as beclomethasone and to the availability of high strength preparations of fluticasone, i.e. 250 microg per actuation.

No abstract

We describe the case of a 67-year-old asymptomatic man who was referred to our hospital for abnormal laboratory results. He was incidentally found to have a massive empyema without underlying bronchopulmonary pneumonia. Following thoracentesis, he was diagnosed with chronic Streptococcus anginosus empyema. Therapeutic thoracentesis and treatment with tissue plasminogen activator and deoxyribonuclease failed to resolve the empyema, and there was residual loculated pleural fluid that was surrounded by a thick rind. The patient was referred to thoracic surgery for decortication of the pleural space via video-assisted thoracoscopic surgery. At 2-month follow-up, the patient had complete re-expansion of the lung tissue.

No abstract

A 28-year-old healthy woman presented with a 2-week history of dyspnea, cough, wheezing, and lithoptysis (expectoration of calcific material). She had no significant past medical history. She did not smoke, drink alcohol, or use illicit drugs. The patient was living in New England but had previously lived in Nebraska, Colorado, Mississippi, and Florida. Recent travel included visits to Uganda, Afghanistan, Albania, and Croatia and frequent hiking and camping trips. She received initial therapy with inhaled albuterol and oral azithromycin, but symptoms did not improve. A chest radiograph was unremarkable. Subsequent computed tomography (CT) of the chest revealed a mediastinal and endobronchial broncholith compromising the left main-stem bronchus lumen (Figure 1). Extensive testing for Mycobacterium tuberculosis and fungal and bacterial infectious agents were within normal limits, with the exception of a borderline urine Histoplasma antigen level (<0.5 ng/dL).