Patients and methods Children with resistant or recurrent pneumonia presenting over a three year period to Asir Central Hospital, the only tertiary care facility in the region, were studied. All the children were referred to the otolaryngologist by paediatricians. A detailed history including history of feeding of saman was obtained in each case. A chest radiograph was performed before bronchoscopy.Bronchoscopy was carried out by using a Storz ventilating paediatric bronchoscope of the appropriate size. Any secretion in the trachea or bronchi was aspirated using a sterile suction connected to a 'mucus trap'. When secretions were scanty, bronchial lavage was carried out by instilling 1-2 ml of sterile normal saline into the tracheobronchial tree and aspirating the contents after ventilating a few times. The aspirate was viewed macroscopically against a bright light and any oily droplets floating on the surface were noted. The aspirate was subjected to microbiological studies, including Gram and Ziehl-Neelsen staining, appropriate bacterial and fungal cultures, and special stain for fat (oil red 0). The gross bronchoscopic findings such as the state of the mucus membrane, the presence or absence of secretions, their nature, and presence of any other endobronchial pathology were noted. Chest radiographs were repeated within 24 hours ofperforming the bronchoscopy. The condition of the patient at follow up, particularly at one month after bronchoscopy, was also noted. All data were entered into a SPSS/PC computer program for analysis. figure.

It is very rare to have a big foreign body in the lungs without any complications or symptoms for 2 years. A 14-year-old male with episodes of minor hemoptysis for 4 weeks had a history of inhalation of a bullet 2 years earlier. He had asymptomatic for lung complications for 2 years. The bullet was removed by right thoracotomy and non-anatomical wedge stapled resection, and he followed an uneventful recovery. An aspirated foreign body although big can remain asymptomatic for a long time, especially if it has migrated to the periphery.

Objective: To examine the frequency of bacteriological organism present in pleural fluid, in patients positive with thoracic empyema, assessed on the basis of pus culture test. Study Design: Cross-sectional study Place and Duration: Inpatient Department, Chest Medicine Ward 12, JPMC, Karachi, Pakistan for six months duration from 11 February 2019 to 10 August 2019. Methodology: One hundred and thirty nine patients diagnosed with Thoracic Empyema were included in this study. All patients included in the study shall undergo Pus Culture Test prior to identify the presence or absence of bacterial organism. Those with positive bacterial findings (mainly Staph Aureus and gram negative organisms) were further assessed for stratification with reference to their possible variable affecters. Results: There were 107 males and 32 females (%M: F ratio 77:23), with Empyema Thoracic, aged between 25-55 years and having a mean age of 36.28 year (± SD 8.206), were studied. The Pus Culture Test rate was 100% whereas duration of empyema was of average 18.38 days (± S.D 11.16). One hundred and four patients (74.82%) were carrying investigated bacteria which were staph. Aureus in 17 (12.50%) patients. GRAM NEGATIVE ORGANISMS in 87 (62.58%) patients. Echerea Coli in 12 (8.3%) patients, Pseudomonas. Aeruginosa in 46 (33.33%) patients, Klebseilla in 17(12.50%) patients, Enterococcus Species in 12 (8.3%) patients. While remaining thirty five patients (25.17%) were found to have other bacteria, including Streptococcus, Proteus Mirabillis and Acinobacter, responsible for Empyema. Conclusion: It is concluded that 74.82% patients had bacteria and among them 62.58% patients had gram negative organism. Pseudomonas Aeruginosa was the most common organism followed by Klebseilla and staph. Aureus. Keywords: Empyema, Thoracic, Pleural Effusion, Thoracentesis, Thoracostomy

Extragonadal germ cell tumors are the rare tumors originate commonly from the mediastinum and the reason is still unknown however; there are theories, which suggest that the gonadal cells in the mediastinum represent reverse migration from the gonads. A young female presented with mass originating from the middle lobe of lung and right sided pleural effusion that was drained, and biopsy was taken from the mass; diagnosed as choriocarcinoma. She received (BEP) Bleomycin, Etoposide and Cisplatin chemotherapy; responded well and her symptoms improved.