Askin Uysal

Drug hypersensitivity causing organizing eosinophilic pneumonia in a pediatric patient

Abstract Objective To describe a relatively rare hypersentivity reaction with pulmonary manifestations in a pediatric patient. Data sources Electronic medical records. Study selection Patient treatment in the pediatric critical care unit. Data extraction and synthesis Electronic medical records. Conclusions Eosinophilic pneumonias are rare in the pediatric population. Peripheral eosinophilia is not necessary to make the diagnosis. Bronchoalveolar lavage is the diagnostic study of choice. Lung biopsies are rarely needed to make the diagnosis. The treatment of choice is steroids. If steroids fail to improve the patients condition, consider IVIG, and cyclosporine A.

Pulmonary Graft Dysfunction and Elevated Pulmonary Pressures

We would like to congratulate Fruchter et al 1 for their ingenious, effective, and minimally invasive way of treating the very challenging condition of bronchopleural fi stulas as reported in a recent issue of CHEST (March 2011). However, because we were cited in their work, we must make a correction. The misunderstanding is that our fi rst publication was a case report of our fi rst patient (53-year-old man with a right upper lobectomy) using this method. 2 Later, Scordamaglio et al 3 published a review of our experience endoscopically treating airway fi stulas (two bronchopleural and one tracheoesophageal), which included this same patient. Since then, fi ve more fi stulas in four other patients have been treated, making a total of seven fi stulas treated in six patients (one patient with two fi stulas), with fi ve of them already closed. Although the technique used is similar to that in Fruchter et al, 1

What Is the Value of Midregional Proatrial Natriuretic Peptide in COPD Research or Clinical Practice

We read with great interest the study by Bernasconi and colleagues 1 published recently in CHEST (July 2011). According to the study, high midregional proatrial natriuretic peptide (MR-proANP) level was associated, as was high Pa co 2 , with a worse 2-year survival rate compared with normal or lower values. Pulmonary hypertension was not well documented in this study and depended only on historic echocardiographic reports. Pulmonary hypertension was not associated with mortality, contrary to other studies. Cardiopathy (not well explained) was present in 45% of study participants, and those had potentially higher MR-proANP levels due to their cardiac disease, not to COPDrelated right-sided heart strain. High numbers of deaths from nonpulmonary-related causes also were noted in this study (12 of 37 died of cardiac causes, fi ve of 37 of other causes, and 10 of 37 of concomitant malignancies). The authors admit a possible bias by recruiting patients from a single center, including only those requiring admission to the hospital and excluding exacerbations treated as outpatient. This bias may have reduced the ability of the study to evaluate MR-proANP on COPD exacerbations in general. The study revealed prognostic values of Pa co 2 (with very good hazard ratios and CIs) and MR-proANP (hazard ratio, 1.68; close-to-null 95% CI, 1.03-2.7). In clinical practice, and even future research, it is much more cost-effective to depend on Pa co 2 , which is a handy and readily available test for most patients with COPD requiring hospital admission, than on an expensive and potentially confusing test that overlaps with other very common conditions such as renal failure and heart disease. MR-proANP did not offer any prediction for reexacerbations and would not change our clinical practice if applied. Furthermore, it might be just one factor among many others, such as advanced disease stage indicated by a low FEV 1 mean of 0.89 L, 1 advanced age, and a high Charlson comorbidity score. 2

Cysteine as a Biomarker for Obstructive Sleep Apnea

Correspondence 2 . McGaghie WC , Siddall VJ , Mazmanian PE , Myers J; American College of Chest Physicians Health and Science Policy Committee . Lessons for continuing medical education from simulation research in undergraduate and graduate medical education: effectiveness of continuing medical education: American College of Chest Physicians Evidence-Based Educational Guidelines . Chest . 2009 ; 135 ( suppl 3 ): 62S 68S . 3 . Boulet JR . Summative assessment in medicine: the promise of simulation for high-stakes evaluation . Acad Emerg Med . 2008 ; 15 ( 11 ): 1017 1024 . 4 . American College of Chest Physicians. CHEST Challenge Web site. http :// www . chestchallenge . org . Accessed January 19, 2011 . 5 . Savoldelli GL , Naik VN , Park J , Joo HS , Chow R , Hamstra SJ . Value of debriefi ng during simulated crisis management: oral versus video-assisted oral feedback . Anesthesiology . 2006 ; 105 ( 2 ): 279 285 .