Fatma Yildirim

Acute Respiratory Distress Syndrome due to Sepsis in Pregnancy

Acute respiratory distress syndrome (ARDS) is an uncommon condition in pregnant patients. The causes of ARDS are associated with obstetric causes such as amniotic fluid embolism, preeclampsia, septic abortion, and retained products of conception or nonobstetric causes that include sepsis, aspiration pneumonitis, influenza pneumonia, blood transfusions, and trauma [1-3]. The incidence of ARDS in pregnancy has been reported at single institutions and one report found the incidence of ARDS to be 1 in 6229 deliveries for an incidence of 17 patients per 100000 [4]. The mortality associated with ARDS is elevated and has been reported to range from 24% to 39% in pregnants [5,6]. An essential component in management of ARDS involves good communication between the obstetrics team and critical care specialist and a fundamental understanding of mechanical ventilatory support.

A Rare Cause of Cavitary Lesion in the Lung: Richter’s Transformation

Richters transformation (RT) refers to the development of aggressive lymphoma during the course of CLL. Clinically, patients with RT present with an aggressive disease course with rapidly enlarging lymph nodes, hepatosplenomegaly, and elevated serum lactate dehydrogenase levels. But rarely it presents with extra nodal organ involvement at the beginning. Common sites of extra nodal involvement are the gastrointestinal tract, eye, central nervous system, lung, and kidney. We are reporting this case that was presented with RT in the lung involvement diagnosed while researching cavitary lesion etiology.

Total lesion glycolysis by 18F-FDG PET/CT is independent prognostic factor in patients with advanced non-small cell lung cancer.

To determine whether the primary tumor SUVmax and total lesion glycolysis (TLG) measured on 18F‐FDG PET/CT have prognostic significance in patients with non–small‐cell lung cancer (NSCLC).

Noninvasive auto-titrating ventilation (AVAPS-AE) versus average volume-assured pressure support (AVAPS) ventilation in hypercapnic respiratory failure patients: comment

We have read with great interest Gursel et al.’ study [1] where non-invasive auto-titrating ventilation (AVAPS-AE) and average volume-assured pressure support (AVAPS) ventilation in hypercarbic patients had been compared. AVAPS is not a newly invented mode, and AVAPS-AE has been a commercially available modality used since 2015, also they do not fit traditionally defined “modes.” Rather, they can be described as variations of already available non-invasive mechanical ventilation (NIMV) modes of continuous positive airway pressure (CPAP), bilevel positive airway pressure (BIPAP) and pressure support. In AVAPS, if the targeted tidal volume is not reached, the ventilator takes over to provide necessary pressure support to reach the goal [2]. In AVAPS-AE, the ventilator automatically increases the defined pressure support to reach the target tidal volume together with increasing EPAP. As defined in earlier studies, the ventilator adjusts for the target in every cycle. [3] Thus, in both modes, there are no significant differences between two devices, and both are suitable for use in hypercarbic patients. The authors found that 10 mmHg or 10% reduction in PaCO2 levels occurred in a similar number of patients in both modes, with PaCO2 reduction time being shorter in AVAPS-AE group. This is a controversial issue that requires further investigation for a proper clinical comparison. First of all, patients with hypercapnic respiratory failure often have a very low level of PaO2 due to a myriad of reasons, and an exacerbation of chronic obstructive pulmonary disease (COPD) leads to further respiratory muscles fatigue with a worsening of respiratory function. Single limb machines (as TRILOGY 100 used in their patients) may be responsible for a larger share of gas rebreathing if an adequate PEEP level has not been set. In “acute” conditions like a decompensated COPD, an increased WOB can be counteracted by increasing inspirator positive airway pressure (IPAP) and EPAP, as is evident in the AVAPS-AE group of the study in which patients showed a better compliance to the ventilatory mode [4]. Secondly, while a statistically significant difference in maximum IPAP and mostly in maximum EPAP reached was found between the two groups, the arterial blood gas values (most of them were not decompensated) were found to be quite similar. This can explain the reduction in respiratory frequency and the improvement of tidal volume (two determinant components in WOB) being quite the same in both groups despite a better patient satisfaction in the other group [5]. In the authors’ study, the initial PaCO2 levels, pH and HCO3 levels of the patients were 62–69 mmHg, 7.34 and above 30 mEq/l, respectively, and indications to start NIMV treatment were not clearly described. Thirdly, in their study a single limb machine was used that had an intentional leak. This may be the underlying reason why a higher level of PEEP reached by AVAPS-AE led to a higher tidal volume being reached, but also produced higher air leaks. Regarding this, a further investigation is required to observe if higher air leaks (which may be caused by higher pressures) may change patient–ventilator synchrony. Lastly, from a pulmonary mechanics point of view, a higher PEEP certainly could be helpful in patients with high * Fatma Yıldırım ftagassi@hotmail.com

Diffuse alveolar hemorrhage associated with low molecular weight heparin and dual anti-platelet therapy after percutaneous coronary intervention

A 54‐year‐old man underwent percutaneous coronary intervention (PCI) and two stents were placed on left anterior coronary artery and circumflex artery. Low molecular weight heparin (LMWH) together with ticagrelor 90 mg twice a day and acetylsalicylic acid (Aspirin) were started after PCI due to high risk of stent thrombosis. On the fourth day of patients follow‐up in the intensive care unit (ICU), bloody secretion was started from endotracheal tube. Hemoglobin dropping, bilateral infiltration on the chest X‐ray and bleeding from lung were diagnosed as diffuse alveolar hemorrhage (DAH). Apart from LMWH and antiplatelet therapies with aspirin and ticagrelor, there were no other identified risk factors for DAH. As far as we know, our report is the first case of DAH caused by LMWH and dual anti‐platelet therapy including ticagrelor.

18F-FDG uptake in focal organising pneumonia mimicking bronchial carcinoma

Organising pneumonia (OP) is not a well‐known cause of increased 18F‐FDG uptake, and the relationship of the increased 18F‐FDG uptake to clinical parameters has not been clearly identified. This study aims to assess the role of positron emission tomography–computed tomography (PET‐CT) for the diagnosis of focal organised pneumonia that may mimic malignity because of mass‐like lesions on the radiological images it causes.

Tracheal Papilloma Treated with Cryotherapy and Interferon-α: A Case Report and Review of the Literature

Tracheal papilloma (TP) is characterized by papillomatous growth of the bronchial epithelium that involves the trachea as a response to Human Papilloma Virus (HPV) infection. A 40-year-old male, with 3-month history of progressive dyspnea was admitted to our hospital, and there were no any other respiratory symptoms. Physical examination was unremarkable. Chest computed tomography (CT) showed that there was a papillomatous mass at the distal trachea. The lesion occupied 80% of tracheal lumen. This patient received cryotherapy and mechanical debridement under general anesthesia and postoperative pathology showed endotracheal papillomatosis. Patient was treated with interferon-α (IFN-α) and he showed no recurrence at the 8th month of his therapy.

Comparison of Single Agent Gemcitabine and Docetaxel in Second-Line Therapy for Advanced Stage Non-Small Cell Lung Cancer in a University Hospital in Turkey

PURPOSE To compare the efficacy and toxicity of gemcitabine versus docetaxel in a second-line setting of nonsmall cell lung cancer (NSCLC) patients previously treated with platin-based combination chemotherapy. MATERIALS AND METHODS We retrospectively evaluated the medical records of 57 patients treated with single agent gemcitabine or docetaxel in second-line setting of advanced NSCLC who received one prior platinum-based therapy. RESULTS The mean age was 56.7 ± 8.39 years with 55 ( 96.5%) males and two (3.5%) females. Forty of them received docetaxel and 17 gemcitabine. The mean number of chemotherapy cycles was 6.8 ± 4.0 in the gemcitabine group, while it was 4.6 ± 3.0 in the docetaxel group. Overall response rates were 8% and 12% (P=0.02) for gemcitabine and docetaxel, respectively. The median survival time was 22 versus 21 months for gemcitabine and docetaxel, respectively. The median times to progression were 8 and 5 months. There was no difference between the two groups in terms of incidence of adverse affects (40% vs 47.1%). All of the hematological side effects were grade 1/2. No major toxicity was encountered necessitating stopping the drug for either group. CONCLUSIONS Treatment with gemcitabine demonstrated clinically equivalent efficacy with a significantly improved safety profile compared with those receiving docetaxel in the second-line setting for advanced NSCLC in this study. Based on these results, treatment with gemcitabine should be considered a standard treatment option for second-line NSCLC.

Recurrent Septo-Optic Dysplasia Accompanied by Omphalocele: A Case Report

Septo-optic dysplasia, also known as de Morsier syndrome, is a rare congenital entity almost always characterized by hypoplasia/dysplasia of the optical nerve, chiasma or optic radiations and the complete or partial absence of the septum pellucidum. It may also be accompanied by other malformations, including multiple facial dysmorphism, midline defects, cleft lip and palate, musculoskeletal and other non-neurological eye features. Various cases have been reported which have presented various combinations of symptoms and stigmata of the syndrome. We here present a unique case of septo-optic dysplasia with familial repetition, a considerably early antenatal diagnosis and an accompanying omphalocele, a feature never before connected with the syndrome.

Lung cancer and intensive care: which patient how long?

Lung cancer still remains the leading cause of cancer death among all the cancer types. Early diagnosis is the most important factor for efficient treatment and disease management. Nowadays, several new methodologies are being used in clinical practise for diagnosis, staging and treatment of disease. Therefore, survival is prolonged even in patients who are not eligible for surgery. This has led to increase in the acceptance of lung cancer patients in intensive care units (ICU) due to both the disease and the treatments applied and also due to the comorbidity of the patients. However, it is unclear which lung cancer patient will benefit from intensive treatment. In this review, we shared the ICU admission reasons and prognosis of the early stage and advanced stage lung cancer patients and when these patients were referred to ICU and treatment modalities in ICU were discussed.