Spontaneous pneumorrhachis, pneumomediastinum, pneumopericardium, and subcutaneous emphysema. Rare features of Hamman Syndrome.

INTRODUCTION AND IMPORTANCE: Pneumorrhachis (air within the spinal canal), Pneumomediastinum (abnormal air in the mediastinum), Pneumopericardium (air in the pericardial space), and Subcutaneous emphysema (air trapped under the skin) are rare conditions which are rare features of Hamman Syndrome. Some of pulmonary diseases that relate to pneumorrhachis have been reported in the literature; but Hamman Syndrome with Pneumorrhachis and Pneumopericardium due to violent coughs that triggered by tongue scraping are very rare. CASE PRESENTATION: A 20-year-old male with no previous lung disease or trauma was brought to the emergency department due to acute chest pain, dyspnea, choking, syncope, and neck swelling which started after several self-induced coughs when he was brushing his tongue. Chest CT scan revealed Pneumorrhachis, pneumomediastinum, Pneumopericardium and extensive subcutaneous emphysema associated with lung contusions. CLINICAL DISCUSSION: Barotrauma due to violent coughs that triggered by tongue scraping may lead to lung injury resulting in Hamman Syndrome with rare features of pneumorrhachis and Pneumopericardium. To our knowledge this is the first case report of Hamman syndrome with pneumorrhachis and Pneumopericardium secondary to tongue brushing-induced lung injury in Somalia. CONCLUSION: Violent coughs from tongue scarping can lead to Hamman Syndrome with Pneumorrhachis and Pneumopericardium.

The Relationship Between Glutathione S-Transferase-P1 and Beta-2 Adrenoreceptor Genotypes with Asthmatic Patients in the Turkish Population.

BACKGROUND: Individual differences in the activity of enzymes that metabolize xenobiotics can impact health and disease. Beta-2 adrenoreceptor (ADRB2) is a functional G-coupled protein expressed in the vascular endothelium of lungs, alveolar walls, and the ganglions of cholinergic nerves which induces bronchodilation in response to catecholamines. Glutathione S-Transferase-P1 (GSTP1) is a candidate pi class GST gene, which controls pi class glutathione S-transferase activity. AIMS: In this study we determined the relationship between the ADRB2 Arg16Gly polymorphism and GSTP1 polymorphisms, involved in bronchodilator response and oxidative stress, respectively, with susceptibility to asthma. METHODS: In this study, 129 asthmatic patients and 127 healthy control cases were recruited to determine ADRB2 and GSTP1 genotypes by allele-specific polymerase chain reaction and restriction fragment length polymorphism assays, respectively. RESULTS: The ADRB2 genotype frequencies of the patients and control cases were found to be 10.9% (Arg16Arg), 48.8% (Arg16Gly), and 40.3% (Gly16Gly) and 24.4% (Arg16Arg), 36.2% (Arg16Gly), and 39.4% (Gly16Gly), respectively. GSTP1 genotype frequencies of patients and control cases were found to be 55% (Ile105Ile), 43.4% (Ile105Val), and 1.6% (Val105Val) and 75.6% (Ile105Ile), 22% (Ile105Val), and 2.4% (Val105Val), respectively. In the case of the GSTP1 gene, we found statistically significant differences in the genotype frequency of Ile105Val and the allele frequency of Val105 in the asthmatic group compared with the controls. Moreover, we observed a relationship between allele frequencies and clinical phenotypes including atopia nocturnal dyspnea, and steroid dependency in the asthmatic patients. CONCLUSION: Our results suggest that the GSTP1 Ile105Val polymorphism may be linked to the severeness of airway dysfunction.

Cineangiographic intraoperative evaluation of venous grafts during coronary bypass surgery.

BACKGROUND AND OBJECTIVE: Evaluation of graft patency is an important component of coronary bypass surgery. In the present study, intraoperative cineangiography was performed in a cardiovascular hybrid operating room to evaluate anastomosis quality and patency of coronary venous grafts. METHOD: This prospective study evaluated coronary bypass grafts in 34 patients between January 2012 and June 2012. Radiopaque material was administered into the grafts through a vessel cannula before the proximal anastomosis. Then, cineangiographic images were obtained using a mobile C-arm cineangiography system. The myocardial perfusion scintigraphy (MPS) of the patients was compared between preoperative and first month postoperative periods to assess graft function. RESULTS: The localization of the grafts in the target vessel, structural status of the grafts, anastomosis line, and availability of the target vessel were easily evaluated. Angiographic defects were detected in two grafts (3%, n = 60) in two patients (6%, n = 34). Staining was observed in the distal myocardial segments of the saphenous vein grafts following the administration of radiopaque material. The procedure took eight minutes, on average (range, 5-14 minutes), and a mean of 15 mL (range, 10-35 mL) of opaque material was used. None of the patients developed intraoperative myocardial infarction, postoperative complications, or contrast material-induced renal failure. No mortality was observed. The distal myocardial segments of saphenous vein grafts were detected to be perfused 92% normally, 5% reversibly defective, and 3% irreversibly defective with postoperative MPS controls. CONCLUSION: Cineangiographic graft evaluation in a hybrid operating room is a practical, safe, noninvasive, easily available, and easily applicable method.

The clinical value of incidental 18F-fluorodeoxyglucose-avid foci detected on positron emission tomography/computed tomography.

OBJECTIVE: This study was performed to show the malignant potential and clinical value of incidental focal 18F-fluorodeoxyglucose (18F-FDG) uptake on positron emission tomography/computed tomography (PET/CT) with the confirmation of histopathologic findings or with a series of consequent correlative imaging methods. METHODS: A total of 2370 18F-FDG-PET/CT studies performed over a 16-month period in patients with various malignant diseases were retrospectively reviewed. Unexpected PET foci that were in an unusual site for metastatic spread of known malignancy and not considered to be physiologic uptake were evaluated by histopathologic findings or follow-up with correlative imaging methods for a period of 1 year or longer. There were 121 such incidental PET lesions in 116 patients. RESULTS: Seventy-four incidental PET lesions in 70 PET/CT patients were investigated further. Forty-seven lesions in 46 patients were lost to follow-up. Fifty-nine lesions were confirmed histopathologically. Fifteen lesions were evaluated with radiologic methods or instrumental examination. Thirty-six incidental PET foci were unexpected malignant or premalignant lesions (1.5% of 2370 patients and 49% of 74 PET foci). Nineteen of these 36 malignant or premalignant lesions were synchronous carcinomas, 14 lesions were unusual or unexpected malignant spread of known malignancy and three lesions were premalignant colonic adenomas. Thirty-three of 74 incidental PET lesions were of benign origin (1.4% of 2370 patients and 44% of 74 PET foci). Five PET foci were false-positive findings (7% of 74 lesions). CONCLUSION: The detection of incidental 18F-FDG-PET foci on PET/CT may reflect unexpected malignant lesions related to unusual malignant spread of primary malignancy or synchronous tumor. Follow-up of these PET foci may result in significant change in therapy management and early diagnosis of various abnormalities that require a medical approach or surgical intervention.