Simple renal cysts and hypertension are associated with angiotensinogen (AGT) gene variant in Shiraz population (Iran).

AIM: To our knowledge, the relationship between simple renal cysts, hypertension and three significant genes of the renin-angiotensin system (AGT, AT1R and ACE1) has not been studied. The present study was designed to search for possible relationships between these significant polymorphic components, hypertension and simple renal cysts in Shiraz province (Iran). METHODS: A total of 160 participants were recruited from the Motahari Clinic at Shiraz University of Medical Sciences. The subjects were divided into four main groups. Detection of the ACE1 genotype was performed with a nested-polymerase chain reaction (PCR) protocol. Two separate restriction fragment length polymorphism-PCR assays were used to identify AGT and AT1R genotypes. RESULTS: The allele frequency of AGT M235T differed significantly between group 1 (patients with simple renal cysts and hypertension) and normal individuals (p < 0.05). There were no significant differences in frequency for the other genes (ACE1 and AT1R). CONCLUSIONS: Our findings show a relationship between the AGT-TT genotype and hypertension in patients with both hypertension and simple renal cysts. This finding suggests an additive role for the AGT gene of the renin-angiotensin system in the process of hypertension and simple renal cysts formation. Future studies are needed to elucidate the mechanisms through which this association is mediated.

Value of ultrasound in diagnosis of pneumothorax: a prospective study.

Transthoracic ultrasound (US) is useful in the evaluation of a wide range of peripheral parenchymal, pleural, and chest wall diseases. Furthermore, it is increasingly used to guide interventional procedures of the chest and pleural space. The role of chest US in the diagnosis of pneumothorax has been established, but comparison with lung computed tomography (CT) scanning has not yet been completely performed. The purpose of this study is to prospectively compare the accuracy of US with that of chest radiography in the detection of pneumothorax, with CT as the reference standard. One hundred ninety-seven patients who were evaluated by spiral chest CT scan for various clinical indications were prospectively evaluated. Ultrasonography was performed by a radiologist, blinded to the chest CT findings. Sensitivity, specificity, and accuracy of ultrasound in the detection of pneumothorax were then compared with chest CT scan. CT scan showed pneumothorax in 92 patients. Sonography and plain X-ray of the chest revealed 74 and 56 cases of pneumothorax, respectively. Statistical analysis disclosed the US to be 80.4 % sensitive and 89 % specific in the detection of pneumothorax with an overall accuracy of 85 %. In this study, US was more sensitive than chest radiography in the detection of pneumothorax. The results of this study suggest that thoracic US, when performed by trained individuals, can be helpful for the detection of pneumothorax.

Retroesophageal aortic arch in a patient with pulmonary embolism.

The authors report an interesting case of right retroesophageal aortic arch (REAA) with pulmonary embolism that presented like the dissection of the aortic aneurysm but eventually diagnosed by means of spiral CT. Right REAA should be considered as a rare cause of mediastinal widening in the patients in whom significant difference between the blood pressure and pulse intensity of both extremities is evident to prevent the erroneous diagnosis and treatment.

Sonographic measurement of the inferior vena cava as a predictor of shock in trauma patients.

Detecting and monitoring blood loss is always a challenging dilemma in emergency settings. The diameter of the inferior vena cava (IVC) in trauma patients may be useful in this way. This has been classically done with computed tomography (CT); however, doing it with ultrasound as a bedside easily available modality is a relatively novel approach. Between January 2006 and March 2006, 88 injured patients referred to our center were investigated. The patients were divided in to two groups: a shock group (n = 11, 12.5%) and a control group (n = 77, 87.5%) who were trauma patients with normal blood pressure. The maximum anteroposteroir diameter of IVC was measured ultrasonographically both in inspiration (i) and expiration (e) by M-mode in the subxyphoid area. The difference between the diameters of IVCe and IVCi was regarded as collapsibility, and collapsibility index was defined as IVCe - IVCi/IVCe. Statistical analysis included Mann-Whitney U test and correlation analysis. The average diameters of IVCe and IVCi in the shock group at arrival were significantly smaller than in the control group (5.6 +/- 0.8 mm, 4.0 +/- 0.7 mm versus 11.9 +/- 2.2 mm, 9.6 +/- 2.0 mm; P < 0.0001). The maximum diameter of IVC in the shock group was in a 30-year-old male patient with an IVCe and IVCi of 7.0 and 5.3 mm, respectively. Correlation analysis revealed a negative correlation between the diameter of IVCe (r = 0.72) and IVCi (r = 0.73) and the presence of shock. Regarding the collapsibility index, the mean collapsibility index of IVC was significantly higher in the shock group compared to patients in the control group (27% versus 20%; P < 0.001). The diameter of IVC was found to correlate with shock in trauma patients. The measurement of the IVC may be an important addition to the ultrasonographic evaluation of trauma and other potentially volume-depleted patients and can be added to the focused assessment with sonography for trauma (FAST) of the trauma patient with minimum additional time.

Methanol poisoning: acute MR and CT findings in nine patients.

INTRODUCTION: Methanol poisoning is an uncommon but potent central nervous system toxin. We describe here the CT and MR findings in nine patients following an outbreak of methanol poisoning. METHODS: Five patients with a typical clinical presentation and elevated anion and osmolar gaps underwent conventional brain MRI with a 1.5-T Gyroscan Interna scanner. In addition nonenhanced CT was performed in another three patients with more severe toxicity. RESULTS: Bilateral hemorrhagic or nonhemorrhagic necrosis of the putamina, diffuse white matter necrosis, and subarachnoid hemorrhage were among the radiological findings. Various patterns of enhancement of basal ganglial lesions were found including no enhancement, strong enhancement and rim enhancement. CONCLUSION: A good knowledge of the radiological findings in methanol poisoning seems to be necessary for radiologists. The present study is unique in that it enables us to include in a single report most of the radiological findings that have been reported previously.