Latest updates on cellular and molecular biomarkers of gliomas.

Gliomas are the most common central nervous system malignancies, compromising almost 80% of all brain tumors and is associated with significant mortality. The classification of gliomas has shifted from basic histological perspective to one that is based on molecular biomarkers. Treatment of this type of tumors consists currently of surgery, chemotherapy and radiation therapy. During the past years, there was a limited development of effective glioma diagnostics and therapeutics due to multiple factors including the presence of blood-brain barrier and the heterogeneity of this type of tumors. Currently, it is necessary to highlight the advantage of molecular diagnosis of gliomas to develop patient targeted therapies based on multiple oncogenic pathway. In this review, we will evaluate the development of cellular and molecular biomarkers for the diagnosis of gliomas and the impact of these diagnostic tools for better tailored and targeted therapies.

Assessing the cognitive status of older adults attending primary healthcare centers in Saudi Arabia using the Mini-Mental State Examination.

OBJECTIVES:  To assess the cognitive status of older adults in Saudi Arabia. METHODS:  This was a cross-sectional, multistage, stratified study of older individuals (≥60 years of age) attending primary healthcare centres in Riyadh, Saudi Arabia between January 2015 and April 2017. We collected data using a structured questionnaire, which incorporated questions regarding demographic and anthropometric variables, the Arabic version of Mini-Mental State Examination, the Mini-Nutritional Assessment tool, and the Modified Katz Index of Independence in activities of daily living. RESULTS:  Of the 1299 participants, 914 (70.4%) were male, with a mean age of 66.2 ± 5.9 years. Approximately 79.1% of the participants had intact cognitive function, 17.1 had mild cognitive impairment, and 3.8% had severe cognitive impairment. Impaired cognitive function was associated with increased age, female gender, low education, unmarried status, and unemployed (p less than 0.001). Reduced cognitive impairment was significantly associated with functional impairment and malnutrition (p less than 0.001). CONCLUSION:  Cognitive impairment affected around 21% of the participants. The reduced cognitive function was associated with increased age, female gender, low education level, unmarried, low income, dependency on others, functional impairment, and malnutrition. Such information could motivate health-policy makers to introduce appropriate measures to improve older adults' existing healthcare services in primary care, including cognitive function assessment.

Normative Data for Handgrip Strength in Saudi Older Adults Visiting Primary Health Care Centers.

Background and objective: Handgrip strength (HGS) plays a vital role as a predictor of adverse health outcomes. Several studies have established HGS norms by age, sex, hand, occupation, culture or disability in different countries and for children in Saudi Arabia. However, standardized values for Saudi older adults have not yet been reported. Therefore, the current study was aimed to establish normative data for HGS in Saudi older adults visiting primary health care centers (PHCCs). Material and Method: In this descriptive cross-sectional study, HGS in kilograms was measured using a hydraulic hand dynamometer in Saudi older adults (n = 2045) aged ≥60 years visiting 15 PHCCs selected randomly from the five geographical regions of Riyadh, Saudi Arabia between January 2015 and April 2017. The average mean from three successive trials, standard deviations, and 95% confidence intervals presented for the left and right hands of men and women in six age groups (60-64, 65-69, 70-74, 75-79, 80-84, and 85+ years). The analyses were performed using the ANOVA test for all the age groups and to determine whether any differences exist between them. Results: The average mean HGS was significantly (p < 0.0001) differ by the left and right hands of men and women in six age groups. Conclusions: The current study presents specific norms for HGS in Saudi older adults by age, sex, and hand. Further studies are required to examine the utility of these norms for prediction of morbidity and mortality in this population.

MBBS teaching program, according to DREEM in College of Medicine, University of Bahri, Khartoum, Sudan.

INTRODUCTION: Learning environment might be defined as anything that can affect the learning directly or indirectly. During the era of accreditation and quality assurance, we are badly in need to evaluate our program strength and pick possible areas for curriculum reform. OBJECTIVES: The aim of this study was to investigate the perception of medical students in the University of Bahri (UB) about the educational environment and analyze the variation of this perception with gender, level of study, type of intake, type of certificate, and accommodation. METHODOLOGY: This is a cross-sectional study that was conducted at the Faculty of Medicine, UB, in Sudan during July-August 2017, enrolling 347 students. Dundee Ready Education Environment Measure (DREEM) questionnaire was used as a survey tool for this study. RESULTS: Overall DREEM average score of 125.2997/200 is perceived. This score is distributed in all DREEM subclasses. CONCLUSION: Having some negative perceptions is a huge burden on policymakers, administration, and all stakeholders to revise the whole educational environment at the UB with special efforts needed for curriculum revision, faculty development, mentoring, and other skills development.

Evaluation of health care services provided for older adults in primary health care centers and its internal environment. A step towards age-friendly health centers.

OBJECTIVES: To evaluate the health care services provided for older adults by primary health care centers (PHCCs) in Riyadh, Kingdom of Saudi Arabia (KSA), and the ease of use of these centers by older adults. METHODS: Between October 2013 and January 2014, we conducted a descriptive cross-sectional study of 15 randomly selected PHCCs in Riyadh City, KSA. The evaluation focused on basic indicators of clinical services offered and factors indicative of the ease of use of the centers by older adults. Evaluations were based upon the age-friendly PHCCs toolkit of the World Health Organization. RESULTS: Coverage of basic health assessments (such as blood pressure, diabetes, and blood cholesterol) was generally good. However, fewer than half of the PHCCs offered annual comprehensive screening for the common age-related conditions. There was no screening for cancer. Counseling on improving lifestyle was provided by most centers. However, there was no standard protocol for counseling. Coverage of common vaccinations was poor. The layout of most PHCCs and their signage were good, except for lack of Braille signage. There may be issues of access of older adults to PHCCs through lack of public transport, limited parking opportunities, the presence of steps, ramps, and internal stairs, and the lack of handrails. CONCLUSIONS: Clinical services and the internal environment of PHCCs can be improved. The data will be useful for health-policy makers to improve PHCCs to be more age-friendly.

Effect of oxidized phosphatidylcholine on biomarkers of oxidative stress in rats.

In this study it was planned to investigate the effect of oxidized phosphatidylcholine (derived from egg) feeding on lipid peroxidation of different tissues in rats. Male Wistar albino rats were fed oxidized and unoxidized phosphatidylcholine for 2 and 4 weeks, respectively. During the period of study food intake and body weights of animals increased gradually. Animals fed oxidized phosphatidylcholine for 2 and 4 weeks showed 33 and 15% spontaneous hemolysis of red blood cells in vitro. Under identical experimental conditions animals given unoxidized phosphatidylcholine showed 14.5 and 13.4% hemolysis for 2 and 4 week's period, respectively. Thiobarbituric acid reactive substances (TBARS) level in thymus, spleen, kidney, heart, liver and lung significantly increased in rats given oxidized phosphatidylcholine as compared to unoxidized group. Furthermore, in oxidized phosphatidylcholine group TBARS values in kidney, liver and lungs continued to rise for 4 weeks of treatment while TBARS level in heart, spleen and thymus was found to be decreased at the end of 4 weeks of oxidized phosphatidylcholine feeding. Plasma triacylglycerol and cholesterol was found to increase in rats who had received oxidized phosphatidylcholine for 2 weeks. These findings suggest that excess and persistent intake of oxidized phosphatidylcholine can cause significant damage to organs.

[Daily management of acute pericarditis: clinical and paraclinical outcomes, etiological diagnosis]. / Prise en charge au quotidien des péricardites aiguës: présentation clinique, paraclinique, diagnostic étiologique.

INTRODUCTION: Acute pericarditis is a frequent hospitalization cause. A prospective, bicentric study aimed at different goals: population description, aetiologies screening, and evaluation of the interest of a coordinated and combined management between cardiologists and internists. PATIENTS AND METHODS: Between May 2005 and September 2007, all patients admitted for acute pericarditis were prospectively enrolled. Physical examination, ECG, echocardiography, biological screening were performed. Patients were asked to consult both cardiologist and internist, one month later. RESULTS: Hundred and three patients were enrolled (mean age 43 years). Clinical outcome was classical in 60% of cases. ECG was typical in 59%. Troponin elevation was noted in 30% of patients. CRP was normal at diagnosis in 27% of patients, and increased significantly at first day (P=0.002). Possible cause was identified in 44 patients. In 26 patients (24.3%), precise diagnosis was performed: six cancers, one hemopathy, three connectivities, one EBV and one parvovirus B19 seroconversions, two untreated HIV patients, four inflammatory diseases, three endocrinology troubles, one oesophagitis, one dental sepsis, one amyloidosis, one acute pancreatitis, one declined dialysis indication. Eighteen de novo diagnoses (16.5%) were performed, out of them at least 12 benefited from specific management. CONCLUSION: Population of patients admitted for acute pericarditis are very heterogeneous. Our co-management between internists and cardiologists aims to diagnose earlier and easier curable diseases. Long-term follow-up remains of great interest, in order to diagnose later other disorders, which remained hidden, and to follow evolution of the population.

[Comparative susceptibility evolution in Escherichia coli from urinary tract infections in outpatients and inpatients at Perpignan hospital in 2002 and 2004]. / Evolution comparée de la sensibilité de souches de Escherichia coli isolées d'infections urinaires de patients consultant aux urgences et de patients hospitalisés en 2002 et 2004 à l'hôpital de Perpignan.

The medical emergency ward makes a link between outpatients and hospitalized ones, so we can study community bacterial ecology. The antibiotic susceptibility in Escherichia coli strains isolated from urinary tract infections (UTI) of patients consulting at emergency ward of our hospital in 2002 and 2004 was determined and compared with the susceptibility of the same strains isolated from UTI of hospitalized patients on the same period. The antibiotic susceptibility was performed with Microscan (Dade Behring). All bacteria were tested against the following antimicrobial agents: amoxicilline (Amx), l'amoxicilline+clavulanic acid (AMC), nalidixic acid (NA), ciprofloxacine (Cip), cotrimoxazole (SXT), nitrofurantoin (Ft). Susceptibility in E. coli strains isolated from outpatients vary from 58 to 54% for Amx, from 88 to 83% for NA, from 96 to 89% for Cip, from 82 to 79% for SXT, from 94 to 96% for Ft and remains at 60% for AMC from 2002 to 2004. Susceptibility in E. coli strains isolated from hospitalized patients vary from 52 to 47% for Amx, 55 to 53% for AMC, from 79 to 70% for NA, from 87 to 79% for Cip, from 74 to 69% for SXT, from 93 to 92% for Ft. Susceptibility in E. coli strains isolated in the community from UTI outpatients is decreasing and it becomes worrying particularly concerning the fluoroquinolones, therefore empiric treatment of pyelonephritis by fluoroquinolones must be assessed again.

Impact evaluation of nutrition education intervention for an elementary school in riyadh city.

A nutritional education intervention (NEI) was conducted to assess its impact and suitability for the 5th and 6th graders at a governmental girls' elementary school in Riyadh city. The study design was a randomized posttest only control group. The results revealed that the mean knowledge score of the first posttest for intervention classes was higher than that of their controls (F=91.147, p<0.001). This score increased markedly among all classes at the post-posttest. The mean self-efficacy (SE) score of the control class of 5th graders and intervention class of 6th graders at posttest were much lower than that of their comparable classes and both classes showed significant increase of SE in the post-posttest (paired t=2.819 and 4.561, p<0.01 and p<0.001 respectively). The mean practice score of the posttest was lower among intervention class of the 5th graders than their control, but both means were much higher than that of both classes of the 6th graders (F=6.856, p<0.001). Only control class of the 6th graders showed increased mean practice score at the post-posttest. Stepwise linear regression models reveal that exposure to NEI session was a major predictor of students knowledge at posttest (R(2)=.345). Knowledge score was a predictor of students' dietary SE and practices scores at posttest (R(2)=.041 & .136). Self efficacy was a predictor of students' dietary practices at posttest and post-posttest (R(2)=.107 & .162) as well as lower body mass index (R(2)=.048). The study recommends the replication of such a program among diverse population of school students to have more improvement in students' dietary knowledge, SE and practices.

Pregnancy and progression to AIDS: results of the French prospective cohorts. SEROGEST and SEROCO Study Groups.

OBJECTIVE: To investigate whether pregnancy accelerates HIV-1 disease progression. METHOD: In two large French SEROCO and SEROGEST prospective cohorts of HIV infected patients, the progression to AIDS in 365 women with a known date of HIV-1 seroconversion was examined by comparing those who delivered after HIV infection (n = 241) with those who did not become pregnant while HIV-infected (n = 124). RESULTS: The crude relative risk of developing AIDS associated with pregnancy was 0.7 [95% confidence interval (CI), 0.4-1.2]. Adjustment for age at seroconversion, the CD4+ cell percentage at entry, and the method used to date seroconversion did not modify the results (adjusted relative risk, 0.7; 95% CI 0.4-1.2). CONCLUSIONS: No deleterious effect of pregnancy on progression from seroconversion to AIDS was found. This result has important implications for the counselling of HIV-infected women of child-bearing age.

Haemodynamic assessment of hypovolaemia under general anaesthesia in pigs submitted to graded haemorrhage and retransfusion.

We have compared the value of different variables used in the assessment of blood loss during progressive hypovolaemia and resuscitation under general anaesthesia in anaesthetized pigs. We measured mean arterial pressure (MAP), pulmonary capillary wedge pressure (PCWP), the negative component of the systolic arterial pressure variation (delta Down) and left ventricular end-diastolic area (LVEDa) using echocardiography. Blood was progressively withdrawn (up to 35 ml kg-1 in seven steps) and then reinfused after the same pattern. Regression coefficient (r) and normalized slope (nS) of the regression relationship between each variable and amount of blood loss were determined. The difference between the withdrawal and reinfusion curves was assessed by the area between the curves. We also estimated the minimal loss of blood volume which induced significant changes in each variable compared with that under control conditions during withdrawal of blood (minWBV) and maximal loss in blood volume which induced no significant changes in a variable compared with control conditions during retransfusion (maxRBV). During haemorrhage, MAP decreased (from mean 74 (SD 9) to 31 (5) mm Hg; P < 0.001), delta Down increased (from 1.2 (1.4) to 11.4 (4.2) mm Hg; P < 0.001), PCWP decreased (from 6.2 (2.1) to 0.3 (1.0) mm Hg; P < 0.001) and LVEDa decreased (from 13.8 (2.0) to 5.1 (2.0) cm2; P < 0.01). The highest r values were obtained with MAP and LVEDa, and the highest nS value with delta Down. The least difference between withdrawal and reinfusion was with LVEDa, the lowest values of minWBV were with PCWP and LVEDa, and the highest value of maxRBV was obtained with PCWP. During progressive haemorrhage under general anaesthesia, LVEDa was an accurate variable for assessment of blood volume loss, delta Down contributed no further information compared with MAP, and PCWP was the most reliable variable for assessing return to baseline blood volume.

Use of transesophageal echocardiography for diagnosis of traumatic aortic injury.

This prospective study was conducted to describe the signs on transesophageal echocardiography (TEE) associated with traumatic aortic injury (TAI). Twenty-eight patients with TAI underwent TEE, and they were compared with a control group of 30 thoracic trauma patients without aortic injury. The TEE signs were classified as direct or indirect signs, and the quality of imaging was assessed. Patients' TEE images were compared with their anatomic lesions. The direct signs were thick stripes (n=19), false aneurysm (n=7), aortic dissection (n=6), free-edge intimal flap (n=15), aortic wall hematoma (n=2), fusiform aneurysm (n=13), and complete aortic obstruction (n=2). The indirect signs included minor increases in aortic diameter (n=7), impairment of the aortic Doppler color flow (n= 18), and an increase of aorta-probe distance, indicating hemomediastinum (n=23). TEE allowed diagnosis of recently described limited intimal lesions frequently missed by other conventional methods, and permitted rapid diagnosis of complete rupture in which fast degeneration means that more time-consuming methods are not practicable. Significant blurring of the aortic outline was noted in 20% of cases and intraluminal artifacts were observed in 36% of cases, but neither sign impaired accurate diagnosis of TAI. The echocardiographic signs of aortic injury are complex and may be confined to a short section of the aorta. Therefore, examination by a physician highly trained in echocardiography is necessary in such cases.

[Ectopic pregnancy recurrence: role of gynecologic, obstetric, contraceptive and smoking history]. / La récidive de GEU: rôle des antécédents gynéco-obstétricaux, contraceptifs et du tabagisme.

The purpose of this study, based on data from the register of ectopic pregnancy in Auvergne (centre of France), is to identify risk factors of recurrence of ectopic pregnancy (EP). The social characteristics, gynaecological, surgical and reproductive history and conditions of the conception of 96 women with a previous EP were compared to those for 566 women without previous EP. Risk factors associated with the management of the first EP could not be analysed with the data available. Several factors increased the risk of recurrence: previous proved or suspected salpingitis (OR = 3.6), maternal smoking (OR = 1.7 to 2.0 according to the consumption level), maternal age greater than 30 (OR = 2.0), and previous recurrent spontaneous abortions (SA) among childless women (OR = 3.4 to 11.9 according to the number of SA). The last of these factors may reflect another unknown risk factors common to recurrent SA and recurrent EP (for example hormonal or karyotype factors). Previous use of intra uterine device is associated with a decrease in the risk of recurrence of EP (OR = 0.27), but this contraceptive method should be considered as an indicator of good fertility rather than as a protective factor for EP recurrence.

Lack of behavioural risk factors for squamous intraepithelial lesions (SIL) in HIV-infected women.

HIV-infected women have a high prevalence of abnormal Papanicolaou smears and cervical intraepithelial neoplasia. A multiparametric analysis of epidemiological and behavioural risk factors has been performed in a cohort of 204 HIV-infected women in an outpatient clinic with the aim to investigate risk factors associated with squamous intraepithelial lesions (SIL) in HIV-seropositive women. The prevalence of SIL in the study population was 35.7%. Univariate and multivariate analysis of demographic, behavioural and immunological variables only identified cigarette smoking > 20/day and CD4+ cell counts < or = 200 x 10(6)/L as risk factors significantly associated with SIL in the study population. We found no epidemiological/behavioural risk factors specifically associated with SIL in HIV-infected women as compared with the general population. The results suggest that the high prevalence of SIL in HIV disease is related to acquired immune deficiency in HIV-seropositive women.

Flow cytometric cell cycle kinetics and quantitative measurement of c-erbB-2 and mutant p53 proteins in normal, hyperplastic, and malignant endometrial biopsies.

OBJECTIVES: The purpose of this study is to biologically characterize endometrial hyperplasia by investigating changes in DNA ploidy pattern, the expression of c-erbB-2 p185 and mutant p53 proteins. METHODS AND RESULTS: Our results show that all normal endometria (n = 62) were exclusively diploid and 2 (2.5%) of 79 endometrial hyperplasias and 22 (68.8%) of 32 endometrial carcinomas were aneuploid. Upper 95% normal values for synthetic phase fraction (SPF), c-erbB-2 and p53 were applied as cut-off values to discriminate between normal and malignant endometria. When 9%, 3.2 HNU (Human Neu Unit)/microgram protein, and 0.39 ng/mg protein were used as cut-off values for SPF. c-erbB-2, and p53 respectively, 13.9%, 20.2%, and 0% of endometrial hyperplasia and 50%, 56.3%, and 12.5% of endometrial carcinoma showed raised levels of the corresponding parameters. CONCLUSIONS: Our results indicate that subsets of endometrial hyperplasia are biologically different as evidenced by the presence of DNA aneuploidy, high SPF and c-erbB-2 overexpression, which may provide biological markers for assessing progression to endometrial carcinoma.

[Attendance at a health center by clandestine prostitutes in Djibouti]. / Fréquentation d'un centre de santé par les prostituées clandestines à Djibouti.

The extent of clandestine prostitution in Djibouti is difficult to evaluate. Due to the secrecy of the prostitutes and often their low level of education, the follow-up of these patients is also difficult. A sexually transmitted disease clinic specialized in the treatment of prostitutes and their customers has been established in Djibouti since 1963. We tried to evaluate the available data on the clandestine prostitutes attendance at the center. The population was young with a mean age of 23 years. Fifty percent had children and 60% were divorced or separated. Ninety-one percent were Ethiopian and 73% lived in the same district of the city of Djibouti. Almost half of them were HIV positive. The duration of residence in Djibouti before the first visit to the clinic varied widely with a median of 12 months. However, the total duration of prostitution before the first visit was shorter with a median of 3 months. The complaint at the first visit was most often minor. Among the prostitutes who first came to the center in 1993, half of them came only once. The overall duration of follow-up was 8 months, for an average of 3.7 visits per patient. Alternatively, 20 patients had more than 10 consultations and this represented one third of the consultations given to previous patients. This last group is the only one which tended to respect the monthly visits proposed to each patient at the first consultation. The other patients seemed to come only when they felt ill. The routine statistical activities which separately counted the new and previous patients gave an optimistic but faulty impression: these showed an increase in the total number of patients and also an increase in the percentage of previous patients visiting (from 42 to 69% between 1988 and 1994). It is difficult to evaluate the follow-up of such a mobile population. The few patients known for their fidelity contrasted with the fact that half of the patients had visited the center only once. This low frequency of visitation could be due to either the management of the center or to the lack of proximity of the contacts within the districts.

Comparison between radionuclide ejection fraction and fractional area changes derived from transesophageal echocardiography using automated border detection.

BACKGROUND: Left ventricular fractional area changes (FAC) can be derived from transesophageal echocardiography using an automated border detection system. However, FAC has not yet been compared to left ventricular ejection fraction (EF) evaluated by a reference technique. The aim of this study was to correlate transesophageal echocardiography automated FAC to EF derived from radionuclide angiography to obtain a quantifying method of global left ventricular systolic function at the bedside. METHODS: Ten critically ill patients, whose lungs were mechanically ventilated, were included in this prospective study. Patients were scheduled for radionuclide EF evaluation when at least 75% of the endocardium was clearly visualized on transesophageal echocardiography. Patients with esophageal pathology or cardiac dysrhythmia were excluded. Ejection fraction derived from radionuclide angiography was measured using technetium 99m. Echocardiographic data were obtained using an ultrasound system with automated border capabilities. Simultaneous measurements of left ventricular EF and FAC were obtained for each patient, both before and after starting a dobutamine intravenous infusion to modify left ventricular contractility. RESULTS: Mean values for radionuclide EF and transesophageal echocardiography FAC were, respectively: 55% +/- 19% (range 19-89%) and 46% +/- 18% (range 17-80%). Left ventricular EF and FAC were significantly correlated (r = 0.85, SEE = 9.6%). Variations of EF and FAC, induced by dobutamine, were also correlated (r = 0.70, SEE = 4.9%). CONCLUSIONS: Fractional area changes determined by transesophageal echocardiography using automated border detection correlate well with radionuclide EF and may be used at the bedside to quantify left ventricular function in selected intensive care unit patients.

Plasma ionized calcium in brain-dead patients.

BACKGROUND: The mechanism of brain death-induced myocardial dysfunction remains debatable. Hypocalcemia is known to induce reversible myocardial dysfunction. However, the incidence of hypocalcemia and its effect on myocardial function during brain death is unknown. METHODS: In 54 consecutive brain-dead patients, we measured plasma total and ionized calcium concentrations, QT and corrected QT intervals, and left ventricular ejection fraction area (LVEFa), using transesophageal echocardiography. RESULTS: 49 (91%) of brain-dead patients had a decrease in total plasma total calcium concentration but only 19 (35%) had a decrease in plasma ionized calcium. Corrected total plasma calcium failed to predict ionized calcium concentration and QT intervals were not significantly different in normo and hypocalcemic patients. The LVEFa was not significantly different between normo and hypocalcemic patients (53 +/- 13 versus 50 +/- 20%), and no correlation was found between LVEFa and ionized calcium (R = 0.02, NS). Hypocalcemic patients required greater doses of dopamine (8.2 +/- 5.2 versus 5.0 +/- 3.4 micrograms.kg-.min-1, p < 0.02) to maintain arterial pressure. Hypocalcemia was associated with a higher volume loading and a lower plasma protide concentration which reflected hemodilution. CONCLUSION: A decrease in plasma ionized calcium is not frequent, rarely severe, and probably not the main mechanism of myocardial dysfunction in brain-dead patients. Hypocalcemic patients required higher doses of dopamine, suggesting a decrease in systemic resistance. Only direct measurement of ionized calcium can assess plasma calcium ion status in brain-dead patients.

Systemic gas embolism complicating pulmonary contusion. Diagnosis and management using transesophageal echocardiography.

Systemic air embolism has been frequently reported after penetrating thoracic trauma. In blunt thoracic trauma, systemic air embolism has been rarely diagnosed, and then only after an invasive procedure such as thoracotomy. Transesophageal echocardiography has been recently introduced for the early assessment of trauma patients and is considered a sensitive noninvasive procedure to diagnose air embolism. We report three cases of systemic air embolism in patients with pulmonary contusion secondary to a blunt thoracic trauma requiring controlled ventilation. Transesophageal echocardiography was performed for evaluation of hemodynamic instability, and it showed air bubbles in the left atrium and left ventricle during the insufflation phase, which disappeared during apnea. A decrease in airway pressure (release of PEEP, low tidal volume, high frequency jet ventilation) significantly reduced the systemic air embolism. We concluded that systemic air embolism can occur after blunt thoracic trauma, and transesophageal echocardiography enables a rapid and accurate diagnosis that may be useful for therapeutic management.