Nasal foreign bodies: our experience

Background: The experience of a mother of a child with a foreign body stuck in its nasal cavity can be quite panicky and horrifying. The nasal foreign bodies are one of the commonest emergencies in the department of otorhinolaryngology. The common foreign body objects that are removed from the nasal cavity includes beads, pencil butts, peas or other grains, seeds, sponge, stones, paper bits, erasers, metallic objects, crayons, batteries.Methods: An observational prospective study was performed at the department of otorhinolaryngology, government medical college, Kathua, Jammu and Kashmir. In this study we examined 120 cases of foreign body nose that had presented to us from March 2019 up to March 2020. Once detected a written consent was obtained from the patient’s attendants after duly explaining the involved risks to the child. Thereafter the foreign bodies were removed using appropriate instruments. Microsoft Excel tool were used to analyze and interpretate the data.Results: Amongst the 120 patients, there were 23 adults and 97 children under 10 years. Study included 72 males and 48 females. The 86 patients had a clear history of foreign body insertion. The 12 patients were brought to our OPD with history of a long standing unilateral nasal discharge. The 12 patients had presented with history of epistaxis. Eight patients had presented with headache and recurrent episodes of rhinorrhea. Two cases presented with symptoms of pain over the nasal bridge and swelling.  In our study 86% of the patients were brought with a history of foreign body insertion and only 14% a foreign body was detected when the child had presented to the outpatient department with nasal complaints. Amongst the patients 88 of them (74%) had presented with foreign bodies in their right nostril.Conclusions: Any history of insertion of a foreign body inside the nose should be thoroughly investigated. Appropriate clinical examination and diagnostic nasal endoscopy (wherever indicated) should be done. Appropriate instrument should be selected and used for foreign body removal

Thermodynamic properties of vapours

A new method (Couldwell et al., 1978) has been developed for the measurement of the second virial coefficients of condensable gases. This method evaluates the second virial coefficients in terms of three pressure measurements (temperature maintained constant) and avoids the difficult volume calibration associated with former p-V-T-n and other volumetric methods. Measurements are reported for n-hexane at temperatures of 323.15, 328.15, 338.15, 348.15, 358.15 amd 373.15 K, and for benzene and cyclohexane at temperatures of 323.15, 348.15 and 373.15 K. The influence of surface adsorption of the vapours on the measurement of second virial coefficients is observed. It is suggested that future measuremets be made for loading pressure less than 0.34 to 0.4 times the saturation vapour pressure of the gases, corresponding to a region of monolayer adsorption. The influence of the third virial coefficient is determined, thus enabling the estimations of the "true" second virial coefficients which are at variance with the literature values (Dymond and Smith, 1980). Reasons are advanced to explain this anomaly. The results interpreted in the same manner, as the literature values, are in agreement with the latter. In a parallel study. an existing apparatus (McElroy et al., 1980) has been modified to measure unlike interaction second virial coefficients (Battino et al., 1983). The excess second virial coefficients (B12ōB11+B22)/2) for benzene, cyclohexane and n-hexane vapour binary mixtures have been measured at the temperatures 298.15, 323.15. 348.15, 373.15 and 398.15 K. The method permits the interaction second virial coefficients, B12 , to be determined with an accuracy three times better than that can be obtained from measurement of second virial coefficients of the mixtures. The lower temperature measurements are affected by surface adsorption. A postulated mathematical model (Shannon, 1976) has been checked to calculate a correction for surface adsorption. The interaction virial coefficient values, for benzene + cyclohexane. Are compared with B12 values in the literature and the values obtained from empirical correlations

Levels of protein C and soluble thrombomodulin in critically ill patients with acute kidney injury: a multicenter prospective observational study.

Endothelial dysfunction contributes to the development of acute kidney injury (AKI) in animal models of ischemia reperfusion injury and sepsis. There are limited data on markers of endothelial dysfunction in human AKI. We hypothesized that Protein C (PC) and soluble thrombomodulin (sTM) levels could predict AKI. We conducted a multicenter prospective study in 80 patients to assess the relationship of PC and sTM levels to AKI, defined by the AKIN creatinine (AKI Scr) and urine output criteria (AKI UO). We measured marker levels for up to 10 days from intensive care unit admission. We used area under the curve (AUC) and time-dependent multivariable Cox proportional hazard model to predict AKI and logistic regression to predict mortality/non-renal recovery. Protein C and sTM were not different in patients with AKI UO only versus no AKI. On intensive care unit admission, as PC levels are usually lower with AKI Scr, the AUC to predict the absence of AKI was 0.63 (95%CI 0.44-0.78). The AUC using log10 sTM levels to predict AKI was 0.77 (95%CI 0.62-0.89), which predicted AKI Scr better than serum and urine neutrophil gelatinase-associated lipocalin (NGAL) and cystatin C, urine kidney injury molecule-1 and liver-fatty acid-binding protein. In multivariable models, PC and urine NGAL levels independently predicted AKI (p=0.04 and 0.02) and PC levels independently predicted mortality/non-renal recovery (p=0.04). In our study, PC and sTM levels can predict AKI Scr but are not modified during AKI UO alone. PC levels could independently predict mortality/non-renal recovery. Additional larger studies are needed to define the relationship between markers of endothelial dysfunction and AKI

99mTc-DMSA (V) in Evaluation of Osteosarcoma: Comparative Studies with 18F-FDG PET/CT in Detection of Primary and Malignant Lesions

To evaluate the role of 99mTc-DMSA (V) and [18F]FDG PET-CT in management of patients with osteosarcoma, 22 patients were included in our study. All patients underwent both 99mTc-DMSA (V) and whole-body [18F]FDG PET-CT scans within an interval of 1 week. 555–740 MBq of 99mTc-DMSA (V) was injected i.v. the whole-body planar, SPECT images of primary site and chest were performed after 3-4 hours. [18F]FDG PET-CT images were obtained 60 minutes after i.v. injection of 370 MBq of F-18 FDG. Both FDG PET-CT (mean SUVmax = 7.1) and DMSA (V) scans showed abnormal uptake at primary site in all the 22 patients (100% sensitivity for both). Whole-body PET-CT detected metastasis in 11 pts (lung mets in 10 and lung + bone mets in 1 patient). Whole-body planar DMSA (V) and SPECT detected bone metastasis in one patient, lung mets in 7 patients and LN in 1 patient. HRCT of chest confirmed lung mets in 10 patients and inflammatory lesion in one patient. 7 patients positive for mets on DMSA (V) scan had higher uptake in lung lesions as compared to FDG uptake on PET-CT. Three patients who did not show any DMSA uptake had subcentimeter lung nodule. Resuts of both 99mTc-DMSA (V) (whole-body planar and SPECT imaging) and [18F]FDG PET-CT were comparable in evaluation of primary site lesions and metastatic lesions greater than 1 cm. Though 99mTc-DMSA (V) had higher uptake in the lesions as compared to [18F]FDG PET-CT, the only advantage [18F]FDG PET-CT had was that it could also detect subcentimeter lesions

Assessment of genotoxicity induced by helminthes parasites in freshwater fishes of river Ganges

Several parasites have been shown to induce genotoxicity in humans and fish are important intermediate hosts for completing the life cycle of many parasites, posing a huge economic loss worldwide through the ecosystem food chain. In the present study, we assessed the genotoxic potential of helminth Rostellascaris sp. through a benchmark of comet assay and micronucleus (MNi) tests on the hepatocytes, muscle, and whole blood of infected fish Bagarius bagarius (Hamilton) collected from different sites of the river Ganges. The percentage of the mean tail length of the comet was 10.28±0.36 in the reticulocytes of the infected fish which was significantly (P ˂0.05) longer compared to the control (2.86±0.12). Similarly, a significantly (P ˂0.05) higher DNA damage was observed in hepatocytes of parasite-infected fish (12.15±0.24) when compared to the control (3.024±0.013). A comparatively higher DNA damage was observed in the hepatocytes than the reticulocytes, indicative of tissue-specific DNA damage as hepatocytes are the biomarkers of metabolic functions prone toward biotic stress. A higher induction of MN was observed in infested fish (0.18±0.07) as compared to the control. Our results suggest that parasites contribute to the induction of cellular and DNA damage in fish during the progression of the host-parasite interaction

Hybrid SPECT-CT with 99mTc-labeled red blood cell in a case of blue rubber bleb nevus syndrome: added value over planar scintigraphy

Blue rubber bleb nevus syndrome (BRBNS) is a rare vascular anomaly syndrome consisting of multifocal venous malformations most commonly involving the skin, soft tissues, and gastrointestinal tract. The gastrointestinal lesions of BRBNS are the most clinically relevant malformations and carry a significant potential for serious bleeding. William Bennet Bean first coined the term “BRBNS” in 1958, and only 200 cases have been described since then (1). A few reports have described the use of 99mechnetium (99mTc)-labeled red blood cell (RBC) planar scintigraphy in BRBNS patients to localize the site of bleeding (2–5). To the best of our knowledge, however, the role of single-photon emission computed tomography-computed tomography (SPECT-CT) in examining such patients has not been evaluated. Here, we report the value of 99mTc-labeled RBC hybrid SPECT-CT over planar scintigraphy alone in a patient with BRBNS

Preoperative characterization of indeterminate large adrenal masses with dual tracer PET-CT using fluorine-18 fluorodeoxyglucose and gallium-68-DOTANOC: initial results

PURPOSEWe aimed to evaluate the usefulness of dual tracer positron emission tomography-computed tomography (PET-CT) with flourine-18 fluorodeoxyglucose (18F-FDG) and gallium-68 [1,4,7,10-tetraazacyclododecane-1,4,7,10-tetraacetic acid]-1-NaI3-octreotide (68Ga-DOTANOC) in preoperative characterization of large indeterminate adrenal masses.MATERIALS AND METHODSTen patients (four males, six females; median age, 35 years) with indeterminate, large (≥4 cm) adrenal masses were included in this prospective study. All patients underwent both 18F-FDG PET-CT and 68Ga-DOTANOC PET-CT within one week. Images were evaluated both visually and semi-quantitatively, with standardized uptake value (SUVmax) and SUVratio (SUVmax) of tumor/SUVmax) of mediastinum). Based on differential uptake pattern on 18F-FDG and 68Ga-DOTANOC, lesions were classified as cortical (18F-FDG>68Ga-DOTANOC), medullary (68Ga-DOTANOC>18F-FDG), or indeterminate (18F-FDG=68Ga-DOTANOC). Histopathology was taken as reference standard. Receiver operating characteristic (ROC) analysis was performed to find a cut-off of SUVmax) and SUVratio to differentiate cortical and medullary lesions.RESULTSOn histopathology, eight lesions were adrenocortical carcinomas, one was benign pheochromocytoma, and one was malignant pheochromocytoma. Visually, 18F-FDG PET-CT was positive in all ten lesions, while 68Ga-DOTANOC PET-CT was positive in two, both of which were pheochromocytomas. On SUVmax) based analysis, nine lesions were cortical and one was medullary. On ROC analysis, a SUVmax) cut-off of > 2.3 was obtained for 18F-FDG PET-CT and 3.6 for 68Ga-DOTANOC PET-CT for differentiating adrenal cortical and medullary lesions. The cut-off for SUVratio was 4.5 on 18F-FDG PET-CT and 11.1 on 68Ga-DOTANOC PET-CT.CONCLUSIONThese preliminary results demonstrate that dual tracer PET-CT using 18F-FDG and 68Ga-DOTANOC could be informative in the preoperative characterization of large indeterminate adrenal masses

Hybrid SPECT-CT for characterizing isolated vertebral lesions observed by bone scintigraphy: comparison with planar scintigraphy, SPECT, and CT

PURPOSEWe aimed to assess the role of single photon emission computed tomography-computed tomography (SPECT-CT) for characterizing isolated vertebral lesions observed by bone scintigraphy compared to planar scintigraphy, SPECT, and CT, and to evaluate the impact of SPECT-CT on patient management. MATERIALS AND METHODSData from 99 patients (mean age, 52.4±18.9 years; females, 58.5%) with 108 isolated vertebral lesions visible on planar bone scintigraphy, who had undergone SPECT-CT of a selected volume, were retrospectively analyzed. Planar scintigraphy, SPECT, CT, and SPECT-CT images were independently evaluated in separate sessions to minimize recall bias. A scoring scale of 1 to 5 was used, with 1 being definitely metastatic, 2 most likely metastatic, 3 indeterminate, 4 most likely benign, and 5 definitely benign. Sensitivity, specificity, and predictive values were calculated; a score ≤3 was defined as metastatic. The areas under the receiver operating characteristic curve were calculated and compared. Clinical and imaging followup with or without histopathology were used as a reference standard. RESULTSAmong the 108 lesions, 49 were indeterminate on planar scintigraphy, 16 on SPECT, and one each on SPECT-CT and CT. SPECT-CT was superior to both planar scintigraphy (P < 0.001) and SPECT alone (P = 0.014), but not to CT (P = 0.302). CT was superior to planar scintigraphy (P < 0.001) but only slightly superior to SPECT (P = 0.063). SPECT-CT correctly characterized 96% of the indeterminate lesions observed by planar scintigraphy. SPECT-CT had an impact on the clinical management of 60.6% patients compared to planar scintigraphy and 18.1% compared to SPECT. CONCLUSIONSPECT-CT is better than planar scintigraphy and SPECT alone, but not CT alone, for characterizing equivocal vertebral lesions that are observed by bone scintigraphy, thus SPECT-CT can have a significant impact on patient management

Primary penile lymphoma: the use of PET-CT for accurate staging and response monitoring

Primary penile lymphoma is an extremely rare neoplasm. We present a case of 63-year-old man with painless diffuse pe- nile swelling and retention of urine. Biopsy from the penile swelling demonstrated CD20+ diffuse large B-cell lymphoma. Staging was performed using fluorine-18-fluorodeoxyglucose (FDG) positron emission tomography-computed tomography (PET-CT) and revealed a FDG avid penile mass with enlarged and FDG avid multiple inguinal and aortocaval lymph nodes. A follow-up FDG PET-CT scan after eight cycles of combina- tion chemotherapy showed complete remission of the dis- ease. Thus, FDG PET-CT should be integrated in management protocols of rare primary penile lymphoma

SPECT-CT for characterization of extraosseous uptake of 99mTc-methylene diphosphonate on bone scintigraphy

Bone scintigraphy is a sensitive and popular method for imaging a wide array of benign or malignant skeletal abnormalities. However, the uptake of tracers used for bone scintigraphy may be observed in various extraosseous sites, thereby limiting its specificity. It is difficult to correctly localize such sites of uptake on planar bone scintigraphy alone. The addition of hybrid single-photon emission computed tomography-computed tomography (SPECT-CT) under such circumstances is very useful. The present essay illustrates the commonly encountered extraosseous uptake of 99mTc-methylene diphosphonate (MDP) and the usefulness of hybrid SPECT-CT in clarifying 99mTc-MDP uptake