A foreign body in the mediastinum as a cause of chronic cough in a 10-year-old child with asthma.

Introduction: Chronic cough is a common problem faced by pediatricians, with a reported prevalence of 20% among preschoolers. It is also the most frequent symptom of asthma. Many causes of chronic cough may also be possible causes of asthma exacerbations.Case study: We describe a 10-year-old boy with asthma, which was admitted to the hospital with a persistent dry cough for five months. Initially, he was treated as an exacerbation of asthma; however, a subsequent chest X-ray identified a wire during the next hospitalization. Although the wire was not found during bronchoscopy, a CT scan located the wire in the mediastinum.Results: The patient required urgent thoracic surgery, ending with the extraction of a 3 cm-long metallic wire. The history revealed that he had choked on a pizza shortly before the onset of coughing: it is most likely that the foreign body had been aspirated, and that it may have originated from a metal brush used to clean the oven. However, it is difficult to determine whether the wire was originally aspirated into the airways or into the gastrointestinal tract; from the latter, it would have perforated either the bronchus or esophagus and migrated to the mediastinum.Conclusion: The symptoms associated with aspiration or ingestion of a foreign body in the upper aerodigestive tract can simulate other pediatric diseases, such as asthma, and delay the correct diagnosis. Our findings demonstrate that chronic cough in children with asthma is not always a result of exacerbation. Precise interviewing and correct interpretation of basic diagnostic testing may be key for setting an accurate diagnosis.

Cortical presentation of language functions in patients after total laryngectomy: a fMRI study.

PURPOSE: The aim of this study is to use functional magnetic resonance (fMRI) to analyse the cortical presentation of selected language functions in patients after a total laryngectomy. METHODS: Eighteen patients after total laryngectomy treated with electrolarynx speech and 18 volunteers were included. The mean number of patients' post-operative speech rehabilitation sessions was five (range of 3-8 sessions). Four paradigms were used, including noun generation, pseudoword reading, reading phrases with pseudowords, and nonliteral sign reproduction. RESULTS: In noun, the most significant difference between the groups was the stronger activation of both lingual gyri in the volunteers. Pseudoword reading resulted in stronger activations in patients than in volunteers in the lingual gyri, the right cerebellum, the right Broca's area, and the right parietal operculum. Reading phrases with pseudowords involved different parts of the Brodmann area 40. During nonliteral sign reproduction, there was a stronger activation of the left Broca's area in volunteers and a stronger activation of the left premotor cortex in patients. CONCLUSION: This study provides evidence of altered cortical activation in response to language tasks in patients after a laryngectomy compared with healthy volunteers, which may be considered brain plasticity in response to a laryngectomy.

Monoexponential and Biexponential Fitting of Diffusional Magnetic Resonance Imaging Signal Analysis for Prediction of Liver Fibrosis Severity.

OBJECTIVE: The objective of this study is to compare the value of monoexponential and biexponential approach to the diffusion-weighted magnetic resonance imaging signal in the prediction of the liver fibrosis. METHODS: Forty patients with hepatitis C were included. Quantification of the apparent diffusion coefficient (ADC) and pure molecular diffusion (D), pseudodiffusion (D*), and perfusion fraction (f) was performed using 9 b values (b = 0, 20, 50, 100, 200, 400, 600, 800, 1000 s/mm). RESULTS: Significant fibrosis was found in 14 subjects. Monoexponentally derived ADC parameters were significantly correlated. Apparent diffusion coefficient calculated from all b values and ADC based on high b values were significantly related to the fibrosis grade (P < 0.02), and none of intravoxel incoherent motion parameters presented such an association. Apparent diffusion coefficient based on high b values was the best predictor of significant fibrosis with area under the curve of 0.81, sensitivity of 0.57, and specificity of 0.92. CONCLUSION: Intravoxel incoherent motion parameters did not allow for prediction of the liver fibrosis. Apparent diffusion coefficient calculated based on high b values presents considerable specificity in predicting significant fibrosis.

Contemporary follow-up imaging after endovascular repair of lower extremity atherosclerotic lesions.

Atherosclerotic disease is currently one of the most important problems of modern medicine because it is a leading cause of increased morbidity, morbidity and mortality, and disability in the Western World. Atherosclerosis of the lower limbs (peripheral arterial disease - PAD) significantly affects the quality of life and in a considerable proportion of patients is a cause of disability. Radical treatment of PAD, both surgical and endovascular, aims at revascularisation of ischaemic tissues distal to obstructed arteries. Surveillance imaging is an important part of patient management after endovascular repair of PAD. Apart from availability and contraindications, challenges of imaging include calcifications, flow dynamics, and stent-related artefacts. The aim of this paper was to review the current literature on imaging methods for follow-up after endovascular repair of atherosclerotic lesions, with special attention paid to novel techniques. As a non-invasive modality, ultrasound is still the first-line examination, but computed tomography angiography remains a current state-of-the art technique for follow-up. However, since current imaging recommendations seem not to adhere to contemporary imaging possibilities, more attention should be paid to recent improvements in magnetic resonance angiography technology.

Analysis of IVIM Perfusion Fraction Improves Detection of Pancreatic Ductal Adenocarcinoma.

The purpose of this study was to evaluate whether intravoxel incoherent motion (IVIM) parameters can enhance the diagnostic performance of MRI in differentiating normal pancreatic parenchyma from solid pancreatic adenocarcinomas. This study included 113 participants: 66 patients diagnosed with pancreatic adenocarcinoma and 47 healthy volunteers. An MRI was conducted at 1.5 T MR unit, using nine b-values. Postprocessing involved analyzing both conventional monoexponential apparent diffusion coefficient (ADC) and IVIM parameters (diffusion coefficient D-pure molecular diffusion coefficient, perfusion-dependent diffusion coefficient D*-pseudodiffusion coeffitient, and perfusion fraction coefficient (f)) across four different b-value selections. Significantly higher parameters were found in the control group when using high b-values for the pure diffusion analysis and all b-values for the monoexponential analysis. Conversely, in the study group, the parameters were affected by low b-values. Most parameters could differentiate between normal and cancerous tissue, with D* showing the highest diagnostic performance (AUC 98-100%). A marked decrease in perfusion in the patients with pancreatic cancer, indicated by the significant differences in the D* medians between groups, was found. In conclusion, standard ADC maps alone may not suffice for a definitive pancreatic cancer diagnosis, and incorporating IVIM into MRI protocols is recommended, as the reduced tissue perfusion detected by the IVIM parameters is a promising marker for pancreatic adenocarcinoma.

Early Cerebral Microvasculature Impairment and Increased Body Mass Index in Patients with Psoriasis.

Psoriasis induces systemic atherosclerosis, but its impact on cerebrovascular function remains unclear. However, stroke prevention must be considered in psoriasis, as it is commonly comorbid with classic cardiovascular risk factors. Thus, the aim of the study is to assess cerebral microvasculature function and its confounders in patients with psoriasis. The study protocol included cerebral autoregulation assessment with measurements of vasomotor reactivity reserve (VMRr) on the middle cerebral arteries with the use of a Transcranial Doppler (TCD) in 50 patients with psoriasis without cerebrovascular events (46; 21-74 years) and 26 healthy controls (41; 29-58 years). Analyses of VMRr relationships with the psoriasis course, comorbidities, inflammatory markers and intima-media thickness (IMT) were performed. The study showed that VMRr was lower (64% vs. 76%, p = 0.001), and the IMT was higher (0.65 vs. 0.52 mm, p = 0.001) in patients compared to controls. The patients were also characterized by a higher body mass index (BMI) and a higher level of Il-6 than the controls (29.14 vs. 25.76 kg/m2, p = 0.004 and 585 vs. 204 pg/mL, p < 0.001, respectively), but only BMI was independently impacting VMRr reduction (p = 0.02). In conclusion, early cerebral microvasculature dysfunction may occur in patients with psoriasis, and its extent is associated with an increase in BMI. Thus, body mass reduction should be strongly recommended for stroke prophylaxis in patients with psoriasis.

Correlation Analysis of Nasal Septum Deviation and Results of AI-Driven Automated 3D Cephalometric Analysis.

The nasal septum is believed to play a crucial role in the development of the craniofacial skeleton. Nasal septum deviation (NSD) is a common condition, affecting 18-65% of individuals. This study aimed to assess the prevalence of NSD and its potential association with abnormalities detected through cephalometric analysis using artificial intelligence (AI) algorithms. The study included CT scans of 120 consecutive, post-traumatic patients aged 18-30. Cephalometric analysis was performed using an AI web-based software, CephX. The automatic analysis comprised all the available cephalometric analyses. NSD was assessed using two methods: maximum deviation from an ideal non-deviated septum and septal deviation angle (SDA). The concordance of repeated manual measurements and automatic analyses was assessed. Of the 120 cases, 90 met the inclusion criteria. The AI-based cephalometric analysis provided comprehensive reports with over 100 measurements. Only the hinge axis angle (HAA) and SDA showed significant (p = 0.039) negative correlations. The rest of the cephalometric analyses showed no correlation with the NSD indicators. The analysis of the agreement between repeated manual measurements and automatic analyses showed good-to-excellent concordance, except in the case of two angular measurements: LI-N-B and Pr-N-A. The CephX AI platform showed high repeatability in automatic cephalometric analyses, demonstrating the reliability of the AI model for most cephalometric analyses.

Thallium in color tattoo inks: risk associated with tattooing.

BACKGROUND: Allergic reactions to metals and metal salts used in tattoo pigments occur surprisingly frequently. For this reason, this study focused on the determination of thallium (Tl) in the samples of color tattoo inks. These inks are commonly used in tattooing processes worldwide. MATERIAL AND METHODS: The samples were analyzed with the use of differential pulse anodic stripping voltammetry. The stripping anodic peak current of Tl was linear over its concentration range of 0.5-6.0 µg/l, which corresponds to 2.45×10-9-2.94×10-8 M. The determined value of the limit of detection (LOD) was equal to 0.149 µg/l (7.29×10-10 M). RESULTS: The obtained results revealed a wide range of Tl contents in tattoo inks, i.e., 0.0029-0.4275 µg/g. The content of this metal varied substantially depending on the pigment used in tattoo inks. CONCLUSIONS: Thallium was identified and determined in all tested samples. Its content depends on the country of origin but it does not depend directly on the color. The lowest content of Tl was found in the pink ink and the highest in the violet ink (from Israel), and a similar content was also found in the yellow ink (from Israel). The use of colored inks in larger quantities (a dense pattern and a larger surface area covered) may potentially pose a health risk. The danger of Tl poisoning from tattooing depends on the type of the ink (color) and its origin. As Tl is not considered a micronutrient, introducing such a Tl content into the body may be associated with a potentially harmful accumulation of this metal in body organs, causing various types of ailments and toxic effects primarily on the nervous, skeletal and circulatory systems. The obtained results suggest that tattooists may be exposed to the toxic effects of Tl in tattoo inks. The analytical data presented in the paper may constitute the basis for determining the acceptable limits of toxic Tl contents in tattoo inks. Med Pr. 2020;71(4):405-11.