Pulmonary artery penetration due to fish bone ingestion: A rare case report

Accidental fish bone ingestion is a common manifestation at emergency departments. In most cases, ingested foreign bodies usually pass uneventfully through the gastrointestinal tract and complications only present in less than 5% of all patients. In this report, we present the first documented case of pulmonary artery injury due to a fish bone in a 63-year-old male patient hospitalized with hemoptysis after accidentally swallowing a fish bone 30 days ago. This patient subsequently had surgery and endoscopy to safely remove the foreign body and then recovered well on a follow-up examination. For cases of fish bone ingestion, contrast-enhanced chest computed tomography is one of the most essential tools to assess vascular problems and associated mediastinal infections-risk factors for life-threatening and long-term recurrent inflammation. Reconstructing planes along the foreign body axis and changing windows when analyzing CT scans is necessary to avoid missing lesions and dilemmas.

Diagnostic Performance of Magnetic Resonance Imaging in Discriminating Benign and Malignant Soft Tissue Tumors

Objective

The study aimed to evaluate the role of magnetic resonance imaging (MRI) in differentiating between primary benign and malignant soft tissue tumors (STTs).

Patients and Methods

The study was carried out on 110 patients with histopathological diagnoses of STTs. All patients underwent routine MRI before surgery/biopsy at Viet Duc University Hospital or Vietnam National Cancer Hospital, Hanoi, Vietnam, from January 2020 to October 2022. Data on preoperative MRI as well as the clinical features and pathological results of the patients were collected retrospectively. Univariate and multivariate linear regression were used to analyze the relationship between imaging, clinical parameters, and the ability to differentiate malignant from benign STTs.

Results

Among 110 patients (59 men and 51 women), 66 had benign tumors and 44 had malignant tumors. The qualitative values that were significant in distinguishing between benign and malignant STTs were hypointensity on T1-weighted images (T1W; p<0.001), hypointensity on T2-weighted images (T2W; p=0.003), cysts (p=0.003)), necrosis (p<0.001), fibrosis (p=0.023), hemorrhage (p<0.001), lobulated margin (p<0.001), ill-defined border (p<0.001), peritumoral edema (p<0.001), vascular involvement (p<0.001), and heterogeneous enhancement (p<0.001). Regarding quantitative values, age (p=0.009), size (p<0.001), T1W signal quantification value (p=0.002), and T2W signal quantification value (p=0.007) showed statistically significant differences between benign and malignant tumors. Multivariate linear regression analysis showed that the combination of peritumoral edema and heterogeneous enhancement was the most valuable in the differential diagnosis of malignant tumors from benign tumors.

Conclusion

MRI is valuable in discriminating between malignant and benign STTs. The presence of cysts, necrosis, hemorrhage, lobulated margin, ill-defined border, peritumoral edema, heterogeneous enhancement, vascular involvement, and T2W hypointensity is suggestive of malignant lesions, especially signs of peritumoral edema and heterogeneous enhancement. Advanced age and large tumor size are also suggestive of soft tissue sarcomas.

Economic transition should come with a health warning: the case of Vietnam

STUDY OBJECTIVE

s: To assess the affordability of health care to poor rural households in Vietnam under conditions of transition from a planned to a market economy and, in light of other transitional experience, inform policy on increasing access of the poor to affordable care of acceptable quality.

DESIGN

Observational study by cross sectional socioeconomic survey, longitudinal healthcare seeking survey, and qualitative semi-structured interviews and focus group discussions; qualitative follow up over six years.

SETTING

Four rural communes in north of Vietnam between 1992 and 1998. SURVEY PARTICIPANTS: 656 households (2995 people) selected by systematic random sampling.

MAIN RESULTS

Compared with non-poor households, poor households had significantly lower average per capita rates of healthcare consultation and expenditure (p<0.01 in both cases). Poor households delayed and minimised healthcare seeking, especially of expensive hospital services. Two thirds of average healthcare spending by poor households was on relatively inexpensive but frequent acts of local ambulatory care. The poor restrained their healthcare seeking but not in proportion to income: for households reporting illness, the average proportion of income devoted to health care was 21.9% for the poor compared with 8.2% for the non-poor (p<0.01). To meet healthcare costs, many poor households reduced essential consumption, sold assets and incurred debt, threatening their future livelihood.

CONCLUSIONS

In the short-term the poor need exemption from public sector user fees in both primary and hospital care. In the longer run the government budget and prepayment schemes should replace direct user charges in healthcare finance. Transitional economies like Vietnam should preserve the public health services built up under the planned economy. Market reforms that stimulate growth in the economy appear inappropriate to reform of social sectors.

Vibrational spectra of molecules on zeolites. IV. Raman spectra of cyclopropane on zeolites X

Laser Raman spectra are reported for cyclopropane adsorbed on cation- exchanged zeolites X. The results have been interpreted in terms of an edge-on interaction of the cyclopropane molecule with the zeolitic cation site. The symmetry of cyclopropane, when adsorbed on LiX and NaX, appears to be lowered from the free-molecule symmetry (D3h) to C2V as evidenced by the splitting of the E' mode (v11) of cyclopropane. In contrast to the previously reported case of the adsorption complexes, MX+C2H2 and MA+C2H2, the adsorption interaction appears to follow a direct polarizing-power dependence on the zeolitic cation. Force- constant calculations support an interpretation based on a cation- induced dipole interaction.

[Gastro-duodenal artery arising from the superior mesenteric artery]

These exceptional anomalies of the gastro-duodenal (G.D.) arteries provide a better understanding of certain very odd vessels found on coeliac or superior mesenteric arteries selective arteriography. In our series of 400 dissected bodies, a typical origin of the G.D. artery from the superior mesenteric artery is noted in 4 cases : the aberrant vessel is identified as a G.D. artery because of a) its course, b) and its two usual terminal divisions : superior pancreatico-duodenal and right gastro-epiploic arteries. On the other hand, we have 10 cases of G.D. artery arising from both coeliac hepatic and superior mesenteric arteries with:--a dominant hepatic branch in 6,--a dominant mesenteric branch in 3,--and a balanced origin in 1. A G.D. artery looping around the common bile duct to reach the anterior surface of the pancreas (Michels) was never seen in this series.

The determination of the surface area of silica by laser Raman spectroscopy

Changes in the Raman spectrum of pyridine on a silica surface with increasing surface coverage may be used to determine the monolayer capacity. The method, which is independent of the BET method, produces a result which is in quantitative agreement with the BET result.