[Impacted battery in the nose of a four-year-old girl].

In this case report, it was suspected that a four-year-old girl had an impacted toy in her nose. Initially, she was refused consultation due to a COVID-19 positive parent. Three days later she presented with nasal secretion and facial oedema. At the hospital, an examination revealed an impacted battery and consequent necrosis of nasal structures. The battery was removed in general anesthesia. Afterwards, the girl made fine recovery but developed a permanent septal perforation. Frequent alterations in COVID-19 guidelines challenge doctors to distinguish conditions crucial for evaluation. Batteries are uncommon for nasal impaction but may lead to severe morbidity if left undiscovered.

[Assessment of nasal function by computational fluid dynamics].

This review summarises the knowledge of computational fluid dynamics (CFD) which combines fluid mechanics, mathematics and computer simulation to analyse airflow and air conditioning of the nasal airway. Traditional objective measures are hampered by low correlation to subjective outcome, whereas CFD variables such as heat flux and nasal middle airflow show good correlation. Studies also show great potential for virtual surgery, when the nasal procedure is simulated, and CFD analyse the impact on airflow and conditioning to optimize surgical planning. CFD could be of great value in rhinology and improve nasal surgery.

[Plastic coin in the oesophagus in a one-year-old girl with long-term aerodigestive symptoms].

Oesophageal foreign body ingestion in children, who do not present with acute symptoms, can be difficult to diagnose, especially if ingestion is unwitnessed. This is a case report of a one-year-old girl with long-term aerodigestive symptoms, primarily treated for pneumonia and asthma with uncertain efficacy. After eight months, a broncho-oesophagoscopy was performed, and it unexpectedly revealed a plastic coin embedded in the oesophageal wall. Removal was successful with rigid oesophagoscopy. In children with unresolved aerodigestive symptoms broncho-oesophagoscopy should be considered.

Nonanaplastic follicular cell-derived thyroid carcinoma: mitosis and necrosis in long-term follow-up.

Nonanaplastic follicular cell-derived thyroid carcinoma (NAFCTC) includes differentiated- (DTC) and poorly differentiated thyroid carcinoma (PDTC). DTC has an excellent prognosis, while PDTC is situated between DTC and anaplastic carcinomas. Short-term studies suggest that PDTC patients diagnosed only on tumor necrosis and/or mitosis have a prognosis similar to those diagnosed according to the TURIN proposal. The purpose of this study was to evaluate prognosis for NAFCTC based on long-term follow-up illuminating the significance of tumor necrosis and mitosis. A cohort of 225 patients with NAFCTC was followed more than 20 years. Age, sex, distant metastasis, histology, tumor size, extrathyroidal invasion, lymph node metastasis, tumor necrosis and mitosis were examined as possible prognostic factors. Median follow-up time for patients alive was 28 years (range 20-43 years). Age, distant metastasis, extrathyroidal invasion, tumor size, tumor necrosis and mitosis were independent prognostic factors in multivariate analysis for overall survival (OS). In disease specific survival (DSS) age was not significant. Using only necrosis and/or mitosis as criteria for PDTC the 5-, 10- and 20-year OS for DTC was 87, 79 and 69%, respectively. In DSS it was 95, 92 and 90%. For PDTC the 5-, 10- and 20-year OS was 57, 40 and 25%, respectively. In DSS it was 71, 55 and 48%. Tumor necrosis and mitosis are highly significant prognostic indicators in analysis of long time survival of nonanaplastic follicular cell-derived thyroid carcinoma indicating that a simplification of the actually used criteria for poorly differentiated carcinomas may be justified.