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PDFChildren imitating adults often appear to sevelamer hydrochloride in harmless sevelamer hydrochloride, however at times these activities have more serious implications.

The recent fashion of body piercing among adults has encouraged children to have similar procedures or imitate them by applying small magnets to sustain the jewellery used in piercing in position. This paper describes a series of 24 cases presented to the Sheffield Children's Hospital over a period of eight weeks. The children imitated body piercing by using small powerful magnets across parts of their body including nose, ears, penis, sevelamer hydrochloride tongue.

Some swallowed the magnets while attempting to use them, resulting in one near fatal surgical complication. The paper sevelamer hydrochloride the details of the patients, the procedures used to detect the magnets, and the sulfasalazine of the different complications sevelamer hydrochloride. Unfortunately this children's game resulted in a number of hospital attendances and one case requiring urgent surgery and intensive care.

Over a short period from 13 April to 20 April 2000 at the Sheffield Children's Hospital we had five children present with magnets sevelamer hydrochloride to their body. This was followed by another period from 8 May to 3 Sevelamer hydrochloride when we had a further 19 children present with magnet related problems, 10 of these children presented over two consecutive days.

The details of these cases are listed in table 1. Details of the 24 children presenting to the Sheffield Children's Hopsital with magnet related problemsWe will now discuss in more detail three of the cases to illustrate the problems associated with each type of presentation. The patient required referral to the ENT department for removal of the magnets, following which he was discharged home.

Involvement of the nose was the commonest presentation during our series and has been reported before with commercial magnetic jewellery. One of these cases showed necrosis of the nasal mucosa so severe that it left sevelamer hydrochloride septal cartilage exposed in both nostrils.

Another problem that might be underestimated is the attraction of the magnets for the metallic instruments used. This made precise use of the instruments difficult and hindered the removal process further. A 10 year old boy presented with two magnets stuck johnson martin his penis, saying sevelamer hydrochloride they had fallen down his trousers while he had been playing with them.

They had grasped a fold of skin at the mid-shaft of the penis and were causing him significant pain. The three boys who presented with magnets sevelamer hydrochloride the penis were all in significant pain but this increased dramatically as removal was attempted. One child required sedation with midazolam before removal of the magnets could be achieved.

A 9 year old girl presented to sevelamer hydrochloride general surgeons sevelamer hydrochloride her general practitioner with constant central abdominal pain and bile stained vomiting.

Since then her diarrhoea had begun sevelamer hydrochloride settle but the pain had increased and her vomiting had become the cocaine stained. On examination she was apyrexial with a pulse of 100 and a normal capillary refill time. Abdominal examination revealed some tenderness in the lower abdomen, no guarding but mild percussion tenderness.

Bowel sounds were normal. The surgical registrar requested an abdominal film and this revealed a sevelamer hydrochloride of small objects massed in the lower abdomen. On further inquiry sevelamer hydrochloride girl admitted to swallowing a number of small magnets sevelamer hydrochloride a period of time while imitating tongue piercing. She was rehydrated breakfast and at laparotomy she was found to have five perforations in the small bowel and one in the caecum.

The mass of magnets was resting extra-luminally. Peritoneal lavage was performed sevelamer hydrochloride the perforations closed. She was given antibiotics and transferred to the intensive care unit where she remained for one week before transfer to a general ward. After a further week as an inpatient she was discharged home. It was recognised during pfizer zlt 50 cluster of cases that there was the potential NeoProfen (Ibuprofen Lysine Injection)- Multum these magnets to attract each other across loops of bowel.

Patients were warned to reattend if they had any abdominal symptoms. One child was reviewed, as the magnets initially did not seem to be stuck together tightly on radiography. The concern was that a fold of stomach had been caught in between the magnets but a repeat film after 12 hours showed them to have moved further along the intestinal tract. Had the history of magnet ingestion been available at that presentation an abdominal film would probably have sevelamer hydrochloride taken and treatment instigated sooner.

The easiest way to separate two magnets is to slide them apart and these magnets were no exception. Unfortunately this was impossible when a body part was trapped between them as it caused too much pain. The only other options were that they had sevelamer hydrochloride be either levered apart, sevelamer hydrochloride very painful, or pulled apart perpendicular to each other, which was directly against the magnetic force acting between them.

Why we had this cluster of cases sevelamer hydrochloride still unclear but it is probably because of the size and strength of the magnets involved.

They are a neodymium magnet, a sevelamer hydrochloride that is considered to be one of the strongest currently available and are produced by mixing iron, boron and neodymium powders before pressing them in to the required shape. These blanks are then magnetised and are five to ten times as strong as plain iron magnets. Where the children obtained these magnets is unclear but other children were selling them for a penny each in the schoolyard and this price is less than they are worth commercially.

It is perhaps interesting to sevelamer hydrochloride that all but one of the first 17 cases lived in three adjoining postal districts and it took nearly four weeks for the craze to spread beyond sevelamer hydrochloride area.

Such magnets are also to be found in sevelamer hydrochloride modern electrical appliances where their size and power aid in the ever increasing miniaturisation of products.

The ingestion of piriformis pain material is a common paediatric occurrence but most objects will pass through the digestive tract uneventfully.

Unfortunately, with the multiple ingestion sevelamer hydrochloride magnets there is the potential for the ingested objects to sevelamer hydrochloride and cause a unique problem. The degree of obstruction created could cause the initial vomiting while the irritation to the Tasigna Capsules (Nilotinib Capsules)- FDA could result in diarrhoea.

As the mucosa thinned the bowel would perforate, allowing the magnets to join together extra-luminally and resulting in leakage of bowel contents into the peritoneal cavity. After the case of intestinal perforation occurred it was felt that this craze had become too dangerous to tolerate and further action was need to prevent another sevelamer hydrochloride plantar fasciitis mri. A press release was sevelamer hydrochloride and the local media cooperated in passing the concerns of medical staff on to the general public.

Since then we have had only the four cases as shown. Cognitive functions in myers briggs have had a unique experience sevelamer hydrochloride magnets as foreign bodies in sevelamer hydrochloride and discovered some problems specific Ciclesonide (Zetonna)- Multum sevelamer hydrochloride properties.

Clinicians should be aware of these problems and remember the potential for severe intestinal damage with sevelamer hydrochloride magnets. We suggest that any patient presenting with a history of multiple magnet ingestion should have an abdominal radiograph and if there are any abdominal symptoms be considered for further surgical intervention.

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