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1.
Dermatol Online J ; 25(10)2019 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-31735017

RESUMO

Unusual distributions of contact dermatitis often lead to identification of the offending agent. We present a case of unilateral dermatitis of the chest developing in a patient with a history of allergy to metal. A name tag attached magnetically to his work uniform was identified as the cause of the eruption. Unilateral eruption of the chest can be a manifestation of allergic contact dermatitis to metal objects in breast pockets or attached to clothing.


Assuntos
Dermatite Alérgica de Contato/etiologia , Dermatite Ocupacional/etiologia , Imãs/efeitos adversos , Dermatite Alérgica de Contato/patologia , Dermatite Ocupacional/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Pele/patologia , Tórax/patologia
2.
Hinyokika Kiyo ; 65(8): 341-345, 2019 Aug.
Artigo em Japonês | MEDLINE | ID: mdl-31501404

RESUMO

In daily medical practice, we occasionally encounter patients with a foreign body in the urinary bladder. However, the identification of such a foreign body in an adolescent and the occurrence of an urethrocutaneous fistula caused by the foreign body are extremely rare. Only two cases have been reported previously. Herein we present a case of a foreign body in the urinary bladder and an urethrocutaneous fistula in a young patient. A 14-year-old boy with fever, left scrotal pain and urinary incontinence was referred to our department. Intravenous pyelography and micturition cystourethrography findings revealed a vesical foreign body and an urethrocutaneous fistula. He mentioned that he had inserted two dozen magnets into the urethra for masturbation one year previously. As the foreign bodies were spherical small magnets, we performed transurethral surgery and successfully removed the magnets. His postoperative course was uneventful and he was discharged from our department on the seventh day after surgery. Three months following surgery, the fistula had closed spontaneously.


Assuntos
Fístula Cutânea , Corpos Estranhos , Fístula Urinária , Adolescente , Fístula Cutânea/etiologia , Humanos , Imãs/efeitos adversos , Masculino , Masturbação , Uretra , Bexiga Urinária , Fístula Urinária/etiologia
3.
Khirurgiia (Mosk) ; (4): 77-79, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31120452

RESUMO

It is presented case report of diagnosis and treatment of foreign body of the intestine (magnets) in the 5-year-old child.


Assuntos
Corpos Estranhos/diagnóstico , Corpos Estranhos/terapia , Intestinos , Imãs/efeitos adversos , Pré-Escolar , Corpos Estranhos/complicações , Humanos
4.
J Vet Intern Med ; 33(4): 1833-1839, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31058361

RESUMO

BACKGROUND: Characterization of the clinical signs, response to treatment and prognosis can be useful information for decision-making when evaluating cattle with pharyngeal trauma. OBJECTIVE: To describe the signalment, history, clinicopathologic, endoscopic, ultrasonographic, radiographic, and postmortem findings as well as treatments and outcomes of cattle diagnosed with pharyngeal perforation/trauma. ANIMALS: Review of medical records of cattle >1 month of age admitted to a Veterinary Teaching Hospital from 1995 to 2017. METHODS: Retrospective study. Review of medical records of cattle with pharyngeal perforation/trauma identified by oral or endoscopic examination in hospital setting. RESULTS: Twenty-seven out of 7550 (0.36%) cases met the inclusion criteria. Pharyngeal perforation/trauma was associated with the administration of a bolus in 24 (89%) cows and a magnet in 3 (11%) cases. The boluses contained monensin (n = 12), calcium salts (n = 5), iodine (n = 1), aspirin (n = 1), vitamins (n = 1), and an unknown product (n = 4). The primary clinical signs were dysphagia, swelling of the throatlatch, subcutaneous emphysema, swelling, and pain on palpation of the throatlatch. Seventeen (63%) cows were discharged whereas 10 (37%) were euthanized. Median time between the suspected traumatic event and hospital admission was 1 day (range: 0.5-3 days) and 2 days (range: 0.5-15) for surviving and nonsurviving cattle, respectively. All 5 cows that suffered pharyngeal trauma associated with administration of calcium salt bolus were euthanized. CONCLUSIONS AND CLINICAL IMPORTANCE: Pharyngeal trauma is a rare condition in cattle. Case fatality rate increases if not diagnosed and treated promptly. The nature of the penetrating foreign body influences the outcome.


Assuntos
Administração Oral , Bovinos/lesões , Corpos Estranhos/veterinária , Doenças Faríngeas/veterinária , Faringe/lesões , Animais , Compostos de Cálcio/administração & dosagem , Feminino , Corpos Estranhos/diagnóstico , Imãs/efeitos adversos , Monensin/administração & dosagem , Doenças Faríngeas/diagnóstico , Doenças Faríngeas/terapia , Prognóstico , Estudos Retrospectivos
5.
Otol Neurotol ; 40(5): e482-e487, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31083075

RESUMO

HYPOTHESIS: Audio processor magnets used in transcutaneous active hearing implants vary in retention force. We hypothesized that a range of optimal magnetic retention forces could be derived, based on objective in-situ measurements of individual retention forces. BACKGROUND: The magnetic force required to retain the proper placement of transcutaneous active hearing implants varies among patients. Currently, audiologists rely on personal experience in deciding which magnet to use. Insufficient force causes frequent loss of the single-unit processors or external coils of behind-the-ear devices, and excessive force causes pain and skin irritations. METHODS: We experimentally determined magnetic retention force as a function of the distance between two magnets for different processor-implant magnet combinations. In addition, we studied individual in situ retention forces in 100 patients with hearing devices. Skin status was evaluated by a physician and assessed by patient self-reporting and a questionnaire. RESULTS: Force-distance functions showed that different magnet strengths had differential effects only at distances less than 6 mm. Examiner and patient skin status assessments and comfort scores showed that optimal retention force range was 0.23 to 0.4 N. CONCLUSION: We found that the currently available magnet types restrict the range of feasible skin flap thicknesses to a maximum of 6 mm. Further we conclude that retention forces between 0.23 and 0.4 N could provide the appropriate trade-off between the risk of losing device fixation and of causing skin irritations. We recommend measuring the retention force in all patients.


Assuntos
Implante Coclear/métodos , Implantes Cocleares , Imãs , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Implante Coclear/efeitos adversos , Implantes Cocleares/efeitos adversos , Estudos de Coortes , Dermatite/etiologia , Dermatite/patologia , Feminino , Humanos , Imãs/efeitos adversos , Masculino , Pessoa de Meia-Idade , Dor/etiologia , Conforto do Paciente , Pele/patologia , Adulto Jovem
6.
MedEdPORTAL ; 15: 10808, 2019 02 27.
Artigo em Inglês | MEDLINE | ID: mdl-30931387

RESUMO

Introduction: Emergency physicians must be able to manage inappropriately firing defibrillators. Many physicians may not experience this high-risk, low-frequency patient presentation during residency. We created this simulation to increase residents' knowledge of basic defibrillator function and confidence in managing patients with malfunctioning defibrillators. Methods: Sixteen emergency medicine residents of all levels of training participated in this curriculum. The educational experience began with a lecture. Residents then managed the simulated patient encounter in groups of four. The patient was a 63-year-old male presenting after feeling his defibrillator fire. He was found to have a supraventricular tachycardia with an inappropriately firing defibrillator. Learners needed to recognize the inappropriately firing defibrillator, inactivate it with a magnet, and treat the arrhythmia. Implementation of this scenario required audiovisual equipment and a simulation room equipped with high-fidelity simulator, patient monitor, code cart, defibrillator, and pacemaker magnet. Learners completed pre- and postcourse surveys to assess changes in baseline knowledge of defibrillator function and self-reported confidence in managing these complicated patients. Results: After participating in this educational intervention, residents improved their performance on a 10-question quiz from a class mean of 60% to 84% (p < .001). Residents also exhibited an increase in self-reported confidence in managing patients with inappropriately firing defibrillators (p < .001) and in knowing when to place a magnet over a patient's defibrillator (p < .001). Discussion: Residents demonstrated increased knowledge of defibrillator function as well as increased confidence in managing patients with malfunctioning defibrillators after participating in this simulation experience.


Assuntos
Desfibriladores/efeitos adversos , Internato e Residência/normas , Treinamento por Simulação/métodos , Taquicardia Supraventricular/etiologia , Competência Clínica , Currículo , Avaliação Educacional/métodos , Medicina de Emergência/educação , Falha de Equipamento , Humanos , Internato e Residência/tendências , Conhecimento , Imãs/efeitos adversos , Masculino , Pessoa de Meia-Idade , Simulação de Paciente , Autoimagem , Autorrelato/estatística & dados numéricos , Taquicardia Supraventricular/fisiopatologia , Taquicardia Supraventricular/terapia
8.
Int J Pediatr Otorhinolaryngol ; 120: 64-67, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30771555

RESUMO

Despite various studies that have demonstrated risk of cochlear implant magnet displacement following MRI, minimal literature is available on radiologic recognition of magnet displacement. Current literature emphasizes the status and placement of the electrode component of the implant. This case report examines the consequences of a delay in radiologic diagnosis of a displaced magnet including hospital admission, unnecessary radiation, and prolonged patient discomfort. Additionally, it provides a framework for successful radiologic recognition of a displaced magnet, detailing specific imaging modalities and magnet characteristics that should be evaluated to expedite and facilitate radiologic recognition of displacement.


Assuntos
Implantes Cocleares/efeitos adversos , Imãs/efeitos adversos , Falha de Prótese/efeitos adversos , Osso Temporal/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Criança , Implante Coclear/efeitos adversos , Implante Coclear/instrumentação , Feminino , Hospitalização , Humanos
9.
Laryngoscope ; 129(2): 482-489, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30412276

RESUMO

OBJECTIVE: Our objective is to evaluate the safety in patients with cochlear implants (CIs) and auditory brainstem implants (ABI) undergoing 1.5 Tesla (T) magnetic resonance imaging (MRI). Secondly, we want to raise awareness on CI and MRI safety, and advocate for continued improvement and advancement to minimize morbidity for our CI patients. METHODS: Retrospective case series from 2006 to 2018 at a single tertiary academic center. Data was collected on patients with CI or auditory brainstem implants undergoing MRI. Outcomes collected include demographic data, age at time of MRI, MRI characteristics, complications, CI manufacturer, and image quality. RESULTS: Eighteen patients with CI or ABI collectively underwent a total of 62 MRI scans. Five of 15 (33%) CI patients with magnet had complications: five total of 24 MRI scans (21%). Two patients had magnet removal prior to 29 MRI scans without complications. Four of five MRI-related complications were equipped with a U.S. Food and Drug Administration-approved head wrap. Three of five required a trip to the operating room to explore and reposition the CI magnet; two could not complete MRI secondary to pain. Of the complications, two were Cochlear (Sydney, Australia), two Advanced Bionics (Valencia, CA), and one MED-EL (Innsbruck, Austria). Synchrony model (MED-EL) had 0 of seven complications, with a total of 19 MRI scans, which features a freely rotating and self-aligning magnet. CONCLUSION: Our series offers a diverse number of CI manufacturers and is in accordance with other literature that CI MRI-related adverse events are occurring at an unacceptable frequency. We can promote CI MRI safety through our institutions' MRI CI patient protocols, raise awareness that diagnostic MRI benefits must outweigh CI-related complications, and advocate for continued industry technological innovation. LEVEL OF EVIDENCE: 4 Laryngoscope, 129:482-489, 2019.


Assuntos
Implantes Auditivos de Tronco Encefálico/efeitos adversos , Implantes Cocleares/efeitos adversos , Segurança de Equipamentos/estatística & dados numéricos , Imagem por Ressonância Magnética/efeitos adversos , Imãs/efeitos adversos , Adulto , Idoso , Pré-Escolar , Feminino , Humanos , Imagem por Ressonância Magnética/instrumentação , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
12.
Pediatr Emerg Care ; 35(8): e141-e144, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28463948

RESUMO

INTRODUCTION: Accidental ingestion of foreign bodies is an increasing problem in the pediatric population. Symptoms are often nonspecific and may lead to a missed diagnosis because the ingestion event often goes unwitnessed. CASE: We present a case of a missed diagnosis of a multiple magnet ingestion event in a pediatric patient leading to operative management. A 2-year-old boy with a 4-week history of nonspecific abdominal pain presented to the emergency department (ED) with vomiting and worsening abdominal pain. He was recently seen in the ED for nonspecific abdominal pain diagnosed as acute otitis media. In this second ED visit, the child was found to be febrile and tachycardic and had signs of peritonitis. Radiographs revealed a foreign body in the right lower quadrant. The child was taken to the operating room where multiple intestinal perforations were identified and repaired. The child had an uneventful postoperative course and was discharged 7 days later. DISCUSSION: There are increasing awareness and growing concern over complications from pediatric magnet ingestion. Complications from neodymium magnet ingestion may include bowel obstruction, perforation, and fistula formation. The risk of complications is especially high with multiple-magnet ingestion. Pediatric foreign-body magnet ingestion may be a diagnostic challenge because the associated symptoms are nonspecific, and the ingestion is often unwitnessed. CONCLUSIONS: Our case represents the missed diagnosis of 4 magnets ingested separately over time. Emergency department providers may benefit from a clinical algorithm guiding the management of these increasingly prevalent patient presentations to prevent delayed diagnoses and to decrease morbidity.


Assuntos
Ingestão de Alimentos/fisiologia , Corpos Estranhos/diagnóstico por imagem , Peritonite/diagnóstico por imagem , Dor Abdominal/etiologia , Algoritmos , Pré-Escolar , Serviço Hospitalar de Emergência , Humanos , Perfuração Intestinal/complicações , Perfuração Intestinal/diagnóstico , Perfuração Intestinal/cirurgia , Imãs/efeitos adversos , Masculino , Peritonite/etiologia , Radiografia , Resultado do Tratamento , Vômito/etiologia
13.
J Laparoendosc Adv Surg Tech A ; 29(2): 198-202, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30556776

RESUMO

INTRODUCTION: Laparoscopic magnetic sphincter augmentation (MSA) has been shown to be efficacious therapy for gastroesophageal reflux disease (GERD) refractory to maximal medical management. Herein, we present our experience with this procedure and an analysis of our outcomes. MATERIALS AND METHODS: Medical records were retrospectively reviewed of 98 patients who underwent laparoscopic MSA for GERD at a single institution from 2012 to 2016. Symptoms were assessed with gastroesophageal reflux disease-health-related quality of life (GERD-HRQL) questionnaire. Objective testing included pH testing, manometry, endoscopy, and upper GI series. Postimplantation interventions were recorded. Median follow-up was 46 months. RESULTS: Median preoperative DeMeester score was 32 (interquartile range 21-46). Esophagitis was present in 18%. Hiatal hernia was present in 59%. Operation required full hiatal dissection in 16%. There were no intraoperative complications. Mean hospital stay postimplantation was 18 hours. Reoperative intervention with device explant was necessary in 5 cases, one of which was for intraluminal device erosion. Median GERD-HRQL scores were 25 preoperatively, 8 in short-term follow-up at median 1 month, and 5 in long-term follow-up at median 46 months. Improvement in GERD-HRQL scores was statistically significant with both short and long term compared with preoperative (P < .05), but no different between short- and long-term follow-up. Daily bothersome dysphagia was present in 19 patients preoperatively and in 9 at long-term follow-up. CONCLUSIONS: Laparoscopic MSA is associated with excellent outcomes with decrease in GERD-HRQL scores in short term that are durable to longer term follow-up, and with low rates of new-onset dysphagia.


Assuntos
Esfíncter Esofágico Inferior/cirurgia , Refluxo Gastroesofágico/cirurgia , Laparoscopia , Imãs , Adulto , Idoso , Transtornos de Deglutição/etiologia , Remoção de Dispositivo , Esofagite/etiologia , Feminino , Refluxo Gastroesofágico/complicações , Hérnia Hiatal/complicações , Humanos , Tempo de Internação , Imãs/efeitos adversos , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Qualidade de Vida , Reoperação , Estudos Retrospectivos , Índice de Gravidade de Doença , Inquéritos e Questionários , Avaliação de Sintomas , Fatores de Tempo
14.
Curr Opin Pediatr ; 30(5): 653-659, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30188872

RESUMO

PURPOSE OF REVIEW: Pediatric foreign body ingestion is a common occurrence that presents a challenge both to pediatric gastroenterologists and primary care providers. Increasing prevalence of smaller, more technologically advanced toys in the household has resulted in an increased exposure to higher voltage batteries and powerful magnets that carry a high incidence of morbidity and mortality. This review highlights the latest findings regarding the patients at risk for button battery and magnet ingestions, the symptoms of presentation, and complications of these objects in contributing to long-standing gastrointestinal injury. RECENT FINDINGS: Button batteries may lead to esophageal injury within a few hours. Batteries retained in the esophagus are larger in diameter on average and size is associated with esophageal impaction as well as higher grade esophageal injury. Magnet ingestions, when multiple or with another metallic object, are often initially asymptomatic but may have acute worsening, and therefore warrant close monitoring. SUMMARY: Button battery and magnet ingestions have increased in incidence over the past two decades. Recent literature demonstrates that higher voltage, larger lithium button batteries, and prevalence of high-powered magnets can lead to significant morbidity. High suspicion, early referral, and removal may lead to improved outcomes.


Assuntos
Queimaduras Químicas/diagnóstico por imagem , Queimaduras Químicas/etiologia , Fontes de Energia Elétrica/efeitos adversos , Endoscopia do Sistema Digestório , Corpos Estranhos/diagnóstico por imagem , Imãs/efeitos adversos , Radiografia , Pré-Escolar , Ingestão de Alimentos , Esôfago/diagnóstico por imagem , Esôfago/lesões , Corpos Estranhos/complicações , Corpos Estranhos/cirurgia , Trato Gastrointestinal/diagnóstico por imagem , Trato Gastrointestinal/lesões , Humanos , Jogos e Brinquedos , Guias de Prática Clínica como Assunto
16.
J Gastrointest Surg ; 22(8): 1442-1447, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29667094

RESUMO

BACKGROUND: The magnetic sphincter augmentation device continues to become a more common antireflux surgical option with low complication rates. Erosion into the esophagus is an important complication to recognize and is reported to occur at very low incidences (0.1-0.15%). Characterization of this complication remains limited. We aim to describe the worldwide experience with erosion of the magnetic sphincter augmentation device including presentation, techniques for removal, and possible risk factors. MATERIALS AND METHODS: We reviewed data obtained from the device manufacturer Torax Medical, Inc., as well as the Manufacturer and User Facility Device Experience (MAUDE) database. The study period was from February 2007 through July 2017 and included all devices placed worldwide. RESULTS: In total, 9453 devices were placed and there were 29 reported cases of erosions. The median time to presentation of an erosion was 26 months with most occurring between 1 and 4 years after placement. The risk of erosion was 0.3% at 4 years after device implantation. Most patients experienced new-onset dysphagia prompting evaluation. Devices were successfully removed in all patients most commonly via an endoscopic removal of the eroded portion followed by a delayed laparoscopic removal of the remaining beads. At a median follow-up of 58 days post-removal, there were no complications and 24 patients have returned to baseline. Four patients reported ongoing mild dysphagia. CONCLUSIONS: Erosion of the LINX device is an important but rare complication to recognize that has been safely managed via minimally invasive approaches without long-term consequences.


Assuntos
Transtornos de Deglutição/etiologia , Esfíncter Esofágico Inferior/cirurgia , Refluxo Gastroesofágico/cirurgia , Imãs/efeitos adversos , Próteses e Implantes/efeitos adversos , Bases de Dados Factuais , Remoção de Dispositivo/métodos , Endoscopia Gastrointestinal , Humanos , Estudos Retrospectivos
17.
Bone Joint J ; 100-B(4): 507-515, 2018 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-29629587

RESUMO

Aims: The primary aim of this study was to evaluate the performance and safety of magnetically controlled growth rods in the treatment of early onset scoliosis. Secondary aims were to evaluate the clinical outcome, the rate of further surgery, the rate of complications, and the durability of correction. Patients and Methods: We undertook an observational prospective cohort study of children with early onset scoliosis, who were recruited over a one-year period and followed up for a minimum of two years. Magnetically controlled rods were introduced in a standardized manner with distractions performed three-monthly thereafter. Adverse events which were both related and unrelated to the device were recorded. Ten children, for whom relevant key data points (such as demographic information, growth parameters, Cobb angles, and functional outcomes) were available, were recruited and followed up over the period of the study. There were five boys and five girls. Their mean age was 6.2 years (2.5 to 10). Results: The mean coronal Cobb angle improved from 57.6° (40° to 81°) preoperatively, 32.8° (28° to 46°) postoperatively, and 41° (19° to 57°) at two years. Five children had an adverse event, with four requiring return to theatre, but none were related to the device. There were no neurological complications or infections. No devices failed. One child developed a proximal junctional kyphosis. The mean gain in spinal column height from T1 to S1 was 45.4 mm (24 to 81) over the period of the study. Conclusion: Magnetically controlled growth rods provide an alternative solution to traditional growing rods in the surgical management of children with early onset scoliosis, supporting growth of the spine while controlling curve progression. Their use has clear psychosocial and economic benefits, with the reduction of the need for repeat surgery as required with traditional growing rods. Cite this article: Bone Joint J 2018;100-B:507-15.


Assuntos
Imãs , Osteogênese por Distração/métodos , Escoliose/cirurgia , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Imãs/efeitos adversos , Masculino , Osteogênese por Distração/efeitos adversos , Osteogênese por Distração/instrumentação , Segurança do Paciente , Complicações Pós-Operatórias/epidemiologia , Estudos Prospectivos , Resultado do Tratamento
18.
J Otolaryngol Head Neck Surg ; 47(1): 11, 2018 Feb 05.
Artigo em Inglês | MEDLINE | ID: mdl-29402322

RESUMO

BACKGROUND: The probability that a patient will need an MRI scan at least once in a lifetime is high. However, MRI scanning in cochlear implantees is associated with side effects. Moreover, MRI scan-related artifacts, dislodging magnets, and pain are often the most frequent complications. The aim of this study was to evaluate the occurrence of pain in patients with cochlear implant systems using 1.5T MRI scans. METHODS: In a prospective case study of 10 implantees, an MRI scan was performed and the degree of pain was evaluated by a visual analog scale. Scans were performed firstly with and depending on the degree of discomfort/pain, without a headband. Four of the cochlear implants contained a screw fixation. Six cochlear implants contained an internal diametrically bipolar magnet. MRI observations were performed with a 1.5 T scanner. RESULTS: MRI scans were performed on all patients without causing any degree of pain, even without the use of a headband. CONCLUSION: Patients undergoing 1.5 T MRIs with devices including a diametrically bipolar magnet or a rigid implant screw fixation, experienced no pain, even without headbands.


Assuntos
Implante Coclear/instrumentação , Implantes Cocleares , Imagem por Ressonância Magnética/efeitos adversos , Imãs/efeitos adversos , Dor/etiologia , Adulto , Idoso , Parafusos Ósseos , Implante Coclear/métodos , Feminino , Humanos , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Dor/epidemiologia , Dor/fisiopatologia , Medição da Dor , Estudos Prospectivos , Medição de Risco
19.
J Pediatr Gastroenterol Nutr ; 66(5): e116-e121, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29135818

RESUMO

BACKGROUND AND OBJECTIVES: Ingestion of rare earth magnets is a serious ongoing hazard for pediatric patients. Our study aims to investigate whether 2012 Consumer Product Safety Commission (CPSC) policy action, in coordination with efforts from consumer and physician advocacy groups, decreased the incidence of magnet ingestions in children in the United States since 2012. METHODS: Data from the National Electronic Injury Surveillance System (NEISS) was used to evaluate trends in emergency department (ED) encounters with pediatric patients (<18 years) who presented with suspected magnet ingestions (SMI) from 2010 to 2015. National estimates of SMI were made using the NEISS-supplied weights and variance variables. RESULTS: An estimated 14,586 children (59% male, 50% age <5 years) presented to the ED for SMI from 2010 to 2015. A significant upward trend in magnet-related ED visits preceded the CPSC action, with the peak ingestions of 3167 (95% confidence interval, 1612-4723) recorded in 2012. This was followed by a steady decrease in the rate of SMI to 1907 (95% confidence interval, 1062-2752) in 2015, an average annual decrease of 13.3%. Most importantly, post-federal action estimates demonstrated a downward trend in overall SMI ED visits (P = 0.03). CONCLUSIONS: The frequency of magnet ingestions continued to rise from 2010 and then peak in 2012, followed by a decline in magnet ingestion ED visits during the post-federal action years. This down trend emphasizes the importance of advocacy on decreasing magnet ingestions in children. Further study will be required to determine the impact of the court decision to lift the magnet ban in 2016.


Assuntos
Serviço Hospitalar de Emergência/tendências , Corpos Estranhos/epidemiologia , Trato Gastrointestinal/lesões , Imãs/efeitos adversos , Adolescente , Criança , Pré-Escolar , Qualidade de Produtos para o Consumidor , Bases de Dados Factuais , Ingestão de Alimentos , Feminino , Humanos , Incidência , Lactente , Masculino , Estados Unidos/epidemiologia
20.
J Pediatr Surg ; 53(9): 1815-1819, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28899548

RESUMO

PURPOSE: To review the outcomes of magnet ingestions from two children's hospitals and develop a clinical management pathway. METHODS: Children <18years old who ingested a magnet were reviewed from 1/2011 to 6/2016 from two tertiary center children's hospitals. Demographics, symptoms, management and outcomes were analyzed. RESULTS: From 2011 to 2016, there were 89 magnet ingestions (50 from hospital 1 and 39 from hospital 2); 50 (56%) were males. Median age was 7.9 (4.0-12.0) years; 60 (67%) presented with multiple magnets or a magnet and a second metallic co-ingestion. Suspected locations found on imaging were: stomach (53%), small bowel (38%), colon (23%) and esophagus (3%). Only 35 patients (39%) presented with symptoms and the most common symptom was abdominal pain (33%). 42 (47%) patients underwent an intervention, in which 20 (23%) had an abdominal operation. For those undergoing abdominal surgery, an exact logistic regression model identified multiple magnets or a magnet and a second metallic object co-ingestion (OR 12.9; 95% CI, 2.4 - Infinity) and abdominal pain (OR 13.0; 95% CI, 3.2-67.8) as independent risk factors. CONCLUSION: Magnets have a high risk of requiring surgical intervention for removal. Therefore, we developed a management algorithm for magnet ingestion. LEVEL OF EVIDENCE: Level III.


Assuntos
Corpos Estranhos/cirurgia , Gastroenteropatias/etiologia , Gastroenteropatias/cirurgia , Imãs/efeitos adversos , Criança , Pré-Escolar , Ingestão de Alimentos , Endoscopia Gastrointestinal , Feminino , Corpos Estranhos/diagnóstico por imagem , Hospitais Pediátricos , Humanos , Masculino , Peritonite/etiologia , Peritonite/cirurgia , Estudos Retrospectivos
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