A blacksmith's tale: use of a rare earth magnet to facilitate safe removal of a metallic fragment from the face.

A 48-year-old blacksmith presented to A&E after sustaining facial injuries while operating a metal punch press. Radiographs revealed the presence of a metallic foreign body within the cheek, but this was clinically impalpable. By using a neodymium rare earth magnet extraorally, it was possible to identify the position of the fragment several centimetres lateral to the entry wound. Triangulation of the fragment's position allowed retrieval under local anaesthetic through the original penetration wound, without need for cross sectional imaging or extensive exploration under general anaesthetic. This case highlights an application for magnets in detection and removal of impalpable metallic foreign bodies embedded in superficial soft tissues.

Autoantibody profile in thyroid diseases in black Kenyans.

A controlled prospective study of autoantibody profile on black Kenyan patients with non-toxic goitre (116), thyrotoxicosis (131) and age, sex matched hospital controls is reported. The prevalence of thyroid microsomal and thyroglobulin antibodies is 3.5% in smooth non-toxic goitre and is 5.2% in the nodular non-toxic goitre compared to 1% of the control. The results reflect that autoimmune thyroiditis is less common in Kenyan hospital controls and smooth simple goitre which is even more pronounced in case of multinodular simple goitre as compared to the Caucasians. The prevalence of microsomal antibody of 54% and the occurrence of high titres in 19% of the toxic group is relatively similar in Caucasians and black Kenyans. However, thyroglobulin antibody and parietal cell antibody are far less frequent in the Kenyan toxic group as compared to Caucasians. In conclusion, the black Kenyan toxic cases are reluctant to produce thyroglobulin and parietal cell antibodies while microsomal antibody production is unaffected. The latter is thought to be more significant in the development and progression of autoimmune thyroiditis. The dissociated behaviour of the two thyroid specific antibodies and thyrogastric axis in black Kenyans strongly suggest that the immunogenetic control of these and the related diseases is different in them as compared to the Caucasians.

Measurement of red cell volume and splenic red cell pool using 113m indium.

Using the lipophilic chelating agent, acetylacetone, red cells have been radiolabelled with the short-lived, generator-produced isotope, 113mIn. Following re-injection of these labelled cells, red cell volume has been measured and compared with corresponding values using 99mTc labelled red cells in 18 patients, and with 51Cr labelled red cells in five patients. 99mTc slightly overestimated red cell volume in relation to 113mIn, but 51Cr values were identical to 113mIn values. There was a close correlation between splenic red cell pool measured with 99mTc and with 113In. It was concluded that the intracellular stability and gamma emission of 113mIn make this isotope a superior alternative to 99mTc and 51Cr in measurements of red cell volume and splenic red cell pool.