Elevation of Blood Lead Levels in Emergency Department Patients with Extra-articular Retained Missiles

Nguyen, Ann M.; Schaider, Jeffrey; Manzanares, M a Cristina; Hanaki, Roy; Rydman, Robert J.; Bokhari, Faran

doi:10.1097/01.ta.0000119205.24520.1d

Cited by 31 publications

(28 citation statements)

References 45 publications

(107 reference statements)

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“…[11] However, recent, well-designed studies have reported elevated blood lead levels in patients with retained lead pellets compared to matched controls. [12][13][14][15] Bullet fragmentation, multiple bullets, bone fracture, lodgment of bullet near bone or joint, and increased patient age are significant factors associated with high lead levels. [15] Most symptoms of lead toxicity (plumbism) are nonspecific, and diagnosis is missed or delayed in many instances.…”

Section: Dolar Bilge Et Al Intraorbital Foreign Bodiesmentioning

confidence: 99%

Intraorbital Foreign Bodies: Clinical Features and Outcomes of Surgical Removal

Bilge

Yılmaz

Yazıcı

et al. 2016

Ulus Travma Acil Cerrahi Derg

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Section: Dolar Bilge Et Al Intraorbital Foreign Bodiesmentioning

confidence: 99%

Intraorbital Foreign Bodies: Clinical Features and Outcomes of Surgical Removal

Bilge

Yılmaz

Yazıcı

et al. 2016

Ulus Travma Acil Cerrahi Derg

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“…Regarding these findings, we can infer that it is not right to conclude that there was lead exposure by assessing only blood Pb concentration, and the kidney should be considered as a critical organ for the subjects with retained buckshot residues. Nguyen et al also revealed that in 96% of patients with extra-articular retained missiles, elevated blood lead levels were not clinically significant and did not change patient management [12].…”

Section: Discussionmentioning

confidence: 99%

“…But the management of this problem remains disputable. Some authors argued that these fragments should be taken from the body [8][9][10] whereas the others believe that they are not exactly dangerous in the body owing to surrounding of these fragments [11,12]. In previous studies, the mobilization of lead from the gunshot fragments to the blood in humans and experimental animals has been shown [1,13,14].…”

Section: Introductionmentioning

confidence: 99%

Investigation of Lead Mobilization from the Buckshot Residues to the Critical Organs

Çelbiş

Karakoç

Özdemir

et al. 2010

Biol Trace Elem Res

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Lead exposure causes neurotoxicity, reproductive system dysfunction, renal failure, and blood and endocrine system disorders in human and experimental animals. In this study, we investigated lead mobilization from gunshot fragments to the critical organs (brain, heart, liver, and kidney) and its interaction with essential trace elements on experimental rat model. Thirty-five rats were randomly divided in five groups. The first group was a control and the others were subjected to buckshot implantation in their skeletal muscles (second and third groups) and abdomen (fourth and fifth groups). The control group and the second and fourth groups were sacrificed 1 month after the onset of experiment while the third and fifth groups were followed after 2 months. Blood lead levels were significantly elevated in both 2 month-followed groups and 1 month-followed intraabdominal group. There were significant increases in brain lead levels of both 2 month-followed groups. For the 1 month-followed groups, kidney lead levels were also significantly higher than those of controls. Results show that lead mobilizes from the buckshot residues in distance tissues to the critical organs and interacts with iron, copper, and zinc even though blood lead level sometimes remains unchanged. Our findings are crucial in revealing lead accumulation in critical organs of subjects carrying any gunshot fragments. These subjects and physicians should be in alert for emergence of lead-induced manifestations.

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“…Some studies have noted an increase in serum levels of lead in patients with extra-articular lesions, yet few cases of symptomatic clinical intoxication 3 4. Sanders et al ,5 in a literary review, stated that the neurological and genetic toxicity mechanisms of lead can penetrate practically all bodily tissue.…”

Section: Discussionmentioning

confidence: 99%

Lead intoxication and knee osteoarthritis after a gunshot: long-term follow-up case report

2013

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SUMMARYThis case is of a man who suffered gunshots and developed saturnism. Projectiles were removed from the abdomen, but one was left in the knee for 14 years. The patient presented with weight loss, headaches, loss of sight, tiredness, cramps, painful joints and trembling. We identified ataxic movements such as intense trembling of the limbs and anaemia. The abdominal pain caused eight internments in different hospitals, and the patient always received the diagnosis of intestinal subocclusion. We removed the bullet and did a wide synovectomy. The patient did not receive a clinical treatment with chelates. The symptoms of lead poisoning ceased, but he developed knee osteoarthritis, during the 7 years of follow-up.

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Elevation of Blood Lead Levels in Emergency Department Patients with Extra-articular Retained Missiles

Cited by 31 publications

References 45 publications

Intraorbital Foreign Bodies: Clinical Features and Outcomes of Surgical Removal

Intraorbital Foreign Bodies: Clinical Features and Outcomes of Surgical Removal

Investigation of Lead Mobilization from the Buckshot Residues to the Critical Organs

Lead intoxication and knee osteoarthritis after a gunshot: long-term follow-up case report

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