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Zinc protoporphyrin (ZPP) measurement is a required test under the Occupational Safety and Health Administration's lead standard. However, there is no mention of the influence of hemoglobinopathy on the ZPP test value. We undertook a retrospective laboratory review of 382 employees at the Argonne National Laboratory who had been subjects in a lead surveillance program since 1982. A total of 321 samples were analyzed, after female subjects and samples with abnormally high bilirubin levels were excluded. A group with low mean red blood cell volume (MCV; less than 80.0 fL) was compared with a group with normal MCV (greater or equal to 80.0 fL). A statistically significant difference was noted in ZPP (P < 0.007) and total bilirubin (P < 0.0003) values of two groups. There was no statistically significant difference noted in age, lead levels, or iron levels between the two groups. Abnormally high ZPP levels may occur in individuals with hemoglobinopathies. Only a minor part of this elevation could be explained by the higher bilirubin levels.

Disclosures: F. Chiou-Tan, Elsevier, Receipt of royalties Objective: Spasticity can cause torsion of the upper limb after injury to the brain from stroke or trauma. This may be treated with botulinum toxin, phenol, or alcohol injections. Existing anatomic references do not provide the location of muscle targets in this hemispastic position. This article reviews the anatomy of the proximal arm in the position of upper extremity hemispastic flexion synergy and its relationship to procedures in the clinical setting. Objective: To provide anatomically accurate schematics of proximal arm anatomy in the position of hemispastic flexion synergy relevant to needle procedures. Design: Musculoskeletal ultrasound images were obtained in a healthy subject in anatomic neutral and hemispastic position. Anatomic illustrations were derived from these images. Setting: Academic PMR Department. Participants: Healthy human subjects. Interventions: Musculoskeletal ultrasound images of the arm in the position of hemispastic flexion synergy as compared to anatomic neutral. Main Outcome Measures: not applicable Results or Clinical Course: Cross sectional schematics for the arm were drawn as they appear in imaging projections. The level of cross section was selected to highlight important anatomic landmarks for injection. Color coding was used to emphasize needle procedure targets (blue) and structures to be avoided (red). Change in position of key muscles commonly injected for upper extremity spasticity are illustrated. Conclusions: It is hoped the schematics created in this paper allow for safer and more accurate needle procedures in the arm for the treatment of spasticity.

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