Lead Absorption From Bullets Lodged in Tissues

Machle, Willard

doi:10.1001/jama.1940.02810440028006

Cited by 41 publications

(8 citation statements)

References 5 publications

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“…In addition to the sustained U release into systemic circulation that we have observed in the DU exposed cohort, [McDiarmid et al, 2000[McDiarmid et al, , 2001[McDiarmid et al, , 2004[McDiarmid et al, , 2007[McDiarmid et al, , 2009[McDiarmid et al, , 2011[McDiarmid et al, , 2013, the recent reports of elevated cobalt and chromium levels in the circulation of hip implant patients [Machle, 1940;Dillman et al, 1979;Sunderman et al, 1989;Jacobs et al, 1998; International Agency for Research on Cancer (IARC), 1999; Keegan et al, 2007] suggest that other metals in embedded materials may also mobilize from in situ tissue depots. Such concern has driven the Department of Veterans Affairs to conduct bio-monitoring on patients who have suffered injuries from improvised explosive devices (IED) during the recent Iraq and Afghanistan conflicts.…”

Section: Surveillance For Other Metals In Fragment Alloysmentioning

confidence: 79%

Biologic monitoring and surveillance results for the department of veterans affairs' depleted uranium cohort: Lessons learned from sustained exposure over two decades

McDiarmid

Gaitens

Hines

et al. 2015

American J Industrial Med

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Section: Surveillance For Other Metals In Fragment Alloysmentioning

confidence: 79%

Biologic monitoring and surveillance results for the department of veterans affairs' depleted uranium cohort: Lessons learned from sustained exposure over two decades

McDiarmid

Gaitens

Hines

et al. 2015

American J Industrial Med

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“…Observation of U release into the systemic circulation and other evidence, including the recent spate of reports of medical device implant patients with elevated blood cobalt and chromium levels, suggests that other metals in embedded materials may also mobilize from in situ tissue depots in this DU cohort (IARC 1999;Keegan et al 2007;Machle 1940;Dillman et al 1979;Sunderman et al 1989;Jacobs et al 1998). Because the DU penetrator was not solely composed of DU but was alloyed with titanium (Parkhurst et al 2005), and due to raised concern regarding retained fragments from improvised explosive device (IED) injuries occurring in the recent Iraq and Afghanistan conflicts, the biomonitoring battery has been enlarged to include a suite of 13 metals.…”

Section: Surveillance For Other Metals In Fragment Alloysmentioning

confidence: 99%

The Gulf War Depleted Uranium Cohort at 20 years

McDiarmid¹,

Gaitens²,

Hines³

et al. 2013

Health Physics

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During the 1991 GulfWar, U.S. service members were exposed to depleted uranium (DU) through friendly-fire incidents involving DU munitions and vehicles protected by DU armor. Routes of exposure to DU involved inhalation of soluble and insoluble DU oxide particles, wound contamination, and retained embedded DU metal fragments that continue to oxidize in situ and release DU to the systemic circulation. A biennial health surveillance program established for this group of Veterans by the U.S. Department of Veterans Affairs has shown continuously elevated urine DU concentrations in the subset of veterans with embedded fragments for over 20 years. While the 2011 assessment was comprehensive, few clinically significant U-related health effects were observed. This report is focused on health outcomes associated with two primary target organs of concern for long term effects of this combat-related exposure to DU. Renal biomarkers showed minimal DU-related effects on proximal tubule function and cytotoxicity, but significant biomarker results were observed when urine concentrations of multiple metals also found in fragments were examined together. Pulmonary tests and questionnaire results indicate that pulmonary function after 20 y remains within the clinical normal range. Imaging of DU embedded fragment-associated tissue for signs of inflammatory or proliferative reactions possibly associated with foreign body transformation or with local alpha emissions from DU was also conducted using PET-CT and ultrasound. These imaging tools may be helpful in guiding decisions regarding removal of fragments.

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“…13 Although inhalation and ingestion constitute the majority of lead exposures, implantation is a not uncommon source of lead toxicity. A computerized search of MEDLINE and a manual search of references found in review articles 6,9,12,21,23 revealed 88 publications that describe symptomatic lead poisoning from retained missiles. Most of these publications are case reports, with the earliest dating from 1867 23 and the most recent from 2001.…”

Section: Elevation Of Blood Lead Levels In Ed Patientsmentioning

confidence: 99%

“…In the English language literature, five authors have written reviews of case reports, comparing patients' presentations, the location and duration of missile retention and, where possible, blood lead concentrations. 6,9,12,21,23 Unfortunately, missile location was not documented with uniform precision from case report to case report. The review articles are summarized in Table 3, with the number of EARM cases extrapolated from the authors' descriptions.…”

Section: Elevation Of Blood Lead Levels In Ed Patientsmentioning

confidence: 99%