Lead poisoning due to gunshot bullet in contact with cerebrospinal fluid: case report
Autor(a) principal: | |
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Data de Publicação: | 2009 |
Outros Autores: | , , , , |
Tipo de documento: | Artigo |
Idioma: | eng |
Título da fonte: | São Paulo medical journal (Online) |
Texto Completo: | http://old.scielo.br/scielo.php?script=sci_arttext&pid=S1516-31802009000100011 |
Resumo: | CONTEXT: Lead poisoning due to retained gunshot bullets is a well-known clinical problem that is fairly frequently described in the literature. The risk factors for this occurrence relate mainly to whether the lead bullet is in contact with the joint fluid or cerebrospinal fluid (CSF). The treatment for these cases entails chelation therapy while symptoms are shown and definitive surgical removal of the bullet as a potential source of lead. The aim of this paper is to describe a clinical case of lead poisoning due to a retained gunshot bullet in contact with CSF. CASE REPORT: A 42-year-old male was hit by gunshot bullets during a holdup, and one of them was retained in the spinal cord. Six years later, he developed intense low back pain and underwent laminectomy. Nine years later, he then underwent arthrodesis on L5-S1, but he developed intense abdominal pain after the surgical procedure. For five years, he was treated with calcium versenate in five-day cycles, with a good response. The chelation therapy cycles showed great efficacy during symptomatic periods, thus reducing the symptoms and signs of poisoning and promoting great amounts of lead excretion, thereby reducing the total lead burden responsible for the symptoms. Fortunately, over the last four years, the symptoms have improved and the urine levels of aminolevulinic acid (ALA) have declined, to reach complete normalization. This shows that a healing process is probably taking place on the spinal wound, thereby isolating the bullet fragments from CSF contact. |
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Lead poisoning due to gunshot bullet in contact with cerebrospinal fluid: case reportLead poisoningWounds, gunshotCerebrospinal fluidChelation therapyAminolevulinic acidCONTEXT: Lead poisoning due to retained gunshot bullets is a well-known clinical problem that is fairly frequently described in the literature. The risk factors for this occurrence relate mainly to whether the lead bullet is in contact with the joint fluid or cerebrospinal fluid (CSF). The treatment for these cases entails chelation therapy while symptoms are shown and definitive surgical removal of the bullet as a potential source of lead. The aim of this paper is to describe a clinical case of lead poisoning due to a retained gunshot bullet in contact with CSF. CASE REPORT: A 42-year-old male was hit by gunshot bullets during a holdup, and one of them was retained in the spinal cord. Six years later, he developed intense low back pain and underwent laminectomy. Nine years later, he then underwent arthrodesis on L5-S1, but he developed intense abdominal pain after the surgical procedure. For five years, he was treated with calcium versenate in five-day cycles, with a good response. The chelation therapy cycles showed great efficacy during symptomatic periods, thus reducing the symptoms and signs of poisoning and promoting great amounts of lead excretion, thereby reducing the total lead burden responsible for the symptoms. Fortunately, over the last four years, the symptoms have improved and the urine levels of aminolevulinic acid (ALA) have declined, to reach complete normalization. This shows that a healing process is probably taking place on the spinal wound, thereby isolating the bullet fragments from CSF contact.Associação Paulista de Medicina - APM2009-01-01info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersiontext/htmlhttp://old.scielo.br/scielo.php?script=sci_arttext&pid=S1516-31802009000100011Sao Paulo Medical Journal v.127 n.1 2009reponame:São Paulo medical journal (Online)instname:Associação Paulista de Medicinainstacron:APM10.1590/S1516-31802009000100011info:eu-repo/semantics/openAccessMadureira,Paulo Roberto deDe Capitani,Eduardo MelloVieira,Ronan JoséSakuma,Alice MomoyoToledo,Adriana SafiotiMello,Suely Moreiraeng2009-05-11T00:00:00Zoai:scielo:S1516-31802009000100011Revistahttp://www.scielo.br/spmjhttps://old.scielo.br/oai/scielo-oai.phprevistas@apm.org.br1806-94601516-3180opendoar:2009-05-11T00:00São Paulo medical journal (Online) - Associação Paulista de Medicinafalse |
dc.title.none.fl_str_mv |
Lead poisoning due to gunshot bullet in contact with cerebrospinal fluid: case report |
title |
Lead poisoning due to gunshot bullet in contact with cerebrospinal fluid: case report |
spellingShingle |
Lead poisoning due to gunshot bullet in contact with cerebrospinal fluid: case report Madureira,Paulo Roberto de Lead poisoning Wounds, gunshot Cerebrospinal fluid Chelation therapy Aminolevulinic acid |
title_short |
Lead poisoning due to gunshot bullet in contact with cerebrospinal fluid: case report |
title_full |
Lead poisoning due to gunshot bullet in contact with cerebrospinal fluid: case report |
title_fullStr |
Lead poisoning due to gunshot bullet in contact with cerebrospinal fluid: case report |
title_full_unstemmed |
Lead poisoning due to gunshot bullet in contact with cerebrospinal fluid: case report |
title_sort |
Lead poisoning due to gunshot bullet in contact with cerebrospinal fluid: case report |
author |
Madureira,Paulo Roberto de |
author_facet |
Madureira,Paulo Roberto de De Capitani,Eduardo Mello Vieira,Ronan José Sakuma,Alice Momoyo Toledo,Adriana Safioti Mello,Suely Moreira |
author_role |
author |
author2 |
De Capitani,Eduardo Mello Vieira,Ronan José Sakuma,Alice Momoyo Toledo,Adriana Safioti Mello,Suely Moreira |
author2_role |
author author author author author |
dc.contributor.author.fl_str_mv |
Madureira,Paulo Roberto de De Capitani,Eduardo Mello Vieira,Ronan José Sakuma,Alice Momoyo Toledo,Adriana Safioti Mello,Suely Moreira |
dc.subject.por.fl_str_mv |
Lead poisoning Wounds, gunshot Cerebrospinal fluid Chelation therapy Aminolevulinic acid |
topic |
Lead poisoning Wounds, gunshot Cerebrospinal fluid Chelation therapy Aminolevulinic acid |
description |
CONTEXT: Lead poisoning due to retained gunshot bullets is a well-known clinical problem that is fairly frequently described in the literature. The risk factors for this occurrence relate mainly to whether the lead bullet is in contact with the joint fluid or cerebrospinal fluid (CSF). The treatment for these cases entails chelation therapy while symptoms are shown and definitive surgical removal of the bullet as a potential source of lead. The aim of this paper is to describe a clinical case of lead poisoning due to a retained gunshot bullet in contact with CSF. CASE REPORT: A 42-year-old male was hit by gunshot bullets during a holdup, and one of them was retained in the spinal cord. Six years later, he developed intense low back pain and underwent laminectomy. Nine years later, he then underwent arthrodesis on L5-S1, but he developed intense abdominal pain after the surgical procedure. For five years, he was treated with calcium versenate in five-day cycles, with a good response. The chelation therapy cycles showed great efficacy during symptomatic periods, thus reducing the symptoms and signs of poisoning and promoting great amounts of lead excretion, thereby reducing the total lead burden responsible for the symptoms. Fortunately, over the last four years, the symptoms have improved and the urine levels of aminolevulinic acid (ALA) have declined, to reach complete normalization. This shows that a healing process is probably taking place on the spinal wound, thereby isolating the bullet fragments from CSF contact. |
publishDate |
2009 |
dc.date.none.fl_str_mv |
2009-01-01 |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
http://old.scielo.br/scielo.php?script=sci_arttext&pid=S1516-31802009000100011 |
url |
http://old.scielo.br/scielo.php?script=sci_arttext&pid=S1516-31802009000100011 |
dc.language.iso.fl_str_mv |
eng |
language |
eng |
dc.relation.none.fl_str_mv |
10.1590/S1516-31802009000100011 |
dc.rights.driver.fl_str_mv |
info:eu-repo/semantics/openAccess |
eu_rights_str_mv |
openAccess |
dc.format.none.fl_str_mv |
text/html |
dc.publisher.none.fl_str_mv |
Associação Paulista de Medicina - APM |
publisher.none.fl_str_mv |
Associação Paulista de Medicina - APM |
dc.source.none.fl_str_mv |
Sao Paulo Medical Journal v.127 n.1 2009 reponame:São Paulo medical journal (Online) instname:Associação Paulista de Medicina instacron:APM |
instname_str |
Associação Paulista de Medicina |
instacron_str |
APM |
institution |
APM |
reponame_str |
São Paulo medical journal (Online) |
collection |
São Paulo medical journal (Online) |
repository.name.fl_str_mv |
São Paulo medical journal (Online) - Associação Paulista de Medicina |
repository.mail.fl_str_mv |
revistas@apm.org.br |
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1754209262486159360 |