Lead poisoning due to gunshot bullet in contact with cerebrospinal fluid: case report

Detalhes bibliográficos
Autor(a) principal: Madureira,Paulo Roberto de
Data de Publicação: 2009
Outros Autores: De Capitani,Eduardo Mello, Vieira,Ronan José, Sakuma,Alice Momoyo, Toledo,Adriana Safioti, Mello,Suely Moreira
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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spelling 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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