Blood lead concentration after a shotgun accident.

In an accidental shooting, a man in his late forties was hit in his left shoulder region by about 60 lead pellets from a shotgun. He had injuries to the vessels, the clavicle, muscles, and nerves, with total paralysis of the left arm due to axonal injury. After several surgical revisions and temporary cover with split skin, reconstructive surgery was carried out 54 days after the accident. The brachial plexus was swollen, but the continuity of the nerve trunks was not broken (no neuroma present). We determined the blood lead (BPb) concentration during a follow-up period of 12 months. The BPb concentration increased considerably during the first months. Although 30 lead pellets were removed during the reconstructive surgery, the BPb concentration continued to rise, and reached a peak of 62 microg/dL (3.0 micromol/L) on day 81. Thereafter it started to decline. Twelve months after the accident, BPb had leveled off at about 30 microg/dL. At that time, muscle and sensory functions had partially recovered. The BPb concentration exceeded 30 microg/dL for 9 months, which may have influenced the recovery rate of nerve function. Subjects with a large number of lead pellets or fragments embedded in the body after shooting accidents should be followed for many years by regular determinations of BPb. To obtain a more stable basis for risk assessment, the BPb concentrations should be corrected for variations in the subject's hemoglobin concentration or erythrocyte volume fraction

Copper allergy from dental copper amalgam?

A 65-year-old female was investigated due to a gradually increasing greenish colour change of her plastic dental splint, which she used to prevent teeth grinding when sleeping. Furthermore, she had noted a greenish/bluish colour change on the back of her black gloves, which she used to wipe her tears away while walking outdoors. The investigation revealed that the patient had a contact allergy to copper, which is very rare. She had, however, had no occupational exposure to copper. The contact allergy may be caused by long-term exposure of the oral mucosa to copper from copper-rich amalgam fillings, which were frequently used in childhood dentistry up to the 1960s in Sweden. The deposition of a copper-containing coating on the dental splint may be caused by a raised copper intake from drinking water, increasing the copper excretion in saliva, in combination with release of copper due to electrochemical corrosion of dental amalgam. The greenish colour change of the surface of the splint is probably caused by deposition of a mixture of copper compounds, e.g. copper carbonates. Analysis by the X-ray diffraction technique indicates that the dominant component is copper oxide (Cu2O and CuO). The corresponding greenish/bluish discoloration observed on the back of the patient's gloves may be caused by increased copper excretion in tears

A neurobehavioural study of long-term occupational inorganic lead exposure

A group of 38 male workers at a secondary smelter (period of employment 2-35 years; median 10 years) was divided into two subgroups depending on bone-lead concentration, arranged as 19 matched pairs according to age, education and job level. The median concentrations for finger-bone lead (Bone-Pb) were 16 vs. 32 μg/g; for current blood-lead (B-Pb), 1.6 vs. 1.8 μmol/l; for retrospective peak blood-lead (Peak-Pb), 2.7 vs. 3.0 μmol/l; and for a retrospective cumulative blood lead index (CBLI), 143 vs. 233 μmol/l x months. Nineteen unexposed male workers from a nearby mechanical plant served as controls, using the same matching algorithm. The triplets were examined with a standardised neuropsychological test battery, and four questionnaires for self-rating of symptoms and activity/stress level related to work environment. No sign of behavioural deterioration was observed in the exposed groups, either in objective cognitive tests or in subjective symptom/mood self-rating scales. Despite the limited sample size, the statistical power was sufficient to conclude that a concealed lead-associated effect was unlikely. Covariations between behavioural measures and lead exposure indices were generally low and non-significant, as a whole not exceeding a random level. No confounding or effect-modifying factor was detected that could explain the results as a type II error. To conclude, a current B-Pb of 1.8 μmol/l was not associated with adverse behavioural effects, and a long-term lead exposure around 2.0 μmol/l for 13 years (mean values) was not associated with permanent brain dysfunction

Cadmium exposure in pregnancy and lactation in relation to iron status

Objectives. The purpose of this study was to determine the impact of iron status on cadmium dose among pregnant women. Methods. Iron status and cadmium concentration in blood, urine, and placenta were determined among women followed for 2 years from early pregnancy. Results. Blood cadmium and urinary cadmium were correlated with iron status throughout the study period. Urinary cadmium increased longitudinally among women with exhausted iron stores during their pregnancy. The increase in urinary cadmium with age was more pronounced in multiparous than in nulliparous women. Conclusions. Iron deficiency during pregnancy leads to increased cadmium absorption and body burden. Multiparous women exhibit additional increases with increasing age

Studie av bakgrundshalter av metaller hos svenska ungdomar

Försurande luftföroreningar leder till försurning av mark och vatten. Detta leder till mobilisering av vissa metaller/element (medan andra fixeras starkare i marken). Via dricksvatten och föda kan dessa förskjutningar påverka människans exponering. Ett bra sätt att studera detta är att mäta retentionen genom biologisk monitorering, d.v.s. bestämning av element i biologiskt prov, t ex blod. Upprepade mätningar över tid kan ge en god uppfattning om utvecklingen av miljö- och exponeringssituationen i ett givet område och användas för att utvärdera effekter av insatta åtgärder. För att kunna göra jämförelser och följa utvecklingen är det viktigt att ha tillgång till bakgrundshalter av miljöföroreningar, vilket är en av målsättningarna med detta projekt. Vänersborg-Trollhättan utgör ett område som starkt förorenats med både försurande luftföroreningar samt metaller. 1993/94 togs blodprov på sammanlagt 372 st 15-åringar i Trollhättan och Uppsala. 1995/96 togs nya prover på 292 av ungdomarna, som då var 17 år gamla. Även en rad andra förhållanden registrerades, bl a andra blodvariabler, som återspeglar järnstatus. Tretton element bestämdes i helblod och plasma med induktivt kopplad plasma masspektrometri. Genom intervju och enkät inhämtades uppgifter om bl a livsstilsfaktorer. Utifrån sju dagars kostregistrering beräknades intag av olika näringsämnen. En stor mängd data angående halter av olika element i helblod och serum hos svenska ungdomar har genererats. Särskilt för rubidium (Rb) och bly (Pb), men också för zink (Zn) och kvicksilver (Hg) var halterna högre i helblod än i plasma. För kadmium (Cd) var medianhalten högre i serum än i helblod. För kobolt (Co), koppar (Cu), selen (Se) och tallium (Tl) var koncentrationerna i helblod och serum ungefär lika höga. Det fanns signifikanta samband mellan halterna i helblod och plasma för Co, Cu, Zn, Se, Rb, volfram (W), Hg och Pb, men inte för rhodium (Rd), palladium (Pd), Cd, platina (Pt) eller Tl. 1993/94 fanns en rad skillnader i elementhalter mellan orterna: Halten av Pb (19%), W (75%) och Rb (9%) var högre i både helblod och plasma hos ungdomar i Trollhättan än i Uppsala. Även för Co, Se, Rb och Pd var koncentrationen högre i antingen helblod eller plasma. För inget av det 13 elementen hade Uppsala-ungdomarna högre halter. Mellan 1993/94 och 1995/96 (ungdomar studerade båda åren) visade halterna av Cu, Se och Cd ökande trender i både helblod och plasma, medan W, Hg och Pb sjönk. Det är inte klart hur stor del av detta som är en tidstrend, respektive återspeglar ökande ålder. En rad andra förhållanden påverkade elementhalterna: Flickorna hade högre halter i helblod av Co och Cu än pojkarna, som hade högre halt av Rb och Pb. Halten av Se i serum var associerat med intaget av selen. Koncentrationerna av Hg i både helblod och serum var relaterade till intaget av fisk, såväl totalt (rS=0,32; P=0,0001), som insjö- och annan fisk, serumhalten också med antalet amalgamfyllningar. Cd i helblod var starkt korrelerat till rökning och till dåligt järnstatus, återspeglat i serumhalten av ferritin (rS=-0,17; P=0,002). Det fanns ett stort antal signifikanta associationer mellan halter av olika element i blod, och särskilt i serum, mycket långt över det slumpen skulle kunna förklara. Det är oklart om detta sammanhänger med kopplad exponering eller metabolism, t ex bindningar till proteiner eller interaktion. Mängder av ytterligare bearbetningar återstår i detta omfattande datamaterial

Gold concentration in blood in relation to the number of gold restorations and contact allergy to gold.

Previous studies have demonstrated an association between gold allergy and the presence of dental gold restorations. The aim of the present study was to investigate the relationship between the concentration of gold in blood (B-Au) and the number of tooth surfaces with gold alloys in subjects with and without contact allergy to gold. In 80 patients referred for patch testing because of eczematous disease, blood samples were taken and analyzed for B-Au using inductively coupled plasma mass spectrometry. The detection limit for the Au determination was 0.04 microg/L. In addition, a dentist made a clinical and radiological examination of the patients and registered the number of dental gold surfaces. Patients with dental gold restorations had a statistically significantly higher B-Au in Mann-Whitney U test (P = 0.025), (range < 0.04-1.07 microg/L) than patients without (range < 0.04-0.15 microg/L). Furthermore, a positive correlation was found between B-Au and the number of dental gold surfaces (P < 0.01). There was no statistically significant difference in B-Au between persons with and without contact allergy to gold. The study thus indicates that gold is released from dental restorations and taken tip into the circulation

Lead binding to delta-aminolevulinic acid dehydratase (ALAD) in human erythrocytes

Over 99% of the lead present in blood is usually found in erythrocytes. To investigate the nature of this selective accumulation of lead in erythrocytes, the specific binding of lead to proteins in human erythrocytes was studied using liquid chromatography coupled to inductively coupled plasma mass spectrometry (LC-ICP-MS). The principal lead-binding protein had a mass of approximately 240 kDa, and adsorption to specific antibodies showed that protein was delta-aminolevulinic acid dehydratase (ALAD). Thus, the previous notion that lead in erythrocytes was bound primarily to haemoglobin has to be revised. Furthermore, in lead-exposed workers, the percentage of lead bound to ALAD was influenced by a common polymorphism in the ALAD gene. Specifically, in seven carriers of the ALAD2 allele, 84% of the protein-bound lead recovered was bound to ALAD compared to 81% in seven homozygotes for the ALAD1 allele whose erythrocytes were matched for blood-lead concentration. The small difference was statistically significant in Wilcoxon matched-pairs signed-rank test (P = 0.03). No ALAD allele-specific difference in ALAD-bound lead was found among 20 unexposed controls. Perhaps the difference in ALAD-bound lead can provide an explanation for the previously reported finding of higher blood-lead levels among carriers of the ALAD2 allele than among ALAD1 homozygotes in lead-exposed populations