The Utility of Spot vs 24-Hour Urine Samples for Metal Determination in Veterans With Retained Fragments.

OBJECTIVES: The objective of this investigation is to explore the utility of using a spot urine sample in lieu of a 24-hour collection in assessing fragment-related metal exposure in war-injured veterans. METHODS: Twenty-four veterans collected each urine void over a 24-hour period in separate containers. Concentrations of 13 metals were measured in each void and in a pooled 24-hour sample using inductively coupled plasma mass spectrometry. To assess the reliability of spot sample measures over time, intraclass correlations (ICCs) were calculated across all spot samples. Lin's concordance correlation coefficient was used to assess agreement between a randomly selected spot urine sample and each corresponding 24-hour sample. RESULTS: In total, 149 spot urine samples were collected. Ten of the 13 metals measured had ICCs more than 0.4, suggesting "fair to good" reliability. Concordance coefficients were more than 0.4 for all metals, suggesting "moderate" agreement between spot and 24-hour concentrations, and more than 0.6 for seven of the 13 metals, suggesting "good" agreement. CONCLUSIONS: Our fair to good reliability findings, for most metals investigated, and moderate to good agreement findings for all metals, across the range of concentrations observed here, suggest the utility of spot urine samples to obtain valid estimates of exposure in the longitudinal surveillance of metal-exposed populations.

Metal Exposure in Veterans With Embedded Fragments From War-Related Injuries: Early Findings From Surveillance Efforts.

OBJECTIVE: To characterize systemic metal exposures from retained fragments in a cohort of war-injured US Veterans enrolled in the Department of Veterans Affairs' Embedded Fragment Registry. METHODS: Five hundred seventy nine registry-enrolled Veterans submitted an exposure questionnaire and urine sample for analyses of 14 metals often found in fragments. Urine metal results were compared with reference values of unexposed populations to identify elevations. RESULTS: 55% of Veterans had normal urine metal values. When observed, tungsten and zinc were the metals most frequently elevated, followed by cobalt; however, cobalt levels were not associated with a fragment source, but with surgical implants present. CONCLUSIONS: Though most metal elevations observed are not significantly outside the normal range, on-going accrual of metal burdens in these Veterans over time recommends continued surveillance which may inform future medical management.

Undetected penetrating bladder injuries presenting as a spontaneously expulsed bullet during voiding: a rare entity and review of the literature.

BACKGROUND: Patients presenting with a penetrating missile lodged in the pelvis are at risk for having a urinary tract injury. Once in the bladder, the missile can become impacted in the urethra, causing retention that requires extraction. Rarely, the missile can be expulsed spontaneously through the urethra. OBJECTIVES: To describe the world literature regarding undetected penetrating bladder injuries presenting as spontaneously voided bullets and to contribute an additional case to the literature. CASE REPORT: We present a case report of a 37-year-old man who sustained a gunshot wound to the right buttock, with an undetected urinary system injury and subsequent spontaneous voiding of a bullet. CONCLUSION: There have been <10 cases reported in the literature of spontaneously expulsed bullets from the urethra, all of which were undetected injuries on initial presentation. Physicians should be aware of the potential for undetected urinary tract injuries in patients with penetrating missiles to the pelvis and understand the appropriate evaluation and management strategies for these injuries.

Foreign body in the bladder mimicking nephritis.

Cases of foreign bodies in the bladder self-inserted via urethra are not rare in childhood. Urinary tract infection, dysuria, lower abdominal pain, or haematuria with and without pain are common symptoms. We report on a 11-year-old boy with accidentally detected microscopic haematuria, proteinuria and leukocyturia. Because of increasing proteinuria up to 2330 mg/g creatinine and elevated antistreptolysin titre glomerulonephritis was suspected. However, some echogenic material was detected in the bladder by ultrasound. X-ray of the pelvis showed a 30 cm long tube projecting onto the bladder. The boy then admitted having had inserted a plastic tube into the urethra two years ago. The foreign body was removed cystoscopically. Four weeks after cystoscopy erythrocyturia, leucoyturia and proteinuria had disappeared. We state that symptoms of a local inflammation caused by a foreign body in the bladder can imitate the symptoms of nephritis.

[Iodin 125 seed migration after prostate brachytherapy: a study of 170 patients]. / Migration des grains d'iode 125 après curiethérapie prostatique: étude d'une série de 170 patients.

PURPOSE: To study the number of migrating seeds, the anatomical site of migration and possible predictive parameters of migration, after prostate cancer brachytherapy using a loose-seed (I125) implantation technique. PATIENTS AND METHODS: The charts of the 170 patients consecutively treated by the Institut Curie/Hospital Cochin/Hospital Necker Group between September 1, 2001 and August 31, 2002, were analysed. All seeds having migrated to the lungs and seen on the chest X-ray systematically performed at 2 months, have been recorded, as well as the seeds lost by the urines (after sieving) or in the sperm (condom). RESULTS: Among 12,179 implanted seeds, 44 were found to have migrated (0.36%). Most of the migrating seeds (32/44; 73%), were found in the lungs. Overall, one or several seed migrations were observed in 35 patients (21% of the total number of patients in this series). In the majority of cases (77%), only one seed migrated. A significant relationship (P = 0.04) was found between the number of migrating seeds and the number of implanted ones (or with the prostate volume, but those two parameters were closely linked in our series). More specifically, a significant relationship (P = 0.02) could be demonstrated between the number of seeds implanted at the periphery of the prostate and the number of seeds migrating to the lungs. CONCLUSION: The percentage of migrating seeds observed in this series is low, actually one of the lowest found in the literature when using the loose-seed technique. There was no clinical consequences and the loss of-usually-only one seed is very unlikely to alter the quality of the dose distribution. However, the predominance of pulmonary migrations in our series led us to slightly modify our implantation technique. We now try to avoid too "peripheral" seed implantations, due to the risk of migration towards the periprostatic veins, and subsequently to the lungs.

Detection of depleted uranium in urine of veterans from the 1991 Gulf War.

American soldiers involved in "friendly fire" accidents during the 1991 Gulf War were injured with depleted-uranium-containing fragments or possibly exposed to depleted uranium via other routes such as inhalation, ingestion, and/or wound contamination. To evaluate the presence of depleted uranium in these soldiers eight years later, the uranium concentration and depleted uranium content of urine samples were determined by inductively coupled plasma mass spectrometry in (a) depleted uranium exposed soldiers with embedded shrapnel, (b) depleted uranium exposed soldiers with no shrapnel, and (c) a reference group of deployed soldiers not involved in the friendly fire incidents. Uranium isotopic ratios measured in many urine samples injected directly into the inductively coupled plasma mass spectrometer and analyzed at a mass resolution m/delta m of 300 appeared enriched in 235U with respect to natural abundance (0.72%) due to the presence of an interference of a polyatomic molecule of mass 234.81 amu that was resolved at a mass resolution m/delta m of 4,000. The 235U abundance measured on uranium separated from these urines by anion exchange chromatography was clearly natural or depleted. Urine uranium concentrations of soldiers with shrapnel were higher than those of the two other groups, and 16 out of 17 soldiers with shrapnel had detectable depleted uranium in their urine. In depleted uranium exposed soldiers with no shrapnel, depleted uranium was detected in urine samples of 10 out of 28 soldiers. The median uranium concentration of urines with depleted uranium from soldiers without shrapnel was significantly higher than in urines with no depleted uranium, though substantial overlap in urine uranium concentrations existed between the two groups. Accordingly, assessment of depleted uranium exposure using urine must rely on uranium isotopic analyses, since urine uranium concentration is not an unequivocal indicator of depleted uranium presence in soldiers with no embedded shrapnel.

Excretion of depleted uranium by Gulf War veterans.

During the Persian Gulf War, in 1991, approximately 100 US military personnel had potential intakes of depleted uranium (DU), including shrapnel wounds. In 1993, the US government initiated a follow-up study of 33 Gulf War veterans who had been exposed to DU, many of whom contained embedded fragments of DU shrapnel in their bodies. The veterans underwent medical evaluation, whole-body counting, and urinalysis for uranium by kinetic phosphorescence analysis (KPA). Data are available from seven individuals who exceeded the detection limit for whole-body counting and also had elevated urinary uranium. Urinary excretion rates, in microg U g(-1) creatinine, were determined in 1997 and 1999. The body contents, in mg DU, were determined in 1997; it is assumed there were no significant decreases in total body content in the interim. For the 1997 data, the mean fractional excretion was (2.4 +/- 2.8) x 10(-5) g(-1) creatinine, and for the 1999 data, the mean was (1.1 +/- 0.6) x 10(-5) g(-1) creatinine. However, these means are not significantly different, nor is there any correlation of excretion rate with body content. Thus, human data available to date do not provide any basis for determining the effects of particle surface area, composition and solubility, and biological processes such as encapsulation, on the excretion rate.

[Foreign body in the kidney as a cause of erythruria in a 4-year old girl]. / Cialo obce w nerce przyczyna krwinkomoczu u 4-letniej dziewczynki.

The case of the 4-year-old girl suffering from erythruria is presented. It was caused by the foreign body (needle) in the kidney. Surgical removal of the needle was performed.

Stenturia: An unusual manifestation of spontaneous ureteral stent fragmentation.

Two patients presented with passage of worm-like stent fragments in the urine. The first had undergone attempted percutaneous removal of left renal calculus and ureteral stenting 4 months prior to presentation. The second had left-sided stent placement for obstructive anuria on account of bilateral renal calculi 3 months earlier. The stents had fragmented into multiple pieces over a mean indwelling time of only 3.5 months. Apart from calculus disease, both patients had documented urinary tract infection. Stent fragmentation is a relatively rare (0.3%) but major complication. However, spontaneous excretion of these fragments has not been hitherto reported. These cases of rapid stent disintegration highlight the need for closer monitoring of the indwelling stents, especially in patients with calculus disease and associated persistent infection. In such patients the stent should probably be changed within 3 months.

Urinalysis of body packers in Japan.

Urinalysis was performed on nine body packers/smugglers who were referred to the emergency room of a hospital near the New Tokyo International Airport between September 1994 and February 1996. This analysis had rarely been used on suspected body packers in Japan. Only one of the nine body packers was a female. Foreign bodies were detected in the gastrointestinal tracts of the body packers by plain x-ray photography or computerized tomography, and the suspected drugs were cocaine (five cases), heroin (two cases), opiate (one case), and marijuana (one case). The results of urinalysis and confessions of the smugglers corresponded well for the latter three drugs (four cases). In two of the suspicious cocaine cases, opiates were detected along with cocaine by urinalysis, and the metabolites were confirmed by gas chromatography-mass spectrometry. The urinary screening tests of another two suspicious cocaine cases were negative. Opiates (morphine and codeine), but no cocaine metabolites, were detected in the urine of the subject who confessed to smuggling in cocaine only. It may be inferred from these results that urinalysis on body packers is beneficial to both the patient (body packer) and the physician in preventing the disastrous outcome of drug intoxication. It can also be concluded that there is a need for the prompt establishment of a protocol that includes urinalysis upon admission to the hospital for the management of body packers in Japan.