Abstract
BackgroundProjectile foreign bodies are known to cause chronic heavy metal toxicity due to the release of metal into the bloodstream. However, the local effect around the metallic object has not been investigated and the main goal of our study is to examine the influence of the object in close proximity of the object.Case presentationA 36-year-old Caucasian woman with one metallic pellet close to her sciatic nerve due to a previous shotgun injury at the gluteal area presented with a diagnosis of recurrent lumbar disk herniation at L4–5 level. A physical examination confirmed chronic neuropathy and she underwent a two-stage surgery. The surgery included removal of the foreign body, followed by discectomy and fusion at the involved level. During the removal of the metallic foreign body, a tissue sample around the pellet and another tissue sample from a remote area were obtained. The samples were analyzed by scanning acoustic microscopy, scanning electron microscopy, and energy-dispersive X-ray spectroscopy. Lead, chromium, copper, cadmium, iron, manganese, selenium, and zinc elements in tissue, blood, and serum specimens were detected by inductively coupled plasma optical emission spectroscopy.ConclusionsAn acoustic impedance map of the tissue closer to the metallic body showed higher values indicating further accumulation of elements. Energy-dispersive X-ray spectroscopy results confirmed scanning acoustic microscopy results by measuring a higher concentration of elements closer to the metallic body. Scanning electron microscopy images showed that original structure was not disturbed far away; however, deformation of the structure existed in the tissue closer to the foreign body. Element analysis showed that element levels within blood and serum were more or less within acceptable ranges; on the other hand, element levels within the tissues showed pronounced differences indicating primarily lead intoxication in the proximity of the metallic body. We can state that residues of metallic foreign bodies of gunshot injuries cause chronic metal infiltration to the surrounding tissue and induce significant damage to nearby neural elements; this is supported by the results of scanning acoustic microscopy, scanning electron microscopy, energy-dispersive X-ray spectroscopy, and inductively coupled plasma optical emission spectroscopy.
Highlights
Projectile foreign bodies are known to cause chronic heavy metal toxicity due to the release of metal into the bloodstream
There is evidence that foreign bodies may cause local effects and damage to anatomical structures in close proximity. This local effect has not been studied in detail so far, and, in this research, we aimed to study the local influence of a bullet close to a sciatic nerve by Scanning acoustic microscopy (SAM), Scanning electron microscopy (SEM), Energy-dispersive X-ray spectroscopy (EDS), and inductively coupled plasma optical emission spectroscopy (ICP-OES)
In SAM images, the acoustic impedance (AI) increased as the distance between the metallic body and the tissue sample decreased, which is evidence of Pb mobilization from a gunshot
Summary
Projectile foreign bodies are known to cause chronic heavy metal toxicity due to the release of metal into the bloodstream. Chromium, copper, cadmium, iron, manganese, selenium, and zinc elements in tissue, blood, and serum specimens were detected by inductively coupled plasma optical emission spectroscopy. Metallic foreign bodies from gunshot injuries are typical in clinical practice. Pb toxicity, caused by these gunshot fragments, has been discussed for many years [4, 9, 10]; there is no agreement on the immediate removal of the fragments from the body [11,12,13,14,15]. It was reported that increased Pb concentration provoked a reduction in iron (Fe) and calcium (Ca) concentrations altering the ratios of Fe/copper (Cu), Fe/zinc (Zn), and Ca/Zn in blood, and in hair [17]
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Disclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.