RESUMEN

Combat-related blast trauma results in massive tissue injury and tends to involve multiple systems. Further, an acute measure of injury severity based on underlying biological mechanisms may be important for the triage and treatment of these types of patients. We hypothesized that urinary biomarkers (UBs) would reflect severity of injury and that they would be elevated for blast injuries compared with gunshot wounds (GSW) in a cohort of combat casualties. We also postulated that UBs would be higher in patients with burns compared with patients with non-burn trauma in a civilian cohort. Among 80 service members who sustained combat-related injuries, we performed generalized estimating equations to compare differences in log-transformed concentrations of the UBs by both injury severity and injury mechanism. Among 22 civilian patients, we performed Kruskal-Wallis tests to compare differences for the UBs stratified by burn and non-burn trauma. In the military cohort, with the exception of IL-18, all UBs were significantly (P <0.05) higher for patients with a severe combat-related injury (Injury Severity Score ≥25). In addition, all crude UBs concentrations were significantly higher for blast versus GSW patients (P < 0.05). After adjusting for injury severity score and time of UB draw, KIM-1 (2.80 vs. 2.31; P = 0.03) and LFABP (-1.11 vs. -1.92; P = 0.02) were significantly higher for patients with a blast mechanism of injury. There were no significant differences in UBs between burn and non-burn civilian trauma patients. Future studies are needed to understand the physiologic response to trauma and the extent that UBs reflect these underlying processes.

Asunto(s)

RESUMEN

OBJECTIVE: To ensure that all veterans with retained embedded fragments are properly monitored for potential health effects of embedded materials. METHODS: Urine biomonitoring and health surveillance programs were developed to gather information about health risks associated with chemicals released from embedded fragments. RESULTS: Elevated systemic exposure to depleted uranium (DU) that continues to occur in veterans with DU fragments remains a concern, although no clinically significant DU-related health effects have been observed to date. Other metals and local tissue reactions to embedded fragments are also of concern. CONCLUSIONS: Knowledge gained from these programs will help to develop guidelines for surgical removal of tissue-embedded fragments.

Asunto(s)

Asunto(s)

RESUMEN

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.

Asunto(s)

RESUMEN

Depleted uranium was first used on a large scale as a major component of munitions and armaments employed by the U.S. armed forces during the Gulf War in 1991. In response to concern that exposure to depleted uranium may have been a cause of health problems suffered by returning veterans of that war, an already existing surveillance program following depleted uranium "friendly fire" victims was enlarged to assess the wider veteran community's exposure to depleted uranium. Between August 1998 and December 1999, 169 Gulf War veterans submitted 24-h urine samples for determination of urinary uranium concentration and questionnaires describing their potential exposures to depleted uranium while in the Gulf War theatre. Depleted uranium exposure assessment was determined from 30 separate questionnaire items condensed into 19 distinct exposure scenarios. Results of urine uranium analysis were stratified into high and low uranium groups with 0.05 microg uranium/g creatinine being the cut point and approximate upper limit of the normal population distribution. Twelve individuals (7.1%) exhibited urine uranium values in the high range, while the remaining 157 had urine uranium values in the low range. A repeat test of urine for 6 of these 12 produced uranium results in the low range for 3 of these individuals. Exposure scenarios of the high and low uranium groups were similar with the presence of retained shrapnel being the only scenario predictive of a high urine uranium value. Results emphasize the unlikely occurrence of an elevated urine uranium result and consequently any uranium-related health effects in the absence of retained depleted uranium metal fragments in the veterans.

Asunto(s)

RESUMEN

The utility of spot urine collections for uranium bioassay determinations was examined in a small cohort of depleted uranium exposed Gulf War veterans. Some members of the group are excreting elevated concentrations of urinary uranium resulting from the metabolism of retained metal fragments, the residua of several friendly fire incidents. Uranium determinations were performed on both 24-h timed collections and spot urine samples using kinetic phosphorescence analyzer (KPA) methodology. Results ranged from non-detectable to 30.7 mcg g(-1) creatinine in a 24-h collection. A creatinine-standardized spot sample and a 24-h uncorrected sample both correlated highly (R2=0.99) with a creatinine corrected 24-h collection, presumed to be the best estimate of the urinary uranium measure. This relationship was upheld when the population was stratified by uranium concentration into a high uranium group (> or = 0.05 mcg U/g creatinine) but for the lower uranium group (< 0.05 mcg U/g creatinine) more variability and a lower correlation was seen. The uncorrected spot sample, unadjusted for volume, concentration or creatinine had the lowest correlation with the 24-h creatinine adjusted result, especially at lower urinary uranium concentrations. This raises questions regarding the representativeness of such a sample in bioassay programs.

Asunto(s)

RESUMEN

Firearm fatalities occurring in Yorkshire and Humberside between 1975-1991 were examined; 130 cases were found, 64 were homicides, 55 suicides and 11 were accidental or unclassifiable. All but two of the suicides were men. Shotguns were the most frequent weapon used in both suicides and homicides. Of the 55 suicides, 17 were by men who had murdered before committing suicide. In 15 of these cases the assailants knew their victims. The other two cases involved murder of police officers. These cases were mostly with shotguns. In both homicide and suicide, rifled weapons and handguns were infrequently used. Most suicides and homicides occurred at home. Alcohol was again shown to be a significant factor in suicides. Overall firearms account for less than 10% of homicides in England and Wales and less than 5% of suicides in men and is most unusual in women.

Asunto(s)