title: Mobilization of Metal From Retained Embedded Fragments in a Blast-Injured Iraq War Veteran.
abstract: A frequent comorbidity of traumatic injury due to a blast or explosion, commonly reported in Iraq and Afghanistan veterans, is that of retained embedded fragments typically of unknown content. Because of concerns over both local and systemic health effects related to both the physical presence of and mobilization of materials from embedded fragments, the Department of Veterans Affairs established a surveillance program for this group of veterans. We present here the case of a surveillance-enrolled veteran who submitted: (1) three surgically removed fragments for content analyses, (2) tissue adhered to the fragments for histology and metal concentration evaluation, and (3) pre- and postfragment removal urine samples to assess concentrations of various metals often found in fragments. Results indicate that removed fragments were aluminum-copper alloys. Surrounding tissue analyses revealed elevated concentrations of these metals and evidence of chronic inflammation, but no neoplastic changes. Urine aluminum concentrations, initially elevated compared to normal population values, decreased significantly after fragment removal, illustrating the utility of urine biomonitoring to provide insight into fragment composition. A medical surveillance program integrating fragment composition data, tissue analyses, and repeat urine biomonitoring can help inform the patient-specific medical management of both the local and systemic effects of retained metal fragments.
authors.affiliation: Department of Veterans Affairs Medical Center, 11 North Greene Street, Baltimore, MD 21201.
authors.forename: Joanna M
authors.initials: JM
authors.lastname: Gaitens
authors.affiliation: Division of Biology, Chemistry and Materials Science, Office of Science and Engineering Laboratories, Center for Devices and Radiological Health, U.S. Food and Drug Administration, 10903 New Hampshire Avenue, Building 64, Room 4028, Silver Spring, MD 20993.
authors.forename: Jose A
authors.initials: JA
authors.lastname: Centeno
authors.affiliation: Department of Veterans Affairs Medical Center, 11 North Greene Street, Baltimore, MD 21201.
authors.forename: Katherine S
authors.initials: KS
authors.lastname: Squibb
authors.affiliation: Department of Veterans Affairs Medical Center, 11 North Greene Street, Baltimore, MD 21201.
authors.forename: Marian
authors.initials: M
authors.lastname: Condon
authors.affiliation: Department of Veterans Affairs Medical Center, 11 North Greene Street, Baltimore, MD 21201.
authors.forename: Melissa A
authors.initials: MA
authors.lastname: McDiarmid
mesh_terms: D000535:Aluminum / Q000652:urine; D001753:Blast Injuries / Q000150:complications*; D003300:Copper / Q000652:urine; D004784:Environmental Monitoring / Q000379:methods; D005547:Foreign Bodies / Q000150:complications / Q000601:surgery*; D006801:Humans; D054542:Iraq War, 2003-2011; D008297:Male; D013058:Mass Spectrometry / Q000379:methods; D016273:Occupational Exposure / Q000009:adverse effects; D011795:Surveys and Questionnaires; D014481:United States; D014728:Veterans; D055815:Young Adult
chemical_list: D003300:Copper; D000535:Aluminum