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Biomedical subjects

J W Graef

Publications and source records attributed to J W Graef.

16 recordsLinked to original sources
PubMed1996

Lead intoxication in children with pervasive developmental disorders.

OBJECTIVE: To investigate the observation that children with pervasive developmental disorders have later and more prolonged lead exposure and are more likely to be reexposed when compared to lead-poisoned children without pervasive developmental disorders. DESIGN: Retrospective chart review. SETTING: A large, urban lead treatment program. RESULTS: Over a six year period 17 children with pervasive developmental disorders (including autism) were treated. Compared to a randomly selected group of 30 children without pervasive developmental disorders who were treated for plumbism over the sam interval, those with pervasive developmental delay were significantly older at diagnosis (46.5 vs 30.3 months, p = .03) and had a longer period of elevated blood lead levels (39.1 vs 14.1 months, p = .013) during management. Despite close monitoring, state-mandated environmental inspection and prompt lead hazard reduction or alternative housing, 75% of children with pervasive developmental disorders were reexposed to lead during medical management compared with 23% of children without pervasive developmental disorders (p = .001). CONCLUSIONS: 1) lead intoxication among children with pervasive developmental disorders may appear de novo beyond the third year of life and is associated with a high rate of reexposure; 2) the provision of deleaded housing (by current techniques) may not be sufficient to protect these children from repeated lead exposure; 3) these data support recommendations by the Centers for Disease Control that children with developmental delays be closely monitored for the appearance of lead intoxication. This monitoring should continue beyond the third year of life.

Chelating Agents↗
PubMed1994

Efficacy of oral meso-2,3-dimercaptosuccinic acid therapy for low-level childhood plumbism.

OBJECTIVE: To compare the response to oral meso-2,3-dimercaptosuccinic acid (DMSA) treatment in children with an initial blood lead (BPb) concentration less than versus more than 2.17 mumol/L (45 micrograms/dl). DESIGN: Retrospective cohort study. SETTING: Regional referral lead treatment program in an urban children's hospital. PATIENTS: Thirty consecutive children, median age 34 months (range, 5 to 161 months), with an initial BPb concentration 0.97 to 2.90 mumol/L (20 to 60 micrograms/dl) selected for DMSA use. Reasons for DMSA use included BPb concentration > 2.17 mumol/L (11 children), complications with penicillamine therapy (11), chronic renal failure (1), and compassionate use (7). All patients received required environmental hazard reductions before drug administration. RESULTS: Group 1 (n = 23) had a mean BPb concentration of 1.50 mumol/L (31 micrograms/dl), and group 2 (n = 7) had a mean BPb concentration of 2.41 (51 micrograms/dl). Sixteen patients (70%) in group 1 and five patients (71%) in group 2 had had previous chelation therapy (p value not significant). No significant difference was found in the mean percentage of the reduction of BPb concentration during treatment of group 1 (60%) versus group 2 (58%). The mean BPb concentration in group 1 rebounded to 70% of pretreatment values by mean day 41; the BPb concentration in group 2 rebounded to 69% by day 37 (p value not significant). Prior chelation therapy did not result in a significant difference in either the percentage reduction of BPb concentration or the percentage of rebound BPb. CONCLUSION: DMSA is equally effective in acutely lowering BPb concentration in children with BPb concentrations less than and greater than 2.17 mumol/L.

Adolescent↗
PubMed1992

Lead intoxication in infancy.

Four years of experience in the evaluation and management of lead intoxication in the first year of life were reviewed. This study was conducted in a lead referral program within the state of Massachusetts, whose comprehensive lead laws include extensive (and now mandatory) lead screening of all children. Over the period of study, 50 (14%) of 370 new patients enrolled in the program were infants aged 12 months or younger. Median age of these infants was 11 months (range 1 through 12 months). Mean peak lead level was 39.0 micrograms/dL while the mean peak erythrocyte protoporphyrin concentration was 111.9 micrograms/dL of whole blood. Thirty-two percent of infants were ambulatory at the time lead intoxication was diagnosed; only 24% had a history of pica. Twenty-six percent of parents were welfare dependent. Apparent sources of plumbism included house-hold renovation (n = 20), direct ingestion of paint chips (n = 10), formula preparation with lead-contaminated water (n = 9), lead dust importation (n = 1), and congenital exposure to elevated maternal lead level (n = 1). In 9 cases the source was not found. When this profile was compared with that of a randomly selected group of 47 children aged 18 through 30 months, who were seen in the lead program during the same interval, apparent sources of intoxication in the older group were paint chip ingestion (n = 41), household renovation (n = 2), and unknown (n = 4) (P less than .0001). On the basis of these data, it is concluded that lead intoxication in infants is common and has significantly different origins from that in toddlers.(ABSTRACT TRUNCATED AT 250 WORDS)

Cooking and Eating Utensils↗
PubMed1991

Residential deleading: effects on the blood lead levels of lead-poisoned children.

Acute elevations of venous blood lead levels (PbB) are periodically reported in children with chronic lead poisoning, during deleading of their houses. To evaluate this phenomenon 114 preschool children who entered the Massachusetts Childhood Lead Poisoning Prevention Program case management system during 1984 and 1985 were retrospectively studied. PbB increased from a mean (+/- SE) of 1.76 +/- 0.03 mumol/L (36.4 +/- 0.6 micrograms/dL) prior to deleading to 2.03 +/- 0.07 mumol/L (42.1 +/- 1.5 micrograms/dL) during deleading (P less than .001). Among 41 subjects for whom deleading was done by dry scraping and sanding, the mean mid-deleading PbB was higher than the pre-deleading PbB by 0.44 +/- 0.12 mumol/L (9.1 +/- 2.4 micrograms/dL). However, when deleading was done by covering or replacement of painted surfaces in the residences of 12 subjects, mid-deleading PbB decreased 0.11 +/- 0.12 mumol/L (2.25 +/- 2.4 micrograms/dL) (P less than .005). In a subset of 59 subjects who had no chelation therapy and were available for follow-up 250 +/- 14 days after completion of deleading, PbB had decreased from 1.72 +/- 0.04 mumol/L (35.7 +/- 0.9 micrograms/dL) to 1.24 +/- 0.04 mumol/L (25.5 +/- 0.9 micrograms/dL) (P less than .001). The long-term effect of deleading is a significant reduction in PbB. However, deleading resulted in a significant, albeit transient, increase in PbB.

Age Factors↗
PubMed1989

Lead intoxication from lead-contaminated water used to reconstitute infant formula.

The lead found in drinking water can be a source of lead poisoning to young children, particularly those who consume large amounts of water. The authors describe a 13-month-old infant who was discovered to have plumbism during routine evaluation. The lead source was ultimately traced to the daily administration of powdered formula which was prepared with home tap water having a first-draw lead content of 130 parts per billion. This case suggests that whenever infants are fed powdered formula, consideration should be given to analysis of the home tap water for lead content.

Female↗
PubMed1987

Hazards of 'deleading' homes of children with lead poisoning.

"Deleading" the homes of children with lead poisoning is a necessary step to terminate the child's exposure to lead. Lead poisoning as a result of lead exposure during the process of deleading has occurred in deleading workers but has not been well documented among children whose homes are deleaded. We treated four children with classes I through III lead poisoning (range of blood lead [Pb-B] level, 1.6 to 2.75 mumol/L [33 to 57 micrograms/dL]) who had significant elevation of their Pb-B levels (range, peak 4.34 to 6.27 mumol/L [90 to 130 micrograms/dL]) following deleading of their homes. The methods used for deleading included scraping, sanding, and burning of the paint. Symptoms included irritability (n = 3) and vomiting (n = 1). The elevation of the Pb-B levels was detected early, allowing prompt chelation therapy. Because exacerbation of lead poisoning may occur in children following deleading of their homes, safer approaches of deleading should be determined.

Chelating Agents↗
PubMed1986

The radiologic "lead band" revisited.

After prolonged heavy metal exposure (e.g., lead) "lead bands" develop at the metaphyseal ends of growing bones. These "lead bands," while a constant finding, are used as additional laboratory evidence to diagnose plumbism. In this study, the role of the proximal fibula in distinguishing physiologic sclerosis from pathologic thickening of the zone of provisional calcification is assessed. In addition, laboratory values are compared to radiographic findings in a controlled fashion to establish levels at which "lead bands" appear. The former is a useful adjunct in the radiographic diagnosis of plumbism, while the minimum blood levels at which "lead bands" are seen is much lower than previously described.

Bone and Bones↗