- Discussion:
    - bullets in soft tissue are rapidily encapsulated by fibrous tissue and are therefore essentially eliminated from circulating body fluids;
    - where as serum is a poor solvent and bullets that are in joints are more threatening because of their contact with synovial fluid combined 
           with joint motion, will increase the rate of dissolution;
           - synovial fluid is acidic which also increases its absorption;
    - also be aware of absorption possibilities with lead within a bursa pseudocyst, lung tissue, bone, and suppurating foci;
    - once plumbism is diagnosed, surgery is not the first line of treatment;
    - anemia is one of the many signs of lead toxicity;
    - patient should be stabilized and then receive D-penicillamine to keep serum lead levels below 80 mg/dL;
           - this prevents fatal mobilization of lead during surgery;
    - in the report by Joseph L. McQuirter et al, the authors attempted to assess the impact of retained projectiles on subsequent lead 
           exposure in the population;
           - 48 patients were originally recruited from gunshot victims presenting for care at the King/Drew Medical Center in Los Angeles, California;
           - an initial blood level was measured for all recruited patients and repeated for the 28 participants available for follow-up, 1 week to 8 months later;
           - medical history, including a history of prior firearm injuries and other retained projectiles, was taken, along with a screening and risk factor questionnaire
                  to determine other sources of lead (occupational/recreational) to which the patient might have been, or is at present, exposed;
           - the participants also had K-shell x-ray fluorescence determinations of bone lead in the tibia and calcaneus in order to determine past lead exposures
                  not revealed by medical history and risk factor questionnaire;
           - multivariate models of blood level were made using risk factor and bone lead concentration data;
           - the authors demonstrated that blood lead tends to increase with time after injury in patients with projectile retention,
                  and that the increase in significant part depended on the presence of a bone fracture caused by the gunshot;
           - the authors suggested that the amount of blood lead increase in time after injury is also dependent on the tibia lead concentration;
           - there were too few cases in the study to fully test the effects of bullet location, or the interaction of bullet location with bone fracture or bullet fragmentation