Michele Torre1,2, Luca Genova Gaia2, Maria Grazia Calevo3, Michela Wong2, Maria Raso4, Sebastiano Barco5, Francesca Di Gaudio4, Giuliana Cangemi5. 1. Pediatric Thoracic and Airway Surgery Unit, IRCCS Istituto Giannina Gaslini, Genova, Italy. 2. Department of Pediatric Surgery, IRCCS Istituto Giannina Gaslini, Genova, Italy. 3. Epidemiology and Biostatistics Unit, IRCCS Istituto Giannina Gaslini, Genova, Italy. 4. Chromatography and Mass Spectrometry Section, Quality Control and Chemical Risk (CQRC), Department PROMISE, University Palermo, Palermo, Italy. 5. Chromatography and Mass Spectrometry Section, Central Laboratory of Analyses, IRCCS Istituto Giannina Gaslini, Genoa, Italy.
Abstract
OBJECTIVES: Minimally invasive repair of pectus excavatum (MIRPE) is the most popular surgical approach for paediatric patients with pectus excavatum. A substernal stainless still bar is inserted and left in place for 3 years and then removed. Our goal was to investigate blood metal levels after MIRPE and to correlate them with surgical details, such as the numbers of bars and stabilizers and the length of time the bar was in place. METHODS: Blood levels of iron, chromium, manganese, molybdenum and nickel were analysed in 130 teenagers (108 boys and 22 girls) who had MIRPE using inductively coupled plasma mass spectrometry. A total of 62 patients were operated on using MIRPE (study group) and 68 patients were evaluated at implant time (control group). Differences between the numbers of bars implanted and the presence or absence of stabilizers were also considered. RESULTS: Significant increases in the levels of abnormal chromium were found in patients in the study group compared with the controls (P = 0.02). When we compared the group of patients with 2 or more bars with the group with 1 bar, the percentage of patients with a value above the threshold increased by 29 (P = 0.05). A significant increase in chromium levels was observed in patients with stabilizers (P = 0.03). Above-threshold levels of molybdenum were found in 5.1% of patients in the control group, but the number was not statistically significant (P = 0.09). CONCLUSIONS: We demonstrated that stainless steel devices used in MIRPE can elevate blood metal levels in paediatric patients. Moreover, we demonstrated that the use of metal stabilizers is associated with higher metal levels, probably due to increased dispersion.
OBJECTIVES: Minimally invasive repair of pectus excavatum (MIRPE) is the most popular surgical approach for paediatric patients with pectus excavatum. A substernal stainless still bar is inserted and left in place for 3 years and then removed. Our goal was to investigate blood metal levels after MIRPE and to correlate them with surgical details, such as the numbers of bars and stabilizers and the length of time the bar was in place. METHODS: Blood levels of iron, chromium, manganese, molybdenum and nickel were analysed in 130 teenagers (108 boys and 22 girls) who had MIRPE using inductively coupled plasma mass spectrometry. A total of 62 patients were operated on using MIRPE (study group) and 68 patients were evaluated at implant time (control group). Differences between the numbers of bars implanted and the presence or absence of stabilizers were also considered. RESULTS: Significant increases in the levels of abnormal chromium were found in patients in the study group compared with the controls (P = 0.02). When we compared the group of patients with 2 or more bars with the group with 1 bar, the percentage of patients with a value above the threshold increased by 29 (P = 0.05). A significant increase in chromium levels was observed in patients with stabilizers (P = 0.03). Above-threshold levels of molybdenum were found in 5.1% of patients in the control group, but the number was not statistically significant (P = 0.09). CONCLUSIONS: We demonstrated that stainless steel devices used in MIRPE can elevate blood metal levels in paediatric patients. Moreover, we demonstrated that the use of metal stabilizers is associated with higher metal levels, probably due to increased dispersion.
Authors: Robert J Obermeyer; Sheema Gaffar; Robert E Kelly; M Ann Kuhn; Frazier W Frantz; Margaret M McGuire; James F Paulson; Cynthia S Kelly Journal: J Pediatr Surg Date: 2017-11-14 Impact factor: 2.545
Authors: Brent A Lanting; Matthew G Teeter; James L Howard; Steven J MacDonald; Douglas W Van Citters Journal: J Arthroplasty Date: 2017-03-29 Impact factor: 4.757
Authors: Caroline Fortmann; Thomas Göen; Marcus Krüger; Benno M Ure; Claus Petersen; Joachim F Kübler Journal: PLoS One Date: 2017-10-12 Impact factor: 3.240
Authors: Caroline Fortmann; Thomas Goeen; Norman Zinne; Soeren Wiesner; Benno M Ure; Claus Petersen; Joachim F Kuebler Journal: PLoS One Date: 2022-10-10 Impact factor: 3.752