Nickel contamination after minimally-invasive repair of pectus excavatum persists after bar removal.

BACKGROUND: Minimally-invasive repair of pectus excavatum (MIRPE) has been shown to be associated with high release of trace metals into patient's body. The aim of our study was to analyze the kinetics of metal contamination after MIRPE and after bar removal. METHODS: We prospectively assessed nickel and chromium changes in blood, urine, and local tissue in patients undergoing MIRPE with stainless-steel bar(s). Baseline samples were taken prior to surgery, further samples were taken at six defined time points until 30 months after bar removal. Clinical symptoms were evaluated at the time of every sample collection. RESULTS: 28 patients were included (mean age 16.4 years). At four weeks after MIRPE and persisting up to bar removal, we found significantly elevated trace metal levels in blood and urine. Tissue nickel and chromium levels were significantly elevated at the time of bar removal. After bar removal, the concentration of trace metal in urine and the concentration of chromium in plasma decreased gradually. In contrast, nickel levels in blood further increased. Five patients showed irritative symptoms after MIRPE, all symptomatic patients had elevated metal levels. CONCLUSIONS: Following MIRPE, we found a rapid systemic increase of nickel and chromium. Our data indicate that trace metal release could cause irritative symptoms. The prolonged elevated systemic nickel levels beyond bar removal necessitate further investigations of the long-term side effects of MIRPE.

Spirometry, impulse oscillometry and capnovolumetry in welders and healthy male subjects.

BACKGROUND: Welding processes emit fine and ultrafine aerosol particles which are potentially harmful to the lungs of welders. In the past, changes in lung function were mostly determined by conventional spirometry. In this study spirometry was combined with new techniques such as Impulse Oscillometry (IOS) and Capnovolumetry (CVS) in order to assess welding associated changes in lung function. METHODS: 45 Male welders and 24 non-welders were investigated at two time points: before work shift (baseline) and after work shift. RESULTS: At baseline there were no differences between both study populations in spirometric, IOS, and CVS parameters. However, parameters of the flow-volume curve decreased with increasing long-term welding fume exposure (welding years). Airway resistances measured by IOS increased with welding years. IOS central airway resistance and several parameters of CVS increased during the work shift indicating airway narrowing and more inhomogeneous ventilation. CONCLUSIONS: In this study it has been shown that welding associated long-term and short-term effects could be detected in a population of welders, although exposure conditions were quite heterogeneous. The parameters of IOS and Capnovolumetry showed effects even more pronounced than conventional lung function parameters. Thus, these techniques may be considered as an additional tool for occupational medicine research.