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.

Purpose Literature on priapism as a concomitant manifestation of COVID-19 infection is scarce since less than 10 cases are reported. It is crucial to determine whether priapism in a COVID-19 patient is related to the infection itself or to the ongoing therapy, especially in those critically ill. Our study aims to create an alert for all physicians faced with the management of priapism in SARS-CoV-2 patients. We tried to explore any potential leading factors presenting a case of priapism arising during COVID-19 pneumonia, and we reviewed the current literature available on this topic. Case Presentation We reported the case of a 62-year-old man with severe COVID-19 pneumonia complicated by acute respiratory distress syndrome who developed ischemic priapism during his stay in intensive unit care. Corporal aspiration was performed with injection of 200 μg of intracavernosal phenylephrine resulting in detumescence. After recovery, the patient reported complete erectile dysfunction. Conclusion The etiopathogenetic mechanism of priapism remains not completely clear. The most frequently hypothesized cause is the prothrombotic state associated with the infection. Further elements including the drugs administered during the infection may play a crucial role. Further studies are needed to obtain stronger evidence.