Development of metal allergy after Nuss procedure for repair of pectus excavatum despite preoperative negative skin test

Sesia, Sergio B.; Haecker, Frank-Martin; Shah, Bhairav; Goretsky, Michael J.; Kelly, Robert E.; Obermeyer, Robert J.

doi:10.1016/j.epsc.2013.05.004

Cited by 23 publications

(18 citation statements)

References 15 publications

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“…Orthopedic implants are implanted into the human body in order to assist with carrying out the normal functions of the bone tissues and the joints and, as reported elsewhere [[1], [2], [3], [4], [5]], the implant materials may have to be removed if they are not comprised of biocompatible alloying elements. Nickel (Ni) is an alloying element that results in the most frequent allergic reactions among all alloying elements used in implant materials [6].…”

Section: Introductionmentioning

confidence: 99%

Effect of thermomechanical treatment on the mechanical and microstructural evolution of a β-type Ti-40.7Zr–24.8Nb alloy

Ozan

Lin²,

Weng

et al. 2019

Bioactive Materials

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In this study, the microstructural evolution and mechanical properties of a newly developed Ti-40.7Zr–24.8Nb (TZN) alloy after different thermomechanical processes were examined. As-cast TZN alloy plates were solution-treated at 890 °C for 1 h, after which the thickness of the alloy plates was reduced by cold rolling at reduction ratios of 20%, 56%, 76%, and 86%. Stress-induced α” formation, {332} <113> β mechanical twinning, and kink band formation were observed in the cold-rolled TZN alloy samples. In the TZN sample after cold rolling at the 86% reduction ratio plus a recrystallization annealing at 890 °C for 1 h, the deformation products of a stress-induced α” phase, {332}<113> β mechanical twinning, and kink bands disappeared, resulting in a fine, equiaxed single β phase. The alloy samples exhibited elongation at rupture ranging from 7% to 20%, Young's modulus ranging from 63 to 72 GPa and tensile strength ranging from 753 to 1158 MPa. The TZN alloy sample after cold rolling and recrystallization annealing showed a yield strength of 803 MPa, a tensile strength of 848 MPa, an elongation at rupture of 20%, and an elastic admissible strain of 1.22%, along with the most ductile fractures during tensile testing.

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Section: Introductionmentioning

confidence: 99%

Effect of thermomechanical treatment on the mechanical and microstructural evolution of a β-type Ti-40.7Zr–24.8Nb alloy

Ozan

Lin²,

Weng

et al. 2019

Bioactive Materials

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“…Patients with a prior history of metal allergy, those with a family history of metal allergy, those who's test is positive for nickel, cobalt or some other constituent of stainless steel and patients who suffer from eczema should receive a titanium bar . However, titanium bar placement is much more expensive (4‐5 times more) and more complicated than the steel one . Furthermore, titanium can also cause metal allergy in patients treated with the Nuss procedure even in patch test negative patients .…”

Section: Discussionmentioning

confidence: 99%

“…2 However, titanium bar placement is much more expensive (4-5 times more) and more complicated than the steel one. 5 Furthermore, titanium can also cause metal allergy in patients treated with the Nuss procedure even in patch test negative patients. 4 Our case clearly shows that conversion from non-allergic to allergic status is possible even after the Nuss procedure.…”

Section: Discussionmentioning

confidence: 99%

Metal allergy as a late‐onset complication of the Nuss procedure in a pediatric patient

Navratil

Batinica

Ivković‐Jureković

2018

Pediatric Pulmonology

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“…The authors stated that the clinical significance of an allergic reaction should not be underestimated [7]. One patient even developed a metal allergy after MIRPE despite a preoperative negative skin test [9]. …”

Section: Discussionmentioning

confidence: 99%

“…These reactions occur in 6–8% of the cases and have been attributed to an allergic reaction to the metal bars implanted [7, 8]. However, some patients have developed these symptoms despite a negative preoperative skin test [7–9]. Treatment usually includes the administration of cortisone and antibiotics and, in most cases the symptoms decrease over time [7, 10].…”

Section: Introductionmentioning

confidence: 99%

Trace metal release after minimally-invasive repair of pectus excavatum

et al. 2017

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BackgroundSeveral studies have shown a high incidence of metal allergy after minimally-invasive repair of pectus excavatum (MIRPE). We postulated that MIRPE is associated with a significant release of trace metal ions, possibly causing the allergic symptoms.MethodsWe evaluated the concentration with chromium, cobalt and nickel in blood, urine and tissue in patients prior to MIRPE and in patients who underwent an explantation of the stainless-steel bar(s) after three years.ResultsOur study group consisted of 20 patients (mean age 19 years) who had bar explantation and our control group included 20 patients (mean age 16 years) prior to MIRPE. At the time of bar removal we detected significantly elevated concentrations of chromium and nickel in the tissue compared to patients prior to the procedure (p<0,001). We also found a significant increase in the levels of chromium in urine and nickel in blood in patients three years post MIRPE (p<0,001). Four patients temporarily developed symptoms of metal allergy, all had elevated metal values in blood and urine at explantation.ConclusionsMinimally-invasive repair of pectus excavatum can lead to a significant trace metal exposure.

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Development of metal allergy after Nuss procedure for repair of pectus excavatum despite preoperative negative skin test

Cited by 23 publications

References 15 publications

Effect of thermomechanical treatment on the mechanical and microstructural evolution of a β-type Ti-40.7Zr–24.8Nb alloy

Effect of thermomechanical treatment on the mechanical and microstructural evolution of a β-type Ti-40.7Zr–24.8Nb alloy

Metal allergy as a late‐onset complication of the Nuss procedure in a pediatric patient

Trace metal release after minimally-invasive repair of pectus excavatum

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