Associated risk factors for patients undergoing a unique or double Nuss bar placement for pectus excavatum.

BACKGROUND: Pectus excavatum is the most common chest wall deformity. Surgical correction via Nuss Procedure is a common approach. Patients with long-segment sternal depression require more than one Nuss bar to be inserted. Complications of Nuss procedure include surgical site infection and bar migration which may necessitate surgical re-intervention. There has been conflicting evidence regarding the safety profile of inserting two Nuss bars. We aim to specifically review the safety profile of two Nuss bar insertion and its complications. METHOD: 179 consecutive patients who had undergone Nuss procedure between November 2013 and November 2021 were identified. Data analysis was performed on patient's age at time of operation, gender, height, weight, Haller index, pre-existing medical conditions, indication for surgery, duration of operation, numbers of bars placed, length of stay, post-operative pneumothorax, bar migration, superficial and deep infections, need for surgical intervention and mortality. RESULT: Patients receiving two Nuss bars were at a significantly higher risk of developing infective complications. Lower weight and Haller index increase the risk of surgical site infection and infection requiring re-operation in this group of patients. A cut-off of 50 kg has a specificity of 92.1% with a sensitivity of 68.8% in regards to surgical site infection. CONCLUSION: Patients receiving two Nuss bars as a part of their Nuss procedure are at a significantly higher risk of developing infective complications. Selecting patients more than 50 kg to receive two Nuss bars appear to be a reasonable measure to reduce surgical site infection.

Diffuse large B-cell lymphoma associated with chronic inflammation as an incidental finding and new clinical scenarios.

Diffuse large B-cell lymphoma that develops in the setting of long-standing chronic inflammation is typically associated with Epstein-Barr virus, and usually presents as tumor mass involving body cavities, as in pyothorax-associated lymphoma. It is listed as a distinct entity in the latest World Health Organization lymphoma classification. We report four cases that were incidentally discovered on histologic examination, one each in a splenic false cyst, a long-standing hydrocele, an atrial myxoma, and metallic-implant wear debris. Microscopic foci of atypical (neoplastic) large lymphoid cells were found within the contents of the cysts or curettage material, or within the stroma of the atrial myxoma. Despite the diverse clinical scenarios, all cases showed a homogeneous phenotype: positivity for B-lineage markers (CD20+, CD79a+, PAX5+), non-germinal center immunophenotype (CD10-, BCL6-/+, MUM-1+), and positivity for Epstein-Barr virus with type III latency (LMP1+, EBNA2+). The last feature supports the hypothesis that the lymphoma has arisen in a setting of 'local immunodeficiency' as a result of long-standing chronic inflammation in an enclosed space, a characteristic pathogenetic mechanism of diffuse large B-cell lymphoma associated with chronic inflammation. These cases therefore expand the spectrum of this entity to include new clinical scenarios for the development of this lymphoma type.