BackgroundAn early observation after chest wall correction is direct inspection from the PE patient of their “new” thorax. Changes in self-perception may give raise to other psychological adaptations. The aim of this study was to evaluate the early changes in the fields of self-esteem, body image and QoL.MethodsProspective observational longitudinal multicenter cohort study. Self-esteem, emotional limitations and general health were assessed using the Child Health Questionnaire (CHQ) in patients under 18 and the World Health Organization Quality of Life Questionnaire-bref (WHOQOL-bref) was used for body image, psychological domain and overall QoL in patients over 16 years of age. Measurements were taken before surgery (T1) and 6 weeks (T2), and 6 months thereafter (T3).ResultsScores on post-operative self-esteem were significantly higher compared with scores pre-operatively (p < 0.007). Also body image, psychological domain and emotional limitations showed significant improvement, respectively p < 0.001, p < 0.001, and p < 0.016. Significant improvement in the first three components was mainly achieved in the first 6 weeks post-operative. In emotional limitation, however, the largest change was between 6 weeks and 6 months. Overall quality of life in the WHOQOL-bref and general health domain in the CHQ showed no significant improvement in relation to the pre-operative scores.ConclusionPost-operative PE patients after Nuss procedure showed an improved body image, increased self-esteem and increased psychological resilience in the first 6 months, with the most marked change in the first 6 weeks. Also emotional limitations changed significantly over time. The changes were not large enough to influence general QoL or general health significantly.

In patients with a high probability of mediastinal metastases, based on imaging, and negative endosonography, cervical mediastinoscopy should not be omitted, not even when the aspirate seems representative.

Spontaneous leaflet fracture of mechanical heart valve prostheses is very rare. We describe a case of spontaneous leaflet embolization 31 years after aortic valve replacement with an Edwards‐Duromedics prosthesis (Baxter Healthcare Corp., Edwards Division, Santa Ana, CA). We review the literature on this subject to increase awareness and recognition for this potentially life‐threatening complication.

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Background: Pain is a major concern in the early postoperative phase after correction of pectus excavatum. Most studies only focus on pain management in the first days after surgery and describe methods to alleviate the pain immediately postoperatively. The severity of postoperative pain may be influenced by anxiety. So far, few studies have looked into the relationship between anxiety and postoperative pain after pectus excavatum correction. Objectives: This study aimed to investigate the correlation between preoperative anxiety and late postoperative pain scores. Methods: This was a prospective cohort study. Anxiety was assessed with the State and Trait Anxiety Inventory questionnaire. Visual analogue scale (VAS) for pain scores assessed the pain at rest and activity. Anxiety was measured before surgery and pain scores six weeks after surgery. A hierarchical linear regression analysis was performed to investigate the correlation between baseline anxiety and pain measurements six weeks after surgery. Results: In this study, 136 patients were included. State anxiety was not associated with postoperative pain (mean of pain on activity and in rest), only with pain on activity after six weeks. Age and sex were not effect modifiers in any of the models. Relevant confounding factors, although not significant, consisted of trait, sex, minor complications, epidural duration, major complications, and the number of stabilizer plates. The explained variance of state anxiety on VAS for pain scores was minimum after 6 weeks. Conclusions: Preoperative anxiety does not appear to influence postoperative pain after PE correction.

Introduction: The main indication for surgery of thoracic wall deformities (TWD) is psychological due to cosmetic complaints. The assumption is that appearances have a negative effect on self-esteem and quality of life (QoL). Correction should result in improvement. Methods: Prospective trial. QoL was assessed using the CHQ and the WHOQOL-bref. Measurements were taken before surgery (T1) and 6 weeks thereafter (T2). Results: Forty-two patients were included. WHOQOL-bref showed differences between pre-operative and six weeks past surgery on facet body image (p = 0.003). Self-esteem (CHQ) did not show a significant improvement at T2. Concerning the scores on the single step questionnaire (SSQ), 33 patients were "very" to "extremely satisfied" with appearance and increased self-esteem (p < 0.001). Concerning the domain "pain and physical complaints", CHQ did show a significant change (p < 0.001) with more complaints at T2. Conclusion: Six weeks after surgical correction of a TWD satisfaction with the "new" chest is good; pain seems to be a problem with possible negative influence on self-esteem.

Background: Deep sternal wound problems (DSWP) are a rare, but serious complication following cardiac surgery requiring extensive medical treatment and resulting in increased mortality. Cardiac surgery patients presenting with both obesity and diabetes mellitus type 2 (DM 2) showed an increased incidence of DSWP in our clinic. As platelets upon activation have been shown to excrete growth factors and attractants for tissue stem cells, thus potentially promoting tissue healing, we investigated whether activated platelets could reduce the incidence of DSWP. Methods: We applied activated autologous platelet rich plasma (PRP), forming a gel (PLG), between the sternal halves immediately prior to closure in obese [body mass index (BMI) >30] DM 2 cardiac surgery patients. The reference group constituted of all elective patients with a BMI >30 and DM 2 operated upon in the 2-year period before the application of PLG. Results: The PLG treated group (n=144) showed a significant decrease in DSWP compared to the reference group (n=118), 6 DSWP vs. 13 DSWP respectively, P=0.03. In these groups the application of PLG was associated with a risk reduction for DSWP from 11% to 4.2%. Conclusions: These results suggest PLG application could be beneficial to prevent DSWP following cardiac surgery in a high-risk population.

Background Sealants are used to prevent prolonged pulmonary air leakage (PAL) after lung resections (incidence 5.6–30%). However, clinical evidence to support sealant use is insufficient, with an unmet need for a more effective product. We compared a novel gelatin patch impregnated with functionalized polyoxazolines (NHS-POx) (GATT-Patch) to commercially available sealant products. Methods GATT-Patch Single/Double layers were compared to Progel ® , Coseal ® , Hemopatch ® and TachoSil ® in an ex vivo porcine lung model (first experiment). Based on these results, a second head-to-head comparison between GATT-Patch Single and Hemopatch ® was performed. Air leakage (AL) was assessed in three settings using increasing ventilatory pressures (max =70 cmH 2 O): (I) baseline, (II) with 25 mm × 25 mm superficial pleural defect, and (III) after sealant application. Lungs floating on saline (37 ℃) were video recorded for visual AL assessment. Pressure and tidal volumes were collected from the ventilator, and bursting pressure (BP), AL and AL-reduction were determined. Results Per sealant 10 measurements were performed (both experiments). In the first experiment, BP was superior for GATT-Patch Double (60±24 cmH 2 O) compared to TachoSil ® (30±11 cmH 2 O, P<0.001), Hemopatch ® (33±6 cmH 2 O, P=0.006), Coseal ® (25±13 cmH 2 O, P=0.001) and Progel ® (33±11 cmH 2 O, P=0.005). AL-reduction was superior for GATT-Patch Double (100%±1%) compared to Hemopatch ® (46%±50%, P=0.010) and TachoSil ® (31%±29%, P<0.001), and also for GATT-Patch Single (100%±14%, P=0.004) and Progel (89%±40%, P=0.027) compared to TachoSil ® . In the second experiment, GATT-Patch Single was superior regarding BP (45±10 vs. 40±6 cmH 2 O, P=0.043) and AL-reduction (100%±11% vs. 68%±40%, P=0.043) when compared to Hemopatch ® . Conclusions The novel NHS-POx patch shows promise as a lung sealant, demonstrating elevated BP, good adhesive strength and a superior AL-reduction.