Use of Video-Assisted Thoracoscopic Surgery (VATS) in the Treatment of Primary Spontaneous Pneumothorax (PSP) in Children.

INTRODUCTION: This study aims to review the primary spontaneous pneumothorax (PSP) patients we have treated and to discuss the results in terms of PSP treatment management and video-assisted thoracoscopic surgery (VATS) use in the light of the literature. METHODS: The study was designed retrospectively and conducted at a tertiary referral university hospital between January 1, 2015 and May 1, 2021. Patients under the age of 18 years with a diagnosis of pneumothorax (PTX) were included in the study. Medical records were analyzed in terms of clinical characteristics, demographic data, findings from imaging data, procedures performed, and course of the disease at hospital. Patients with no evidence of PTX on radiologic imaging (direct postero-anterior chest X-ray (PACXR) or thoracic computed tomography (TCT)), incomplete medical records for follow-up, history of trauma, and neonatal PTX were excluded from the study. RESULTS: The study was conducted on a total of 98 PTX cases in 69 patients, 61 (88.4%) males and eight (11.6%) females. The ages of the patients ranged between 13 and 17 years with a mean of 16.59 ± 0.95 years. While 48 (49%) PTX cases were treated with tube thoracostomy, 19 (19.4%) were treated with medical follow-up (nonsurgical treatment) and 31 (31.6%) were treated with VATS. A total of 31 VATS procedures were performed on 28 patients. The follow-up period after VATS ranged from tthree to 78 months, with a mean of 31.5 ± 20.3 months and a median of 28 months. CONCLUSION:  Our retrospective study showed that TCT scanning did not provide additional benefit when PSP was detected on PACXR in patients presenting with chest pain and respiratory distress. According to the findings of our study, it was thought that the probability of undergoing an invasive procedure and surgical intervention increased as the percentage of PTX detected in PACXR increased. Tube thoracostomy may be required in a patient with PSP if PTX does not start to decrease and lung expansion does not increase after an average of 60 hours after the decision for medical follow-up, and if PTX is progressive in the follow-up. VATS can be performed on a patient with PSP when lung expansion does not increase after an average of 18 hours after tube thoracostomy, when PTX progresses, when air leakage continues for more than 10 days despite increased lung expansion, and when recurrent PTX occurs.

Human chorionic gonadotrophin secreting adrenocortical neoplasm presenting with peripheral precocious puberty in an infant.

Adrenocortical tumor (ACT) is a rare malignant tumor which usually present with Cushing syndrome and virilization. Paraneoplastic syndromes (PNS) due to neoplasms can occur with peptides or cytokines secreted by the tumor. Here, we report a 13-month-old-male presented with severe masculinization. He had signs of precocious puberty with enlarged testicles, very high testosterone levels but low levels of gonadotrophins, and elevated ß-hCG. He underwent a left nephrectomy. The histopathological evaluation revealed a diagnosis of adrenocortical neoplasm. The levels of androgens and ß-hCG normalized after the resection of tumor, and the clinical findings improved within few months. We report the first pediatric patient with peripheral precocious puberty due to an ACT that secretes ß-hCG as PNS. A ß-hCG secreting ACT can cause severe virilization due to increased gonadal androgens stimulated by ß-hCG as well as due to increased adrenal androgens from the tumor.

What has changed in children's appendicitis during the COVID-19 pandemic?

BACKGROUND: The present study aimed to investigate the changes in the course of acute appendicitis during the pandemic period by comparing the cases treated during the coronavirus disease 2019 (COVID-19) pandemic with those in the pre-pandemic period. METHODS: The study was conducted with 601 children aged 1-18 years who were operated for acute appendicitis between May 1, 2019, and February 29, 2020 (Group I) and between March 1 and December 31, 2020 (Group II). The demographic and disease characteristics as well as the treatment processes were compared between the groups. RESULTS: It was found that 59.1% (n=355) of the cases included in the study were in Group I and 40.9% (n=246) were in Group II. During the pandemic period; due to the concerns of families about contracting a contagious disease for both themselves and their children, and warnings by health professionals and government officials that they should not leave their homes and not come to the hospital unless there is an emergency, the time to apply to the hospital has been extended. Before the pandemic, 20.3% of the patients presented to the hospital on the 1st day of their complaints, where during the pandemic, only 2% of the patients reported to the hospital on the 1st day, and 15% presented after 4 days or more. As a result, the rate of perforated appendicitis, which was formerly 10.4%, increased to 24.8% during the pandemic period (p<0.01). During the pandemic, we operated on four patients with positive COVID-19 test results. There were no complications related to COVID-19 and surgery in our patients. CONCLUSION: Concern of the current pandemic resulted in late presentation to the hospital, increase in the number of perforated appendicitis, and prolonged hospital stay.