Imaging findings of primary adrenal tumors in pediatric patients

Apart from neuroblastomas, adrenal tumors are rarely seen in children. The most common adrenal tumors are adrenocortical carcinoma and pheochromocytoma. Adrenocortical carcinoma is usually a large heterogeneous, well-marginated mass with solid/cystic areas and calcifications, with poor prognosis. Most of the pheochromocytomas are benign tumors and usually show intense contrast enhancement, the pattern of which may be diffuse, mottled, or peripheral on computed tomography and magnetic resonance imaging. The purpose of this article is to evaluate primary nonneurogenic adrenal tumors

Prepubertal Vaginal Discharge: Vaginoscopy To Rule Out Foreign Body

This clinical study is designed to evaluate the results of vaginoscopies performed to rule out vaginal foreign body in prepubertal girls with vaginal discharge. Medical records of all prepubertal patients who underwent vaginoscopy to rule out vaginal foreign body between 2004 and 2013 were reviewed retrospectively. All patients were evaluated by pediatricians prior to surgical consultation. Vaginoscopy is performed in the operating room under general anesthesia. During the study period, 20 girls with persistent vaginal discharge with a mean age of 6.8 years (1-13 years) underwent vaginoscopy to rule out vaginal foreign body. Six patients had bloody vaginal discharge and 4 had recurrent vaginal bleeding lasting for more than one month. Ten patients had purulent vaginal discharge lasting for 1-7 months. None of vaginal cultures revealed pathological bacteria or candida species. Preoperative imaging techniques revealed vaginal foreign body in one patient only. Vaginoscopy demonstrated vaginal foreign bodies in four patients. Foreign bodies were grass inflorescence, safety pin and undefined brownish particles (n= 2), which may be pieces of toilet paper or feces. There was no complication related to vaginoscopy and removal of foreign body. Hymen integrity was preserved in all patients. Persistent or recurrent vaginal discharge in prepubertal girls should raise the suspect of vaginal foreign body. Continuous flow vaginoscopy is mandatory to detect and remove any vaginal foreign body. Early diagnosis would prevent complications secondary to long-standing foreign bodies.WoSScopu

Meconium Periorchitis: An Incidentally Diagnosed Rare Entity During Inguinal Herniorraphy

Meconium periorchitis (MPO) is a rare disorder caused by meconium peritonitis with the leakage of meconium into the scrotal sac through the patent processus vaginalis. MPO may be rarely detected during inguinal hernia repair. The association of MPO with cystic fibrosis is rarely seen. We present a male infant with the complaint of left groin swelling, compatible with reducible inguinal hernia. An herniotomy was carried out and the greenish nodules with calcifications were detected. Histopathological examination was compatible with MPO. Two months later the patient was diagnosed with atypical cystic fibrosis. Clinicians should be aware of MPO presentations and its appearance on the hernia sac to prevent unnecessary orchiectomy.WoSScopu

Evaluation Of Surgically Treated Breast Masses In Children

We aimed to define the diagnostic and treatment characteristics of breast masses among female children who had undergone surgical treatment in order to figure out which children should be followed conservatively or treated surgically. We reviewed retrospectively 64 female patients operated for breast masses under the age of 18 years between 1977 and 2013. Patient demographics, symptoms, physical examination findings, size of the mass and its relation with menstrual cycle, follow-up period before and after surgery, diagnostic characteristics, laboratory analysis, diagnosis before and after surgery, indications for surgery, histopathological characteristics of the mass, postoperative complications, and recurrence rate were recorded. Histopathologic investigations among 41 girls with complete hospital records showed that 26 had fibroadenoma (FA; 63.4%). Eleven girls among the other 23 cases with incomplete hospital records but with histopathological results have also had FA (47%). The majority of breast masses in childhood are FA, the frequency and duration of follow up is important. If there is a mass that will not regress, that continues to grow or does not reduce in size during follow up, and for those with family history of breast cancer to definitely exclude the possibility of malignancy, surgical treatment may be appropriate.WoSScopu

A Pheochromocytoma Case Diagnosed As Adrenal Incidentaloma

There are two problems that needs to be addressed in cases of an adrenal incidentaloma. The first is to decide whether the adrenal mass is benign or malignant, and the second is to determine whether the mass is hormonally active or not. A 17-year-old male was admitted with the complaint of progressive weight gain. Abdominal ultrasonography was performed for elevation in transaminases which revealed a hypoechoic mass located in the left adrenal gland. Hormonal investigations revealed an increase in fractionated catecholamine and metanephrine levels in 24-hour urine. Surgery was performed and pathological examination was in accordance with pheochromocytoma. Mutation analysis was carried out. This is a rare case of pheochromocytoma presenting as adrenal incidentaloma during adolescence. In view of this case, we review the approach to incidentally discovered adrenal masses and the approach to pheochromocytoma. A mutation analysis should be performed on all cases with pheochromocytoma that are diagnosed below age 20.WoSScopu

Drainage Systems' Effect on Surgical Site Infection in Children with Perforated Appendicitis

WOS: 000410618200003Aim: Effect of replacing open drainage system to closed drainage system on surgical site infection (551) in children operated for perforated appendicitis was evaluated. Material and Method: Hospital files and computer records of perforated appendicitis cases operated in 2004-2010 were evaluated retrospectively. Open drainage systems were used for 70 in cases (group I) and closed systems were used in the others (group II). Results: Eleven of 551 cases had superficial infection and 3 had the organ/space infection. 551 rate was 15.795 for group I and 7.59'n for the group II. The antibiotic treatment length was 7.5 t 3.4 days for group I and 6.4 2.2 days for group II and the difference between groups was not statistically significant. Hospitalization length for group I was 8.2 3.1 days and 6.8 1.9 days for group II and the difference was statistically significant. Discussion: 551 is an important problem increasing morbidity and treatment costs through increasing hospitalization and antibiotic treatment length. Open drainage system used in operation in patients with perforated appendicitis leads an increased frequency of SSI when compared to the closed drainage system. Thus, closed drainage systems should be preferred in when drainage is necessary in operations for perforated appendicitis in children

Impact Of Surgery On Growth, Pulmonary Functions, And Acute Pulmonary Exacerbations In Children With Non-Cystic Fibrosis Bronchiectasis

Background Treatment decisions for the management of bronchiectasis include medical treatment, such as antibiotics, chest physiotherapy, and surgical procedures. Here, we aimed to review the effect of lung resection on longitudinal growth, clinical course of patients depending on annual exacerbation rates, and pulmonary function tests (PFTs) and compare them with the results of only medically treated children with non-cystic fibrosis (non-CF) bronchiectasis. Methods The medical records of patients with non-CF bronchiectasis were retrospectively analyzed. Patients who underwent lobectomy/segmentectomy/pneumonectomy were categorized as surgery group ( n =29). Age- and gender-matched patients who were only medically treated were selected as medical group ( n =33). Annual data of patients were included till the end of postoperative second year in the surgery group and third year of medical treatment in the medical group. Results Mean baseline height z -score was lower in the surgery group, and mean baseline PFT values were all lower in the surgery group than those in the medical group ( p <0.05). In the surgery group, mean values of height z -score were -1.680.92 at the time of surgery and improved to -1.42 +/- 1.22 and -1.34 +/- 1.05 in the first and second postoperative years, respectively, and annual intravenous antibiotic requirements decreased significantly ( p <0.05); however, mean body mass index (BMI) z -score values and PFT parameters did not change significantly. In the medical group, height z -score mean values and PFT parameters showed nonsignificant improvement but annual exacerbation frequency, annual intravenous, and oral antibiotic requirements decreased significantly. Conclusion Surgical management of non-CF bronchiectasis has no significant effect on BMI z -scores, annual exacerbation frequencies, oral antibiotic requirements and lung function tests; but can lead to significant improvement on height z -scores and decrease need of annual intravenous antibiotic requirements for acute severe exacerbations despite small number of patients in this study.WoSScopu

Surgical Treatment Results In Unilateral Wilms Tumor: Experience From A High-Volume Pediatric Oncology Center In Turkey

Objective: The aim of the present study was to evaluate the clinical characteristics, factors affecting treatment approach, and long-term outcome of patients with Wilms tumor. Methods: We identified the demographic features, mode of presentation, applied treatments, and long-term outcomes of 88 patients treated between 1990 and 2011 at Hacettepe University Ihsan Dogramaci Children's Hospital according to the Turkish Pediatric Oncology Group protocol. Data were analyzed using SPSS program, and chi-square test was used for statistical analysis. Results: The study included 88 patients (50 females and 38 males) with a mean age at presentation of 3 +/- 2.48 years. Patients were classified as stage 1 (n=35, 39.8%), stage 2 (n=16, 18.2%), stage 3 (n=17, 19.3%), and stage 4 (n=20, 22.7%). Pathological examination of tumors revealed favorable histology in 76 (86.4%) patients and unfavorable histology in 10 (11.4%) patients. Forty-nine (55.6%) patients received preoperative chemotherapy, and patient's age at diagnosis and physical examination findings influenced the decision of the administration of preoperative chemotherapy (p<0.05). Of the 88 patients, 25% aged <1 year and 75% aged between 3 and 5 years received preoperative chemotherapy. The palpated mass was crossing the midline in 20.5% of patients who were subjected to primary surgery. Tumor ruptured in 5.6% of patients intraoperatively. Long-term prognosis of patients was as follows: 68 (83.9%) children were cured and 13 (16%) children died due to recurrences and metastases. Survival rates reached 100% in stage 1 and 2 patients but decreased to 75% and 50% in stage 3 and 4 patients, respectively. Conclusion: Age at presentation and physical examination findings are significant in surgical planning. Stage is the most important prognostic factor. Patients with Wilms tumor are treated with low complication and high survival rates due to multidisciplinary treatment approach at our institution.Wo

Foreign Body Aspiration in Infants

Background: Foreign body aspiration (FBA) is a serious life-threatening condition in childhood. “Baby-led weaning (BLW)” is a popular method in which the babies are encouraged to self-feed to gain oral motor abilities. The role of BLW in FBA is controversial. A retrospective study was performed to evaluate the results of FBA in infants (<1 year of age) and its relation to the feeding method., Materials and Methods: Children who underwent bronchoscopy for FBA for the past 10 years were included. Infants (<1 year of age) were evaluated for age, gender, clinical findings, and the results of bronchoscopy. The type of feeding, including self-feeding or caregiver-assisted feeding, was noted., Results: The medical records of 826 patients who underwent bronchoscopy were evaluated. FBA was noted in 50.2% (n = 417) of cases. Only 9.07% (n = 75) of patients were <1 year of age and 67% (n = 50) of them had a foreign body according to the bronchoscopy. The mean age was 9 months (5–12 months) and 36% of them were male. When the feeding characteristics of patients were surveyed, 80% of cases aspirated when self-feeding and 14% aspirated during caregiver-assisted feeding., Conclusions: Self-feeding to promote oral motor function may cause FBA in infants. Emergent bronchoscopy is more common in infants and reveals the aspiration of foods that cannot be consumed safely in this age group.PubMedWoSScopu

Recurrent Hemoptysis And A Mass In The Thorax In An Infant: The Split Notochord Syndrome

Split notochord syndrome is a rare group of developmental abnormalities caused by abnormal splitting or deviation of the notochord clinically resulting in the duplicated bowel associated with vertebral anomalies. We report on a case of 11-month-old female infant with mediastinal hyperechogenic cyst and intestinal duplication cyst associated with T5-T6 hemivertebrae, scoliosis, and nonfusion of posterior part of T6 vertebrae, presenting with severe hemoptysis and hematemesis. The cysts were surgically removed, and histopathologic analysis revealed that the mediastinal cyst was lined by gastric mucosa and intestinal one was lined with gastric mucosa including ectopic pancreatic tissue. After removal of the lesion the patient made an uneventful recovery and shows no signs of long-term pulmonary sequelae.PubMe