The PFAPA syndrome: review on diagnosis and management

Introduction and purpose: Periodic fever, aphthous stomatitis, pharyngitis, and adenitis (PFAPA syndrome) is the most common periodic fever condition in child age. Discussed syndrome is generally a self-limited condition, but it can significantly decrease the quality of child’s life. It can be also challenge for parents, as well as medical professionals. Knowledge of the syndrome is very important among many specialists because early detection is the basis of the correct differentia and proper treatment. Many researches has been made to explain the genetic and immunologic elements which play a significant role in the pathogenesis of PFAPA, but it is not fully undestood. This review will focus on current knowledge regarding the pathogenesis of PFAPA, as well as surgical and conservative treatment strategies. Material and methods: This review was based on available data collected in the PubMed database and published between 2013 and 2022. The study was conducted by reviewing key words as follows: "PFAPA","treatment", "diagnosis","tonsillectomy". Results: The diagnosis of PFAPA syndrome consists of a typical clinical presentation, but sometimes diagnosis of this syndrome can be problematic. Some clinical criteria can be useful. We have vary of treatment arms depends on clinical targets. Depite that PFAPA is self limiting syndrome which can dissappear in later years of children’s life.   Conclusions: PFAPA syndrom is rare disease, but is very important to put emphasis on knowledge about it. Early diagnosis of this syndrome can make physicians send patient to specialized ward, and it will be possible to start proper and efficient treatment. It is a question of the future that we will get more patophysiologic knowledge about this disease

Diagnosis of malignant bone tumors in children

Bone cancers occur mainly in adolescents and young adults, and benign lesions are more frequent than malignant ones. The most common malignant tumors include osteosarcoma, Ewing's sarcoma and chondrosarcoma. The course of the disease may not be obvious and symptoms may be ambiguous, so it is important to catch them early and take appropriate action.  Laboratory tests such as CRP, ESR, LDH, ALP may prove useful in the diagnosis of bone neoplasms in children. All children with suspected malignant bone cancer should undergo an x-ray examination. MRI, CT scans are performed to expand the diagnosis and determine the extent of the disease. The basis of diagnosis is histopathological examination. The result of this study is very important in the selection of therapeutic procedures, it influences decisions regarding the scope and degree of radicality of the operation. It is crucial that the entire diagnostic process is carried out in highly specialized centers that have extensive experience in the diagnosis and treatment of malignant bone tumors in children. It is most beneficial to conduct diagnosis and treatment at the same center, and preferably by the same team of specialists. This team should include doctors from orthopedics, radiology, oncology, radiation therapy and pathomorphology. Conducting diagnosis and treatment in highly specialized centers has a positive effect on the prognosis and quality of life of patients. The purpose of this article is to highlight the early and uncharacteristic symptoms of bone cancer in children and to present the complexity of the diagnostic process, as well as the importance of carrying it out in highly specialized centers with extensive experience in treating pediatric bone malignancies