No abstract

A 12-month-old healthy boy was seen at the outpatient ophthalmology clinic with gradually worsening bilateral temporal facial swelling and proptosis that developed in the setting of a recent bilateral ear infection 10 days prior. He was currently being treated with oral amoxicillin. His mother reported a recent decrease in appetite, decreased feeding, increased irritability, and near-constant crying.On examination, he was inconsolable and crying. His pulse rate was 112 beats/min, blood pressure was 122/68 mm Hg, and temperature was 38.7°C. He had soft, bitemporal facial masses (Figure , A). He was proptotic and demonstrated a substantial change in his ocular appearance compared with photographs taken 4 weeks earlier that his mother brought for our review. He appeared to be orthophoric in primary gaze but had bilateral abduction deficits. His pupils were round and reactive, without an afferent pupillary defect. His anterior and posterior segment examination results were normal, without evidence of optic nerve edema or pallor. His pediatrician had obtained a complete blood cell count and head radiograph 10 days prior that were both normal. Diagnosis Metastatic neuroblastoma What to Do Next C. Admit for urgent imaging and inpatient workup DiscussionAcute-onset proptosis in a child is always concerning, and urgent imaging should be obtained. Several underlying etiologies are possible, including an orbital infection or a neoplastic process (neuroblastoma, rhabdomyosarcoma, leukemia, and Langerhans cell Bilateral facial swelling A Magnetic resonance image B * * * * *

Background: Studies characterize the surgical managements of adrenal tumors are not common in rural hospitals. Methods: A retrospective study conducted at a single rural teaching hospital with subjects including 37 patients who had laparoscopic or open adrenalectomy between 2011 and 2017. Baseline characteristics and postoperative outcomes of patients were examined using univariate and multivariate methods. Logistic regression models were used to analyze perioperative complications. Truncated negative binomial regression models was used to analyze hospital length of stay. Pathologic distribution, correlation of pre-op and pathologic diagnoses were also analyzed.Results: On average, five adrenalectomies per year were done for primary adrenal pathology. Adrenocortical adenoma and pheochromocytoma were the two most common pathologic diagnoses. Length of stay increased in patients with open surgery, RR 3.78 (1.60-8.91), and malignancy, RR 3.18 (1.43-7.06), based on multivariate analysis. Factors associated with post-operative complications in univariable analysis are tumor size odds ratio (OR) 1.02 (95% confidence interval 1.00 to 1.05), and open surgery, OR 4.29 (0.96-21.52). This significance was not present at the multivariable analysis. Conclusions: Evaluation and surgical management of adrenal tumors in a rural hospital for seven years were characterized. The results of this study will contribute to future epidemiological research on adrenal incidentalomas and surgical managements of adrenal tumors in rural hospitals.