Introduction The number of patients with necrotizing pneumonia has increased in recent years. The aim of this study is to review the incidence, management, and outcome of pediatric necrotizing pneumonia requiring surgical therapy and to prove that lung resection results in favorable development of patients. We hypothesize that overall lung function in children after lung resection does not differ from that of the healthy population. Materials and Methods A retrospective tertiary referral center study with a prospective follow-up spirometric study of patients with necrotizing pneumonia managed between January 2010 and December 2019 was performed. Results The study cohort consisted of 1,295 patients admitted to the pediatric department for community-acquired pneumonia; 47 patients developed necrotizing pneumonia, 36 of whom underwent parenchymal lung resection. A 5-year rise in the occurrence of necrotizing pneumonia requiring resection was 77%, with a significant increase in the last 3 years (p < 0.05). The median age at the time of surgery was 32.5 (interquartile range [IQR]: 32.25) months. Streptococcus pneumoniae was the most prevalent pathogen (83%), although 53.3% of these patients were vaccinated against the agent. In 67% of patients, preresection procedures were performed: drainage of pneumothorax (17%), drainage of empyema (46%), drainage of empyema with use of alteplase (25%), and thoracoscopic decortication (12%). Surgical procedures included lobectomy (72.2%), wedge resection (13.9%), bilobectomy (8.3%), and pneumonectomy (5.6%). The postoperative complication was bronchopleural fistula in three patients. There were two (5.5%) postoperative deaths due to multiple organ failure. The follow-up spirometry was performed 43.3 (median, IQR 23.8–66.7) months after surgical intervention. Normal lung function was detected in 35 (64.8%) patients, restrictive pattern in 6 (11.1%) patients, obstructive pattern in 11 (20.4%) patients, and combined in 2 (3.7%) patients. Conclusion The number of patients with necrotizing pneumonia requiring resection has increased significantly in the last 3 years (p < 0.05). Aggressive surgical treatment results in significant clinical improvement in most cases and favorable lung function outcome. Long-term follow-up showed normal spirometry in 64.8% of cases.

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Purpose:We investigated quality of life, long-term lower urinary tract symptoms, sexual function and subjective attitudes toward surgery in adult women after feminizing genitoplasty for congenital adrenal hyperplasia.Materials and Methods:We retrospectively reviewed the medical files of all patients with congenital adrenal hyperplasia who underwent feminizing genitoplasty from 1996 to 2018 in our tertiary center. Of those, patients older than 16 years of age were asked to answer 1 nonvalidated and 3 standardized and validated questionnaires evaluating their current mental well-being (WHO-5 Well-Being Index), lower urinary tract symptoms (ICIQ-FLUTS) and sexual function (GRISS). The anonymized answers of this cross-sectional study were compared to a control group of 50 healthy females. Student’s t-test, Pearson's χ2 test, Fisher's exact test and Spearman's rank correlation coefficient were performed. A p-value less than 0.05 was considered significant.Results:Out of 106 patients who underwent feminizing genitoplasty, 64 patients were included and 32 patients, aged 17 to 40 years (median 25.5 years), answered the questionnaires (50% response rate). The difference between congenital adrenal hyperplasia and control group mental well-being was not statistically significant (WHO-5 median score 60 and 64, respectively; p=0.82). We found no significant difference in the lower urinary tract symptoms subscales of filling, voiding or incontinence, nor in the overall lower urinary tract symptoms score (ICIQ-FLUTS overall median score 3.5 and 3, respectively; p=0.43).Conclusions:We found in our group no abnormal mental well-being or prevalence of long-term symptoms of lower urinary tract dysfunction in adult female patients with congenital adrenal hyperplasia following feminizing genitoplasty.

Aim of the study: To review the occurrence, follow-up, and outcome of necrotizing pneumonia requiring surgical management. Methods: A prospective-retrospective, single-centre study of patients with necrotizing pneumonia managed between 1 January 2010 and 31 December 2019. Main results: The study cohort consisted of 1,295 patients admitted to the paediatric department for pneumonia, 36 of whom underwent parenchymal lung resection. A five-year rise in the occurrence of necrotizing pneumonia requiring resection was 77%, with a significant increase in the last three years (P<0.05). The median age at the time of surgery was 32.5 (interquartile range: 32.25) months. Streptococcus pneumoniae was the most prevalent pathogen (83%), although 53.3% of these patients were vaccinated against the agent. In 67% of patients, pre-resection procedures were performed: drainage of pneumothorax (17%), drainage of empyema (46%), drainage of empyema with use of alteplase (25%), and thoracoscopic decortication (12%). Surgical procedures included lobectomy (72.2%), wedge resection (13.9%), bilobectomy (8.3%) and pneumonectomy (5.6%). The post-operative complication was bronchopleural fistula in three patients. There were two (5.5%) postoperative deaths due to multiple organ failure. The follow-up spirometry performed 39.3 months (median) after surgical intervention was normal in 68.3% of patients, restriction was detected in 10.0%, and peripheral obstruction in 18.3%. Conclusions: Despite high rates of vaccination against pneumococcus, the number of patients with necrotising pneumonia requiring resection has increased significantly in the last three years (P<0.05). Aggressive surgical treatment results in significant clinical improvement in most cases and favourable lung function outcome. Significant increase in lung resections for necrotizing pneumonia in children in the past decade: outcomes and follow-up Aim of the study The majority of community-acquired pneumonias in children are managed conservatively without the need for surgical intervention. Surgical resection for necrotizing pneumonia is the last but rescue solution for the most severely affected child. The incidence of necrotising pneumonia has increased in recent years [1-4]. This single-centre study reviews the occurrence of necrotizing pneumonia, the types of surgical management, and outcomes of lung resection, and it prospectively evaluates the postoperative follow-up spirometry in children. Methods We performed a prospective-retrospective, single-centre study of patients with necrotizing pneumonia who underwent parenchymal resection for necrotizing pneumonia between