The aim of this article is to investigate the effect of the coronavirus disease 2019 (COVID-19) pandemic on our surgical department, which is situated in Athens, Greece, as well as to review published literature on the COVID-19 pandemic's impact on surgical activities in our department. We retrospectively reviewed the surgical procedures that were performed in the surgical department of a tertiary University hospital in Athens, Greece, before and during the pandemic. Furthermore, we performed a literature review evaluating articles on surgical activity and COVID-19 published from the beginning of the pandemic up until the January of 2022 on the PubMed database. In total, 894 patients were included in the study. Of those, 264 (29.5%) underwent surgery during the control period and 630 (70.5%) in the pandemic period. Overall, we performed 20.5% fewer surgeries in the post-sanitary period. In particular, elective surgeries decreased on average by 23.9%, emergency procedures decreased by 8.9%, and oncology surgeries increased by an average of 6.4% after the year 2020. Concerning the review of literature, 51 studies were selected for this review. According to them, the main effect of the pandemic on the surgical sector was reflected in the reduction of total surgeries, mainly due to the postponement of elective surgical procedures, which showed a median reduction of 54% compared to the pre-COVID-19 period. A smaller decrease was observed in the number of emergency and oncological surgeries. Reduced surgical activity during the pandemic, due to the health measures imposed, requires courageous corrective interventions to avoid its adverse effects, such as disease progression, increased treatment costs, reduced quality of life, and ultimately the survival of the patients.

DRESS (Drug Reaction with Eosinophilia and Systemic Symptoms) syndrome is a severe systemic drug reaction characterized by a latent period of several weeks following the initiation of drug therapy. Among the most well-known causative agents is allopurinol, commonly prescribed for managing asymptomatic gout. Allopurinol-induced DRESS syndrome is associated with high mortality rates and significant long-term sequelae. This report details the case of an elderly female patient who presented with an extensive rash covering her trunk and extremities which was concurrent with her use of allopurinol. The condition progressed to renal impairment but showed significant improvement upon cessation of the drug and administration of high-dose corticosteroids. This case aims to shed light on one of the most underrecognized types of systemic drug reactions, hoping to raise awareness about this rare yet serious complication of one of the most widely prescribed drugs.

Https://doi.org/10.18632/oncoscience.614 Areti Kalfoutzou, Kalliroi Spanou, Adam Mylonakis, Vassiliki Lagopoulou, Maria Dimitrakoudi, Alexandra Korovila, Christos Piperis, Eleni Tsiouri, Eleni Mostratou

Adrenocortical carcinoma (ACC) is a rare endocrine cancer that originates in the adrenal cortex, known for its capacity to produce hormones such as cortisol, aldosterone, estrogens, or androgens. These hormonal imbalances lead to a diverse array of clinical manifestations. This case report describes a middle-aged male patient presenting with a dual-hormone secreting ACC, characterized by the secretion of both androgens and cortisol. This hormonal profile resulted in Cushing syndrome along with symptoms of androgen excess, including bilateral lower limb edema, prolonged fatigue, and altered mental status. An extensive diagnostic evaluation, including clinical assessments, laboratory tests and imaging revealed the presence of an adrenal mass and lung metastases. Imaging-guided biopsy confirmed diagnosis of ACC with simultaneous androgen and cortisol secretion. This report enriches the sparse literature on dual-secreting ACC, highlighting the complexities in its diagnosis and management.

This article has been corrected to fix a typo in the PRISMA diagram along with missing reference citations in Table 7 in the Appendix. The Materials and Methods section has been revised to state that "Additional studies were identified by searching the reference lists of relevant articles (n = 20), bringing the total to 308."

Splenic infarction is an extremely rare complication of Epstein-Barr virus (EBV) infection. We report a case of a healthy young man who presented with fever and pharyngitis and was diagnosed with acute EBV infection. During his hospital stay, he developed sudden left upper quadrant abdominal pain. Computed tomography scan of the abdomen demonstrated hepatosplenomegaly and multiple splenic hypodense lesions suggestive of infarcts. The patient was managed conservatively and discharged on prophylactic anticoagulation therapy. He is currently under close clinical follow up to minimize the risk of splenic rupture. We aim to highlight the importance of suspecting splenic infarction in patients presenting with fever, splenomegaly, and new onset abdominal pain, particularly in the setting of an ongoing or recent EBV infection.