A comparative randomized study on the efficacy of a systemic steroid therapy vs. a thermal therapy in otitis media with effusion in children.

BACKGROUND: The aim of this study was to compare the effectiveness of a systemic steroid therapy vs. a thermal therapy based on sulphurous water insufflation. The therapy was performed in Telese Terme Spa based on the Salimbani-Politzer technique on children suffering of otitis media with effusion (OME), using the variations of the tympanogram as objective outcome in a short time follow-up. METHODS: Eighty children suffering of monolateral or bilateral OME (44 male, 36 female, age 4-12 years, average age 7.2±2.83 ys.), enrolled in ENT or paediatrics offices, have been included in the study. Children were included in a randomization list in order to obtain two therapeutic groups, the first one to be treated through a systemic steroid therapy, the second one to be treated through sulphuruos water insufflation in Telese Spa. Children underwent otoscopic/otomicroscopic visit and tympanometry before the beginning of the therapy (T0), 7 days after the beginning of the therapy (T1), 7-10 days after the end of the therapy (T2), 30-35 days after the end of the therapy (T3). The variation of the type of tympanogram was considered the objective outcome. The shift either from a type B to a type C or o type A tympanogram and from a type C to a type A tympanogram was considered a positive outcome; the persistence either of the same type of tympanogram and the shift from a type C to a type B or from a type A to a type C or a type B were considered a negative outcome. RESULTS: Thermal therapy showed better outcomes at each time, with differences in improvement and healing often reaching the statistical significance. The most important prognostic indicator was the presence of an initial type B tympanogram, associated to a worst prognosis in both therapeutic groups and in each subgroup of OME. CONCLUSIONS: Sulphurous water insufflation therapy appeared a good therapeutic choose in the treatment of OME in a pediatric population.

Which cystography in the diagnosis and grading of vesicoureteral reflux?

The gold standard procedure for the evaluation of vesicoureteral reflux (VUR) is the radiographic voiding cystourethrography (VCUG); direct radionuclide voiding cystography (DRVC) is an alternative method for detecting VUR. A new imaging procedure, voiding urosonography (VUS) with contrast medium, has recently been introduced. We have carried out a comparative study of these three techniques in 157 patients (aged 6 weeks-4.7 years). VUS showed the presence of VUR in 91 of 311 renal units; VCUG detected reflux in 64 of 233 renal units, and the DRVC in 23 of 78 renal units. VCUG and VUS were compared in 118 patients, and both procedures showed the same grade of reflux in 56 refluxing units (kappa value 0.92); in six cases the reflux grade was greater at VUS than at VCUG. Seven cases of reflux detected by VUS were not identified on VCUG. VCUG did not show a grade of VUR that was higher than in VUS in any patient. In the identification of 4 degrees-5 degrees grade reflux, the sensitivity of VUS reached 100%. VUS and DRVC were found to be equally effective in the detection of VUR (kappa value 0.85). In conclusion, we found that VUS is a useful method for the diagnosis and grading of patients with VUR.

Moderate hyperbilirubinemia induces a transient alteration of neonatal behavior.

OBJECTIVE: To investigate the behavioral changes induced by moderate hyperbilirubinemia in the otherwise healthy, untreated newborn infant. METHODS: Fifty term neonates (23 boys) with untreated moderate hyperbilirubinemia (median: 14.3 mg/dL; range: 13.2-20 mg/dL) and 50 matched control subjects with lower bilirubin concentrations (median: 9.1 mg/dL; range: 5.3-12 mg/dL) were administered the Brazelton Neonatal Behavioral Scale at 87 hours of life (range: 72-110 hours). A subgroup analysis was also performed at 104 hours of life (range: 96-134 hours) and at 3 weeks of age. RESULTS: At the first examination, all behavioral clusters were significantly altered in the group with moderate hyperbilirubinemia. The visual and auditory capabilities of the hyperbilirubinemic infant were especially compromised. Although social-interactive cluster scores significantly correlated both with serum bilirubinemia and birth weight, the former accounted for 8.7% of the variance and the latter accounted for only 4.7%. The moderate hyperbilirubinemia neonates' scores also showed a negative correlation with the autonomic system and more frequent presence of tremors. After 24 hours, a decrease in serum bilirubin within the moderate hyperbilirubinemic group was associated with improved scores. At 3 weeks of age, the behavioral assessment of the 2 groups did not show significant differences. CONCLUSIONS: Untreated moderate hyperbilirubinemia is associated with a transient and apparently reversible alteration of neonatal behavior, particularly in the social-interactive area.