The diagnosis and follow-up of pediatric sinusitis: Water's view radiography versus ultrasonography.

Water's view plain film radiography was compared with ultrasonography in the diagnosis and follow-up of acute maxillary sinusitis in 85 children (170 sinuses). At the first visit, the concordance of the two modalities was 91%, but 20 days later, when the symptoms and signs had disappeared, it was only 76%. At the latter date, the concordance between radiography and clinical findings was 71% and between sonography and clinical findings, 93%. The two modalities studied appear to be equally useful in the initial diagnosis of acute maxillary sinusitis. The loss of back-wall echo correlates well with symptomatic improvement of acute sinusitis. Sonography is also nonionizing and inexpensive, and the examination is simple to repeat.

Diagnosis and follow-up of ultrasonographical sinus changes in children.

Retained secretion within the maxillary sinus was diagnosed by ultrasonography in 86 (19%) of 452 children (4-10 years) who entered Turku University ENT-clinic for adenoidectomy or adenotonsillectomy. Occipitomental radiographs showed signs of sinusitis in 168 (37%) of the children. All 86 children with secretion in one or both maxillary sinuses were operated on and treated with amoxicillin and a nasal decongestant. Fifty children (72 sinuses) were treated with antral lavage and 36 children (49 sinuses) were treated conservatively. After 10 days ultrasonography revealed no secretion in 86% of the irrigated sinuses and in 74% of the sinuses treated without irrigation. After 30 days all the irrigated sinuses were healed but in 5 (10%) of the sinuses treated without irrigation ultrasonography still revealed retained secretion. The difference was statistically significant. The disappearance of the radiographic sinus changes was considerably slower. As a non-ionizing method ultrasonography was found to be especially practical in the follow-up of treatment results. It seems that the disappearance of ultrasonic signs of sinusitis correlates better with the clinical resolving of sinusitis in childhood than the disappearance of radiographic signs of sinusitis.

Diagnosis of frontal sinusitis: one-dimensional ultrasonography versus radiography.

In a series of 407 patients suffering from acute frontal sinusitis, 159 sinuses of 134 patients were trephined. Initial radiography of the operated sinuses pointed out a slight tendency to overdiagnosis; 19 (12 per cent) of the 157 sinuses with positive radiographic signs did not yield secretion. Radiography missed only two true cases of fluid retention. Accuracy of diagnosis by radiography was 87 per cent. Initial ultrasonography gave a sign of retained secretion in 127 cases, of which 122 (96 per cent) were true positive. However, 18 (13 per cent) tracings of the 140 sinuses with secretion gave wrong negative findings. Accuracy of diagnosis by ultrasonography was 86 per cent. It seems evident, that ultrasonography measures better retained secretion (excluding very small amounts) and radiography shows better mucosal swellings.

Diagnosis of subacute maxillary sinusitis in children.

The prevalence of subacute, occult maxillary sinusitis in children undergoing adenoidectomy, adenotonsillectomy or tympanostomy was 27 per cent as confirmed by antral puncture. A-mode ultrasound examination and radiographic examination with the occipito-mental projection were used as preoperative screening tests for the detection of maxillary sinus discharge. 135 children aged 4--10 years were examined. An abnormal radiographic finding was found in 40 per cent of children. When punctured these sinuses yielded discharge in 62 per cent of cases. A normal radiographic finding proved to be reliable (98 per cent). The total agreement between puncture and radiographic finding was 73 per cent. The total agreement between puncture and A-mode ultrasound finding was 94 per cent. The A-scan was positive in 88 per cent of the sinuses with discharge. A-mode ultrasonic examination proved to be a simple, non-ionizing reliable means of monitoring retained secretion within maxillary sinuses of children.

Health and life style among infertile men and women.

OBJECTIVE: Lifetime prevalence of infertility among couples is approximately 10-15%, but studies addressing their health behavior are few. Our aim was to describe health and life style of Finnish men and women who had experienced infertility. DESIGN: Cross-sectional survey. SETTING: Finland. POPULATION AND METHODS: Data from a population-based survey (n=7021) was utilized. Life style of infertile men (n=289) and women (n=155) were compared to other men and fertile women. MAIN OUTCOME MEASURES: Life style (dietary factors, use of alcohol, physical activity), reproductive factors, other diseases and symptoms. RESULTS: After adjusting for age, area and education, infertile women under 50 years consumed more polyunsaturated fat (OR 1.23, 95% CI 1.03-1.46), less saturated fat (OR 0.83, 95% CI 0.74-0.92) and had experienced more hangovers during previous year (OR 1.02, 95% CI 1.00-1.05) than fertile women. Infertile men under 50 years consumed more total fat (OR 1.06, 95% CI 1.03-1.10), polyunsaturated fat (OR 1.20, 95% CI 1.05-1.37) and monounsaturated fat (OR 1.17, 95% CI 1.06-1.28) compared to other men. Infertile men did not consume more alcohol nor smoke more cigarettes but reported more often allergies than fertile men. Infertile women also had Chlamydia trachomatis infection, benign tumor in their uterus and intestinal disease more often than fertile women. Infertile women over 50 years were more often current smokers than fertile women, but the differences in other age-groups were not significant. CONCLUSIONS: Women with infertility experience reported more diseases and less use of oral contraceptives than other women, possibly reflecting reasons to infertility. Since both infertility and unhealthy use of alcohol are an increasing public health issues in western societies, more attention should be paid towards life style, especially alcohol use of infertile women.

Topical adrenaline in the control of intraoperative bleeding in adenoidectomy: a randomised, controlled trial.

OBJECTIVES: To evaluate the efficacy of topical racemic adrenaline (RA) (Micronefrin; Bird Products, Palm Springs, CA, USA) in the control of intraoperative bleeding and the prevention of postoperative bleeding, laryngeal spasm and postoperative pain in adenoidectomy among children <6 years of age. DESIGN: Prospective, randomised, blinded and placebo-controlled trial. SETTING: Kanta-Hame Central Hospital, a district referral center in Finland. PATIENTS: A consecutive sample of 93 children undergoing outpatient adenoidectomy. INTERVENTION: Patients were randomised to receive topical gauze sponges soaked in either 1:500 RA or 0.9% sodium chloride (physiological saline) for 3 min after adenoidectomy. MAIN OUTCOME MEASURES: Amount of intraoperative bleeding (surgeons' subjective estimate), need for additional packings, need for electrocautery, laryngeal spasm, postoperative bleeding and pain, duration of procedure and duration of patients' stay in the operation room (OR). RESULTS: Adrenaline significantly decreased surgeons' subjective estimate of the amount of intraoperative bleeding (proportion of patients with significant decrease 67 versus 21%, P < 0.001), reduced the mean number of packings needed (0.6 versus 1.2, P < 0.001) and use of electrocautery (22 versus 45%, P = 0.015), and shortened the mean duration of the procedure (13 versus 18 min, P = 0.043) and the mean stay in the OR (31 versus 35 min, P = 0.058). The impact of adrenaline was even more pronounced among patients with extensive adenoids and/or profuse intraoperative bleeding. A slight elevation of heart rate was observed more often in the adrenaline group (P = 0.043). CONCLUSIONS: Use of topical adrenaline can be recommended in adenoidectomy among children. It helps control the intraoperative bleeding, reduces the use of electrocautery and shortens the durations of procedure and stay in the OR.

Sinusitis. Diagnostic methods.

Sinusitis, which primarily involves the anterior ethmoid air cells, can spread to the larger sinus cavities to cause acute and chronic secondary infection. Endoscopic and computed tomographic techniques enable earlier diagnosis and treatment of sinusitis and permanent cure. Primary care physicians should try to identify the disease before it reaches a stage where endoscopic control becomes difficult. Ultrasonography is now used in Europe to diagnose sinusitis and initiate treatment.

[Ultrasound testing in the diagnosis and management of maxillary sinusitis in children (author's transl)]. / Die Verlaufskontrolle des Heilungsprozesses der kindlichen Kieferhöhlenentzündung mit der Ultraschalldiagnostik.

A- and B-mode ultrasound testing was used in conjunction with X-ray studies as screening tests for the detection of maxillary sinusitis in 280 children (aged 4-10 years) about to undergo adenoidectomy, and/or tonsillectomy and/or tympanostomy. X-rays were abnormal in 114 (41%) children, while sinus disease with the retention of discharge was diagnosed by ultrasound in 63 (23%) children. These latter children were then treated for ten days with amoxicillin and decongestant (Rinexin). At time of initial surgery, 63 maxillary sinuses (in 43 of the children) were punctured and irrigated. Another group (consisting of 27 sinuses in 20 children) was treated without antral puncture. All children were reexamined after 10, 20 and 30 days with ultrasound and radiography. After 10 days, there was no discharge found in 86% of the sinuses treated by antral puncture and in 85% of the control sinuses. After one month, all sinuses which had been irrigated were found to be free of disease, while three (11%) of the control group contained discharge. However, the healing process in all patients seemed to be slower, as evidenced by sequential sinus X-rays.--We believe that ultrasonic evaluation of the maxillary sinuses is a simple, rapid and reliable method for the diagnosis and followup of maxillary sinusitis in children. With this technique, it is possible to follow the disappearance of residual sinus discharge as well as diagnose cases which need active treatment.

Use of radiotherapy for control of sialorrhea in patients with amyotrophic lateral sclerosis.

Many patients with amyotrophic lateral sclerosis (ALS) develop progressive difficulty with swallowing secretions, and drooling becomes a significant problem. The production of saliva can be reduced with radiation of the submandibular and sublingual salivary gland tissue. This method has been used successfully in Europe and had limited use at Vancouver Hospital. This study was undertaken to determine the lowest effective dose of radiation necessary to control salivary production. Over a 3-year period, patients with ALS who developed significant problems with drooling were identified and treated with a predetermined dose of radiation. The first group received a single dose of 8 Gy in one fraction and the second received a total of 12.5 Gy in two fractions. They were followed over the next 6 months and were evaluated for effectiveness and side effects. Their saliva was measured pre- and postradiation treatment, and they were also asked to evaluate the change subjectively, using a questionnaire. The preliminary findings suggest that 8 Gy of radiation was effective in controlling drooling, and increasing the dose did not improve initial control. Long-term control was difficult to evaluate as the patients entered in the study were very ill and their life expectancy was very short. Radiation at this low dose resulted in very few side effects. Low-dose radiation can safely help control secretions in selected patients with ALS.