Objective: To evaluate the usefulness of adynamic lateral neck radiographs and dynamic video rhinoscopy in assessing adenoid size and the relationship of these methods to associated symptoms and thus the severity of the disease. Methods: Children with suspected adenoid hypertrophy underwent standard lateral neck soft tissue radiographs: the percentage of airway occlusion, adenoid to nasopharynx (AN) ratio, airway to soft palate ratio, and adenoid thickness were assessed by a radiologist. The percentage of airway closure was assessed by direct fibre-optic rhinoscopy in an ear, nose, and throat clinic. Associated clinical symptoms were assessed by parents using a standardized questionnaire, evaluating the severity of symptoms (snoring, sleep apnea, mouth breathing, and otitis media) to give a total symptom score out of 16. Results: Nonparametric statistical analysis using Spearman's correlation coefficients was performed on 32 patients. There was a weak correlation, which approaches significance, between the percentage of airway occlusion assessed by fibre-optic rhinoscopy and the total symptom score (r = .344, p = .054). However, this correlation becomes significant when the frequency of otitis media is omitted (r = .367, p = .039). There was also a significant correlation between airway occlusion assessed by rhinoscopy and the percentage of airway occlusion as determined by lateral neck radiography (r = .431, p = .014). There was no correlation between any of the measurements taken by lateral soft tissue neck radiography and total symptom score. Conclusion: Dynamic video rhinoscopy is more accurate at assessing adenoid hypertrophy, and the percentage of airway occlusion, as estimated by video rhinoscopy, is better correlated to the severity of symptoms than are values obtained by lateral neck radiography. Sommaire Objectif: Evaluer l'utilité de la radiographie latérale du cou adynamique et de la vidéo-rhinoscopie dynamique pour mesurer le volume adénoidien et la relation entre ces méthodes et les symptômes et la sévérité de la maladie. Méthode: Nous avons fait passer à 32 enfants, un rayon-X standard des tissus mous du cou et un radiologiste a procédé aux mesures suivantes : le pourcentage d'occlusion des voies respiratoires, le rapport entre les adénoides et la nasopharynx (AN), le rapport entre les voies respiratoires et le palais mou et l'épaisseur des adénoides. Le pourcentage d'obstruction a aussi été évalué par rhinoscopie directe par fibre optique à la clinique externe. Finalement les parents ont évalué sur 16 la sévérité des symptômes en remplissant un questionnaire standardisé évaluant les aspects suivants : ronflement, apnée du sommeil, respiration buccale et une histoire d'otites moyennes. Résultats: Nous avons trouvé une faible corrélation (Spearman) presque significative entre la rhinosocopie par fibre optique et le score de symptômes (r = .344, p = .054). Cette corrélation devient significative quand on omet l'aspect otites moyennes (r = .367, p = .039). On note aussi une corrélation entre l'obstruc...

Objective: Retrospective analysis of all patients treated for retropharyngeal infection in a tertiary care pediatric hospital. Methods: Charts were reviewed for demographic data, duration of symptoms, radiologic workup, antibiotic choice, microbiologic findings, surgical approach, complications, and duration of medical therapy. Surgical findings were correlated with computed tomographic (CT) scans. Results: Sixty-eight patients were included in the study. Empirical intravenous clindamycin was started for a trial of conservative medical therapy. Fifty-one patients (75%) responded to medical treatment, and only 17 patients (25%) required surgical intervention. The CT scan showed a sensitivity of 43% and a specificity of 63% in this series. None of the patients with retropharyngeal infection died, had a major complication, or had a recurrence. Conclusion: Based on the current study, we propose that all patients should be given a trial of medical treatment with intravenous clindamycin. Surgery should be reserved for those who do not respond. An extensive review of the literature is presented. Sommaire Objectif: Analyse rétrospective de tous les patients traités pour une infection rétropharyngée dans un hôpital de soins tertiaires pédiatriques. Méthode: Nous avons extrait des dossiers les informations suivantes : démographie, durée des symptômes, investigation radiologique, choix d'antibiotiques, constatations microbiologiques, approche chirurgicale, complications et durée du traitement médical. Les trouvailles chirurgicales ont aussi été corrélées avec la tomodensitométrie. Résultats: Nous avons revu 68 dossiers. La clindamycine a été essayée empiriquement dans tous les cas. Cinquante-et-un patients ont bien répondu à ce traitement et seulement 17 (25%) ont donc eu besoin d'une intervention chirurgicale. La tomodensitométrie a montré une sensibilité de 43% et une spécificité de 63%. Aucun de ces patients n'a présenté de complication significative (aucun n'est décédé) ni n'a présenté de récidive. Conclusion: Suite à ces résultats, nous recommandons un traitement médical de clindamycine intraveineuse pour tous. La chirurgie devrait être réservée pour ceux qui ne répondent pas. Nous présentons aussi une revue de la littérature.

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Although all doses of ionizing radiation have some malignancy-inducing potential, a small but important percentage of children with IBD are exposed to particularly high doses of ionizing radiation from diagnostic tests and procedures. Physicians caring for such patients must seek to limit radiation exposure whenever possible to lessen the lifetime risk of malignancy.

Background:Infants with neonatal hydronephrosis and a normal voiding cystourethrogram (VCUG) are presumed to have ureteropelvic junction obstruction (UPJO). There is little current information about the natural history of children with hydronephrosis or clinical factors that predict resolution of the radiological abnormality.Objective:To determine the time course until spontaneous resolution of neonatal hydronephrosis and define risk factors for persistence of the abnormality.Methods:This retrospective single center review examined infants and children <5 years of age with hydronephrosis who were followed for at least 12 months.Results:136 children were identified (96 male:40 female). The mean age at diagnosis of hydronephrosis was 3.3 ± 9.7 months and 76% of the patients were diagnosed at birth. The hydronephrosis was unilateral in 98 (72%) of cases, and hydronephrosis was at least moderate in severity in 22% of affected kidneys. At last follow-up at 30 ± 10 months, the abnormality had resolved in 77 out of 115 (67%) available patients, 30 (26%) had been referred to urology, and 12 (10%) had persistent hydronephrosis. Severity of hydronephrosis was the only clinical feature that predicted persistence of the abnormality (P < 0.001). There was an association between detection at birth and lack of resolution of hydronephrosis.Conclusions:Children with hydronephrosis and presumed UPJO and normal kidney parenchyma can be followed for at least 2 years to allow for spontaneous resolution before referral to urology. Serial sonography can be performed at 6 month intervals in uncomplicated cases. More severe hydronephrosis and presence of the lesion at birth may predict infants and children requiring closer observation and referral for possible surgical correction of the hydronephrosis.

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