320 A-MODE ULTRASOUND OF MAXILLARY SINUSITIS IN CHILDREN
maxillary
SIR,-The diagnosis of acute and subacute sinusitis in children presents a dilemma for the clinician. It is very difficult to elicit symptoms referrable to maxillary sinusitis. The child is usually unable to describe his symptoms and the disease is often mistaken for a persistent head cold. The clinician will want to establish whether a sinus contains secretion or not. Secretion indicates impaired drainage with retention of liquid, usually infected, and requires medical treatment, sometimes irrigation, and follow-up. Diagnostic puncture of the maxillary antrum of a child often requires general anaesthesia. The diagnosis is usually confirmed by radiography. A normal X-ray finding is reliable, up to 95%, but when the picture is abnormal confidence in the diagnosis of discharge by radiographic examination with four standard projection is low, only 24%.1 A-mode ultrasound is a simple diagnostic tool which can be used to confirm discharge within the maxillary sinus. The pattern of the reflected sound waves characterises the air and fluid filled sinus. Accuracy in diagnosing discharge in adults ranges up to 90%.2 The patient requires no special preparation and a routine examination of a child takes less than 10 min. It is a non-ionising diagnostic tool without complications. A-mode ultrasound examination and radiographic examination (occipitomental projection) were used as screening tests for children undergoing adenotomy or adenotonsillectomy to detect the presence of fluid within the maxillary sinuses. 61 children, aged 3-12 years (mean age 6.4) were examined. Nobody had symptoms or signs of sinusitis. 3 children had once had radiologically confirmed maxillary sinusitis. 122 maxillary sinuses were examined. Where the radiographic or ultrasound-patterns were abnormal antral puncture and irrigation were done under general anxsthesia. When the X-ray and ultrasound findings were normal, only a control group underwent diagnostic puncture. The total number of punctured sinuses was 76. Out of the radiologically normal 83 sinuses 37 were punctured. Only 1 yielded discharge; the confidence was 97%. Radiological abnormality was found in 39 sinuses. A fluid level SUMMARY OF A-MODE AND SINUS PUNCTURE FINDINGS
radiograph was found in 5 of these. Of the 39 radiologiabnormal sinuses 21 (54%) yielded discharge, and of these 21 only 5 (23%) showed a fluid level in the radiograph. The A-mode ultrasound was abnormal in 19 cases; all these sinuses yielded discharge on puncture. A normal A-mode ultrasonographic finding in 57maxillary sinuses proved to be misleading in 3. The agreement between the irrigation findings and A-mode ultrasonography was 96% (see table). Of 61 children, 13 (21%) yielded discharge on antral irrigation. Out of the 22 sinuses which yielded discharge, 19 (86%) showed an abnormal ultrasound pattern.
A-mode ultrasound proved to be a simple, reliable screening In small children initial radiographs may be necessary to reveal the presence and size of the maxillary sinus for puncture and irrigation, but A-mode ultrasound offers an excellent, nonionising method for monitoring residual fluid in acute and resolving maxillary sinusitis in children.
test.
Department of Otolaryngology, University of Turku, SF-20520 Turku 52, Finland
GASTRIC INHIBITORY ACTION OF
H2-ANTAGONISTS RANITIDINE AND CIMETIDINE
SIR,-Although its indications remain to be identified, the H1-receptor antagonist cimetidine may well become an important therapeutic agent for the treatment of acid peptic
histamine
diseases-witness an excellent Lancet editorial on the use of the drug in duodenal ulceration’ and reports on broader indications for cimetidine, such as very-long-term treatment of peptic ulcer2 and treatment of symptomatic gastro-oesophageal reflux.3 Cimetidine has been the only widely accepted representative of the H1-receptor antagonists. Like histamine, conventional H1-receptor antagonists, including cimetidine, bear an imidazole ring, and this has been regarded as an essential structural feature.’ Recently, however, a substituted aminoalkyl furan, ranitidine, has been shown to be also a specific competitive Hl-blocker in vitro.5 We have compared the inhibitory actions of ranitidine and cimetidine on gastric acid response to pentagastrin (1.5 p.g kg"’1 h-’ intravenously). On separate days, in each of seven1 healthy volunteers, ranitidine (0.125, 0.25, 0-5, 1.0 mg kg h-1) and cimetidine (0.82 mg kg-1 h-l, equimolar to the highest ranitidine dose) were intravenously infused in random order in the mid-hour of a 3 h pentagastrin period. Normal saline served as control. The maximum inhibitory effect of ranitidine was reached and maintained 60-75 min after beginning of drug infusion. Reduction of acid output was almost linearly related to the log dose of ranitidine (about 67, 80, 90, and 99%) and was significant (p
maxillary
SIR,-The diagnosis of acute and subacute sinusitis in children presents a dilemma for the clinician. It is very difficult to elicit symptoms referrable to maxillary sinusitis. The child is usually unable to describe his symptoms and the disease is often mistaken for a persistent head cold. The clinician will want to establish whether a sinus contains secretion or not. Secretion indicates impaired drainage with retention of liquid, usually infected, and requires medical treatment, sometimes irrigation, and follow-up. Diagnostic puncture of the maxillary antrum of a child often requires general anaesthesia. The diagnosis is usually confirmed by radiography. A normal X-ray finding is reliable, up to 95%, but when the picture is abnormal confidence in the diagnosis of discharge by radiographic examination with four standard projection is low, only 24%.1 A-mode ultrasound is a simple diagnostic tool which can be used to confirm discharge within the maxillary sinus. The pattern of the reflected sound waves characterises the air and fluid filled sinus. Accuracy in diagnosing discharge in adults ranges up to 90%.2 The patient requires no special preparation and a routine examination of a child takes less than 10 min. It is a non-ionising diagnostic tool without complications. A-mode ultrasound examination and radiographic examination (occipitomental projection) were used as screening tests for children undergoing adenotomy or adenotonsillectomy to detect the presence of fluid within the maxillary sinuses. 61 children, aged 3-12 years (mean age 6.4) were examined. Nobody had symptoms or signs of sinusitis. 3 children had once had radiologically confirmed maxillary sinusitis. 122 maxillary sinuses were examined. Where the radiographic or ultrasound-patterns were abnormal antral puncture and irrigation were done under general anxsthesia. When the X-ray and ultrasound findings were normal, only a control group underwent diagnostic puncture. The total number of punctured sinuses was 76. Out of the radiologically normal 83 sinuses 37 were punctured. Only 1 yielded discharge; the confidence was 97%. Radiological abnormality was found in 39 sinuses. A fluid level SUMMARY OF A-MODE AND SINUS PUNCTURE FINDINGS
radiograph was found in 5 of these. Of the 39 radiologiabnormal sinuses 21 (54%) yielded discharge, and of these 21 only 5 (23%) showed a fluid level in the radiograph. The A-mode ultrasound was abnormal in 19 cases; all these sinuses yielded discharge on puncture. A normal A-mode ultrasonographic finding in 57maxillary sinuses proved to be misleading in 3. The agreement between the irrigation findings and A-mode ultrasonography was 96% (see table). Of 61 children, 13 (21%) yielded discharge on antral irrigation. Out of the 22 sinuses which yielded discharge, 19 (86%) showed an abnormal ultrasound pattern.
A-mode ultrasound proved to be a simple, reliable screening In small children initial radiographs may be necessary to reveal the presence and size of the maxillary sinus for puncture and irrigation, but A-mode ultrasound offers an excellent, nonionising method for monitoring residual fluid in acute and resolving maxillary sinusitis in children.
test.
Department of Otolaryngology, University of Turku, SF-20520 Turku 52, Finland
GASTRIC INHIBITORY ACTION OF
H2-ANTAGONISTS RANITIDINE AND CIMETIDINE
SIR,-Although its indications remain to be identified, the H1-receptor antagonist cimetidine may well become an important therapeutic agent for the treatment of acid peptic
histamine
diseases-witness an excellent Lancet editorial on the use of the drug in duodenal ulceration’ and reports on broader indications for cimetidine, such as very-long-term treatment of peptic ulcer2 and treatment of symptomatic gastro-oesophageal reflux.3 Cimetidine has been the only widely accepted representative of the H1-receptor antagonists. Like histamine, conventional H1-receptor antagonists, including cimetidine, bear an imidazole ring, and this has been regarded as an essential structural feature.’ Recently, however, a substituted aminoalkyl furan, ranitidine, has been shown to be also a specific competitive Hl-blocker in vitro.5 We have compared the inhibitory actions of ranitidine and cimetidine on gastric acid response to pentagastrin (1.5 p.g kg"’1 h-’ intravenously). On separate days, in each of seven1 healthy volunteers, ranitidine (0.125, 0.25, 0-5, 1.0 mg kg h-1) and cimetidine (0.82 mg kg-1 h-l, equimolar to the highest ranitidine dose) were intravenously infused in random order in the mid-hour of a 3 h pentagastrin period. Normal saline served as control. The maximum inhibitory effect of ranitidine was reached and maintained 60-75 min after beginning of drug infusion. Reduction of acid output was almost linearly related to the log dose of ranitidine (about 67, 80, 90, and 99%) and was significant (p
