Jeffrey C. Gershel

Utility of Post–Urinary Tract Infection Imaging in Patients With Normal Prenatal Renal Ultrasound:

The American Academy of Pediatrics recommends renal ultrasound (RUS) and voiding cystourethrography (VCUG) for all infants after a first urinary tract infection (UTI). However, many congenital renal anomalies are identified by a prenatal US. At the present time, there are no data regarding the yield of post-UTI imaging among infants who have a documented normal prenatal US. We retrospectively reviewed the charts of all patients <1 year of age with a first UTI who had normal kidneys noted on prenatal US to determine the frequency of abnormal findings. Abnormal RUS and VCUG results were noted in 5.1% (24 of 471) and 20.4% (75 of 368) of infants, respectively. While the abnormal US rate is significantly less than what has been previously reported, the frequency of abnormal VCUGs is similar. These results suggest that a post-UTI RUS may not be needed if the prenatal US was normal. However, a VCUG continues to be indicated.

Dose-related effects of nebulized metaproterenol in asthmatic children

The dose-related effects of inhaled 5% metaproterenol solution in asthmatic children between the ages of six and 12 years with acute bronchospasm were evaluated. Tests included FEV1.0, FEF25–75, and PEFR. For entry into the study, subjects were required to have an FEV1.0 or an FEF25–75 less than 80% of the childs predicted normal value based on height and race. Sixty children were randomly assigned in double-blind fashion to receive one of four different doses of 5% metaproterenol inhalant solution: 0.0 ml (placebo), 0.1 ml, 0.2 ml, or 0.3 ml. Drug efficacy was assessed by spirometry using a DeVilbiss Surveyor I spirometer. Spirometry was performed prior to inhalation of the test dose (baseline) and four times after inhalation: immediately after and 15, 30, and 60 minutes after inhalation. Patients in the three treated groups had significantly higher peak post-dose FEV1.0 and FEF25–75 than the placebo group but were not significantly different from one another. There was a significant relationship between dose and incidence of side effects. These results suggest that 0.1 ml (5 mg) of nebulized metaproterenol may provide as much bronchodilatation as higher doses with fewer side effects.

Gastric Bezoar Treatment Using Oral Coca-Cola:

Bezoars are gastric or intestinal foreign bodies primarily composed of ingested food, foreign bodies, and mucus and are classified according to their composition. Common types include phytobezoars composed of vegetable matter, pharmacobezoars composed of nondissolved medication, and trichobezoars composed of swallowed hair. Bezoar formation has been thought to be secondary to ingestion of nondigestible or slowly digested materials in the setting of delayed gastric emptying or impaired gastric motility, but additional factors may also be involved in those with normal or even accelerated gastric emptying. Trichobezoars are the most common type in children and are usually associated with trichotillomania and trichophagia. Gastric bezoars can present with nonspecific symptoms including abdominal pain, nausea, vomiting, early satiety, and anorexia, or they may be discovered incidentally on abdominal imaging. Gastric bezoar is a relatively rare condition in children, and there is no established standard of care with regard to management. Historically, symptomatic gastric bezoars have been removed surgically in order to prevent the sequelae of obstruction, perforation, and peritonitis. More-recent literature, however, has demonstrated the efficacy of less-invasive approaches including endoscopic fragmentation and removal, and chemical dissolution. Cellulase, papain, acetylcysteine, and Coca-Cola have all been shown to successfully treat gastric bezoars in adults. Of these, Coca-Cola has been reported as a particularly safe, inexpensive, and well-tolerated option. Proposed mechanisms of action include the high phosphoric acid content of Coca-Cola working to degrade the bezoar and the carbonation aiding in physically breaking it apart. Nasogastric lavage, endoscopic injection, and oral administration of Coca-Cola have all been shown to effectively treat phytobezoars in adult patients, but there are no previously published reports of successful bezoar dissolution with Coca-Cola in a pediatric patient.