Fifty-five infants who presented to the Oklahoma Children's Memorial Hospital with vomiting and the clinical suspicion of hypertrophic pyloric stenosis (HPS) were evaluated using real-time ultrasound. Previously published criteria for the sonographic diagnosis of HPS were evaluated in these patients. The anterposterior diameter measurement of 1.5 cm or greater proposed by Strauss et al. had an accuracy of 36/50 (72%). The 4-mm or greater wall thickness measurement of Blumhagen et al. was correct in 46/50 (92%) of cases. A proposed criterion, the true pyloric muscle (TPM) length of 2.0 cm or greater was accurate in 33/33 cases. Application of the TPM length criterion should improve the reliability of sonographic diagnosis of HPS and decrease the need for radiographic studies.

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FOR THE past four years, we have been using a nonendoscopic technic (postural drainage) for removal of the foreign bodies aspirated into the lungs of children. This technic was developed from the methods used to remove thickened secretions from infants and children having asthma and cystic fibrosis. Postural. drainage, when combined with the giving of bronchodilator aerosol, has been successful in the removal of the foreign body in 24 consecutive patients. Only two patients have had complications. A similar conclusion was reached by P~urrin~tc~n ~ in a review of the bronchoscopic results in 82 infants and children; he has found that urgent removal of the foreign body is not necessary and has also recommended that the postural drainage technic be used initially. Cases StudiedFourteen boys and ten girls between the ages of ten months and 16 years (mean age 3.6 years) comprise this series. Eight patients were referred with a diagnosis of recurrent pneumonia of unknown etiology. Two were referred with a diagnosis of recurrent pneumonia secondary to airway damage from sunflower seeds. Both of these patients were thought to have expectorated the seeds. The remaining patients were referred as cases of acute aspiration of foreign matter.

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