Have we Overtreated Children with Vesicoureteric Reflux?

Urinary tract infections (UTI) are the most common serious bacterial infections in young children. These UTIs have a high association with vesicoureteric reflux (VUR). The pathophysiology of VUR's renal sequelae; its investigation and management is presently undergoing a reassessment. This review documents these changes focusing on compelling new data. With regard to the need for and benefit of imaging procedures in children with UTIs we present an algorithm for investigation that is tailored to the African context. The value of continuous antibiotic prophylaxis is questioned and the role of injectable ureteric bulking is discussed with reference to the Swedish Reflux Trial

Management of penetrating spinal cord injuries in a non spinal centre: experience at Enugu, Nigeria

BACKGROUND:Penetrating injuries of the spinal cord are among the most dangerous of injuries. They are often associated with injuries to other vital organs of the body, which may demand priority attention. The objectives of this study were to determine the pattern of the penetrating spinal cord injuries and to evaluate outcome of treatment in our setting.METHODS:This is a retrospective study of all penetrating spinal cord injuries seen at the National Orthopaedic Hospital, Enugu over a fifteen-year period (April 1990 March 2005). Information about the demographics aetiology, level of injury, associated injuries, time of presentation, duration of hospitalization and outcome of treatment were retrieved from patients case notes. Data were analyzed using SPSS for windows version 11.RESULT: There were 22 patients, 13 males and 9 females, giving a M:F ratio of 1.7:1. Gunshot injury was the most common aetiological factor. The thoracic spine {9 (41%)} was most often involved. Chest and abdominal injuries were common associated injuries in 5 cases. The circumstances of the injury were mostly armed robbery attack {13 (59%)}. On admission the neurological status was Frankel grade A in 20(91%) cases. Period of hospitalization ranged from 1 week to 36 weeks with a mean of 11 weeks. Pressure sore was the most common complication that delayed rehabilitation. Five (23%) patients with injury at cervical level died from respiratory failure.CONCLUSION:Penetrating spinal cord injuries are relatively rare and demand extra care. Early recognition of associated injuries, minimal wound excision and antibiotic therapy give good result