Surgical complications of the haemolytic uraemic syndrome.

During the first outbreak of haemolytic uraemic syndrome (HUS) to be reported in Australia, 22 children were admitted to the Women's and Children's Hospital, Adelaide. The outbreak was caused by an entero-haemorrhagic Escherichia coli strain (EHEC) of serotype 011:H-, a strain rarely implicated as a cause for HUS. In all 22 patients, the onset of HUS was preceded by a gastrointestinal (GI) prodrome. All patients had diarrhoea. In 17 (73%), the diarrhoea became bloody; in 20 (86%) there was vomiting; in 15 (65%) there was abdominal pain; and in 12 (50%) all three symptoms were present. Abdominal symptoms continued to complicate the course of 4 patients. Two of these underwent exploratory laparotomy, both had gangrenous colon excised, and both survived. The 2 remaining patients were successfully treated non-operatively. One further patient underwent appendicectomy before the diagnosis of HUS was made. There was 1 death during this epidemic. In patients with HUS and GI involvement, optimal surgical management requires careful consideration of the indications for, and the timing of, surgical intervention.

Developing an Ecological Land Classification for the Fundy Model Forest, southeastern New Brunswick, Canada.

The methodology for developing and mapping a hierarchical Ecological Land Classification (ELC) is presented. The classification provided a systematic methodology that explained the distribution and composition of southern New Brunswick's forested landscape. The nested structure of the ELC identified and provided a hierarchical linkage between ecosystems from the size of forest stands to climate regions. This framework made the collection and analysis of data efficient and gave confidence that tree species distributions, which were central to understanding the influence of abiotic factors on the forest systems, were controlled by the factors examined at each level of the hierarchy. This ELC methodology, developed for the Fundy Model forest, was successful in describing and mapping the Climate, Geomorphologic, and Regolith controlled forest ecosystems. Preliminary classification indicates that spatial referencing of the Site Level is achievable.

Distinct skeletal abnormalities in four girls with Shprintzen-Goldberg syndrome.

We describe 4 girls with Shprintzen-Goldberg syndrome. Skeletal abnormalities common to 3 of them include bowing of long bones (with a variable degree of progression over time), flare of the metaphyses, a large anterior fontanel with persistent patency into the second to fourth years of life, 13 pairs of ribs, distinct vertebral abnormalities which were absent neonatally but evolved by the second year of life, and progressive osteopenia. These abnormalities were generalized and, in one case, progressive over the first few years of life. Communicating hydrocephalus was present in all 4 cases. The eldest, an 11-year-old girl, had additional anomalies not reported previously in this syndrome, including intestinal malrotation, an anteriorly placed anus, and mild cerebral atrophy. This is the first detailed report of skeletal manifestations in this rare disorder of unknown cause. These cases, in conjunction with a review of the literature, suggest that skeletal abnormalities are common in Shprintzen-Goldberg syndrome.

Severe meningococcal septicaemia associated with splenic rupture.

OBJECTIVE: To present the first report of ruptured spleen associated with meningococcal septicaemia. CLINICAL FEATURES: A 13-year-old girl presented with an acute abdomen and clinical signs of meningococcal septicaemia. Features of her illness placed her in a high mortality group. INTERVENTION AND OUTCOME: She required cardiovascular and respiratory support in the Intensive Care Unit. Failure to initially identify the organism led to percutaneous fine-needle aspiration of fluid in the lesser sac. A laparotomy revealed free intraperitoneal blood and a ruptured spleen. During the course of her illness she was given penicillin and methylprednisolone, and required haemodialysis. She made a complete recovery. CONCLUSION: Ruptured spleen does occur with severe meningococcaemia, and may complicate management.