Intrauterine stab leading to a radial nerve palsy.

Penetrating injuries to the gravid uterus are rare. This report documents a fetus that sustained a complete radial nerve palsy (a hemopneumothorax) after a knife wound (complete nerve transection is suspected). Surgical exploration of the nerve was delayed because of respiratory distress. Six weeks later, when exploration was scheduled to be undertaken, some recovery was noted, and exploration was thus deferred. The injury recovered completely in the absence of formal repair.

The use of diverting colostomies in paediatric peri-anal burns.

Over a 3 yr period we performed colostomies in 13 paediatric perineal burn patients out of a total of 1544 patients admitted to our Burns Unit during that period. The mean total body surface area (TBSA) burn was 34% (14-65%); ten patients sustained fire burns and the remaining three hot water burns. We performed prophylactic colostomies in seven children, therapeutic colostomies (to counteract deep wound infection and septicaemia with gut-derived organisms) in five patients and one colostomy in a cerebral palsy child with a left hemiparesis. A sigmoid end-colostomy with Hartmann's closure of the distal segment was the preferred method of choice. In all children but one (died from multi-organ failure 13 days after admission) there was a marked improvement in the clinical appearance of the burn wounds and subsequent graft-take and healing. There was a change in the bacterial profile away from predominantly gut-derived Gram negative organisms to either Pseudomonas aeruginosa or no pathological organisms grown. Complications were few--two children suffered prolapse of their colostomy requiring manual reduction. We advocate diverting colostomies in a highly select group of paediatric burn patients in whom continual faecal soiling is threatening to both graft and life.

Conn's syndrome due to adrenocortical adenoma--a rare but rewarding cause of curable hypertension.

OBJECTIVE: To determine the characteristics of an aldosterone-producing adenoma (APA) as a cause of hypertension, its mode of presentation and investigation, as well as the outcome of surgical removal. DESIGN: Retrospective survey with follow-up. SETTING: Groote Schuur Hospital, Cape Town. PATIENTS: 18 patients who had an APA removed between 1975 and 1993. OUTCOME MEASURES: Clinical and biochemical features, morbidity and mortality rates associated with adrenalectomy, and the degree of amelioration of hypertension. RESULTS: Eighteen of 41 patients with primary hyperaldosteronism had an APA. Features of symptomatic hypokalaemia (muscular weakness 9, fatigue 7) were present for a mean of 60 (9 - 240) months. The mean systolic arterial pressure was 153 (117 - 200) mmHg. The mean potassium level was 2,2 mmol/l and the mean aldosterone level 1 639 (147 - 5 153) pmol/l, which, paradoxically, fell on ambulation in 12 patients. All renin levels were suppressed in the supine (mean 0,1 +/- 0,1 (0 - 0,6) ng/ml/h) and ambulatory positions (mean 0,4 +/- 0,5 (0 -1,8) ng/ml/h). Each of 17 tomographic and 6 iodocholesterol scans correctly identified the lesion. There was no surgical mortality, and all patients became normokalaemic. At 1 month or at the time of discharge, 12 (66%) patients were normotensive, 7 without medication. Age, length of history, severity of hypertension and evidence of target organ damage did not predict response to surgery. CONCLUSIONS: An APA is a rare cause of hypertension and hypokalaemia, but it is important to identify as surgery may be beneficial in most cases.