How healthy is South Africa's medical schemes industry?

An analysis of the membership demographics, the financial health and especially the sustainability of the South African medical schemes industry is presented. From the financial and in particular the actuarial analyses it is obvious that the current system is unsustainable, and if a private health care sector is to survive at all it will have to contain costs far more effectively than it has in the past. It is suggested that medical schemes (and other mechanisms of funding health care) review their funding policies and move towards advance funding of pensioner benefits, and also that the schemes be actuarially valued on a regular basis.

Recent advances in urinary stone management.

The treatment of urolithiasis is one of the branches of urological surgery that has undergone great changes during the last decade. Since all the new modalities will soon be available to patients in this country an overview of the different treatments and overseas trends in urinary stone management is presented.

Spontaneous renal infarction due to polyarteritis nodosa. A case report.

A case of spontaneous infarction of the kidney due to polyarteritis nodosa of the vasa vasorum of the right main renal artery is reported. The diagnosis was unsuspected until histological examination of a nephrectomy specimen revealed the typical vascular changes in the renal arterial wall.

Sacral agenesis and neurogenic bladder dysfunction. A case report and review of the literature.

A case of partial sacral agenesis resulting in mixed upper and lower motor neurogenic bladder dysfunction is reported. Although the patient also has a concomitant congenital absence of one forearm she is being managed successfully on intermittent clean self-catheterization, illustrating the value of this modality in the management of neurogenic bladder dysfunction and that it can quite easily be managed by a young woman with only one functional hand. A review of the literature on this uncommon condition is also presented.

Fournier's gangrene: necrotising fasciitis of the male genitalia.

The aetiology, clinical syndrome and outcome of nine patients with necrotising subcutaneous infections of their external genitalia have been analysed. These patients constituted just under 1% of all of our urological admissions during a nine-month period. Eight of the nine patients suffered from the secondary variety of this disease with urethral strictures and extravasation being the most common precipitating conditions. Necrotising fasciitis of the genitalia still carries a high risk of mortality and morbidity, frequently necessitating long periods of hospitalisation and repeated surgical procedures. Special attention was given to the bacteriology of the disease and recommendations concerning antibiotic therapy are made.

Analgesic nephropathy. Local experience in Bloemfontein.

In a prospective study we found analgesic nephropathy (AN) to be responsible for approximately 13% of all cases of end-stage renal disease being treated at our renal unit in Bloemfontein. There seemed to be a lack of awareness of this preventable cause of chronic renal failure among the general public and the medical profession alike. The study also confirms previous reports regarding the potential reversibility of AN and its association with peptic ulcer disease and urothelial cancer. Certain cystoscopic and histological changes in the bladder urothelium were present in varying combinations in all our patients with AN and these may be regarded as specific and more objective aids in establishing this elusive diagnosis.

Bladder urothelium in analgesic-associated nephropathy--a valuable diagnostic aid.

A brownish discoloration of the bladder mucosa on cystoscopy and the histological findings in a bladder biopsy specimen of submucosal vascular basement membrane thickening, pigment or chronic inflammatory changes in the absence of infection were present in various combinations in all our patients with analgesic-associated nephropathy. None of these findings was present in a control group of patients with other established causes of renal function impairment. More objective diagnostic aids may lead to a greater awareness and earlier diagnosis of this preventable cause of chronic renal failure.