Nocturnal enuresis: what is happening?

Primary nocturnal enuresis is common and has considerable psychological ramifications for children as they get older. It is a familial condition with complex inheritance patterns. The pathophysiology of the condition appears to be related to poor arousal from sleep, nocturia due to deficient vasopressin release in sleep and possibly a decrease in functional bladder capacity especially at night. The mainstay of treatment is the bed-wetting alarm. In recent years, desmopressin nasal spray has found a clinical niche as a short-term solution for children attending school camps or sleeping over at friends' houses and as treatment in the medium term for those unresponsive to treatment with a bed-wetting alarm. It may also be used as an adjunct to the use of the alarm. Treatment with imipramine is increasingly in disfavour because the relapse rate is unacceptably high and fatal overdose is a real possibility.

Genital examination under ketamine sedation in cases of suspected sexual abuse.

Sedation for genital examination in suspected sexual abuse is seldom discussed. The cases are presented of three children in whom genital examination was facilitated by ketamine sedation; these children could not be examined under any other circumstances. Ketamine provides safe, effective sedation, analgesia, and amnesia in an ambulatory setting. Its use should be considered in selected patients.

Multiple hornet (Vespa orientalis) stings with fatal outcome in a child.

A case of multiple hornet stings is described with a rapidly fatal course due to the combination of massive haemolysis, coagulopathy, rhabdomyolysis, hyperkalaemia, acute renal failure, encephalopathy, hepatotoxicity and hyperglycaemia. These features of systemic envenomation can all be attributed to the toxic properties of Oriental hornet venom described in in vitro and in vivo experimental studies. Greater awareness of these features, aggressive treatment of hyperkalaemia and early institution of treatments such as peritoneal dialysis and plasma exchange may prevent fatalities in such cases.

Glossal cysts in four infants.

Cysts at the base of the tongue causing stridor may be fatal if they are not recognised and treated. Digital palpation along the surface of the tongue to the epiglottis is a useful diagnostic method. An operative technique that might avoid the need for tracheostomy is described.