Haemolytic uraemic syndrome (HUS) is a triad of microangropathic haemolvtic anaemia, thromhocytopoenia and acute renal failure. It is one of the renal disorders not often diagnosed in children in the tropics, yet the clinical scenario presents itself from time to time in our children's wards. This, therefore, raises the question as to whether it missed or misdiagnosed as some other similar renal lesions which may require similar management strategies. This articles provides an update on the subject through reviews of relevant literatures. It also enumer­ ate.\· some clinical features (singly or in condition) that should raise clinical suspicion of the syndrome

Premature rupture of membranes (PROM), resulting from array of Pathological mechanisms, is a recognized complication of pregnancy and its management is usually of concern to the obstetricians because of the possible Lethal associated complications. PROM can occur at term or before term with the preterm type constituting greater risks to the fetus and the mother. Numerous controversies exist regarding the best methods of clinical assessment and management of the gravida and the fetus after PROM. These controversies which have plagued this disorder fro many decades appear rf recent to be taking a more consensus outlook among the authorities involved. Management now generallv hinges on evaluation o f the relative risks of infection, umbilical cord accident, operative or expectant delivery and the gestational age in-patients not in Labour. A Literature review on PROM has thus been carried out, throwing some Lights on the current understanding of this condition based on published data, consensus and expert opinion. The possible aetiology, diagnosis, complications and management are discussed. Some management guidelines are proffered.

Over a 12-year period (.January, 1988- December I 999), a prospective study was carried out on -13 patients 1•ith urethral mucosa prolapse managed at the University of llorin Teaching Hospital (U/1H), Ilorin. patients were aged mostly between 3 and 12 years and the commonest complaint was bleeding per vaginam (83.7%) closely followed by dysuria (41.9%). All the patients were Africans and were treated surgically with postoperative complications urinary retention (11.6%) and dysuria (7.0%). There was no urethral stricture or recurrence of the mucosa prolapse in the post-operative one year follow-up period. The differential diagnosis and pathological changes of the disorder are discussed.

Traumatic rupture of the diaphragm is not common in children. 8 children with blunt traumatic rupture of the diaphragm are reviewed; 6 were male and 2 female. They presented in the acute, Latent and delayed phases of diaphragmatic rupture. Diagnosis was made from a high index l / clinical suspicion followed by carefully interpreted chest radiographs. Cardio-respiratory and gastro-intestinal symptoms were observed alongside symptoms of other associated injuries. The definitive treatment was prompt surgical repair. The abdominal approach was preferred. The st1wch, spleen, transverse colon and omentum were the abdominal organs most frequently translocated into the thorax. Rupture was in the left hemidiaphragm in 7 patients. There was complete recovery without complications in 5 patients. There were 2 postoperative deaths main(v from severe associated multiple i1 iuries. In every severe thoracic or abdominal injury, rupture of the diaphragm should be suspected and deliberate(v sought for clinically and radiological(v.

Twenty-eight adult Nigerians (20 males and 8 females) who presented with acute malaria fever were studied for acute cardiac effects of parenteral chloroquine therapy. The parameters studied included the ( 1) Change in heart rate (2) Blood Pressure (3) Electrocardiographic (ECG) intervals including QRS and Q-T intervals. Results showed a significant change in both heart rate and blood pressure compared to baseline readings after the chloroquine injection (P<0.02). There was also a slight but not significant change in QRS duration. There was no appreciable change in rate corrected Q- Tc interval.

Oxygen therapy is the most important aspect of supportive care in the management of a criticallv ill child. Knowledge of the physiology of oxygenation is a key to proper oxygen therapy. High flow .systems are more dependable devices for oxygenation and their use needs to be stressed. Patients on oxygen need close monitoring. Ventilatory support and Continuous Positive Airway Pressure (CPAP) is mandatory in some patients in addition to oxygen therapy for the prevention and treatment of hypoxia. {Indian J Pediatr 2000; 67(12): 885-891/

This study was motivated in the University Of Benin Teaching Hospital, Benin City, by the cases fJj three patients with perforated abdominal viscera who were having antibiotic treatment for typhoid fever on account of "significant" titre on Widal testing. One hundred apparently healthy medical students each had their sera tested for agglutinins to Salmonella typhi '0' and H antigen and Paratyphi A, Band C, between January and March, . This demonstrated the sero-prevalence of16% of Salmonella agglutinins in this group and thus provide a background for interpretation of Widal test results from general community. We conclude that a significant Widal reaction in a febrile patient should not preclude search for another abdominal pathology. None of the 3 patients had typhoid perforation of the ileum nor any surgical complications of typhoid fever.

This study was aimed to highlight that carcinoma of colon may underly acute appendicitis in young patients. Three patients were seen with features of acute appendicitis and had appendectomy done, but did they not get better. They were subsequently managed as cases of chronic intestinal obstruction due to adhesions and ear(v humls for variable periods of time. Two of them had exploratory laparotomy much later at which malignant tumors were found with direct spr ad beyond the serosa of bowel. The third patient died and, was at autop!)y, found to have carcinoma in the hep tic flexure of the colon with extensive direct and metastatic spread to the liver. The three cases highlight that appendicitis and carcinoma of right colon could co-exist in an unsuspecting age group. We advocate that impite of the Low incidence of colonic cancer in the second and third decades of life Medical Practitioners should be mindful of the possibility of a predisposing malignant colonic lesion.