Hypertensive Encephalopathy Treated by Percutaneous Nephrostomy

Although hypertension is a known complication of hydronephrosis, it is never severe enough to cause encephalopathy. Here we report a baby boy with unilateral hydronephrosis who presented with hypertensive encephalopathy and whose condition was cured by the insertion of percutaneous nephrostomy followed by pyeloplasty.

Postnatal management of antenatally diagnosed ureteropelvic junction obstruction

OBJECTIVE

The management of antenatally diagnosed ureteropelvic junction obstruction (PUJO) is controversial. Here, we present our experience over a period of 13 years and discuss our management protocol.

MATERIALS AND METHODS

We reviewed the files of 234 patients with antenatally diagnosed congenital hydronephrosis due to PUJO. Management was tailored to each patient, based on a combination of diethylenetetraminepentacetic acid renogram outcome, pelvic diameter, as well as the patient's symptoms.

RESULTS

Pyeloplasty was carried out early in 52 kidneys. Of the total, 182 patients were managed expectantly. Out of these, 45 underwent delayed pyeloplasty. The remaining 137 patients (189 units) were managed non-operatively. In patients who underwent early pyeloplasty, the mean split differential renal function was 37% before and 40.05% after surgery. In those with delayed intervention, the mean renal function was 37.8% before and 42.2% after surgery. In patients who did not have surgery, the mean differential renal function was 45.7% initially and 48.2% at the last accepted follow up. The overall operative success rate was 97.9%.

CONCLUSION

We believe that pyeloplasty is the proper treatment for babies with congenital PUJO and <40% split differential function and/or pelvic diameter >35 mm at the initial visit. In other patients a period of observation is warranted, and pyeloplasty should be carried out only if their kidney function deteriorates or the renogram curve does not show improvement. With the excellent results of pyeloplasty we believe that a safer approach is to operate on more kidneys rather than risk of losing valuable kidney function.

Continent Gastric Pouch Bladder Replacement

The use of the stomach for bladder enlargement and replacement has been known since Sinaiko's work in a canine model. Mitchell et al later showed that the use of the stomach for bladder replacement and enlargement had many advantages especially in situations of acute acid loading and azotaemia. The advantages of using the stomach included protection against hyperchloraemic acidosis (due to net excretion of chloride), reduced mucus production and decreased urine infection rate, plus the elastic properties of the stomach. We report the use of part of the stomach as a continent urinary reservoir to replace a missing urinary bladder and we discuss the advantages and disadvantages of using the stomach in the urinary tract

Establishing community-orientated medical schools: key issues and steps in early planning

OBJECTIVES

To describe briefly the process of early planning and establishment of community-based medical schools with highlights of the key issues and milestones.

DESIGN

After outlining some basic concerns and provisos for the Dean and suggested strategies for setting the stage (preparing the ground) for the innovation, three phases of early planning and action steps within each are listed to serve as a guide and a general checklist.

SETTING

University of Gezira, Sudan and UAE University, AL-Ain.

CONCLUSION

As the curriculum with its implications constitutes the driving force for establishing the schools, it has been given due emphasis and greater share in planning. The communication is concluded with further advice to founding Deans through the proposition of a five-star Dean.

Community-oriented medical education: what is it?

The pressing need for this communication has emerged from the author's experience in conducting educational workshops, seminars and meetings for the orientation of health professionals in community-oriented medical education. Many questions are raised and many statements made which clearly indicate that the term 'community-oriented medical education' (COME) is still misunderstood. It carries a different meaning for different people. Many give it their own meaning and attach to it their own interpretations. This has resulted in wide propagation of the wrong concepts to the detriment of promoting the approach. (It is worth noting that 'community medicine' has over the years suffered the same fate. Is it because both terms include the word 'community', which often has a poor image for much of the medical profession?) An attempt is made here to clarify the situation by a process of questions and answers, the questions being those frequently asked as such or posed in the form of statements. They are by no means exhaustive. Seven major such questions are addressed with reference to personal experience and the literature. (1) What do we mean by COME, community-based education (CBE) and community-based learning (CBL)? (2) COME is third-grade medical education producing third-grade graduates and 'barefoot doctors'. (3) COME produces community health doctors/specialists. (4) COME is not scientifically based (based only on soft sciences) and basic sciences are neglected. (5) Graduates from COME programmes are not competent in dealing with patients as they spend most of their time in the community. (6) If it is community-oriented education, then what about the hospital?(ABSTRACT TRUNCATED AT 250 WORDS)

Interdisciplinary field training research and rural development programme

The programme outlined is an interdisciplinary activity involving students working as groups in villages. It runs through the educational programme in summer blocks of 6 weeks each. It blends medical education with rural development and it is hoped to develop in students team-work and community orientation as well as research skills. The purpose of the communication is to exchange ideas in this field and hopefully receive some comments and views from readers and at the same time pave the way for support, financial or otherwise.