Resolving duodenal-jejunal hematoma in abused children

Acute intramural duodenal-jejunal hematoma is a classical finding in the battered child syndrome. The radiographic findings of a large obstructing intramural mass associated with the "coiled-spring" appearance generally raise the question of child abuse in any patient without appropriate accidental injury. In this study the radiologic features of resolving duodenal-jejunal hematoma are detailed in five abused children. The results show that the coiled-spring appearance is an acute phenomenon associated with a well-localized intramural hematoma. In the resolving phase, localized mural masses in the lateral aspect of the descending duodenum and fold thickening are indications of prior intramural hemorrhage. When these radiologic features are encountered in a child with nonspecific abdominal complaints, child abuse should be suspected. Furthermore, in patients with suspected occult trauma, resolution of abdominal symptoms should not deter the radiologist from performing an upper gastrointestinal tract series, which may provide evidence of child abuse.     

SPECTRUM OF ACUTE RENAL FAILURE IN A SERVICE HOSPITAL

A prospective study of 82 patients with acute renal failure was carried out over the last 2 years. Mean age of the patients was 35.6 years (8-82 years). Male to female ratio was 3.5:1. The etiological factors were septicaemia in 18 patients (21.95%), aminoglycoside toxicity in 16 patients (19.51%), open heart surgery in 8 patients (9.76%), volume depletion and blood loss in 12 patients (14.63%), glomerulonephritis in 4 patients (4.88%), renal allograft dysfunction in 4 patients (4.88%), and miscellaneous causes in 20 patients (24.39%). Non-oliguric renal failure was observed in 39.02 per cent cases. Dialysis support was required in 65.8 per cent of the cases; with average 5.6 (4 to 11) dialysis sessions. Four patients of acute renal failure following open heart surgery were given continuous arterio-venous haemofiltration. Overall mortality was 32.5 per cent, septicaemia accounting for 60 per cent of the deaths.KEYWORDS: Antibiotics, Aminoglycoside, Renal failure acute, Septicemia