No abstract

Primary vesicoureteric reflux (VUR) was detected by prenatal sonography in 34 infants (55 renal units); males accounted for 31 cases. Associated genitourinary anomalies were common, occurring in 29% of the patients. Some element of hydroureteronephrosis was noted at initial cystography in 89% of refluxing renal units, but the degree of renal abnormality at 99Tc DMSA renography was not predicted by the severity of VUR. Overall, 60% of refluxing renal units were renographically abnormal. Although a high rate of urinary infection was encountered during follow-up, most DMSA assessments were carried out prior to infection and hence likely reflect congenital rather than acquired abnormalities. It was concluded that renal impairment associated with high grade primary VUR is frequently present at birth and not secondary to subsequent infection.

We also found an increased risk of cancer of the peritoneum and other digestive organs. One explanation for this association is that some of the observed cancers in this category were misclassified testicular or extragonadal germ cell tumours. Extragonadal germ cell tumours have been associated with testicular carcinoma in situ, 28 29 suggesting a common aetiology with testicular cancer.From a public health perspective, our study provides some reassurance to men identified with abnormal semen characteristics, despite the increased relative risks. The absolute excess of cancers is about 36 cases per 32 442 men followed for 297 750 person years. The absolute increase in risk for the individual is therefore very small.

Objective  To assess the outcome after pyeloplasty in children with an ante‐natal diagnosis of hydronephrosis, shown on post‐natal renography to be due to pelvi‐ureteric junction (PUJ) obstruction, and in particular to review the outcome of those who had initially been managed expectantly. Patients and methods  Between 1984 and 1995, 321 patients were diagnosed as having PUJ obstruction, after investigating ante‐natal hydronephrosis. Of these, 47 had undergone pyeloplasty and also had a normal contralateral kidney; 26 patients had early pyeloplasty because of impaired function and 21 underwent surgery after a period of expectant management. Renal function was assessed renographically before and at least one year after surgery. Results  Relative renal function was stabilized in those patients who underwent early pyeloplasty (mean differential function 28.1% before and 32.7% after surgery). In patients who underwent pyeloplasty after a period of expectant management, the mean relative function decreased from 44.8% initially to 30.5% before surgery; this recovered to 37.5% at the post‐operative reassessment, representing a statistically significant loss of function (P<0.01). Conclusion  In patients born with PUJ obstruction and impaired renal function, pyeloplasty failed to significantly improve function, possibly because of cortical loss. In patients with ante‐natal PUJ obstruction managed expectantly there is a small but significant risk of a modest loss of renal function

LiverpoolSUMMARY In a retrospective series of 37 cases of intussusception in children over 2 years of age, it was found that a subacute or chronic presentation was more common than in infancy, that few of them had rectal bleeding, and only a minority had a palpable intussusception. Diagnosis was often difficult but was helped by plain abdominal x-rays. Although the majority of children underwent surgery, with a 22% incidence of lead points, it is concluded that attempted hydrostatic reduction in these older children is not contraindicated, provided x-rays do not show small bowel obstruction.Intussusception mainly affects infants in whom it generally presents with a short history of colic, vomiting, and passage of blood per rectum, and the lesion is generally palpable abdominally or rectally. Rarely is an underlying anatomical cause found.1-5 Less than one-quarter of cases of intussusception are in children over age 2 years, but these older children have a less consistent mode of presentation, offer a greater diagnostic challenge, and are more likely to have an underlying cause.6-8 As such children had not hitherto been considered separately, we now review our experience of intussusception with them.