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SUMMARY Over a five year period 55 fetuses had abnormalities of the urinary tract detected by antenatal ultrasound scan. The incidence was 1:935 total births during a one year prospective study. Intrauterine intervention was undertaken in five for suspected obstructive uropathy, which was confirmed in only two. Of 51 live born infants, five died (two with renal failure), and only 18 (35%) had a clinically detectable abnormality at birth. Twenty seven patients underwent postnatal operations, the remainder being treated conservatively.Antenatal counselling was seldom undertaken by those responsible for the postnatal care. There were many instances of prospective parents receiving little or inappropriate information. Greater cooperation is required between all the staff concerned particularly as the natural history and appropriate postnatal management of some urinary tract abnormalities are still not known. diagnoses.Problems of diagnostic accuracy are combined with uncertainty about both the prognosis of many of the abnormalities and of the role of prenatal surgery.7 8 Urinary tract abnormalities occur in about 1:1200 pregnancies9 and hence the individual members of the obstetric and paediatric staff Care likely to have only limited experience with these lesions. Poor communication among staff in different specialities will only add to the difficulties of counselling the parents both antenatally and postnatally. We report our experience to illustrate some of the diagnostic and therapeutic dilemmas that arise when urinary tract abnormalities are detected antenatally. We emphasise the need for good communication and exchange of information among staff in the departments of obstetrics, radiology, and paediatrics. Patients and methodsBetween January 1982 and December 1986, 55 cases of antenatally diagnosed urinary tract abnormalities came to our attention either by referral for postnatal management, notification by the perinatal pathologist, or (latterly) referral for antenatal counselling.The number of cases increased from five in 19,82 to 21 in 1986. The data were collected prospectively during 1986 and included fetal urinary tract abnormalities that resulted in termination of pregnancy or intrauterine fetal death.It is the policy in all the referring centres to perform a routine ultrasound scan between 16 and 20 weeks' gestation. Further ultrasound examinations were for obstetric reasons except in one Nottingham centre where serial ultrasound scans were routinely carried out between 28 and 34 weeks as part of a research project into fetal growth. The ultrasound scans were performed by trained radiographers who called in a radiologist for more detailed scanning if an abnormality was detected or strongly suspectedfor example, if oligohydramnios was seen.Five mothers were referred to a specialist centre where antenatal bladder drainage procedures were 719 copyright.

Mayell, M. J. (1972). Archives of Disease in Childhood, 47, 20. Intussusception in infancy and childhood in Southern Africa. A review of 223 cases. Two hundred and twenty-three cases of intussusception admitted over a 9a-year period are analysed. Six deaths occurred.Sigmoidorectal intussusception occurred on 5 occasions and in each case was referred as a case of rectal prolapse, and the diagnosis and management of this particular form of intussusception are discussed.Intussusception is a common cause of intestinal obstruction in infancy and childhood and its occurrence is world wide. That there are geographical variations in its incidence is well known, but a review of the cases admitted to the Children's Hospital in Cape Town has shown certain other differences not previously reported. It is the purpose of this paper to present the Cape Town experience with intussusception and to draw attention to and comment upon these apparent continental and racial variations in the disease pattern.The data presented are drawn from a review of 223 children admitted with intussusception to hospital during a 91-year period ending in May 1970. The hospital is multiracial and admits children of all ages up to and including 12 years.The mean annual admission rate for the review period was 23 5 but the variation from year to year was quite marked (Fig. 1) have been termed idiopathic in the absence of any obvious local lesion though in many cases more general predisposing factors were present; their significance is discussed later.The age range was from 1 month to 11 years, the peak incidence being between 4 and 8 months (Fig. 2). Idiopathic intussusception was more common in infants under 1 year (129/206 or 63%), whereas 14 of the 17 cases with leadpoint pathology were over the age of 1 year. Separate consideration of the 3 main racial groups showed that most of the European children were under 1 year (36/41), two-thirds of the African

Traumatic pneumatocele is a recognized but uncommon complication of blunt thoracic trauma. Its clinical relevance lies in the difficulty the attending surgeon encounters in differentiating the x-ray appearances from more serious pathology requiring urgent surgical intervention. We document this case because it is important that surgeons be aware of this condition and of its benign course so as to avoid unnecessary diagnostic or operative procedures.

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