Background-Xanthogranulomatous pyelonephritis is a severe, atypical form of chronic renal parenchymal infection accounting for 6/1000 surgically proved cases of chronic pyelonephritis. Its manifestations mimic those of neoplastic and other inflammatory renal parenchymal diseases and, consequently, it is often misdiagnosed preoperatively. Conclusions-Increasing awareness of this condition should lead to the diagnosis being suspected preoperatively. (Arch Dis Child 1999;81:483-486)

Over the period 1980-1989, 49 patients with congenital duodenal obstruction due to duodenal atresia, duodenal stenosis or annular pancreas were treated. There were three deaths, all related to associated severe congenital anomalies and none related to surgery for duodenal obstruction; 78 per cent of the patients had associated congenital anomalies which, in some instances, complicated their management. Prenatal diagnosis by ultrasonography was made in 18 per cent of the patients and these patients had operations relatively earlier.

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In a series of 292 children with intussusception ten (3.5 per cent) were caused by small bowel tumours. The average age of these patients was greater than in idiopathic cases; seven of the ten being older than 2 years. Intussusception due to Peutz-Jeghers hamartomas was jejunojejunal whereas other small bowel tumours causing intussusception were in the terminal ileum. The majority of these intussusceptions were either irreducible or gangrenous and all required resection of bowel. There was only one death in the entire series of 292 patients, and this was a child with lymphosarcoma.

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We describe the technique of laparoscopy when seeking to locate an impalpable testis. The procedure was used in 86 boys with unilateral or bilateral undescended testes; of the 103 testes which were sought, 64 were present, 39 were absent and 53 were intra-abdominal. Laparoscopy is useful in the management of the impalpable testis. The information gained from the study is valuable when advising parents of the significance of an impalpable testis. For example, there is a 39% chance it will be absent, a 29% chance that it will be easily placed in the scrotum and a 38% chance that a staged procedure may be necessary.

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