Detailed antenatal sonography was performed on 18 766 pregnant women between 1990 and 1994. Antenatal hydronephrosis, defined as an antero-posterior diameter of the renal pelvis (APPD) greater than 5 mm, was detected in 100 cases (0.59%). Sixty four infants had postnatal hydronephrosis at one and/or six weeks after delivery; 21 of these had urological anomalies.Twelve infants had vesico-ureteric reflux. In all refluxing units the APPD of the renal pelvis was less than 10 mm. Three patients had obstruction at the pelviureteric junction (PUJ); all required surgery.Vesico-ureteric reflux is emerging as the most common urological finding in infants with antenatal hydronephrosis and is likely to be missed if kidneys with APPD of less than 10 mm are not further investigated. In contrast, pelvi-ureteric junction obstruction may be overdiagnosed, based only on drainage patterns of dynamic renogram studies. (Arch Dis Child 1997;76:F31-F34) Keywords: antenatal hydronephrosis; urinary tract; antero-posterior diameter of the renal pelvis.Abnormalities of the urinary tract are reported to account for 30-50% of fetal anomalies.

diarrhoea caused by Cryptosporidium in a child undergoing therapy for acute lymphocytic leukaemia. J Pediatr 1983; 103:256-9. 4 Sloper KS, Dourmashkin RR, Bird RB, Slavin G, Webster ADB. Chronic malabsorption due to cryptosporidiosis in a child with immunoglobulin deficiency. Gut 1982;23:80-2. 5 Anonymous. Cryptosporidiosis: assessment of chemotherapy of males with acquired immunodeficiency syndrome (AIDS).

For the Noonan syndrome patient, the most concerning physical defect is often congenital webbing of the neck or pterygium colli. We present a patient with pterygium colli and a low and laterally displaced nuchal hairline. Since its description, various surgical approaches have been implemented to correct the deformity. Previously reported posterior and lateral approaches have notable disadvantages with regard to hairline displacement and recurrence. In order to address these disadvantages, a new surgical technique was used on this patient. We have termed this technique an M to T rearrangement. Using a lateral approach, the M and T incisions are made and the trapezial fascial web is directly visualized and able to be completely excised. This prevents the recurrence seen with the use of posterior techniques. Inferolateral displacement of hair-bearing skin can be removed with resection of the superior intervening triangle and improves the appearance of the low nuchal hairline. The excision of excess skin along with the zig-zag closure also prevents postoperative scar contraction and recurrence. An important effect of this technique is the prevention of anterior displacement of hair bearing skin. M to T rearrangement is an effective technique for the correction of webbed neck deformities seen in Noonan and Turner syndromes.

Constituents of feeding regimens Substance Sodium Carbohydrate Hypernatraemia content content reported (mmol/l) (gll) Oral rehydration fluid 90 20 No3 Formula milk 49 50 Yes' Lytren F 50 100 Yes4 Glucose mixture <20 250 Yes5 Maxijul 20%t 4 200 This case .Mead Johnson; tScientific Hospital Supplies. On examination he was floppy and semiconscious, with poor skin texture, sunken eyes, and a doughy abdomen. His weight on admission was 10-6 kg (compared with 12-4 kg in the clinic one month before). Plasma sodium concentration was 182 mmol/l, potassium 4-9 mmol/l, urea 6-2 mmol/l, and glucose 8-3 mmol/l. Serum osmolarity was 373 mmol/l, and serum ammonia concentration 36 [tmol/l (reference range <50 [tmol/l). Acidbase balance showed a pH of 7 44, bicarbonate 21 mmolIl, and base deficit 3. No pathogens

or delivery and had been taking phenobarbitone and phenytoin for many years. At 2 days of age the baby was jittery and required sedation with diazepam for 48 hours. He was a slow and difficult feeder in hospital and this feeding pattern continued throughout infancy.He presented again at age 31/2 years as a slow talker. His medical history showed some delay in gross motor milestones; he had first sat unsupported at age 10 months and walked independently at two years. On examination his height was on the 10th centile, weight on the third centile, and head circumference on the 50th centile. He had pointed incisors and generally poor teeth enamel. He had a paraumbilical hernia and incurving of the fourth toes bilaterally. His vision and hearing were normal.A Stanford-Binet assessment gave an intelligence quotient between 70 and 80. All investigations as to the cause of his mild mental retardation and speech delay were negative. A Reynell assessment at age 5-3 years showed that his comprehension of language was delayed by 2-2 SD and his expressive skills by more than 3 SD. A cinepalatogram at age 7 years showed normal palate structure but severe functional abnormalities similar to those described in our first patient. His soft palate rarely met the posterior pharyngeal wall at all, with gross incompetence when he swallowed or attempted to produce speech sounds. DiscussionThe first report of a higher than expected incidence of congenital abnormalities in the children of mothers with epilepsy was in 1968. Subcutaneous emphysema may develop after tears in the gastrointestinal, genitourinary, and respiratory systems and from the entry of gas-forming organisms into the subcutaneous tissues. Cervicofacial emphysema has been described in association with dental procedures, the Valsalva manoeuvre, traumatic injury or surgery involving the air sinuses, and in association with pneumomediastinum. We report an unusual case of recurrent cervicofacial emphysema. Case reportA 15 year old boy presented to the emergency department with a 12 hour history of facial swelling. He reported he had been leaning out of a window when he felt something hit his cheek. There was no apparent injury but shortly afterwards he developed facial swelling which became progressively worse. Apart from mild asthma which required no treatment, he had previously been well. A noticeable unilateral periorbital and facial subcutaneous emphysema extending downwards towards the neck was found on examination ( Figure). A tiny puncture mark was noted in the skin but no corresponding buccal lesion was detectable. Sinus radiographs were normal and his signs settled spontaneously.He presented four months later with similar physical findings. On this occasion there was no history of possible preceding injury and subcutaneous emphysema alone was present with no evidence of any skin trauma. He denied any unusual activities despite repeated questioning. He seemed very anxious about his symptoms and was reluctant to be discharged from hospital until they had completely se...