This book demonstrates clearly how to perform a clinical examination in the infant or child with a surgical condition. While most textbooks of pediatric surgery focus on the pathological classification and overall management of disease, in clinical practice physicians and surgeons usually use a problem-oriented approach to clinical diagnosis. Surprisingly, this is rarely taught to students. The authors attempt to redress this imbalance by providing a clinical approach to the patient which can be learned with a minimum of factual information. The book should therefore remain useful to the practitioner throughout his or her medical career. It includes detailed coverage of the usual presentations of common diseases, but does not attempt to cover all aspects of the presentations of uncommon diseases unless their recognition is important for the well-being or survival of the child. Generously illustrated, this is a book for all who are learning the art of pediatric surgical diagnosis.

Cryptorchidism remains a common but poorly understood anomaly affecting 2%-5% of children. Major controversies exist over the timing and type of treat ment (i. e. surgical vs hormonal therapy) and whether intervention prevents sub sequent infertility and testicular cancer. Part of the dilemma is caused by lack of understanding of the normal process of descent, despite intensive research and study since the eighteenth century, when Hunter and von Haller first described the gubernaculum (caudal genito-inguinal ligament) and processus vaginalis (Williams and Hutson 1991a). More needs to be known, not only of the normal mechanism, but also of the ways that it can be deranged to produce undescended testes. This review describes the recent results of studies on normal descent, with emphasis on our studies of the different stages of descent. As the reader will appreciate, the ever-more complex models proposed to account for normal tes ticular descent predict that undescended testes will be caused by a multitude of anomalies affecting different stages of the process. A description is given of current hypotheses of the aetiology of cryptorchidism, correlating these with studies of cryptorchid animal models. For a more detailed description of the numerous ideas about the mechanism, the reader is referred to Heyns and Hutson (1995) and other monographs (Fonkalsrud and Mengel 1981; Abney and Keel 1989)."

The new, fully updated edition of this successful book, brings together the combined experience of a leading dedicated unit over 25 years in delivering expert medical and surgical care to children with DSD (Disorders|Differences of Sex Development) in a holistic environment. It documents the most recent advances in the molecular biology and embryology of sex development, and describes each variation in detail. The main focus of the book is on patients with variations with their anatomy and hormone function. New chapters describe the developments in the field in terms of definitions and incidence, the mental health of DSD patients and discuss the perspectives of patients families and support groups. The clinical presentation and approach to diagnosis are described both for babies and for children presenting later in childhood or at adolescence. The chapters on management highlight all the latest knowledge and include the shared wisdom of the authors on current controversies, such as the timing of surgical treatment. Finally, the authors describe their short-, medium-, and long-term outcomes, which demonstrate the strengths of holistic team management.