Definitive identification of a patent processus vaginalis by intraoperative injection of methylene blue into the hydrocoele sac.

Objective: Seven percent of patent processus vaginalis (PPVs) are obliterated at exploration. This potentially increases the risk of cord injury with a subsequent increased risk of testicular atrophy or reduced fertility. We report a modification of a technique to improve identification of the PPV and thus potentially minimise the risk to the cord.

First-trimester biochemical markers of aneuploidy and the prediction of small-for-gestational age fetuses.

Objectives: To examine the clinical utility of the first-trimester biochemical markers of aneuploidy in their ability to predict subsequent delivery of a small-for-gestational age (SGA) infant.

Methods: We examined singleton pregnancies with no chromosomal abnormality and with complete outcome data that had undergone screening for trisomy 21 by a combination of fetal nuchal translucency (NT) thickness and maternal serum free beta-human chorionic gonadotropin (beta-hCG) and pregnancy-associated plasma protein-A (PAPP-A) at 11 + 0 and 13 + 6 weeks' gestation. The biochemical markers were converted to multiples of the expected normal median (MoM) for a pregnancy of the same gestation.

First-trimester ultrasound and biochemical markers of aneuploidy and the prediction of preterm or early preterm delivery.

Objectives: To examine the clinical utility of the first-trimester markers of aneuploidy in their ability to predict preterm delivery.

Methods: We examined 54 722 singleton pregnancies with no chromosomal abnormality and with complete outcome data that had undergone screening for trisomy 21 by a combination of fetal nuchal translucency (NT) thickness and maternal serum free beta-human chorionic gonadotropin (beta-hCG) and pregnancy-associated plasma protein-A (PAPP-A) at 11 + 0 and 13 + 6 weeks' gestation. The biochemical markers were converted to multiples of the median (MoM) of the expected normal median for a pregnancy of the same gestation and the measurements of fetal NT were expressed as the difference (delta) from the normal median NT for crown-rump length.

Laparoscopically assisted retrieval of lost IUCD/foreign bodies: a novel locating technique with fluoroscopic image intensifier.

Migration of therapeutically implanted intrauterine contraceptive devices and foreign bodies pose challenges in accurate localization and removal through the least invasive method. Laparoscopic removal is the desired method of treatment due to the lessened surgical and anesthetic morbidity and accurate and rapid localization of the devices are imperative in aiding an endoscopic removal. Difficulties in locating the device leads to prolonged intraoperative times and at times culminate in a laparotomy with its attendant increased morbidity.

ADAM12 as a marker of trisomy 18 in the first and second trimester of pregnancy.

Background: ADAM12 (a disintegrin and metalloprotease 12) is a placentally derived glycoprotein that appears to be involved in growth and differentiation. The maternal serum concentration of ADAM12 appears to be a very good marker of trisomy 21 in the early first trimester when levels are reduced, and in the second trimester around 16-18 weeks levels are elevated. One small preliminary study of first trimester pregnancies with trisomy 18 found reduced levels in the maternal serum, and we examine herein the potential of ADAM12 as a marker of trisomy 18 in both the first and second trimester of pregnancy.

Nitrous oxide inhalation to improve patient acceptance and reduce procedure related pain of flexible cystoscopy for men younger than 55 years.

Purpose: Flexible cystoscopy in men younger than 55 years is painful despite the current best standard anesthesia (20 ml 2% lidocaine gel 15 minutes before endoscopy). The anesthetic value of lidocaine gel is debated and led us to seek an alternative. Nitrous oxide is a well established analgesic and anxiolytic agent, and it significantly reduces pain associated with transrectal ultrasound guided prostate biopsy.

Management of extra-tubal and rare ectopic pregnancies: case series and review of current literature.

Objective: Management of extra-tubal ectopic gestations remains an inadequately explored clinical field due to the rarity of the presentations. We present a synopsis of the management highlighted by our personal case series.

Method: A literature search was conducted through Pubmed and Medline databases.

Hydroxyurea therapy: a rare cause of reversible azoospermia.

Background: Essential thrombocythaemia (ET) is an uncommon chronic myeloproliferative disorder characterized by a marked increase in the number of platelets. Hydroxyurea is effective in preventing thrombosis in high-risk patients with essential thrombocythaemia. In previous studies different side effects of Hydroxyurea have been pointed out, but attention has not really been focused on the possible side effects on spermatogenesis.

Aneuploidy screening in the first trimester.

This article reviews the performance of first trimester screening for chromosomal anomalies using various combinations of ultrasound and maternal serum biochemical modalities. Detection rates in excess of 90% can be routinely achieved for Trisomy 21, Trisomy 13, Trisomy 18 using a combination of fetal nuchal translucency (NT) thickness and maternal serum free ss-hCG and PAPP-A at 11 + 0 to 13 + 6 weeks of gestation.

First-trimester ADAM12 and PAPP-A as markers for intrauterine fetal growth restriction through their roles in the insulin-like growth factor system.

Background: PAPP-A is a marker used as part of the most effective method of screening for chromosomal anomalies in the first trimester. ADAM12 is a recently discovered pregnancy associated member of the ADAM (a multidomain glycoprotein metalloprotease) family. Recently, ADAM12 has been shown as a potential marker for early screening for chromosomal anomalies.

Second-trimester uterine artery Doppler pulsatility index and maternal serum PP13 as markers of pre-eclampsia.

Objective: To evaluate whether measurement of maternal serum PP13 at 22 to 24 weeks of gestation, alone or in combination with second-trimester biochemical markers or uterine artery pulsatility measured by Doppler velocimetry, is useful in predicting those women at risk of developing pre-eclampsia.

Study Design: A nested case-control study of pre-eclampsia cases with controls matched for gestational age and storage time for the maternal serum. PP13 was tested by an ELISA, with the samples blinded to pregnancy outcome.

First-trimester combined screening for trisomy 21 in a predominantly Chinese population.

Objective: To examine the effectiveness of first-trimester fetal trisomy 21 screening using a combination of maternal age, nuchal translucency thickness (NT) and maternal serum free beta-human chorionic gonadotropin (beta-hCG) and pregnancy-associated plasma protein-A (PAPP-A) levels in a predominantly Chinese population in Hong Kong.

Methods: This was a prospective study over a 1.5-year period of 2990 women who underwent combined screening for trisomy 21 between 11+0 and 13+6 weeks of gestation in a university fetal medicine unit.

Is there an association between maternal ABO and rhesus blood groups and the first-trimester serum markers free beta-hCG and PAPP-A used for the detection of fetal aneuploidy?

Objectives: To evaluate whether first-trimester levels of PAPP-A and serum free-beta-human chorionic gonadotrophin (free beta-hCG) vary with maternal blood group and rhesus status and to assess whether this has implications for first-trimester screening for chromosomal anomalies.

Methods: Blood group and rhesus status information was extracted from birth records for women undergoing first-trimester screening. The birth records were combined with prenatal screening records by an in-house developed record linkage software.

First-trimester maternal serum PP-13, PAPP-A and second-trimester uterine artery Doppler pulsatility index as markers of pre-eclampsia.

Objective: To evaluate whether measurement of maternal serum placental protein-13 (PP-13) and pregnancy-associated plasma protein-A (PAPP-A) at 11 + 0 to 13 + 6 weeks of gestation alone or in combination with second-trimester uterine artery pulsitility measured by Doppler velocimetry is useful in predicting those women who will develop pre-eclampsia

Methods: This was a nested case-control study of pre-eclampsia cases with controls matched for gestational age and storage time for the maternal serum. Samples were collected as part of a first-trimester prenatal chromosomal anomaly screening program and were routinely tested for PAPP-A. PP-13 was tested using an enzyme linked immunosorbent assay (ELISA) by an examiner who was blinded to pregnancy outcome.

A case of polymyalgia rheumatica, microscopic polyangiitis, and B-cell lymphoma.

Background: A 73-year-old, previously well woman was admitted to an emergency department because of a 3-month history of severe proximal girdle pain and stiffness with loss of appetite and weight. She was referred to a rheumatologist 10 days after her initial presentation. Within 4 weeks she presented to an outpatient clinic with nausea, vomiting, shortness of breath, painful mouth ulcers, rash on her legs and a further decline in appetite; she was readmitted to hospital.

Ameloblastoma: a rare nasal polyp.

Ameloblastoma is an odontogenic neoplasm of enamel organ type tissue which does not undergo transformation to the point of enamel formation. We present the second case in the English literature of maxillary ameloblastoma that presented with nasal obstruction and rhinorrhoea, and the first to be excised using a combined maxillotomy and endoscopic ethmoidectomy. The patient had no previous dental history.

Comparison of vibration perception thresholds in individuals with diffuse upper limb pain and carpal tunnel syndrome.

The study objective was to compare vibration perception and patterns of blood flow in outpatients with diffuse upper limb pain disorder (ULPD), carpal tunnel syndrome (CTS) and age and sex matched healthy controls. Vibration perception and discrimination thresholds were compared in subjects with ULPD (n=27), CTS (n=27) and healthy matched controls (n=54). Vibration measurements were taken bilaterally at three sites: (a) over the dorsum of the second and (b) fifth metacarpals and (c) the palmar aspect of the first and second metacarpals, corresponding to the innervation territories of the radial, ulnar and median nerves, respectively.

First-trimester ultrasound and biochemical markers of aneuploidy and the prediction of impending fetal death.

Objectives: To examine the clinical utility of the first-trimester markers of aneuploidy in their ability to predict future fetal loss.

Methods: We examined 54,722 singleton pregnancies with no chromosomal abnormality and with complete outcome data that had undergone screening for trisomy 21 by a combination of fetal nuchal translucency (NT) thickness, maternal serum free beta-human chorionic gonadotropin (beta-hCG) and pregnancy-associated plasma protein-A (PAPP-A) at 11 + 0 and 13 + 6 weeks' gestation. The biochemical markers were converted to multiples of the expected normal median for a pregnancy of the same gestation (MoM) and the measurements of fetal NT were expressed as the difference (delta) from the normal median NT for crown-rump length (CRL).