Inevitable risk of high-order multiple pregnancies following IUI, the need for strict criteria for its prevention: two case reports.

Intrauterine insemination with controlled super-ovulation (IUI/SO) is appropriate management of subfertility where the Fallopian tubes are healthy and patent and the sperm quality is satisfactory. The treatment is monitored by intermittent transvaginal ultrasound scans to assess follicular development. There is an unavoidable increased risk of multiple pregnancy including higher order pregnancy.

Review of augmentation 'clam' cystoplasy in a district general hospital setting.

Eighteen patients underwent augmentation 'clam' cystoplasty over a three-year period. All patients had urodynamic proven detrusor instability, which was refractory to conservative management. Fifteen of the patients are dry and appliance free.

Locked-in syndrome caused by basilar artery ectasia.

Despite various presentations of vertebrobasilar artery ectasia, the true incidence and its distribution and the frequency with which it produces symptoms are still uncertain. We report on a case of Locked-in syndrome caused by an ectatic elongated basilar artery, which predisposed to thrombosis and brain stem infarction.

A queue paradigm formulation for the effect of large-volume alcohol intake on the lower urinary tract.

We examine the urologic consequences of large-volume alcohol intake in light of recent advances in hollow viscera biomechanics and urinary tract pharmacology. Recent studies have shown that alcohol is depressive on the isolated rabbit detrusor. Patients teetering on or having manifest pelvi-ureteric junction obstruction or bladder outflow obstruction have been known to demonstrate symptoms on alcohol consumption.

Sausage asphyxia.

A foreign body causing obstruction of the larynx is usually removed by coughing, blows to the back, chest thrusts, abdominal compression or finger sweep manoeuvres on the unconscious victim. In extremis, crichothyroidotomy or emergency tracheostomy may be the only life-saving option. Direct laryngoscopy may permit the removal of a foreign body from the larynx of an unconscious victim.

Ballotability of cuff to confirm the correct intratracheal position of the endotracheal tube in the intensive care unit.

The cuff ballotability method was used in 120 adult patients to confirm the correct depth of insertion of the endotracheal tube after tracheal intubation. The correct tube position was assumed when the cuff of the endotracheal tube could be felt to distend over the suprasternal notch when the pilot balloon was squeezed and the pilot balloon was felt to distend when pressure was applied over the suprasternal notch. Chest radiography was performed later to confirm the position of the endotracheal tube.

Perforation of uterus by the GyneFix intrauterine contraceptive device.

A case of intrauterine perforation by a GyneFix contraceptive device in a 29-year-old parous woman is described. It is the first report of uterine perforation by the frameless, anchored GyneFix in the UK since its introduction here in 1997. Perforation was diagnosed 12 days after insertion and was complicated by visceral perforation and infection.

Different prevalences of reflux oesophagitis and hiatus hernia among dyspeptic patients in England and Singapore.

Objective: To compare the frequency of reflux oesophagitis and hiatus hernia in dyspeptic patients in England with that in Singapore.

Design: Demographic, clinical and endoscopic findings in consecutive dyspeptic patients seen in England and Singapore by the same clinician were compared. The association of various factors with the occurrence of hiatus hernia and oesophagitis was analysed by logistic regression.

Mivacurium apnoea: a trap for the unwary.

We present a case of unanticipated postoperative apnoea in a patient with associated medical illness to illustrate the diagnostic difficulty that can arise in the detection and subsequent management of mivacurium apnoea. A high index of suspicion is essential in the presence of concomitant medical conditions that may cause prolonged apnoea. To our knowledge, no report exists documenting the unanticipated occurrence of mivacurium apnoea in a patient with previously undiagnosed pseudocholinesterase deficiency and concomitant medical illness who has previously undergone 'balanced' general anaesthesia.

Audit of methods of laparoscopic cholecystectomy.

Background: The operation of laparoscopic cholecystectomy began the modern era of laparoscopic surgery. Refinements in technique continue to appear. The techniques currently favoured by British surgeons have been reviewed.

'Acute' residual ovary syndrome.

This development of pathology in conserved ovaries is defined as the residual ovary syndrome (ROS). It consists of pelvic pain, pelvic mass, dyspareunia as a single or a cluster of symptoms. It is estimated that at least 5% of patients will develop ROS and require surgery for it following hysterectomy.

Use of a disposable electrode for recurrent laryngeal nerve monitoring.

Our experience with a non-invasive, disposable electrode for intra-operative identification and monitoring of the recurrent laryngeal nerve is described. The electrode system, while simply attached to the endotracheal tube, acts as a laryngeal surface electrode and detects electromyographic activity of the intrinsic laryngeal muscles when the recurrent laryngeal nerve is stimulated. We have successfully used this electrode to monitor 19 recurrent laryngeal nerves in 15 patients who have undergone partial or total thyroidectomy.

Soft-tissue amyloidoma. A case report.

A myloidoma of soft tissue is rare and there have been no previously published reports of limb involvement. We describe a case in which the tumour was present in the popliteal fossa. There was no evidence of systemic amyloid disease or of malignant neoplasm one year after the diagnosis.

Thiopentone and propofol: a compatible mixture?

The physical compatibility of thiopentone and propofol mixtures was investigated. The investigations used were macroscopic and microscopic observations, zeta potential and oil droplet size measurements. There was no evidence of instability in the mixtures.

Disinfection of latex gloves with ethyl alcohol.

The ability to disinfect latex gloves successfully between procedures would save time and be cost-effective. An in vitro study examined the efficacy of using an ethyl alcohol/bactericide compound to disinfect latex gloves contaminated with five common bacteria.

Horner's syndrome following low-dose epidural infusion for labour: a cautionary tale.

While Horner's syndrome is a rare and occasionally reported complication of epidural 'top-ups' administered for labour and Caesarean delivery, the case reported here followed a low-dose epidural infusion of bupivacaine. Low-dose epidural infusions have generally been regarded as a safer alternative to bolus doses in labour. It is also the case that close supervision is deemed unnecessary in some centres where the mother is receiving such an epidural infusion.