Warming of Echovist contrast media to body temperature is a simple and effective intervention in reducing discomfort at the time of HyCoSy.

We present a 25-year-old Caucasian woman in her first pregnancy (conceived on clomiphene) who had an uncomplicated course until 19 weeks of pregnancy. She has given written permission for the case to be reported. Booking blood tests in 2003 showed her to be blood group A positive and negative for hepatitis B virus and HIV. A nuchal translucency scan was low risk and confirmed the gestational age. She had a past history of ileo-caecal resection for Crohn's disease 4 years earlier.Between 19 and 23 weeks of gestation she had recurrent episodes of abdominal pain and vaginal bleeding warranting admission and a 2-unit blood transfusion. At 22 weeks an ultrasound scan showed normal fetal anatomy and a normal posterior, not low, placenta. However, it showed an 8.5-cm complex cystic mass on the anterior uterine wall. This was felt likely to represent a blood clot because it had not been present on the routine anomaly scan at 20 weeks. She remained an inpatient as she continued to have intermittent vaginal bleeding.After 6 days she complained of breathlessness and pleuritic chest pain. An ECG showed sinus tachycardia and a chest X-ray showed multiple rounded opacities throughout both lungs, measuring up to 2 cm in diameter, suggestive of metastases. A subsequent computed tomography pulmonary angiogram showed no evidence of embolic disease but confirmed multiple lesions highly suggestive of metastases. Renal, liver and thyroid function were normal and a quantitative b-human chorionic gonadotrophin (bhCG) measurement was 115 000 IU/l. Clinical examination of the breasts and skin revealed no abnormality and there were no palpable lymph nodes in the neck, groin and axilla.

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Introduction: Mountaineering refers to the sport of climbing mountains. The skill set and level of fitness required for mountaineering is very different from those required for other activities. It is a sport which involves considerable risk of injuries not only because of the technical demands but also because of the challenges posed by high altitude. Mountaineers are aware about the importance of physical fitness required in mountaineering, they may not be fully aware about the minute aspects such as the intensity and level of training from their base fitness levels. Physiotherapy helps narrow this gap and provides subjective levels of training required for a mountaineer and their fitness Objective: To assess the Awareness about the role of physiotherapy in mountaineering among Indian mountaineers. Methods: 68 Mountaineers between 16-49 years of age who have completed at least one trek above 12,000 ft participated in the study. A validated online questionnaire was circulated among the participants after taking their consent. The data collected was subjected to descriptive analysis. Results: The study revealed that most of the mountaineers have considerable knowledge about the role of physiotherapy in treatment of musculoskeletal injuries. However, there is lack of awareness about the role of physiotherapy in the aspects of cardiopulmonary function, injury prevention and prevention of AMS. Conclusions: This study shows that mountaineers need to be educated about the role of physiotherapy in all aspects of mountaineering and how it can help them perform better. KEYWORDS: Trekking, Rock Climbing, Ice Climbing, High Altitude, Climbing Sports.