Extrauterine fibroids often present a diagnostic challenge due to the unusual locations they arise from. We present a series of rare extrauterine fibroids. In recent years, these fibroids have been associated with previous morcellated hysterectomies or myomectomies. Our series of six patients were found to have extrauterine fibroids (confirmed through histology) and underwent open hysterectomy and open or laparoscopic myomectomy. Four had undergone previous laparoscopic myomectomies while the other two had no previous intra-abdominal surgeries. Postsurgical occurrence may be caused by incomplete removal of morcellated fibroid tissue. Spontaneous occurrence can be associated with congenital Müllerian system defects. Extrapolating from this hypothesis, we recommend physicians to make sure that counselling for extrauterine seeding and dissemination of unexpected malignancy is undertaken in cases of minimally invasive surgeries where morcellation is expected. Long-term tumour surveillance is thus essential in such instances.

The velocity and attenuation of sound has been determined for freshly excised human and canine arterial tissues using a time delay spectrometer (TDS) technique. Frequency was swept from 0 to 10 MHz with data being taken in the range from 2 to 10 MHz. The velocity was determined using a comparison of the time delay for the received signal between a water path and a sample tissue of measured thickness. The velocity of sound was measured for various pathologies and related to biochemical assays of tissue. It was found to increase with increasing ultrasound attenuation of the tissue. The velocity was shown to increase with increased collagen, C, expressed as a percentage of wet weight of the tissue, [V = 17.8* C + 1561 m/s at 37 degrees C, r = 0.77] but was strongly dependent on tissue cholesterol or low levels of calcium. For highly calcified lesions, the velocity of sound was found to be approximately 2000 m/s at 37 degrees C.

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Singapore had her first HIV patient tested sero-positive in 1985. Ever since then, the number of new patients being diagnosed has been on the uprising trend. Based on the current evidences in the literature, we look at how our local practice should be positioned. The objective is to study the general profile of all HIV-positive women in Singapore and to compare the difference in vertical transmission rate between women with very low viral count i.e. < 50 copies/ml who underwent caesarean section and normal vaginal deliveries. Also with proper intrapartum and postpartum advice and care, we look at the outcome of unbooked pregnancies. A ten-year retrospective review of HIV-positive women who delivered in KK Women's & Children's Hospital (Singapore) was conducted. All case notes were reviewed and data was collected and analysed using Microsoft Excel. A total of 75 deliveries by 67 women were identified. Four neonates were tested HIV-positive, amounting to a vertical transmission rate of 5.3%. Of the 12 women who were found to have viral counts of less than 50 copies/ml before their deliveries, four underwent normal vaginal deliveries while eight underwent caesarean sections. All babies were tested HIVnegative. Among the five unbooked pregnancies and two pregnancies that were booked at term, one neonate was found to be positive (14.3%). There is no difference in perinatal transmission in women with very low viral count irrespective of the mode of delivery. For those women with unbooked pregnancies, proper intrapartum care, neonatal anti-retroviral therapy together with avoidance of breastfeeding reduces vertical transmission rate and improves neonatal outcome.

a b s t r a c tObjectives: This study aims to evaluate the efficacy of a newly developed Lin soft outer sheath that is used as a continuous flow system for outpatient flexible hysteroscopy. Materials and methods: Diagnostic hysteroscopy was performed in 134 patients who presented to our center with uterine bleeding over the 25-month study period. The flexible hysteroscope was equipped with a Lin soft outer sheath. Results: Hysteroscope insertion failure was observed in six cases of, i.e., an insertion failure rate of 4.5%. Out of the other 128 women, accurate diagnosis of four patients could not be made because of intrauterine blood clots, i.e., a success rate of 92.5%. No complication, except postprocedure bleeding for a few days, was encountered. Conclusion: The new Lin soft outer sheath is effective as a continuous flow system for outpatient flexible hysteroscopy.