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The specialty training application process can be a challenging time, and adequate preparation is essential. With the resources available, and with appropriate guidance from colleagues, experiences gained as a General Duties Medical Officer (GDMO) can be used to produce a highly competitive application. This paper aims to to provide guidance for Medical Officers (MOs) applying for specialty training.

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The Intermediate Command and Staff Course (Maritime) is an eight-week residential course held at the Joint Services Command and Staff College, Shrivenham. It is designed to prepare mid-late-seniority Lieutenants and newly-promoted Lieutenant Commanders of the Royal Navy for command, charge and staff appointments, and also to assess their suitability for further staff training. This paper aims to assist officers in the Royal Navy Medical Services in their preparation for attending this course, and also to familiarise them with aspects of the course.

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OBJECTIVE: To determine the effect of mechanical assisted hatching on the pregnancy rate (PR). DESIGN: A retrospective comparative analysis of hatched versus nonhatched consecutive assisted reproductive technology (ART) cycles. SETTING: A hospital-based ART program. PATIENT(S): Patients undergoing ART treatment with assisted hatching (1994-1996) were compared with patients who did not have assisted hatching (1990-1993). INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Pregnancy rate, multiple PR, and rate of monozygotic twinning. RESULT(S): With hatching, the clinical PR per ET increased from 25.2% to 37.1% and the multiple PR per ET increased from 6.8% to 13.1%. In the nonhatched series, there were no monozygotic twins compared with eight cases in the hatched series (1.2% per ET). CONCLUSION(S): Mechanical assisted hatching increases the PR but concomitantly elevates the rate of multiple gestation and multiple gestation of high order. There is a particularly high risk of monozygotic twinning with mechanical hatching.

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The outcomes of twins resulting from multifetal reduction were analyzed to examine whether the outcome was improved over that of triplet and quadruplet pregnancies and similar to that of twin pregnancies not involving multifetal reduction. Maternal and perinatal outcomes were examined retrospectively in 62 infertile women who conceived multiple gestations with ovulation induction. The mean gestational age at birth of quadruplets was significantly less than that of twins reduced from quadruplets (24.8 versus 31.0 weeks; P less than .001), and there was appreciable neonatal mortality in the nonreduced quadruplets (62%). In twins selectively reduced from triplets as compared with nonreduced triplets, the mean gestational age at birth, though statistically significant, differed by an average of only 1.7 weeks (34.8 versus 33.1 weeks; P less than .05), and the mean gestational birth weight differed only by 380 g (2305 versus 1924.7 g; P less than .05). Triplets required a longer average stay in the neonatal intensive care unit than did twins resulting from multifetal triplet reduction (20.7 versus 8 days; P less than .001). Although five sets of triplets (20%) were born before 32 weeks, there were only two neonatal deaths, with the remainder of the 58 infants eventually discharged home. The mean gestational age of twins selectively reduced from triplets or quadruplets was significantly less than that for nonreduced twins (32.6 versus 35.3 weeks; P less than .001), and the groups differed by 1605 g in mean birth weight (1841.8 versus 2447.5 g; P less than .001).(ABSTRACT TRUNCATED AT 250 WORDS)

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Recent reports have suggested that focal hyperechoic abdominal masses detected during the second trimester may represent a normal variation in fetal intestinal development that is transient in nature and not associated with pathologic conditions. The patient described here had second-trimester ultrasonic findings of fetal meconium peritonitis without ascites, polyhydramnios, or other anomalies. Subsequent ultrasound examinations at 22, 30, and 36 weeks demonstrated no change in the abdominal appearance. At birth, this preterm male infant had clinical symptoms of congenital cytomegalovirus infection confirmed by viral culture and serologic studies. Retrospective studies of maternal serum obtained early in the second trimester confirmed a primary cytomegalovirus infection 4 weeks before the initial ultrasound examination. Although fetal hydrops and ascites have occasionally been associated with intrauterine cytomegalovirus infection, fetal meconium peritonitis has not been previously recognized in patients with congenital cytomegalovirus.

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Heparin has a short half-life (8 to 12 hours) and therefore must be administered by continuous infusion or by intermittent subcutaneous injection. Intermittent subcutaneous injection may lead to fluctuation in the levels of anticoagulation attained. In correcting this deficiency, the programmable automated subcutaneous infusion pump in conjunction with weekly home nursing visits has been used. Eight pregnant women with documented deep venous thrombosis or embolic events before pregnancy who received such therapy were studied. Eight similar subjects who received intermittent subcutaneous injection, matched for age, parity, site of deep venous thrombosis, and days on a regimen of heparin therapy, served as the control group. The mean daily dose of heparin by subcutaneous infusion pump was higher (29,445 vs 13,822 U), resulting in smoother, more therapeutic heparinization (mean partial thromboplastin time, 20.6 vs 10.4 seconds above control) when compared with the intermittent subcutaneous injection group (p less than 0.05, p less than 0.007). There were two complications (hematoma, site infection) in the intermittent subcutaneous injection group while none occurred in the subcutaneous infusion pump group. When used in concert with weekly home visits, the subcutaneous infusion pump method of administration allowed more even control of anticoagulation, appeared to result in fewer complications (although not statistically significant), and subjectively was better received by patients than the intermittent subcutaneous injection technique.

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This study was done to measure normal lengths of fetal kidneys sonographically during pregnancy. Knowledge of these measurements may allow earlier diagnosis of a variety of abnormalities. The greatest length of each of 498 kidneys in 397 consecutive fetuses between 18 and 41 weeks gestation was measured on sonograms. Gestational ages were determined by last menstrual period and biometry; significant discrepancies led to case exclusion. Abnormal fetuses, twins, offspring of diabetic mothers, and fetuses with renal pelvic dilatation of 4 mm or greater were excluded to avoid any questionable measurements. The results show that mean lengths are greater and confidence intervals are wider than previously reported. Renal lengths are similar to those reported in premature and full-term neonates. Strong correlation exists between renal length and gestational age, determined by biparietal diameter, femoral length, and abdominal circumference, and an average of the three. No significant difference was found between right and left renal lengths in fetuses in whom both kidneys were imaged. Average renal lengths are significantly different when compared across the range of gestational ages (p less than .001). No correlation is seen (r = .00) between parental height or weight and fetal renal length. Our results show that fetal renal lengths are longer than previously reported.

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The first case of acquired immune deficiency syndrome (AIDS) in pregnancy is reported. The patient, a drug addict, presented with lymphadenopathy, pulmonary infiltrates, and skin lesions of Kaposi's sarcoma, a tumor rarely found in young women in this country. The helper T-lymphocyte to suppressor T-lymphocyte ratio showed the profound inversion characteristic of this cell-mediated immune deficiency disease. Chemotherapy, a combination of doxorubicin, bleomycin, and vinblastine, was initiated during pregnancy. A growth-retarded infant was delivered vaginally. At four months of life, the infant had no apparent evidence of immune deficiency. Transplacental transmission of AIDS has not, as yet, been demonstrated. The social factors, clinical and laboratory features, and the controversies surrounding this new disease are discussed.

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Seven human fetuses with intermittently recurring cardiac arrhythmias of ectopic origin were studied intensively during labor and the early neonatal period. Neonatal outcome, judged by Apgar scores and neonatal acid-base parameters, was favorable in all 7 patients. Three of the seven arrhythmias reverted spontaneously to sinus rhythm within 72 hours, and six of the seven resolved by 5 days of age. One neonate, with supraventricular tachycardia, developed congestive heart failure, necessitating digitalization, but was free of symptoms at 6 weeks and showed no evidence of congenital heart disease. The literature on fetal cardiac arrhythmias is reviewed. A number of etiologic mechanisms and several methods of pharmacologic therapy of these irregularities have been proposed. These cases suggest, however, that fetal arrhythmias of ectopic origin need not represent signs of fetal distress or cardiac anomaly and may be inocuous. Evidence to date indicates that in utero pharmacologic treatment of fetal arrhythmias is not indicated.

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