Preimplantation genetic diagnosis for gender selection for family balancing: a view from India.

The use of PGD for sex selection arouses considerable debate, especially in countries like India that have a marked cultural preference for boys. It is argued that using PGD for sex selection is a treatment option that can be ethically offered to couples who desire to use this technology to plan their families.

The use of preimplantation genetic diagnosis in sex selection for family balancing in India.

This paper describes the use of preimplantation genetic diagnosis (PGD) in sexing embryos for family balancing in a private IVF clinic in India from April 1999 to April 2001. Embryos were biopsied and analysed on day 3, cultured in sequential media and then transferred on day 4 or day 5 after morphological selection of the best embryos. From a total of 42 cycles started, 14 clinical pregnancies and nine live births have been achieved so far, with five ongoing pregnancies. The benefits of delayed transfer 24-48 h after the embryo biopsy are that PGD centres could use the extra time available to confirm the diagnosis or introduce additional diagnostic tests for the same embryo. The selection of blastocysts for transfer should also permit the transfer of fewer embryos, thus reducing the risk of multiple gestations and increasing the pregnancy rate as a consequence of the expected higher implantation rate. This is the first report of the use of PGD in sex selection for family balancing in India, where couples place a premium on having baby boys, and the social and ethical aspects of the use of this technology in this setting are briefly discussed.

Preimplantation sex selection for family balancing in India.

We describe our experience with the use of embryo biopsy and fluorescent in-situ hybridization (FISH) in order to sex embryos for the purpose of family balancing in a private IVF clinic in India from April 1999-April 2001. Embryos were biopsied and analysed on day 3, cultured in sequential media, and then transferred on day 4 or day 5 after morphological selection of the best embryos. From a total of 42 cycles started, we achieved 14 clinical pregnancies and have had nine live births so far with five ongoing pregnancies. This is the first report of the use of preimplantation sex selection for family balancing in India, where couples place a premium on having baby boys, and the social and ethical aspects of the use of this technology in this setting are discussed.

Management of intraocular cysticercosis.

BACKGROUND: A study was carried out to investigate the various posterior segment presentations of intraocular cysticercosis and their management. METHODS: A retrospective study of five consecutive cases of intraocular cysticercosis seen at our institute was done. Pars plana vitreous surgery for removal of intact cysts was done in all cases. RESULTS: Complete removal of the intact cyst through the pars plana route was achieved in all cases. Postoperative periods were uneventful, with visual recovery to 6/9 or better in all cases. CONCLUSIONS: Complete surgical removal of the intact cyst can result in good functional recovery in eyes with intraocular cysticercosis.

A new curved vitreous cutter for managing phakic retinal detachment with proliferative vitreoretinopathy.

In the presence of proliferations anteriorly, adequate excision of the vitreous base is essential. To enable a good vitreous base excision, removal of lens often becomes necessary as it may be damaged while attempting to remove peripheral vitreous. To avoid damage or the need to remove the crystalline lens we have used a new modified curved vitreous cutter along with a wide angle observation system binocular indirect ophthalmomicroscope (BIOM). Use of BIOM during vitreous surgery enables easy viewing of the retinal periphery without the need for scleral depression. Sclerotomies are made as for any regular three-port vitrectomy procedure and the vitrectomy is carried out using the curved vitreous cutter, including the vitreous base, avoiding damage to the crystalline lens. The modified curved vitreous cutter is helpful in removing the peripheral vitreous without damaging the crystalline lens, giving the patient the advantage of intraocular lens implantation at a later date.

Inappropriate use of new technology: impact on women's health.

While medical technology is very useful we need to be aware of its inappropriate use. Examples are given, such as: continuous vs. intermittent electronic fetal monitoring; widespread use of magnetic resonance image technology where simple methods could be as effective; laparoscopically assisted vaginal hysterectomies replacing simple vaginal hysterectomies and increasing the cost; ultrasound to provide the first pictures of the baby or to detect female fetuses for female feticide; use of technology for defensive medicine rather than using it for the patient's welfare, and pecuniary indications. Woe betide the doctor who does not make enough money--he may find that his contract is not renewed. We need to empower patients with information, so that they can judge the technology and its appropriateness as it relates to them. Opinion programs have helped to curb the misuse of unnecessary surgery, and audit and peer review programs also provide a check on the misuse of technology. The provision of consensus statements, e.g. by the National Institutes of Health, USA, have helped to clarify issues and to guide doctors as to the appropriateness of the newer technologies, and practice guidelines formulated by experts are also very helpful. We need to teach medical students and residents how to be critical, how to evaluate claims and study the literature, so that they are not hoodwinked by 'authority' or misled by manufacturer's claims.

Postsurgical endophthalmitis: diagnosis and management.

Infectious endophthalmitis following intraocular surgery is a complication that could cause severe visual loss or loss of the eye. The categorisation of the event that led to intraocular infection will help the clinician to predict the infectious agent and begin appropriate therapy. Most of the cases of postsurgical endophthalmitis are seen following cataract surgery. It is important for all ophthalmologists, irrespective of specialisation and areas of interest, to be familiar with the management of endophthalmitis. This review briefly describes the facets of clinical and laboratory diagnosis, pathology, and management. While the different viewpoints in the management of endophthalmitis are mentioned in appropriate places, more attention is paid to present a rational approach to the management of endophthalmitis.

Vaginal hysterectomy following previous cesarean section.

OBJECTIVE: To determine whether hysterectomy by the vaginal route is safe and feasible in patients with previous cesarean section. METHODS: A retrospective study of the records of private and public hospital patients who underwent vaginal hysterectomy performed by the senior author. Two hundred twenty patients who had had previous cesarean sections were compared with a control group of 200 patients who had not had previous pelvic surgery, with special reference to operative difficulties, intraoperative complications, surgical time and length of hospital stay. RESULTS: It was possible to perform vaginal hysterectomy safety in patients with previous cesarean sections. Three of 200 (1.5%) patients had inadvertent intraoperative urological trauma because of dense adhesions. CONCLUSIONS: The vaginal route is the route of choice for performing a hysterectomy in patients with previous cesarean section.