for testicular US, outcome and follow-up. We also searched Medline/PubMed, using the same keywords for published data on TM from 1970 to 2006. RESULTSOver the study period 711 testicular scans were taken in 623 patients; seven cases (1.1%) of TM were identified. The mean (range) age at presentation was 12 (7-15) years. The presenting symptoms were testicular pain (three), undescended testes (two), hydrocele (one) and asymptomatic scrotal swelling (one). In five cases the TM was bilateral and in two a solitary kidney was identified. Only one patient had tumour markers measured ( β -human chorionic gonadotrophin and α -fetoprotein) and these were within normal limits. On yearly US follow-up, the TM was less prominent in one patient, unchanged in four and two were lost to follow-up. Three patients are currently on yearly US follow-up while two are under the care of adult general surgeons. The analysis of reports published to date indicated that malignancy only develops when TM is associated with other predisposing factors. CONCLUSIONThere is no convincing evidence that TM alone is premalignant. However, when it accompanies other potentially premalignant features we recommend annual US follow-up.

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Overall respondents reported early intervention services for young children with ID in Western Australia provided satisfactory family-centred care by means of the 56-item MPOC. The frequency of contact with allied health professionals was positively associated with parental ratings of family-centred care. The study indicates under-servicing in dental care and psychology services.

Minor degrees of exomphalos have been known to be associated with vitellointestinal duct anomalies. The most frequent association is Meckel's diverticulum. It is unusual for a fistula to be communicating directly with the exomphalos sac. We report five neonates that presented with a fistula on the exomphalos sac over a 10-year period. The different variants of patent vitellointestinal duct in these cases have been discussed with a review of the literature.