Selective salpingography and fallopian tube recanalisation: experience from a district general hospital.

The Royal College of Obstetricians and Gynaecologists has included selective salpingography and tubal catheterisation (SS-TC) in its evidence-based clinical guideline for the management of infertility in secondary care. In spite of being a cost-effective and minimally invasive treatment option for proximal tubal blockage, SS-TC has been slow to become adopted across the UK. We here describe our initial experience with setting up of tubal recanalisation service in a district general hospital (DGH) in the UK, along with our preliminary results. Tubal patency was achieved in 11 patients out of 14 who underwent SS-TC (78%). Four women achieved spontaneous pregnancy (success rate 28.57%) within 1 year of treatment. The procedure should become a universally accepted, taught and practiced approach in the diagnosis and treatment of the fallopian tube. Especially in infertility units located in a DGH it can be used selectively in the patients with good prognosis and other cases referred to tertiary center for more rapid in-vitro fertilisation (IVF).

Ultrasound in children with osteomyelitis.

Ultrasound (US) is a proven method of identifying subperiosteal abscess formation in osteomyelitis, but its precise role in the management of children with the condition is contentious. We reviewed nine children in whom US was used in the management of long bone osteomyelitis, including ribs. US was helpful in confirming the presence of a subperiosteal abscess in those children with an appropriate history and localizing signs. In these circumstances a bone scan is unnecessary. Problems were encountered when US failed to identify a subperiosteal abscess, because of the early stage of the disease process, and in multifocal abnormalities. In these circumstances a bone scan should still be performed.

Comparison of light reflection rheography with ascending venography in the diagnosis of lower limb deep venous thrombosis.

A prospective evaluation of light reflective rheography (LRR) in the diagnosis of acute lower limb deep venous thrombosis (DVT) has been conducted by the comparison of rheographic changes with ascending venography. LRR reliably predicts the absence of DVT, but cannot accurately detect its presence. It is suggested that the technique may be used for surveillance but should not replace venography as a method for establishing the diagnosis of DVT.

Pyogenic sacroiliitis, the missed diagnosis?

Pyogenic sacroiliitis is considered to be an uncommon infection, which is often diagnosed late because of poor localization of symptoms and normal plain radiographs at presentation. Nine cases aged between 20 months and 14 years who presented with sacroiliitis over a 7 year period are reviewed retrospectively. Isotope bone scanning is a useful technique in establishing early diagnosis and its relationship to other diagnostic imaging modalities is discussed. By routinely obtaining views of the entire pelvis in children presenting with hip pain and a limp, pyogenic sacroiliitis may be detected more frequently.

Osteoarthritis associated with distal interphalangeal joint involvement in rheumatoid arthritis.

A study was undertaken to investigate the relationship between the clinical and radiological findings in patients with rheumatoid arthritis (RA), osteoarthritis (OA), and combined osteoarthritis and rheumatoid arthritis (OA/RA) affecting the hands. Fifty patients were selected for each group from those attending a rheumatology clinic. The study showed a good correlation between the clinical and radiological diagnosis of combined OA/RA and that marginal erosive changes in the distal interphalangeal (DIP) joints occur more commonly in patients with rheumatoid arthritis who have coexisting osteoarthritis.