National survey of current practice in assessing tubal patency in the UK

We conducted a postal survey to find out the current practice in the UK regarding the methods employed to assess tubal patency. A questionnaire was developed to evaluate the methods used to assess tubal patency in women presenting with infertility with or without risk factors suggesting pelvic disease. A total of 496 questionnaires were sent and 174 responded (35%). The survey represented an overall view as both gynaecologists and radiologists from secondary and tertiary centres responded. In the responses from radiologists, a hysterosalpingogram was the investigation of choice for both low risk (61%) and high risk women (50%). However in the responses from gynaecologists, in patients with no past gynaecological history, the majority performed a hysterosalpingogram (58%) or hystero contrast sonography (HyCoSy) (14%) whereas in patients in whom pelvic pathology was suspected, most (84%) performed a laparoscopy and dye test. The survey also showed that HyCoSy was performed in only a few centres in the UK. The responses from the majority of gynaecologists were in accordance with the RCOG guidelines. However, still some centres (28%) offered laparoscopy and dye test in low risk women as the primary test for assessing tubal patency. Given the risks associated with laparoscopy, this should be reserved for cases where pathology is suspected and scheduled to be combined with laparoscopic surgery.     

Menstrual disorders in adolescence: investigation and management

Menstrual disorders in adolescence may present diagnostic and management challenges for the gynaecologist. This review will describe the common and uncommon menstrual disorders that may arise in early reproductive life, together with guidance on their investigation and management.     

Current indications for (adeno)tonsillectomy in children: a survey in The Netherlands

OBJECTIVE: Despite the fact that (adeno)tonsillectomy is one of the procedures most frequently performed on children, studies of current indications are scarce. The purpose of this study is to determine the indications for (adeno)tonsillectomy in children younger than 15 years of age according to Dutch ENT surgeons and general practitioners (GPs). METHODS: During a period of 8 months, 18 ENT surgeons in seven ENT practices and 210 referring GPs filled out standard questionnaires for 349 children listed for tonsil surgery. RESULTS: Apart from recurrent tonsillitis (ENT: 40%, GP: 35%), findings such as enlarged tonsils (ENT: 42%, GP: 24%) and tonsillar crypt debris (ENT: 29%, GP: 17%) and non-specific symptoms such as listlessness (ENT: 28%, GP: 19%) and poor appetite (ENT: 28%, GP: 16%) were considered important criteria for surgery. Symptoms of obstructive sleep apnea were present in 25% (ENT) and 6% (GP) of patients but were considered indicative for surgery in only 11% (ENT) and 4% (GP). In contrast to ENT surgeons, GPs considered otitis media and hearing loss relatively important for (adeno)tonsillectomy. CONCLUSIONS: Apart from the generally accepted indications such as recurrent tonsillitis and obstructive sleep apnea, other indications play an equally important role in the decision to perform tonsil surgery in The Netherlands.     

A postal survey of embryo transfer practice in the UK

In this postal survey a questionnaire was sent to all unit directors in the UK to determine their attitudes to the factors influencing embryo transfer practice. They were requested to rate each step on a scale of 1-10, where 1 was irrelevant and 10 very important. A total of 80 practitioners from 40 units replied. Over 50% of the corresponding practitioners were consultants, 33% were middle-grade clinicians, and 12% were infertility nurse specialists. The factor that got the highest rating was the need for a standardized protocol for all unit staff regarding embryo transfer technique. The second critical factor voted by the respondents was the presence of blood on the embryo transfer catheter. Not touching the uterine fundus was deemed to be the third most important factor while the type of embryo transfer catheter used was a very close fourth. Prolonged bed rest following embryo transfer was voted the least important factor to influence the outcome. The wide variations in practice and choice of catheters encountered in this survey are indications of the divided opinion and lack of concrete evidence on which to base any firm decisions. The need for large clinical studies to assess clearly whether higher pregnancy rates will result from modifications in embryo transfer practice is highlighted.     

Endovascular stenting of veins and grafts: preliminary clinical experience

Stenotic lesions of veins and bypass grafts are often difficult to dilate and have a high frequency of recurrence. In an effort to provide an endoluminal mechanical support, the new concept of transluminal vascular stenting was applied in four patients with stenoses of nonarterial vessels, including two with postoperative venous stenoses, one with a stenosed mesenteric artery graft anastomosis, and one with a long stenosis of the basilic vein distal to a hemodialysis shunt graft. All four were successfully treated with percutaneous transluminal angioplasty followed by endovascular stenting. All but one of the stented segments were patent, with no significant restenosis after a follow-up of 4 1/2-12 months. There have been previous reports of transluminal vascular stenting in the arterial system, and the preliminary results from this study suggest that endovascular stenting also may play an important role in the treatment of venous and graft stenoses. However, further follow-up and careful patient selection will have to be done to establish the long-term benefit of this new procedure.