[Gallbladder torsion]. / Torsie van de galblaas.

BACKGROUND: Gallbladder torsion or gallbladder volvulus is a rare condition of the hepatobiliary system, defined as a rotation of the gallbladder along its long axis causing an interruption of the vascular and biliary flow. It clinically mimics acute cholecystitis which makes accurate preoperative diagnosis challenging. CASE DESCRIPTION: We present the case of an 81-year-old woman with a three day history of upper-right quadrant pain, nausea, vomiting and no evidence of cholelithiasis on imaging. Emergency cholecystectomy was performed, intraoperative findings included a necrotic gallbladder with complete torsion. After the secondary diagnosis of gallbladder torsion, the clinical and radiologic findings were reviewed retrospectively. CONCLUSION: The acute onset of abdominal pain without clear progression over time should initially be the trigger for differential diagnostic consideration of gallbladder torsion. This combined with the previously described risk factors and radiological characteristics could result in successful pre-operative diagnosis of gallbladder torsion.

Congenital Bilateral Anomaly of the Flexor Pollicis Longus Tendon Without Thenar Atrophy: A Case Report.

In this case report, we describe an adult patient with bilateral congenital absence of the m. flexor pollicis longus (FPL) without any other anomalies or thenar atrophy. The FPL muscle acts to flex the thumb and is innervated by the anterior interosseous nerve. Impaired function of the FPL muscle may have several causes. A bilateral anomaly of the FPL tendon is a rare phenomenon, with only a few cases having been reported. This case report does not only demonstrate the diagnosis of bilateral FPL tendon anomaly by physical examination and magnetic resonance imaging, it also includes the embryological development of the FPL muscle and tendon.

Correction to: Frequency and characteristics of contralateral breast abnormalities following recall at screening mammography.

The original version of this article, published on 17 April 2018, unfortunately contained a mistake.

Frequency and characteristics of contralateral breast abnormalities following recall at screening mammography.

PURPOSE: To determine the frequency and characteristics of contralateral, non-recalled breast abnormalities following recall at screening mammography. METHODS: We included a series of 130,338 screening mammograms performed between 1 January 2014 and 1 January 2016. During the 1-year follow-up, clinical data were collected for all recalls. Screening outcome was determined for recalled women with or without evaluation of contralateral breast abnormalities. RESULTS: Of 3,995 recalls (recall rate 3.1%), 129 women (3.2%) underwent assessment of a contralateral, non-recalled breast abnormality. Most lesions were detected at clinical mammography and/or breast tomosynthesis (101 women, 78.3%). The biopsy rate was similar for recalled lesions and contralateral, non-recalled lesions, but the positive predictive value of biopsy was higher for recalled lesions (p = 0.01). A comparable proportion of the recalled lesions and contralateral, non-recalled lesions were malignant (p = 0.1). The proportion of ductal carcinoma in situ was similar for both groups, as well as invasive cancer characteristics and type of surgical treatment. CONCLUSIONS: About 3% of recalled women underwent evaluation of contralateral, non-recalled breast lesions. Evaluation of the contralateral breast after recall is important as we found that 15.5% of contralateral, non-recalled lesions were malignant. Contralateral cancers and screen-detected cancers show similar characteristics, stage and surgical treatment. KEY POINTS: • 3% of recalled women underwent evaluation of contralateral, non-recalled lesions • One out of seven contralateral, non-recalled lesions was malignant • A contralateral cancer was diagnosed in 0.5% of recalls • Screen-detected cancers and non-recalled, contralateral cancers showed similar histological characteristics • Tumour stage and surgical treatment were similar for both groups.

Incidence and tumour characteristics of bilateral and unilateral interval breast cancers at screening mammography.

BACKGROUND: Detected by screening mammography, bilateral breast cancer has a different pathological profile compared to unilateral breast cancer. We investigated the incidence of bilateral interval breast cancers and compared their characteristics with those of unilateral interval breast cancers. METHODS: We included all 468,720 screening mammograms of women who underwent biennial screening mammography in the South of the Netherlands between January 2005 and January 2015. We collected breast imaging reports, biopsy results and surgical reports of all referred women and of all women who presented with interval breast cancer. The tumour with the highest tumour stage (index cancer) was used for comparison with unilateral interval cancers. RESULTS: A total of 753 interval cancers were detected, of which 24 (3.2%) were bilateral. Among the invasive interval cancers, bilateral cancers more frequently showed a lobular histology than unilateral cancers (37.5% (9/24) vs. 16.1% (111/691), P = .01). There is a trend towards a larger proportion of bilateral than unilateral interval cancers graded 1 (45.8% (11/24) vs. 27.8% (192/691), P = .08). There were no other statistically significant differences in tumour characteristics. Also, the proportion of interval cancers showing significant mammographic abnormalities at the latest screen was comparable for unilateral and bilateral interval cancers (23.0% vs. 25.0%, P = .9). DISCUSSION: Bilateral interval cancers comprise a small proportion of all interval cancers. Except of a higher proportion of invasive lobular cancers and a more favourable histological grade of invasive cancers, tumour characteristics are comparable for bilateral and unilateral interval breast cancers.

Interval breast cancer characteristics before, during and after the transition from screen-film to full-field digital screening mammography.

BACKGROUND: To determine the proportion of "true" interval cancers and tumor characteristics of interval breast cancers prior to, during and after the transition from screen-film mammography screening (SFM) to full-field digital mammography screening (FFDM). METHODS: We included all women with interval cancers detected between January 2006 and January 2014. Breast imaging reports, biopsy results and breast surgery reports of all women recalled at screening mammography and of all women with interval breast cancers were collected. Two experienced screening radiologists reviewed the diagnostic mammograms, on which the interval cancers were diagnosed, as well as the prior screening mammograms and determined whether or not the interval cancer had been missed on the most recent screening mammogram. If not missed, the cancer was considered an occult ("true") interval cancer. RESULTS: A total of 442 interval cancers had been diagnosed, of which 144 at SFM with a prior SFM (SFM-SFM), 159 at FFDM with a prior SFM (FFDM-SFM) and 139 at FFDM with a prior FFDM (FFDM-FFDM). The transition from SFM to FFDM screening resulted in the diagnosis of more occult ("true") interval cancers at FFDM-SFM than at SFM-SFM (65.4% (104/159) versus 49.3% (71/144), P < 0.01), but this increase was no longer statistically significant in women who had been screened digitally for the second time (57.6% (80/139) at FFDM-FFDM versus 49.3% (71/144) at SFM-SFM). Tumor characteristics were comparable for the three interval cancer cohorts, except of a lower porportion (75.7 and 78.0% versus 67.2% af FFDM-FFDM, P < 0.05) of invasive ductal cancers at FFDM with prior FFDM. CONCLUSIONS: An increase in the proportion of occult interval cancers is observed during the transition from SFM to FFDM screening mammography. However, this increase seems temporary and is no longer detectable after the second round of digital screening. Tumor characteristics and type of surgery are comparable for interval cancers detected prior to, during and after the transition from SFM to FFDM screening mammography, except of a lower proportion of invasive ductal cancers after the transition.

Screening outcome in women repeatedly recalled for the same mammographic abnormality before, during and after the transition from screen-film to full-field digital screening mammography.

OBJECTIVE: The aim of this study was to retrospectively determine screening outcome in women recalled twice for the same mammographic lesion before, during, and after transition from screen-film (SFM) to full-field digital screening mammography (FFDM). METHODS: We included women with a repeated recall for the same mammographic abnormality (37 at subsequent SFM-screening, obtained between January 2000-April 2010; respectively 54 and 65 women with a prior SFM-screen or FFDM-screen followed by subsequent FFDM-screening, obtained between May 2009-July 2013). RESULTS: At SFM-screening, repeated recalls for the same lesion comprised 1.2 % of recalls (37/3217), including 13 malignancies (positive predictive value (PPV), 35.1 %). During the SFM to FFDM transition (SFM-screen followed by FFDM-screen), FFDM recalls comprised more repeated recalls for the same lesion (2.2 %, P = 0.002), with a lower PPV (14.8 %, P = 0.02). This proportion increased to 2.8 % after transition to FFDM (i.e., two successive FFDM-screens), with 16 malignancies (PPV, 24.6 %). Invasive cancers at repeated recall were smaller than interval cancers (T1a-c, 79.4 versus 46.8 %, P = 0.001), with less lymph node involvement (20.6 versus 46.5 %, P = 0.007). CONCLUSIONS: More women are repeatedly recalled for the same mammographic abnormality during and after the transition from SFM to FFDM-screening, with comparable cancer risks before and after the transition. These cancers show better prognostic characteristics than interval cancers. KEY POINTS: • FFDM-screening increases the number of repeated recalls for the same mammographic abnormality. • The PPV of these recalls is comparable before and after transition to FFDM-screening. • Cancers diagnosed after a repeated recall are smaller than interval cancers. • These cancers also show less lymph node involvement than interval cancers.

Re-attendance at biennial screening mammography following a repeated false positive recall.

We determined the re-attendance rate at screening mammography after a single or a repeated false positive recall and we assessed the effects of transition from screen-film mammography (SFM) to full-field digital mammography (FFDM) on screening outcome in women recalled twice for the same mammographic abnormality. The study population consisted of a consecutive series of 302,912 SFM and 90,288 FFDM screens. During a 2 years follow-up period (until the next biennial screen), we collected the breast imaging reports and biopsy results of all recalled women. Re-attendance at biennial screening mammography was 93.2 % (95 % CI 93.1-93.3 %) for women with a negative screen (i.e., no recall at screening mammography), 65.4 % (95 % CI 64.0-66.8 %) for women recalled once, 56.7 % (95 % CI 47.1-66.4 %) for women recalled twice but for different lesions and 44.3 % (95 % CI 31.4-57.1 %) for women recalled twice for the same lesion. FFDM recalls comprised a significantly larger proportion of women who had been recalled twice for the same lesion (1.9 % of recalls (52 women) at FFDM vs. 0.9 % of recalls (37 women) at SFM, P < 0.001) and the positive predictive value of these recalls (PPV) was significantly lower at FFDM (15.4 vs. 35.1 %, P = 0.03). At review, 20 of 52 women (39.5 %, all with benign outcome) would not have been recalled for a second time at FFDM if the previous hard copy SFM screen had been available for comparison. We conclude that a repeated false positive recall for the same lesion significantly lowered the probability of screening re-attendance. The first round of FFDM significantly increased the proportion of women recalled twice for the same lesion, with a significantly lower PPV of these lesions. Almost 40 % of repeatedly recalled women would not have been recalled the second time if the previous hard copy SFM screen had been available for comparison at the time of FFDM.

Silent cardiac ischemia after an ischemic stroke of the right hemisphere.

A patient is described who previously had daily complaints of angina pectoris, yet no longer experienced chest pain after an ischemic stroke of the right hemisphere, despite several recorded episodes of electrocardiographic changes and an elevation of cardiac enzymes compatible with myocardial ischemia. The cingulate gyrus is involved in spatial attention and neglect, and is, according to positron emission tomography studies, less activated in silent myocardial ischemia. We suggest that this patient was not aware of the angina because of putamen ischemia and secondary disturbed projection to the cingulate gyrus and no longer felt or experienced this referred pain.

Design of the PROCON trial: a prospective, randomized multi-center study comparing cervical anterior discectomy without fusion, with fusion or with arthroplasty.

BACKGROUND: PROCON was designed to assess the clinical outcome, development of adjacent disc disease and costs of cervical anterior discectomy without fusion, with fusion using a stand alone cage and implantation of a Bryan's disc prosthesis. Description of rationale and design of PROCON trial and discussion of its strengths and limitations. METHODS/DESIGN: Since proof justifying the use of implants or arthroplasty after cervical anterior discectomy is lacking, PROCON was designed. PROCON is a multicenter, randomized controlled trial comparing cervical anterior discectomy without fusion, with fusion with a stand alone cage or with implantation of a disc. The study population will be enrolled from patients with a single level cervical disc disease without myelopathic signs. Each treatment arm will need 90 patients. The patients will be followed for a minimum of five years, with visits scheduled at 6 weeks, 3 months, 12 months, and then yearly. At one year postoperatively, clinical outcome and self reported outcomes will be evaluated. At five years, the development of adjacent disc disease will be investigated. DISCUSSION: The results of this study will contribute to the discussion whether additional fusion or arthroplasty is needed and cost effective.

Bilateral profound hearing loss due to meningeal carcinomatosis.

Meningeal carcinomatosis (MC) is an uncommon form of metastasis of solid tumors. Hearing loss as the presenting symptom of MC is very uncommon. A patient with an esophageal signet ring cell carcinoma 3 years previously presented with sudden onset of profound hearing loss affecting both ears. He had no evidence of local tumor recurrence. Brain magnetic resonance imaging (MRI) showed swelling and increased signal intensity on T2 weighted images of both acoustic nerves and the right trigeminal nerve. After gadolinium administration, enhancement of both acoustic and trigeminal nerves was seen. He later developed unsteadiness and head-movement-dependent oscillopsia due to vestibular areflexia and diplopia. At that time MRI showed leptomeningeal enhancement. MC was diagnosed, although cerebrospinal fluid cytology could not confirm that diagnosis. The patient died 16 weeks after the onset of deafness. In patients with progressive unilateral and bilateral hearing loss, meningeal carcinomatosis should be considered, especially if there is a history of previous malignancy.