Patient-reported outcome measurement compared with professional judgment of cosmetic results after breast-conserving therapy.

Background: In the present study, we set out to compare patient-reported outcomes with professional judgment about cosmesis after breast-conserving therapy (bct) and to evaluate which items (position of the nipple, color, scar, size, shape, and firmness) correlate best with subjective outcome. Methods: Dutch patients treated with bct between 2008 and 2009 were analyzed. Exclusion criteria were prior amputation or bct of the contralateral breast, metastatic disease, local recurrence, or any prior cosmetic breast surgery. Structured questionnaires and standardized six-view photographs were obtained with a minimum of 3 years' follow-up. Cosmetic outcome was judged by the patients and, based on photographs, by 5 different medical professionals using 3 different scoring systems: the Harvard scale, the Sneeuw questionnaire, and a numeric rating scale. Agreement was scored using the intraclass correlation coefficient (icc). The association between items of the Sneeuw questionnaire and a fair-poor Harvard score was estimated using logistic regression analysis. Results: The study included 108 female patients (age: 40-91 years). Based on the Harvard scale, agreement on cosmetic outcome between the professionals was good (icc: 0.78). In contrast, agreement between professionals as a group compared with the patients was found to be fair to moderate (icc range: 0.38-0.50). The items "size" and "shape" were identified as the strongest determinants of cosmetic outcome. Conclusions: Cosmetic outcome was scored differently by patients and professionals. Agreement was greater between the professionals than between the patients and the professionals as a group. In general, size and shape were the most prominent items on which cosmetic outcome was judged by patients and professionals alike.

Systemic air embolism after cardiopulmonary resuscitation in a preterm infant.

UNLABELLED: We report a preterm infant with extensive systemic air embolism after cardiopulmonary resuscitation for cardiac arrest due to an occluding thrombus in the inferior vena cava. After excluding other potential causes (air infusion, necrotizing enterocolitis or pulmonary leakage syndrome), we postulate that the pressure gradient needed for air embolism to occur is related to the resuscitation procedure. An important clue of air embolism was noted on the chest X-ray taken before death showing intracardial air. CONCLUSION: Systemic air embolism may occur as a very rare complication after cardiopulmonary resuscitation.

Magnetic resonance angiography used to detect kinking in the iliac arteries in endurance athletes with claudication.

In endurance athletes, leg complaints upon maximal exercise caused by flow limitations in the iliac arteries are frequently encountered. We theorize that functional kinking of the vessels, which occurs especially during hip flexion, may be a cause for such flow limitations. Conventional diagnostic tests cannot demonstrate such kinkings. Using gadolinium-enhanced magnetic resonance angiography, a 3D dataset of the aorto-iliac arteries could be obtained with the hips flexed. An image processing procedure was developed using a new segmentation algorithm to be able to use standard surface rendering techniques to visualize the arteries with an improved 3D appearance. These techniques were applied in the current study in 42 endurance athletes with documented flow limitations in the iliac arteries. As a control group 16 national level competitive cyclists without flow limitations in the iliac arteries were studied. Forty-six affected legs were examined in 42 patients. In all patients and reference persons image quality was adequate and the segmentation algorithm could be applied. In 22 affected legs (48%) a kinking in the common iliac artery could be demonstrated, compared with one leg (3%) in the control group. In 13 affected legs (28%) a kinking in the external iliac artery could be demonstrated, compared with three legs (9%) in the control group. It can be concluded that flow limitations in the iliac arteries in endurance athletes are associated with kinkings in the common and/or the external iliac arteries. Magnetic resonance angiography with the hips flexed followed by this newly developed segmentation algorithm is effective to visualize and score these kinkings.

MR features of a 24-year-old gossypiboma. A case report.

Retained surgical sponges can cause serious diagnostic problems. We report on our experience with a piece of gauze, encapsulated for 24 years, that mimicked a soft-tissue neoplasm, and we describe its MR features.

Radiographic anthropometry in patients with multiple epiphyseal dysplasia.

OBJECTIVE: This study investigated the diagnostic value of radiographic anthropometry in patients with multiple epiphyseal dysplasia (MED). SUBJECTS AND METHODS: In 15 children of one family with MED (12 affected, three unaffected), all of whom were less than 16 years old, measurements were made of the distal femoral metaphysis and epiphysis on standard anteroposterior radiographs of the knee. In each individual, the height of the epiphysis was plotted against the width of both the epiphysis and the metaphysis. Sensitivity, specificity, and positive and negative predictive values were calculated. RESULTS: In 11 of 12 children with MED, the plotted values were more than 2 SDs below the mean. Sensitivity was 92%, specificity was 100%, and positive predictive value was 100%. CONCLUSION: Anthropometry is useful to detect involvement of a child in a family with MED. For this particular family, anthropometry had a high positive predictive value.