Acute cytomegalovirus cholecystitis following renal transplantation.

Solid organ transplant recipients are at risk of infection from cytomegalovirus (CMV). A wide range of disease is associated with CMV infection and we report two cases of CMV cholecystitis in patients following renal transplantation. Both patients presented with severe hemorrhagic cholecystitis, which required immediate resuscitation and emergency cholecystectomy. The diagnosis of CMV infection was confirmed in both cases using CMV-specific staining of the gallbladder. The diagnosis of CMV cholecystitis must be considered in all patients with upper abdominal pain after renal transplantation.

Follow-up of benign screen-detected breast lesions with suspicious preoperative needle biopsies.

AIM: To study the outcome of patients with screen-detected breast lesions in whom preoperative core biopsy (CB), or fine needle aspiration cytology (FNAC), or both were suspicious of malignancy or malignant, but the final histology of the excised lesion was benign. MATERIALS AND METHODS: Thirty-nine patients who fulfilled the above criteria were identified from a prospectively entered database of 192,153 breast screening examinations at the Bedfordshire and Hertfordshire Breast Screening Unit. Thirty-four patients had suspicious or malignant preoperative FNAC and/or CB, and five had FNAC only. Follow-up was mainly by mammograms. Outcome data were collected from hospital case notes and radiology reports. RESULTS: The median follow-up period was 3 years following excision biopsy. One patient whose excision biopsy histology was atypical ductal hyperplasia developed a mammographically occult carcinoma in the same breast after 24 months. There were no other cancers reported during this time. CONCLUSION: The problem of suspicious preoperative needle biopsies with benign excision biopsy is uncommon in the breast screening population. These patients are not at an increased risk of being diagnosed with a carcinoma in the subsequent 3 years and may be discharged back to standard breast screening.

The use of ultrasound by breast surgeons in outpatients: an accurate extension of clinical diagnosis.

AIMS: To assess the accuracy of breast ultrasound scan (USS) performed by a surgeon in outpatients and to evaluate the additional contribution of USS to clinical diagnosis. METHODS: A prospective study of 302 patients with symptomatic breast disease (322 lumps) was performed. Group 1 consisted of 213 clinic USS of lumps surgically removed for appropriate clinical indications. In Group 2, a USS was performed on 231 lumps by both the surgeon and radiologists as part of triple assessment. Each clinic USS was compared to the surgical pathology (Group 1) or USS performed by the radiologist (Group 2). RESULTS: In Group 1 (n=213), 89 lumps were proven benign and 124 malignant on histology. Ultrasound scans performed by the surgeon compared to histology had a sensitivity of 98.3% and specificity of 91.7%. An abnormal clinic USS heightened the index of suspicion in 22/213 (10.3%) of cases felt clinically to be benign but subsequently confirmed malignant on histology. Fifty-seven lumps felt to be indeterminate clinically were correctly identified on USS by surgeon as benign (n=56) or malignant (n=1). In Group 2 (n=231), there was complete concordance of USS scans by surgeon and radiologists in 197 (96%) and complete discordance in eight (3.9%) patients. Of the discordant scans, the surgeon correctly identified 7/8 diagnoses on histology. A USS examination by the radiologists provided a correct diagnosis of 6/14 scans scored by the clinician as indeterminate. CONCLUSION: USS performed in outpatients by a breast surgeon is accurate and a useful adjunct to clinical assessment. This enables rapid diagnosis in one-stop breast clinics, selecting difficult diagnostic procedures for USS by radiologists at the same visit.

Is diagnostic arthroscopy of the hip worthwhile? A prospective review of 328 adults investigated for hip pain.

We describe a prospective study of 328 patients undergoing arthroscopy of the hip. Arthrography, CT or MRI was performed when clinically indicated. A preoperative diagnosis was reached in 174 patients (53%), while the remaining 154 were diagnosed as having 'idiopathic hip pain'. In seven patients, access to the hip was inadequate. Arthroscopy altered the diagnosis in 176 hips (53%). The new primary diagnoses were osteoarthritis (75 patients), osteochondral defects (34), torn labra (23), synovitis (11) and loose bodies (9). In 172 hips (52%) an operative procedure was undertaken. In the remaining 84 patients (26%), arthroscopy neither changed the diagnosis nor provided surgical treatment. Arthroscopy of the hip is considered to be of value in assessing and treating the adult patient with pain in the hip of uncertain cause.