Ultrasound-guided breast-conserving surgery for early-stage palpable and nonpalpable invasive breast cancer: decreased excision volume at unchanged tumor-free resection margin.

Ultrasound guidance (USG) during breast-conserving surgery improves tumor-free surgical resection margins. The objective of this study was to evaluate whether USG reduces resection volumes without compromising margin status. 134 patients with palpable or nonpalpable T1-2N0-1 invasive breast cancer were treated with USG and compared with a historical reference control group (CON) consisting of palpation-guided (PAG) or wire-guided localization (WIG) breast-conserving surgery. Primary outcomes were excess resection volume and clear margin status, and secondary outcome was re-excision rate. 66 patients underwent USG. In the CON group (n = 68), PAG was performed in 24 (35 %) and WIG in 44 (64 %) patients. Median excision volume [39 (IQR 20-66) vs 56 (38-94) cm(3); p = 0.001] and median calculated resection ratio [1.7 (1.0-2.9) vs 2.8 (1.4-4.6) (p = 0.005)] were significantly smaller in the USG than in the CON group. Median minimal distance to the resection margin [4 mm (IQR 2-5 mm) vs 2 mm (1-4 mm), p = 0.004] was significantly larger. Clear resection margins were achieved in 58 of the USG patients (88 %) and in 58 of the CON patients (86 %) (p = 0.91); this was true in patients with palpable as well as nonpalpable lesions. Reexcision was needed in 6.1 and 7.2 % respectively. Relative risk for re-excision in the USG group was 0.82 (95 % CI 0.23-2.93). In patients with palpable and nonpalpable breast cancers, USG allows for lower excision volume and reduced resection of healthy breast tissue, without increased re-excision rate.

[Diagnostic image (144) A man with clubbing of fingers. Hypertrophic osteoarthropathy (Pierre-Marie-Bamberger syndrome)]. / Diagnose in beeld (144). Een man met trommelstokvingers. Hypertrofische osteoartropathie (syndroom van Pierre-Marie-Bamberger).

A 59-year-old man presented with clubbing of fingers and toes, arthralgia and a tumour of the left lung. Pulmonary hypertrophic osteoarthropathy (Pierre-Marie-Bamberger syndrome) was diagnosed. After pneumonectomy of the left lung the clubbing disappeared.

Primary aortoenteric fistula: report of six new cases.

Primary aortoenteric fistula (PAEF) is defined as a communication between the native aorta and the gastrointestinal tract, in contrast to secondary fistulas, which arise between a suture line of a vascular graft and the intestine. Arteriosclerosis is the predominant cause of PAEF and accounts for more than two-thirds of the cases reported. The pathogenesis is usually based on direct adhesion of a segment of the gastrointestinal tract to an aortic aneurysm, followed by progressive erosion through the bowel wall. The clinical presentation is usually one of intermittent gastrointestinal haemorrhage resulting in lethal exsanguination. Pain in the abdomen, a pulsatile abdominal mass or fever may be present. The choice of various diagnostic procedures is often decided by the clinical presentation. Esophagogastroduodenoscopy, ultrasound and CT scan may be useful in the evaluation of these patients. Current recommendations for repair include debridement of the aneurysmal aorta, repair with an in situ graft and primary repair of the gastrointestinal tract, followed by aggressive antimicrobial therapy. We present six cases of PAEF surgically treated at the St. Radboud Hospital, the Canisius Wilhelmina Hospital in Nijmegen and the Lukas Hospital in Apeldoorn over a period of 15 years.

[Cystic degeneration of the adventitia of the popliteal artery after PTA of the superficial femoral artery]. / Zystische Adventitiadegeneration der A. poplitea bei Zustand nach PTA der A. femoralis superficialis.

Cystic adventitial degeneration is rare. Most frequently it occurs in the popliteal artery, occasionally it may be found in other arteries and even in veins. It is always localized in joint-adjacent vessel areas and appears to originate in ectopic synovial tissue occasionally with a stemlike connection with the adjacent joint. The diagnosis of a cystic adventitial degeneration should be considered in cases of isolated stenosis or occlusion of the popliteal artery. Realtime ultrasound or computerized tomography may help to establish the diagnosis. The treatment of choice is surgival removal of the cysts or reconstruction with an autologous vein interponate. A rare case of simultaneous occurrence of cystic adventitial degeneration and arteriosclerotic occlusive disease is described.