E. Coerkamp - Academia.edu (original) (raw)
Papers by E. Coerkamp
The archives of bone and joint surgery, 2016
BACKGROUND The I-Space is a radiological imaging system in which Computed Tomography (CT)-scans c... more BACKGROUND The I-Space is a radiological imaging system in which Computed Tomography (CT)-scans can be evaluated as a three dimensional hologram. The aim of this study is to analyze the value of virtual reality (I-Space) in diagnosing acute occult scaphoid fractures. METHODS A convenient cohort of 24 patients with a CT-scan from prior studies, without a scaphoid fracture on radiograph, yet high clinical suspicion of a fracture, were included in this study. CT-scans were evaluated in the I-Space by 7 observers of which 3 observers assessed the scans in the I-Space twice. The observers in this study assessed in the I-Space whether the patient had a scaphoid fracture. The kappa value was calculated for inter- and intra-observer agreement. RESULTS The Kappa value varied from 0.11 to 0.33 for the first assessment. For the three observers who assessed the CT-scans twice; observer 1 improved from a kappa of 0.33 to 0.50 (95% CI 0.26-0.74, P=0.01), observer 2 from 0.17 to 0.78 (95% CI 0.36-...
Arthroscopy: The Journal of Arthroscopic & Related Surgery, 2006
To assess the accuracy of shoulder infiltrations in the subacromial bursa (SAB) by a posterior or... more To assess the accuracy of shoulder infiltrations in the subacromial bursa (SAB) by a posterior or an anteromedial approach. Magnetic resonance imaging (MRI) and clinical outcome were used for evaluation. Type of Study: A prospective randomized study. Methods: Thirty-three patients (22 women, 11 men; average age, 46 years; range, 25 to 64 years) with clinical signs of subacromial impingement were infiltrated with a mixture of bupivacaine, methylprednisolone, and gadolinium-DTPA directly followed by MRI to determine the actual site of injection. The SAB was randomly infiltrated posteriorly (n ϭ 17) or anteromedially (n ϭ 16). Injection confidence of the surgeon and body-mass index of the patient were recorded. Follow-up consisted of the Constant Score, Simple Shoulder Test, and visual analog scale score for pain taken within 24 hours and 6 weeks after infiltration. Results: Thirteen injections (76%) were in the SAB with a posterior approach and 10 (69%) with an anteromedial approach. Many surrounding structures were hit as well, especially the rotator cuff. A positive correlation between the injection confidence of the orthopaedic surgeon and the MRI was found in 66%. Only injection of the SAB alone resulted in a significant decrease of the pain (P ϭ .004) and an increase in the functional scores. Injection in the bursa and rotator cuff muscle showed a significant increase in pain (P ϭ .032) but no change in clinical scores. The body mass index had no influence on the scores. Conclusions: Injections in the SAB are inaccurate, despite the confident feeling of the clinician. The finding that many different structures can be infiltrated with 1 injection can create both false-positive and-negative results. Level of Evidence: Level II.
Knee Surgery, Sports Traumatology, Arthroscopy, 2002
Radiation Oncology, 2014
Introduction: In breast conserving radiotherapy differences of target volume delineations between... more Introduction: In breast conserving radiotherapy differences of target volume delineations between observers do occur. We evaluated whether delineations based on co-registered computed tomography (CT) and magnetic resonance (MR) imaging may result in an improved consistency between observers. We used the delineation conformity index (CI) to compare clinical target volumes of glandular breast tissue (CTV breast) and lumpectomy cavity (LC) on both imaging modalities. Methods and materials: Four observers delineated CTV breast and LC on co-registered CTMR images in ten breast cancer patients. CIs were determined for CT and CTMR. Furthermore, the Cavity Visualization Score (CVS) of LC was taken into account. Results: The mean CI for CTV breast (CI CT;CTV : 0.82 and CI CT-CTMR;CTV : 0.80) and LC (CI CT;LC : 0.52 and CI CT-CTMR;LC : 0.48) did not differ significantly (p = 0.07 and p = 0.33, respectively). Taking CVS into account for the LC, with a CVS ≥ 4 the mean CI was 0.62 for both CI CT;LC and CI CT-CTMR;LC. Conclusion: The mean volume of the delineated glandular breast tissue based on CT was significantly larger compared to the volume based on CTMR. For patients with a CVS ≥ 4, the mean CIs of the LC were higher compared to CVS < 4 for volumes delineated on both CT as well as CTMR images. In our study cohort no significant differences between the CIs of the CTV breast and the LC delineated on CTMR co-registered images were found compared to the CIs on CT images only. Adding MR images does not seem to improve consistency of the delineation of the CTV breast and the LC, even though the volumes were copied from CT images. Since we included only ten patients, caution should be taken with regard to the results of our study.
Radiotherapy and Oncology
JBR-BTR : organe de la Societe royale belge de radiologie (SRBR) = orgaan van de Koninklijke Belgische Vereniging voor Radiologie, 2007
Background: A 50-year-old male patient was referred to the orthopedic surgeon for non specific kn... more Background: A 50-year-old male patient was referred to the orthopedic surgeon for non specific knee pain of five months duration. At physical examination the anterior cruciate ligament (ACL)-test was normal. A standard routine MRI of the knee was performed on a 3.0T scanner.
Radiotherapy and Oncology, 2012
European Radiology, 2005
The aim of this study is to evaluate the relation between bone bruise and (peri-)articular derang... more The aim of this study is to evaluate the relation between bone bruise and (peri-)articular derangement and to assess the impact of bone bruise on presentation and short term course of knee complaints. We recorded MR abnormalities in 664 consecutive patients with sub-acute knee complaints. Patients were divided in four groups: patients with and without intra-articular knee pathology, subdivided in patients with and without bone bruise. We assessed function and symptoms at the time of MR and 6 months thereafter. Bone bruises were diagnosed in 124 of 664 patients (18.7%). Patients with bone bruise had significantly more complete ACL, lateral meniscal, MCL and LCL tears. Both with and without intraarticular pathology patients with bone bruise had a significantly poorer function at the time of MR (Noyes score of, respectively, 313.21 versus 344.81 and 306.98 versus 341.19). Patients with bone bruise and intraarticular pathology showed significantly more decrease in activity (decrease of Tegner score from 6.28 to 2.12 versus 5.70-2.55). At 6 months there were no significant differences in clinical parameters between the four groups. We concluded that bone bruise in combination with MCL tear is an important cause of initial clinical impairment in patients with sub-acute knee complaints. Clinical improvement within 6 months is more pronounced than in patients without bone bruise.
British Journal of Surgery, 1994
The ultrasonographic measurement of abdominal aortic aneurysm (AAA) must be accurate as the decis... more The ultrasonographic measurement of abdominal aortic aneurysm (AAA) must be accurate as the decision on elective repair will usually be based on such results. To detect expansion, measurements must be comparable. The interobserver variation of ultrasonographic measurement of infrarenal aortic aneurysms under standardized conditions is described.
Clinical Radiology Extra, 2002
Epiploic appendices are pedunculated adipose protrusions from the serosal surface of the colon. A... more Epiploic appendices are pedunculated adipose protrusions from the serosal surface of the colon. An epiploic appendix may undergo infarction followed by secondary in¯ammatory changes, a process which has been named epiploic appendagitis in order to avoid confusion with vermiform appendicitis. Presenting symptoms are non-speci®c, leading to a presumed clinical diagnosis of diverticulitis or appendicitis in most cases [1]. Misdiagnosis may result in unwarranted surgical procedures and hospitalization, as epiploic appendagitis is a self-limiting disease [2,3]. Ultrasound (US) and computed tomography (CT) are capable of a reliable diagnosis of epiploic appendagitis [2±4]. This is the ®rst report of the magnetic resonance (MR) imaging features of epiploic appendagitis, in two patients.
Virchows Archiv A Pathological Anatomy and Histopathology, 1987
A hybridoma cell line (OV632) producing monoclonal antibody against ovarian carcinomas was develo... more A hybridoma cell line (OV632) producing monoclonal antibody against ovarian carcinomas was developed from the spleen cells of a mouse immunized with cystic fluid from a serous cystadenocarcinoma. Immunohistological studies in frozen sections showed that 22 out of 28 nonmucinous ovarian carcinomas, which included serous, endometrioid, clear cell, and undifferentiated tumours, reacted with this antibody. Three out of 7 mucinous ovarian carcinomas were positive, whereas only 7 out of 122 extra-genital malignant lesions, predominantly adenocarcinomas, were positive. The negative cases included 38 breast carcinomas and 24 colon carcinomas, tumours which are responsible for most of metastatic disease in the ovary. On the basis of these findings, the antibody OV632 is considered appropriate for histodiagnostic purposes as an aid in the distinction between primary and secondary ovarian cancer.
Nederlandsch tijdschrift voor geneeskunde, Mar 25, 2000
Three patients, 2 men aged 22 and 62 years en 1 woman aged 49, presented with symptoms of an acut... more Three patients, 2 men aged 22 and 62 years en 1 woman aged 49, presented with symptoms of an acute abdomen. While infiltrative signs were described on radiodiagnostic images two patients underwent laparotomies. In all three subsequently the diagnosis of pneumonia was established and the patients made full recovery after antibiotic therapy. When a patient presents with symptoms of an acute abdomen, the possibility of an existing pneumonia should always be borne in mind. It is therefore recommended to make a chest radiograph with frontal and lateral view. In the presence of infiltrative signs the existence of pneumonia as the cause of abdominal symptoms should be considered in order to avoid unnecessary laparotomy.
Epiploic appendagitis and segmental omen- tum infarction are considered to be rare conditions, wh... more Epiploic appendagitis and segmental omen- tum infarction are considered to be rare conditions, which may mimic an abdominal surgical emergency. The purpose of our study was to describe clinical find- ings, US and CT appearance of infarction of an epi- ploic appendage and omentum, and to determine their epidemiological characteristics and natural his- tory. We retrospectively studied clinical, US and CT findings at hospital admission and follow-up of all pa- tients who were diagnosed at our institution with epi- ploic appendagitis or omentum infarction between June 1988 and November 1997. We found a relatively high incidence of 40 cases: 20 patients with epiploic appendagitis, 11 with omentum infarction, and 9 in whom it was not possible to discriminate between the both. All 40 patients recovered under conservative treatment without complications. We conclude that US and CT features allow a reliable diagnosis, there- by obviating unnecessary surgery. Discriminating be- tween both con...
In a 59-year-old woman with pain in the right upper abdomen, echography and CT-scan revealed aden... more In a 59-year-old woman with pain in the right upper abdomen, echography and CT-scan revealed adenomatosis of the gallbladder. Her symptoms did not disappear after cholecystectomy, even though echography showed no further abnormality. In a 46-year-old man with fever and weight loss, echography revealed two polyps in the gallbladder. Following cholecystectomy, histopathology revealed cholesterol polyps and an infection with Entamoeba coli. In a 63-year-old man with systemic symptoms, a biopsy of the echographically diagnosed tumour of the gallbladder revealed that he had actually had cholecystitis. The management was wait-and-see and the patient recovered completely. In a 68-year-old woman with jaundice and attacks of abdominal pain, a CT-scan revealed gallstones. The symptoms recurred following an ERCP. Following cholecystectomy, an adenocarcinoma of the gallbladder was found. One year later, a contact metastasis developed forwhich she received radiotherapy. After 4 years she was in good condition. Patients with a tumour in the gallbladder are often diagnosed with gallbladder cancer, which has a poor prognosis. Other diseases should also be considered, since the treatment and prognosis differ greatly. It is important to differentiate at an early stage. Ultrasound, CT and MRI have improved the possibility of differentiating and choosing the correct treatment.
Nederlands tijdschrift voor geneeskunde, 2000
Nederlands tijdschrift voor geneeskunde, 2007
A man of 47 years with hypercholesterolaemia had no complaints but the family doctor suspected ch... more A man of 47 years with hypercholesterolaemia had no complaints but the family doctor suspected cholecystolithiasis because of abnormal results of the haematological study. Ultrasonography of the abdomen revealed a polyp in the gallbladder. The patient underwent laparoscopic cholecystectomy. Pathological examination revealed that the polyp was a carcinoma. No evidence for a recurrence was found during a return visit after 2 years. A woman of 74 years was admitted to the hospital due to persistent rectal bleeding. She had fever, loss of appetite, nausea and weight loss. A bleeding duodenal ulcer was identified during gastroduodenoscopy. Laparotomy was performed due to haemodynamic instability. During the operation an abnormal gallbladder was found with infiltration in and perforation of the duodenum. The gallbladder was resected and the perforation of the duodenum was sutured. Pathological examination revealed carcinoma of the gallbladder. A palliative policy was adhered to; the patient died 1 month later. Carcinoma ofthe gallbladder is an uncommon but highly fatal malignancy. Several risk factors have been identified and treatment is primarily surgical.
Radiotherapy and Oncology
Radiology, 2007
To prospectively evaluate the cost and effectiveness of magnetic resonance (MR) imaging performed... more To prospectively evaluate the cost and effectiveness of magnetic resonance (MR) imaging performed to exclude the need for arthroscopy in patients with nonacute knee symptoms who are highly suspected clinically of having intraarticular knee abnormality. The study was approved by the institutional review boards of three hospitals; informed patient consent was obtained. All 584 included patients (406 male, 178 female; mean age, 31.1 years+/-8.0 [standard deviation]) underwent MR imaging. Patients with an MR result positive for the diagnosis of intraarticular knee abnormality underwent arthroscopy (group A). Patients with a negative MR result were randomly assigned to undergo either conservative (group B) or arthroscopic (group C) treatment. Treatment was considered effective if the Noyes function score had increased 10% or more at 6 months. A cost analysis was performed from a societal perspective to compare the treatment strategy involving MR imaging with the strategy not involving MR...
The archives of bone and joint surgery, 2016
BACKGROUND The I-Space is a radiological imaging system in which Computed Tomography (CT)-scans c... more BACKGROUND The I-Space is a radiological imaging system in which Computed Tomography (CT)-scans can be evaluated as a three dimensional hologram. The aim of this study is to analyze the value of virtual reality (I-Space) in diagnosing acute occult scaphoid fractures. METHODS A convenient cohort of 24 patients with a CT-scan from prior studies, without a scaphoid fracture on radiograph, yet high clinical suspicion of a fracture, were included in this study. CT-scans were evaluated in the I-Space by 7 observers of which 3 observers assessed the scans in the I-Space twice. The observers in this study assessed in the I-Space whether the patient had a scaphoid fracture. The kappa value was calculated for inter- and intra-observer agreement. RESULTS The Kappa value varied from 0.11 to 0.33 for the first assessment. For the three observers who assessed the CT-scans twice; observer 1 improved from a kappa of 0.33 to 0.50 (95% CI 0.26-0.74, P=0.01), observer 2 from 0.17 to 0.78 (95% CI 0.36-...
Arthroscopy: The Journal of Arthroscopic & Related Surgery, 2006
To assess the accuracy of shoulder infiltrations in the subacromial bursa (SAB) by a posterior or... more To assess the accuracy of shoulder infiltrations in the subacromial bursa (SAB) by a posterior or an anteromedial approach. Magnetic resonance imaging (MRI) and clinical outcome were used for evaluation. Type of Study: A prospective randomized study. Methods: Thirty-three patients (22 women, 11 men; average age, 46 years; range, 25 to 64 years) with clinical signs of subacromial impingement were infiltrated with a mixture of bupivacaine, methylprednisolone, and gadolinium-DTPA directly followed by MRI to determine the actual site of injection. The SAB was randomly infiltrated posteriorly (n ϭ 17) or anteromedially (n ϭ 16). Injection confidence of the surgeon and body-mass index of the patient were recorded. Follow-up consisted of the Constant Score, Simple Shoulder Test, and visual analog scale score for pain taken within 24 hours and 6 weeks after infiltration. Results: Thirteen injections (76%) were in the SAB with a posterior approach and 10 (69%) with an anteromedial approach. Many surrounding structures were hit as well, especially the rotator cuff. A positive correlation between the injection confidence of the orthopaedic surgeon and the MRI was found in 66%. Only injection of the SAB alone resulted in a significant decrease of the pain (P ϭ .004) and an increase in the functional scores. Injection in the bursa and rotator cuff muscle showed a significant increase in pain (P ϭ .032) but no change in clinical scores. The body mass index had no influence on the scores. Conclusions: Injections in the SAB are inaccurate, despite the confident feeling of the clinician. The finding that many different structures can be infiltrated with 1 injection can create both false-positive and-negative results. Level of Evidence: Level II.
Knee Surgery, Sports Traumatology, Arthroscopy, 2002
Radiation Oncology, 2014
Introduction: In breast conserving radiotherapy differences of target volume delineations between... more Introduction: In breast conserving radiotherapy differences of target volume delineations between observers do occur. We evaluated whether delineations based on co-registered computed tomography (CT) and magnetic resonance (MR) imaging may result in an improved consistency between observers. We used the delineation conformity index (CI) to compare clinical target volumes of glandular breast tissue (CTV breast) and lumpectomy cavity (LC) on both imaging modalities. Methods and materials: Four observers delineated CTV breast and LC on co-registered CTMR images in ten breast cancer patients. CIs were determined for CT and CTMR. Furthermore, the Cavity Visualization Score (CVS) of LC was taken into account. Results: The mean CI for CTV breast (CI CT;CTV : 0.82 and CI CT-CTMR;CTV : 0.80) and LC (CI CT;LC : 0.52 and CI CT-CTMR;LC : 0.48) did not differ significantly (p = 0.07 and p = 0.33, respectively). Taking CVS into account for the LC, with a CVS ≥ 4 the mean CI was 0.62 for both CI CT;LC and CI CT-CTMR;LC. Conclusion: The mean volume of the delineated glandular breast tissue based on CT was significantly larger compared to the volume based on CTMR. For patients with a CVS ≥ 4, the mean CIs of the LC were higher compared to CVS < 4 for volumes delineated on both CT as well as CTMR images. In our study cohort no significant differences between the CIs of the CTV breast and the LC delineated on CTMR co-registered images were found compared to the CIs on CT images only. Adding MR images does not seem to improve consistency of the delineation of the CTV breast and the LC, even though the volumes were copied from CT images. Since we included only ten patients, caution should be taken with regard to the results of our study.
Radiotherapy and Oncology
JBR-BTR : organe de la Societe royale belge de radiologie (SRBR) = orgaan van de Koninklijke Belgische Vereniging voor Radiologie, 2007
Background: A 50-year-old male patient was referred to the orthopedic surgeon for non specific kn... more Background: A 50-year-old male patient was referred to the orthopedic surgeon for non specific knee pain of five months duration. At physical examination the anterior cruciate ligament (ACL)-test was normal. A standard routine MRI of the knee was performed on a 3.0T scanner.
Radiotherapy and Oncology, 2012
European Radiology, 2005
The aim of this study is to evaluate the relation between bone bruise and (peri-)articular derang... more The aim of this study is to evaluate the relation between bone bruise and (peri-)articular derangement and to assess the impact of bone bruise on presentation and short term course of knee complaints. We recorded MR abnormalities in 664 consecutive patients with sub-acute knee complaints. Patients were divided in four groups: patients with and without intra-articular knee pathology, subdivided in patients with and without bone bruise. We assessed function and symptoms at the time of MR and 6 months thereafter. Bone bruises were diagnosed in 124 of 664 patients (18.7%). Patients with bone bruise had significantly more complete ACL, lateral meniscal, MCL and LCL tears. Both with and without intraarticular pathology patients with bone bruise had a significantly poorer function at the time of MR (Noyes score of, respectively, 313.21 versus 344.81 and 306.98 versus 341.19). Patients with bone bruise and intraarticular pathology showed significantly more decrease in activity (decrease of Tegner score from 6.28 to 2.12 versus 5.70-2.55). At 6 months there were no significant differences in clinical parameters between the four groups. We concluded that bone bruise in combination with MCL tear is an important cause of initial clinical impairment in patients with sub-acute knee complaints. Clinical improvement within 6 months is more pronounced than in patients without bone bruise.
British Journal of Surgery, 1994
The ultrasonographic measurement of abdominal aortic aneurysm (AAA) must be accurate as the decis... more The ultrasonographic measurement of abdominal aortic aneurysm (AAA) must be accurate as the decision on elective repair will usually be based on such results. To detect expansion, measurements must be comparable. The interobserver variation of ultrasonographic measurement of infrarenal aortic aneurysms under standardized conditions is described.
Clinical Radiology Extra, 2002
Epiploic appendices are pedunculated adipose protrusions from the serosal surface of the colon. A... more Epiploic appendices are pedunculated adipose protrusions from the serosal surface of the colon. An epiploic appendix may undergo infarction followed by secondary in¯ammatory changes, a process which has been named epiploic appendagitis in order to avoid confusion with vermiform appendicitis. Presenting symptoms are non-speci®c, leading to a presumed clinical diagnosis of diverticulitis or appendicitis in most cases [1]. Misdiagnosis may result in unwarranted surgical procedures and hospitalization, as epiploic appendagitis is a self-limiting disease [2,3]. Ultrasound (US) and computed tomography (CT) are capable of a reliable diagnosis of epiploic appendagitis [2±4]. This is the ®rst report of the magnetic resonance (MR) imaging features of epiploic appendagitis, in two patients.
Virchows Archiv A Pathological Anatomy and Histopathology, 1987
A hybridoma cell line (OV632) producing monoclonal antibody against ovarian carcinomas was develo... more A hybridoma cell line (OV632) producing monoclonal antibody against ovarian carcinomas was developed from the spleen cells of a mouse immunized with cystic fluid from a serous cystadenocarcinoma. Immunohistological studies in frozen sections showed that 22 out of 28 nonmucinous ovarian carcinomas, which included serous, endometrioid, clear cell, and undifferentiated tumours, reacted with this antibody. Three out of 7 mucinous ovarian carcinomas were positive, whereas only 7 out of 122 extra-genital malignant lesions, predominantly adenocarcinomas, were positive. The negative cases included 38 breast carcinomas and 24 colon carcinomas, tumours which are responsible for most of metastatic disease in the ovary. On the basis of these findings, the antibody OV632 is considered appropriate for histodiagnostic purposes as an aid in the distinction between primary and secondary ovarian cancer.
Nederlandsch tijdschrift voor geneeskunde, Mar 25, 2000
Three patients, 2 men aged 22 and 62 years en 1 woman aged 49, presented with symptoms of an acut... more Three patients, 2 men aged 22 and 62 years en 1 woman aged 49, presented with symptoms of an acute abdomen. While infiltrative signs were described on radiodiagnostic images two patients underwent laparotomies. In all three subsequently the diagnosis of pneumonia was established and the patients made full recovery after antibiotic therapy. When a patient presents with symptoms of an acute abdomen, the possibility of an existing pneumonia should always be borne in mind. It is therefore recommended to make a chest radiograph with frontal and lateral view. In the presence of infiltrative signs the existence of pneumonia as the cause of abdominal symptoms should be considered in order to avoid unnecessary laparotomy.
Epiploic appendagitis and segmental omen- tum infarction are considered to be rare conditions, wh... more Epiploic appendagitis and segmental omen- tum infarction are considered to be rare conditions, which may mimic an abdominal surgical emergency. The purpose of our study was to describe clinical find- ings, US and CT appearance of infarction of an epi- ploic appendage and omentum, and to determine their epidemiological characteristics and natural his- tory. We retrospectively studied clinical, US and CT findings at hospital admission and follow-up of all pa- tients who were diagnosed at our institution with epi- ploic appendagitis or omentum infarction between June 1988 and November 1997. We found a relatively high incidence of 40 cases: 20 patients with epiploic appendagitis, 11 with omentum infarction, and 9 in whom it was not possible to discriminate between the both. All 40 patients recovered under conservative treatment without complications. We conclude that US and CT features allow a reliable diagnosis, there- by obviating unnecessary surgery. Discriminating be- tween both con...
In a 59-year-old woman with pain in the right upper abdomen, echography and CT-scan revealed aden... more In a 59-year-old woman with pain in the right upper abdomen, echography and CT-scan revealed adenomatosis of the gallbladder. Her symptoms did not disappear after cholecystectomy, even though echography showed no further abnormality. In a 46-year-old man with fever and weight loss, echography revealed two polyps in the gallbladder. Following cholecystectomy, histopathology revealed cholesterol polyps and an infection with Entamoeba coli. In a 63-year-old man with systemic symptoms, a biopsy of the echographically diagnosed tumour of the gallbladder revealed that he had actually had cholecystitis. The management was wait-and-see and the patient recovered completely. In a 68-year-old woman with jaundice and attacks of abdominal pain, a CT-scan revealed gallstones. The symptoms recurred following an ERCP. Following cholecystectomy, an adenocarcinoma of the gallbladder was found. One year later, a contact metastasis developed forwhich she received radiotherapy. After 4 years she was in good condition. Patients with a tumour in the gallbladder are often diagnosed with gallbladder cancer, which has a poor prognosis. Other diseases should also be considered, since the treatment and prognosis differ greatly. It is important to differentiate at an early stage. Ultrasound, CT and MRI have improved the possibility of differentiating and choosing the correct treatment.
Nederlands tijdschrift voor geneeskunde, 2000
Nederlands tijdschrift voor geneeskunde, 2007
A man of 47 years with hypercholesterolaemia had no complaints but the family doctor suspected ch... more A man of 47 years with hypercholesterolaemia had no complaints but the family doctor suspected cholecystolithiasis because of abnormal results of the haematological study. Ultrasonography of the abdomen revealed a polyp in the gallbladder. The patient underwent laparoscopic cholecystectomy. Pathological examination revealed that the polyp was a carcinoma. No evidence for a recurrence was found during a return visit after 2 years. A woman of 74 years was admitted to the hospital due to persistent rectal bleeding. She had fever, loss of appetite, nausea and weight loss. A bleeding duodenal ulcer was identified during gastroduodenoscopy. Laparotomy was performed due to haemodynamic instability. During the operation an abnormal gallbladder was found with infiltration in and perforation of the duodenum. The gallbladder was resected and the perforation of the duodenum was sutured. Pathological examination revealed carcinoma of the gallbladder. A palliative policy was adhered to; the patient died 1 month later. Carcinoma ofthe gallbladder is an uncommon but highly fatal malignancy. Several risk factors have been identified and treatment is primarily surgical.
Radiotherapy and Oncology
Radiology, 2007
To prospectively evaluate the cost and effectiveness of magnetic resonance (MR) imaging performed... more To prospectively evaluate the cost and effectiveness of magnetic resonance (MR) imaging performed to exclude the need for arthroscopy in patients with nonacute knee symptoms who are highly suspected clinically of having intraarticular knee abnormality. The study was approved by the institutional review boards of three hospitals; informed patient consent was obtained. All 584 included patients (406 male, 178 female; mean age, 31.1 years+/-8.0 [standard deviation]) underwent MR imaging. Patients with an MR result positive for the diagnosis of intraarticular knee abnormality underwent arthroscopy (group A). Patients with a negative MR result were randomly assigned to undergo either conservative (group B) or arthroscopic (group C) treatment. Treatment was considered effective if the Noyes function score had increased 10% or more at 6 months. A cost analysis was performed from a societal perspective to compare the treatment strategy involving MR imaging with the strategy not involving MR...