Publications by authors named "Alexander D Montauban van Swijndregt"

14 Publications

  • Page 1 of 1

Renal biopsies performed before versus during ablation of T1 renal tumors: implications for prevention of overtreatment and follow-up.

Abdom Radiol (NY) 2021 01 20;46(1):373-379. Epub 2020 Jun 20.

Department of Urology, OLVG, Oosterpark 9, 1091 AC, Amsterdam, The Netherlands.

Purpose: To assess the difference between renal mass biopsy (RMB) performed either before or during the ablation procedure.

Methods: A retrospective multicenter study was performed in patients with a cT1 renal mass treated with ablation between January 2007 and July 2019, including a search in the national pathology database for patients with a RMB planned for ablation. Patient and tumor characteristics and information on malignant, benign, and non-diagnostic biopsy results were collected to establish rates of overtreatment and number of ablations avoided in case of benign or non-diagnostic histology.

Results: RMB was performed in 714 patients, of which 231 patients received biopsy before planned ablation, and 483 patients at the time of ablation. Pathology results before ablation were malignant in 63% (145/231), benign in 20% (46/231) and non-diagnostic in 17% (40/231). Pathology results at the time of ablation were malignant in 67.5% (326/483), benign in 16.8% (81/483) and non-diagnostic in 15.7% (76/483), leading to a total of 32.5% of ablation of benign or non-diagnostic lesions. Of the patients with a benign biopsy obtained before ablation, 80.4% (37/46) chose not to undergo ablation. Patients with inconclusive biopsy before planned ablation chose an informed individualized approach including ablation, repeated biopsy, or no intervention in 56%, 34% and 10%.

Conclusion: This study emphasizes the importance of obtaining a biopsy prior to the ablation procedure in a separate session to lower the rate of potentially unnecessary ablations.
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http://dx.doi.org/10.1007/s00261-020-02613-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7864836PMC
January 2021

A Comparative Cost-Effectiveness Analysis of Percutaneous Transluminal Angioplasty With Optional Stenting and Femoropopliteal Bypass Surgery for Medium-Length TASC II B and C Femoropopliteal Lesions.

J Endovasc Ther 2019 04;26(2):172-180

5 Amsterdam Cardiovascular Sciences, Department of Surgery, Amsterdam University Medical Center, University of Amsterdam, the Netherlands.

Purpose: To evaluate the total midterm costs and cost-effectiveness of percutaneous transluminal angioplasty with optional stenting (PTA/S) as initial treatment compared with femoropopliteal bypass (FPB) surgery in patients with medium-length TransAtlantic Inter-Society Consensus II (TASC) B and C femoropopliteal lesions.

Materials And Methods: Over a period of 3 years, all hospital health care costs for 226 consecutive patients were calculated: 170 patients with a TASC B lesion and 56 patients with a TASC C lesion. In the 135-patient PTA/S group (mean age 69.9±10.9 years; 83 men), 108 (63.5%) patients had TASC B lesions and 27 (48.2%) patients had TASC C lesions. Ninety-one patients (mean age 68.4±10.9 years; 60 men) were treated with FPB for 62 TASC B and 29 TASC C femoropopliteal lesions. The main outcome measure was the primary patency rate at 3-year follow-up. Multiple imputation and bootstrapping techniques were used to analyze the data. The adjusted incremental cost-effectiveness ratios (ICERs) were calculated by dividing the difference in total costs by the difference in 3-year primary patency rate. Costs were expressed in euros (€), and cost differences are presented with the 95% confidence interval (CI).

Results: Mean total costs per patient were €29,058 in the PTA/S treatment group vs €42,437 in the FPB group (mean adjusted difference -€14,820, 95% CI -€29,044 to -€5976). Differences in 3-year primary patency between PTA/S and FPB were small and nonsignificant (68.9% and 70.3%, respectively). An ICER of 563,716 was found, indicating that FPB costs €563,716 more per one extra patient reaching 3-year primary patency in comparison with PTA/S treatment.

Conclusion: FPB in medium-length femoropopliteal lesions involved higher total costs when evaluated over a 3-year follow-up period. An endovascular-first approach is recommended, as this will result in cost minimization for patients with medium-length femoropopliteal disease.
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http://dx.doi.org/10.1177/1526602819833646DOI Listing
April 2019

Long-Term Clinical Outcomes of Percutaneous Transluminal Angioplasty with Optional Stenting in Patients with Superficial Femoral Artery Disease: A Retrospective, Observational Analysis.

Eur J Vasc Endovasc Surg 2018 Nov 11;56(5):690-698. Epub 2018 Aug 11.

Department of Vascular Surgery, Amsterdam University Medical Centre, Amsterdam, The Netherlands.

Background And Objective: The recent ESC guideline advises primary stent placement in superficial femoral arterial disease (SFAD). The aim of this study was to compare clinical outcomes of SFAD patients selected for stent placement with plain percutaneous transluminal angioplasty (PTA).

Materials And Methods: A single centre retrospective, observational analysis was performed of all consecutive patients undergoing endovascular treatment for SFAD from 2004 to 2015. Primary endpoints were primary and secondary clinical patency rates in patients with or without stent placement. Secondary endpoints were recurrence rates and number of amputations. Kaplan-Meier curves were used to compare patency rates. Multivariable Cox regression analysis was performed to adjust for confounding variables and to identify variables associated with loss of patency.

Results: A total of 389 patients were analysed with a median follow up of 42 months. Two hundred and fifty one patients (64.5%) were stented. Primary clinical patency rates at 1, 3, and 5 years were 82.8%, 71.0%, and 65.6% after PTA and 76.3%, 65.7%, and 58.1% after stent placement (PTA-S), respectively (p = .30). Secondary patency rates were also comparable for the PTA and PTA-S group resulting in 1, 3 and 5 year clinical secondary patency of 89.1%, 81.0%, and 76.3% in the PTA group versus 87.8%, 78.5%, and 71.9% in the PTA-S group (p = .58). Multivariable analysis revealed equal primary and secondary clinical patency between the treatment groups. The absolute re-intervention rate was 29.3%. The number of re-interventions and amputation rate did not significantly differ between the two groups (p = .41 and p = .75).

Conclusions: Selective stenting in patients with SFAD shows comparable results in long-term clinical outcomes in patients who were treated with plain PTA as well as patients who are selected for stent placement. An approach of selective stenting is justified.
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http://dx.doi.org/10.1016/j.ejvs.2018.06.063DOI Listing
November 2018

MRI characteristics of proctitis in Crohn's disease on perianal MRI.

Abdom Radiol (NY) 2016 10;41(10):1918-30

Department of Radiology, Academic Medical Center, University of Amsterdam, PO Box 22660, 1100 DD, Amsterdam, The Netherlands.

Purpose: Multiple features have been described for assessing inflammation in Crohn's disease (CD) in MR enterography, but have not been validated in perianal magnetic resonance imaging (MRI). Retrospectively, we studied which MRI features are valuable in assessing proctitis.

Materials And Methods: CD patients (≥18 years) who underwent colonoscopy (reference standard) and perianal fistula MRI within 8 weeks were included. Seventeen MRI features were blindly scored by three observers and correlated to endoscopy (regression analysis). Reproducibility (multirater kappa, intraclass correlation coefficient) was determined for all three observer pairs. MRI features were considered relevant when significantly correlated to endoscopy for ≥2 observers, and reproducibility was ≥0.40 for ≥2 observer pairs.

Results: Perianal MRI of 58 CD patients were included. Wall thickness, rectal mural fat, creeping fat, and size of mesorectal lymph nodes showed a significant correlation with endoscopy for ≥2 observers (p = 0.000-0.023, p = 0.011-0.172, p = 0.007-0.011 and p = 0.000-0.005, respectively) with a kappa/intraclass correlation coefficient of ≥0.60 for ≥2 observer pairs. Perimural T2 signal and perimural enhancement significantly correlated to endoscopy (all p values ≤0.05) for all three observers and the reproducibility was ≥0.40 for ≥2 observer pairs. Mural T2 signal and degree and pattern of T1 enhancement showed significant correlation to endoscopy for two observers, but with poor to moderate reproducibility.

Conclusion: Wall thickness, mural fat, and mesorectal features (perimural T2 signal, perimural enhancement, creeping fat, and size of mesorectal lymph nodes) had significant correlation to endoscopy and were reproducible in diagnosing proctitis. Some established luminal features in MRE were considered not useful.
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http://dx.doi.org/10.1007/s00261-016-0802-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5018025PMC
October 2016

Burden of waiting for surveillance CT colonography in patients with screen-detected 6-9 mm polyps.

Eur Radiol 2016 Nov 8;26(11):4000-4010. Epub 2016 Apr 8.

Department of Radiology, Academic Medical Center, University of Amsterdam, PO Box 22700, 1100 DE, Amsterdam, The Netherlands.

Purpose: We assessed the burden of waiting for surveillance CT colonography (CTC) performed in patients having 6-9 mm colorectal polyps on primary screening CTC. Additionally, we compared the burden of primary and surveillance CTC.

Materials And Methods: In an invitational population-based CTC screening trial, 101 persons were diagnosed with <3 polyps 6-9 mm, for which surveillance CTC after 3 years was advised. Validated questionnaires regarding expected and perceived burden (5-point Likert scales) were completed before and after index and surveillance CTC, also including items on burden of waiting for surveillance CTC. McNemar's test was used for comparison after dichotomization.

Results: Seventy-eight (77 %) of 101 invitees underwent surveillance CTC, of which 66 (85 %) completed the expected and 62 (79 %) the perceived burden questionnaire. The majority of participants (73 %) reported the experience of waiting for surveillance CTC as 'never' or 'only sometimes' burdensome. There was almost no difference in expected and perceived burden between surveillance and index CTC. Waiting for the results after the procedure was significantly more burdensome for surveillance CTC than for index CTC (23 vs. 8 %; p = 0.012).

Conclusion: Waiting for surveillance CTC after primary CTC screening caused little or no burden for surveillance participants. In general, the burden of surveillance and index CTC were comparable.

Key Points: • Waiting for surveillance CTC within a CRC screening caused little burden • The vast majority never or only sometimes thought about their polyp(s) • In general, the burden of index and surveillance CTC were comparable • Awaiting results was more burdensome for surveillance than for index CTC.
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http://dx.doi.org/10.1007/s00330-016-4251-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5052316PMC
November 2016

Computer tomography colonography participation and yield in patients under surveillance for 6-9 mm polyps in a population-based screening trial.

Eur Radiol 2016 Aug 11;26(8):2762-70. Epub 2015 Nov 11.

Department of Radiology, Academic Medical Center, University of Amsterdam, PO Box 22700, 1100 DD, Amsterdam, The Netherlands.

Purpose: Surveillance CT colonography (CTC) is a viable option for 6-9 mm polyps at CTC screening for colorectal cancer. We established participation and diagnostic yield of surveillance and determined overall yield of CTC screening.

Material And Methods: In an invitational CTC screening trial 82 of 982 participants harboured 6-9 mm polyps as the largest lesion(s) for which surveillance CTC was advised. Only participants with one or more lesion(s) ≥6 mm at surveillance CTC were offered colonoscopy (OC); 13 had undergone preliminary OC. The surveillance CTC yield was defined as the number of participants with advanced neoplasia in the 82 surveillance participants, and was added to the primary screening yield.

Results: Sixty-five of 82 participants were eligible for surveillance CTC of which 56 (86.2 %) participated. Advanced neoplasia was diagnosed in 15/56 participants (26.8 %) and 9/13 (69.2 %) with preliminary OC. Total surveillance yield was 24/82 (29.3 %). No carcinomas were detected. Adding surveillance results to initial screening CTC yield significantly increased the advanced neoplasia yield per 100 CTC participants (6.1 to 8.6; p < 0.001) and per 100 invitees (2.1 to 2.9; p < 0.001).

Conclusion: Surveillance CTC for 6-9 mm polyps has a substantial yield of advanced adenomas and significantly increased the CTC yield in population screening.

Key Points: • The participation rate in surveillance CT colonography (CTC) is 86 %. • Advanced adenoma prevalence in a 6-9 mm CTC surveillance population is high. • Surveillance CTC significantly increases the yield of population screening by CTC. • Surveillance CTC for 6-9 mm polyps is a safe strategy. • Surveillance CTC is unlikely to yield new important extracolonic findings.
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http://dx.doi.org/10.1007/s00330-015-4081-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4927597PMC
August 2016

Evolution of Screen-Detected Small (6-9 mm) Polyps After a 3-Year Surveillance Interval: Assessment of Growth With CT Colonography Compared With Histopathology.

Am J Gastroenterol 2015 Dec 20;110(12):1682-90. Epub 2015 Oct 20.

Department of Radiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.

Objectives: Volumetric growth assessment has been proposed for predicting advanced histology at surveillance computed tomography (CT) colonography (CTC). We examined whether is it possible to predict which small (6-9 mm) polyps are likely to become advanced adenomas at surveillance by assessing volumetric growth.

Methods: In an invitational population-based CTC screening trial, 93 participants were diagnosed with one or two 6-9 mm polyps as the largest lesion(s). They were offered a 3-year surveillance CTC. Participants in whom surveillance CTC showed lesion(s) of ≥6 mm were offered colonoscopy. Volumetric measurements were performed on index and surveillance CTC, and polyps were classified into growth categories according to ±30% volumetric change (>30% growth as progression, 30% growth to 30% decrease as stable, and >30% decrease as regression). Polyp growth was related to histopathology.

Results: Between July 2012 and May 2014, 70 patients underwent surveillance CTC after a mean surveillance interval of 3.3 years (s.d. 0.3; range 3.0-4.6 years). In all, 33 (35%) of 95 polyps progressed, 36 (38%) remained stable, and 26 (27%) regressed, including an apparent resolution in 13 (14%) polyps. In 68 (83%) of the 82 polyps at surveillance, histopathology was obtained; 15 (47%) of 32 progressing polyps were advanced adenomas, 6 (21%) of 28 stable polyps, and none of the regressing polyps.

Conclusions: The majority of 6-9 mm polyps will not progress to advanced neoplasia within 3 years. Those that do progress to advanced status can in particular be found among the lesions that increased in size on surveillance CTC.
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http://dx.doi.org/10.1038/ajg.2015.340DOI Listing
December 2015

The costs and effects of contrast-enhanced magnetic resonance angiography and digital substraction angiography on quality of life in patients with peripheral arterial disease.

Acta Radiol 2014 Apr 12;55(3):279-86. Epub 2013 Aug 12.

Department of Vascular Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands.

Background: Contrast-enhanced magnetic resonance angiography (MRA) and intra-arterial digital subtraction angiography (DSA) both have a high diagnostic performance in the imaging of peripheral arterial occlusive disease (PAOD). However, little is known about the effects of initial, preoperative imaging using MRA or DSA on quality of life (QoL) in relation to costs (cost-utility).

Purpose: To compare cost-utility of treatment strategies using either MRA or DSA as the principal imaging tool, related to QoL, in patients with PAOD.

Material And Methods: In a prospective subgroup analysis of patients randomized between MRA and DSA (n = 79) for preoperative imaging, QoL questionnaires (SF-36) were obtained at randomization and at 4-month follow-up. Cost-effectiveness from hospital perspective was subsequently compared between groups and the difference in gained or lost QoL per € spent assessed using bootstrap analysis.

Results: No difference in quality of life was found. A treatment trajectory employing MRA as the principal imaging modality was almost 20% cheaper, leading to a better cost-utility ratio in favor of MRA.

Conclusion: A treatment plan for peripheral arterial occlusive disease employing MRA versus DSA as the principal imaging modality yields a better cost/QoL ratio for MRA.
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http://dx.doi.org/10.1177/0284185113496560DOI Listing
April 2014

Hybrid treatment of a ruptured diverticulum of Kommerell.

J Endovasc Ther 2010 Dec;17(6):762-6

Department of Vascular Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands.

Purpose: To report a patient with a ruptured diverticulum of Kommerell and to discuss treatment options and complications.

Case Report: An 82-year-old woman with no prior medical history was diagnosed with a ruptured aneurysmal proximal aberrant right subclavian artery (diverticulum of Kommerell). She was treated with a carotid-subclavian bypass, a thoracic aortic stent-graft covering both subclavian orifices, and a vascular plug in the proximal right subclavian artery. After an initially uneventful recovery, the patient developed delayed ischemic esophageal ulcerations and subsequent perforation at 6 weeks postoperatively, leading to mediastinitis and stent-graft infection.

Conclusion: A hybrid approach may be of value in cases of ruptured diverticulum of Kommerell. However, despite the anticipated reduction in perioperative mortality, this technique still yields a considerable risk of postoperative complications and mortality.
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http://dx.doi.org/10.1583/10-3174.1DOI Listing
December 2010

CT colonography with limited bowel preparation: prospective assessment of patient experience and preference in comparison to optical colonoscopy with cathartic bowel preparation.

Eur Radiol 2010 Jan 23;20(1):146-56. Epub 2009 Jul 23.

Department of Radiology, University of Amsterdam, Meibergdreef 9, 1100 DD Amsterdam, The Netherlands.

The purpose of this study was to prospectively compare participant experience and preference of limited preparation computed tomography colonography (CTC) with full-preparation colonoscopy in a consecutive series of patients at increased risk of colorectal cancer. CTC preparation comprised 180 ml diatrizoate meglumine, 80 ml barium and 30 mg bisacodyl. For the colonoscopy preparation 4 l of polyethylene glycol solution was used. Participants' experience and preference were compared using the Wilcoxon signed rank test and the chi-squared test, respectively. Associations between preference and experience parameters for the 173 participants were determined by logistic regression. Diarrhoea occurred in 94% of participants during CTC preparation. This side effect was perceived as severely or extremely burdensome by 29%. Nonetheless, the total burden was significantly lower for the CTC preparation than for colonoscopy (9% rated the CTC preparation as severely or extremely burdensome compared with 59% for colonoscopy; p < 0.001). Participants experienced significantly more pain, discomfort and total burden with the colonoscopy procedure than with CTC (p < 0.001). After 5 weeks, 69% preferred CTC, 8% were indifferent and 23% preferred colonoscopy (p < 0.001). A burdensome colonoscopy preparation and pain at colonoscopy were associated with CTC preference (p < 0.04). In conclusion, participants' experience and preference were rated in favour of CTC with limited bowel preparation compared with full-preparation colonoscopy.
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http://dx.doi.org/10.1007/s00330-009-1517-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2803752PMC
January 2010

CT colonography with limited bowel preparation: performance characteristics in an increased-risk population.

Radiology 2008 Apr 21;247(1):122-32. Epub 2008 Feb 21.

Department of Radiology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1100 DD, Amsterdam, the Netherlands.

Purpose: To prospectively evaluate the sensitivity and specificity of computed tomographic (CT) colonography with limited bowel preparation for the depiction of colonic polyps, by using colonoscopy as the reference standard.

Materials And Methods: Institutional review board approval and written informed consent were obtained. Patients at increased risk for colorectal cancer underwent CT colonography after fecal tagging, which consisted of 80 mL of barium sulfate and 180 mL of diatrizoate meglumine. Bisacodyl was added for stool softening. A radiologist and a research fellow evaluated all data independently by using a primary two-dimensional approach. Discrepant findings for lesions 6 mm or larger in diameter were solved with consensus. Segmental unblinding was performed. Per-patient sensitivity and specificity, per-polyp sensitivity, and number of false-positive findings were found (for lesions > or = 6 mm and > or = 10 mm in diameter). Per-patient sensitivities (blinded colonoscopy vs CT colonography) were tested for significance with McNemar statistics. Interobserver variability was analyzed per segment (prevalence-adjusted bias-adjusted kappa values [kappa(p)]).

Results: One hundred fourteen of 168 patients (105 men, 63 women; mean age, 56 years) had polyps, with 56 polyps 6 mm or larger and 17 polyps 10 mm or larger. Per-patient sensitivities were not significantly different for CT colonography (consensus reading) and colonoscopy (P > or = .070). Sensitivity of CT colonography for patients with lesions 6 mm or larger and 10 mm or larger was 76% and 82%, respectively, and specificity of CT colonography was 79% and 97%, respectively. Blinded colonoscopy depicted 91% (lesions > or = 6 mm) and 88% (lesions > or = 10 mm) of disease in patients. Per-polyp sensitivity for CT colonography was 70% (lesions > or = 6 mm) and 82% (lesions > or = 10 mm). Number of false-positive findings was 42 (lesions > or = 6 mm) and six (lesions > or = 10 mm). kappa(p) Was 0.88 (lesions > or = 6 mm) and 0.96 (lesions > or = 10 mm).

Conclusion: CT colonography with limited bowel preparation has a sensitivity of 82% and specificity of 97% for patients with polyps 10 mm or larger.
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http://dx.doi.org/10.1148/radiol.2471070439DOI Listing
April 2008

Chest radiography in general practice: indications, diagnostic yield and consequences for patient management.

Br J Gen Pract 2006 Aug;56(529):574-8

Department of Radiology, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands.

Background: Chest radiography (CXR) is frequently performed in Western societies. There is insufficient knowledge of its diagnostic value in terms of changes in patient management decisions in primary care.

Aim: To assess the influence of CXR on patient management in general practice.

Design Of Study: Prospective cohort study.

Setting: Seventy-eight GPs and three general hospitals in the Netherlands.

Method: Patients (n = 792) aged > or =18 years referred by their GPs for CXR were included. The main outcome was change in patient management assessed by means of questionnaires filled in by GPs before and after CXR.

Results: Mean age of the patients was 57.3+/-16.2 years and 53% were male. Clinically relevant abnormalities were found in 24% of the CXRs. Patient management changed in 60% of the patients following CXR. Main changes included: fewer referrals to a medical specialist (from 26 to 12%); reduction in initiation or change in therapy (from 24 to 15%); and more frequent reassurance (from 25 to 46%). However, this reassurance was not perceived as such in a quarter of these patients. A change in patient management occurred significantly more frequently in patients with complaints of cough (67%), those who exhibited abnormalities during physical examination (69%), or those with a suspected diagnosis of pneumonia (68%).

Conclusion: Patient management by the GP changed in 60% of patients following CXR. CXR substantially reduced the number of referrals and initiation or change in therapy, and more patients were reassured by their GP. Thus, CXR is an important diagnostic tool for GPs and seems a cost-effective diagnostic test.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1874520PMC
August 2006

Upper abdominal ultrasound in general practice: indications, diagnostic yield and consequences for patient management.

Fam Pract 2006 Oct 21;23(5):507-11. Epub 2006 Jun 21.

Department of Radiology, University Medical Centre Utrecht Utrecht, Utrecht, The Netherlands.

Background: Abdominal ultrasound (US) is frequently performed in Western societies. There is insufficient knowledge of its diagnostic value in terms of changes in patient management decisions in primary care.

Objective: To assess the influence of upper abdominal US on patient management in general practice.

Methods: A prospective cohort study with 76 GPs and three general hospitals in The Netherlands. A total of 395 patients aged >or=18 years referred by their GPs for upper abdominal US were included. The main outcome was change in anticipated patient management assessed by means of questionnaires filled in by GPs before and after abdominal US.

Results: Mean age of the patients was 54.0 +/- 15.8 years, 35% were male. Clinically relevant abnormalities were found in 29% of the abdominal US, mainly cholelithiasis. Anticipated patient management changed in 64% of the patients following abdominal US. Main changes included fewer referrals to a medical specialist (from 45 to 30%); and more frequent reassurance of the patient (from 15 to 43%). However, this reassurance was not perceived as such in almost 40% of these patients. A change in anticipated patient management occurred significantly more frequently in patients with a prior cholecystectomy (82%).

Conclusion: Anticipated patient management by the GP changed in 64% of patients following upper abdominal US. Abdominal US substantially reduced the number of intended referrals to a medical specialist, and more patients could be reassured by their GP.
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http://dx.doi.org/10.1093/fampra/cml027DOI Listing
October 2006

Myoma expulsion after uterine artery embolization: complication or cure?

Am J Obstet Gynecol 2004 Nov;191(5):1713-5

Department of Gynecology and Radiology, Academic Medical Center, Amsterdam, The Netherlands.

A 54-year-old woman had an expulsed myoma 10 weeks after uterine artery embolization. After treatment with antibiotics and a small surgical intervention, she recovered completely without any sign of myomatous disease afterwards. Patients should be informed about the possibility of expulsion. Expulsion of myomas after uterine artery embolization occurs relatively frequently and may be just one of the ways to attain cure.
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http://dx.doi.org/10.1016/j.ajog.2004.02.001DOI Listing
November 2004
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