[A male patient with blisters in the face]. / Een man met blaren in het gelaat.

BACKGROUND: Recurrent blisters in the face can be a sign of linear IgA disease, a rare blistering disease with cutaneous as well as mucosal involvement. CASE DESCRIPTION: A 75-year-old male patient visited our Dermatology outpatient department with complaints of recurring blisters in his face. Erosions and crusts, but no blisters, were seen during physical examination. Histopathologic examination showed subepithelial vesicles. Eventually, direct immunofluorescence showed IgA deposition at the basement membrane zone which confirmed the diagnosis of linear IgA disease. The patient was successfully treated with dapsone. Due to possible mucosal involvement, the patient was also referred to the ENT-specialist and the ophthalmologist who could not find any abnormalities. CONCLUSION: With a story of recurrent blisters in the face, one should be aware of the blister disease called linear IgA disease. Clinical presentation may be subtle. Physicians should rule out mucosal involvement as this can lead to great morbidity.

MRI-based guidelines for selective neoadjuvant treatment in rectal cancer: Does MRI adequately predict the indication for radiotherapy in daily practice in a large teaching hospital.

OBJECTIVES: According to new Dutch guidelines for rectal cancer, MRI-defined tumour stage determines whether preoperative radiotherapy is indicated. Therefore, we sought to evaluate if preoperative MRI accurately predicts the indication for neoadjuvant treatment in rectal cancer cases in daily practice according to the new Dutch guidelines. METHODS: Data for all rectal cancer patients who underwent mesorectal excision in our hospital, between January 2011 and January 2018 were collected retrospectively. We compared histopathologic outcome with tumour staging on preoperative MRI for patients who received no radiotherapy prior to resection or short-course radiotherapy directly followed by resection. RESULTS: Of 223 patients treated according to the old guidelines, 94% received neoadjuvant therapy. Of 301 patients treated according to the new guidelines, only 49% did. Under the old guidelines, MRI predicted lymph node metastases with a sensitivity of 74.2% and a specificity of 52.6%. With the new guidelines, sensitivity was 47.5% and specificity was 77.3%. The new guidelines resulted in 45% more patients not being exposed to disadvantages of radiotherapy, but 13% of all patients were undertreated. CONCLUSIONS: Concordance between clinical lymph node staging on preoperative MRI and histopathologic staging is limited, resulting in many rectal cancer patients not receiving adequate neoadjuvant therapy.

Iron deficiency anemia as initial presentation of a non-small cell lung carcinoma: A case report.

Duodenal metastases secondary to lung cancer are very rare and most of the time asymptomatic. When symptomatic they usually present with bowel obstruction or perforation. We here describe the case of a 68 year-old man with a solitary metastasis in the duodenum from a non-small cell lung carcinoma (NSCLC). The patient presented with reduced exercise tolerance and iron deficiency anemia without clinical gastrointestinal blood loss. Further investigation showed a tumor in the left upper lung lobe and a duodenal metastasis for which he received chemotherapy. To the best of our knowledge this is the first case report of iron deficiency anemia as initial presentation of a duodenal metastasis from a NSCLC.

Foreign body reaction associated with polyethylene mesh interposition used for treatment of trapeziometacarpal osteoarthritis: report of 8 cases.

PURPOSE: To report the incidence of foreign body reactions associated with placement of a polyethylene mesh implant in patients treated with trapiezectomy for trapeziometacarpal osteoarthritis. METHODS: Between November 2008 and September 2012, 70 hands in 66 adults with stage IV trapeziometacarpal osteoarthritis had a trapiezectomy with interposition of a spacer made of polyethylene terephthalate mesh (Anchois Ligastic, Orthomed SA, St Jeannet, France). Out of these 70 implants, 8 implants (11%) in 8 patients (mean age, 60 y; range, 49-75 y) were removed because of persistent swelling, synovitis, and pain. RESULTS: The mean interval between primary and revision surgery was 14 (range, 5-27) months. Histological analysis in all cases showed a foreign body giant cell reaction. Two hands showed bone resorption or carpal bone cysts similar to silicone particle synovitis. The cysts resolved after implant removal and bone grafting. CONCLUSIONS: In the light of these results and the available literature, we recommend not using this material for interposition in the treatment of osteoarthritis of the trapeziometacarpal joint. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.