Percutaneous cholecystostomy is an effective definitive treatment option for acute acalculous cholecystitis.

AIMS: Acute acalculous cholecystitis can be treated with percutaneous cholecystostomy in critically ill patients unfit for surgery. However, the evidence on the outcome is sparse. We conducted a retrospective analysis of acute acalculous cholecystitis patients treated with percutaneous cholecystostomy during a 10-year study period. METHODS: An observational study of 56 consecutive patients treated with percutaneous cholecystostomy for acute acalculous cholecystitis was conducted in the period from 1 June 2002 to 31 May 2012. All data were obtained by review of medical records. RESULTS: A total of 56 consecutive patients were treated with percutaneous cholecystostomy for acute acalculous cholecystitis. Six patients (10.7%) died within 30 days after the procedure. Percutaneous cholecystostomy could serve as a definitive treatment option in 45 patients (80.4%), whereas 1 patient (1.8%) required cholecystectomy due to recurrence of cholecystitis. Four patients (7.1%) were treated with percutaneous cholecystostomy as a bridging procedure to subsequent elective laparoscopic cholecystectomy within a median of 8.8 months (range: 7.7-33.4 months). There was no significant difference in the risk of cholecystitis recurrence between patients with (6/37) and without (2/3) contrast passage to the duodenum on cholangiography (p = 0.096). CONCLUSION: Percutaneous cholecystostomy is successful as a definitive treatment option in the majority of patients with acute acalculous cholecystitis. It is associated with a low rate of mortality and subsequent cholecystectomy.

Predictive value of parathyroid scintigraphy in the preoperative evaluation of patients with primary hyperparathyroidism.

BACKGROUND AND AIMS: The surgical gold standard in primary hyperparathyroidism was until recently exploration of all four parathyroid glands. Today more patients undergo minimal invasive procedures demanding more accurate preoperative localization studies. The aim of the study was to determine the positive predictive value (PPV) of parathyroid scintigraphy (PS) and to some extent ultrasonography (US), defined as the probability of finding one single adenoma on the affected side at surgery when the scans had shown one single focus. MATERIAL AND METHODS: Eighty-eight surgically treated patients (76 women and 12 men, 8 with multiglandular disease) were included. The PS consisted of 99mTc-sestamibi scan with dual-phase technique, both planar and SPECT imaging, followed by 99mTc-pertechnetate scan. A positive scan was defined as a single focus accumulating sestamibi. Focal lesions on US were defined as hypoechoic nodules. RESULTS: PS was positive in 80 patients. Seventy-nine had only one focus, of which 64 were correctly localized adenomas (PPV 81%). Forty-seven of 77 US examinations were positive. In 44 there was only one focus of which 38 were correctly localized (PPV 86%). PPV was 97% when both examinations were positive. CONCLUSIONS: Both PS and US have acceptably high PPVs defined as the ability to predict whether or not one single focus represents a parathyroid adenoma. Concordant positive results were accompanied by a PPV close to 100%.

Diagnosis of acute rupture of the anterior cruciate ligament of the knee by sonography.

The accuracy of sonography in the diagnosis of acute rupture of the anterior cruciate ligament (ACL) was tested. Sixty-two patients with a recent traumatic haemarthrosis were examined. A haematoma at the origin of the ACL in the femoral intercondylar notch was interpreted as evidence of ligament injury. The standard of reference was arthroscopy or clinical follow-up. The sonographic findings were confirmed in 59 of 62 cases. The sensitivity was 88%, the specificity 98%, and the positive and negative predictive values 93 and 96%.

Women's knowledge of and attitude towards organized cervical smear screening.

OBJECTIVE: To describe women's barriers to cervical screening by asking about their experience with and knowledge of smear tests and by examining the women's contact and relationship with their GP. SETTING: Questionnaires sent to women in Aarhus County, Denmark. METHODS: A case control study in a cohort. The cohort, 133,500 women, represents women aged 23-60 years who were invited to the organized cervical screening program between 1.10.90 and 1.4.94. A case group, non-attenders (n=694), who had not had a smear within the previous 42 months, and a control group, attenders (n=1131), who had at least one smear test within the previous 42 months, were compared with each other. Predictor variables in the two groups were analyzed by univariate and multivariate (logistic regression) analysis. RESULTS: Non-attenders more often had insufficient contact with the GP (having a bad relationship, feeling of not receiving sufficient information) and associated a gynecological examination with more psychological unpleasantness. Most non-attenders (65.5%) and attenders (88.5%) intended to attend next time they were invited for cervical screening, and resistance to mass screening on principle did not seem to have great influence on the number of non-attenders. Both non-attenders and attenders had poor knowledge of the smear test. No significant difference was found concerning the characteristics of the general practice used by non-attenders and attenders. CONCLUSIONS: The main barriers to regular cervical screening are insufficient contact with the GP and psychological unpleasantness associated with the gynecological examination. Resistance to cervical screening on principle does not seem to have a great influence on attendance.

Duration of postoperative pneumoperitoneum.

OBJECTIVE: To find out the duration of postoperative pneumoperitoneum and the factors that are responsible for its persistence. DESIGN: Prospective open (non-random) study. SETTING: County hospital, Denmark. SUBJECTS: 32 patients over 18 years of age undergoing abdominal operations during a 6 month period. INTERVENTIONS: Abdominal radiographs with the patient in the left lateral position were taken at fixed time intervals until no free air could be seen. MAIN OUTCOME MEASURES: The amount of free air and the time postoperatively by which it had disappeared. RESULTS: In 20 [corrected] patients the air had disappeared within 48 hours and only one patient (3%) had free air for more than five days postoperatively. High body mass index and a small initial amount of free air were associated with the shortest period of postoperative pneumoperitoneum. CONCLUSION: Postoperative pneumoperitoneum disappeared within two days in most patients. Heavier patients and patients with small volumes of free air initially had the shortest duration of pneumoperitoneum. There were large variations among patients in the volumes of free air.

[Characterization of "non-attenders" in an organized screening against cancer of cervix uteri]. / Karakteristik af "ikkedeltagere" i organiseret screeningsundersøgelse mod livmoderhalskraeft.

The aim of the study was to present social and other characteristics of non-attenders in an organized cervical screening programme. It was conducted a case-control study in a cohort. The cohort consists of women in the age group 23-60 years who were invited to the organized cervical screening programme in Aarhus county, Denmark, between 1.10.1990 and 1.4.1994, totalling 133,500 women. The case group included 694 "non-attenders" and the control group 1131 women who had had at least one smear performed during the previous 42 months. The results showed that non-attenders, compared to attenders, had less frequent contact to their general practitioner. The non-attender group did not have an over-representation of markers for special risk of cervical cancer.

Characteristics of subgroups of attenders and non-attenders in an organised screening programme for cervical cancer.

OBJECTIVE: Several studies have compared attenders and non-attenders in organised cervical screening programmes but few have analysed subgroups of attenders and non-attenders. This study presents social and other characteristics of such subgroups. SETTING: Aarhus County, Denmark. METHODS: A case-control study in a cohort of 133,500 women, aged 23-60, included in the programme from 1 October 1990 to 1 April 1994. The participation rate was 75%, and those taking part comprised women with opportunistic screening or who had had a smear owing to symptoms in the previous three years ("active" attenders), and women who were invited for screening because they had not been otherwise tested ("passive" attenders). "Passive" (n = 708) and "active" attenders (n = 692) were compared. Women who had never had a smear test ("never" attenders, n = 287) were then compared with "ever" attenders (n = 1215)-that is, women who had not had a smear test during the previous 42 months, but had had at least one previous test. Data were collected by mailed questionnaires. RESULTS: The response rate was 81% and 53% for attenders and non-attenders, respectively. After correction for age, there was no difference between the "active" and "passive" attenders for cancer risk factors (smoking, age of first intercourse, number of sexual partners, and social group), or in the degree of responsibility for close relatives, but "active" attenders seemed to have more frequent contact with their general practitioner. "Never" attenders had less frequent contact with their general practitioner than "ever" attenders. They were more often living alone and nullipara, but had no overrepresentation of cancer risk factors. CONCLUSIONS: Increased effect cannot be obtained by focusing on the described groups, but by increasing the participation rate. "Never" attenders do not belong to a special risk group.