[Psychotherapy in the era of evidence-based medicine]. / Psychotherapie in het tijdperk van evidence-based medicine.

Psychotherapy is a popular treatment for many psychiatric symptoms and disorders. Finding evidence for the effectiveness of therapies and bridging the gap with daily practice are a challenge. The current state of psychotherapy is explored from the perspective of evidence-based medicine. Hundreds of meta-analyses, based on thousands of studies, showed an average effect size of 0.60. Discussion in this paper focuses on the achievements and limitations of research into methods and specific disorders. Much is known about the specificity of psychotherapies and about other issues relevant to service delivery. If patient-based indication is to be a goal for the future, we will need to have a differentiated spectrum of evidence-based psychotherapies. This approach will require the integration of effective elements taken from a variety of methods, the development of multi-dimensional indicators for patient-based indication, and research into cost-effectiveness to underpin the relevance of psychotherapy for the community at large.

Three cases of non-tumoural tight stenosis of the bifurcation of the hilar bile ducts.

Stenosis of the bifurcation of the hepatic bile duct is usually caused by malignant lesion. We report on three different causes of benign stenosis of the hepatic confluence with a similar radiological pattern on direct cholangiography. The first case is considered a spontaneous neuroma, the second a periductal abscess, and the third case a postoperative stricture Bismuth type 4.

Iatrogenic spinal epidermoid tumour associated with tuberous sclerosis. A diagnostic pitfall.

We present a case of spinal epidermoid tumour that was probably caused by lumbar punctures. The tumour was detected on MRI in a child with tuberous sclerosis complaining of atypical low back pain. Preoperatively the tumour was considered to be a cystic astrocytoma of ependymoma of the conus terminalis. The association of tuberous sclerosis with a spinal tumour is rare but has been recorded in the literature. The diagnosis was an epidermoid tumour (E.T.). The MRI appearances were unusual for a spinal ET: the signal intensity changes were different from those reported in the literature and the presence of calcification and cavitation has not yet been reported. This case represents a diagnostic pitfall, since both entities were unrelated.

[The significance of focal hypoechoic lesions in the peripheral zone of the prostate]. / De betekenis van een focaal hyporeflectief letsel in de perifere zone van de prostaat.

Hypoechoic lesions in the peripheral zone of the prostate gland are one of the commonest abnormalities at transrectal ultrasonography (TRUS). 90% of all carcinomas originating in the peripheral zone present as a hypoechoic lesion. Hypoechogenicity though is not specific, as many benign lesions are also hypoechoic. In this retrospective study, based on TRUS alone 57% of the hypoechoic lesions showed carcinoma in the biopsy core (43% of the biopsy cores were benign). The number of positive biopsies increased up to 75% when the hypoechoic lesion was palpable at digital rectal examination. 5.2% of the hypoechoic cancers would have been missed when non-palpable lesions would not have had a biopsy. When the hypoechoic lesion was associated with increased serum concentration of prostate specific antigen (PSA > 4 ng/ml) 74% of the biopsies were positive. 20% to 25% of all hypoechoic cancers would not have had a biopsy. The positive predictive value was 85% when the hypoechoic lesion was palpable at digital rectal examination and the PSA-concentration was > 4 ng/ml (and 90% when volume-adjusted PSA-parameter would have been applied).