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Background: Bleeding is a serious cause of hypotension and tachycardia after childbirth and should always be considered. Case presentation: A healthy woman in her thirties who had previously undergone caesarean section, underwent induction and operative vaginal delivery. Postpartum, she experienced chest pain, hypotension and tachycardia, and had signs of ischaemia on electrocardiogram. A CT scan showed a large intraperitoneal haematoma. The patient underwent immediate laparotomy and received a massive blood transfusion. However, no large haematoma was found. The chest pain was attributed to a myocardial infarction caused by hypovolaemic shock. After discharge, the patient experienced significant vaginal bleeding and was transferred to a different university hospital. A CT scan revealed a large retroperitoneal haematoma. Emergency surgery was performed based on the suspicion of active bleeding, but only an older haematoma was found. Re-evaluation of the initial CT scan revealed that the haematoma was in fact located retroperitoneally and was thereby not found in the first operation. Interpretation: This case highlights the importance of bleeding as an important cause in unstable postpartum patients. Additionally, it is a reminder that retroperitoneal haematomas can occur in obstetric patients and can mask typical symptoms of uterine rupture such as abdominal pain. also hindering perioperative diagnosis.

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To determine possible effects of lifestyle, diet, housing and professional activities on differences in individual levels of decabromodiphenyl ether (BDE-209) in serum of women, 20 to 40years of age, in The Netherlands, the United Kingdom, Norway and Spain. BDE-209 was measured in serum of 145 female volunteers with no known occupational exposure from Norway, United Kingdom, The Netherlands and Spain. Blood levels of BDE-209 in a subgroup of 40 Dutch women were determined twice at a six months' interval. An extensive questionnaire was used to obtain detailed information about lifestyle factors that might contribute to BDE-209 exposure. Serum levels were used to determine margin of systemic exposure compared with a 28d rat toxicity study. Median BDE-209 serum concentrations were highest in The Netherlands and United Kingdom, respectively 8.8 and 9.3pg/gww. or 2.6 and 2.8ng/g lipid. Median levels in Spain and Norway were lower, respectively 7.4 and 5.2pg/gww. or 3.3 and 0.8ng/g lipid. Maximum levels in individual women were higher by one order of magnitude than the mean or median. The country of residence was the only variable significantly associated with BDE-209 levels; we found that the differences between countries could not be explained by any of the investigated exposure variables, and that these did not explain differences between individuals either. No consistent relationships were determined between diets, household, clothes, number and duration of use of electronics and occupational activities for the whole study group. We could not identify which of the multiple sources of exposure accounted for individual differences in blood levels. Although small differences in mean BDE-209 serum levels were recognized between countries, these differences are unlikely to cause a differential result with respect to risk assessment.

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OBJECTIVE: The last few years have witnessed a significant increase in the preoperative use of Magnetic Resonance Imaging (MRI) for staging purposes in breast cancer (BC) patients. Many studies have confirmed the improvement that MRI can provide in terms of diagnostic assessment, especially with regard to additional disease foci. In the present study, we address the advantages and disadvantages of MRI in the preoperative setting for BC patients. PATIENTS AND METHODS: There were 1513 consecutive breast MRI studies performed in patients with either primary or recurrent BC, who were scheduled for surgery. RESULTS: Beyond the primary lesion, 10.4% of our cases had additional disease at the final histological assessment. MRI overall sensitivity, when considering tumour size and additional foci together, was 74.3%, and 80.3% when considering additional foci exclusively. MRI specificity for additional disease was 95.3%, positive predictive value was 77.4%, and negative predictive value was 94.6%. Nevertheless, 5% of cases had additional tumours that were missed by MRI or, conversely, had additional foci on MRI that were not confirmed by histology. Age (p=0.020) and lobular carcinomas (p=0.030) showed significance in the multivariate analysis by logistic regression, using the presence of additional foci diagnosed by MRI as a dependent variable. CONCLUSION: Preoperative MRI seems to have a role in preoperative tumour staging for breast cancer patients, as it discloses additional disease foci in some patients, including contralateral involvement. However, given the lack of absolute accuracy, core-needle biopsy cannot be neglected in the diagnosis of such additional malignant foci, which could result in a change in surgical treatment.

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