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A 30 year old man with a history of migraine presented at the neurology outpatient clinic with hypesthesia of the left side of his body during a migraine attack, which was unusual for him. His family history was positive for Rendu-Osler-Weber syndrome. MRI and magnetic resonance angiography (MRA) of the brain showed multiple small infarcts, without vascular malformations. CT angiography revealed an arteriovenous fistula in the lung. Rendu-Osler-Weber syndrome (or hereditary haemorrhagic telangiectasia, HHT) is an autosomal dominant condition affecting the blood vessels. It is estimated that about 60-80% of the patients with a pulmonary arteriovenous malformation (AVM) have HHT. Neurological complications include cerebral infarction and brain abscess. Also, there is a higher prevalence of migraine in patients with HHT, although the role that HHT plays in the pathogenesis of migraine is unclear. The treatment of choice of pulmonary AVM is endovascular treatment, with a success rate of 75% in the long term.

Chronic thrombo-embolic pulmonary hypertension (CTEPH) was diagnosed in two patients, a man aged 55 years and a woman aged 54 years, who had both suffered an episode of pulmonary embolism. CTEPH is a rare but serious late complication of pulmonary embolism. If left untreated, it is a progressive disease with a poor prognosis. Pulmonary endarterectomy is the treatment of choice for CTEPH; both patients were treated successfully with this operation. In clinical practice patients are often initially misdiagnosed, due to unawareness of the condition, and are therefore subjected to a long delay before treatment. In the first patient the condition had not been recognised on CT scans. The second patient had initially been treated with psychotherapy for a suspected burn-out. All physicians involved in taking care of patients with pulmonary embolism, must be aware of this serious complication. Diagnosis and treatment of CTEPH require a high level of expertise.

In three patients, a man aged 52 years, a woman aged 35 years and a man aged 72 years, respectively, severe bile duct injury occurred following conversion from laparoscopic to open cholecystectomy. Treatment included percutaneous transhepatic drainage, abdominal drainage and bile return via a duodenal canula, and hepaticojejunostomy with Roux-and-Y reconstruction. Bile duct injury is the most significant complication following cholecystectomy, with substantial long term morbidity. The most common treatment for gallstones is laparoscopic cholecystectomy, irrespective of the presence of risk factors for conversion and bile duct injury. Generally, when the 'critical view of safety' cannot be obtained during laparoscopic cholecystectomy, conversion to open surgery is advocated to prevent bile duct injury. Surgical residents however, now have little or no experience with the open procedure. Conversion does not always provide a better view of the anatomy and, without experience with this procedure, it may even lead to more severe bile duct injury, such as transection or resection of the duct. In the case of a difficult laparoscopic cholecystectomy, a change of surgical strategy, such as antegrade or subtotal cholecystectomy or even drainage, may be more important than conversion per se.

Interventional oncology is a new specialism which focuses on image-guided minimal-invasive treatment of cancer patients. Interventional oncology has joined the traditional treatments of surgery, chemotherapy and radiotherapy as the fourth pillar of cancer care. Oncological interventions can be divided into three categories: intra-arterial techniques, tumour ablation techniques, and palliative procedures. Two examples of such interventions in Dutch hospitals are the intra-arterial Yttrium-90 microsphere radioembolisation of colorectal liver metastases and the CT-guided radiofrequency ablation of tumours such as renal cell carcinoma. In interventional oncology all procedures are performed under image guidance. Imaging is used to guide the instruments and for real-time monitoring of the procedure.

Interventional oncology is a new specialism which focuses on image-guided minimal-invasive treatment of cancer patients. Interventional oncology has joined the traditional treatments of surgery, chemotherapy and radiotherapy as the fourth pillar of cancer care. Oncological interventions can be divided into three categories: intra-arterial techniques, tumour ablation techniques, and palliative procedures. Two examples of such interventions in Dutch hospitals are the intra-arterial Yttrium-90 microsphere radioembolisation of colorectal liver metastases and the CT-guided radiofrequency ablation of tumours such as renal cell carcinoma. In interventional oncology all procedures are performed under image guidance. Imaging is used to guide the instruments and for real-time monitoring of the procedure

Interventional oncology is a new specialism which focuses on image-guided minimal-invasive treatment of cancer patients. Interventional oncology has joined the traditional treatments of surgery, chemotherapy and radiotherapy as the fourth pillar of cancer care. Oncological interventions can be divided into three categories: intra-arterial techniques, tumour ablation techniques, and palliative procedures. Two examples of such interventions in Dutch hospitals are the intra-arterial Yttrium-90 microsphere radioembolisation of colorectal liver metastases and the CT-guided radiofrequency ablation of tumours such as renal cell carcinoma. In interventional oncology all procedures are performed under image guidance. Imaging is used to guide the instruments and for real-time monitoring of the procedure.

In three patients, a man aged 52 years, a woman aged 35 years and a man aged 72 years, respectively, severe bile duct injury occurred following conversion from laparoscopic to open cholecystectomy. Treatment included percutaneous transhepatic drainage, abdominal drainage and bile return via a duodenal canula, and hepaticojejunostomy with Roux-and-Y reconstruction. Bile duct injury is the most significant complication following cholecystectomy, with substantial long term morbidity. The most common treatment for gallstones is laparoscopic cholecystectomy, irrespective of the presence of risk factors for conversion and bile duct injury. Generally, when the 'critical view of safety' cannot be obtained during laparoscopic cholecystectomy, conversion to open surgery is advocated to prevent bile duct injury. Surgical residents however, now have little or no experience with the open procedure. Conversion does not always provide a better view of the anatomy and, without experience with this procedure, it may even lead to more severe bile duct injury, such as transection or resection of the duct. In the case of a difficult laparoscopic cholecystectomy, a change of surgical strategy, such as antegrade or subtotal cholecystectomy or even drainage, may be more important than conversion per se