Diagnosis of acute left-sided colonic diverticulitis by three radiological modalities.

PURPOSE: To compare the findings at US, CT and contrast enema (CE) with the clinical, biochemical, and surgical findings in patients with suspected acute left-sided colonic diverticulitis (ALCD). MATERIAL AND METHODS: The study comprised 32 consecutive patients hospitalized with clinically diagnosed ALCD. During the first 3 days of hospitalization, they were examined by US and CT of the pelvis and abdomen, and CE. RESULTS: Of the 32 patients, 21 had ALCD according to the combined radiological, clinical, biochemical and surgical findings. Findings compatible with ALCD were verified by radiological examination alone in 12 patients (4 patients at US, 10 at CT, and 6 at CE). In 9 patients, only diverticula or tethering was found at either CE or CT, and the diagnoses were then supported by clinical and biochemical findings and clinical follow-up. The most common clinical symptoms and signs associated with ALCD were left lower quadrant pain, left-sided tenderness, and fever. Most patients showed elevations of the white blood-cell count, erythrocyte sedimentation rate, and C-reactive protein, but there was no statistical difference in the stages of severity of ALCD, or between ALCD and other abdominal disorders. CONCLUSION: Radiological examination is valuable in confirming the diagnosis of ALCD. CT was the radiological modality that best demonstrated ALCD and revealed complications (e.g. pericolic abscesses) during the course of the illness.

Randomized controlled trial of postoperative radiotherapy and short-term time-scheduled 5-fluorouracil against surgery alone in the treatment of Dukes B and C rectal cancer. Norwegian Adjuvant Rectal Cancer Project Group.

BACKGROUND: The purpose of the present study was to investigate whether a 1-month regimen of postoperative radiotherapy combined with 5-fluorouracil could reduce the local recurrence rate and improve survival in patients with Dukes B and C rectal cancer. METHODS: One hundred and forty-four patients were randomized to surgery alone or surgery combined with postoperative radiotherapy (46 Gy) and bolus 5-fluorouracil 30 min before six of the radiotherapy fractions. One hundred and thirty-six patients were eligible. RESULTS: The adjuvant treatment was well tolerated. After an observation time of 4-8 years, patients in the adjuvant treatment group had a cumulative local recurrence rate of 12 per cent compared with 30 per cent in the group that had surgery only (P = 0.01). The 5-year recurrence-free and overall survival rate was 64 per cent in the adjuvant group compared with 46 per cent (P = 0.01) and 50 per cent (P = 0.05) respectively in the surgery group. The adjusted relative risk of recurrence and death for the adjuvant group was 0.48 (95 per cent confidence interval 0.28-0.82) and 0.56 (0.33-0.94) respectively. CONCLUSION: The 1-month postoperative combination regimen improved treatment results in patients with Dukes B and C rectal cancer, in terms of local recurrence rate, recurrence-free survival and overall survival, without serious side-effects.