The value of preoperative computed tomography combined with ultrasound in the investigation of small indeterminate liver lesions in patients with colorectal cancer.

Background Computed tomography (CT) is used routinely for the preoperative detection of colorectal cancer (CRC) metastases. When small indeterminate focal liver lesions are detected that are too small to characterize (TSTC) on CT, additional imaging is usually needed, resulting in a potential delay in obtaining a complete diagnostic work-up. Purpose To determine the diagnostic accuracy of ultrasound (US) of the liver performed in direct conjunction to CT in the preoperative investigation among patients with newly diagnosed CRC when indeterminate liver lesions were found on CT. Material and Methods Preoperative investigations with CT and consecutive US where CT had shown at least one focal liver lesion in 74 patients diagnosed with CRC between June 2009 and February 2012 were retrospectively reviewed. Either histopathological findings or a combination of imaging and clinical follow-up one to three years after surgery was used as the reference. Results Liver metastases were diagnosed with CT/US in 13 out of 74 patients (17.6%). In one patient, a liver cyst was preoperatively regarded as liver metastasis by a combined CT/US. The sensitivity and specificity for the CT with consecutive US procedure was 100% (13/13) and 98.4% (60/61). Conclusion US performed in conjunction with CT in patients with indeterminate focal liver lesions on CT is an accurate work-up for detection of liver metastases in patients with newly diagnosed CRC. Although our results are promising, they cannot be considered safely generalizable to all hospitals.

Anterior dynamic ultrasound of the infant hip: evaluation of investigator dependence.

BACKGROUND: Anterior dynamic ultrasound of the infant hip has been shown to be a valuable tool for detection of developmental dysplasia of the infant hip, but to what extent the results from this method depends on the investigator is unknown. PURPOSE: To study to what extent the proportion of positive findings at anterior dynamic ultrasound investigation of infant hips varies with the observer. MATERIAL AND METHODS: Information on all ultrasound investigations of infant hips at a county hospital between January 2004 and August 2007 was evaluated. Proportion of findings for different investigators were calculated and in a multivariable logistic regression analysis, risk of treatment by investigating orthopedic surgeon and radiologist were adjusted for each other as well as for calendar period and infant sex. RESULTS: There was a striking variation in proportion of positive findings depending on the investigator. The proportion of infants treated varied with orthopedic surgeon from 4.2 to 53.9% (95% CI: 2.27 to 7.13 and 43.0 to 64.6, respectively) and the corresponding variation for radiologists ranged from 7.4 (95% CI: 4.29 to 11.8) to 23.9% (95% CI: 17.2 to 31.8). In the adjusted analysis, variation between different investigators remained essentially unaltered. CONCLUSION: Although the true proportions of positive findings in our study are unknown, our findings are unlikely to be explained by selection bias or chance. Thus, our study suggests that anterior dynamic ultrasound of the infant hip is highly dependent on the investigator and further studies of the implications of our results are warranted.

Conservative treatment of acute colonic diverticulitis: are antibiotics always mandatory?

OBJECTIVE: Most patients admitted for acute colonic diverticulitis (AD) are managed conservatively and receive antibiotics, although it is uncertain whether all patients with AD benefit from this treatment. The aim of this study was to evaluate the influence of antibiotic treatment on outcome in the conservative management of patients with mild AD. MATERIAL AND METHODS: A retrospective audit of 311 patients (64% F, mean age 60 years) hospitalized for AD was carried out. All patients were initially treated conservatively with observation and restriction of oral intake. Patients receiving antibiotics (n=118) were compared with patients treated with observation and restriction of oral intake only (n=193). Mean follow-up time (FU) was 30 months. RESULTS: Inflammation in patients treated with antibiotics was more pronounced (laboratory parameters (C-reactive protein, white blood cell count) were higher (p<0.01), fever was more common (p<0.01) and CT grading of inflammation was classified as severe in a higher proportion (p<0.01)) compared with patients treated without antibiotics. When initially treated with antibiotics, 3 patients (3%) failed to respond to treatment and had to undergo surgery. There were 7 (4%) failures in patients initially treated without antibiotics, and antibiotics were then added. During FU, 29% of patients treated with antibiotics had further events (recurrent AD and/or subsequent surgery) compared with 28% (NS) among those treated without antibiotics. In a multivariate analysis, the risk of a further event was not influenced by antibiotic treatment (OR 1.03, CI 95% 0.61-1.74). CONCLUSIONS: Our results indicate that antibiotics are not mandatory in mild AD. Treatment without antibiotics appears to be safe and seems not to change the rate of further events. These results warrant further randomized prospective studies.