Computed tomography (CT) was used in place of contrast enemas as the initial imaging study to evaluate patients with the clinical diagnosis of acute sigmoid diverticulitis. This report attempts to clarify the role of CT in the management of acute sigmoid diverticulitis by reviewing its usefulness in the diagnosis and treatment of 59 patients. CT established that three patients (5 percent) were hospitalized with an incorrect clinical diagnosis. Thirty-seven patients (62.7 percent) were identified as having uncomplicated acute diverticulitis. These patients were all treated successfully with nonsurgical therapies and were discharged in an average of 6.8 days. In the remaining 19 patients (32.2 percent), CT revealed complicated acute diverticulitis by identifying abscess, fistula, peritonitis, or obstruction. Eleven of these 19 patients required urgent surgery or CT-guided percutaneous drainage of an abscess. The four patients whose abscesses were drained percutaneously responded favorably and underwent an elective single-stage resection. The average hospital stay for patients with complicated diverticulitis was 13.6 days. Computed tomography is a useful aid in the initial management of patients with acute diverticulitis. It is a noninvasive test that recognizes and stratifies patients according to the severity of their disease. It has the further advantage of providing information about extracolonic pathology and anatomic variation useful for surgical planning. Additionally, early CT-guided needle drainage allowed downstaging of complicated diverticulitis, avoided emergent surgery, and permitted single-stage elective surgical resection.

Computed tomography in the initial management of acute left-sided diverticulitis.

Purpose: To compare follow-up results of sclerotherapy for renal cyst using 50% acetic acid with those using 99% ethanol as sclerosing agents.

Acetic acid as a sclerosing agent for renal cysts: comparison with ethanol in follow-up results.

Ablation of canine prostate using transurethral intraprostatic absolute ethanol injection

Objective: To assess the effectiveness and long-term results of two repeated ethanol injections in the treatment of symptomatic renal cysts. Methods: Sixty-eight patients 47to 75 years old with 77 large (6.3–14.8 cm; mean 8.62 cm)symptomatic cysts were included in this study. Of the 68patients, in 4 cases there were renal cysts associated with renal calculi. An 8FR Pigtail catheter was inserted into the cyst under ultrasound guidance followed by aspiration of cystic fluid. Two repeated ethanol 95% injections were performed every 24 hours. Patients were followed-up by ultrasonography for a period of 12–48 months (mean 30). Results: In two patients the cyst puncture was not feasible because of poor visualization of puncture site while in one patient there was communication of cystic cavity with the pelvocaliceal system. In these patients surgical resection of cysts was performed. Complete and partial regression rates were 57/68 (83.82%) and 8/68 (11.76%)respectively. In four patients with renal stones and renal cysts, extracorporeal shock wave lithotripsy (ESWL) was successfully executed 1 month after sclerotherapy. Conclusion: Our results suggest that percutaneous aspiration followed by two repeated ethanol injections is highly effective on reducing recurrence of simple renal cysts.

Long-term results after percutaneous minimally invasive procedure treatment of symptomatic simple renal cysts.

OBJECTIVES To further assess the safety and feasibility of prostatic chemoablation with ethanol and to address previous concerns associated with transperineal injection using a canine model. MATERIALS AND METHODS The study included 25 dogs; normal saline or 98% dehydrated ethanol were injected into the prostate using both routes, at volumes of 25-50% of the total prostate volume. The prostate and adjacent structures were examined grossly and histopathologically after the dogs were killed humanely at 4 h, 7 days and 12 weeks after injection. RESULTS Transperineal injection resulted in tissue necrosis in all prostates and significant extraprostatic necrosis in two of three animals treated. With transurethral injection, the control groups showed minimal change, whereas the group injected with ethanol resulted in lesions with variable necrosis and location. CONCLUSIONS Intraprostatic chemoablation is possible with ethanol injection both transperineally and transurethrally. Transperineal ethanol injections were associated with more extraprostatic necrosis. Transurethral injections resulted in larger amounts of necrosis in the prostatic parenchyma with minimal extraprostatic effects. However, the extent of prostatic necrosis/ablation was inconsistent and further research is warranted.

Intraprostatic ethanol chemoablation via transurethral and transperineal injection.

Renal cyst: Treatment with alcohol

The efficacy of percutaneous drainage (PD) of abdominal abscesses and fluid collections has been proved by the simple fact that the number of successfully treated patients is steadily increasing in all institutions practising this therapeutic modality. Gerzof et al. [1, 2] reported on a series of 24 patients in 1979, expanded to include 67 patients in 1981. Martin et al. [5] employed PD in a series of 42 abscesses by 1982 and expanded the series to comprise 150 abscesses by 1985. Van Sonnenberg et al. [6, 9] reported on PD of 51 patients in 1982, expanding their series to comprise 212 patients and 250 abscesses in 1984. Likewise, the number of our patients treated by PD increased from 27 in 1982 to 120 in 1986 [7, 8].

D. Pavcnik

Papers

Renal cyst: Treatment with alcohol

Percutaneous Drainage of Abdominal Abscesses and Fluid Collections