Aims In this article we present our experience with radiofrequency ablation (RFA) in the treatment of 105 renal tumors. Materials and Methods RFA was performed on 105 renal tumors in 97 patients, with a mean tumor size of 32 mm (11-68 mm). The mean patient age was 71.7 years (range, 36-89 years). The ablations were carried out under ultrasound (n = 43) or CT (n = 62) guidance. Imaging followup was by contrast-enhanced CT within 10 days and then at 6-monthly intervals. Multivariate analysis was performed to determine variables associated with procedural outcome. Results Eighty-three tumors were completely treated at a single sitting (79%). Twelve of the remaining tumors were successfully re-treated and a clinical decision was made not to re-treat seven patients. A patient with a small residual crescent of tumor is under follow-up and may require further treatment. In another patient, re-treatment was abandoned due to complicating pneumothorax and difficult access. One patient is awaiting further re-treatment. The overall technical success rate was 90.5%. Multivariate analysis revealed tumor size to be the only significant variable affecting procedural outcome. (p = 0.007, Pearson v 2 ) Five patients had complications. There have been no local recurrences. Conclusion Our experience to date suggests that RFA is a safe and effective, minimally invasive treatment for small renal tumors.Keywords Kidney Á Computed tomography Á Kidney neoplasms Á Therapeutic radiology Á Radiofrequency ablation In recent years radiofrequency ablation (RFA) has continued to evolve into an effective image-guided tool for the minimally invasive destruction of small-volume, discrete tumors. While the vast majority of experience has been gained in the treatment of hepatocellular carcinoma (HCC) and colorectal metastases in the liver, recent attention has turned to renal tumors [1][2][3][4]. Renal tumors represent 3% of all human tumors [5] and the 5-year survival rate for RCC has increased from 34% in 1954 to 62% in 1996 [6]. There has also been a 126% increase in the incidence of renal cell carcinoma in the United States since 1950 [6]. Both the increased incidence and the improved survival are largely attributable to the radiologic detection of early-stage disease [7]. In addition, despite other strategies, this detection is largely serendipitous at cross-sectional imaging studies for other symptomatology. Some series have suggested that up to 85% of all renal tumors are in fact detected incidentally [8]. The improved outcome from smaller-volume tumors has been reflected by the TNM classification

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Objective Magnetic resonance imaging (MRI) is increasingly accepted as the radiological modality of choice staging rectal cancer but is subject to error. Neoadjuvant therapy is increasingly used in rectal cancer and MRI is used to stage response and occasionally plan surgery. We aim to assess the staging accuracy of MRI following chemoradiotherapy in rectal cancer.Method Retrospective analysis of 86 patients with MRI stage pre-and postlong-course chemoradiotherapy and comparison with pathological assessment.Results Fourty-nine patients (34 men, 15 women) with median age 68 years (60-74) were analysed. The median time from completion of CRT to MRI was 32 days (16-37). Chemoradiotherapy led to significant down-staging (P < 0.001). MRI-staging accuracy was 43% (21 ⁄ 49) with over-and under-staging in 43% (21 ⁄ 49) and 14% (7 ⁄ 49) respectively. T-stage accuracy was 45% (22 ⁄ 49) with overstaging in 33% (16 ⁄ 49) and under-staging in 22% (11 ⁄ 49).MRI stage correlated poorly with pathological assessment for International Union Against Cancer (j = 0.255) and T stages (j = 0.112). MRI nodal assessment was 71% (35 ⁄ 49) accurate, with 82% (9 ⁄ 11) sensitivity, 68% (26 ⁄ 38) specificity and positive predictive value (PPV) of 43% (9 ⁄ 21) and negative predictive value of 93% (26 ⁄ 28). There was a significant difference in node positivity between MRI and pathological staging (P = 0.005, Fisher's exact). Complete radiological response was observed in 4% (2 ⁄ 49). Complete pathological response was observed in 10% (5 ⁄ 49), which were staged 0(1), I(1), II(2) and III(1) postchemoradiotherapy by MRI.Conclusion MRI staging following chemoradiation is poor. Over-staging occurs three times more commonly than under-staging. Over-staging is due to poor PPV of nodal assessment.

Background/Aims: Anastomotic failure occurs in up to 10% of patients following anterior resection. Selective use of a loop ileostomy may reduce the septic consequences of anastomotic leak. The use of gastrograffin enema to confirm the anastomotic integrity prior to ileostomy closure is still controversial. Our aim was to determine the impact of the routine use of gastrograffin enema on patients’ management prior to ileostomy reversal. Methods: A review of 81 patients who underwent low anterior resection with loop ileostomy for rectal cancer over 3 years. Results: Gastrograffin enema was performed in 69 patients (85.2%). The mean time from operation to gastrograffin enema was 22 weeks. Four patients (5.8%) had a positive radiological leak without clinical suspicion of anastomotic problems, 2 patients (2.9%) of these subsequently had the ileostomy closed despite the positive result, 2 patients (2.9%) had a gastrograffin enema repeated which showed no leak and the patients are awaiting reversal. Conclusion: The incidence of positive radiological leak in uncomplicated patients is low; such patients had their loop ileostomies closed with or without serial gastrograffin enema. Routine gastrograffin enema in the absence of a clinical suspicion of anastomotic failure would appear to be of little value.

PTBD and stenting offer a safe and effective method in providing palliative treatment for patients with biliary obstruction. Patients likely to have high levels of morbidity and mortality can be predicted before PTBD, using a risk stratification score, highlighting the need for closer clinical observation and delayed stent placement.