A critical review of chemical lymph node clearance and staging of colon and rectal cancer at Ferguson Hospital, 1977 to 1982.

A unique opportunity to evaluate the method of chemical lymph node clearance for colorectal cancer exists at Ferguson Hospital. Lymph node clearance has been used at the institution since 1977, and this retrospective analysis was undertaken to ascertain its validity there. Furthermore, the node positive group was evaluated to ascertain if the current staging system (Turnbull, 1967) is prognostically accurate for the Dukes' C group. Specifically evaluated for possible prognostic variance was the survival of those patients whose tumors demonstrated partial bowel wall penetration and only one to four positive nodes, a "C1 subset," previously reported to have favorable prognosis. Eight hundred sixty-four cases of colon and rectal cancer treated surgically from 1977 to 1982 were analyzed. There was a mean of 27 lymph nodes retrieved per specimen and a mean of 4.5 positive nodes per Dukes' C specimen. There were 43 C1 and 201 C2 cases with five-year survival rates of 73 and 38 percent, respectively. The results of chemical clearance at Ferguson Hospital were found to be comparable with that of other centers using chemical clearance and superior to hand dissection. The C1 subset clearly is noted to have prognostic advantage and should occupy a separate designation in any staging system.

Anorectal and colonic disease and the immunocompromised host.

The immunocompromised host is becoming increasingly ubiquitous in the authors' patient population. There are growing numbers of long-term transplant recipients, and combination chemotherapy is producing many long-term survivors. Of greatest concern is that the number of patients with human immunodeficiency virus (HIV) causing immunosuppression is increasing. The literature is reviewed to produce a current summary of conditions affecting the anorectum and colon and arising as a direct consequence of the immunocompromised host. Pathophysiology and theoretic considerations are mentioned where applicable and current therapy is discussed. The conditions are classified under infectious, neoplastic, iatrogenic, and congenital. Although the colorectal surgeon will encounter most of these conditions sometime during a career, many are infrequent, and a current review is provided herein to provide categorization and updated information.

Spontaneous thrombosis of the internal jugular vein.

The internal jugular vein is an uncommon site of deep venous thrombosis. Infection, prolonged central venous catheterization, and trauma are the usual causes of this condition. We present an unusual case of spontaneous thrombosis of the internal jugular vein. The evaluation of this case included a search for possible anatomic, hematologic, and oncologic conditions which could predispose to hypercoagulability and thrombosis. Anticoagulation therapy resulted in complete resolution of thrombosis and subsequent recanalization of the internal jugular vein.