Methylene blue intra-arterial staining of resected colorectal cancer specimens improves accuracy of nodal staging: A randomized controlled trial.

INTRODUCTION: Metastatic involvement of regional lymph nodes is a major prognostic factor of colorectal cancer, which influences also its treatment strategy. International consensus foresees retrieval of ≥12 lymph nodes from colorectal specimens. The aim of the study was to assess the effect of intra-arterial staining of colorectal specimens with methylene blue on lymph node harvest. MATERIALS AND METHODS: A total of 266 radically operated colorectal cancer patients were randomized into the methylene blue staining and non-staining groups. In the staining group, methylene blue solution was injected into the colorectal specimen's artery after its removal. The specimens were analysed for lymph node count, diameter and metastatic involvement. RESULTS: The median number of lymph nodes was higher in the staining group, 27 (95% CI 23-31%), compared with the control group, 16 (95% CI 14-19, p < 0.001). The number of examined lymph-nodes was ≥12 in 86% of the cases in the staining group and in 69% of the cases in the control group (p = 0.001). In the staining group more small-diameter (≤4 mm) lymph nodes were examined (median number 20.5 vs. 10, p < 0.001). The proportion of patients with metatatic lymph nodes was 42% in the staining group and 43% in the control group (NS). CONCLUSIONS: Methylene blue staining improves significantly staging accuracy through finding more small-diameter lymph nodes. It enables to detect ≥12 lymph nodes in the majority of cases. We recommend routine use of this technique in all colorectal resections with curative intent.

Acute upper gastrointestinal haemorrhage in Central Finland Province, Finland, and in Tartu County, Estonia.

BACKGROUND AND AIMS: A comparative study of the epidemiology of acute upper gastrointestinal haemorrhage (UGIH) was carried out in Central Finland province (CF), Finland, and in Tartu county (TC), Estonia. PATIENTS AND METHODS: All patients from CF and TC aged > or = 15 who were treated in the Central Hospital of Central Finland and in Tartu University Hospital for UGIH, entered the prospective study during 1 August 1992-31 July 1994. Altogether 298 patients (198 men, 100 women) were treated in CF and 270 patients (159 men, 104 women) in TC. RESULTS AND CONCLUSIONS: The overall incidence of UGIH was 68.3/100,000 adults per year in CF and 98.6 in TC. The incidence increased considerably with age: from 3.1 in those aged 20-29 to 314.1 in those > or = 80 in CF, and from 13.2 to 299.1 in TC, respectively. Incidence rates were twice as low in younger age groups in CF compared to TC, almost equalized in those > or = 60 and became even higher in those > or = 80. 63% of the patients (55% men, 79% women) in CF and 49% (35% men, 70% women) in TC were > or = 60. NSAID use before UGIH was equally common (46%) in both regions. Peptic ulcer accounted for over 50% of UGIH cases both in CF and TC. Mortality rate was 8.1% in CF and 9.9% in TC. The main epidemiological differences between the regions are the lower overall incidence of UGIH, due to the lower incidence of haemorrhage in the younger age groups, and the higher proportion of the elderly patients in CF compared to TC.

Peptic ulcer haemorrhage in Tartu County, Estonia: epidemiology and mortality risk factors.

BACKGROUND: The aim of the study was to assess the epidemiology and mortality risk factors of peptic ulcer haemorrhage (PUH) in Tartu County, Estonia. METHODS: In a prospective unselected defined area study, data for 144 patients aged > or = 15 years with new cases of PUH were analysed during a 2-year period. RESULTS: The incidence of PUH was 57 per 100,000 adult population per year, increasing from 12 in patients aged 20-29 years to more than 135 in those > or = 70 years. The incidence was 2.3-fold higher for men. The incidence of gastric ulcer haemorrhage was 26 (men, 33; women, 20) and that of duodenal ulcer 22 (men, 39; women, 9). Of the women 72% and of the men 37% were > or = 60 years. Nonsteroidal anti-inflammatory drugs (NSAIDs) were used by 45% of the patients (64% of women, 36% of men). Helicobacter pylori infection was present in 93% of the duodenal ulcer patients and in 81% of the gastric ulcer patients. Mortality (8%) was related to age, shock, haemoglobin < 80 g/l, cardiac comorbidity, and recurrence of haemorrhage. CONCLUSIONS: The incidence of PUH is relatively high owing to a high incidence among the younger population in Tartu County. Women with PUH are older, have consumed more NSAIDs, and have mainly gastric ulcer; men are younger, have consumed less NSAIDs, and are prone to duodenal ulcer haemorrhage. H. pylori infection is common in PUH patients. Mortality risk factors coincide with those reported by other researchers.