Clinicopathologic factors associated with lymph node retrieval in resectable colon cancer: a Veterans' Affairs Central Cancer Registry (VACCR) database analysis.

BACKGROUND: A long-term determinant of survival in resectable colon cancer is the involvement of regional lymph nodes. We evaluated the clinicopathologic factors associated with lymph node retrieval. METHODS: We conducted a retrospective analysis of patients with resected stage I-III colon cancer in the Veteran's Affairs Central Cancer Registry between 1995 and 2008. One-way ANOVA compared the differences between various groups. Multivariate logistic regression analysis was performed to determine the factors associated with the harvest of 12 or more lymph nodes for pathologic examination. RESULTS: There were 19,240 patients with resectable colon cancer included in our analysis. Mean number of lymph nodes retrieved increased with later year of diagnosis, higher overall stage, higher T descriptor, age <65 years, poorer differentiation and right-sided tumors (P < 0.01 for all covariates). These aforementioned factors are also associated with an increased probability of retrieving 12 or more lymph nodes after surgical resection (P < 0.01 for all covariates). CONCLUSIONS: Later year of diagnosis, younger patients, right-sided tumors, poorer differentiation, higher T descriptor and overall stage are associated with increased number of lymph nodes retrieved. These may indicate the presence of an immunological response of tumor versus host affecting lymph node retrieval.

Mid-Ventricular Variant of Dobutamine-Induced Stress Cardiomyopathy.

INTRODUCTION: Dobutamine stress testing is a commonly used modality in detecting and estimating the prognosis in coronary artery disease (CAD). Although it is well tolerated by most patients, adverse events have been reported. Rarely, transient wall motion abnormalities can occur in the absence of obstructive CAD to suggest stress cardiomyopathy. CASE PRESENTATION: We report a 48-year-old female with intermittent chest pain. Her physical exam, cardiac enzymes and transthoracic echocardiogram were unremarkable. She underwent dobutamine stress echocardiogram to rule out obstructive CAD. After 40 micrograms (mcg)/kg/minute and 0.5 mg atropine, she complained of intense chest pain and became hypertensive. Stress echocardiogram demonstrated mid-anterior and mid-septal hypokinesis. Emergent coronary angiogram demonstrated normal coronaries. Left ventricular angiogram in the right anterior oblique projection revealed mid-ventricular ballooning during systole with apical and basal hypercontractility. Patient demonstrated excellent recovery with expectant management. CONCLUSIONS: The mechanism of mid-variant of Dobutamine-induced stress cardiomyopathy remains unclear. We think that multiple mechanisms are involved and this risk should be considered in patients with comorbid psychiatric conditions and with use of centrally acting stimulants.