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Patent blue V is a well-known dye for visualisation of the lymph nodes in a sentinel lymph node biopsy in breast carcinoma. We present four cases of an adverse reaction to patent blue V, one of which was an anaphylactic shock. The adverse reactions to patent blue and isosulphan blue as found in the literature are discussed and an alternative is suggested.

Objective: Comparison of an aggressive approach (including total mesorectal excision and combined modality adjuvant therapy) with a conventional approach in the treatment of primary rectal cancer., Design: Retrospective study., Setting: Memorial Sloan-Kettering Cancer Centre, New York (MSKCC) and University Hospital Leiden, the Netherlands (UHL)., Subjects: One hundred and sixty-nine patients treated at MSKCC and 96 patients treated at UHL., Interventions: Total mesorectal excision (MSKCC) and conventional resection (UHL)., Main Outcome Measures: Overall survival and local recurrence-free survival., Results: Five-year overall survival was 73% for MSKCC patients and 52% for UHL patients (P < 0.001). Five-year local recurrence-free survival was 83% for MSKCC patients and 72% for UHL patients (P=0.001). Relative risk of dying or developing a local recurrence was 3.37 and 2.61, respectively, for patients treated at UHL compared to patients treated at MSKCC (P<0.001 and P=0.008, respectively)., Conclusions: These data suggest that an aggressive approach including total mesorectal excision and combined modality adjuvant therapy improves survival and local control compared to a conventional approach.