Gross intraoperative assessment can be used to ensure negative margins at the time of surgery. Previous studies of this technique were conducted before the introduction of consensus guidelines defining a “positive” margin. We performed a retrospective study examining the accuracy of this technique since these guidelines were published. We identified all specimens that were grossly examined at the time of breast conserving surgery from January 2014 to July 2020. Gross and final microscopic diagnoses were compared and the performance of intraoperative examination was assessed in terms of false positive and false negative rates. Logistic regression models were used to examine the effect of clinicopathologic covariates on discordance. 327 cases were reviewed. Gross exam prompted re-excision in 166 cases (61%). The rate of false negative discordance was 8.6%. In multivariate analysis, multifocality on final pathology was associated with discordance. We consider the false negative rate acceptable for routine clinical use; however, there is an ongoing need for more accurate methods for the intraoperative assessment of margins.

intracranial part of both internal carotid arteries. She died 6 months after conversion at home of unknown causes. She did not present any hypo-or hyperglycemic events in the days before her death. Although the family declined autopsy, death was likely related to a new stroke. The second patient required cholecystectomy 7 weeks after conversion because of acute cholecystitis and an amputation of a necrotic toe because of diabetic macroangiopathy. During these episodes, it was not necessary to reintroduce insulin therapy.These data indicate that steroid-free, sirolimus-based immunosuppression can be beneficial for islet transplants, particularly in the context of borderline engrafted islet mass. Insulin-dependent patients with stable islet graft function, who are immunosuppressed with cyclosporine and prednisone, may benefit from conversion to tacrolimus and sirolimus-based immunosuppression with lowering of prednisone doses.

Lumbar artery pseudoaneurysms are infrequent complications of penetrating trauma. When present, they are often accompanied by other injuries; however, we report the case of an isolated traumatic lumbar artery aneurysm resulting from a single knife stab. The lesion was successfully treated with endovascular microcoil embolization. While these injuries are uncommon, the surgeon must maintain a high index of suspicion, even with seemingly uncomplicated injuries, as a missed traumatic pseudoaneurysm may be life threatening.

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Pseudoaneurysms are potentially fatal complications of vascular trauma; however, they are rarely seen as the sole complication of penetrating injury. We present a case of a pseudoaneurysm with an associated arteriovenous fistula of the left lateral thoracic artery as a result of direct trauma from a knife stab. The patient presented only with a painful, swollen left pectoralis muscle. Upon diagnosis, he was taken to the interventional radiology suite and treated successfully with fluoroscopic guided coil embolization. Cases such as these are infrequent and should encourage more aggressive use of contrast enhanced computed tomography imaging for soft tissue injury, as a missed traumatic pseudoaneurysm may result in life-threatening hemorrhage.