Background: The increasing utilization of lymphatic mapping techniques for breast carcinoma has made intraoperative evaluation of sentinel lymph nodes attractive. Axillary lymph node dissection can be performed during the initial surgery if the sentinel lymph node is positive, potentially avoiding a second operative procedure. At present the optimal technique for rapid sentinel lymph node assessment has not been determined. Both frozen sectioning and intraoperative imprint cytology are used for rapid intraoperative sentinel lymph node evaluation at many institutions. The purpose of this study is to evaluate experience with imprint cytology for intraoperative evaluation of sentinel lymph nodes in patients with breast cancer. Methods: A retrospective review of the intraoperative imprint cytology results of 678 sentinel lymph node mappings for breast carcinoma was performed. Sentinel nodes were evaluated intraoperatively by either bisecting or slicing the sentinel node into 4 mm sections. Imprints were made of each cut surface and stained with H&E and/or Diff-Quik. Permanent sections were evaluated with up to four H&E stained levels and cytokeratin immunohistochemistry. Intraoperative imprint cytology results were compared with final histologic results. Results: The sensitivity of imprint cytology was 53%, specificity was 98%, positive predictive value was 94%, negative predictive value was 82% and accuracy was 84%. The sensitivity for detecting macrometastases ( more than 2mm) was significantly better than for detecting micrometastases (<2 mm), 81 versus 21%, respectively (P < 00001). Conclusions: The sensitivity and

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Hypothesis: Use of the vacuum assisted closure device (VAC) for securing split-thickness skin grafts (STSGs) is associated with improved wound outcomes compared with bolster dressings. Design: Consecutive case series. Patients and Setting: Consecutive patients at a level I trauma center requiring STSG due to traumatic or thermal tissue loss during an 18-month period. Main Outcome Measure: Repeated skin grafting due to failure of the initial graft. Secondary outcome measures included dressing-associated complications, percentage of graft take, and length of hospital stay. Results: Sixty-one patients underwent STSG placement. Indications for STSG were burn injury (n=32), soft tissue loss (n=27), and fasciotomy-site coverage (n=2). Patients were treated with the VAC (n = 34

In this study, US guidance for arterial cannulation was successful more frequently and it took less time to establish the arterial line as compared with the palpation method.

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