No ideal localization technique is available; thus, the choice still depends on surgeon's preference and local availability of both specialists and instruments.

Following laparotomy, almost 95% of patients develop adhesions. To prevent adhesion formation, peritoneal lavage has been investigated and many different lavage solutions have been proposed. In this study, different peritoneal lavage solutions were evaluated, testing their ability to prevent adhesion formation. Three consecutive steps were followed: (1) The lethal dose of Eschericia coli injected in the rat peritoneal cavity was determined, (2) the morbidity and mortality rates of different solutions for peritoneal lavage (i.e., saline, twice-distilled water, antiseptics, and antibiotics solutions) was investigated, and (3) the capability of the different lavage solutions to prevent adhesion formation was tested. Two hundred and ninety-eight rats were employed in this study. After intraperitoneal injection of E. coli, infection (clinical signs and animal vitality), adhesion formation (explorative laparoscopy, peritoneumgraphy and Zühlke scale grading), and animal performance status were investigated. All differences were evaluated by chi-square and analysis of variance (ANOVA) tests. Saline solution showed a low morbidity rate with no deaths. Twice-distilled water was associated with 100% mortality rate, as opposed to 45-75% for antiseptics, and 0-3% mortality for antibiotics. Antibiotics determined higher adhesion formation by Zühlke score as compared to saline solution (p < .001), while no difference was observed between antiseptics and saline (p = NS). Peritoneal lavage with 37 degrees C saline solution was associated with low adhesion formation and high survival rate as compared to twice-distilled water and antiseptics. Antibiotics solutions had high survival rate and high adhesion formation. Twice-distilled water and antisepsis should be avoided when based on the data obtained in this work.

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Evaluation of the SLNs in the internal mammary chain may provide more accurate staging in breast cancer patients. If an internal mammary sampling is not performed, patients may be understaged. This technique may allow better selection of those patients who will be submitted to adjuvant locoregional radiotherapy.

Analysis of the primary breast lesion in patients with micrometastatic SLN and metastatic NSLNs revealed the presence of lymphovascular invasion, Mib-1 index > 10%, and tumor size > 2 cm. Patients without lymphovascular invasion, Mib-1 < 10% and T size < 2 cm could avoid further ALND.

coronary vein without IABP counterpulsation.Our article 1 does not support the idea of coronary venous arterialization. We did not ligate the cardiac vein distally to isolate the arterialized venous system from the rest of the venous anatomy and to prevent steal through the coronary sinus to the right atrium, as is performed in surgical or percutaneous arterialization of the coronary venous system. However, even in the presence of the steal to the right atrium, the flow pattern of the arteriovenous graft we demonstrated may give the readers some suggestions regarding the physiology of the arterialized coronary venous system.To be exact, the main finding of our article 1 is that it is impossible to detect incorrect grafting of the LITA to the coronary vein by flow waveform analysis with the transit time flow measurement under IABP counterpulsation.

p53 Alterations and Other Tumor CharacteristicsJ ones et al. recently investigated p53 expression in cases of breast carcinoma obtained from 145 African-American (AA) and 177 white (W) patients. 1 Using immunohistochemistry, they found that breast carcinomas that develop in AA patients were more likely to be p53 positive compared with those in W patients (25% in AA patients vs. 7% in W patients). They also reported the following characteristics among the AA cases: later disease stage, higher tumor grade, and loss of estrogen receptor (ER) expression. We conducted a similar study involving breast carcinoma cases from 100 AA and 100 W patients. 2 We did not find any significant differences with regard to tumor grade or p53 expression between the two cohorts, and it appeared initially that our findings contradicted those in the study by Jones et al. However, on further review, the majority of these differences can be explained.Our cases were matched on age at diagnosis, stage of disease, and ER status. Matching was performed to minimize the confounding effects of demographic and clinicopathologic variables on the study endpoints, including prognosis. Therefore, the proportion of ER-positive cases was similar in both groups (73% in AA patients and 69% in W patients). It is well known that ER-positive breast carcinomas are more likely to be p53-negative, well differentiated tumors. 3 In fact, this inverse association between ER positivity and p53 positivity was noted in both our AA (odds ratio [OR] of 0.38) and W (OR of 0.13) cases. Therefore, grade distribution and p53 positivity (36% in AA patients and 38% in W patients) were similar among our AA and W cases. However, in the study by Jones et al., 1 the cases were not matched on ER status, disease stage, or patient age, and the proportion of ER-negative cases was found to be significantly higher among the AA cases (54% compared with 39% in the W cases), a finding that is consistent with previous reports. 4 Therefore, the findings of Jones et al. 1 of higher tumor grade and p53 expression may be explained in part by the higher prevalence of ER-negative tumors. However, the authors did include a multivariate analysis in which p53 positivity remained significantly more common among AA cases after adjusting for several variables, including ER status. It is not clear whether the contrasting results reported by our group and by Jones et al. are the result of actual differences in the two datasets or of errors that occurred during either matching or multivariate analysis. We hope that the types of studies performed by Jones et al. and

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