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Abstract Active surveillance (AS) in the management of small, low risk papillary thyroid cancer (PTC) as an alternative option to thyroidectomy, is an area of active research. A national Canadian study is proposed to evaluate the long-term outcomes of patients with small, low risk PTC who choose AS or surgery. This letter describes the proceedings of a national investigator meeting to plan the study. Graphical abstract

Background The purpose of this study was to assess the utility of the pectoralis major muscle flap (PMMF) in the prevention of pharyngocutaneous fistula for total laryngectomy after radiotherapy (RT) Methods We conducted a retrospective review of 166 patients who underwent a total laryngectomy after RT between 1998 and 2012 at the CHU de Quebec. Results One hundred fifteen patients underwent a total laryngectomy with primary pharyngeal closure alone and 51 patients received an onlay PMMF. The incidence of pharyngocutaneous fistula in the PMMF group was 14% compared to 36% when only primary closure was done (p = .004). However, the PMMF did not influence the treatment needed for the healing of this complication (p = 1.00). The development of pharyngocutaneous fistula increased the length of stay from 19 to 50 days (p

Background The conventional technique for cancer resection margin analysis studies only 0.1% of the surgical margins. Complete frozen section margins - also known as Mohs margins – allows for analysis of 100% of the surgical margins. Methods The objective of our study is to compare oral cavity cancer loco-regional recurrence rates when treated by total frozen sections technique (Total Mohs margins) versus conventional margins. We conducted a multicenter retrospective cohort chart review. Loco-regional oral cancer recurrence rates were compared between patients treated with total Mohs margins (2007–2013) and patients treated with conventional margins techniques (2002–2007). Results After applying inclusion criteria, a total of 60 patients treated by total Mohs margins and 57 patients with conventional margins were identified. Patients had similar baseline cancer stages, pathological types, past head and neck cancers and comorbidities (all p > 0.05). One-year recurrence rate was lower (10.0% vs 21.1%, p = 0.019) in favor of Mohs total margins and stayed significantly lower at 5 years of follow-up. When adjusted for T grade with N0 disease, Mohs technique was still beneficial in loco-regional recurrence for Tis-T4N0 up to 2 years (10.5% vs 25.7%, z-score 1.849, p = 0.032). The Number Needed to Treat at 2 years of follow-up for this subgroup of patients (Tis-T4N0) is 6.6. Margins had to be retaken more often intra-operatively in Mohs technique (68.3% vs 12.3%, p

Objectives/Hypothesis: To determine the effectiveness of dexamethasone to reduce pain after tonsillectomy in adults by at least 13 mm on the visual analogue scale. The secondary objective was to reduce the use of narcotics by at least 20%. Study Design: This multicentric study is a prospective double-blind randomized controlled trial. Methods: A total of 102 patients were enrolled and received a 4-day trial either of dexamethasone in decreasing doses or placebo. The patients were asked to note the level of pain on the visual analogue scale daily for 7 days. They also had to record their consumption of analgesic and any eventual side effects. Results: There were no statistically or clinically significant differences between the two groups for the level of pain noted on the visual analogue scale for the first 4 and 7 days. There were no statistical differences for the consumption of hydromorphone between the two groups. Conclusion: We cannot recommend the use of dexamethasone on a routine basis following tonsillectomy in adults for the reduction of pain or narcotics consumption.

Objectives: To test the prognostic significance of standard clinicopathologic factors in patients with well-differentiated thyroid carcinoma (WDTC). Study Design: A retrospective chart review of the thyroid cancer database at Mount Sinai Hospital (Toronto, Canada 1963-2000) was carried out. Methods: All patients consecutively treated for WDTC with a follow-up period of at least 5 years were eligible for inclusion. Relevant patient, tumor, treatment, and outcome data were collected. The main outcome measures were recurrence rate, actuarial overall, and disease-specific survival at 20 years. Results: Three hundred and thirty-three patients (F 275, M 58) with a median age of 39.7 (range 9-82.9) years were eligible for inclusion in this study (median follow-up 10.4 years, range 5-34.4 years, minimum 5 years). The recurrence rate was 15.6% (52 /333). The overall and disease-specific survival at 10 years was 97.5% and 98.5%, respectively. Likewise, the overall and disease-specific survival at 20 years was 88.4% and 93.3%, respectively. Clinicopathologic factors significant on multivariate regression for the development of disease recurrence included family history of WDTC, advanced stage, and total thyroidectomy (all P

Background. Our aim was to review the presenta- tion, treatment, and outcome of patients with metastatic cu- taneous squamous cell carcinoma involving the parotid gland at a tertiary referral center. Methods. We performed a retrospective chart review of the cancer registry at the Princess Margaret Hospital, Toronto, from 1970 to 2001. All patients had a previously untreated metastatic cutaneous head and neck squamous cell carcinoma involving the parotid gland. A minimal follow-up of 1 year was mandatory for inclusion in the study. Results. Fifty-six white patients (43 men and 13 women), with a median age of 76 years (range, 49-97 years), were eligible for inclusion. The disease in all patients was retro- spectively staged according to a new system. Twenty patients had P1 disease, 14 had P2, and 22 had P3. Therapy included surgery and adjuvant external beam radiation in 37 patients, single-modality external beam radiation in 12, and surgery alone in seven patients. The overall recurrence rate was 29%. The disease-specific survival was significantly worse in patients treated with external beam radiation alone (p 6 cm (p < .01) and the presence of facial nerve involvement (p < .01) were poor prognostic factors. Conclusions. Metastatic cutaneous squamous cell carcino- ma to the parotid gland is an aggressive neoplasm that requires combination therapy. The presence of a lesion in excess of 6 cm or with facial nerve involvement is associated with a poor prognosis. A 2004 Wiley Periodicals, Inc. Head Neck 26: 727-732, 2004

Objectives:Comparing management of tracheotomies in older (>75 years old) versus younger patients ≤75 years old) for duration of hospitalization secondary to tracheotomy and finding associated risk factors.Methods:Retrospective chart review (2003-2013) for all patients >75 years old who had tracheotomy compared to patients ≤75 years old.Results:Mean age is 79.3 versus 53.1 years, respectively (P < .0001). Main reason for tracheotomy is prolonged endotracheal intubation (59/112-52.7% vs 65/99-65.7%, P = .181). There is a statistically significant difference between time performing tracheotomy and its weaning for older versus younger patients: 33.14 (24.41-41.87 confidence interval [CI] 95%) versus 22.90 days (19.22-26.59 CI 95%, < .0285). Older patients stayed 4.73 days longer at hospital specifically for tracheotomy management (1.97-41.87, CI 95%) versus 0.58 days for younger patients (0.00-1.42 CI 95%, P < .0001). When leaving hospital with a tracheotomy, discharge is delayed by 14.39 days in older (5.80...

Lors de la planification de l’enquete sociale et de sante de 1998, des questions ont ete inserees pour determiner la prevalence des maladies chroniques respiratoires et les sibilances. Les objectifs de cette etude etaient 1) de documenter la prevalence des sibilances dans la population quebecoise ainsi que leur validite comme indicateur de maladie chronique respiratoire au Quebec; 2) d’examiner la relation entre divers determinants potentiels des maladies chroniques respiratoires et leur prevalence. Au total, 30 386 personnes ont participe a l’etude. Tout âge confondu, la prevalence des sibilances etait de 5,4 %, et etait significativement associee a l’asthme, aux allergies, a la bronchite chronique et a l’emphyseme. Un faible revenu familial et le tabagisme etaient associes aux sibilances, a l’asthme, a la bronchite chronique et a l’emphyseme. Le tabagisme passif etait en relation avec les sibilances, alors que la presence de tapis l’etait avec les sibilances et avec l’asthme. Entre 32 et 48 % des familles de sujets asthmatiques ou allergiques ont declare avoir modifie leur logement en raison des problemes respiratoires. La prevalence des sibilances documentees dans l’etude actuelle etait beaucoup plus basse que dans les pays anglo-saxons. Un facteur culturel ou une perception differente des sibilances pourraient expliquer cet etat de fait. La lutte contre le tabagisme doit demeurer la priorite en relation avec la prevention des maladies chroniques respiratoires.

The authors investigated the effects of detoxification on alexithymia scores in a sample of psychoactive substance-dependent patients. At baseline, 48 subjects were administered the 20-item Toronto Alexithymia Scale (TAS–20); a second measurement was carried out 4–6 weeks later. The mean TAS–20 total score of these subjects at baseline (55.5 ± 12.0) was higher than healthy population norms (46.5 ± 10.3), and no significant change in totals was elicited after detoxification. The results suggest that, in substance abusers, alexithymia tends to be a stable trait and is not significantly altered as a result of abstinence.

To establish whether outpatient thyroid surgery is safe.Prospective, observational cohort.Two tertiary care centres.Although there is currently a trend toward ambulatory surgery in many domains, thyroidectomy has traditionally remained an inpatient procedure. We present our 200-case experience of total and partial thyroidectomy in an outpatient setting. Consecutive patients were prospectively recruited between May 2009 and October 2010. Surgeries were performed by four surgeons. A postoperative parathyroid hormone (PTH) level was obtained in the recovery room and used to guide the prescription of calcium and calcitriol oral supplements according to our institutional protocol.Postoperative complications, admission and readmission rates, patients' satisfaction, and feeling of security on a 10-point scale.A total of 171 patients, for a total of 200 surgical procedures: 100 hemithyroidectomies, 34 completion hemithyroidectomies, and 66 total thyroidectomies (including 14 with central compartment dissection). Immediate admission was decided in 12% of cases due to peroperative findings (15 patients), anesthetic considerations (7 patients), bilateral vocal fold paralysis noted in the recovery room (1 patient), and surgery late in the afternoon (1 patient). Two patients were readmitted for surgical site infections and one due to hypocalcemia. Temporary symptomatic hypocalcemia or decreased PTH level occurred in 10% (20 patients). On average, patients' satisfaction and feeling of security reached 9.3 on a 10-point scale.Outpatient thyroid surgery is a safe and desirable option.

Positive margins for squamous cell carcinoma of the oral tongue on final pathology are a poor prognostic factor associated with a higher likelihood of local recurrence. Obtaining margin status in a relatively short time by using complete frozen sections, such as Mohs margins for skin cancer, would lower the recurrence rate. The goal of this study was to compare, on pig tongue, the efficacy of different techniques used to obtain complete frozen sections on histologic glass slides of optimal quality.We compared the quality of frozen section glass slides on fresh pig tongues. The partial glossectomy was executed with either a sharp instrument (scalpel and scissors), electrocautery in the cutting mode, or electrocautery at the coagulation mode. For each of the three methods, we also compared the frozen section, obtained on the line of resection and for a thickness of 1 to 1.3 mm, using either the cryostat or isopentane for the freezing phase. The percentage and quality of epithelium and muscle present on histologic glass slides were assessed by a pathologist independently.Complete frozen margins of high quality were obtained in a relatively short time for all techniques (28-38 minutes). Sharp dissection showed better results: a shorter processing time for the specimens and better quality for the histologic glass slides. Using cryostat or isopentane for the freezing phase did not show any significant difference.Complete frozen margins (Mohs margins) of high quality are feasible. Histologic glass slides of very good quality are obtained when using a sharp dissection technique. For the freezing period, both isopentane and cryostat offer very good results. This approach is appropriate on animals and needs further study in clinical situations. The human experience will be presented in the next article which is: Complete frozen section margins (with measurable 1 or 5 mm thick free margin) for cancer of the oral tongue (Clinical experience Part 2 [CSO2008]).

To obtain completely negative margins of 1 to 5 mm at the time of surgery for oral tongue squamous cell carcinoma by using a Mohs-like technique.Case series of 12 patients (4 T1, 5 T2, 2 T3, 1 T4) and a review of the literature.For the first six cases, complete, colored for precise orientation, frozen margins of high quality were obtained in a relatively short time (20-75 minutes). Four levels were evaluated within 1 to 2 mm of the line of resection. Obtaining complete free margins for a thickness of 5 mm was done for the last six cases. The time was longer (70-120 minutes) but did not exceed the time necessary to perform the neck dissection, except for one patient. The technique using the scalpel and scissors implied slightly more bleeding, which was never a problem. We have observed no recurrence for these 12 patients (follow-up 12-34 months).The review of the literature demonstrates that invaded and close margins confer a higher recurrence rate. We have obtained 1 to 2 mm (first six patients) and 5 mm (last six patients) thick, complete, oriented, and free frozen margins with success and no recurrence, but the follow-up was short. We prefer to obtain a 5 mm thick margin when possible. The delay to obtain the pathologic result is reasonable. This approach should reduce dramatically the problem of positive and close margins at the final pathology and, consequently, the rate of local control.

Objective To examine the relationship between intratumoral lymphatic vessel density and clinical and pathological variables in patients with head and neck squamous cell carcinoma. Design Archived paraffin-embedded biopsy specimens were sectioned and stained with hematoxylin-eosin and anti–LYVE-1 antibody, a highly specific marker for lymphatic endothelium. Tumor grade, infiltrating margin, inflammatory infiltrate, and percentage of tumor necrosis were noted and lymphatic vessel density measured using Chalkley point counting. Setting Tertiary care center at a university hospital. Patients A total of 168 previously untreated patients with advanced squamous cell carcinoma (73, larynx; 62, oropharynx; and 33, hypopharynx) treated with primary radiation (with or without planned neck dissection) and salvage surgery from 1992 to 1999. Interventions Measurement of intratumoral lymphatic vessel density in pretreatment tissue biopsy specimen. Main Outcome Measures Disease-free and disease-specific survival, tumor occurrence, and nodal status. Results In patients with laryngeal carcinoma there was a significant relationship between the presence of intratumoral lymphatics and nodal metastases at presentation ( P = .02) and poorly differentiated tumor grade ( P = .02). Patients with high lymphatic vessel density also had a significantly worse disease-specific survival ( P = .03). However, this difference was not significant with multivariate analysis. No significant relationship existed between the presence of intratumoral lymphatics and any of the clinical or pathological variables in oropharyngeal and hypopharyngeal carcinoma. Conclusions In this patient sample, the development of intratumoral lymphatics in laryngeal carcinoma, but not in oropharyngeal or hypopharyngeal carcinoma, is associated with a spread of the tumor to regional lymph nodes. Detecting tumor lymphatic vessel proliferation is another step in the understanding of tumor biology, and the targeting of lymphatic growth may be of potential therapeutic benefit in selected patients with head and neck squamous cell carcinoma.

BACKGROUND:The Health and Social Survey of Quebec Children and Youth, conducted on representative samples of children nine, 13 and 16 years of age, provided data on the prevalence and determinants of asthma and allergic rhinitis in Quebec.OBJECTIVES:To determine the prevalence of asthma and allergic rhinitis among children in the province of Quebec and to identify the determinants of these pathologies.METHODS:Three groups of more than 1100 children aged nine, 13 and 16 years were recruited. Respiratory symptoms were documented using the International Study of Asthma and Allergies in Childhood questionnaire. Questions enquiring about family income, smoking, degree of urbanization of the child's school's location and various variables related to indoor air were also included. The comparisons of proportions were done using theX2test.RESULTS:The prevalence rates for reported history of asthma varied from 14% to 15% depending on the age group. The prevalence of wheezing in the past year was 7% to 8%. Asthma was the primary cause of the limitation of activities due to a health problem in nine- and 13-year-old Quebecers, and the second most common cause in 16-year-old Quebecers. The prevalence of rhinitis, rhinoconjunctivitis and reported history of hay fever increased with age, reaching 28.0%, 15.9% and 21.1%, respectively, in the 16-year-old group. The prevalence of asthma and wheezing was associated with family history and allergies, and inversely related to family income.CONCLUSIONS:The prevalence of childhood asthma is high in the province of Quebec. It is a major cause of the limitation of activities due to a health problem for young Quebecers. A family history of asthma and an atopic predisposition are important determinants in the development of asthma in Quebec.