Patient-reported outcomes post prophylactic risk-reducing mastectomy: improved breast and psychosocial satisfaction yet poorer physical well-being.

Background: Few studies have investigated patient-reported outcomes (PROs) for patients with high breast cancer risk undergoing elective risk reduction mastectomy and reconstruction. These patients incur operative risk in the absence of active cancer, which renders their treatment experience unique. This study aimed to identify longer-term quality of life (QoL) issues that persist in this patient cohort.

How does thyroidectomy for benign thyroid disease impact upon quality of life? A prospective study.

Background: Choosing which patients to recommend surgery for benign thyroid conditions can be difficult due to the subjective nature of compressive thyroid and hormonal symptoms. The aim of this prospective study was to analyse changes in quality of life (QOL) following thyroid surgery using a validated disease-specific assessment tool, the thyroid-related patient-reported outcome (ThyPRO) questionnaire.

Methods: Participants undergoing elective thyroid surgery for benign conditions were recruited.

Systematic differences between ultrasound and pathological evaluation of thyroid nodules: a method comparison study.

Background: The size of thyroid nodules as measured by ultrasound (ultrasound size, USS) is routinely used in clinical decision-making. Reports of discrepancy between USS and pathological size (PS) evaluation have not analysed their systematic differences. The objective of this study was to uncover the lack of agreement (bias) between USS and PS measurements.

Practice patterns among thyroid cancer surgeons: implications of performing a prophylactic central neck dissection.

Background: Indications for performing a prophylactic central neck dissection (pCND) in papillary thyroid cancer (PTC) remain controversial. It is unclear how identification of lymph node (LN) metastases should impact the decision to treat with radioactive iodine (RAI). The goals of this study were to identify indications for performing pCND and identify factors that predict the use of adjuvant RAI.

Acute Colonic Pseudo-Obstruction (Ogilvie's Syndrome) Following Total Laparoscopic Hysterectomy.

Rapid identification of acute colonic pseudo-obstruction (ACPO), or Ogilvie's syndrome, is paramount in the management of this condition, which, if unresolved, can progress to bowel ischemia and perforation with significant morbidity and mortality. We present the first case report, to our knowledge, of ACPO following total laparoscopic hysterectomy. We describe the presentation and management of ACPO in a patient who underwent uncomplicated total laparoscopic hysterectomy to treat menorrhagia and dysmenorrhea after declining conservative treatment.

Kikuchi-Fujimoto lymphadenitis imitating metastatic melanoma on positron emission tomography: a case report.

Background: Accurate staging is critical for decision-making for the treatment of malignant conditions. Fluoro-deoxy-glucose positron emission tomography-computed tomography (FDG PET-CT) is a highly sensitive imaging modality for the assessment of distant metastases; however false positive results are possible due to its lower specificity with detection of other hypermetabolic pathologies.

Case Presentation: A patient with high-risk thigh melanoma was staged with FDG PET-CT.

Isolated limb infusion: Efficacy, toxicity and an evolution in the management of in-transit melanoma.

Background: Isolated limb infusion (ILI) delivers low-flow chemotherapy via percutaneous catheters to treat melanoma in-transit metastases.

Objective: To describe the experience of two regional referral centres with ILI.

Methods: A retrospective review of patients who underwent ILI between 2002 and 2012 was performed.

Extent of central neck dissection among thyroid cancer surgeons: Cross-sectional analysis.

Background: It is unclear if surgeons are performing comprehensive central neck dissections for well-differentiated thyroid cancer. The purpose of this study was to determine mean lymph node retrieval in central neck dissection as well as variability across surgeons and institutions.

Methods: A prospectively collected database identified 18 surgeons performing 425 central neck dissections, 313 unilateral and 112 bilateral.

Evaluating population-based breast cancer surgical practice in real time with a web-based synoptic operative reporting system.

Background: A Web-based synoptic operative reporting system (WebSMR) incorporates implicit guidelines and real-time feedback of a surgeon's practice compared with provincial data. This study compares rates of total mastectomy (TM) between the overall provincial and WebSMR patients and examines decision-making factors in WebSMR patients.

Methods: Patients treated for invasive breast cancer (2007 to 2011) were identified from WebSMR and the Alberta Cancer Registry.

Comparison of outcomes for malignant melanoma of the face treated using Mohs micrographic surgery and wide local excision.

Background: Mohs micrographic surgery (MMS) is an accepted treatment for nonmelanoma skin cancer and has an evolving role in melanoma.

Objective: To review oncologic outcomes of MMS and wide local excision (WLE) treatments for facial melanoma.

Methods And Materials: A retrospective review of patients with invasive melanoma of the face between 1997 and 2007 identified from the Alberta Cancer Registry (Canada) was performed.

Predictors of treatment with mastectomy, use of sentinel lymph node biopsy and upstaging to invasive cancer in patients diagnosed with breast ductal carcinoma in situ (DCIS) on core biopsy.

Background: There are few established indications for sentinel lymph node biopsy (SLNB) in breast ductal carcinoma in situ (DCIS). This study examines factors contributing to the high rate of SLNB in DCIS in Alberta, Canada.

Methods: Patients who underwent definitive surgery from January 2009 to July 2011 for DCIS diagnosed on preoperative core-needle biopsy were identified using a provincial synoptic operative report database (WebSMR).

Quality indicators for ductal carcinoma in situ (DCIS) of the breast: development using a multidisciplinary delphi process and its use in monitoring population-based treatment.

Background And Objectives: Evaluation of the management of DCIS poses challenges, as standard breast cancer outcome measures such as mortality do not apply. We have developed quality indicators (QIs) to measure the quality of DCIS treatment in Alberta, Canada.

Methods: A modified Delphi process was used to determine QIs in the treatment of DCIS after review of evidence-based clinical practice guidelines.

Primary small cell carcinoma of the breast with TTF-1 and neuroendocrine marker expressing carcinoma in situ.

Primary small cell carcinoma (SmCC) of the breast is very rare and may be difficult to distinguish from metastatic small cell carcinoma. Confident histopathological diagnosis of a primary breast SmCC requires the demonstration of an in situ component. We report a case of primary small cell carcinoma of the breast with coexisting carcinoma in situ in which the invasive carcinoma and in situ component both expressed neuroendocrine markers and Thyroid transcription factor-1 (TTF-1) by immunohistochemistry.

Proximal esophageal amyloidoma presenting with life-threatening dysphagia.

Amyloidoses are abnormal deposits of insoluble proteins in tissues that can lead to tissue dysfunction. Although elderly patients often have amyloid deposition in the gastrointestinal tract, they are usually asymptomatic. When symptoms are present, they are most often functional in nature; rarely are they caused by a localized amyloid deposition (amyloidoma).

Outcomes of ERCP: prospective series from a rural centre.

Background: Endoscopic retrograde cholangiopancreatography (ERCP) is an important procedure for the investigation and management of pancreaticobiliary disease. There is a recognized potential for significant morbidity, and a number of studies have identified patient and operator risk factors for the development of complications, including small case volume. We look at the outcomes of ERCP from a single operator at a rural centre and compare these with published figures.

Mycobacterium ulcerans ulcers: a proposed surgical management algorithm.

Mycobacterium ulcerans (MU) is the third common mycobacterial infection after tuberculosis and leprosy. In endemic areas, MU ulcers should be considered in the differential diagnosis of any unusual or nonhealing lesion or ulcer. Diagnosis and treatment should be instigated promptly.