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Purpose: To describe the occurrence of radiation-induced soft tissue sarcomas in a retrospectively analyzed cohort of patients. To analyze the histologic subtypes and survival in this rare disease. Patients and Methods: While performing a retrospective analysis of soft tissue sarcomas in patients treated between 1974 and 1999 at the two major cancer centres in Alberta (Canada), eight patients presenting with nine sarcomas occurring in a previously radiated site were identified. Eight fulfilled the criteria for radiation-induced sarcoma. Results: Radiation-induced sarcomas occurred between 10 months and more than 50 years after irradiation (median 7.35 years). Patients' ages ranged from 36 to 88 years (median 77.3 years) at the time of their sarcoma diagnosis. Histologically, four malignant fibrous histiocytomas, two dermatofibrosarcoma protuberans, two carcinosarcomas, and one fibrosarcoma were diagnosed. All patients received surgery as the primary treatment, Complete resection could not be achieved in three cases. Two of them died of disease. The 5-year disease-specific survival rate was 50%, whereas the 5-year overall survival rate was 25%. Conclusions: Radiotherapy can induce malignancies after a latency period of a few months to several years. Radiation-induced sarcomas are associated with poor overall prognosis. The treatment in most cases is late and ineffective. The population at risk for the development of radiation-induced sarcoma is increasing, so vigilance is required in the follow-up of those patients. [ABSTRACT FROM AUTHOR]

Presents a medical case of a 53-year-old female with multinodular goitre. Medical examinations done to the patient; Information on the rationale for surgical removal of the goitre in the patient; Actions to be taken to case in which compression of the superior vena cava was causing remarkable clinical symptoms.

The article reports a case of giant cell carcinoma of the hypopbarynx treated with chemoradiation and salvage laryngopharyngectomy and associated with fatal metastatic disease. A 48-year-old man presented in February 2000 with dysphagia, odynophagia, and hoarseness of 3 months duration. Indirect laryngoscopy revealed a large, exophytic mass arising in the right hypopharynx. Vocal cord mobility was unimpaired, and there was no lymphadenopathy. Examination under anesthesia demonstrated a necrotic, pedunculated tumour arising from the lateral portion of the right piriform apex. Sarcomatoid carcinomas of the lung form a group of poorly differentiated neoplasms composed of atypical spindle cells and/or giant cells, often associated with elements of conventional adenocarcinoma or squamous cell carcinoma.

Documents the use and complications involving gastrostomy tubes placed following surgery for oral cancer and other topics. Identification of factors that are predictive of gastrostomy tube placement; Mean time from surgery to tube placement; Mean length of hospital stay among gastrotomy patients; Absence of significant complications; Correlation of the increased incidence of tube insertion with disease stage progression.

Investigates the tumour volume to determine if it predicts locoregional control of T2/T3 glottic/supraglottic laryngeal carcinoma with radiotherapy or surgery. Assessment of the effect of radiotherapy dosage in those patients treated with primary radiotherapy; Study method; Difference in the mean tumour volume between those patients treated with radiotherapy and those treated surgically; Tumour volume as predictor of local failure in T2 laryngeal tumours treated with radiotherapy.

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The article announces the presentation of a Fellowship Award to Dr. Navin Prinja by the Canadian Society of Otolaryngology-Head and Neck Surgery Fund and Glaxo Welcome Canada Inc. in 1997. Prinja has pursued post-residency training in Facial Plastic and Reconstructive Surgery during the 1996-1997 academic year.

Objective: The goal of the study is to determine if the implementation of a protocol for the preoperative and postoperative care of patients receiving a laryngectomy for cancer of the larynx or hypopharynx (i.e., laryngectomy clinical pathway) reduced length and cost of hospital stay without increasing complication rates., Design: This study is a comparison of the perioperative course of two groups of laryngectomy patients. Data were collected retrospectively from the records of patients operated on before the implementation of the clinical pathway as the institutional historical control. Comparison was made with data collected prospectively on patients operated on after the implementation of the clinical pathway., Setting: The study was performed at a mid-sized teaching hospital associated with two regional cancer centres. All surgeries were performed by one of two otolaryngology-head and neck surgeons and residents under their supervision., Methods: The demographic, patient, tumour, treatment, dietary, and complication data were analyzed. Fisher's exact (two-tailed) statistical test was used for parametric data and Wilcoxon scores for nonparametric data., Main Outcome Measure: The principal outcome measure was the length of postoperative inpatient stay. Secondary outcome measures were readmissions and postoperative complications., Results: There was a statistically significant decrease of 6.7 days in the mean length of hospitalization in the clinical pathway group even when taking postoperative readmissions into account. There was no concomitant increase in surgical complications. The mean reduction in hospital cost per case was calculated to be $3,420 (Can)., Conclusions: Application of a clinical pathway for patients receiving laryngectomy is both feasible and effective.

Objective: This study was conducted to evaluate the effectiveness of a same-day admission thyroidectomy programme., Design: Prospective patient surveys and a retrospective quality assurance study were conducted., Method: Management of the initial 58 patients having a thyroidectomy at St. Joseph's Hospital, London, Ontario, after May 1992 when a same-day admission thyroidectomy programme was initiated, was evaluated. Early in the process, staff evaluation of the programme was also surveyed., Results: The average length of stay for these patients was reduced from 4.5 to 3.2 days. No operative delays, cancellations, readmissions, or increased complications resulted from the new protocol. Also, patient and staff acceptance of the new programme was high., Conclusion: Our success with this programme has encouraged us to apply these concepts to more complex surgical patients.

Objective: The aim of this study was to evaluate the effectiveness of fine-needle aspiration (FNA) in the diagnosis of primary lymphoid processes of the salivary gland., Design: A retrospective study., Method: Between 1987 and 1994, 35 patients who underwent fine-needle aspiration (FNA) of the salivary gland had a diagnosis of a primary lymphoid process. Most presented with palpable parotid (28 patients) or submandibular (4 patients) gland masses which prompted a clinical diagnosis of pleomorphic adenoma. FNA was performed with immediate on-site evaluation. Flow cytometric cell-surface-marker analysis was performed in 28 of the 35 cases to determine the clonality of the B-cell proliferations., Results: Sixteen cases of reactive hyperplasia and nine cases of malignant lymphoma diagnosed by FNA were confirmed by subsequent histopathologic examination. Lymphoma was confirmed in six of eight cases diagnosed as suspicious for lymphoma by FNA. Hodgkin's disease was suspected but not confirmed in one case and was diagnosed as a probable Warthin's tumour in another case. In all cases, the FNA diagnosis of either a reactive or malignant lymphoid process was unexpected and influenced the patient's further management. For patients diagnosed with an intraparotid lymph node, surgery could be deferred for a short period with the hope that the lymphadenopathy would spontaneously regress. For patients with a preoperative FNA diagnosis of lymphoma, a more limited biopsy could be performed, thereby reducing the operative risk to the patient and plans to process the tissue according to the institution's lymphoma protocol could be made., Conclusion: Clinically, reactive intraparotid lymph nodes and lymphomas present as parotid enlargements that are indistinguishable from pleomorphic adenomas. FNA is the only method of accurately establishing a preoperative diagnosis in these patients.

The role of dipeptidyl aminopeptidase IV (DAP IV) activity staining in the investigation of a thyroid mass was explored. The study consisted of two parts: the first part involved DAP IV staining performed on various thyroid lesions sampled from operative specimens. These included frozen tissues or cytologic smears. The second part of the study, which is ongoing, prospectively examines the DAP IV activity in fine-needle aspiration (FNA) specimens from patients with a thyroid mass. Results from part 1 of the study indicated that DAP IV activity staining was a useful adjunct in distinguishing differentiated carcinoma from benign lesions, particularly the "follicular lesions." Preliminary findings of the second part of the study suggest that DAP IV staining can be applied to FNA specimens. The measure of DAP IV activity and its influence on the diagnostic accuracy of FNA remain to be seen.

The nutritional status of patients with head and neck cancer has been suspected as being a significant risk factor for surgical complications and cancer recurrence. Clinical dietary assessment was performed on a mixed group of 42 previously untreated, head and neck cancer patients scheduled to receive surgery with curative intent. Cox regression analysis was performed to investigate the relationship between demographic and tumour factors and nutritional status. Nutritional status correlated only with the locoregional stage of disease. A further regression analysis was performed to determine if nutritional status is an independent risk factor for early postoperative complications or recurrence. Nutritional status was not shown to influence surgical outcomes independent of tumour stage. Further study of the relationship between nutritional status and surgical results is required before recommending preoperative hyperalimentation in head and neck cancer patients.

Current hospital resource limitations prompted efforts to shorten the postoperative in-hospital recovery time after thyroid and parathyroid surgery by hastening the removal of wound drains. Thirty patients' wounds were closed with fibrin tissue glue (Tisseel) and sutures. These were retrospectively compared with 30 randomly selected patients undergoing identical procedures and standard suture closures. Mean drainage the first postoperative night was 18 ml in the test group versus 39 ml in the controls. The average times to drain removal were 1.6 days and 2.2 days respectively. The mean test postoperative hospital stay was reduced by 0.9 days in test patients (2.8 days versus 3.7 days). There was no difference in the complication rate between the two groups. Using this technique, significant increases in the efficiency of resource utilization appear to be possible. A randomized prospective trial of fibrin glue versus traditional closure is required at this time to verify the usefulness of fibrin tissue glue in thyroid surgery.

Usher's syndrome is an autosomal recessive disease characterized by congenital sensorineural hearing loss and retinitis pigmentosa (RP). Evidence for genetic heterogenicity within a single pattern of transmission of RP, be it autosomal recessive, dominant or sex-linked recessive, has been demonstrated by clustering patterns within and between families of specific clinical parameter weightings. Fishman, et al have noted corresponding evidence for subtypes of Usher's Syndrome, of paramount importance in mounting molecular level studies elucidating pathogenesis and management. Our study is of 25 consecutive patients studied by clinical investigation, including audiometric, vestibular and electro-ocular tests. Evidence for and against horizontal as well as proximal to distal receptors is weighed against loss of both visual and cochleo-vestibular systems. The clinical relevance is discussed.

Ten cases of chronic nonspecific sialadenitis of the parotid and submandibular glands were studied by a combination of immunohistochemistry (to detect cytoplasmic filaments), morphometry, and electron microscopy in order to assess histological modifications that might reflect on the concepts for the induction of neoplasia in these glands. Histologically, the gradual atrophy of the glandular parenchyma results in the presence of many small ductules. Although structural alterations were apparent at all levels of the secretory/excretory glandular components, and in all types of cells, the fact that many such ductules resulted from gradual dedifferentiation of acinar cells was a major finding. The results suggest that no cell-type in salivary gland can be excluded as having a potential for neoplastic transformation and that the basis for the currently held reserve cell hypothesis is likely incorrect.