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he city of Montreal has recently been encouraging bicycle use as an alternative mode of transportation by expanding the bike path network, implementing urban bicycle paths, increasing bicycle parking spaces, and sponsoring a bicycle sharing rental program (BIXI). Unfortunately, cycling in a metropolis is not without risks, with records of 600 to 800 cyclist collisions each year on the island of Montreal, not including unreported incidences or those not involving a vehicle. 1 Each year, bicycle injuries are responsible for a significant proportion of hospitalizations in Canada. In 2009-2010, the Canadian Institute for Health Information reported 4,324 hospitalizations as a result of cyclist injury. Fifteen percent of these cases involved a traumatic brain injury (TBI), and the majority (78%) who sustained a TBI were not wearing a helmet at the time they were injured, potentially resulting in serious long-term consequences and morbidity, and often an economic burden on society. 2 In 2011 alone, the downtown Montreal Trauma Centre admitted 71 patients injured while cycling, with an average Injury Severity Score (ISS) of 16. Of these patients, 28 sustained a TBI (average ISS: 24) and warranted treatment by the TBI team, specialists who evaluate, treat and rehabilitate patients who sustain a TBI. Seventy-nine percent of these patients were not wearing a helmet at the time of their injuries. 3 Fortunately, research has shown that hospitalized cyclists who were wearing a helmet at the time of their injuries sustained less severe head injuries than those not wearing a helmet, with reports of a 63-88% reduction of the risk of head injuries with helmet use. 4-6 Studies have shown that the implementation of helmet legislation, injury prevention and awareness campaigns, and the provision of free helmets increase helmet use. 7-12 Despite the evidence, bicycle helmets are not uniformly mandated throughout all of the provinces of Canada, where there is either no helmet legislation, helmet legislation for minors only, or for all ages. In fact, Quebec has no legislation for any age group. Our institution has committed to developing and implementing various injury prevention programs, one of which is a TBI awareness and helmet campaign. The purpose of this study was therefore to describe helmet use of Montreal cyclists as a step towards injury prevention programming.

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IntroductionTargeted axillary dissection (TAD) is a novel technique in the field of surgical oncology. During TAD, patients with node-positive breast cancer who clinically responded to neoadjuvant chemotherapy undergo resection of a previously proven metastatic node together with sentinel lymph node dissection (SLND). We aimed to assess the success rates of seed insertion and seed retrieval in the Canadian setting, as well as hospital costs of the procedure. MethodsPatients converted to clinically node-negative status post-neoadjuvant chemotherapy underwent TAD. Before surgery, an iodine-125 radioactive seed was inserted in the previously proven metastatic node. The seed node was resected together with an SLND. Axillary lymph node dissection (ALND) was performed in all patients with residual metastases. ResultsRadioactive seeds were successfully inserted in 34/35 patients. In 34 patients, the targeted node was successfully resected with the radioactive probe during TAD. In one patient, the seed was retrieved inferiorly in the axilla during surgery. There was no adverse event. In total, 50% (17/34) of patients had no residual metastases and were able to avoid ALND. Eight out of 17 patients who underwent ALND did not have any residual disease in their specimen. The mean cost of TAD was 25% superior to the mean cost of ALND (p = 0.02). However, the mean total cost of the hospital stay for TAD was 20% superior to the mean cost of ALND (p = 0.11). The mean cost of TAD was 4,322 Can$ (Canadian dollars), similar to the mean cost of both ALND and SLND performed during the same procedure (4,479 Can$). ConclusionsTAD was successful in 97% of patients. Despite increased procedural costs, with a lesser impact on total hospital stay costs, TAD was beneficial in 50% of patients. These patients avoided the unnecessary morbidity associated with ALND.