[The clinical assessment of regional resection in the benign tumor of parotid gland].

Objective:To evaluate the clinical assessment of regional resection and superficial lobe total resection in the treatment of benign tumors of the parotid gland. Method:One hundred and nighty-five patients operated in the First Hospital of Peking University from January 1998 to March 2017 with benign tumor of the parotid gland were retrospectively analyzed. There were 189 patients with single side tumor and 6 patients with bilateral sides, 157 cases underwent regional resection and the other 44 cases underwent superficial lobe total resection. All the results and complications were recorded and analyzed between the two groups.Result:There were total 195 patients with 201 cases. All the complications were as follows, 4 cases with recurrence, 44 cases with temporal facial paralysis, 13 cases with permanent facial paralysis, 80 cases with earlobe numbness, 49 cases with facial numbness, 44 cases with skin retraction, 26 cases with operated region effusion, 2 cases with sialosyrinx, 55 cases with Frey syndrome. There were no significant differences between the two groups in the incidences of recurrence, temporal facial paralysis, permanent facial paralysis, earlobe numbness, facial numbness, skin retraction. The incidence of Frey syndrome in the superficial lobe total resection group was significantly higher than the regional resection group(45.5%, 22.3%，P<0.05). The incidence of operated region effusion or sialosyrinx in the regional resection group was significantly higher than the superficial lobe total resection group (16.6%, 4.5%,P<0.05),further analysis showed that the operation method and the location of the tumor were the independent risk factors. Conclusion:Regional resection in the parotid gland tumor was less invasive, the incidences in the most complications were in consistent with superficial lobe total resection, and it was helpful in preventing the occurrence of Frey syndrome. Although regional resection conserved more parotid gland tissue so that the more conserved gland function and it also did not increase the incidence of sialosyrinx, the operated region effusion was significantly increased. If the operated region effusion was not discovered and handled, there would be a risk of sialosyrinx.

Adhesion reduction agents in gynaecological procedures: can NHS aff ord it? An economic cost efficiency analysis.

We examined the total costs to the National Health Service (NHS, UK) paid to treat adhesion complications and determine the theoretical savings and cost-effectiveness incurred if anti-adhesion agents were adopted. Using Healthcare Resource Groups (HRG) codes, we calculated the costs incurred through Payment by Results (PbR) and then calculated the financial savings that could be realised through the use of anti-adhesion agents. There were 62,186 adhesion-related consultant episodes between 2004 and 2008 encountered within the NHS. If an anti-adhesion agent cost £110 per usage, and can reduce adhesions in 25% of patients undergoing surgery, assuming that 25% of patients were readmitted in the first year after the primary surgery, the financial cost to the health service is, at best, savings of more than £700,000 and at worst, cost neutral to the NHS.

A prospective dose-finding study of the amount of thermal energy required for laparoscopic ovarian diathermy.

BACKGROUND: This prospective dose-finding study was undertaken to determine the optimal amount of thermal energy required for laparoscopic ovarian diathermy (LOD) in women with polycystic ovary syndrome (PCOS). METHODS: Thirty women with clomiphene-resistant PCOS were included in the study. All women underwent LOD. A modified Monte Carlo up-and-down design was utilized. Women were treated in groups of three (10 groups). The amount of energy applied was standardized at 150 J/puncture. The number of punctures in each group was decreased/increased according to the number of responders in the previous group. The main outcome was ovulation as defined by a serum progesterone concentration of > or =30 nmol/l. RESULTS: Four groups (n=12) were treated with four punctures/ovary, three groups (n=9) with three punctures, two groups (n=6) with two punctures and one group (n=3) with one puncture. Ovulation occurred in 67, 44, 33 and 33% of women treated with four, three, two and one puncture/ovary respectively. The corresponding pregnancy rates were 67, 56, 17 and 0%. The reductions in the free androgen index and the serum concentrations of testosterone and androstenedione after LOD were observed only in women treated with three and four punctures/ovary. CONCLUSION: The clinical response to LOD seems to be dose-dependent, with an increase in the frequency of ovulation and conception with an increasing dose of thermal energy up to 600 J/ovary.

A pilot survey of orthodontic awareness among a group of young people in Singapore.

A questionnaire survey was conducted in 1995 on a group of students and their teachers (n = 80) from 3 Independent Schools in Singapore, to assess their orthodontic need, demand, attitude and awareness. Motivational factors and barriers to treatment were also analysed. 36% had orthodontic experience, another 49% perceived need but did not elect to have treatment. Parents and dentists remain the main motivational force behind orthodontic demand. The survey demonstrated high orthodontic utilisation in this group of subjects.

Reversal of sterilisation vs. IVF: a cost-benefit analysis.

A consecutive series of 132 cases of reversal of sterilisation carried out in a teaching hospital in England between 1982 and 1995 was analysed. Follow-up data was obtained on 112 patients. The overall cumulative conception rate was 47% at 12 months and 55% at 24 months. Among the 71 pregnancies there were seven miscarriages (9%) and 11 ectopic pregnancies (15%). Factors affecting the outcome of surgery were examined. The pregnancy rate achieved with microsurgical techniques was significantly higher than the conventional (macrosurgical) techniques (61% v. 40%, P = 0.05). The method of sterilisation also has a significant impact on the outcome; Filshie clips 69%; Fallope ring 46%; Pomeroy technique 31% (P < 0.05). Age, associated infertility factors and the interval between sterilisation and reversal operation did not appear to have a significant impact on the outcome. When compared with IVF, reversal of sterilisation is associated with a higher ectopic rate, lower multiple pregnancy rate and a lower miscarriage rate. We conclude that reversal of sterilisation carries a higher overall success rate than IVF and is more cost effective when the method of sterilisation is by the clip or ring and when the reversal operation is carried out with microsurgical techniques.

Inter-observer variability at laparoscopic assessment of pelvic adhesions.

A total of 25 women undergoing videolaparoscopy and a dye test to investigate pelvic adhesions and infertility were evaluated to determine whether applying a score system to pelvic adhesions was reproducible, and its place in determining prognosis or management. The surgeon performing the laparoscopies scored each case using the American Fertility Society (AFS) system, gave an estimate of the likely prognosis from microsurgery and recorded a recommended management [surgery or in-vitro fertilization (IVF)]. The video images and histories were independently reviewed by two other surgeons experienced in tubal surgery, who also scored each case and recorded prognosis from surgery and recommended management. Several differences in adhesion scores for each case were noted. Agreement was present between surgeons regarding estimated prognosis for microsurgery and also in recommending management, particularly when prognosis was considered poor and IVF was recommended. Despite some reproducibility, the AFS score system did not predict outcome or management decisions. However, the surgeons' fundamental impression of the state of the pelvis and recommendation for either surgery or IVF were more consistent and reproducible. Any future proposed system for adhesion classification will need to account for, and be predictive of, the decreasing number of patients for whom surgery (rather than IVF) is the preferred management.

The techniques and complications of out-patient uterine washing in the assessment of endometrial function.

The complications of a consecutive series of 90 uterine washings performed among 52 women were studied. The amount of discomfort was significantly less than that of endometrial biopsy but greater than that of cervical smear or blood sampling. Incomplete recovery of fluid (< 8 ml from 10 ml flushing fluid) was reported in only 3% of cases. Vaginal bleeding, pelvic infection and delayed abdominal pain were not encountered. The techniques of uterine washing are simple and may have important implications in the study of endometrial function.

Are factors that influence oocyte fertilization also predictive? An assessment of 148 cycles of in vitro fertilization without gonadotropin stimulation.

Fertilization characteristics of 152 consecutively obtained oocytes in an in vitro fertilization (IVF) program employing only natural and clomiphene citrate-induced cycles were retrospectively analyzed. Fertilization occurred significantly more often (1) in women with tubal infertility, (2) in spontaneous cycles, and (3) in cases of secondary infertility. Grade I sperm motility from the original semen sample and the duration of infertility were also significant influencing factors. A similar sperm correlate was not identified on samples after sperm migration. Preovulatory follicular fluid steroids, progesterone (P), estradiol (E2), E2:P ratio, and luteinizing hormone (LH), as well as baseline plasma LH and the magnitude of the LH surge did not correlate with fertilization. However, when the identified factors were used to predict fertilization (discriminant analysis), only 58.3% of oocytes were correctly classified. This data supports the concept of performing IVF as a test in its own right.

Data assessing the usefulness of screening obstetrical ultrasonography for detecting fetal and placental abnormalities in uncomplicated pregnancy: effects of screening a low-risk population.

To investigate the usefulness of screening in low-risk populations, the authors evaluated the yield of ultrasonography for detecting abnormalities in 678 clinically uncomplicated pregnancies. The yield of ultrasonography in high-risk women who were referred for amniocentesis was remarkably similar to the yield in other women. All four diagnoses of twins were correct, but overall only six of 12 initial ultrasound diagnoses of fetal demise or fetal anomalies were confirmed at delivery. Of the eight major fetal anomalies present at delivery, including two cases of Down's syndrome, three had been detected by ultrasonography; none of the nine minor anomalies had been detected, usually because they were too small or might be detectable only at a later gestational age. Although ultrasonography may have a nearly perfect predictive value for certain anomalies, on average, in this study, positive ultrasonography increased the probability of an adverse outcome of pregnancy from 5.3% to 36%, while a normal ultrasound examination decreased the probability to 4.4%. These data, which emphasize the implications of screening a low-risk population, suggest that recommendations regarding routine screening obstetrical ultrasonography should await sufficiently large controlled trials demonstrating consistent clinical benefit, in terms of reassurance or of providing a baseline for future comparison or in terms of improved outcome at a reasonable cost.