Sialodochitis fibrinosa managed with staged bilateral total parotidectomy.

OBJECTIVE: This paper reports a rare case of a 61-year-old man with sialodochitis fibrinosa. METHODS: Clinical case report and review of current literature. RESULTS: Sialodochitis fibrinosa is a diagnosis of exclusion and in many cases can be managed conservatively. Conservative management failed for this patient and he was managed successfully with staged bilateral total parotidectomy. CONCLUSION: Sialodochitis fibrinosa should be considered as a differential diagnosis of painful bilateral facial swelling. While conservative management is successful for many patients, staged bilateral total parotidectomy may be necessary for full remission of symptoms; the timing of this is crucial to reduce the risk of facial nerve palsy.

Treatment outcomes of laryngectomy compared to non-surgical management of T3 laryngeal carcinomas: a 10-year multicentre audit of 179 patients in the northeast of England.

OBJECTIVE: Wide-ranging outcomes have been reported for surgical and non-surgical management of T3 laryngeal carcinomas. This study compared the outcomes of T3 tumours treated with laryngectomy or (chemo)radiotherapy in the northeast of England. METHODS: The outcomes of T3 laryngeal carcinoma treatment at three centres (2007-2016) were retrospectively analysed using descriptive statistics and survival curves. RESULTS: Of 179 T3 laryngeal carcinomas, 68 were treated with laryngectomies, 57 with chemoradiotherapy and 32 with radiotherapy. There was no significant five-year survival difference between treatment with laryngectomy (34.1 per cent) and chemoradiotherapy (48.6 per cent) (p = 0.184). The five-year overall survival rate for radiotherapy (12.5 per cent) was significantly inferior compared to laryngectomy and chemoradiotherapy (p = 0.003 and p < 0.001, respectively). The recurrence rates were 22.1 per cent for laryngectomy, 17.5 per cent for chemoradiotherapy and 50 per cent for radiotherapy. There were significant differences in recurrence rates when laryngectomy (p = 0.005) and chemoradiotherapy (p = 0.001) were compared to radiotherapy. CONCLUSION: Laryngectomy and chemoradiotherapy had significantly higher five-year overall survival and lower recurrence rates compared with radiotherapy alone. Laryngectomy should be considered in patients unsuitable for chemotherapy, as it may convey a significant survival advantage over radiotherapy alone.

[Pregnancy, delivery and perinatal outcome in adolescent pregnancy]. / Bremennost, razhdane i perinatalen izkhod pri adolestsentni bremenni.

Retrospectively 398 adolescent primiparas have been analyzed in respect of the process of pregnancy, antenatal complications, mode of delivery and perinatal outcome. The researched contingent was divided into 2 age groups--up to 15 years and between 16-18 years. The results obtained were compared to a control group of 398 primiparas at the age of 20-24 years. The results indicate that the process of adolescent pregnancy is related to a substantially higher relative share of some complications like anemia, premature rupture of the membranes and preeclampsia. The frequency of pre-term labor has essentially increased. A basic model of birth-giving is the vaginal delivery, and the duration of delivery of the adolescent does not differ from that of the adult primiparas. There is not a significant difference between the adolescent and the adult pregnant in the placental and in the early puerperal period. An increased frequency of the fetal retardation is missing at the adolescent pregnancy.

[The active management of the placental period with Remestyp]. / Aktivno vodene na platsentarniia period s Remestyp.

The aim of this prospective study is to asses, the possibility to use Remestyp after the delivery of the head as a prophylaxis of blood lost during the third stage of labor. The material includes 209 cases: 82 with bolus dose of 0.2 mg Methergin, 54 cases with 10 ME Oxytocin, 32 parturition with 200 mg Remestyp, and 41 controls without any uterostonics during the placental period. The blood lost is assessed by gravimetric method. The results show that the total blood lost from the delivery of the neonate to two hours after it is significantly lower in active management of labor than in expectant one. The type of uterostonic is not essential in regard of total blood lost. The prophylactics of blood lost with Remestyp has best results in cases of stimulated with Oxytocin infusion labor. The active management of third stage of labor with Methergin or Remestyp has less complication than are used oxytocin or without uterostonics. The mean time for delivery of placenta is shortest in the group with Remestyp. The three uterostonics in mansion doses do not influenced significantly the artery pressure. Our experience demonstrates that Remestyp can be used for active management of third stage of labor and the results are as those with Methergin. Remestyp is preferable when are expected significant lacerations of the birth canal.

[Cytological and histological parallels in atypical colposcopic findings]. / Tsitologichni i khistologichni paraleli pri atipichni kolposkopski nakhodki.

The aim of the present study was to analyse the cytological and histological equivalents in 112 patients with atypical colposcopical findings. The results showed the follow distribution of the findings: for cytological examination in 66 of the patients-I gr. PAP, in 32-II gr. PAP, in 6 III-A gr. PAP, in 1-III-B gr. PAP, in 4-IV gr. PAP and in 3-V gr. PAP. The histological study of the obtained target biopsies established: 7 cases with normal epithelium, 82 with different findings of abnormal epithelium with or without nonspecific and specific inflammatory changes; 18 cases with dysplasia from I to III degrees, 2 cases with CIS and 3 with invasive cancer. The degree of correlation of the different findings, as well as the possible causes for hypo and hyperdiagnostic assessments are discussed.

[An analysis of the indications for episiotomy in current obstetrical practice]. / Analiz na indikatsiite za epiziotomiia v suvremennata akusherska praktika.

The aim is to analyze the accepted indications for episiotomy in nowadays practice. The investigations is retrospective for the period from April to May 1996. The material includes 459 term singleton pregnancy in vertex presentation and 46 cases of premature neonates with weight from 1300 to 1499 g. The results show high risk (77.1%) of episiotomy in nulliparous women. The multiparity, the length of second period and the high risk pregnancies have not effect on the use of episiotomy. The wight of the fetus is essential factor. The highest rate of episiotomy is at premature births (65.2%) followed by the group of neonates with weight over 4000 g (61.5%). The lowest rist of episiotomy is then the weight of newborn is between 2500 and 3800 g (21.8%). Almost hundred percent rate of episiotomy in operative vaginal and breech deliveries show that we accept the episiotomy as obligatory of these vaginal deliveries.

[The results of the limited use of episiotomy in managing the second stage of labor]. / Rezultati ot ogranicheno prilozhenie na epiziotomiia pri vodene na vtori period na razhdaneto.

The purpose is to asses the effect of restrictive use of mediolateral episiotomy on the spontaneous laceration of the low birth canal. The material includes 613 labors some of which gave birth with indication for episiotomy and control group of 441 retrospective cases with routine management of the second period of labor. The restrictive use of episiotomy decreases the rate from 45.6% in the routine practice to 32.8%. The reduced rate of episiotomy has as a consequent increase rate of second degree perineal laceration adn insignificant increase of vaginal lacerations. The management of restrictive and liberal use of mediolateral episiotomy has not effect on third and four degree perineal laceration, on the accessory tears of the vagina and on the rate of perineotomy. If from all labors are subtracted operative deliveries, surgical intervention for repairing the laceration of the birth canal and pathology of the placental period the rate of labors without any intervention is only 13.3%. Our results suggest that labor nowadays is operative activity.

[Blood loss in the placental period in relation to the type of prophylaxis]. / Kruvozaguba v platsentarniia period v zavisimost ot vida na profilaktikata ì.

The aim of this study is to asses the blood loss in third period of labor according the method of its prophylactic. The material consist of 144 prospective and 192 retrospective cases. The blood loss is assessed visually and after that it is weighted. Up to the delivery of placenta the visually assessed blood loss is insignificantly greater than the weighted one. All cases are subdivided in three groups according the management of third period: -with methergin, with oxytocin and without uterostonic. The blood loss associated with the separation and delivery of the placenta is not different in the groups, but the early postpartum haemorrhage is significantly greater in the cases without uterostonics for the delivery of placenta. In premature labors the blood loss associated with the separation of placenta is significantly greater that in term labor.