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Objectives: Vaginal delivery is a risk factor in pelvic floor disorders. We previously described changes in the pelvic floor associated with pregnancy and parturition in the squirrel monkey, a species with a humanlike pattern of spontaneous age and parity associated pelvic organ prolapse. The potential to prevent or diminish these changes with scheduled cesarean section has not been evaluated in a randomized, controlled trial. Therefore, this trial compares female squirrel monkeys undergoing spontaneous vaginal delivery with those undergoing scheduled primary cesarean section for pelvic floor muscle volumes, muscle contrast changes, and dynamic effects on bladder neck position. Materials and Methods: In a prospective randomized trial Levator ani (LA), obturator internus (OI), and coccygeus (COC) muscle volumes and contrast uptake were assessed by MR imaging in 20 nulliparous females examined prior to pregnancy, a few days after delivery, and 3 months post-partum. The position of bladder neck relative to boney reference line was also assessed with abdominal pressure using a dynamic MRI. Results: Baseline measurements of 10 females randomly assigned to scheduled primary cesarean sections were not different from those of 10 females assigned to spontaneous vaginal delivery. LA and OI muscle volume did not differ between the two groups. However, the volume was reduced (p \ 0.05) in the observation immediately after pregnancy for both muscles. The COC muscles increased (p \ 0.05) immediately after delivery for females in the spontaneous vaginal delivery group, but did not change in females in the scheduled cesarean section group. Position of the bladder neck descended (p\0.05) by 3 months post-partum in both groups. Conclusion: This study provides the first observations in a randomized, controlled trial that scheduled cesarean section diminishes changes in COC muscle volume and contrast reported to be associated with spontaneous vaginal delivery. However, pelvic support of the bladder was not protected by this intervention suggesting that effects of pregnancy and delivery are not uniformly prevented by this procedure.

Background Multifocal nodular oncocytic hyperplasia (MNOH) is a rare condition of the parotid gland. It is characterised by multiple nodules of oncocytic cells and may be seen in association with oncocytoma. Occasionally the oncocytic cells will have a clear cell appearance which can pose a diagnostic challenge. Case report A 60-year-old male presented with a right facial swelling. A fine needle aspirate of the right and left parotid glands showed small crowded groups of acinar cells, however a low cellular yield made definitive diagnosis difficult. The patient underwent a bilateral parotidectomy. An 18 mm mass was seen in the right parotid gland. Histology of the mass showed eosinophilic and clear cells arranged in ribbons, nests and tra-beculae. Both parotid glands showed multiple nodules, measuring up to 2.5 mm in diameter, composed of mixed oncocytic and clear cells. Immunohistochemical staining for low molecular weight cytokeratins showed strong focal positivity. Staining for PTAH, CD10, CEA and vimentin were negative. A diagnosis of parotid oncocytoma with bilateral MNOH, clear cell variant was made. Discussion This case highlights the differential diagnosis of mixed oncocytic and clear cells within the parotid gland which includes MNOH, renal cell carcinoma metastasis and clear cell acinic cell carcinoma amongst others. The use of immunohisto-chemical staining is of value in assisting diagnosis.