Infections in the gynaecological tract

In the context of infections in the body, those that occur in the gynaecological tract are less common and perhaps less clinically significant compared with other body sites. However, a few infections are important in view of their association with pathological sequelae such as tumour formation or pelvic inflammatory disease complex.This review will discuss some of the most relevant infections, first under histology, which will be further subdivided into locations in the genital tract and then under cytology, which focuses mainly on the infections seen in cervical cytology samples. There will be only brief mention of the less common infections or those that do not produce diagnostic challenges or lead to significant complications.     

Granulomatous Variant of Giant Centrifugal Miliaria Profunda

Abstract: Two infants presented with multiple asymptomatic papules and geographic and annular plaques over the extensor aspect of the upper and lower extremities and trunk. Skin biopsy of both lesions showed plugged and hyperplastic dilated acrosryingia and deep dermal ducts, along with granulomatous inflammatory reaction. These lesions showed self‐healing with complete resolution. A previous report described similar clinical and histopathologic features and labeled it giant centrifugal miliaria profunda. Because of the large granulomatous plaques and deep infiltrate, we propose that it was a granulomatous variant of giant centrifugal miliaria profunda. We report these cases for their rarity and self‐healing nature.     

Tobacco use is associated with accelerated clinical recurrence of Crohn's disease after surgically induced remission

GOALS: To study the association between tobacco exposure and postoperative clinical recurrence in Crohn's disease patients and quantify the time to clinical relapse following surgical resection. BACKGROUND: It is well accepted that cigarette smoking has a negative impact on postoperative course in Crohn's disease. However, the effect of smoking to hasten clinical recurrence has not been clearly delineated. STUDY: We reviewed medical records of patients undergoing surgical resection for medication-refractory disease within a 5-year period. Patients were followed for a period of 250 weeks. Outcomes were compared between smokers and nonsmokers and stratified by gender. RESULTS: Fifty-nine patients were studied. Sixty-nine percent of smokers versus 23% of nonsmokers had recurrent symptoms (P = 0.02) by the end of the observation period. There was no difference in the mean ages, gender, disease location, use of postoperative medications, or number of postoperative visits (P > 0.09). Smoking was associated with an increased risk of clinical recurrence [odds ratio 2.96 (95% confidence interval, CI 1.5-5.6)]. The time to clinical relapse for smokers was 130 weeks versus 234 weeks in nonsmokers (P < 0.001). CONCLUSION: Smoking is associated with clinical recurrence of Crohn's disease, and the time to clinical recurrence in smokers is shorter. Strategies for smoking cessation are warranted.     

Inflammatory bowel disease in pregnancy

Fertility is affected in ulcerative colitis after surgery and in active Crohn's disease. Adverse fetal outcomes are not increased when IBD is quiescent. Active disease at conception increases the risk of adverse fetal outcomes. Most medications for IBD are safe during pregnancy and breastfeeding, with notable exceptions. Active disease is usually more deleterious than maintaining medical therapy.     

Role of a Dentist in Comprehensive Management of a Comatose Patient with Post Traumatic Head Injury and Neuropathological Chewing

Injury of the head and neck region can result in substantial morbidity. Comprehensive management of such patients requires team work of several specialties, including dentists. A young female patient with extensive loss of cranium and associated pathological chewing was referred to the dental department. The lost cranium was replaced by a custom-made, hand-fabricated cranioplast. Trauma due to pathological mastication was reduced by usage of a custom-made mouthguard. Favorable results were seen in the appearance of the patient and after insertion of the mouthguard as evidenced in good healing response. The intricate role of a dental specialist in the team to manage a patient with post traumatic head injury has been highlighted. The take away message is to make the surgical fraternity aware of the scope of dentistry in the comprehensive management of patients requiring special care.     

Le-fort I access osteotomy to nasopharyngeal tumor – A case-report

Removal of extensive central skull base and paranasal sinus tumors is a significant challenge that is often hampered by limited access and exposure. The safety and efficacy of the Le Fort I osteotomy approach to the skull base have been well established. The purpose of this article is to describe the use of Le fort-1I osteotomy as an access procedure to reach tumors in the nasopharyngeal region in a young patient. The large mass which he presented within the nasopharyngeal region, later diagnosed to be juvenile nasopharyngeal angiofibroma, posed a challenge for surgical access.