Surgical challenges in unusual fibroids - a case series

Uterine leiomyoma are benign monoclonal tumours arising from smooth muscle tissue. There are different types of fibroids depending on the location of fibroid. There are various operative challenges in long standing huge fibroids on abnormal location. Surgical difficulties associated with these cases are due to poor access to the operative field, distorted anatomy, difficulty in suturing the repairs, increased blood loss. It is an art and skill to surgically remove these difficult fibroids and do difficult hysterectomies. Here we present case series of 7 cases, we have described variety of fibroid at different ages, presentations, precautions and also surgical challenges and the steps to overcome them successfully. Case 1- cervical fibroid, case 2- submucosal fibroid polyp, case 3- Bulky uterus with fundal fibroid during vaginal hysterectomy, case 4- broad ligament fibroid, case 5- multiple fibroids, case 6- multiple subserosal fibroids during caesarean section, and case 7- giant fibroid. Different types of fibroids are tackled in different ways. So, fibroid mapping by imaging studies and also ureteric stenting preoperatively whenever needed, helps to prevent untoward injuries. Following principles of surgery in any difficult fibroids leads to successful management and also helps to prevent injuries to the urinary tract and avoiding intra operative blood loss

Comparative evaluation of changes in salivary flow rate, pH, and Streptococcus mutans levels in children undergoing fixed and removable space maintainer therapy

Background: Placement of intraoral appliances such as space maintainers (SMs) may be associated with the alteration of microbial and nonmicrobial parameters of saliva which may lead to the initiation of incipient caries. Aim: The aim of this study was to compare and evaluate the changes in salivary flow rate, pH, and Streptococcus mutans levels in children undergoing fixed and removable SM therapy. Materials and Methods: The study participants comprised 40 children aged 4–10 years divided into two groups of 20 each. Children undergoing fixed (Group I = 20) and removable SM therapy (Group II = 20). Salivary flow rate, pH, and S. mutans levels were recorded just before and 3 months after the placement of SMs. Data were compared for both groups. Statistical Analysis: It was analyzed using SPSS software version 20. The level of significance was kept at 5%. Results: A significant increase in salivary flow rate (<0.05) and S. mutans level (<0.05) was evident, however, no significant difference in pH was found in both the groups from baseline to 3 months after appliance placement. Group I showed a significant increase (<0.05) in S. mutans level as compared to Group II. Conclusion: SM therapy allied both favorable and unfavorable changes in salivary parameters, thus emphasizing the importance of parent and patient education about maintaining proper oral hygiene during SM therapy