Service provision and barriers to care for homeless people with mental health problems across 14 European capital cities

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Congenital epulis of the jaw: a series of five cases and review of literature

This article describes five cases of congenital epulis, a rare and benign swelling in the mouth of a newborn, which is not widely known. We present five cases: four cases presented as single pedunculated nodules of the gingiva and in one case two nodules were present. Of all, 50% were located at the maxilla. Excision was performed in four of the five cases and in one case, spontaneous regression was awaited. No recurrence was reported. The characteristic features of congenital epulis are a pedunculated, flesh-pink coloured tumour with a predominant occurrence on the anterior maxillary alveolar ridge in a female newborn. Although the aetiology is unknown, most authors suggest a mesenchymal, rather than an odontogenic, origin. Endogenous hormonal factors might influence growth prenatally. Histological findings include granular cells with eosinophilic cytoplasm and small, eccentric nuclei. Despite the fact that the lesion can be a striking sight, spontaneous regression is possible and can be awaited. Indications for non-radical excision under local anaesthesia are severe upper airway obstruction and interference with feeding technique. In conclusion, we provide clinical and histological information about congenital epulis, so that this entity will be more easily recognised and relevant information given to parent

The epidemiology of self‐reported intermenstrual and postcoital bleeding in the perimenopausal years

ObjectiveTo obtain estimates of the rates of occurrence and spontaneous resolution of intermenstrual and postcoital bleeding, and investigate any association with underlying malignancy.DesignTwo-year prospective cohort study with medical record review during the survey period, and for the subsequent 2 years.SettingSeven general practices with 67 100 registered patients.PopulationAll women aged 40–54 years on the practices age–sex registers.MethodsBaseline postal questionnaire, with follow-up questionnaires sent to naturally menstruating respondents at 6, 12, 18 and 24 months. Medical record review using computerised searches from baseline to 48 months.Main outcome measuresPrevalence and incidence of intermenstrual and postcoital bleeding, and rate of spontaneous resolution.ResultsA total of 7121 baseline questionnaires were sent out, with an initial response rate of 66%. A total of 2104 naturally menstruating women were recruited for the prospective cohort study. The 2–year cumulative incidence of intermenstrual bleeding was 24% (95% CI 21–27%), and that of postcoital bleeding was 7.7% (95% CI 6.2–9.5%). The rates of spontaneous resolution without recurrence for 2 years were 37% (95% CI 29–45) and 51% (95% CI 40–62), respectively. Of the 785 women identified with intermenstrual and/or postcoital bleeding, only one developed uterine cancer.ConclusionThere is a high prevalence, incidence, and spontaneous rate of resolution of intermenstrual and postcoital bleeding in naturally menstruating women during the perimenopausal years. The association of these symptoms with malignancy is weak. This is of importance to women in deciding when to consult and to those devising public health campaigns concerning symptoms of possible oncological significance