|
|
|
|
| HEALTH & FITNESS |
|
|
|
Beware of “mouse” in the breast Effect of sexual violence on health Health Notes
|
|
Beware of “mouse” in the breast I am sure the readers must be taken by surprise to read this title. It looks funny and unbelievable but this is an accepted terminology to describe “fibroadenoma” of the breast, a commonly occurring benign problem. Fibroadenomas of the breast are swellings in the breast composed of fibrous and glandular tissue, usually seen in the child-bearing age. These are commonly seen in females but may be seen in males also. It is the most common breast tumour in adolescent women. Their incidence declines with increasing age, and, in general, they appear before the age of 30 years. They also occur in a small number in post-menopausal women. Fibroadenomas are partially hormone-dependent and frequently regress after menopause. Fibroadenoma is commonly seen as a single solid swelling in any part of the breast, painless to start with, slowly grows in size and in a few cases it may take an enormous size, may even occupy the whole breast. Higher intake of fruits and vegetables, a higher number of live births, use of oral contraceptives and moderate exercise are associated with lower frequency of fibroadenomas. A small fibroadenoma slips under the finger and moves freely in the breast and that is why it is called “breast mouse”. A surgeon is able to diagnose fibroadenoma simply by doing a good clinical examination, but clear differentiation from cancer is essential. The following investigations are undertaken for diagnosis: A. Mammography: This can be conventional one or can be undertaken by ultrasound. Ultrasound mammography, also known as sonomammography, is the procedure of choice in young females with firm breasts. B. FNAC or core biopsy examination of the nodule is undertaken to confirm the diagnosis.
Management
1. A large number of fibroadenomas are left in situ and monitored by a doctor, or the patient in question. FNAC is often a reliable diagnostic investigation; many surgeons may decide not to operate to remove the lesion and instead opt for a follow-up to serially observe the lesion over time using clinical examination and mammography for its rate of growth. A growth rate of less than 16 per cent per month in women under 50 years of age, and a growth rate of less than 13 per cent per month in women over 50 years of age have been reported to be safe. 2. Saheli, a commonly used contraceptive pill in India, has been reported as a good treatment for fibroadenoma. It has shown good and safe results as compared to the drugs (danazole and bromocriptine) being commonly used. Further randomized studies are in progress to determine its definitive role for continued non-operative treatment for fibroadenoma of the breast. 3.
Operative management: Fibroadenomas which are large in size or increasing in size or causing pain or have some doubtful features on FNAC are surgically removed. It is important to give a good cosmetic result as a large percentage of the patients being young women desire a good result. It is possible to give a good result in a large number of cases. The fibroadenomas are excised with a thin rim of normal breast tissue all around and the left-over cavity is obliterated by mobilising the surrounding breast tissue. The excised specimen is sent for a pathological examination, and if the features show atypical cells or any other feature of pre-cancerous lesion, then it should be excised in toto. 4. A rapidly growing fibroadenoma should be excised as not only there is a possibility of it being phylloides tumour, but as it grows in size the surgical incision to remove it will be also longer and the cosmetic result may not be satisfactory. Fibroadenomas have not been shown to recur following complete excision or transform into phyllodes tumours after partial or incomplete excision. The following two procedures for the management of fibroadenoma of the breast have been undertaken recently in foreign countries (these are not yet used in India): A. Europe recently recognised an alternative treatment what is called echotherapy. This uses high intensity focussed ultrasound to treat breast fibroadenoma. This method is non-invasive and relies on tissue heating to destroy fibroadenoma cells. Focused ultrasounds have been used for a long time in the treatment of different tumours such as prostate, liver or uterus, where they proved their efficacy. A French company, Theraclion, develops an echotherapy device for benign tumour treatment, especially breast fibroadenoma. B. Cryoablation treatment: The FDA has approved cryoablation (the use of extreme cold to destroy any tissue) of a fibroadenoma as a safe, effective and minimally-invasive alternative to open surgical removal in the procedure, ultrasound is used to guide a probe into the mass of breast tissue. Extremely cold temperatures are then used to destroy the abnormal cells, and in due course of time the cells are reabsorbed into the body. The procedure can be performed as an outdoor procedure with local anaesthesia only, and it leaves substantially less scarring than open surgical procedures. The following criteria to establish a patient as a candidate for cryoablation of a fibroadenoma have been recommended: 1. The lesion must be visible on an ultrasound examination. 2. The diagnosis of fibroadenoma must be confirmed histologically. 3. Lesions should be less than 4 cm in diameter. The writer is a former Sr Professor and Head of Surgery,
PGI. |
|
Effect of sexual violence on health Sheena, 13, presented to her gynaecologist with a history of abdominal pain and vaginal bleeding. She admitted to having had sex with a man. Coitus was painful and she remembered hearing a popping sound on penetration. She later developed dizziness and started to have abdominal pain. On arrival to the clinic she was noted to be in a painful condition, her abdomen was found to be tender. On vaginal examination, she was found to have a posterior fornix laceration, which was bleeding. She was referred to a tertiary care centre where emergency laparotomy was performed. The 4 cm full thickness laceration of the posterior fornix was sutured. She was discharged after a few days with no ill effects. This was possible with early and adequate medical/ surgical care, else it could prove disastrous. Sheena is not an isolated case but she was lucky to get early and proper care. Many other cases of child rapes with serious injuries, who are unable to get prompt surgical care at a suitable centre are reported have succumbed to their injuries or became moribund for the rest of their lives. Unfortunately India is emerging as the new capital of child rapes and murders. Is it for sexual enjoyment, vicarious gratification of blood letting or simple criminality to snuff out tender lives? Children constitute 42 per cent of India's total population and 53.22 per cent of the children have reported having faced sexual abuse of varying degree (52.94 per cent were boys, 47.06 per cent girls). What is being reported may be the tip of the iceberg. A 4-year-old victim died in a Nagpur hospital from multiple infections, bleeding and cardiac arrest. In Delhi girl's case the 'genital area' had been mutilated beyond description, objects had been inserted inside her, causing serious internal injuries. Many more such cases have been/ are being reported from various parts of the nation. These victims need to be referred to a tertiary care centre capable of dealing with the severely injured child and providing multi-disciplinary care. This includes urgent resuscitation, medical, surgical, psychological, social and rehabilitation components of care. There should be a team of highly skilled surgeons from different specialities — a disaster management team — in a state of full preparedness to deal with disaster victims.
Health consequences
Genital injuries may involve vagina, urethra and rectum, posterior fourchette, labia minora, hymen, and fossa navicularis. Anogenital injuries are denoted using the word TEARS — tears, ecchymoses, abrasions, redness, and swelling. Tears mean any breaks in tissue integrity, including fissures cracks, lacerations, cuts, or rips. Ecchymoses denotes skin or mucous membrane discoloration due to damage to small blood vessels. Abrasions entail skin excoriations caused by the removal of the epidermal layer. Redness is erythematous skin with inflammation Swelling shows engorgement of tissues. Sometimes uterine rupture can occur in cases of gang rapes or insertion of hard objects. Other consequences include (1) extragenital injury; (2) psychologic symptoms — fear, nightmares, sleep problems, anger, embarrassment, shame, guilt etc; (3) sexually transmitted diseases (STDs) like hepatitis, syphilis, gonorrhea, chlamydial infection, trichomoniasis, HIV infection; (4) pregnancy.
The need for prompt referral to disaster management team
While medico-legal examination is a must, precious time should not be lost due to lack of constitution or preparedness of the disaster team. Signs of shock such as tachycardia, pallor, poor peripheral perfusion and hypotension need to be attended urgently. It may require administration of blood. Any source of external bleeding should be controlled fast. Plugging the vagina, rectum is not advisable as the injury can be exacerbated and evidence can be altered. The writer is a senior gynaecologist based in Chandigarh. |
|
Grilled food may increase cancer risk
Washington: It's time for picnics and parties with lots of grilled goodies, but experts at Dana-Farber Cancer Institute have warned that all that sizzling and flipping on the gas or charcoal grill may also be cooking up cancer-causing chemicals. And surprisingly, those chemicals have been linked to breast, stomach, prostate, and colon cancer, according to the American Institute for Cancer Research. But Stacy Kennedy, MPH, RD, CSO, LDN, a Dana-Farber nutritionist, said that doesn't mean giving up those tasty summer time treats like burgers, steaks, and ribs. "It's really about planning ahead and making wise choices," he stated. There are two risk factors to keep in mind. First, research has shown that high-heat grilling can convert proteins in red meat, pork, poultry, and fish into heterocyclic amines (HCAs). These chemicals have been linked to a number of cancers. — ANI ‘ Artificial pancreas` set to transform diabetes treatmentLondon: Researchers have tested an artificial pancreas that could one day improve lives of millions of people suffering from diabetes in a home environment for the first time. Blood glucose levels are monitored by the device which uses an infrared data link to relay info to an insulin pump attached to the patient's body, which adjusts insulin levels accordingly. Researchers at the University of Cambridge have been working on the artificial pancreas for many years and by the end of this year, 24 people will have taken part in home trials, the Independent reported. However, the device still has a long way before it is commonly available as a treatment for Type 1 diabetes, and will initially be used only to stop people's insulin levels from falling too low at night. — ANI Abnormal heartbeat linked to faster cognitive decline
Washington: A new research from the University of Alabama at Birmingham (UAB) School of Public Health has found that an abnormal heartbeat, known as atrial fibrillation, is associated with faster cognitive decline. Atrial fibrillation is an irregular heartbeat that can lead to blood clots, stroke, heart failure and other heart-related complications. Study lead author Evan Thacker, statistician in the Department of
Epidemiology, wanted to investigate whether people who had not experienced a stroke had cognitive decline, or memory and thinking problems, more quickly after being diagnosed with atrial fibrillation. Stroke has previously been found to increase cognitive decline. "We found that age-related declines in average cognitive test scores did occur faster after diagnosis of atrial fibrillation, even after accounting for other factors that can hasten cognitive decline," Thacker said. — ANI
|
A swelling in the breast is commonly associated with breast cancer, but this is not always correct as 70 to 80 per cent of breast swellings/nodules are benign — noncancerous in nature. Fibrocystic disease of breast, fibroadenoma, granulomatous disorders are the common non-cancerous problems of female breast.