LaSt wEEk-Endotracheal Intubation and Intravenous cannulation
· Endotracheal intubation
· Indicated in cardiac arrest, serious head injury, certain acute respiratory and trauma settings, and prior to many surgical operations
- Effective bag and mask ventilation is better than multiple attempts at endotracheal intubation in the arrest setting.
- Except in a dire emergency endotracheal intubation should not be performed without expert supervision.
Equipment:
• 10mL syringe.
• Endotracheal tube (ET; size 8-9 for females and 9-11 for males).
• Laryngoscope.
• Ribbon to secure tube; lubricating jelly
Steps:
• Pre-oxygenate the patient.
• Ensure that the laryngoscope and ET cuff are functioning.
• Remove any dentures, and suction excess saliva and secretions.
• Extend the neck.
• Insert the laryngoscope pushing the tongue to the left.
• Advance the scope anterior to the epiglottis and pull gently but firmly upwards to expose the vocal cords. Take care not to lever on the upper teeth with the scope.
• Insert the lubricated ET tube between the cords into the trachea.
• Confirm correct positioning of the tube by observing chest movements, and listening over lung bases and stomach.
• Progressively inflate the cuff and attach ventilation equipment.
• Confirm correct cuff inflation by listening for whistling or bubbling in the larynx suggesting air leak and secure the tube in place with ribbon.
• * Patients not in cardiac arrest or who maintain a gag reflex will need anesthetizing prior to oropharyngeal intubation, i.e. administration of inducing agent plus muscle relaxant.
• * The best setting to learn intubation is preoperatively in the anesthetic room of a theater with good supervision in controlled conditions.
and .....
Intravenous cannulation
A similar skill to that of simple venepuncture but needs plenty of practice to become competent. If having difficulty, observe a few experts in action.
Indications
Venous access for administration of IV fluids, blood, or IV drugs.
Equipment
• Tourniquet.
• Cannula: 20G or 18G.
• Adhesive dressing/tape.
• Alcohol swabs.
• 5mL syringe containing 0.9% saline or heparinized saline.
• IV fluid bag with giving set, if necessary.
Preparation
Apply tourniquet above or below the elbow and inspect the arm for suitable engorged veins.
Method
• Clean the skin thoroughly at the site of access.
• Identify a suitable vein.
• Tether the skin distal to the proposed site of puncture.
• Pass the cannula obliquely through the skin at a point approximately 1cm distal to the point at which you wish to enter the vein.
• Advance the cannula smoothly until the vein is entered: a flashback seen in the hub of the cannula.
• Hold the hub of the needle with one hand and advance the cannula into the vein, while maintaining skin fixation until the cannula is well into the vein.
• Remove the tourniquet and press on the vein proximal to the cannula as the needle is removed. Apply the screw cap to the end of the cannula.
• Secure the cannula in place with a dressing.
• If the cannula is not going to be used immediately, flush with heparinized saline
Tips
- Poor veins. If
the patient is cold and the samples non-urgent, place the arm in warm
water and this may aid venous dilatation. Veins on the dorsum of the hand
may be the only ones readily available-try using a smaller or butterfly
needle to obtain samples.
- Obese patients.
Try the dorsum of the hand or the radial aspect of the wrist; access may
be easier here.
- Failed attempts.
Repeated failed attempts will distress the patient and demoralize the
doctor! Ask someone to help. If the samples are extremely urgent, a
femoral stab may be the best option for obtaining blood samples, e.g.
during cardiac arrest.
- IV cannulae. If
blood samples and IV access are needed, a sample can be taken immediately
after inserting the cannula. However, do not use a peripheral cannula for
routine samples; they can be haemolysed, contaminated by IV fluids, and
unreliable.
- Agitated or
fitting patients. Try not to place the cannula over a joint, as these tend
to become easily dislodged
- Secure the
cannula. Cannulas are all too easily dislodged because of poor fixation to
the skin. Use of two cannula dressings (one placed above and one below)
and a bandage is often needed.
- Hairy arm.
Shaving the skin at the planned cannula site seems tedious but will allow
the cannula to be secured adequately.
- Non-dominant
hand. Placing the cannula in the non-dominant hand, if possible, will
allow the patient a little bit more freedom and may prevent the cannula
becoming dislodged easily.
- Fragile veins.
This tends to be a problem in elderly or debilitated patients. Try using a
smaller cannula: the dorsum of the hand is often an ideal site.
- Poor peripheral
access. In some patients with multiple collapsed or damaged veins
alternative cannula sites may have to be considered, e.g. feet. If
peripheral cannulation becomes impossible, a central line will have to be
considered.
- Blood
transfusion. If blood is being given IV then an 18G or 16G cannula will be
needed.
Size and function of different cannulae
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before I end this post..
Last Week:
Wonder how this happen.(.it is a button)
 |
| This made to go back that day.. |
missing them..
during free time..
by Lakdhes..
Heel Pain Management
Heel Pain Management
heel pain/foot pain/feet pain/leg pain
Plantar fascitis , also known as Plantar Heel Pain (PHP) is a painful inflammatory process of the plantar fascia, the connective tissue or ligament on the sole (bottom surface) of the foot. It is often caused by overuse of the plantar fascia, increases in activities, weight or age. It is a very common condition and can be difficult to treat if not looked after properly.
Longstanding cases of plantar fasciitis often demonstrate more degenerative changes than inflammatory changes, in which case they are termed plantar fasciosis. Since tendons and ligaments do not contain blood vessels, they do not actually become inflamed. Instead, injury to the tendon is usually the result of an accumulation over time of microscopic tears at the cellular level.
The plantar fascia is a thick fibrous band of connective tissue originating on the bottom surface of the calcaneus (heel bone) and extending along the sole of the foot towards the toes. It is commonly associated with long periods of weight bearing and much more prevalent with hyper-pronation (flat feet). Among non-athletic populations, it is associated with a high body mass index. The pain is usually felt on the underside of the heel and is often most intense with the first steps of the day. Another symptom is that the sufferer has difficulty bending the foot so that the toes are brought toward the shin (decreased dorsiflexion of the ankle). A symptom commonly recognized among sufferers of plantar fasciitis is an increased probability of knee pains, especially among runners
An incidental finding associated with this condition is a heel spur, a small bony calcification on the calcaneus heel bone, in which case it is the underlying plantar fasciitis that produces the pain, and not the spur itself. The condition is responsible for the creation of the spur; the plantar fasciitis is not caused by the spur.
Sometimes ball-of-foot pain is mistakenly assumed to be derived from plantar fasciitis. A dull pain or numbness in the metatarsal region of the foot could instead be metatarsalgia, also called capsulitis. Some current studies suggest that plantar fasciitis is not actually inflamed plantar fascia, but merely an inflamed flexor digitorum brevis muscle (FDB) belly. Ultrasound evidence illustrates fluid within the FDB muscle belly, not the plantar fascia.
Treatment
Physical treatments
Based on current research, recommendations for immediate relief and reduction of inflammation include heel and foot stretching exercises as can be tolerated, microcurrent treatment, rest, wearing shoes with good support and cushions. Other steps to relieve pain include: applying ice or ice-heat-ice, and/or using night splints to stretch the injured fascia. Customized functional foot orthotics can offer a decrease in the pain associated with plantar fasciitis and may provide an additional benefit in terms of increased functional ability in patients with the condition.
Some evidence shows that stretching of the calf and plantar fascia may provide up to 2–4 months of benefit. One study has shown improvement over a four-month period with stretching. One study has shown high success rates with a stretch of the plantar fascia, but has been criticized because it was not blinded, and contained a bias because the analysis did not use the intention to treat method. Because it is impractical to do double-blind experiments involving stretching, such studies are vulnerable to placebo effects.
Pain with the first steps of the day can be markedly reduced by stretching the plantar fascia and Achilles tendon before getting out of bed. Night splints can be used to keep the foot in a dorsi-flexed position during sleep to improve calf muscle flexibility and decrease pain on waking. These have many different designs. The type of splint has not been shown to affect outcomes.
Surgery
Surgery carries the risk of nerve injury, infection, rupture of the plantar fascia, and failure to improve the pain.This allows more space for the inflamed muscle belly, thus, relieving pain/pressure. An ultrasound-guided needle fasciotomy can be used as a minimally invasive surgical intervention for plantar fasciitis. A needle is inserted into the plantar fascia and moved back and forwards to disrupt the fibrous tissue.Coblation surgery has been used successfully in the treatment of recalcitrant plantar fasciitis. This procedure utilizes radiofrequency ablation and is a minimally invasive procedure.
Medication
To relieve pain and inflammation, nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin and ibuprofen are often used but are of limited benefit.Dexamethasone 0.4 % or acetic acid 5% delivered by iontophoresis(Iontophoresis is a physical process in which ions flow diffusively in a medium driven by an electric field to treat of excessive sweating of the hands and feet ) combined with low Dye strapping and calf stretching has been shown to provide short term pain relief and increased function.
Local injection of corticosteroids often gives temporary or permanent relief, but may be painful, especially if not combined with a local anesthetic and injected slowly with a small-diameter needle.(Injecting dexamethasone and lidocaine ,but dont try yourself).Recurrence rates may be lower if injection is performed under ultrasound guidance.Repeated steroid injections may result in rupture of the plantar fascia.
by Lakdhes..
Methods of Surgical Suturing
Suture Material
Many different suture materials are available. The main classifications are absorbable or nonabsorbable. A more subtle subclassification is whether the suture material is braided or nonbraided. Unless there is a dire emergency, never use regular thread for sutures because of the risk of infection.
Nonabsorbable Sutures
Nonabsorbable sutures remain in place until they are removed. Because they are not dissolved by the body, they are less tissue-reactive and therefore leave less scarring as long as they are removed in a timely fashion. They are best used on the skin.
Absorbable Sutures
Absorbable sutures are dissolved by the body's tissues. The great advantage is that the sutures do not need to be removed. However, absorbable sutures tend to leave a more pronounced scar when used as skin sutures. Absorbable sutures are primarily used under the skin, where they are well hidden. It is sometimes difficult to get patients to return for suture removal. If this is a concern, use an absorbable suture for skin closure. You should warn the patient that absorbable sutures probably will result in a more noticeable scar than nonabsorbable sutures with later removal. Because it is often difficult to remove stitches from children (because of their crying and difficulty in staying still), absorbable materials should be used when suturing their wounds.
Braided Sutures
Braided sutures are made up of several thin strands of the suture material twisted together. Braided sutures are easier to tie than nonbraided sutures. However, braided sutures have little interstices in the suture material, which can be a place for bacteria to hide and grow, resulting in an increased risk of infection.
Nonbraided Sutures
Nonbraided sutures are simply a monofilament, a single strand. They are not made up of the little subunits found in a braided suture. Nonbraided sutures are recommended for most skin closures, especially wounds that may be at risk for infection
Suturing Techniques
When suturing the edges of a wound together, it is important to evert the skin edges—that is, to get the underlying dermis from both sides of the wound to touch. For the wound to heal, the dermal elements must meet and heal together. If the edges are inverted (the epidermis turns in and touches the epidermis of the other side), the wound will not heal as quickly or as well as you would like. The suture technique that you choose is important to achieve optimal wound healing.
Instruments Needed
Needle holder:
used to grab onto the suture needle.
Forceps:
used to hold the tissues gently and to grab the needle
Suture scissors:
used to cut the stitch from the rest of the suture material
How to Hold the Instruments
Whenever you use sharp instruments, you face the risk of accidentally sticking yourself. Needlesticks are especially hazardous because of the risk of serious infection (hepatitis, human immunodeficiency virus).
To prevent needlesticks, get in the habit of using the instruments correctly. Never handle the suture needle with your fingers.
1.Scissors-Place your thumb and ring finger in the holes. It is best to cut with the tips of the scissors so that you do not accidentally injure any surrounding structures or tissue (which may happen if you cut with the center part of the scissors).
2.Needle Holder-Place your thumb and ring finger in the holes. When using the needle holder, be sure to grab the needle until you hear the clasp engage, ensuring that the needle is securely held. You grab the needle at its half-way point, with the tip pointing upward. Try not to grab the tip; it will become blunt if grabbed by the needle holder. Then it will be difficult to pass the tip through the skin.
3.Forceps-Hold the forceps like a writing utensil. The forceps is used to support the skin edges when you place the sutures. Be careful not to grab the skin too hard, or you will leave marks that can lead to scarring. Ideally, you should grab the dermis or subcutaneous tissue—not the skin—with the forceps, but this technique takes practice. For suturing skin, try to use forceps with teeth, which are little pointed edges at the end of the forceps.
Placing the Sutures
For most areas of the body, except the face ,the sutures should be placed in the skin 3–4 mm from the wound edge and 5–10 mm apart. Sutures placed on the face should be approximately 2–3 mm from the skin edge and 3–5 mm apart.
Sutures placed elsewhere on the body should be approximately 3–4 mm from the skin edge and 5–10 mm apart.Start on the side of the wound opposite and farthest from you to ensure that you are always sewing toward yourself. By sewing toward yourself, the suturing process is made easier from a biomechanical standpoint.
Simple Sutures Indication.
This technique is the easiest to perform. It is used for most skin suturing.
Technique
1.Start from the outside of the skin, go through the epidermis into the subcutaneous tissue from one side, then enter the subcutaneous tissue on the opposite side, and come out the epidermis above.
2.To evert the edges, the needle tip should enter at a 90°angle to the skin. Then turn your wrist to get the needle through the tissues. 3.You can use simple sutures for a continuous or interrupted closure.
Interrupted Sutures
•Interrupted sutures are individually placed and tied.
•They are the technique of choice if you are worried about the cleanliness of the wound.
•If the wound looks like it is becoming infected, a few sutures can be removed easily without disrupting the entire closure.
•Interrupted sutures can be used in all areas but may take longer to place than a continuous suture.
Continuous Closure
•Place the sutures again and again without tying each individual suture.
•If the wound is very clean and it is easy to bring the edges together, a continuous closure is adequate and quicker to perform. •Continuous closure is the technique of choice to help stop bleeding from the skin edges, which is important, for example, in a scalp laceration.
Mattress Sutures Indication.
Mattress sutures are a good choice when the skin edges are difficult to evert. Sometimes you may want to close a wound with a few scattered mattress sutures and place simple sutures between them. It is a bit more technically challenging to place mattress sutures, but it is often worth the effort because good dermis-to-dermis contact is achieved
Technique
1.Start like a simple suture, go from the outside of the skin through the epidermis into the subcutaneous tissue from one side, then enter the subcutaneous tissue on the opposite side, and come out the epidermis above.
2.Turn the needle in the opposite direction and go from outside the skin on the side that you just exited and come out the dermis below. Then enter the dermis on the opposite side and come out of the epidermis above.
3.Your suture is now back on the side on which you started.
Buried Intradermal Sutures
Indication-
This technique is useful for wide, gaping wounds and when it is difficult to evert the skin edges. When buried intradermal sutures are placed properly, they make skin closure much easier. The purpose of this stitch is to line up the dermis and thus enhance healing. The knot needs to be as deep into the tissues as possible (hence the term buried) so that it does not come up through the epidermis and cause irritation and pain.
Technique
1.Use a cutting needle and absorbable material.
2.Start just under the dermal layer and come out below the epidermis. You are going from deep to more superficial tissues
3.Now the technique becomes a bit challenging. You need to enter the skin on the opposite side at a depth similar to where you exited the skin on the first side, just below the epidermis. To do so, you should position the needle with the tip pointing down and pronate your wrist to get the correct angle. It will help to use the forceps (in the other hand) to hold up the skin. The needle should come out of the tissues below the dermis. Try to get as little fat in the stitch as possible; it does not contribute to the suture.
4.Tie the suture.
Figure-of-eight Sutures
Indication.This technique is useful for bringing together underlying tissues such as muscle, fascia, or extensor tendons. It is not commonly used for skin closure.
Technique
1.Usually a tapered needle and absorbable sutures are used.
2.Start on the side opposite from you. Go through the full thickness of tissues on that side, then finish the first half of the stitch by going from bottom to top on the opposite side. Advance just a little farther (1.0–1.5 cm) along the tissue. The needle should now be back on top of the tissue.
3.Now enter the first side (going from top to bottom) just across from the suture on the other side. Again go through the full thickness of the tissue and come out on the undersurface of the tissue.
4.Now enter the undersurface of the other side even with the first suture and come out on top.
5.The suture can now be easily tied.
Tying the Suture
The simplest way to tie the suture is by doing an “instrument tie".
Simple Sutures
1.Pull the suture through the skin so that just a short amount of suture material (a few centimeters) is left out.
2.Take the needle out of the needle holder.
3.Place your needle holder in the center between the skin edges parallel to the wound. One end of the suture should be on each side of the wound without crossing in the middle.
4.Wrap the suture that is attached to the needle once or twice around the needle holder in a clockwise direction.
5.Grab the short end of the suture with the needle holder.
6.Pull it through the loops, and have the knot lie flat. The short end of the stitch should now be on the opposite side.
7.Let go of the short end.
8.Bring the needle holder back to the center, parallel to the wound edges.
9.Repeat steps 4–8 at least one or two times more.
10.Cut the suture ends about 1 cm from the knot
Mattress Sutures
1.Pull the suture through the skin so that just a short amount of suture material (a few centimeters) is left out.
2.Take the needle out of the needle holder.
3.Both ends of the suture are on the same side. Place your needle holder between the ends of the suture.
4.Wrap the suture that is attached to the needle once or twice around the needle holder in a clockwise direction.
5.Grab the short end with the needle holder.
6.Pull it through the loops, and have the knot lie flat. The short end of the stitch should now be on the opposite side.
7.Let go of the short end.
8.Bring the needle holder back to the center, between the suture ends.
9.Repeat steps 4–8 at least one or two times more.
10.Cut the suture ends about 1 cm from the knot.
Continuous Suture
1.Do not pull the next to-the-last stitch all the way through; leave it as a loop.
2.Place your needle holder between the loop and the suture attached to the needle. The needle holder should be almost perpendicular to the wound.
3.Wrap the suture that is attached to the needle once or twice around the needle holder in a clockwise direction.
4.Grab the loop with the needle holder.
5.Pull it through, and have the knot lie flat. The short loop should now be on the opposite side.
6.Let go of the loop.
7.Bring the needle holder back to the center between the loop and the suture end.
8.Repeat steps 3–7 at least one or two times more.
9.Cut the suture ends about 1 cm from the knot.
Suture Removal
If the sutures are taken out within 7–10 days, suture removal is usually easy and should not cause more than a pinching sensation to the patient.
Simple Sutures-
1.Cut the suture where it is exposed, crossing the wound edges. 2.Remove the entire stitch by grabbing the knot with a clamp or forceps and pulling gently.
Mattress Sutures -
Removal of mattress sutures can be a little more difficult.
1. Grab the knot and try to lift it up a little; this should allow you to see a space between the suture strands
2.Cut one strand of the suture under the knot.
3.Remove the entire stitch by grabbing the knot with a clamp or forceps and pulling gently. This suture will be a little harder to remove than a simple suture.
4.If you accidentally cut both ends of the suture, you will leave suture material behind.
5.Look on the opposite side of the skin for the suture. Grab it with a clamp or forceps, and gently remove the remaining suture material.
Continuous Sutures-
1.Cut the suture in several places where it is exposed, crossing the wound edges.
2.Remove portions of the stitch by grabbing an end with a clamp or forceps and pulling gently.
3.The sutures to the knot must be cut in several places for removal.
by Lakdhes..
Breast Cancer
Posting after sometime..Sorry if there's lot of spelling mistakes..Most people feel shy to ask about this topic 'breast cancer'.I too feel hard to explain about it..So let me just write those things i remember..Things that i miss out here,I will complete it once I'm back to Bangladesh..Unfortunately I didn't bring my books along with me.
Cystic Swellings of Breast
Classification:
1.Inflammatory :Acute bacterial mastitis with abscess
2.Neoplastic:
a.Benign:Cystosarcoma phylloides
b.Malignant: Intracystic carcinoma of the breast
3.Non-neoplastic cyst:
a.Fibroadenosis.
b.Simple cysts of the breast
4.Retention cyst of the breast: Galactocoele
5.Other rare causes of cysts of the breast:
a.Tuberculous mastitis with cold abscess of breast.
b. Lymphatic cyst of the breast (congenital).
c. Hydatid cyst of the breast.
d. Haematoma of the breast.
BREAST ABSCESS
Entry of organisms --> Stage of cellulitis -->Stage of abscess
This is the pathogenesis of breast abscess..and remember that,benign tumor is less fatal than malignant tumor because benign tumor do not metastasis while malignant will metastasis to different location..Metastasis means spread of the cancer cell from one part to another..For example ,the origin of cancer will be at breast tissue but since its a malignant type,it can spread to liver,kidney,bone,lungs n etc..
1.Severe pain in the breast due to spreading inflammatory exudate.
3.Once breast abscess develops,there is high grade fever with chills and rigor and soft,cystic fluctuant swelling can be felt in the breast.In untreated cases,abscess may rupture through the skin resulting in necrosis of the skin of the breast,ulceration ,discharge.
Cystic Swellings of Breast
Classification:
1.Inflammatory :Acute bacterial mastitis with abscess
2.Neoplastic:
a.Benign:Cystosarcoma phylloides
b.Malignant: Intracystic carcinoma of the breast
3.Non-neoplastic cyst:
a.Fibroadenosis.
b.Simple cysts of the breast
4.Retention cyst of the breast: Galactocoele
5.Other rare causes of cysts of the breast:
a.Tuberculous mastitis with cold abscess of breast.
b. Lymphatic cyst of the breast (congenital).
c. Hydatid cyst of the breast.
d. Haematoma of the breast.
BREAST ABSCESS
Entry of organisms --> Stage of cellulitis -->Stage of abscess
This is the pathogenesis of breast abscess..and remember that,benign tumor is less fatal than malignant tumor because benign tumor do not metastasis while malignant will metastasis to different location..Metastasis means spread of the cancer cell from one part to another..For example ,the origin of cancer will be at breast tissue but since its a malignant type,it can spread to liver,kidney,bone,lungs n etc..
ACUTE BACTERIAL MASTITIS (Breast abscess--pyogenic mastitis)
Aetiopathogenesis
l. Most commonly encountered during lactational mastitis.
Precipitating factors are:
-crack /fissure in the nipple.
-Retracted nipple. Hense, cleaning of the breast is a problem
-oral cavity infection in the child.
2. It can be due to an infection of a haematoma.
-In both conditions the common organism is Staphylococus aureus which enters through the nipple, proliferates intraductally and produces clotting of the milk. Within the clot the organisms multiply
which results in a cellulitic stage or the breast (mastitis) and in untreated cases,it may give rise to a breast abscess. Initially only one lobule and duct get affected. later other lobules,giving rise to an intramammary abscess.
Clinical features:
1.Severe pain in the breast due to spreading inflammatory exudate.
2.Breast is swollen, tense, tender, warm to touch. These are the signs of cellulitic stage.
3.Once breast abscess develops,there is high grade fever with chills and rigor and soft,cystic fluctuant swelling can be felt in the breast.In untreated cases,abscess may rupture through the skin resulting in necrosis of the skin of the breast,ulceration ,discharge.
4.In deep seated abscess, it is difficult to elicit fluctuation and often fluctuation is a late sign.Hence,if throbbing pain,fever with chills and rigors are present, immediate drainage is mandatory.If not, significant amount of breast tissue will be destroyed.
Antibioma
-It means antibiotic induced. 'oma'= Tumour (swelling)
-it occurs in the breast .When there is an abscess, if antibiotic are given without draining the abscess,the abscess cavity may become fibrous and it results in firm to hard lump in the breast.It gives rise to vagus ill-health of the patient.
-Treatment. Excision of antibioma.
-Treatment. Excision of antibioma.
Carcinoma of the Breast:
Aetiological factors that causing breast cancer:
1.Genetic factors
Only 5–10% of breast cancers are thought to be linked to an inherited breast cancer gene. Our genes store the biological information we inherit from our parents. The genes most commonly linked to an increased risk of breast cancer in families are BRCA1 and BRCA2. Other genes have been identified, but they only slightly increase the risk. If you have one relative who was diagnosed with breast cancer at an older age, it’s not likely that the cancer is due to an inherited breast cancer gene.
A genetic mutation that increases the risk of breast cancer is only likely to be present in a family if:
-there are three close relatives on the same side of the family who developed breast cancer at any age
-there are two close relatives on the same side of the family who developed breast cancer under the age of 60
-there is one close relative who developed breast cancer under the age of 40
-there is a close male relative with breast cancer
-there is a close relative with breast cancer in both breasts
-there is a close relative with breast cancer and another relative on the same side of the family with ovarian cancer.
-Close relatives, sometimes called your first degree relatives, are parents, children, sisters and brothers.
2.Alcohol
Drinking more than two units of alcohol a day over many years can damage your liver. This increases your breast cancer risk because the liver helps to control oestrogen levels.
3.Your weight
After the menopause, body fat is the main source of oestrogen. So if you’re overweight, the level of oestrogen in your body may be high, increasing your breast cancer risk.
4.Smoking
Smoking heavily over many years, especially if you started smoking at a young age, increases your risk.
5.Age
The risk of breast cancer increases with age. It’s rare in women under 35, and 8 out of 10 breast cancers (80%) occur in women aged 50 or over.Breast cancer can also occurs to men.
6.History of Breast Cancer
Women who’ve had breast cancer or other breast conditions in the past may be at a higher risk of developing breast cancer. This includes women who have previously had:
-breast cancer, including ductal carcinoma in situ (DCIS)
-lobular carcinoma in situ (LCIS)
-an over-production of slightly abnormal cells called atypical ductal hyperplasia
-radiotherapy to the chest to treat Hodgkin lymphoma at a young age
-dense breast tissue (when the breast is mostly made up of glandular and connective tissue with very little fatty tissue).
7.Hormonal factors
Exposure to the hormones oestrogen and progesterone for long, uninterrupted periods can affect your breast cancer risk. Factors that increase this risk include:
-taking combined hormone replacement therapy (HRT) containing oestrogen and progesterone over several years (if you’re over 50)
-not having children or having them later in life
-not having breastfed or breastfeeding for less than a year
-starting your periods early (under 12) or having a late menopause (after 50)
-taking the contraceptive pill (but the risk reduces if you stop taking it).
Ways To Examine Your Breasts :
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* Use the finger pads of the three middle fingers on your left hand to feel for lumps in the right breast. Use overlapping dime-sized circular motions of the finger pads to feel the breast tissue.
* Use 3 different levels of pressure to feel all the breast tissue. Light pressure is needed to feel the tissue closest to the skin; medium pressure to feel a little deeper; and firm pressure to feel the tissue closest to the chest and ribs. A firm ridge in the lower curve of each breast is normal. If you’re not sure how hard to press, talk with your doctor or nurse. Use each pressure level to feel the breast tissue before moving on to the next spot
* Lie down and place your right arm behind your head. The exam is done while lying down, and not standing up. This is because when lying down the breast tissue spreads evenly over the chest wall and it is as thin as possible, making it much easier to feel all the breast tissue. In such a state any abnormality will be noticed easily.
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* Move around the breast in an up and down pattern starting at an imaginary line drawn straight down your side from the underarm and moving across the breast to the middle of the chest bone.(sternum or breastbone). Be sure to check the entire area. Breast area going down until you feel only ribs and up to the neck or collar bone (clavicle).
* There is some evidence to suggest that the up and down pattern (sometimes called the vertical pattern) is the most effective pattern for covering the entire breast without missing any breast tissue.
* Repeat the exam on your left breast, using the finger pads of the right hand.
* While standing in front of a mirror with your hands pressing firmly down on your hips, look at your breasts for any changes of size, shape, contour, dimpling, or redness or scaliness of the nipple or breast skin. (The pressing down on the hips position contracts the chest wall muscles and enhances any breast changes.)
* Examine each underarm and armpits while sitting up or standing and with your arm only slightly raised so you can easily feel in this area. Raising your arm fully straight up tightens the tissue in this area and makes it difficult to examine.
-and one more thing..Do those examination after your menses..If possible not a week before your date.You might confuse with the tenderness and swelling which is actually due to hormonal changes..
Let me explain the differences between the tests.
-Sometime,one of the early signs of breast cancer are certain types of microcalcifications. Microcalcifications are tiny deposits of calcium...and remember,swelling or sensation of lump in breast tissue doesn't mean that it's cancer.It might be due to infection,inflammation,cyst ,or any other cause other than cancer.In worst case even it is cancer,it might be benign ..So don't worry much.. .
Breast ultrasound is good at distinguishing between a fluid-filled cyst and a solid mass. Ultrasound cannot image the entire breast at once, so it's used for a diagnostic spot check of areas that a screening mammogram has already revealed.These can be seen fairly well on mammograms, but cannot be seen at all with ultrasound. If the only sign of breast cancer are these microcalcifications, an ultrasound will not see it.
Also, a mammogram provides a good image of the entire breast, where as an ultrasound of the breast is highly directed. It mean, ultrasound is very good if the patient can feel a lump.
Mammography is superior for less dense breasts (usual after the menopause) and is almost invariably performed. A combination of ultrasound and mammography can detect more invasive tumours.
Ultrasound is very effective (especially in younger women). It is particularly useful when breast tissue is dense. In young patients it can be diagnostically more useful than mammography.
MRI tends to be used in difficult cases such as dense breast tissue (especially in young women), cases of familial breast cancer associated with BRCA mutations, silicone gel implants, positive axillary lymph node status with occult primary tumour in the breast or where multiple tumour foci are suspected. A positive result on MRI alone should not result in operation.
Honestly ,you cannot possibly self-diagnose a breast cancer. Even doctors, including oncologist, can't confirm until the appropriate tests have been done.So if you suspect that you might have it,then without delay,go to the nearest hospital.
by Lakdhes ..
1.Genetic factors
Only 5–10% of breast cancers are thought to be linked to an inherited breast cancer gene. Our genes store the biological information we inherit from our parents. The genes most commonly linked to an increased risk of breast cancer in families are BRCA1 and BRCA2. Other genes have been identified, but they only slightly increase the risk. If you have one relative who was diagnosed with breast cancer at an older age, it’s not likely that the cancer is due to an inherited breast cancer gene.
A genetic mutation that increases the risk of breast cancer is only likely to be present in a family if:
-there are three close relatives on the same side of the family who developed breast cancer at any age
-there are two close relatives on the same side of the family who developed breast cancer under the age of 60
-there is one close relative who developed breast cancer under the age of 40
-there is a close male relative with breast cancer
-there is a close relative with breast cancer in both breasts
-there is a close relative with breast cancer and another relative on the same side of the family with ovarian cancer.
-Close relatives, sometimes called your first degree relatives, are parents, children, sisters and brothers.
2.Alcohol
Drinking more than two units of alcohol a day over many years can damage your liver. This increases your breast cancer risk because the liver helps to control oestrogen levels.
3.Your weight
After the menopause, body fat is the main source of oestrogen. So if you’re overweight, the level of oestrogen in your body may be high, increasing your breast cancer risk.
4.Smoking
Smoking heavily over many years, especially if you started smoking at a young age, increases your risk.
5.Age
The risk of breast cancer increases with age. It’s rare in women under 35, and 8 out of 10 breast cancers (80%) occur in women aged 50 or over.Breast cancer can also occurs to men.
6.History of Breast Cancer
Women who’ve had breast cancer or other breast conditions in the past may be at a higher risk of developing breast cancer. This includes women who have previously had:
-breast cancer, including ductal carcinoma in situ (DCIS)
-lobular carcinoma in situ (LCIS)
-an over-production of slightly abnormal cells called atypical ductal hyperplasia
-radiotherapy to the chest to treat Hodgkin lymphoma at a young age
-dense breast tissue (when the breast is mostly made up of glandular and connective tissue with very little fatty tissue).
7.Hormonal factors
Exposure to the hormones oestrogen and progesterone for long, uninterrupted periods can affect your breast cancer risk. Factors that increase this risk include:
-taking combined hormone replacement therapy (HRT) containing oestrogen and progesterone over several years (if you’re over 50)
-not having children or having them later in life
-not having breastfed or breastfeeding for less than a year
-starting your periods early (under 12) or having a late menopause (after 50)
-taking the contraceptive pill (but the risk reduces if you stop taking it).
Ways To Examine Your Breasts :
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* Use the finger pads of the three middle fingers on your left hand to feel for lumps in the right breast. Use overlapping dime-sized circular motions of the finger pads to feel the breast tissue.
* Use 3 different levels of pressure to feel all the breast tissue. Light pressure is needed to feel the tissue closest to the skin; medium pressure to feel a little deeper; and firm pressure to feel the tissue closest to the chest and ribs. A firm ridge in the lower curve of each breast is normal. If you’re not sure how hard to press, talk with your doctor or nurse. Use each pressure level to feel the breast tissue before moving on to the next spot
* Lie down and place your right arm behind your head. The exam is done while lying down, and not standing up. This is because when lying down the breast tissue spreads evenly over the chest wall and it is as thin as possible, making it much easier to feel all the breast tissue. In such a state any abnormality will be noticed easily.
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* Move around the breast in an up and down pattern starting at an imaginary line drawn straight down your side from the underarm and moving across the breast to the middle of the chest bone.(sternum or breastbone). Be sure to check the entire area. Breast area going down until you feel only ribs and up to the neck or collar bone (clavicle).
* There is some evidence to suggest that the up and down pattern (sometimes called the vertical pattern) is the most effective pattern for covering the entire breast without missing any breast tissue.
* Repeat the exam on your left breast, using the finger pads of the right hand.
* While standing in front of a mirror with your hands pressing firmly down on your hips, look at your breasts for any changes of size, shape, contour, dimpling, or redness or scaliness of the nipple or breast skin. (The pressing down on the hips position contracts the chest wall muscles and enhances any breast changes.)
* Examine each underarm and armpits while sitting up or standing and with your arm only slightly raised so you can easily feel in this area. Raising your arm fully straight up tightens the tissue in this area and makes it difficult to examine.
-and one more thing..Do those examination after your menses..If possible not a week before your date.You might confuse with the tenderness and swelling which is actually due to hormonal changes..
Let me explain the differences between the tests.
-Sometime,one of the early signs of breast cancer are certain types of microcalcifications. Microcalcifications are tiny deposits of calcium...and remember,swelling or sensation of lump in breast tissue doesn't mean that it's cancer.It might be due to infection,inflammation,cyst ,or any other cause other than cancer.In worst case even it is cancer,it might be benign ..So don't worry much.. .
Breast ultrasound is good at distinguishing between a fluid-filled cyst and a solid mass. Ultrasound cannot image the entire breast at once, so it's used for a diagnostic spot check of areas that a screening mammogram has already revealed.These can be seen fairly well on mammograms, but cannot be seen at all with ultrasound. If the only sign of breast cancer are these microcalcifications, an ultrasound will not see it.
Also, a mammogram provides a good image of the entire breast, where as an ultrasound of the breast is highly directed. It mean, ultrasound is very good if the patient can feel a lump.
Mammography is superior for less dense breasts (usual after the menopause) and is almost invariably performed. A combination of ultrasound and mammography can detect more invasive tumours.
Ultrasound is very effective (especially in younger women). It is particularly useful when breast tissue is dense. In young patients it can be diagnostically more useful than mammography.
MRI tends to be used in difficult cases such as dense breast tissue (especially in young women), cases of familial breast cancer associated with BRCA mutations, silicone gel implants, positive axillary lymph node status with occult primary tumour in the breast or where multiple tumour foci are suspected. A positive result on MRI alone should not result in operation.
Honestly ,you cannot possibly self-diagnose a breast cancer. Even doctors, including oncologist, can't confirm until the appropriate tests have been done.So if you suspect that you might have it,then without delay,go to the nearest hospital.
by Lakdhes ..
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If you're reading this,first of all congratz.Now let's get into business.What I'm going to share here is basically my mistakes...
