Gynecomastia

Gynecomastia

What is gynecomastia?

Gynecomastia means enlargement of breast tissue in male.This may occur during three distinct age period:

1)transiently at birth

2)again beginning with puberty and declining during the late teenage years

3)in adults over age 50years.

In the new born ,it is caused by stimulation from maternal hormones.A milky secretion(witch milk) maybe produced:;the condition disappears within  a few weeks.

During adolescence ,as many as 60% of boys may develop some degree of gynecomastia ,either unilateral  or bilateral and if bilateral,often with  varying degree of growth between the two sides.

It is consider a normal nonpathological condition and usually disappears within 18 month.Hormonal assays should be performed only if the condition appears before puberty ,persists longer than 2 years,or is associated with other signs of endocrine disorder.

In older men,the condition can be  caused by pituitary or testicular tumors,medication such as spironolactone or antiandrogens or cirrchosis of the liver causing enhanced activity (due to delayed liver catabolism) of naturally produced oestrogens.

Treatment:

Therapy depends on then cause.Because gynecomastia has a high rate of spontaneous regression ,medical therapies are most effective during active proliferative phase.To help alleviate the acute embarrassment from the condition adolescence boys may suffer,they should be reassured that the problem will go away.Tender breasts should be treated with analgesics.As a final stage, surgery should be done.

Some other causes:

-Taking certain drugs such as ranitidine,ketaconazole having gynecomastia as a side effect.

-Eating large amount of injected chicken,that means those chicken which given antibiotic to grow .

Bodybuilding and Gynecomastia

-Using androgenic substance such as steroids for bodybuilding.Steroid such as sustanon,deca durabolin have high testosterone level which will convert into estrogen ..Normal testosterone level is about 22.5micromml .If its exceed more than 50 -70micromml,there’s high chance for it to convert into estrogen.To over come it, bodybuilders should take antiestrogenic drugs such as nolvadex or tamoxifien during the period of steroid usage.During the post cycle, clomifine is highly recommended to bring back the normal testosterone  level. Increase estrogen level will elevate the risk of gynecomastia.

During the usage of steroid, a mild tender will be felt at chest area,around nipple.A small lump can be feel in the nipple.At this stage,all types of steroid should be stopped and antiestogens should be consume However,gynecomastia by steroid is irreversible .So be careful before you take any type of steroids.

Focus

How to manage our self...

Hie friends..Most of us think our lives accumulate.We think they are adding up to something.We think of our lives as being strung together like a long smoky train,so that we can add new freight cars when we're feeling right, and dump the others on a siding somewhere when we're not.Even me think that way..But somehow i realized that Life is now.Life is not later on.The more we hypnotize ourselves into thinking we have all the time in the world to do what we want to do,the more we sleepwalk past life's finest opportunities. Its all flows from the importance we attach to today.

Most of us ,however ,don't want it to be this way.-'Today I was at my best'.

If someone asked us if today can be used as a model to judge our entire life by,we would shriek, 'No Way!!It isn't one of my better days.Give me a year or two and I'll live a day,I'm certain of it, that you can use to represent my life."

How to change your attitude...

If you want to change yourself,its in your willingness to do very tiny things-but to do them today.You were born when you woke up,and you will die when you go to sleep.Its was designed this way,so that you could live your whole life in a day.Today is a microcosm of your entire life.It is your whole life in miniature.

Over the years I've used Arnold's idea of creating as a vision as a self motivational tool.'Create a vision of who you want to be,and then live into that picture as if it were already true.' If i didn't apply it,for sure I  can't go through each my days here.Life here was really bad.

The more you sweat in peacetime,the less you bleed in war.  J

Most of the time I never really focus.I constantly feel a kind of irritating psychic chaos because I keep trying to think of too many things at once.Life as a medical student seems to be that way.Not only medicine,a student life always will be this way right?..There's always too much up there on the screen of our mind.

When we laid a two-by four across a floor ,everybody there would walk across it and not fall,because our focus would be that we were going to walk that two-by four.

BUT…

 If we put that same two-by four 20 stories high between two building,only a few would make it because the focus would be on falling.

Focus is everything.

Maybe most of us tend to lose our focus in life,studies,relationship etc because we're perpetually worried about so many negative possibilities.To be honest ,I always do it.Rather than focusing on the two-by four,we worry about all the ramification of falling.Rather than focusing on our goal,our aims,we are distracted by our worries and fears.

But if we really focus on what we want,it will come into our life one day...Take Care friends...

By Lakdhes.

The Identifying Points For Histological Slides.

The Identifying Points For Histological Slides.

Identification of Histology Slide

What you think about anatomy?
	boring
	interesting
	no idea
	cool
	worst subject
	my favourite
	i wish it could be easier
by Lakdhes

1.Loose Connective Tissue

-bundle of collagen and elastic fibre present

-connective tissue cells are present.

-ground substance and different connective tissue cells are scattered in the fibres or in the masses.

2.Hyaline Cartilage

-homogeneous matrix (glass like)

-cells(chondrocytes)lie in lacunae forming groups or colony

-dense fibrous connective tissue covering(perichondrium) present.

3.Elastic Cartilage

-elastic fibres are abundant.

-elastic firbres form branching and anastomosing  network

-cells are scattered within fibres

4.FibroCartilage

-coarse ,long ,parallel ,wavy bundle of collagen fibres present

-cells lie in row between collagen fibre bundles

5.Compact Bone

-presence of Haversian canal containing neuro-vascular bundle.

-concentric bony lamellae surrounding central canal present

-lacunae (containing osteocytes )and canaliculi present.

6.Spinal Cord

-inner ‘H’ shaped gray matter,outer white matter.

-Central canal present,lined by simple ciliated columnar epithelium(ependyma).

-anterior median fissure and posterior median sulcus or septa present

7.Cerebellum

-outer gray matter ,inner white matter present

-cortex have three layers

-Purkinje cells in the middle layer of cortex

8.Cerebrum

-composed of six layers of nerve cells

-pyramidal cells  maybe seen in 3^rd and 5^th layers

-outer gray matter,and inner white matter present

9.Skeletal Muscle

-prominent transverse cross striation present

-multiple nuclei located peripherally

-muscle fibres are cylindrical shaped

10.Smooth Muscle

-cross striation absent

-nucleus is single and centrally placed

-spindle shaped muscle cell

11.Cardiac Muscle

-fibres branch and anastomose with one another.

-intercalated disc present

-single ,oval,centrally place nucleus

-cross striation (faint)present

Artery

12.Large (Elastic )Artery

-a series (40-60) of concentrically arranged elastic fibres are present in tunica media

-tunica intima is thicker but adventitia is relatively thin

-external and internal elastic lamina are not prominent

13.Medium Sized (Muscular)Artery

-a series of (up to 40) circularly arranged smooth muscle cell present in tunica media.

-internal elastic lamina is very prominent and thrown into wavy folds.

-tunica intima is not thick

14.Vein

-large ,irregular luman present but wall is thinner

-tunica adventitia is the thickest coat

-tunica media is thin

-elastic lamina is indistinct or absent

15.Lymph Node

-thin capsule and thin trabeculae are present

-subcapsular  lymph sinus present

-presence of outer cortex and inner medulla

-cortex shows closely packed lymph nodules ,some having germinal centres.

16.Spleen

-thick capsule and trbeculae present

-not differentiated into cortex and medulla

-red pulp and white pulp present

-white pulp (malpighian body )has eccentric arteriole

17.Thymus

-composed of lobules separated by interlobular connective tissue

-lobule has outer cortex and inner medulla

-medulla contain Hassall’s corpuscles

-cortex is dense but without any lymphatic nodules

18.Tonsil(palatine)

-presence of tonsillar crypts

-crypts are lined by non keratinized stratified squamous epithelium

-deep to crypts lie a number of lymph nodules (with germinal centres)

19.Tongue

-papillae present

-lined by non keratinized stratified squamous epithelium

-skeletal muscle in various direction(u can name the intrinsic and extrinsic muscles if you want)

20.Oesophagus

-lined by non keratinized stratified squamous epithelium.

-oesophageal gland present in submucosa.

-muscularis mucosa is thock (differentiation from vagina)

-subepithelial papillae are present.

21.Stomach

-lined by simple  columnar epithelium

-gastric pit present and gastric gland open at its bottom.

-muscular layer-outer longitudinal ,middle circular and inner oblique

-mucosal fold(rugae) present

22.Duodenum

-brunner’s  gland present in submucosa.

-leaf like villi present.

-lining epithelium is simple columnar with striated border.

-muscle coat-outer longitudinal ,inner circular.

23.Small Intestine (except duodenum)

-villi is present and lined by simple columnar epithelium

-lymphatic nodule present in submucosa.

-muscle coat-outere longitudinal ,inner circular.

24.Large Intestine

-numerous goblet cells present in submucosa.

-lining epithelium is simple columnar.

-lymphatic nodules present in lamina propria.

25.Vermiform Appendix

-a complete ring of lymphatic nodule in lamina propria disrupting muscularis mucosa extends up to submucosa.

-lining epithelium is simple columnar.

-muscle coat-outer longitudinal ,inner circular.

26.Parotid Gland

-only serous alveoli present

-composed of lobule separated by interlobular connective tissue.

-Ducts are profuse and prominent

-groups of adipose tissue are present.

27.Submandibular Gland

-both serous and mucous alveoli with serous demilune.

-excretory duct present.

-scattered adipose tissue present.

28.Sublingual Gland

-mucous alveoli abundant ,few serous alveoli present.

-interlobular connective tissue prominent .

-excretory duct present.

29.Pancreas

-pancreatic acini present

-Islets of Langerhans present between the acini.

-centroacinar cells present in acini.

-composed of lobule separated by interlobular connective tissue.

-only serous alveoli present.

30.Liver

-central vein in hexagonal hepatic lobules.

-hepatocytes are radially  arranged from central vein towards the periphery.

-portal triad lies between the lobule containing a branch of hepatic artery,portal vein and bile ductule.

31.Gallbladder

-mucosa projects into fold which look like villi.

-lined by simple columnar epithelium .

-present three coats:outer adventitia,middle fibromuscular,and inner mucosa.

32.Epiglottis

-consists of central core of elastic cartilage

-covered with non-keratinized  stratified squamous epithelium on upper surface ,pseudo-stratified ciliated columnar on lower surface.

33.Trachea

-lining epithelium is pseudo-stratified ciliated columnar with goblet cells.

-trachealis (smooth) muscle present.

-‘c’ shaped ring of hyaline cartilage present.

-outer fibrous coat present.

34.Lung

-alveoli is lined by simple squamous epithelium

-intra-alveolar septa is thin containing capillary plexus.

-bronchus contains pieces of hyaline cartilage.

-different orders of bronchial tree scattered in alveoli (having thin walls broken at many places)

35.Skin

-lined by keratinized stratified squamous epithelium .

-composed of outer epidermis and inner dermis.

-presence of hair follicle,sweat and sebaceous gland in dermis.

36.Kidney

-composed of outer cortex  and inner medulla.

-cortex contains renal corpuscles ,proximal and distal convoluted tubule.

-medullary ray present

37.Ureter

-lined by transitional epithelium

-wall has adventitia,muscular and mucous coat

-adventitia is composed of fibro adipose tissue.

-star shaped lumen.

38.Urinary Bladder

--lined by transitional epithelium

-muscle coat is thick and crisscross

-submucosa absent.

-lumen is irregular.

39.Pituitary Gland

-pars distalis is very cellular and contain three types of cells –chromophobes,acidophils,basophils.

-pars  intermedia forms thin sheet of blue staining cells

-pars nervosa- presence of many nerve fibres.

40.Thyroid Gland

-composed of lobule separated by interlobular connective tissue.

-lobule contains large number of follicles

-follicle lined by simple cuboidal epithelium containing colloid particle.

41.Adrenal Gland

composed of outer cortex and inner medulla.

-Cortex has:

a)Outer zona glomerulosa(rounded groups of cells)

b)middle zona fasciculate (cells in longitudinal column)

c)inner zona reticularis(cells in anastomosing cord)

-Medulla contain basophilic cells around the sinusoid .

42.Testis

-seminiferous tubule present separated by connective tissue.

-between the tubules interstitial cell of Leydig present.

-tubules lined spermatogenic cells.

-sperms may be seen in the lumen.

43.Epididymis  

-lined  by pseudo-stratified columnar with stereocilia.

-clumps of sperm in lumen

-lumen is large

44.Vas Deferens

-thick middle vascular coat

-lined by simple columnar epithelium

-muscle coat-outer and inner longitudinal ,middle circular.

-very thick wall with small lumen

45.Seminal Vesicle

-mucous coat shows profuse branching and anastomosis giving it a honeycombed appearance.

-linning epithelium is pseudo-stratified columnar.

-outer fibrous and middle muscular coat.

46.Prostate

-fibromusculogland organ

-follicle with wide lumen ,some showing in folding .

-follicle lined by pseudo-stratified columnar epithelium.

47.Ovary

-lined by simple cuboidal epithelium

-composed of outer cortex and inner medulla

-cortex contain follicles of different stages.

-cortex also contain corpus luteum.

48.Uterine Tube

-numerous mucosal fold present ,which almost fill the lumen of the tube.

-mucosa lined by simple columnar epithelium ,partly ciliated and partly secretory .

-muscle coat composed of outer longitudinal and inner circular.

-serous is lined by mesothelium

49.Uterus

-very thick muscular coat.

-mucosa is lined by simple columnar epithelium

-uterine glands are present in lamina propria.

Uterine Gland

They give a saw –toothed appearance in longitudinal section.

-straight in follicular phase

-tortuous in luteal phase

50.Vagina

-lined by non-keratinized stratified squamous epithelium.

-lymphatic nodule present in lamina propria.

-muscularis mucosa absent (differs from oesophagus )

-mucosa has transverse fold.

51.Mammary Gland

-composed of lobule of glandular tissue and varying amount of fat.

-lobule are packed with alveoli and lined by simple cuboidal epithelium .

-duct present.

[Difference between resting and active(lactating) period:During resting period –abundant fibrous tissue,few acini are seen ,but in active stage-fibrous tissue are minimal ,acini abundant.]

52.Umbilical  Cord

-two umbilical artery and one umbilical vein present.

-wharton’s jelly present..

By Lakdheswaran