SURGERY FOR BREAST DISEASES: BIOPSY, ADAIR’S OPERATION AND MICRODOCHECTOMY
Biopsy of the breast
Some years ago surgeons were taught that if a woman had a lump in her breast, the diagnosis should always be confirmed by excision of the lump and examination of it under a microscope. This procedure has now been almost entirely replaced by the use of fine needle aspiration biopsies or of a wider Tru-Cut needle to remove a core of breast tissue when a more substantive biopsy is required.
Although some women would prefer to have a local anesthetic for an open breast biopsy, this is not usually possible. It is surprisingly difficult, once a small incision has been made in the breast following a local anesthetic injection, for the surgeon to locate a breast lump, and this is more easily done if the patient has had a general anesthetic. Not only is it disconcerting for a surgeon not to be able to find a breast lump which has been hidden by the injection of the local anesthetic, but the surgeon’s concern about the difficulties might also be transferred to the patient.
Adair’s operation
Also known as Hadfield’s operation, this is performed for duct ectasia.
A general anesthetic is used, and a peri-areolar incision is made around the upper or lower half of the nipple. A piece of tissue containing the central breast ducts is then removed. The excised tissue is about the same size as a 50p piece; it is always sent to the pathology laboratory to be looked at under the microscope.
The skin is then closed with a cosmetic subcuticular stitch, i.e. a stitch beneath the surface of the skin. The suture is made using either a non-absorbable material such as Prolene, which is rather like Nylon and must be taken out after 7 to 8 days, or an absorbable material which does not need to be removed. There is a tendency for wounds to leak more if closed with the absorbable material, although there is no associated increased risk of infection.
The most common problem after an Adair’s operation is bruising. There may also be a 10 to 15 per cent risk of recurrence of the previous disease.
Microdochectomy
Occasionally, a small warty growth or a very early cancer can appear in the ducts just underneath the nipple and cause a bloody nipple discharge. If the offending duct can be identified, it is possible to use X-ray mammography to locate the growth. A small cannula is placed into the duct and dye is then injected through it, so that the small warty lesion or papilloma within the duct becomes clearly visible.
The operation to remove the duct is known as microdochectomy, and involves the use of a general anesthetic. A probe is put into the affected duct and then removed through a radial incision made from the tip of the nipple. The probe takes with it the duct containing the lesion and the skin is then closed as described above.
If the warty lesion turns out to be entirely benign, which is usually the case, the operation is complete. If, as happens rarely, an intraductal cancer which is showing some sign of invasion is found, the operation may need to be followed up by more radical surgery.
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IUDS, ÒÀ M P Î N S AND EXERCISE AS POSSIBLE FACTORS INCREASING RISK OF ENDOMETRIOSIS
IUDs
It has often been assumed that use of an IUD (intrauterine device) would be associated with an increased risk of developing endometriosis because IUDs increase the menstrual blood flow by 50% to 100%. This presumes that the amount of retrograde menstruation is also greater. The studies so far have produced no clear evidence of the role of IUDs in the development of endometriosis.
Òà m p î n s
Opinions differ widely as to whether or not the use of tampons affects a woman’s likelihood of developing endometriosis. Some believe that tampons act as a barrier to the vaginal menstrual flow which thereby promotes retrograde menstruation. Others believe that tampons act as a wick which promotes the vaginal menstrual flow and thereby reduces the amount of retrograde menstruation. There is also the belief that tampons have no effect on the vaginal menstrual flow.
The only two studies published to-date have found no evidence to suggest that the use of tampons leads to an increased risk of developing endometriosis.
Exercise
One study has found that women who exercised regularly were less likely to develop endometriosis. This effect was limited to women who had begun regular exercise before the age of 26 and who exercised for more than two hours per week; the effect was most marked in women who engaged in vigorous exercise such as jogging or aerobics.
It is thought that this protective effect is due to the fact that regular vigorous exercise usually lowers the oestrogen levels in the body which in turn reduces the amount of oestrogen available for the growth of the endometrial implants.
Association with other diseases
For many years there has been some speculation by doctors that women with endometriosis have a higher incidence of other chronic health problems, particularly allergic conditions, such as hay fever and eczema, and auto-immune diseases, such as rheumatoid arthritis and systemic lupus erythematosus (SLE).
Unfortunately, only a couple of small studies investigating this topic have been published to-date: they found that women with endometriosis had a higher incidence of yeast infections and allergic conditions, particularly food sensitivities and hay fever, but were unable to show an association of endometriosis with any auto-immune diseases – probably due to the limited number of women involved.
Interestingly, these studies also found that more women with endometriosis reported that they had suffered from glandular fever.
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PREVENTIVE MEDECINE: THE PHYSICAL EFFECTS OF STRESS
These are many and profound. When an individual, whether with justification or not, finds a situation stressful, his or her body undergoes a ‘fight or flight’ reaction. This is a primitive response seen in all animals but most animals don’t meet life-or-death situations that trigger off this response very often. The problem with human beings is that their way of life has set them up to perceive many things as stressful and they react biologically to stimuli that do not affect the animal world generally. This occurs partly, of course, because humans are so complex emotionally and psychologically. The body’s reactions to stress are:
• The hypothalamus (a part of the brain) initiates a number of hormonal changes.
• The pituitary gland is activated by the hypothalamus and in turn activates the adrenal glands
to produce more adrenaline and non-adrenaline. These powerful hormones do many things
but the main ones are:
• The heart beats more powerfully and faster
• The pupils of the eyes dilate
• The blood pressure rises
• The muscles tense
• The breathing rate increases
• Blood is directed from the digestive system and the skin to other more vital functions
• Blood flow to the kidneys is reduced so as to reduce urine output
• Saliva dries up
• The liver releases stored glucose for energy
• The immune system (which fights infection) shuts down temporarily
In the average stressful situation these changes are temporary and normality resumes after the stress-inducing situation is past. However, for many of us in the West today many or all of these changes become an almost permanent feature of the way our bodies work, as one stressful event follows another. This produces symptoms such as:
Headaches
Dizziness
Sweating
Coiled legs
Hair twisting
Finger drumming
Clenched fists
Nail biting
High blood pressure
Allergies
Ulcers
Skin rashes
Depression
Unreasonable fears
Breathlessness
Little interest in life
Poor appetite
Nervous tics and twitches
A fear of becoming ill
Poor self-esteem
Difficulty in relaxing
Difficulty with concentration
Hunched shoulders
A worried frown
A gripped thumb
Clenched teeth
Insomnia
Blurred vision
Swallowing difficulties
Sex problems
Heartbeat irregularities
Indigestion
Backache
Colitis
Irritability
Disturbed sleep
Fatigue and tiredness much of the time
A tendency to cry
Aching shoulders and neck muscles
Food cravings between meals
Smoking or drinking to calm yourself
Feeling neglected or let down
Feeling a failure towards others
Rarely laughing
Feeling uncomfortable touching or being touched
None of these conditions is a ‘disease’ in itself but a combination of several reduces the quality of life and many of them together can reduce a person almost to the point where he or she is unable to cope with everyday life. Many of these conditions will be dealt with more fully in the body of the book and even though there are other reasons for many, if not most, of them stress is probably the commonest.
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FEED YOUR BODY RIGHT: HE HIT THE ROAD TO WEIGHT LOSS SUCCESS
Rob Christie credits a cooler with helping him lose 60 pounds.
A fortysomething entrepreneur from Shreveport, Louisiana, Rob had been thin for most of his life. That changed when he decided to start his own business. Soon, he was practically living in his car, hustling from one sales call to the next. When he grabbed a bite to eat, it was usually at the nearest fast-food restaurant.
Five years and hundreds of cheeseburgers later, Rob was severely overweight and out of shape. His low point came the day he found himself lying in bed, unable to move because of intense back pain. “I knew my lifestyle and the extra weight were contributing to the problem,” he said. “Right then, I committed to getting my health back.”
His first step was to make an appointment with a personal trainer. With the trainer’s guidance, Rob began a regular fitness program consisting of two 30-minute strength-training sessions each week. That prompted him to overhaul his eating habits.
That’s when he bought a cooler.
Before hitting the road, he enjoyed a low-fat breakfast of oat-I meal and fruit at home. At dinnertime, he ate a balanced meal con-I sisting of lean meat, plenty of vegetables, and a modest serving of pasta or another starch. All the while, he was continuing his twice-weekly workouts.
In just 6 months, Rob dropped 60 pounds. One year later, he’s a fit and muscular 205. “Losing that weight and getting in shape has increased my energy level tremendously,” Rob says. “I feel 25 instead of 45!”
WINNING ACTION
Stock up for road trips. Rob’s strategy really works. Whenever I’m traveling for business or pleasure (at least 100 days a year!), I always make sure to put something healthy—a V8, a Clif Bar, a banana, or pretzels—in my briefcase or travel bag. I feel better knowing that I can eat nutritious low-fat foods, and I get there more relaxed because I don’t have to wait in long food lines.
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