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Benign conditions of the breast are important because of the discomfort they produce and frequent confusion with neoplastic disease 1 mg finax with amex medicine 2016. Anatomy nd The protuberant part of the human breast is generally described as overlying the 2 th to 6 ribs purchase 1 mg finax with visa medications used to treat depression, It extends from the lateral border of the sternum to the anterior axillary line buy promethazine 25 mg mastercard, between th th clavicle and to the 7 and 8 ribs below. The nipple contains smooth muscle fibers arranged concentrically and longitudinally. These could be secondary to either benign disease conditions, or fatal carcinomas. Students should be familiar with some of differentiating mechanisms between malignant and benign breast lumps. Breast cysts This is a rare condition which may occur in the last decade of reproductive life due to a non- integrated involution of stroma and epithelium. If there is residual lump after aspiration, if fluid is blood stained, or if cyst recurs, local excision for histological diagnosis is advisable. Fibroadenoma Usually occurs during 15-25 years of age and arises from hyperplasia of a single lobule. Most fibroadenomas can be excised through periareolar incision with good cosmetic result. Phyllodes Tumor Are benign tumors Usually occur in women over 40 years but can appear in younger woman. Ductectasia/ periductal mastitis Definition: This is dilatation of the breast ducts associated with periductal inflammation. Pathogenesis: Dilatation of lactiferous ducts that will be subsequently filled with a stagnant brown or green secretion. The fluid sets up an irritant reaction in surrounding tissue leading to periductal mastitis, even abscess or fistula formation. When the diagnosis of carcinoma is in doubt There are cases where one cannot be sure whether the particular lump in the breast is area of mammary dysplasia, benign tumor or an early carcinoma. If there is doubt on clinical, cytological or radiological examination, it is essential to obtain a tissue diagnosis. Bacterial mastitis is the commonest variety of mastitis and nearly always commences acutely. It is associated with lactation in the majority of cases 136 Cause Most cases are caused by staphylococcus aureus. Clinical presentation o Pain o Swelling o Redness o Tenderness and hotness of the affected side. Complication: - breast abscess If acute infection of breast doesnt resolve with in 48 hours, or if after emptied of milk there is an area of tense induration, the inflammation has resulted in an abscess. Unlike majority of localized infections; fluctuation is a late sign so incision must not be delayed. Drainage of breast abscess Under general or local anesthesia, incision is sited in a radial direction over the affected segment.
- Vein of Galen aneurysmal dilatation (VGAD)
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The cervix fully dilated order finax us medicine journal, although she will usually reach full dilation however was fully dilated finax 1mg line medications for fibromyalgia. The round ligaments (21-18) stood out on either side of (2);The foetal head is damaged cheap 2.5 mg altace with visa, so that brain injury may the ballooned lower segment, like the guy ropes of a tent. At operation the uterus was (3);Pressure necrosis and sloughing of the vaginal wall found to have ruptured into the abdominal cavity. As this slough separates, a fistula develops anteriorly but was asphyxiated, and died within 1hr. Several things can then fistula can be repaired, she may be infertile, and the vagina happen: may be so stenosed that sexual intercourse is difficult. The head of the foetus, showing signs of foetal distress, was stuck to the scar of a previous lower-segment Caesarean high, and overlapped the brim of the pelvis. The vulva and cervix were oedematous, and although the foetal head could be felt just inside the cervix, this was not because it had descended, but because it was severely elongated. Lack of progress should which needs a combined vaginal and abdominal approach) is therefore alert you to the possibility that rupture might be absolutely contraindicated if the uterus has already imminent. Frequent strong uterine contractions, with little or no relief of neglected obstructed labour in the operating theatre, pause between them. Caesarean Section has a limited role in the management of obstructed labour, especially if neglected, and is likely to be After rupture, a woman may have little or no pain. It is mainly her, she will tell you that contractions were strong, but then indicated when the foetus is alive and the mother is in suddenly stopped, and were replaced by a lesser continuous reasonable condition. She may be alert and even talkative, heart beat is still present just before you start the incision! You feel no uterine part is fixed in the pelvis, and the uterus has not ruptured, contractions, but you can usually feel the foetus through the and is in no danger of doing so. In the bustle of treating her, do not forget to complications of the surgery, not the labour. If you do not, she may blame you for its death, and not come to hospital when she is pregnant next time. Suspect obstructed labour or neglected obstructed labour if If a woman with obstructed labour is admitted from you find: home, she may have been in labour for days, and tried many (1). Hypertonic uterine contractions, with poor relaxation in Vaginal delivery is often possible, but try to predict when it between. If you are prepared to perform vacuum extraction (9) Offensive discharge or fever.
Prepare the vulva with antiseptic as ask her to do the abdominal palpation and keep the foetus usual generic finax 1mg visa treatment impetigo, and the abdominal wall also safe 1mg finax medicine urology. Palpate the membranes because you do not want the cervix to close; abdomen with your left hand order famvir line. Search for a foot, which you the presenting part will come down after the stimulus of will recognize by its heel. If you find this difficult, work out which way round the If the presenting part comes down, this is a sign of foetus is lying, and then feel in the direction of the impending success. Use your other clinched by fundal pressure, a vacuum extraction or a hand if this seems easier. When you have found a foot, breech/delivery extraction but this is bound to be easy. Hold the ankle between your index and middle finger, with your thumb on the dorsum of the foot. Internal version is only for the 2nd twin with intact or if possible as far as the vulva. The buttocks and other leg recently ruptured membranes, during a delivery which you will follow. It is not suitable for a retained 2nd At the same time push the head upwards towards the twin. If you still do not know what is presenting, do not When the buttocks are out, deliver the shoulders by waste time waiting for the presenting part to come down. A contracted pelvis with a diagonal conjugate of <11cm, or a true conjugate <9cm (21. A major malpresentation of the leading twin, such as a transverse lie, locked twin or footling breech. Lack of progress in labour, not amenable to oxytocin after artificial rupture of membranes. A 2nd twin with a transverse lie which you cannot correct because the membranes have long been ruptured. The cervix will dilate again, as soon as the presenting part of the second twin comes down. Contraction of the cervix will not at first delay delivery of the 2nd twin, and is no reason for delaying rupture of the membranes. If there is heavy bleeding before delivery of the 2nd twin, the placenta of the 1st foetus has probably separated. If either twin is a breech presentation and the patient pushes well and the breech descends well, Fig. Occasionally, it is enough to pull down a leg into the vagina, and let the patient do the pushing (an assisted breech delivery); but do not rely on this, and be ready to assist her if she is uncooperative or exhausted. It is the commonest clotting defect, and is an (3);Lacerations of the genital tract: rupture of the uterus, important and mostly preventable cause of maternal death.