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Tuesday, September 30, 2008
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Depression-Menopause



Description

Feeling down or depressed once in awhile is normal for most people. However, if these feelings become very intense and persist for a very long period of time, and obstruct normal daily activities, clinical depression has set in and must be treated.

Depression is not a temporary setback in emotions or a result of emotional weakness. It is a real mental illness that cannot be overcome by sheer will. It brings many difficulties occupationally, socially, and physically. Unlike sadness or sorrow, depression does not resolve with a change in circumstance (good news, for instance), and unlike the gradual recovery from mourning a loved one's death, it does not get better.

If depression is not treated, it can persist for several years, hampering relationships, reducing productivity at work, undermining confidence and self-esteem, and, ultimately, even leading to suicide. A depression sufferer is not able to solve his/her problem on his/her own. It is a mental illness that requires professional treatment. With proper treatment, depression is relatively easy to treat and has a success rate as high as 80%.



Dynamics

Depression is a common disorder occurring in 15% of men and 25% of women during their lifetimes. Presumably, women have a higher tendency to suffer depression than men because of the extra societal pressures put upon them and the hormonal roller coaster they go through during pregnancy and delivery. Generally, the first episode of depression happens in the mid-twenties, and then again during menopause for women, and after retirement in men. Although depression is a relatively easy disease to treat, without prompt and proper care, it can become chronic or recurrent.


Types

Depression, just like other diseases, can appear in many different forms. It is divided into three major groupings: major depression, dysthymia, and manic-depressive. In all three types of depression, the number, severity, and duration of the symptoms will vary depending on the individual.

Major Depression
The most serious of the three types, major depression, affects the body physically, emotionally, mentally, and behaviorally. Thus, work performance suffers and even daily activities, such as sleeping and eating, can be affected.

Dysthymia
Dysthymia is a relatively mild form of depression in which unhappiness lingers for a long period of time bringing sub-par performance in daily activities. Sometimes, patients with dysthymia also exhibit symptoms of major depression.

Manic-depressive
Manic-depressive depression does not occur as frequently as the other forms of depression. Here, the patient is seen to alternate from a state of depression and mania, forming a periodic cycle. Mania can be described as a condition of being restless, occupied in thought, and unnecessarily busy in behavior. In contrast, depression is a submergence of feeling, a settling of thought and behavior, which together with its antithesis, mania, comprise manic-depressive. The depressive cycle of manic-depressive depression often appears in the form of major depression, as discussed above.


Causes

There are many different causes of depression.

Physiological
Physiologically, neurotransmitters, the substance that links nerve cells to other nerve cells, may be the source of the problem. It is believed that the brain's activity, namely our thoughts and emotions, arise out of the change in the properties of these neurotransmitters. In the case of depression, it is believed that a decline in the activities of the neurotransmitters, norepinephrine and serotonin, are involved in the disorder.

Heredity
Heredity can play a factor in depression. If a close relative (parents, siblings, or children) suffers from depression, the chances of falling into major depression are 2-3 times greater. Although heredity is an influential factor in causing depression, it does not necessitate it.

Environmental, Psychological, and Societal
There are environmental, psychological, and societal factors that can also drive a person into depression. A person with low self-esteem, a strong superego, weak social interaction, and a very dependent personality will be more susceptible to these external pressures, whether it may be due to divorce, failure, or family discord.


Symptoms

The most notable symptoms of depression are gloominess, loss of interest and pleasures, fatigue, and loss of vigor. In addition, there are other symptoms, such as loss of concentration and attentiveness, loss of self-respect and self-confidence, guilt, lack of self-worth, hopelessness, thoughts of suicide, insomnia, and a loss of appetite. Sometimes, these symptoms may occur due to the accumulation of unexpressed anger, emotions, or personal preferences bottled up by peer-pressure, societal rules and customs, resulting in a redirected expression of these emotions in the form of various psychosomatic symptoms, such as loss of appetite and sexual desire, insomnia, etc. For teenagers, anger or other misgivings may be expressed with truancy, by smoking, drinking, getting into fights, or leaving home. Menopausal women may exhibit symptoms of "being on pins and needles" and become anxious and irritable.


Treatment

The treatment of depression can be divided as follows: medication, psychotherapy, and electroconvulsive therapy. Some people are cured by psychotherapy or taking medications. Most people, however, choose to take advantage of both, benefiting from the fast acting power of medications and the know-how of coping with daily problems acquired from psychotherapy. The important point here is that most people can be treated for depression with proper attention. In rare cases, electroconvulsive therapy is used to treat extreme depression.

Medication: Antidepressants
Traditionally, depression has been treated through the use of three types of antidepressants, namely tricyclic antidepressants (TCAs), monoamine oxidase inhibitors (MAO inhibitors), and selective serotonin reuptake inhibitors (SSRIs). TCAs are encumbered by side effects such as dry mouth, constipation, drowsiness, and a decrease in sexual performance. MAO inhibitors have the inconvenience of having to avoid certain foods, such as cheese and wine. Recent additions to the antidepressant lineup do not have such side effects. These include the new class of antidepressants called SSRIs. Since antidepressants take 2 to 6 weeks to take effect, it is important that drug use be maintained for a reasonable amount of time before deciding to quit. If any difficulties arise, consult the prescribing doctor immediately. Alcohol and other medications can interfere with the potency of antidepressants and must be avoided.

Psychotherapy
Psychotherapy aids patients by identifying and resolving their problems through consultations with a psychiatrist, and helps patients get a better understanding of their mental illness. Behavioral therapy involves directing individuals to gain satisfaction and initiative by their own actions, and helping them to understand ways to avoid behaviors that may lead to depression. It also teaches them to adjust to their environment, becoming a master of their environment rather than a slave to it. Personal relations therapy and human-behavioral therapy are also helpful. Personal relations therapy rectifies the wrongs of personal behavior that contribute to depression, and human-behavioral therapy eliminates the patient's negative behavior and frame of mind that is associated with depression. Retrogressive psychotherapy focuses on the psychological problems of childhood as the center stage for resolving conflicts in the patient's current mental state.

Electroconvulsive Therapy
Electroconvulsive therapy is useful in treating very severe depression accompanied by suicidal tendencies, as well as those patients incapable of taking antidepressants. It is very effective in treating patients who have not completely recovered after using antidepressants.

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Late Childbearing



Description

Late marriages occur more frequently, and, consequently, the number of women having babies later is increasing. The World Health Organization defines late childbearing as giving birth at age 35 or older. Late childbearing is associated with increased risk of miscarriage, premature birth, Down syndrome, and low birth-weight infant.



Gestosis and hypertensive diseases

According to most reports, late child-bearers are 2-4 times more likely to have high blood pressure than young pregnant women.


Diabetes and gestational diabetes

The incidence rate for tumors, alcoholism, and non-insulin-dependent diabetes, or type 2 diabetes, increases with age, as do disorders of the cardiovascular system, nervous system, kidney, connective tissue, and lungs. If thrombus, pulmonary edema, or chronic high blood pressure, exists the risk of heart failure also increases.


Cesarean sections

The frequency of cesarean sections for premature separation of the placenta and placenta previa increases in pregnant women 35 and older. Plus, an increase in hypertensive diseases, diabetes, and premature labor in this age bracket necessitates more cesarean sections.


Maternal mortality rate

The maternal mortality rate is 4 times higher for women between 35 and 39 than it is for women 20-24. This difference is more striking for minorities.
# In the late-pregnancy age group, the early miscarriage rate, attributable to natural miscarriage or chromosome abnormalities, increases. Also the perinatal morbidity rate and mortality rate for preterm delivery, fetal growth delay, and fetal death within the uterus increase.


Miscarriage

Most investigations report that the risk of natural abortion increases with late childbearing. Pregnant women in their 40s have a natural miscarriage rate 2-4 times higher than that of pregnant women in their 20s.


Premature birth and fetal growth delay

There is a higher incidence in low birth-weight infants among late child-bearers because there is an increase in early delivery and fetal growth delay. The perinatal mortality rate increases for the same reason. Older pregnant women have an increased risk of giving birth to a large baby due to the prevalence of diabetes in this age group.


Congenital deformation

Down syndrome is the congenital deformation that is closely related to the women's age. It occurs most frequently in babies born to late child-bearers over 40. This is because the delay in fertilization causes the eggs to mature too much and non-disjunction takes place. With the exception of Down syndrome, there is no clear relationship between the age of pregnant women and rate of other chromosome abnormalities.


Age of pregnant woman

Frequency of occurrence of Down syndrome
< 25 years old 1/2,000
25 - 34 1/2,300
35 - 44 1/250
> 45 1/80
All ages 1/800



Benefits of late childbearing

Older pregnant women are mentally relaxed because they look forward to giving birth. Most have been married for a long time and are financially stable.


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Definition of Menopause



Description

Menopause, or climacterium, marks the completion of a woman's childbearing years and the cessation of menses (menstrual cycles), as the ovaries slow down and, eventually, stop functioning. Women typically reach this phase in their lives between ages 45 and 55. As a result of hormonal changes due to this process, women undergoing menopause may experience feelings of irritability, as well as "hot flashes" on the neck, chest, face and arms. There are other less obvious physiological indications that indicate that menopause has begun.



Causes

As a woman enters menopause, the number of eggs in the ovaries decrease, which lowers ovary function and leads to a dramatic reduction in estrogen secretion. At the same time, the pituitary gland increases the secretion of a follicle-stimulating hormone (FSH), which makes the eggs grow faster and the periods shorter. Sometimes ovulation does not occur.


Symptoms

In the years preceding menopause, the menstrual cycle is shortened by an increase in FSH, ovulation becomes irregular, and there is less estrogen in the blood. The decrease in estrogen causes various climacterium symptoms such as hot flashes, depression, dryness of the vagina, and a decline in sexual function.

Hot flashes
Hot flashes are the most common early symptom when blood levels of estrogen decrease. When less estrogen is secreted, the capillaries expand irregularly, causing hot sensations in the face, neck, and chest. It becomes hard to sleep because of night sweats caused by hot flashes. In severe cases, these symptoms occur 40 times a day. Approximately 67% of women experience these symptoms for a year, and 25% of women experience them for more than 5 years. Impatience, irritation, anxiety, and worry may also occur in conjunction with hot flashes.

Urinary system changes
The decrease in estrogen also affects skin and epithelial cells. With less estrogen being secreted, epithelial cells in the vagina and urinary system become thin and dry, losing elasticity. This causes the muscles in the perineum, urethra and bladder neck to weaken. As a result, many women find it hard to control urine, and lose a little when they cough, sneeze, laugh or exercise. Menopausal women may also have an urgent need to urinate even when the bladder is not full.

The uterus and vagina become atrophic with lack of estrogen during menopause, so sometimes there is a sagging or slacking sensation when lifting heavy objects.



If dryness of the vagina, or colpoxerosis, is severe, it can cause pain and small tears during intercourse. A drier, menopausal vagina is also more susceptible to yeast infections.

Emotional changes and sexual function
Many women in menopause complain about anxiety, depression, sensitivity, fatigue, forgetfulness, and insomnia. These symptoms are partially caused by decreases in estrogen, luteinizing hormone, and male hormone. A lack of female and male hormones decreases sexual desire (libido) and causes the painful intercourse (from dryness) that some women experience during menopause. These symptoms can be improved with hormone replacement therapy.

Skin changes
After menopause, skin loses elasticity and stretches, causing more wrinkles. Although the lack of estrogen is not the main cause, hormone treatment will help the skin maintain elasticity.

Breast changes
The lack of estrogen affects the breasts' size, quality, and supporting tissue. Breasts stretch, decrease in size, and become soft because there is less connective tissue.




Diagnosis

Menopause is diagnosed by history of an absence of menstrual periods for at least 6 months and by a hormone level (FSH > 35 IU/L).

Menstruation before menopause is nonovulational and signals the beginning of climacterium. One way of determining whether or not ovulation occurs is to measure basal body temperature. Normally the basal body temperature is low for the first half of the menstrual cycle and high during the latter half. When ovulation does not occur, there is no change in body temperature.

When menstruation becomes irregular, a woman may also be experiencing early symptoms of menopause. When ovulation stops, the secretion of progesterone stops and without progesterone, the little estrogen that is secreted facilitates growth of the endometrium (endometrial hyperplasia). This growth cannot be sustained, and as it breaks down little by little, irregular bleeding occurs. Eventually, menopause commences as ovary function comes to a halt and the secretion of estrogen stops.


Treatment

Menopause signals the beginning of potentially new health issues for women. Hormone replacement therapy can improve and prevent many menopause-related symptoms and problems, including osteoporosis, a degenerative bone disease. Bone density decreases at the rate of 1-2% per year after menopause. For some women, osteoporosis progresses more severely.

The reduction of estrogen after menopause can increase a woman's risk for high blood pressure, heart attacks, cerebral hemorrhages, and other cardiovascular diseases. After menopause, the level of low-density lipoprotein (LDL) or "bad cholesterol" increases and the level of high-density lipoprotein (HDL) or "good cholesterol" decreases. HDL removes cholesterol from the arteries, reducing the risk of vascular diseases. High LDL levels are related to the occurrence of arteriosclerosis. Hormone replacement therapy may prevent coronary artery disease in postmenopausal women.

Premature menopause is menopause that has occurred before age 35, and treatment is necessary to prevent side effects. If menstruation continues after age 55, a uterine myoma (a benign tumor) may be present and a woman should seek a medical examination.

If both ovaries have been surgically removed, then menopause is "surgically induced" and severe estrogen deficiency symptoms will occur. Hormone replacement therapy is needed in cases of surgically induced menopause.


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Urinary Incontinence and Menopause



Description

Urinary incontinence is the involuntary loss of urine, sufficient enough to cause a social or cleanliness problem.

By age 65, 1 in 10 women experiences urinary incontinence. It is most commonly seen in women who have had one or more vaginal deliveries, which cause a change in the anatomy of the uterus, vagina, and supporting structures of the bladder, urethra, and rectum. Changes may be temporary, mild, or very significant.

If you suffer from urinary incontinence, there are many new products and surgical methods available to treat this condition.



Causes

Urinary incontinence is often caused by a combination of the following:

* Pregnancy, particularly vaginal delivery.
* Weakened or damaged pelvic muscles that support the bladder.
* Lack of estrogen, e.g., menopause.
* Medical problems that affect the bladder function, e.g., diabetes mellitus.
* Urinary tract infections.
* Constipation causing straining.
* Repeated coughing, e.g., smoker's cough.
* Certain prescription and nonprescription medications.

Symptoms



Symptoms vary depending on the type of incontinence:

Stress incontinence is the loss of urine when there is a sudden increase in pressure in the abdomen caused by laughing, coughing, sneezing, exercising, or lifting something heavy.

Urge incontinence is the most common type of incontinence. It occurs when someone suddenly feels as though they need to use the toilet, but is unable to reach it in time. Urge incontinence has many causes.

Mixed incontinence is a combination of stress and urge incontinence.

Overflow incontinence occurs when the bladder cannot empty properly. A person makes frequent trips to the toilet, letting out small amounts of urine each time. Because the bladder never empties completely, it may feel full again very quickly. Some people may have periodic leaking without any sensation of fullness.

Functional incontinence is not caused by problems with the bladder. Accidents occur because it may be difficult for a person to get to the toilet due to illness, arthritis, or lack of available facilities.

Diagnosis

* Review of medical history.
* Physical exam, including pelvic examination.
* Laboratory tests, including urinalysis and urine culture to rule out a urinary tract infection; blood sugars to rule out diabetes mellitus.
* Urodynamic studies where the physician tests the function of bladder and urethra by measuring bladder pressure and urine flow.
* Cystoscopy, which involves the direct visualization of the urinary bladder and urethra from inside by inserting an endoscopic tube through the urethra. Please see cystoscopy for more information.
* Cystogram to show abnormal anatomy and functions that may be causing incontinence. For a cystography or voiding cystourethrography, the bladder is filled with iodine containing X-Ray dye, and an X-Ray is taken of the bladder and urethra when filled, during urination, and immediately after urination.


Treatment



Treatment depends on the type of incontinence and may require one or more of the following:

* Estrogen creams, if estrogen deficiency (from menopause) is suspected.
* Antibiotics to treat a urinary tract infection.
* Medication to help regulate the bladder and urethra.
* Surgery to support the bladder and correct the pelvic anatomy.
* Kegel exercises to strengthen the pelvic muscles.
* Bladder training to help a person control the urgent need to urinate.
* Vaginal pessaries to support a partially prolapsed bladder.



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Sex During Menopause



Description

A woman's normal sexual response can be divided into four stages: attraction, arousal, climax, and resolution. As women age, dysfunction in each of these stages becomes more and more likely.

For menopausal women the most common genital symptoms are urinary frequency, vaginal dryness and irritation. The most common sex-related symptoms during menopause are loss of libido and painful intercourse. Other menopausal-related symptoms include lack of orgasms and problems associated with the partner's sexual dysfunction.



The loss of female hormones during menopause can cause an increase in the frequency of vaginal atrophy, dryness, and inflammations. The atrophy of the vaginal mucosa can cause an avoidance of intercourse due to extreme vaginal pain.



Even under these circumstances, sexual encounters must be increased and enhanced with psychological stimulations to arouse sexual desires. Taking a warm bath before intercourse or using a topical lubricant can help. The most effective method of treatment, however, is estrogen supplements or applying estrogen-enhanced creams directly on the atrophied vagina.



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Practicing Longevity



Description

Human life expectancy has increased greatly over recent years. Currently, the average lifespan in the United States is 76.9 years -- 79.5 years for females and 74.1 years for males (National Vital Statistics Reports, 2000). With an extended lifespan, we aspire to optimize our health and wellness in order to reduce suffering from illnesses and live a fuller, richer life.



The ideal way to launch your quest for aging in wellness and healthy longevity is to receive an expert examination and receive a personal and tailored prescription for diet and exercise and, if needed, hormonal supplements, antioxidants, and supplements. After receiving a personal prescription, it is important to receive checkups 2-3 times a year to monitor your health conditions.


Longevity experts share and practice the following health guidelines.

1. Never overstrain. Exercise moderately everyday or as frequently as possible.
2. Do not eat fried foods. Eat low-fat grains that have not been whitened or bleached. Protein consumption should consist of fish and poultry.
3. Eat fresh fruits and vegetables that are in season, every day.
4. Do not smoke or drink alcohol, or limit alcohol consumption to red wine with a meal.
5. Meditate everyday for 10-30 minutes. Practice one's own stress-relieving methods often.
6. No matter what, keep a positive attitude toward life.
7. Take antioxidants and other health supplements daily.



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Suicide



Description

Most suicide victims were not receiving treatment at the time of their death. Suicidal thoughts usually suggest mental illness, especially depression. Suicide tends to occur during an intense episode of depression. Depression can be treated with proper medical attention, and professional help can prevent suicides.



Those at a high risk for suicide are:

* people with a past history of suicide attempts or thoughts, depression, or other mental illnesses, such as bipoloar disorder, schizophrenia, anxiety, etc.
* people with a history of alcohol or drug abuse.
* people with a serious physical illnesses, such as AIDS or cancer.
* people with a family history of depression, suicide, or mental illnesses.
* Men and people over 60. Though depression is two to four times more common in women than men, men are four to ten times more likely to complete suicide.



If someone talks about suicide, take the matter seriously and let family members or a mental health professional know immediately.


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Sex After 50 and Menopause

Description
In the process of aging, the number of cells in the organs of the body is diminished due to the loss of regenerative capability in the living organism. Aging, on the sexual level, is marked by a sudden reduction of male/female hormones at around the ages of 35-40. Then, at around age 60, the concentration of sexual hormones again drops drastically in the blood stream and continues at this level until 80.



The loss of sexual vigor with age does not include a loss in sexual interest. Human male hormones, unlike those of other animals, do not have absolute control over sexual activity, and its level at 80 is as much as 2/3 its level at age 20. Therefore, the idea that sex is only for the young is a misconception. The closeness, stimulation, and happiness that having sexual intercourse brings to a relationship does not decrease with age. Further, erectile dysfunction in men and frigidity in women are not necessarily physiological problems, but may be due to worries about sex or other mental insecurities. For example, a man may worry over whether he will be able to satisfy his partner; and likewise, a woman may be concerned about her dryness, which can pose a greater threat than any physical factor.



As males age, there are distinctive changes that happen related to their ability to function sexually:

* At an advanced age, an erection takes longer to attain. The length of time it stays in that state diminishes, also.
* At youth, the time needed for sexual arousal is only 5-10 seconds; whereas, at 60-70 years, it may take more than 3 times as long, if at all.
* At the point of erection, the penis makes an angle of 30-50 degrees to the flat of the stomach (abdominal wall) for youths; after 60, the angle will drop to 150 degrees or to the 7- 8 o'clock position from the stomach.
* For men in their 20s and 30s, maintaining an erection lasts on average of 40-50 minutes. As men age, lasting even 10 minutes can be difficult.
* At youth, sometimes there is a two-stage orgasm; with age, the urgency of sex disappears and even one orgasm may be difficult to achieve.
* The pressure with which the semen is ejaculated also varies with age, shooting from 50-100 cm during youth to just barely making it out with a dribble at old age.



The root of human sexual desire originates from the functionality of the testicles and ovaries; however, the brain plays a big part through memory, associations, emotion and experience. Therefore, the secret to a lifetime of healthy, pleasurable sex is not only to maintain a healthy body but a healthy mind, as well -- a mind that keeps sexual interests alive.

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Osteoporosis and Menopause

Description
* Osteoporosis is a disease of progressive bone loss associated with an increased risk of fractures. It literally means "porous bone." The disease often develops unnoticed over many years, with no symptoms or discomfort, until a fracture occurs. Osteoporosis often causes a loss of height and dowager's hump (a severely rounded upper back region). * Osteoporosis is a major public health threat for 28 million Americans, 80% of whom are women. In the U.S. today, 10 million individuals already have osteoporosis and 18 million more have low bone mass, placing them at increased risk for this disease. One out of every two women and one in eight men over 50 will have an osteoporosis-related fracture in their lifetime * More than 2 million American men suffer from osteoporosis, and millions more are at risk. Each year, 80,000 men suffer a hip fracture and one-third of these men die within a year. Osteoporosis is responsible for more than 1.5 million fractures annually, including 300,000 hip fractures, and approximately 700,000 vertebral fractures, 250,000 wrist fractures, and more than 300,000 fractures at other sites.



Causes



Doctors do not know the exact medical causes of osteoporosis, but they do know many of the major factors that can lead to the disease. * Aging. Everyone loses bone with age. After age 35, the body builds less new bone to replace losses of old bone. In general, the older you are, the lower your total bone mass and the greater your risk for osteoporosis. * Heredity. A family history of fractures; a small, slender body build; fair skin; and a Caucasian or Asian background can increase the risk for osteoporosis. Heredity also may help explain why some people develop osteoporosis early in life. * Nutrition and lifestyle. Poor nutrition, including a low calcium diet, low body weight and a sedentary lifestyle has been linked to osteoporosis, as have smoking and excessive alcohol use. * Medications and other illnesses. Osteoporosis has been linked to some medications, including steroids, and to other illnesses, including some thyroid problems.


Diagnosis

* The diagnosis of osteoporosis is usually made by your doctor using a combination of a complete medical history and physical examination, skeletal X-rays, bone densitometry and specialized laboratory tests. If your doctor finds low bone mass, he or she may want to perform additional tests to rule out the possibility of other diseases that can cause bone loss, including osteomalacia (a vitamin D deficiency) or hyperparathyroidism (overactivity of the parathyroid glands). * Bone densitometry is a safe, painless x-ray technique that compares your bone density to the peak bone density that someone of your same sex and ethnicity should have reached at about age 20 to 25, when it is at its highest. * It is often performed in women at the time of menopause. Several types of bone densitometry are used today to detect bone loss in different areas of the body. Dual beam X-ray absorptiometry (DXA) is one of the most accurate methods, but other techniques can also identify osteoporosis, including single photon absorptiometry (SPA), quantitative computed tomography (QCT), radiographic absorptometry and ultrasound. Your doctor can determine which method would be best suited for you.


Treatment



* Because lost bone cannot be replaced, treatment for osteoporosis focuses on the prevention of further bone loss. Treatment is often a team effort involving a family physician or internist, orthopedist, gynecologist, and endocrinologist. * While exercise and nutrition therapy are often key components of a treatment plan for osteoporosis, there are other treatments as well. * Estrogen replacement therapy (ERT) is often recommended for women at high risk for osteoporosis to prevent bone loss and reduce fracture risk. A measurement of bone density when menopause begins may help you decide whether ERT is for you. Hormones also prevent heart disease, improve cognitive functioning, and improve urinary function. It should be discussed with your doctor. * New anti-estrogens known as SERMs have been introduced. They increase bone mass, decrease the risk of spine fractures, and lower the risk of breast cancer. * Calcitonin is another medication used to decrease bone loss. A nasal spray form of this medication increases bone mass, limits spine fractures, and may offer some pain relief. Bisphosphonates, including Alendronate, markedly increase bone mass and prevent both spine and hip fractures. HRT, Alendronate, SERMs, and calcitonin all offer the osteoporosis patient an opportunity to not only increase bone mass, but also to significantly reduce fracture risk. Prevention is preferable to waiting until treatment is necessary.


Prevention

There is a lot you can do throughout your life to prevent osteoporosis, slow its progression, and protect yourself from fractures. Include adequate amounts of calcium and vitamin D in your diet. * Calcium. During the growing years, your body needs calcium to build strong bones and to create a supply of calcium reserves. Building bone mass when you are young is a good investment for your future. Inadequate calcium during growth can contribute to the development of osteoporosis later in life. Whatever your age or health status, you need calcium to keep your bones healthy. Calcium continues to be an essential nutrient after growth because the body loses calcium every day. Although calcium cannot prevent gradual bone loss after menopause, it plays an essential role in maintaining bone quality. Even if you have gone through menopause or already have osteoporosis, increasing your intake of calcium and vitamin D can decrease your risk of fracture. How much calcium you need will vary depending on your age and other factors. The National Academy of Sciences makes the following recommendations regarding daily intake of calcium:

Males and females 9 to 18 years: 1300 mg per day
Women and men 19 to 50 years: 1000 mg per day
Pregnant or nursing women up to age 18: 1300 mg per day
Pregnant or nursing women 19 to 50 years: 1000 mg per day
Women and men over 50: 1500 mg per day
Dairy products, including yogurt and cheese, are excellent sources of calcium. An eight-ounce glass of milk contains about 300 mg of calcium. Other calcium-rich foods include sardines with bones, and green leafy vegetables, including broccoli and collard greens. If your diet does not contain enough calcium, dietary supplements can help. Talk to your doctor before taking a calcium supplement.

* Vitamin D. Vitamin D helps your body absorb calcium. The recommendation for vitamin D is 400 IU daily for adults and 800 IU daily for the elderly. Supplemented dairy products are an excellent source of vitamin D. (A cup of milk contains 100 IU. A multivitamin contains 400 IU of vitamin D.) Vitamin supplements can be taken if your diet does not contain enough of this nutrient. Again, consult with your doctor before taking a vitamin supplement. Too much vitamin D can be toxic. * Exercise regularly. Like muscles, bones need exercise to stay strong. No matter what your age, exercise can help you minimize bone loss while providing many additional health benefits. Doctors believe that a program of moderate, regular exercise (3 to 4 times a week) is effective for the prevention and management of osteoporosis. Weight-bearing exercises such as walking, jogging, hiking, climbing stairs, dancing, treadmill exercises, and weight lifting are probably best. Falls account for 50% of fractures, therefore, even if you have low bone density you can prevent fractures if you avoid falls. Programs that emphasize balance training, especially, Tai Chi, should be emphasized. Consult your doctor before beginning any exercise program.

Are you at risk for osteopenia and osteoporosis?


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Menopause Symptoms



Description

Menopause, or climacterium, marks the completion of a woman's childbearing years and the cessation of menses (menstrual cycles), as the ovaries slow down and, eventually, stop functioning. Women typically reach this phase in their lives between ages 45 and 55.
As a result of hormonal changes due to this process, women undergoing menopause may experience feelings of irritability, as well as "hot flashes" on the neck, chest, face and arms. There are other less obvious physiological indications that indicate that menopause has begun.



Causes



As a woman enters menopause, the number of eggs in the ovaries decrease, which lowers ovary function and leads to a dramatic reduction in estrogen secretion. At the same time, the pituitary gland increases the secretion of a follicle-stimulating hormone (FSH), which makes the eggs grow faster and the periods shorter. Sometimes ovulation does not occur.


Symptoms

In the years preceding menopause, the menstrual cycle is shortened by an increase in FSH, ovulation becomes irregular, and there is less estrogen in the blood. The decrease in estrogen causes various climacterium symptoms such as hot flashes, depression, dryness of the vagina, and a decline in sexual function.

Hot flashes



Hot flashes are the most common early symptom when blood levels of estrogen decrease. When less estrogen is secreted, the capillaries expand irregularly, causing hot sensations in the face, neck, and chest. It becomes hard to sleep because of night sweats caused by hot flashes. In severe cases, these symptoms occur 40 times a day. Approximately 67% of women experience these symptoms for a year, and 25% of women experience them for more than 5 years. Impatience, irritation, anxiety, and worry may also occur in conjunction with hot flashes.

Urinary system changes
The decrease in estrogen also affects skin and epithelial cells. With less estrogen being secreted, epithelial cells in the vagina and urinary system become thin and dry, losing elasticity. This causes the muscles in the perineum, urethra and bladder neck to weaken. As a result, many women find it hard to control urine, and lose a little when they cough, sneeze, laugh or exercise. Menopausal women may also have an urgent need to urinate even when the bladder is not full.

The uterus and vagina become atrophic with lack of estrogen during menopause, so sometimes there is a sagging or slacking sensation when lifting heavy objects.

If dryness of the vagina, or colpoxerosis, is severe, it can cause pain and small tears during intercourse. A drier, menopausal vagina is also more susceptible to yeast infections.

Emotional changes and sexual function
Many women in menopause complain about anxiety, depression, sensitivity, fatigue, forgetfulness, and insomnia. These symptoms are partially caused by decreases in estrogen, luteinizing hormone, and male hormone. A lack of female and male hormones decreases sexual desire (libido) and causes the painful intercourse (from dryness) that some women experience during menopause. These symptoms can be improved with hormone replacement therapy.

Skin changes
After menopause, skin loses elasticity and stretches, causing more wrinkles. Although the lack of estrogen is not the main cause, hormone treatment will help the skin maintain elasticity.

Breast changes
The lack of estrogen affects the breasts' size, quality, and supporting tissue. Breasts stretch, decrease in size, and become soft because there is less connective tissue.




Diagnosis

Menopause is diagnosed by history of an absence of menstrual periods for at least 6 months and by a hormone level (FSH > 35 IU/L).

Menstruation before menopause is nonovulational and signals the beginning of climacterium. One way of determining whether or not ovulation occurs is to measure basal body temperature. Normally the basal body temperature is low for the first half of the menstrual cycle and high during the latter half. When ovulation does not occur, there is no change in body temperature.

When menstruation becomes irregular, a woman may also be experiencing early symptoms of menopause. When ovulation stops, the secretion of progesterone stops and without progesterone, the little estrogen that is secreted facilitates growth of the endometrium (endometrial hyperplasia). This growth cannot be sustained, and as it breaks down little by little, irregular bleeding occurs. Eventually, menopause commences as ovary function comes to a halt and the secretion of estrogen stops.


Treatment

Menopause signals the beginning of potentially new health issues for women. Hormone replacement therapy can improve and prevent many menopause-related symptoms and problems, including osteoporosis, a degenerative bone disease. Bone density decreases at the rate of 1-2% per year after menopause. For some women, osteoporosis progresses more severely.

The reduction of estrogen after menopause can increase a woman's risk for high blood pressure, heart attacks, cerebral hemorrhages, and other cardiovascular diseases. After menopause, the level of low-density lipoprotein (LDL) or "bad cholesterol" increases and the level of high-density lipoprotein (HDL) or "good cholesterol" decreases. HDL removes cholesterol from the arteries, reducing the risk of vascular diseases. High LDL levels are related to the occurrence of arteriosclerosis. Hormone replacement therapy may prevent coronary artery disease in postmenopausal women.

Premature menopause is menopause that has occurred before age 35, and treatment is necessary to prevent side effects. If menstruation continues after age 55, a uterine myoma (a benign tumor) may be present and a woman should seek a medical examination. If both ovaries have been surgically removed, then menopause is "surgically induced" and severe estrogen deficiency symptoms will occur. Hormone replacement therapy is needed in cases of surgically induced menopause.

The Natural Way- Common symptoms of menopause and the classification of each stage


Thursday, September 25, 2008
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Magnetic Resonance Imaging



Also known as

MRI

Description

MRI (magnetic resonance imaging) is an imaging technique used to get cross-sectional images of the body using strong magnetic field and radio waves (radio frequency pulses) instead of X-rays.

In MRI scanning, patients are placed inside a very large and strong magnet, so that all the protons in the atoms of the patient's body can be aligned to a magnetic field. Then, radio waves (called radio frequency pulses) are directed at the protons (i.e., the nuclei of hydrogen atoms) to excite the protons. Once the radio waves are stopped, excited atoms emit radio signals received by an antenna (i.e., a surface coil in the MRI machine), which are then measured and processed to form an image using a computer.

In the human body, protons are most abundant in the hydrogen atoms of water. Thus, MRI images represent the water content in the area of the exam. The more water present, the more radio signals emitted, and the whiter the image.

MRI can provide a clear and detailed picture of soft tissue structures near and around bones and joints, such as tendons, ligaments, muscles, joint capsules and mass.


Types of MRI

# Head MRI Brain MRI
# Sellar MRI
# Head and Neck MRI
# Orbit MRI
# Temporal MRI

Spine MRI
# Cervical spine MRI
# Thoracic spine MRI
# Lumbosacral spine MRI

Body MRI
# Abdominal MRI
# Male pelvis MRI
# Female pelvis MRI
# Thorax MRI

Cardiovascular MRI (including heart, aorta and blood vessels)

Musculoskeletal MRI
# Ankle MRI
# Hip MRI
# Knee MRI
# Shoulder MRI
# Wrist MRI

Advantages of this procedure

* To provide cross-sectional images in any anatomical plane (upper to lower, right to left, front to back, oblique).
* To provide clear, detailed images of various soft tissues, such as internal organs, tumors, and blood vessels.
* No radiation.
* Compared to the iodine-based contrast medium in X-ray or CAT scan, MRI dye is relatively safe.
* Provides angiographic images without being invasive.
* MRI can evaluate organ function, as well as structure.


How this procedure is performed

You will be asked to lie on the scan table. After proper positioning, the exam table will slide into the center of the magnet.

During the scan you will be alone in the exam room, but you can talk to and listen to the technologist using an intercom, who will watch you through a glass window and video camera.

During actual scanning, you will hear loud tapping noises, but you are required to remain still until it's done (to get clear pictures).

In the event that a contrast medium is needed to make organs and blood vessels stand out, it will be injected into your vein during the exam.

The exam usually takes from 15 minutes to an hour and a half.

Preparation for this procedure

* Wear comfortable, loose-fitting clothing.
* Disrobe in the examining area and put on a hospital gown. Remove any metal objects, such as watches, car keys, wallets, beepers, cellular phones, zippers, snaps, hairpins, jewelry, accessories, eyeglasses, hearing aids and any removable dental work, because they can be affected by the huge magnet and degrade quality imaging. The information on credit cards can be erased by this strong magnetic field.
* Let your radiologist or technologist know when you have a metal object in your body, such as a cardiac pacemaker, prosthetic heart valve, prosthetic hip or knee joint, implanted infusion pump, intrauterine device (IUD), cochlear implant, aneurysm clip or vascular clips, hearing aid, metal monitoring device, surgical staples, metal plates, pins, screws, bullets, shrapnel or any metal fragments. This is because the strong magnetic fields can cause these ferromagnetic metal objects to move, dislodge, cause burns, or electrical currents.
* Tattoos may degrade image quality.
* For contrast-enhanced MRI, you will be asked if you have any drug allergies.
* Earplugs can be used to protect your ear from loud repetitive noises during scanning.


Results of this procedure

A radiologist (a physician specialist trained to interpret MRI images or other radiology exams, such as CAT scans, X-rays, mammographies, etc.) reviews the body MRI and reports the results to your personal doctor. Your physician's office will inform you of the results when they are complete, and will use the results as a reference in evaluating and treating your condition.

Risks of this procedure

* The strong magnetic field can cause metal implants to dislodge, burn, and cause additional injuries. If you have any metal implants in your body, such as a pacemaker, prosthetic valves, or clips, you should let your radiologist or technologist know its brand name and model. If it is not confirmed to be compatible with the magnet, you should not take the MRI. If you have had bullet injuries or possible metal fragments in your body, X-rays can be taken, instead.
* Women in the first 12 weeks of pregnancy should avoid MRI and the contrast medium. There are no known harmful effects to pregnant women and unborn babies. However, because it is a recently developed technology, the long-term effects of MRI are not known.
* Allergic reactions to the contrast medium are possible, but very rare.
* If you have any history of claustrophobia, you should inform your radiologist or technologist. Sedatives can be given before scanning.


Limitations of this procedure

* Limited ability in imaging bone -- conventional X-ray or CAT scan is better in demonstrating bone details.
* MRI is less sensitive in demonstrating acute hemorrhage when compared to CAT scans.
* Hard to depict calcifications.
* MRI does not always distinguish between tumor tissue and edema fluid.
* Less sensitive in detecting small abnormalities compared to CAT scan (poor spatial resolution).
* Inability to scan critically ill patients requiring life-support systems and monitoring devices that employ ferromagnetic materials.
* May be dangerous in scanning patients with metal implants and other metal objects.
* May provoke claustrophobia.
* Longer exam time compared to CAT scans.
* Safety in scanning pregnant women is not known.




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Vasectomy and Reverse Vasectomy



Vasectomy

There are many types of contraceptives available for both men and women. However, many are only temporary measures that require preparation each time before intercourse.

A more permanent solution to preventing unwanted pregnancies is the vasectomy (surgical removal of the ductus deferens or ligature of right and left ductus deferens) for men and the salpingectomy (removal of the uterine tube) for women.


The principle behind a vasectomy is to block the passage of sperm from the testicles, where it is produced, through the vas deferens and the urethra, by tying up or removing the vas deferens. Nowadays ligature, or crossover vasectomy, is preferred, as surgical reconstruction may restore the use of the canals in men who change their minds and decide to father more offspring (see Reverse Vasectomy below).

Occasionally, after surgery, there may be pain in the area, bleeding, inflammation of the epididymis, leakage of sperm, and even a return to fertility. Thus, as a precautionary measure, other contraceptive measures should be used until the semen is verified to be without sperm.

There are concerns that a vasectomy might reduce sexual energy or the amount of semen produced; however, these concerns are unfounded. The male erection is mainly influenced by the corpus cavernosum, and the vas deferens has no role in an erection. The male hormone, which is produced in the testicles, is continuously secreted and absorbed by the body, leaving sexual function unaffected. The seminal fluid is mostly a secretion of the prostate gland and the seminal vesicle, and is composed of only 1% sperm, so a reduction in the amount of semen should be of very little concern.


Reverse Vasectomy

A reverse vasectomy is a surgical procedure to reconnect or unblock the vas deferens to restore reproductive capability for patients who have had a vasectomy or are sterile for other reasons. Reversing a vasectomy will not necessarily bring back reproductive capability. Therefore, it is very important to carefully consider the consequences before deciding on a vasectomy.

Due to the increase in divorce and remarriage rates, the number of men wishing to reverse a vasectomy is on the rise. Since the surgical procedure is microscopic in nature, and uses threads thinner than human hair, a reverse vasectomy is a very delicate operation and is only successful 90% of the time for men who have had a vasectomy within the last 10 years. However, the pregnancy rate for these people may be much lower -- 60-70% -- depending on such factors as the fertility of the spouse and the receptivity of the sperm in the women's reproductive tract.

When recovering from a reverse vasectomy, extreme exercise should be avoided, and for the first 2-3 days it is advisable to fix or secure the testicles to keep them from being disturbed. A bath should not be taken until after 5 days, and the man should abstain from sexual relations for 1 month, at which point the semen is tested for the absence of sperm. The success rate of the reverse operation is highest during the first 5-7 years after a vasectomy and drops off after 7 years, so an early decision can be the difference between success and failure.



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Tuboplasty

Description

Fallopian tubes are pipe-like structures about 12 cm long that extend both ways from the uterus toward the ovaries and flare out into the shape of a trumpet. The internal diameter of the fallopian tubes is as thin as a stand of hair near the uterus, but much wider near the ovaries. During ovulation, the wider end“blooms?like a trumpet flower, receiving the egg from the ovaries. After intercourse, the sperm migrate past the uterus and into the fallopian tube to meet and fertilize the ovum. The fallopian tube then transports the fertilized egg to the uterus.



When to use this procedure



If the fallopian tubes become constricted, allowing passage of the sperm but not the egg, an ectopic pregnancy in the fallopian tube may occur. When a woman undergoes surgical sterilization, the fallopian tubes are tied with a ring or completely blocked to prevent the ovum from leaving the ovaries. Nowadays, an increasing number of patients want to reverse this procedure, and they are turning to tuboplasty to get the results they desire. With modern microscopic technology, tuboplasty has come a long way from the days when a magnifying glass and the naked eye were the only tools surgeons had to rely on. The procedure offers an improved success rate and a same-day hospital discharge. However, not all tuboplasty surgeries can recover or reverse reproductive capability, so careful consideration is advised before choosing sterilization in the first place.


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Prenatal Ultrasound



Description

More than any other diagnostic tool, the introduction of ultrasound has been most effective and revolutionary in the field of obstetrics and gynecology. Ever since its first use in 1958, it has become widely accepted as an essential diagnostic tool in medicine. With over 43 years of clinical use, it has proven to be very safe in its use of low-frequency sound waves. Some indications for ultrasound use in obstetrics are as follows.


Indications for ultrasound

# Evaluation of fetal growth
# Unknown vaginal bleeding
# Examination of fetal position
# Suspected multiple fetuses
# Amniotic sac examinations (assist in needle insertion)
# Abnormal difference in the size of the fetus and the uterus
# Pelvic tumors
# Pregnancy outside the uterus (ectopic pregnancy)
# Suspected fetal death
# Suspected deformity in the uterus
# Verification of uterine apparatus
# Examination of fetal health
# Verification of fetal location during labor pains
# Abnormal results of fetal tests for deformity
# Prior history of fetal deformity


Prenatal ultrasound


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Perineorrhaphy



Also known as

Episiotomy repair

Description

# Perineorrhaphy is the surgical repair of the perineum, usually after an episiotomy has been made to assist the delivery of a baby and decrease damage to the mother's perineum and its structures, e.g., urethra. However, a perineorrhaphy is the repair of any tear or laceration to the perineum.



Procedure

# Using a local or regional anesthetic, the cut or laceration is repositioned as close as possible to the original position using absorbable sutures, which dissolve in about 10 days and do not have to be removed.


Complications

# Infection of the wound
# Separation of the wound


Postsurgical Care

To prevent complications, the sutured wound should be kept clean and dry. It is impossible to keep it totally sterile because of the location.

# Remove pads and use toilet paper from front to back to avoid contaminating the wound, urethra, and vagina with feces.
# Wash hands before and after performing wound care, changing perineal pads, urinating, and defecating.
# Avoid constipation and straining by eating fresh fruits, vegetables, cereals, and using stool softeners.
# Inspect the wound to see that is healing and if the wound is closed.
# Lochia, the uterine discharge that commonly occurs after delivery, should decrease. Report any bright red bleeding or foul smelling discharge, which may indicate an infection in the uterus.
# The discomfort associated with perineorrhaphy should subside in 4 or 5 days; otherwise consult your physician if pain increases.
# Discomfort can be relieved by a cream or suture line spray and application of intermittent cold packs and heat, in the form of sitz baths for the first 24 hours, or a heat lamp or a rubber K-pad, through which warm water circulates. Make sure someone teaches you how to use these correctly.
# Kegel exercises also help relieve discomfort and promote healing by increasing circulation to and relieving edema at the operative site.
# To avoid discomfort while sitting, squeeze the buttocks together before sitting.
# Do not put anything (tampons, douche, etc.) into the vagina until your doctor says it is safe to do so.

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Pelvic Ultrasound



Also Known As

Pelvic ultrasound (US) scanning, pelvic US imaging, pelvic ultrasonography or sonography.

Description

Ultrasound scans are high frequency sound waves too high for humans to hear. After the Titanic hit an iceberg and sank in 1912, many people researched ways to find underwater icebergs. During this time, SONAR (sound navigation and ranging), which uses ultrasound, was developed.

Ultrasound waves sent to the part of the body being examined are reflected, refracted, or absorbed at the interfaces inside the body. Echoes that return in this way, carry information about the size, distance, and uniformity of internal organs. This is displayed on a monitor to create an ultrasound image.



Pelvic sonography is a useful way of examining pelvic organs, such as the uterus, ovaries, fallopian tubes (uterine tubes), bladder in females; and the prostate gland, seminal vesicles, and bladder in males. During pregnancy, it is used to monitor the health and development of the fetus/embryo (unborn baby in mother's womb).

During a pelvic sonography, a hand-held device called a "transducer", is placed on the skin surface of the area being examined and is moved around. This transducer generates ultrasound and sends it through the body. It also detects the returning echoes and transmits them as electrical signals. Because one transducer continuously generates many ultrasound waves while detecting echoes, a real time image can be produced on a viewing monitor. These images can be recorded on videotape or can be frozen and recorded on to film.

Ultrasound is similar to audible sound in that it can pass through water and human organs easily, but it can't pass through air or bone. So, gel is applied to the skin to bridge the gap between the transducer and the internal organs to more effectively send the ultrasound waves.

When taking a pelvic ultrasound, drink a lot of water to fill the bladder. Normally the uterus and ovaries are behind the intestine and hard to see, but a distended bladder pushes the intestine up and the uterus back, spreading them out evenly and making the uterus and ovaries easy to see.

Advantages of this procedure

* Safe, painless, easy, fast, and widely available.
* No radiation.
* Real time imaging -- ultrasonography can be used to guide invasive procedures such as biopsy, and to visualize bowel movement and blood flow.
* In case of an emergency, bedside sonography can be done without special patient preparations.


Types of Pelvic Ultrasound

There are three types of pelvic ultrasound procedures:

1.Transabdominal (abdominal) ultrasound
While the patient is lying down, a transducer is placed on the lower stomach allowing the uterus, ovaries, and pelvic organs to be seen through a full bladder. The bladder must be full with urine, and resolution is low, but a wide picture of the entire pelvis can be seen.

2.Transvaginal (endovaginal, vaginal) ultrasound
A protective cover and lubricating gel is placed on the end of a thin, long transducer, which is inserted into the vagina to obtain US images. As the transducer by-passes the intestine and is more closely positioned to the pelvic organs, like the uterus and ovaries, better images can be obtained. There is no need to fill the bladder for this exam.

3.Transrectal (rectal) ultrasound
A protective cover and lubricating gel is placed on the end of a thin, long transducer, which is inserted into the rectum through the anus to examine the prostate gland. Because the prostate gland is right in front of the rectum, good images can be obtained through the transducer.

Doppler ultrasound can be done during each type of pelvic ultrasound procedure, which provides additional information about blood flow, helps diagnose blockages in pelvic blood vessels, and is used for examining ovarian tumors. Transvaginal ultrasound with color doppler can be used for individuals at high risk of developing ovarian cancer. Color doppler, duplex doppler and power doppler are three different techniques of doppler ultrasound.

Conditions that benefit from this procedure

* Monitoring fetal development.
* Pelvic pain.
* Pelvic mass.
* Abnormal bleeding.
* Abnormal discharge.
* Menstrual problems.
* To guide invasive procedures such as a needle biopsy and withdrawal of fluid.
* To examine blood flow and reveal blockages, including atherosclerotic plaque and blood clots, in the arteries and veins of the pelvis.


Common conditions revealed by this procedure

* Fibroids (myoma) of the uterus
* Cysts of the ovaries, uterus
* Ectopic pregnancy
* Infection
* Pelvic inflammatory diseases
* Abscess -- tubo-ovarian abscess, pelvic abscess
* Tumors, cancers of the ovaries, uterus
* Congenital anomaly
* Injury
* Stones in the bladder, urethra, lower ureters
* Lost IUD (intrauterine contraceptive device)
* Congenital anomalies, intrauterine growth retardation, death of the fetus/embryo
* Complications of pregnancy -- spontaneous abortion, missed abortion, threatened abortion, incomplete abortion
* Placental abnormality
* Hydatidiform mole
* Hyperplasia, cancer of prostate gland (in males)
* Tumor, inflammation of bladder


How this procedure is performed

You will need to remove your upper garments and put on a hospital gown. You will then be positioned on an examination table on your back with your hands above your head, and a lubricating gel will be applied to your pelvic area. An apparatus, known as a transducer, will be placed on your pelvic area and moved around to get real-time images.

If needed, a transvaginal ultrasound or transrectal ultrasound examination may be added. If so, you will be asked to urinate completely and remove all your lower garments. While lying down, a transducer will be inserted into your vagina or rectum.

After the examination, the gel will be cleaned off and you can change back into your clothes. The entire examinations usually take 10-30 minutes.

Preparation for this procedure

* Drink six glasses of water one to two hours prior to your exam, and avoid urinating. A full bladder helps with visualization of the uterus, ovaries, and bladder wall.
* Wear comfortable, loose-fitting clothing.
* Remove your upper garments before examination and put on a hospital gown.
* For transvaginal ultrasound or transrectal ultrasound examinations, you need to remove lower garments and urinate before your exam and.
* In an emergency, bedside exams can be done without special preparations.
* Tell the sonographer, sonologist, or physician sonologist conducting the examination about pain, bleeding, discharge, fever, or any other symptoms you have. Telling the examiner about past ultrasounds and surgeries is also helpful, and is sometimes crucial information.


Result of this procedure

The image recorded on film or videotape is interpreted and analyzed by a radiologist (a physician specialist experienced in ultrasound and other radiology exams). The official report is sent to the practitioner who requested the examination, who will inform you of the results and will use them as a reference in your evaluation and treatment.

Risk of this procedure

There is no known risk to humans from diagnostic ultrasound. Unlike X-ray examinations, ultrasound does not use radiation.

Limitations of this procedure

* Ultrasound does not penetrate air or bone. So if an abnormality is behind bowel gas, ribs, or calcified rib cartilage, it may not be discovered via this procedure.
* There is a limitation to ultrasound's ability to reach deep into the body. Because ultrasound is absorbed and reflected inside the body, only some of the waves reach deep places farthest from the transducer. For example, given two tumors of equal size, the tumor closest to the transducer will be discovered more readily than the more distant one. Consequently, examinations are not as productive for obese, tall patients as they are for thin or petite ones.
* Ultrasonography is an operator-dependent, subjective test. The more experienced the operator and the more closely the patient follows the operator's instructions (e.g. 'hold your breath', 'do not eat', 'repress the urge to urinate'), the better the results. Further, the more the operator knows about the patient's past medical history, current medical history, and the results of other radiological and laboratory tests, the better the examination. For best results, before taking ultrasonography, ask if the practice where the scan is being performed is accredited either by the American Institute of Ultrasound in Medicine or the American College of Radiology.
* Not all abnormalities can be discovered with a pelvic ultrasonography. For example, a PAP smear is a more sensitive test than ultrasound in detecting cervical cancer. And when diagnosed with cervical cancer, CT scans and MRI are more accurate than ultrasound in making plans for treatment.


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Pap Smear


Description

# In the 1940s Dr. George Papanicolaou proposed that a trained observer could detect cancer of the cervix by scraping cells from the cervix and then evaluating them under a microscope. This test came to be known as the Pap smear, and, now serves as the modern basis for screening women for cervical cancer.
# Women should be screened with Pap smears, starting at either the year that they become sexually active or age 18, whichever comes first. Initially, the smears should be done every year, but sometimes screening can be done every 3 years if the first three or four specimens are normal and you are with the same sexual partner who is also monogamous. However, if you change sexual partners or notice any changes in your vaginal discharge and/or have spotting or bleeding after intercourse or between periods, see your gynecologist immediately.
# The Pap smear is the only screening test for cancer, and it is responsible for a decrease in cervical cancer cases and deaths.
# A Pap smear is a screening tool, not a diagnostic test; further evaluation is required when abnormal changes are reported. Occasionally, cervical cancer is present and the Pap smear is normal, which is why a gynecologist orders further tests if there is something abnormal on the cervix.
# Pap smears do not detect cancer of the uterus, fallopian tubes, or ovaries.



Causes



Of abnormal pap smear:
# Human papilloma virus (HPV) is the most important cause, because HPV is found in over 99% of women with cervical cancer. Tobacco use increases the cancer-causing potential of HPV. HPV is the major cause of genital warts, but people may have HPV on their genital organs and surrounding skin without any visible changes. Unfortunately, HPV is epidemic since condoms are not very effective in preventing HPV.
# Other cervical infections: Herpes simplex, Trichomonas, Candida, etc.
# Chemicals from contraceptive gels and/or foams, douches, etc.
# Acquired immunodeficiency syndrome (AIDS) and other lowered immune states allow HPV and other infections to grow and cause more damage.

Diagnosis

Pap smear:
# Requires a trained cytologist (person who looks at cells) and/or pathologist who will assign a 'class' to each Pap smear slide.
# Class I means that the sample is normal.
# Class II means that there are atypical (abnormal) cells present.
# Class III means dysplasia (a premalignant condition) is present.
# Class IV means there is carcinoma in situ present (cancer cells have not invaded).
# Class V means that there is evidence that invasive cancer is present.

Coloposcopy



# A colposcope is used to magnify the features of the cervix, allowing for a more detailed and thorough examination of the surface of the cervix than with the unaided eye. A colposcope is a large, electric microscope with a bright light and is positioned approximately 30 cm from the vagina. When a person uses the colposcope to determine the cause of an abnormal Pap smear or just to get a better look, the procedure is called colposcopy. Colposcopy is relatively simple and painless, and is performed in your physician's office. The time needed for colposcopy varies, depending on the cervix, but on average takes 15 minutes.
# Biopsy of the cervix: Definitive diagnose requires removal of a small sample of tissue from the cervix.

Treatment

# Medication for cervical and/or vaginal infection
# Stop using tobacco
# Removal of specific lesion on the cervix
# Cryosurgery freezes the surface of the cervix; the intent is that it will destroy abnormal cells and they will not be present when the cervix heals.
# Laser therapy uses heat to destroy the surface of the cervix.
# Conization: This procedure removes the surface of the cervix in the shape of an inward pointing cone.


Abnormal Pap Smear



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Mammography

Also Known As

Mammogram, mammography exam

Description

Mammography is an X-ray examination of the breasts. It differs from a general X-ray exam in that it uses low energy X-rays to get high resolution and high contrast images of soft tissue.

Mammography is the most effective way to detect breast cancer early. It is capable of discovering breast cancer that is too small to be revealed by palpitation (i.e., felt with the hands). Early detection of breast cancer -- when it is still small -- is the best way to improve patient survival rates, as there are several effective treatment methods to choose from, and prognosis is good.

Mammography can find 85-90% of all breast cancer, making it the most reliable screening test. The remaining 10-15% that doesn't show up on a screening mammography may be discovered by hand. According to recent research, mammography can detect breast cancer up to 2 years earlier than by hand.

Done concurrently -- regular mammograms, monthly breast self-examinations, and breast examinations by your doctor ?these three procedures provide the best protection against this voracious cancer with one of the highest morbidity rates of all diseases.



Advantages of this procedure

* Fast and safe.
* The most sensitive test used to detect breast cancer early.
* Low dose of radiation.


Conditions that benefit from this procedure

* Breast lump
* Thickening of the breast
* Breast pain
* Nipple discharge
* Skin change on the breast
* Women over age 50


Common conditions revealed by this procedure

Screening mammography



1. Can detect breast cancer early, even in the absence of complaints or symptoms.

Diagnostic mammography

1. Used to diagnose breast diseases, usually prompted by a lump, pain, thickening, nipple discharge, or a change in breast size or shape.
2. Used to evaluate abnormalities detected on a screening mammogram.
3. Used as a screening test in the case of breast implants.


Common diseases revealed by this procedure

Benign conditions

1. Cyst
2. Fibroadenoma
3. Fibrocystic breast condition
4. Abscesses
5. Fat necrosis
6. Galactoceles

Breast cancer

1. Ductal carcinoma
2. Invasive ductal carcinoma
3. Medullary carcinoma


How this procedure is performed



After the radiologist places your breast on a specially designed cassette, a transparent plastic paddle is pushed down on your breast. Once the breast is adequately compressed, the technologist flips a switch and exposes it to X-ray beams. X-rays pass through the breast and reach the film inside the cassette to make an image. A series of X-rays will be taken, with the cassette placed next on the outside of the breast, with the paddle compressing it from the inside. Top to bottom and side views of the other breast are taken in the same way.

The breast is compressed to spread the tissue apart, allowing for quality images with lower doses of radiation. The breast compression lasts only a few seconds and may cause minor discomfort, but it does not harm the breast, even with the presence of breast implants. If it feels painful, tell the technologist to stop.

During the diagnostic mammogram, additional views (such as cone views with magnification, localized views of a specific area) will be taken to carefully evaluate any breast abnormality.

Wait for the technologist to tell you whether the X-rays came out okay. If no additional examinations are needed, you can go home. The entire examination usually takes 20 to 30 minutes.

Preparation for this procedure

* Before scheduling a mammogram, you should discuss any new findings or problems in your breasts with your doctor. Also, inform your doctor of any prior surgeries, hormone use, and family or personal history of breast cancer (Recommendations of the American Cancer Society). Women who are pregnant or suspect pregnancy should inform their doctor or X-ray technologist.
* If your breasts are often tender, schedule your mammogram one week following your period. Do not schedule a mammogram for the week before your period.
* Wear a two-piece outfit or loose-fitting clothing with no necklace. You will be asked to remove all jewelry and clothing above the waist and to change into a hospital gown. Do not wear deodorant, talcum powder, lotion, creams, or perfumes on your breasts or under your arms on the day of the exam. These can appear on the mammogram film as calcium spots.
* Describe any breast symptoms or problems you might have to the technologist. If possible, obtain your prior mammogram films (not reports) and make them available to the radiologist for comparison. Ask when you can expect the results of your mammogram.



Results of this procedure

A radiologist (a physician specialist trained to interpret mammography images or other radiology exams, such as X-ray, CAT scans, MRI, etc.) reviews the mammography and reports the results separately to you and to your doctor. You can get the results at the time of your appointment or by mail. Your doctor's office will inform you of your official mammography results.

If abnormalities have been found, appropriate treatment and additional examinations will be given.

If you don't receive mammography results within 30 days after the examination, call your mammography facility or your doctor.

Risks of this procedure

* Mammography uses X-rays to image breast tissue. Radiation exposure received from two mammographic views is equivalent to six months of natural background exposures (i.e., radon gas from buildings, cosmic rays).
* Radiation exposure from a screening mammography is believed to be safe.
* If you are pregnant or suspect pregnancy, let your doctor or technologist know, so that special care will be taken to ensure maximum safety.
* When you have breast implants, particularly those placed in front of the chest muscles, they can hinder accurate imaging of breast tissue. When you make the appointment, inform the doctor's office that you have implants so that special care and techniques can be taken by the technologist to improve images without rupturing your implants.
* Screening mammograms miss about 20 percent of breast cancers, even when the tumors are present at the time of examination. This "false negative" rate is higher in younger women. So, women should have regular clinical breast exams (by a professional health care provider), in addition to a screening mammography.
* Most abnormalities detected on mammography are not breast cancer. Between 5 and 10 percent of screening mammograms are abnormal, but only a few of them prove to be cancer by additional exams, such as a diagnostic mammogram, ultrasound, or aspiration biopsy. This "false positive" rate is also higher in younger women.


What to do if the result are abnormal



Most mammographic abnormalities turn out to be benign (non-cancerous) change, such as a cyst, thicker breast tissue, and fibroadenoma. According to a study of 100 women age 50 and older who have a mammographic abnormality, only about 14 actually have invasive breast cancer.

To find out whether the abnormality seen on the mammogram is cancer or not, you may need to take diagnostic mammography, breast ultrasonography, galactogram, magnetic resonance imaging (MRI), biopsy, or aspiration.

Breast biopsy, which can be done surgically, is the final confirmative diagnostic test. Part or all of the lesion may be removed after a skin incision is made. A needle biopsy can be done without surgery. In this procedure, only a part of the suspicious tissue is removed with biopsy needles, and is examined under a microscope. Very thin needles can be used to remove fluid or fragments of tissue (a procedure called "fine needle aspiration biopsy"). Larger needles can be used to remove a cylindrical piece of tissue to examine larger amounts of tissue (a procedure called "core needle biopsy").

If you have breast implants

When you schedule your mammogram, tell the doctor's office that you have implants and make sure they are experienced in X-raying patients with implants.

Breast implants can hide breast tissue when you take mammograms without special care. Four additional films will be taken, as well as the four standard images. These additional X-rays, called "implant displacement (ID) views", will be taken with the breast pulled forward and the implant pushed back. Compression of the breasts during mammography does not cause implant rupture.

If you suspect implant rupture or other problems with implants, magnetic resonance imaging (MRI) is the best alternative.

Getting high-quality mammograms

All mammography facilities except VHA (veterans hospital administration) facilities are required to be FDA certified by federal law (MQSA - Mammography Quality Standards Act). When the equipment at the facility in question, along with the people who work there (i.e., technologists, radiologists, and medical physicists), and the records they keep, all meet federal standards, then that facility is accredited by the FDA and allowed to display an MQSA certificate.

MQSA regulations also require mammography facilities to give patients an easy-to-read report on the results of their mammogram, as well as an official medical report to their personal doctor.

You can get high-quality mammograms in breast clinics, radiology departments of hospitals, private radiology offices, and doctor's offices. Mobile units (often vans) also offer screening mammograms at shopping malls, community centers, and offices.

To find an FDA-certified mammography facility near you, ask your doctor, or call the National Cancer Institute's Cancer Information Service toll free at 1-800-4-CANCER. You can find the information on the FDA's web site at http://www.fda.gov/cdrh/mammography/certified.html.

Risk factors for breast cancer

Age
As you get older, your risk of breast cancer increases.

Personal history of breast cancer
If you have had breast cancer, there is a higher chance of recurrence.

Family history of breast cancer
A woman's chance of developing breast cancer increases if her mother, sister, daughter, or two or more other close relatives, such as cousins, have a history of breast cancer (especially if they were diagnosed before age 50).

Genetic alterations
There is a high chance of developing breast cancer when there are genetic alterations, such as BRCA1 and BRCA2. Ten percent of all breast cancer is related to genetic alterations.

Certain breast changes
There is a high chance of developing breast cancer if there have two or more biopsies from past benign conditions, atypical hyperplasia, or lobular carcinoma in Situ (LCIS.)

Dense breast tissue
When the mammogram shows dense breast tissue, the chances of developing breast cancer are higher.

Radiation therapy
There is a higher risk of developing breast cancer later as a result of radiation exposure at an early age used to treat diseases like Hodgkin's disease.

Reproductive and menstrual history
The later a woman has a baby after 30, the younger a woman was when she started menstruation (before 12), and the later a woman enters menopause (after 55), the higher the chances of developing breast cancer. Also women who have never given birth have a high risk of breast cancer.


When to start this procedure

Consult your doctor to see when you should start receiving screening mammograms and how often you should receive them. Here are some general guidelines women should to follow:

Age 50-69
Get annual screening mammograms. There is good evidence that mammograms decrease deaths from breast cancer in women in this age group.

Age 40-50 without a past or family history of breast cancer
Discuss with your doctor the risks and benefits of getting regular mammograms, and make a personal decision. Receiving routine screening mammograms at this age is still controversial.

Many health and medical organizations (National Cancer Institute, American Medical Association, American Cancer Society, American College of Obstetrics and Gynecology, American College of Surgeons, American College of Radiology) recommend routine mammograms every other year or every year for women in their forties.

But several organizations (American College of Physicians, US Preventive Services Task Force, American Academy of Family Practice, Canadian Task Force on the Periodic Health Exam) are against routine mammography under age 50 because the risks outweigh the potential benefit.

Age 35-40
The American Cancer Society and American College of Surgeons recommend that women in this age group obtain their first baseline mammogram.

Previous breast cancer
All women, at any age, who has had breast cancer should get annual screening mammograms.

Family history of breast cancer If your mother, sister, or daughter has or has had breast cancer, you should start annual screening mammograms at age 40 or 5-10 years earlier than the earliest age that your relative(s) acquired the disease.


Further procedures

Galactogram
To evaluate the cause of nipple discharge, a fine plastic tube is placed onto the nipple through which contrast dye is injected to fill the ducts, and a mammogram is taken.

Breast sonography
The best way to distinguish a cyst from solid mass is to use high frequency sound waves (inaudible sound) to image breast tissue by picking up echoes. This imaging technique is useful to help guide a mass or cyst biopsy when doctors cannot feel any abnormality.

MRI (magnetic resonance imaging)
MRI uses magnetization and radio waves to produce high contrast cross-sectional images. Contrast material (Gadolinium DTPA) can be injected into a vein in the arm to improve diagnostic capability. This is the best imaging method to detect ruptured breast implants.





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