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
* 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.
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.
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.
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.
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
# 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.
# 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.
# Infection of the wound # Separation of the wound
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.
Pelvic ultrasound (US) scanning, pelvic US imaging, pelvic ultrasonography or sonography.
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.
# 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.
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.
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.
# 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.
# 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.
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
1. Can detect breast cancer early, even in the absence of complaints or symptoms.
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.
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.
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.
Dilation and suction and/or curettage are often referred to as a D&C because the name was used before suction was invented. D&C refers to dilation of the cervix (widening the cervix) and curetting or scraping out the endometrium (the lining of the uterus). Suction devices have revolutionized this procedure and the uterus can now be emptied more rapidly and through a smaller opening in the cervix. The material obtained from suction and/or curettage is sent to the laboratory where it is placed on slides, stained, and then examined by a pathologist.
1. Abnormal or heavy bleeding from the uterus. D&C may temporarily or permanently cure the problem and will at least diagnose the cause of the bleeding. 2. Incomplete abortion (miscarriage) or to make sure abortion is complete. 3. Early termination of pregnancy a. Genetic analysis of cells collected during amniocentesis reveals a severely abnormal fetus. b. Pregnancy is inadvisable for medical reasons, e.g., cancer, heart disease. c. The mother ingested medication(s), alcohol or drugs (teratogens) which could result in the birth of a severely deformed fetus. d. The mother had an infection early in pregnancy, e.g., rubella, which is known to cause congenital defects. e. The pregnancy is unwanted.
# The patient's cervix is usually numbed or anesthetized with a needle containing a local anesthetic, e.g., lidocaine. Additional medication to put the patient to sleep, eliminate any pain, or decrease anxiety may be given intravenously. If the uterus is large or it is difficult to enter the cervix, e.g., a postmenopausal woman who has not had children vaginally, the physician may recommend that the patient be hospitalized and be given an epidural or general anesthetic. # Dilation can be carried out in many ways. If the patient is having a miscarriage, the cervix may already be dilated, so the contents of the uterus just have to be suctioned and/or curetted out. If the cervix is not dilated, a series of dilators, starting with a very small one and increasing in size, are introduced through the external os and internal os of the cervix. # Alternatively, one can use laminaria to dilate the cervix. Laminaria are thin pieces of specially prepared and sanitized seaweed, Laminaria japonicum, which grow in the Sea of Japan. One or more laminaria are inserted into the cervix and left in place for a period of time. They absorb moisture from the surrounding tissue and slowly expand, dilating the cervix over several hours. They are usually inserted the day before a suction and/or curettage procedure. They may cause cramping and require a pain reliever such as acetaminophen (Tylenol); aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) should be avoided because they inhibit the formation of clots and may increase bleeding. # Once the cervix is dilated, the interior of the uterus can be probed to determine its size or look for uterine growths, e.g., a polyp or fibroid. If a polyp is suspected, a pair of grasping forceps is inserted into the uterus and closed; the polyp is pulled out of the uterus if it is not too strongly attached. # In a classic D&C, a uterine curette is inserted into the uterine cavity and the wall of the cavity is scraped. More recently, the cavity is often suctioned first. The material suctioned and scraped away from the wall can then be sent for pathological examination.
Procedures specific to Abortion: # Vacuum Aspiration: From 6 to 13 weeks, vacuum aspiration is used to empty the uterus. This traditional first trimester abortion involves three main steps: (1) an injection to numb the cervix, (2) insertion of a soft flexible tube through the cervix into the uterus, and (3) suction created by an aspirating machine to remove the uterine contents. It takes less than 5 minutes to complete. # IPAS Syringe - Early Abortion with Manual Vacuum Aspiration (MVA): As soon as the pregnancy can be detected by ultrasound (typically 3-4 weeks), an abortion can be performed using a manual aspiration device called the IPAS Syringe. Similar to the suction aspiration procedure, the IPAS system consists of thin flexible tubing, but instead of using a machine to create suction a hand-held syringe is used. The procedure usually takes less than 5 minutes to complete. Aftercare is the same as with suction aspiration method. 1. 1. D & E (Dilate and Evacuate): # From 13 to 24 weeks, the Dilation and Evacuation (D&E) procedure may be administered. Usually, appointments are made for 2-3 consecutive days. On the first day, an ultrasound (sonogram) is performed to determine the size of the fetus. Then, the abortion procedure begins, and the cervix is numbed with injections and dilators are inserted into the cervix. Overnight, these dilators gently expand, opening the entrance to the uterus. The next day, the cervix is again numbed, the dilators are removed, and the doctor uses special instruments inserted into the uterus to remove the fetus. The final step is suction, using the aspirating machine. In more advanced pregnancies, additional dilators are inserted on the second day and the fetus is removed on the third day. Removal of the pregnancy actually takes about 10-15 minutes.
# Perforation of the uterus with an instrument may occur because the uterus is very soft from pregnancy, distorted by disease, or the uterus is tipped back toward the spine (retroverted) making entrance into the uterus more difficult. The uterus probably heals on its own more often than we realize because the injury goes unrecognized. If an injury is recognized, your physician may recommend a laparoscopy and/or laparotomy (opening the abdomen) to exam and repair the hole. # Infection: D&C is often done to prevent the development of infection, particularly after an incomplete abortion. However, it the cervix was infected by chlamydia, gonorrhea or other harmful organisms, they may be pushed up into the uterus during the procedure and cause an infection of the uterine lining (endometritis), less commonly the infection spreads into the fallopian tubes (salpingitis), or further. It is important that you report any foul smelling discharge from your vagina, fever, chills, or continuous pelvic pain so the infection can be treated before it causes permanent damage. # Reaction to anesthetic or other problems associated with anesthesia: Patients rarely have adverse reactions to a local anesthetic, however, if you have had any problems at the dentist or with burn sprays containing anesthetics (Benzocaine), make sure you tell your physician. Serious complications from general anesthesia occur in approximately 1-2 people/10,000, which is why your physician may recommend a local or epidural over a general anesthetic. # Infertility: Infertility rarely occurs today as a complication of D&C because of the use of suction and effective antibiotics to treat infection.
Video laparoscopic surgery and laser laparoscopic surgery are the latest gynecological surgical techniques. Until these procedures were made available, most gynecological surgeries required that the abdomen be opened (laparotomy). However, recent advancements in medical tools and the efforts of surgeons have eliminated many abdominal surgeries.
Diagnostic laparoscopy is the process of determining the condition and cause of the disorder, whereas surgical laparoscopy is the process of operating on the disorder, through the use of lasers and video. Some of its surgical applications are:
* ectopic pregnancy (pregnancy in the fallopian tube), ovarian cyst, uterine myoma, endometriosis, and other gynecologic problems; * papilloma of the fallopian tubes; * infertility due to adhesions around the fallopian tubes and the pelvic region; * hysterectomy; * plastic surgery for the fallopian tubes (tuboplasty).
Advantages over laparotomy
* surgical time is short; * bleeding is minimal; * very little scaring; * requires short or no hospitalization; * fast recovery.
Anesthesia, general anesthesia, or subdural anesthesia is applied. Three to four incisions, approximately 0.5-1 cm long, are made in the lower abdomen. Then, operation-specific tools, electronic controls, and the laser are used to operate on the affected area with the guidance of an external viewing monitor, which is connected to the laparoscope.
Though complications are rare, potential risks of laparoscopic surgery may include:
* pelvic infection; * bleeding from the stitches; * discharge and infection of the incision; * internal bleeding; * damage to internal organs or vessels; * adhesion formation; * pain; * fever; * complications caused by anesthesia.
Also Known as 'Tubogram' or 'Hysterosalpingography'
Description An hysterosalpingogram (HSG) is an X-ray test performed to evaluate the inside of the uterus and fallopian tubes by injecting radiologic dye into the uterine cervix through the vagina.
Normally, injected dye will fill the uterus, pass through the fallopian tubes and spill out into the peritoneal cavity. Fallopian tube abnormalities and infertility due to adhesion in the uterine cavity (e.g. tubal blockages, fibroid tumors, polyps, scar tissue, or an abnormal shape to the cavity) can be diagnosed with an HSG.
Usually an HSG is taken 2-5 days after menstruation has ended, and before ovulation, to ensure the patient is not pregnant during the procedure. Limited research suggests that fertility increases after X-rays are taken with an oil contrast, the hypothesis being that after administration, adhesions fall off, function of the uterine cavity improves, mucous is removed, and the ability of the smooth muscle improves. This suggests that the HSG may have treatment applications; but most HSGs are performed only for diagnostic purposes because its therapeutic effect is still controversial.
Indications of HSG
1. Infertility 2. To detect a blocked fallopian tube. 3. To detect uterine abnormalities, such as uterine anomalies, endometrial polyps, fibroids, intrauterine adhesions, genital tuberculosis. 4. To evaluate the results of tubal surgeries, such as a tubal ligation or reversal operation.
How to prepare for HSG
* An HSG is usually scheduled within 2-5 days after the period ends (day 7-10 of the menstrual cycle) and before ovulation (day 14 of the cycle) to avoid exposing the uterus to radiation and X-ray dye, if the woman is pregnant. Tell your doctor if you might be pregnant. * If you have had a pelvic inflammatory disease or sexually transmitted disease (gonorrhea, chlamydia, etc.), you are at a higher risk of developing complications after the HSG. Tell your doctor if you suspect pelvic infection, as you may need to take antibiotics before the test. * Tell your doctor before the test if you: - are allergic to X-ray dye (iodine), any medications or foods. - are asthmatic. - are taking any medications. - have any bleeding disorders.
How it is done You will be asked to disrobe below the waist and lie on an exam table under a fluoroscopy (real-time X-ray machine with a video monitor). The gynecologist or radiologist will insert a speculum in the vagina, place a tube into the opening of the cervix, then gently inject a small amount of X-ray dye into the uterus while watching the fluoroscopy monitor. Contrast material will fill the uterus and fallopian tubes and finally spill out into the pelvic cavity around the uterus and tubes. Several X-ray pictures will be taken during the procedure.
This procedure may cause mild to moderate cramping, similar to menstrual cramping. Tell your doctor if you experience cramping for more than several hours after an HSG.
Risks and complications of an HSG
* Infection is the most common complication of an HSG, but it is rare and found in less than 1% of all cases. It usually occurs in patients with a history of pelvic infection. If you have fever or abdominal pain within a day or two after the HSG, contact your doctor immediately. * Allergic reaction to iodine dye may cause skin rash, itching, shortness of breath, or swelling in the throat or in other parts of the body. * Fainting. * The patient may experience a small amount of vaginal bleeding a few days after an HSG. * The amount of radiation from HSG is too small to do any harm. However, if you suspect that you are pregnant, you should not take the test. * Damage to the uterus or fallopian tubes.
# Hysterectomy is the second most frequent major surgery performed on women in the United States, with about half a million procedures performed each year. For instance, in 1995, approximately 590,000 women in this country underwent the procedure. One in three women will have a hysterectomy by age 60. Annual costs associated with this surgery exceed $5 billion, and there are wide variations in rates of hysterectomy in different parts of the country. # The procedure is performed for a variety of diseases, and, particularly, for cancer of the uterus or ovary. Most women who undergo hysterectomy are between the ages of 35 and 54, with the highest age-specific rate for women 35 to 44 years of age.
# Fibroids account for approximately one third of hysterectomies. # Endometriosis accounts for 18% of surgeries. # Cancer of the uterus, the ovaries, or the cervix # Uterine prolapse # Very heavy or irregular bleeding # Stress incontinence (involuntary loss of urine) # Chronic pelvic pain, severe pelvic infection # Emergency heavy bleeding from the uterus after delivery or during surgery
Hysterectomy is the surgical removal of the uterus. It ends menstruation and the ability to become pregnant. Depending on the patient's specific condition, the surgery may also involve removal of other organs and tissue in addition to the uterus. Here are the different procedures: # Total hysterectomy: removal of the uterus, including the cervix # Subtotal hysterectomy: removal of the uterus, leaving the cervix, ovaries, and fallopian tubes in place # Total hysterectomy with bilateral salpingo-oophorectomy: removal of the uterus, cervix, ovaries, and fallopian tubes # Laparoscopic hysterectomy: Hysterectomy is carried out using a laparoscope instead of a large incision. # Vaginal hysterectomy: The uterus is removed through the vagina.
# Effects of anesthesia # Damage to nearby organs: bowel or rectum, bladder or ureter # Hemorrhage (bleeding) that may require a blood transfusion # Wound infection, urinary tract infection, bowel obstruction # Incontinence or urinary retention requiring the continued use of a catheter # Vaginal pain, fistula (abnormal passage) between the vagina and bladder or rectum
Many women suffer from vaginal bleeding and leukorrhea due to cervical erosion and vaginitis. Vaginitis can be treated by proper feminine hygiene and medications, but cervical erosion cannot be completely treated, even with long-term treatments (3 months to 1 year). If cervical erosion is not properly treated, vaginitis may recur. An even more threatening consequence of improper or inadequate treatment is the higher likelihood of uterine cancer, which experts believe is connected with the disappearance and reappearance of vaginitis and, ultimately, with cervical erosion. Thus, early treatment of cervical erosion is highly recommended as a preventive measure against uterine cancer and in reducing leukorrhea and vaginal bleeding.
Cervical erosion is not easily treated and none of the available treatment measures are 100% effective, thus, some doctors contend it is not necessary to treat it. However, considering the possible consequences of untreated cervical erosion, the best strategy, and the current consensus, is that the best available treatment measure should be taken. Methods include electrical cauterization, cryocoagulation method, cold coagulator coagulation method, laser surgery, conization, and high-frequency coagulation method. Electrical cauterization, cryocoagulation method, and the cold coagulator coagulation method have the drawback of not being permanent treatments; laser surgery has the disadvantage of being delicate and difficult to perform, as well as inducing a lot of bleeding. Therefore, high-frequency coagulation method is recommended.
What is high-frequency coagulation method?
# In the high-frequency coagulation method, the instruments automatically and accurately focus the needed energy to the eroded area and to a depth of 5 mm, which is needed to adequately treat cervical erosion. # The high-frequency coagulation method has a single surgical success rate of about 95%, surpassing that of any other method by a large margin. This is because the technique uses an automated machine that is much more accurate than other methods, which rely on human interpretation. # Surgery just takes 3-5 minutes, and usually only treatment is needed. # The amount of pain during surgery is equivalent to that of menstruation and labor and, thus, anesthetics are usually not needed. # There are no reported cases of sterility, arthresthesia of the cervix, pyometra, or perforation due to extreme coagulation, as a result of this surgery.
Computed tomography is an examination that uses X-Rays to obtain cross-sectional images of the human body. When X-Rays are irradiated onto the human body, some of them are absorbed and some pass through the body to produce an image.
In plain X-Ray imaging, the film directly absorbs penetrated X-Rays; whereas, with a CT scan, an electronic device called a detector array absorbs the penetrated X-Rays, measures their amount, then transmits this data to a computer system.
A sophisticated computer system calculates and analyzes data from each detector and reconstructs multiple two-dimensional cross-sectional images. An X-Ray source and a CT detector rotate around the patient to obtain each cross-sectional image.
CT images represent density and the atomic number of human tissue just like a general X-Ray image. On a CT scan, the denser the tissue and the higher the atomic number, the whiter the CT image: bone and calcium appear white; air in lungs appears black; water, blood and internal organs, such as liver, kidneys, and brain appear gray; and fat tissue appears dark gray.
* Provides detailed two-dimensional images with great clarity. * Better images of many types of tissues, including the lungs; bones, soft tissue, and blood vessels. * In trauma cases, a CT scan can reveal internal bleeding and other life-threatening injuries quickly. * Simple, painless and noninvasive. * Sensitive in detecting traumatic injuries, cancer and many other diseases. * Cost-effective imaging tool for a wide range of clinical problems (when compare to MRI). * Distinguishes normal and abnormal structures accurately: Useful in guiding biopsy, fluid removal/aspiration, drainage of abscesses, other minimally invasive procedures, and radiotherapy. * Can provide three-dimensional images.
You will be asked to lie down on the CT table. For Head CT Scans, a pillows will be placed to support your head. For Body CT Scans, your arms will be raised above your head.
After placing you in the proper position, a technologist will move into the console room and begin exposing you to X-Rays. Once the X-Ray tube rotates around your body 360 degrees to take one cross-sectional image, the table will be slightly moved in order to get the next plane. You will be asked to hold your breath during the scanning process.
Though you will be alone in the examination room during X-Ray exposure, you will be able to communicate with your technologist by using an intercom or raising your hands. The technologist will watch you during the scanning through a glass window, as well as a video camera.
If a contrast medium is required to make organs and blood vessels more visible, it will be injected into a vein during the exam.
The exam usually takes from 10-30 minutes.
Preparing for a CT scan
You will be asked to put on a hospital gown, and to remove all metal objects from your body, such as zippers, snaps, and other accessories, as they can interfere with the imaging quality. You will be required to lie still on the exam table until the technologist tells you otherwise.
For contrast-enhanced CT scans, you should not eat or drink for one or more hours before the exam. If you know that you have allergies to contrast mediums, medications, iodine, specific foods, or if you have a history of kidney problems, asthma, thyroid problems, diabetes or a heart condition, inform your technologist or doctor beforehand. Contrast agents will be injected into your bloodstream before X-Ray exposure.
For abdominal/pelvic CT scans, you may need to avoid food or drink for several hours. You may be asked to swallow a liquid contrast agent to allow better viewing of the stomach, small bowel, and colon. Sometimes the contrast agent needs to be administrated by enema to study the colon, or by vaginal tampon to evaluate the uterine cervix.
For a Head CT Scan, you may be asked to remove jewelry, eyeglasses, dentures, hairpins, hearing aids, etc. If you are pregnant or suspect pregnancy, you should inform your doctor, technologist, or radiologist prior to the scan.
A radiologist will review the CT scan and report the results to your personal doctor, who will inform you of the results.
Risks of CT scan
Radiation exposure during a CT examination is equal to a year's worth of natural background radiation (i.e., radon gas in a home, soil, or cosmic rays). It is much more than the radiation exposure from a general X-Ray exam, such as a chest X-Ray or a skull X-Ray, but it is less than that from barium enema, upper GI series, or cardiac catheterization.
The benefits of CT study outweighs the risk of radiation exposure. Special care should be taken, however, to expose children only when absolutely necessary, because growing children are more sensitive the hazards of radiation. Adverse reactions to contrast agent given intravenously, include:
Allergic reactions Rashes, hives, itching, etc. Usually self-limiting, antihistamine can be administered.
Anaphylactic reaction This very rare reaction can cause breathing difficulty or swelling in the throat or other parts of the body. Potentially life-threatening, it can be treated with epinephrine, corticosteroids, or antihistamines. Radiology departments are well trained to deal with it.
Kidney failure Particularly among patients taking Glucophage (Metformin) for diabetes.
Mothers nursing their babies may resume breast-feeding 24 hours after the contrast medium is given intravenously.
Bone, air, fat, and other tissues are easy to distinguish with a CT scan because they distinctly appear with different densities; however, it is difficult to distinguish between body organs, tumors, cancer, blood vessels, muscles, and fluids. Also, CT scans have limited ability to image knee joints, shoulder joints, intervertebral discs and related structures. MRI is a better imaging modality for the evaluation of soft tissue.
CT scans only provide axial cross-sections. If longitudinal cross-sections are necessary to evaluate a problem, such as in a meniscus tear of knee joint, ligament tear of rotator cuff, or a three-dimensional evaluation of cancer before planning surgical removal, an MRI is recommended instead.
# This surgical method of delivery requires that an incision be made in the mother's stomach and uterus so the baby can be removed through the incisions. Supposedly, Roman emperor Julius Caesar was born in this manner, thus, the procedure's name. # Cesarean sections are a good way to manage emergency situations that put either the mother or baby, or both, at risk. This method of delivery is not recommended "on demand" as a way to avoid the labor associated with a vaginal delivery. A natural childbirth should be encouraged. If a cesarean section is inevitable, it is usually for the following reasons.
# Maternal causes # Pelvis is smaller than the baby's head. # Severe toxemia of pregnancy (gestosis) # An STD has infected the uterine neck or vagina, putting the baby at risk of infection if delivered naturally. # Water breaks early, and the umbilical cord is exposed. # Placenta previa: The placenta is blocking the uterine opening. # A multiple pregnancy, which can result in possible premature birth and delays in delivery. # Induced labor has failed # The mother has diabetes, heart disease, high blood pressure, myoma of the uterus, or ovarian cyst, making natural birth difficult. # Fetal causes # Fetus is upside down or lying sideways. # Abnormal pulse before or during delivery and deteriorating condition that may cause a stillbirth # Fetus is too big to fit through the pelvis.
# If you need to have a cesarean birth, you will receive an epidural, spinal, or general anesthesia. # If you have epidural or spinal anesthesia, you can be awake during your surgery and you can see your baby right after he/she is born. # A presurgical fast is required for at least 8 hours, as well as a basic preoperative evaluation, such as a blood test that includes blood typing, urine test, liver function test, and an electrocardiogram. # The surgical region is shaved and disinfected, and a catheter is inserted to discharge urine. An IV is started to facilitate the administration of drugs. # General anesthesia, epidural anesthesia, or spinal anesthesia is then administered. # The uterine incision is then made down to the amniotic sac (fetal membranes or bag of water). # Once the incisions are made, the baby is removed-the fetal head or buttocks are delivered through the uterine incision, followed by the rest of the body-in 5-10 minutes # The umbilical cord is cut, the placenta is completely removed before the incision is closed (the layers of the abdominal wall are sutured, and then the skin closed with either suture or staples), and the mother is taken to the recovery room after the incision has been closed. # Total surgical time, from anesthesia to stitches, is 40 minutes to an hour.
Medical advances have greatly reduced the dangers associated with cesarean sections. Still, compared to a natural childbirth, there are risks, sometimes life-threatening for the mother, associated with this procedure.
# A baby born comfortably in the absence of labor pains, or few labor pains, has less ability to adjust to the uncomfortable and irritating outside world, and has a higher risk for developing dyspnea, i.e., difficulty breathing. # During a normal vaginal birth, the baby's chest is pressed by the birth canal, pushing amniotic fluids and other secretions out of its lungs, but this action becomes weak in surgery. If the baby is parturient and healthy, problems rarely occur; if the baby is weak, it will have trouble spitting and develop dyspnea.
# The incision on the uterus may heal well, but there will be a scar on the uterine muscle and the uterus may not recover to its original state. Most scarred areas are weak and occasionally become paper thin, which can rupture during the next pregnancy or labor. # The danger for rupture increases when the uterus has been cut vertically because of placenta previa and cross birth (transverse presentation). Mothers who have received vertically cut cesarean sections should remember this and remind their physician, in the event of subsequent births.
Pregnancy at the region of the incision
# Chances are high that the next pregnancy will occur where the uterine incision was made, thereby increasing the possibility of placenta previa. # If an embryonic sack grows on the outside of the incision region, there is a danger of hysterorrhexis (metrorrhexis) early in the pregnancy. Appropriate measures should be taken to avoid an extrauterine pregnancy (ectopic pregnancy).
Limited Number of Operations
# Women often receive abdominal incisions (celiotomy, laparotomy) because of uterine and ovarian abnormalities or extrauterine pregnancies. A cesarean section adds to the overall number of surgeries. Most women who undergo a cesarean section receive another with each additional pregnancy, continuously burdening the body. Therefore, it is recommended that a natural birth be attempted with the first pregnancy.
American Cancer Society Recommendations for Early Breast Cancer Detection: Doctors recommend you begin practicing breast self-examination (BSE) as soon as your breasts start developing. This will help you become familiar with your normal breast structure and to learn to notice any unusual changes. If you have no breast cancer symptoms, your doctor should examine your breasts every 3 years if you are between 20 and 40 years of age and every year for those over the age of 40. Women should have a baseline screening mammogram by age 40, and a follow-up mammogram every 1-2 years from age 40-49 and every year for women age 50 and over. Women with a personal or family history of breast cancer should consult their physician about more frequent exams or mammograms. If a change occurs, such as development of a lump or swelling, skin irritation or dimpling, nipple pain or retraction (turning inward), redness or scaliness on the nipple or breast skin, or a discharge other than breast milk, you should see your health care provider as soon as possible for evaluation. Experienced health care professionals can examine the breast and determine whether the changes you have noticed are most likely benign or whether there is a possibility they may be due to breast cancer. They can determine when additional tests are appropriate to rule out a cancer and when follow-up exams are the best strategy. If there is any suspicion of cancer, a biopsy will be recommended.
The best time for a BSE is about a week after your menstrual period starts, because your breasts are not tender or swollen at that time. # Lie down, put a pillow under your right shoulder, and your right hand behind your head. Gently massage and feel your breast for lumps or other changes. # Use the finger pads of the three middle fingers on your left hand to feel for lumps in the right breast. Press firmly enough to know how your breast feels. A firm ridge in the lower curve of each breast is normal. If you are not sure how hard to press, talk with your doctor or nurse. # Repeat with towel under left shoulder with left hand behind head. # Stand in front of a mirror. Look for any changes such as puckering, changes in size or shape, dimpling, or changes in your skin texture. # Look for changes to the shape or texture of your nipples. Gently squeeze each nipple and look for discharge or blood. # Repeat these steps with your hands on your hips, over your head, and at your side. # Raise your right arm and examine every part of your left breast. Move in increasingly smaller circles, from the outside in, using the pads of your index and middle fingers. # Gently press and feel for lumps or thickenings of the breast area and outside your breast, such as under your arm. # Using body cream, if necessary, continue to circle and gently massage the area outside your breast and under your arm. # Repeat with your left arm and right breast.
1. The mother is 35 or older at the time of delivery. The probability of fetal malformation increases with age. Up to 35, the increase in probability is slow; but after 35, probability of fetal malformation increases rapidly. 2. The mother has delivered a baby with chromosome abnormalities. 3. One of the parents is a balanced translocation carrier or has abnormalities with chromosome structure. 4. A close relative has Down Syndrome or other chromosome abnormality. 5. There is a danger of Mendelian or polymeric genetic diseases such as cleft lip, cystic fibrosis, and Tay-Sachs disease. 6. In the past, children or parents have had a neural-tube defect, or the mother's blood serum (fetoprotein or triple screen) test results were abnormal. 7. The fetus appears abnormal on ultrasound. 8. Mother has given birth to a baby with multiple major malformations, but has not received a cytogenetic examination. 9. There is danger of a severe sex-linked genetic disease, and the sex of the baby needs to be determined. 10. A significant answer has been given to a genetic screening question. 11. The mother is worried about fetal deformation and requests an examination.
Examining the amniotic fluid
Generally, it is ideal to perform or undergo an amniocentesis between the 15th and 18th week of the pregnancy, when the success rate for cultivating fetal cells is high. However, since it takes 3 weeks to cultivate cells, abnormalities may not be discovered until the 5th month of the pregnancy. Recently, early amniocentesis examinations have been performed between the 11th and 14th weeks of gestation. An early amniocentesis carries a 2.5 times higher risk of miscarriage than an amniocentesis conducted during weeks 15 through 18.
How the fluid is examined
After the mother's abdomen is draped and prepped, a 3- to 6-inch needle is used to penetrate the abdomen and uterus to collect amniotic fluid from the amniotic sac. Approximately 20-30 ml is needed for cultivation, and additional fluid may be collected for DNA analysis.
Complications with the examination
The three main dangers associated with amniocentesis are: injury to the mother and fetus, infection, and miscarriage or premature labor.
(For mothers with Rh-negative blood who are bleeding, special precautions and procedures will be necessary to avoid iso-immunization in the mother).
The chance of losing a baby from an amniocentesis performed during weeks 15 to 18 is approximately 1 in 200 to 1 in 300 procedures, similar to the chance of losing a baby during this time if an amniocentesis was not performed. Therefore, an amniocentesis performed during weeks 15 to 18 is considered relatively safe.
Most pregnant women can safely undergo an amniocentesis. Special circumstances that prevent the use of an amniocentesis are: if symptoms of infection are present; if the woman refuses to undergo the procedure; if danger of a premature birth exists.