Posted by James
INTRODUCTION
Breast cancer is the most common cancer among women in the United States. It is diagnosed in approximately 240,000 women and kills an estimated 40,000 women each year. It is suspected that as the baby boomer population ages the absolute number of women diagnosed will rise by one-third over the next 20 years, increasing the number to 320,000 females diagnosed annually. The peak age of diagnosis is 45-65 years, with approximately 77% occurring in females age >50. Though screening recommendations vary among organizations, American Cancer Society guidelines for breast cancer screening consist of optional monthly self-breast exams starting at age 20, and clinical breast exams every 2-3 years until the age of 40, then annually. Yearly mammograms are initiated at the age of 40 as well, or earlier, based on preexisting risk factors. Multiple risk factors for breast cancer have been identified including: increasing age, presence in a first-degree relative, early menarche, nulliparity, delayed first pregnancy, prior personal history of breast cancer, endometrial cancer, abnormal breast biopsy, exogenous estrogen use, radiation exposure, geographical influence, diet and white race.
Read the rest of this entry »
Posted by James
CASE 2
A 60-year-old postmenopausal woman presented with 10 months history of painless left breast mass that increased rapidly in size three months prior to presentation. There was an associated productive cough, which subsided with cough mixture. Patient was a known hypertensive on generic adalat, moduretic and canadian atenolol. There was no history of previous surgery. Family and social history was not contributory. Physical examination revealed a middle-aged woman who weighed 63 kg. Her pulse was 96 beats/min, full, regular and blood pressure was 140/90. Respiratory rate was 22 cycles/min. The chest was clinically clear with good air entry bilaterally. She had an enlarged firm left breast with inverted nipple and peau d’orange skin change. There was associated ipsilateral non-tender, matted axillary lymph nodes and a few discrete, firm, nontender contralateral axillary lymph node enlargements. Hematological and serum biochemistry results were essentially normal. However, radiological examination of the chest showed widespread cannon-ball metastasis in both lung fields (Figure 3). Abdominal ultrasound showed stones in the gall bladder but no evidence of metastasis in the liver. Electrocardiogram (ECG) showed left atrial enlargement. FNAC of the left breast mass and ipsilateral axillary lymph node was positive for malignant cells.
Read the rest of this entry »
Posted by James
The patient was sedated overnight with oral diazepam 10 mg and premedicated with another 10 mg diazepam orally just before being transferred to the theater on the morning of operation.
Read the rest of this entry »
Posted by James
Mastectomy is a common surgical procedure for breast malignancies. General anesthesia is traditionally favored for the operation. However, there are situations when general anesthesia may be considered unsuitable. Regional anesthesia was chosen for mastectomy in our patients due to compromised pulmonary status, resulting from widespread malignant infiltrations of the lungs.
Read the rest of this entry »
Posted by James
INTRODUCTION
The era of regional anaesthesia dates back to 1884 when Koller discovered the anesthesia properties of cocaine. Since then, the scope of regional anesthesia has continued to widen and clinicians have succeeded in gaining access to almost every nerve in the body. Consequently, patients who for one reason or another are considered unsuitable for general anesthesia may now have their operations done under regional anesthesia. Such was the situation with the two patients discussed in this report. Since the breasts are ectodermal organs, which arose as a modification of the sweat glands, they are more or less superficial structures, which can be isolated and selectively blocked for surgical excision. Combining intercostal nerves block with infraclavicular and midline subcutaneous infiltration with local anesthetic provided effective and reliable anesthesia for simple mastectomy in the two patients.
Read the rest of this entry »
