A type of mammoplasty.
It takes up to 15 years to train a surgeon from the time at which he or she enters medical school; after graduating as a doctor a surgeon has to pass a comprehensive two-stage examination to become a fellow of one of the ?ve recognised colleges of surgeons in the UK and Ireland.
Surgery is carried out in specially designed operating theatres. Whereas it used to necessitate days and sometimes weeks of inpatient hospital care, many patients are now treated as day patients, often under local anaesthesia, being admitted in the morning and discharged later in the day.
More complex surgery, such as transplantation and neurosurgery, usually necessitates patients being nursed post-operatively in high-dependency units (see INTENSIVE THERAPY UNIT (ITU)) before being transferred to ordinary recovery wards. Successful surgery requires close co-operation between surgeons, physicians and radiologists as well as anaesthetists (see ANAESTHESIA), whose sophisticated techniques enable surgeons to undertake long and complex operations that were unthinkable 30 or more years ago. Surgical treatment of cancers is usually done in collaboration with oncologists. Successful surgery is also dependent on the skills of supporting sta? comprising nurses and operating-theatre technicians and the availability of up-to-date facilities.... surgery
Heart transplant Replacement of a person’s unhealthy heart with a normal heart from a healthy donor. The donor’s heart needs to be removed immediately after death and kept chilled in saline before rapid transport to the recipient. Heart transplants are technically demanding operations used to treat patients with progressive untreatable heart disease but whose other body systems are in good shape. They usually have advanced coronary artery disease and damaged heart muscle (CARDIOMYOPATHY). Apart from the technical diffculties of the operation, preventing rejection of the transplanted heart by the recipient’s immune system requires complex drug treatment. But once the patient has passed the immediate postoperative phase, the chances of ?ve-year survival is as high as 80 per cent in some cardiac centres. A key di?culty in doing heart transplants is a serious shortage of donor organs.... heart surgery
The size and shape and general appearance of the breasts may vary during the menstrual cycle, during pregnancy and lactation, and after the menopause.
During pregnancy, oestrogen and progesterone, secreted by the ovary and placenta, cause the milkproducing glands to develop and become active and the nipple to become larger.
Just before and after
childbirth, the glands in the breast produce a watery fluid known as colostrum.
This fluid is replaced by milk a few days later.
Milk production and its release is stimulated by the hormone prolactin.... breast
The first sign of breast cancer may be a painless lump. Other symptoms may include a dark discharge from the nipple, retraction (indentation) of the nipple, and an area of dimpled, creased skin over the lump. In 90 per cent of the cases, only 1 breast is affected. The cancer may be suspected after discovering a lump during breast self-examination or mammography. If a lump is detected, cells will be collected from it by needle aspiration or surgical biopsy. If the lump is cancerous, the treatment given depends on the woman’s age, the size of the tumour, whether or not there are signs of spread to the lymph nodes, and the sensitivity of the tumour cells to hormones, as assessed in the laboratory. A small tumour, with no evidence of having spread outside the breast, is removed surgically. Lymph nodes in the armpit are also commonly removed at the same time. Surgery may be combined with radiotherapy and/or anticancer drugs.
Secondary tumours in other parts of the body are treated with anticancer drugs and hormones. Regular check-ups are required to detect recurrence or the development of a new cancer in the other breast. If the cancer recurs, it can be controlled, in some cases, for years by drugs and/or radiotherapy.... breast cancer
MIS is commonly carried out by means of an operating laparoscope (a type of ENDOSCOPE) that is slipped through a small incision in the skin. MIS now accounts for around 50 per cent
of all operations carried out in the UK. A small attachment on the end of the laparoscope provides an image that can be magni?ed on a screen, leaving the surgeon’s hands free to operate while his assistant operates the laparoscope. Halogen bulbs, ?breoptic cables and rod lenses have all contributed to the technical advancement of laparoscopes. Operations done in this manner include extracorporeal shock-wave LITHOTRIPSY for stones in the gall-bladder, biliary ducts and urinary system; removal of the gall-bladder; appendicectomy; removal of the spleen and adrenal glands; and thoracic sympathectomy. MIS is also used to remove cartilage or loose pieces of bone in the knee-joint.
This method of surgery usually means that patients can be treated on a day or overnight basis, allowing them to resume normal activities more quickly than with conventional surgery. It is safer and lessens the trauma and shock for patients needing surgery. MIS is also more cost e?ective, allowing hospitals to treat more patients in a year. Surgeons undertake special training in the use of MIS, a highly skilled technique, before they are permitted to use the procedures on patients. The use of MIS for hernia repair, colon surgery and repairs of duodenal perforations is under evaluation and its advantages will be enhanced by the development of robotic surgical techniques.... minimally invasive surgery (mis)
Alternatives:– External treatment. Lotion – few drops Tincture Arnica in eggcup of water. Aloe Vera or Comfrey cream. Marshmallow and Slippery Elm ointment. ... breast, guitar nipple
Rosemary. 1 teaspoon leaves to cup boiling water; infuse 15 minutes. Half-1 cup 2-3 times daily.
Tea. Formula. Equal parts leaves, Agnus Castus, Rosemary, Balm. 1-2 teaspoons to each cup boiling water; infuse 15 minutes; 1 cup 2-3 times daily.
Evening Primrose oil. 10 drops (or 2 × 250ml capsules) 3 times daily.
Poke root. Internally and externally.
Yorkshire gypsy device: fix a cabbage or a rhubarb leaf beneath brassiere.
Liquid Extract Blue Cohosh BHP (1983): 0.5-1ml, Thrice daily. Alternative: Liquid Extract Rosemary BHP (1983): 2-4ml. Thrice daily.
Vitamins. All-round multivitamin and mineral supplement. Vitamin C (1g daily). Vitamin E (400iu daily). ... breast (female) tenderness, pain
Symptoms. A small lump comes to light while washing, a discharge from the nipple, change in nipple size and colour, irregular contour of the breast surface. Though tissue change is likely to be a cyst, speedy diagnosis and treatment are necessary. Some hospital physicians and surgeons are known to view favourably supportive herbal aids, and do not always think in terms of radical mastectomy. Dr Finlay Ellingwood, Chicago physician (1916) cured a case by injection of one dram Echinacea root extract twice a week into the surrounding tissues.
The condition is believed to be due to a number of causes including suppression of ovulation and oestrogen secretion in pregnant and lactating women. A high fat diet is suspected of interference with the production of oestrogen. Some women are constitutionally disposed to the condition which may be triggered by trauma or emotional shock. Increase in incidence in older women has been linked with excessive sugar consumption. “Consumption overwhelms the pancreas which has to ‘push it out’ to all parts of the body (when broken down by the digestive process) whether they need it or not. The vital organs are rationed according to their requirements of nutrients from the diet. What is left over has to ‘go into store elsewhere’. And the breast is forced to take its share and store it. If it gets too much, for too long, it may rebel!” (Stephen Seely, Department of Bacteriology and Virology, Manchester)
“Women who nurse their babies less than one month are at an increased risk for breast cancer. The longer a woman breast-feeds – no matter what her age – the more the risk decreases. (Marion Tompson, co-founder, The La Leche League, in the American Journal of Epidemiology)
Lactation reduces the risk of pre-menopausal breast cancer. (Newcomb P.A. et al New England Journal of Medicine, 330 1994)
There is currently no treatment to cure metastatic breast cancer. In spite of chemotherapy, surgery and radiotherapy survival rate has not diminished. Herbs not only have a palliative effect but, through their action on hormone function offer a positive contribution towards overcoming the condition. Their activity has been widely recorded in medical literature. Unlike cytotoxic drugs, few have been known to cause alopecia, nausea, vomiting or inflammation of the stomach.
Treatment by a general medical practitioner or oncologist.
Special investigations. Low radiation X-ray mammography to confirm diagnosis. Test for detection of oestrogen receptor protein.
Treatment. Surgery may be necessary. Some patients may opt out from strong personal conviction, choosing a rigid self-disciplined approach – the Gentle Way. Every effort is made to build up the body’s natural defences (immune system).
An older generation of herbalists believed tissue change could follow a bruise on the breast, which should not be neglected but immediately painted with Tincture Arnica or Tincture Bellis perennis.
Vincristine, an alkaloid from Vinca rosea (Catharanthus roseus) is used by the medical profession as an anti-neoplastic and anti-mitotic agent to inhibit cell division.
Of possible therapeutic value. Blue Flag root, Burdock root, Chaparral, Clivers, Comfrey root, Echinacea, Figwort, Gotu Kola, Marshmallow root, Mistletoe, Myrrh, Prickly Ash bark, Red Clover, Thuja, Wild Violet, Yellow Dock.
Tea. Equal parts: Red Clover, Clivers, Gotu Kola, Wild Violet. 1 heaped teaspoon to each cup boiling water; infuse 5-15 minutes. 3 or more cups daily.
Decoctions. Echinacea, Blue Flag root, Queen’s Delight, Yellow Dock.
Tablets/capsules. Blue Flag root, Echinacea, Poke root, Mistletoe.
Formula. Echinacea 2; Gotu Kola 1; Poke root 1; Mistletoe 1; Vinca rosea 1. Mix. Dose: Powders: 500mg (two 00 capsules or one-third teaspoon). Liquid extracts: 1 teaspoon. Tinctures: 2 teaspoons. Thrice daily and at bedtime. According to progress of the disease, increase dosage as tolerated.
Maria Treben’s tea. Parts: Marigold (3), Yarrow 1; Nettles 1. Mix. 2 teaspoons to each cup boiling water. 1 cup as many times daily as tolerated.
William Boericke, M.D. recommends Houseleek. E.H. Ruddock M.D. favours Figwort.
Topical. Treatments believed to be of therapeutic value or for use as a soothing application.
(1) Cold poultice: Comfrey root.
(2) Poultice of fresh Marshmallow root pulped in juicer.
(3) Injection of Extract Greater Celandine (Chelidonium), locally, gained a reputation in the Eclectic school.
(4) The action of Blood root (Sanguinaria) is well known as a paint or injection.
(5) Ragwort poultice: 2oz Ragwort boiled in half a pint potato water for 15 minutes. See: POULTICE.
(6) Popular Russian traditional remedy: Badiaga (Spongilla fluviatilis), fresh water sponge gathered in the autumn; dried plant rubbed to a powder. Poultice.
(7) Maria Treben’s Poultice: Carefully washed fresh Plantain leaves, pulped, and applied direct to the lesion.
(8) If lymph glands are affected, apply Plantain poultice to glands.
(9) Dr Brandini’s treatment. Dr Brandini, Florence, used 4 grains Citric Acid (prepared from lemons) in 1oz (30ml) water for ulcerated cancer of the breast considered incurable. “The woman’s torments were so distressing that neither she nor other patients could get any rest. Applying lint soaked in the solution, relief was instantaneous. Repeated, it was successful.”
(10) Circuta leaves. Simmered till soft and mixed with Slippery Elm bark powder as a poultice morning and night.
(11) Decoction. Simmer gently Yellow Dock roots, fine cut or powdered, 1oz to 1 pint, 20 minutes. Saturate lint or suitable material and apply.
(12) Yellow Dock ointment. Half ounce Lobelia seed, half ounce Yellow Dock root powder. Baste into an ointment base. See: OINTMENT BASE.
(13) Infusion, for use as a wash. Equal parts: Horsetail, Red Clover, Raspberry leaves. 1oz to 1 pint boiling water infuse 15 minutes.
(14) Dr Christopher’s Ointment. Half an ounce White Oak, half an ounce Garden Sage, half an ounce Tormentil, half an ounce Horsetail, half an ounce Lemon Balm. Method: Boil gently half an hour in quart water, strain. Reduce to half a pint by simmering. Add half a pound honey. Bring to boil. Skim off scum. Allow cool. Apply: twice daily on sores.
(15) Dr Finlay Ellingwood. Poke root juice. “Fresh juice from the stems, leaves and roots applied directly to diseased tissue. Exercises a selective action; induces liquefaction and promotes removal, sometimes healing the open wound and encouraging scar formation. Masses of such tissue have been known to be destroyed in a few weeks with only a scar, with no other application but the fresh juice. Produces pain at first, but is otherwise harmless.”
(16) Lesion painted with Mandrake resin. (American Podophyllum)
(17) Dust affected parts with Comfrey powder. Mucilage from Comfrey powder or crushed root with the aid of a little milk. See: COMFREY.
(18) Dr Samuel Thomson’s Cancer Plaster. “Take heads of Red Clover and fill a kettle. Boil in water for one hour. Remove and fill kettle with fresh flower heads. Boil as before in the same liquor. Strain and press heads to express all the liquor. Simmer over a low fire till of the consistency of tar. It must not burn. Spread over a piece of suitable material.”
(19) Wipe affected area with cut Houseleek. (Dr Wm Boericke)
(20) Chinese Herbalism. Take 1-2 Liang pulverised liao-ko-wang (Wickstroemia indica), mix with cold boiled water or rice wine for local compress. Also good for mastitis.
(21) Italian women once used an old traditional remedy – Fenugreek tea.
(22) A clinical trial of Vitamin D provided encouraging results. Patients with locally advanced breast cancer were given a highly active Vitamin D analogue cream to rub on their tumours. “It was effective in one third of the tumours,” said Professor Charles Coombes, clinical oncologist, Charing Cross Hospital, London.
Diet. “A diet rich in cereal products (high in dietary fibre) and green leafy vegetables (antioxidants) would appear to offer women some protection against breast cancer due to the relation between fibre and oestrogen metabolism. Meat-free diet. In a study of 75 adolescent girls, vegetarians were found to have higher levels of a hormone that women suffering from breast cancer often lack. (Cancer Research) Supplements. Daily. Chromium. Selenium (600mcg). Zinc chelate (100mg morning and evening). Beta carotene. “Low levels of Selenium and Vitamins A and E are shown in breast cancer cases.” (British Journal of Cancer 49: 321-324, 1984).
Vitamins A and D inhibit virus penetration in healthy cell walls. Multivitamin combinations should not include Vitamin B12, production of which in the body is much increased in cancerous conditions. Vitamins B-complex and C especially required.
Note: A link between sugar consumption and breast cancer has been reported by some authorities who suggest that countries at the top of the mortality table are the highest also in sugar consumption; the operative factor believed to be insulin.
Screening. Breast screening should be annual from the age of forty.
General. Mothers are encouraged to breast-feed children for the protection it offers against mammary malignancy. (Am.J. Obstet. Gyn. 15/9/1984. 150.)
Avoidance of stress situations by singing, playing an instrument. Adopt relaxation techniques, spiritual healing and purposeful meditation to arouse the immune system; intensive visualisation. Avoid the carcinogens: smoking, alcohol.
Information. Breast Cancer Care. Free Help Line. UK Telephone: 0500 245345. ... cancer - breast
Prominent cyst formations have been reduced, even eliminated by Poke root, internally and externally, though surgery is sometimes indicated. Diuretics influence the kidneys to expel more body fluids and are sometimes helpful to reduce size. Cold water packs may be applied to the affected area two or more times daily, as practical.
Alternatives. Tea. Formula. Equal parts: Ground Ivy, Clivers, Horsetail. One heaped teaspoon to each cup boiling water; infuse 15 minutes. 1 cup morning and evening.
Poke root. Tablets, powders. Tincture. 5-10 drops in water 3 times daily.
Evening Primrose oil. Two 500mg capsules, 3 times daily. Trials carried out by departments of Surgery at the University of Wales and the University of Dundee found Evening Primrose oil effective and safe. Poultice. Poke root. Horsetail.
Diet. As salt favours retention of fluid in cystic tissue it should be restricted.
Supplements. Daily. Beta carotene; B-complex; B6, Vitamin C 1g; Zinc. Vitamin E contra-indicated.
Treatment by or in liaison with a general medical practitioner. ... fibrocystic breast disease (fbd)
Formula. Fringe Tree bark 2ml; Black root 7ml; Echinacea 4ml; Distilled water to 4oz (120ml). Dose: teaspoon every two hours. (W.H. Black MD, Tecumseh, Oklahoma, USA)
Hypertrophy. Equal parts: tinctures Goldenseal and Fringe Tree. 15-60 drops in water before meals and at bedtime.
Diet. Low fat. Artichokes, Dandelion coffee, lecithin.
Supplements. Vitamin B6. ... liver enlargement
(1) Arises from the exertions of professional athletes. Extra strain enlarges the heart and calls for compensation. Other causes: high blood pressure and diseased valves.
(2) From anaemia, thyroid disorder, or extra strain demanded by fever. Thin walls always lead to heart weakness, robbing the organ of its maximum power.
Treatment. When compensation is delayed cardiac supportives include Bugleweed (American) to increase force of contractions of the heart and reduce the rate BHP (1983).
Right ventricular enlargement – Stone root.
Left ventricular enlargement – Lily of the Valley.
Both remedies have the advantage of being diuretics, thus aiding elimination of excess fluids.
Diet. See: DIET – HEART AND CIRCULATION. ... heart – enlargement
In suction lipectomy (liposuction), a rigid hollow tube is inserted through a small skin incision and use to break up large areas of fat, which can then be sucked out through the instrument.
Minor irregularities and dimpling of the skin commonly occur after surgery.... body contour surgery
Cardiovascular surgery includes operations to prevent or repair damage caused, for example, by congenital heart disease (see heart disease, congenital), atherosclerosis, or a myocardial infarction (heart attack).
Procedures include heart valve surgery, coronary artery bypass, and heart transplant.... cardiovascular surgery
Cosmetic surgery techniques include the removal of skin blemishes or dermabrasion; rhinoplasty to alter the shape or size of the nose; face-lifts; mammoplasty to reduce or enlarge the breasts; body contour surgery to remove excess body fat and tissue; hair transplants; blepharoplasty to remove excess skin on the eyelids; and mentoplasty to alter the size or shape of the chin.
All cosmetic surgery carries the risk of side effects from the anaesthetic, as well as of complications of the procedure itself.... cosmetic surgery
At least 90 per cent of lumps are noncancerous; the rest are breast cancer.
Many women have generally lumpy breasts, with the lumps more obvious in the days before a period.
Once known as fibrocystic disease or fibroadenosis, this is now considered to be a variation of normal.
Lumpy breasts do not increase the risk of developing breast cancer.
However, any new, distinct, or separate lump should be assessed by a doctor.
In a young woman, a single lump is most likely to be a fibroadenoma.
This noncancerous growth is usually round, firm, and rubbery, causes no pain, and can be moved about beneath the skin using the fingertips.
In an older woman, a lump is more likely to be a noncancerous, fluid-filled breast cyst.
Regular breast self-examination may detect any changes.
Treatment depends on the cause and type of lump.
Cysts can be drained in a simple outpatient procedure.
Other lumps can be removed surgically.... breast lump
and other changes that might be an indication of early breast cancer. To carry out self-examination, the breasts should be checked in a mirror for any dimpling of the skin or changes in the nipples or breast size and shape. Then, with one arm behind the head, and using small circular movements, the breast should be gently but firmly pressed. The entire breast, armpit area, and nipple should be examined. Regular self-examination helps a woman to become familiar with the appearance and feel of her breasts; any changes should be reported to a doctor without delay.... breast self-examination
Cyclical tenderness may be relieved by reduced caffeine intake, relaxation
exercises for stress, a well-fitting bra, or weight loss to reduce breast size.
If these measures do not work, hormonal treatment may be recommended.... breast tenderness
Stereotaxic procedures can be used to treat pituitary tumours; for a brain biopsy; or to destroy small areas of the brain to treat disabling neurological disorders.... stereotaxic surgery
Rejection is a major problem. However, a combination of a corticosteroid drug and ciclosporin are given in order to suppress this response.
Every patient who undergoes an organ transplant operation must take immunosuppressant drugs indefinitely. (See also heart transplant; heart–lung transplant; liver transplant; kidney transplant.)... transplant surgery
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