Saturday 18 July 2015

Pubertal gynecomastia in boys - a bothersome condition

 Gynecomastia is a benign condition in males, which occurs due to proliferation of glandular elements resulting in concentric enlargement of one or both breasts.

It can be seen during puberty, due to transient relative imbalance between estrogen and testosterone.
Usually this condition can resolve by age 18 years when adult androgen and estrogen ratios are achieved.
If gynecomastia persists even after 18 years better to get evaluated.
By clinical assessment to estimate the testes volume, and by investigations like estimation of levels of testosterone, estradiol, gonadotropins etc and by doing karyotype, the possible cause of problem can be identified and treated.
Usually the mainstay in treatment of pubertal gynecomastia is sympathetic reassurance because of the benign nature of the condition.

 Surgery is needed only in boys who are having persistent gynecomastia even after completing of puberty or after completing 18 years.

Friday 17 July 2015

Screening methods of breast carcinoma which every women should be aware of

As early detection can decrease the morbidity of breast carcinoma, screening methods of  breast carcinoma are getting popular.
Every woman should be aware of these methods to protect herself from the complications of breast diseases.
Self breast examination, periodic mammography and sonomammography are commonly used and important methods that help in detecting breast problems at the earliest. to  detect breast problems earlier
  Self breast examination should be done monthly at same period of menstrual cycle preferably after completion of menstrual cycle. This is to avoid mistakes due to hormonal influenced breast changes. Woman should do self breast examination by standing in front of mirror. She should use the pads of her fingers to palpate the breast tissue.
First she should observe her breast in positions:
-Arms hanging beside the body
-Arms behind the head

-Arms keeping on waist and bending forward.

-Palpation of breast in circular movements or in longitudinal movements or in wedge pattern.
 Breast tissue should be palate upto axillary tail.
-Palpation of nipple

-Palpation of breast and nipple in lying down position.

If any abnormality is detected, she should consult the doctor and go for mammogram.

In mammography low energy x-rays are used to examine the breat tissue.
By identifying any possible masses or calcifications breast disease can be diagnosed.

Sonomammogram is breast ultrasound, which gives distinct images of the internal structures of the breast and helps in detecting breast diseases.

After 35 years every woman should undergo yearly mammogram or sonomammogram as screening method towards breast carcinoma.

Thursday 16 July 2015

Predicting the possible date of conception

According to the menstrual history of the women and coital history, the possible date of conception can be predicted to some extent.

Usually conception occurs around the time of ovulation.
With regular menstrual history the possibility of the ovulation can be predicted according to the previous cycles.
In case of regular 28 days menstrual cycles ovulation usually occurs between 12th to 16th day of the cycle, whereas in 30 days menstrual cycles ovulation can occur between 14th to 18th day of the cycle.
In case of regular lengthier cycles, usually ovulation is expected to occur during last 14 to 16 days of cycle.
So, if unprotected intercourse occurs around the period of ovulation, that can lead to pregnancy.
Sometimes spermatozoa can survive for around 4 to 5 days in female genital tract and ovum can be alive for 24 hours to 48 hours. This time period should also be considered while predicting the date of conception.
If menstrual cycles are irregular, it is difficult to predict the date of ovulation and conception.
In that case around three weeks prior to the date of first positive pregnancy test can be considered as possible conception period.
Ultrasound also helps in predicting the possible conception date.
Three weeks before appearance of gestational sac or four before appearance of fetal heart beat can be considered as possible conception period.
Uterus becomes abdominal organ usually at around 12 weeks. Ten weeks prior to the date of palpating the uterus per abdominally, can approximately give the date of conception.

Wednesday 15 July 2015

Microprolactinoma - possibility of recurrence

 Microprolactinoma is a small sized pituitary tumor which secreat prolactin in larger quantities.
Usually medical treatment can cure this condition.

But sometimes it may take longer periods for the treatment.
In case of persistent elevation of prolactin levels even after treatment, factors should be ruled out like:
-Thyroid hormonal abnormalities and kidney function abnormalities, which can affect prolactin levels.
-Some medicines can lead to increased prolactin levels like:
○The anti-sickness medicines metoclopramide and domperidone.
○Antidepressants of the selective serotonin reuptake inhibitor (SSRI) type.
○Some medicines used to treat schizophrenia or bipolar disorder.
-Prolactinomas can recur even after successful treatment with medication or surgery.
So monitoring with regular blood tests is needed to check that the prolactinoma has not come back.
If it recurs, then treatment should be restarted.

Intercourse during pregnancy

Many people express doubts regarding whether intercourse can be practiced during pregnancy.


In case of normal low risk pregnancy, intercourse may not cause complications.
But the safety of practicing intercourse during pregnancy depends on factors like:
-If the woman is having risk factors like:
•Previous miscarriages,
•Low lying placenta,

•Intermittent spotting or threatened abortion in present pregnancy,
•Partner with possible sexually transmitted diseases,
•Vaginal infection,
•Cervical incompetence, •Premature rupture of membranes,
•Cervical intraepithelial neoplasia etc,
better to avoid intercourse.
-During intercourse, better to prefer lateral position and avoid pressure on abdomen.
-If the woman develop any problems like postcoital bleeding, pain etc, better to avoid intercourse and have to consult her doctor.
Take care. 

Ultrasound in pregnancy

Nowadays ultrasound has became a very important investigation in pregnancy.
It helps in detecting the pregnancy, in monitoring the well being of the baby and to detect any abnormality, so that necessary action can be taken.
Some procedures like chorionic villi sampling, amniotic fluid reduction etc can be under ultrasound guidance.

Usually in low risk pregnancy ultrasound is advisable during:
-Around 5 to 6 weeks of pregnancy, to confirm the intrauterine pregnancy, to estimate the gestational age and to rule out ectopic pregnancy etc.
- Around 9 to 11 weeks, to estimate the expected date of delivery, to find out the nuchal thickness etc. This helps in  finding out risk factors like chromosomal abnormalities specially down syndrome.
-At around 18 to 20 weeks TIFFA scan 'Targeted imaging for fetal anomalies' is advised, which helps in finding out any fetal anomalies, so that necessary action can be taken accordingly.
Then further ultrasound scans can be planted according to the report.
Usually in normal low risk pregnancy further ultrasound examinations around 28 weeks, 36 weeks and before delivery are recommended to monitor the growth of the baby, estimate the amount of liquor, condition of placenta etc.
Any maternal and fetal complications can alter this schedule and need for more ultrasound examinations may arise depending upon the problem.

How to determine estimated date of delivery(EDD)

Detecting the estimated date of delivery(EDD) is important in the management of pregnancy.

EDD can be calculated according to the last menstrual period. This will be reliable if the woman is having the previous 3 regular menstrual cycles.
 Generally 9 months and 7 days from the last menstrual period can be considered as EDD.
 If woman is having irregular menstrual cycles or if there is any history of usage of birth control like contraceptive pills etc in last three months, the last menstrual period may not help in predicting the estimated date of delivery.
Other methods of evaluating the estimated date of delivery are evaluating the uterine size periodically.
 But sometimes obesity, altered position of the uterus, amount of the liquor etc can influence this method.
 The date of delivery can be calculated according to the first date of hearing the fetal heart tones.

Doppler devices can hear fetal heart tones at around 10 weeks whereas standard obstetrical stethoscope can hear at 20 weeks.
Expected date of delivery can be calculated according to the date of first positive pregnancy test. Adding 4 to 5 weeks to positive pregnancy date can give the approximate date of delivery.
Date of fruitful coitus can also help in finding the EDD. Around 8 months 3 weeks from the date of fruitful coitus or ovulation can approximately estimate the EDD.
 Ultrasound also helps in estimating the expected date of delivery.
 Usually early ultrasound at around 9 to 11 weeks gives accurate EDD. Whereas upto 24 weeks also ultrasound can help in estimating approximate EDD. But usually EDD by ultrasound alone is unreliable after 30 weeks.
Calculating the estimated date of delivery according to two parameters like last menstrual period and early ultrasound is more accurate and reliable compared with any single parameter.
But usually only 4 % of women deliver on expected date of delivery, whereas around 80% percent of women deliver during the period of 2 weeks before and one week after the expected date of delivery.