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By T. Basir. A. T. Still University.

Local infiltration is an early feature of these tumors with spread by lymphatics and blood stream cheap 4 mg zofran visa. They are extremely lethal tumors with death occurring in most cases within months generic zofran 4mg online. Many lesions present in advanced stages with tracheal obstruction and require urgent tracheal decompression discount 8mg zofran otc. Radiotherapy should be given in all cases and may provide a worth while period of palliation. Compare and contrast papillary and follicular thyroid carcinoma with respect to root of metastasis, overall mortality and location of recurrence? This is due to lack of screening facilities, low index of suspicion among health professionals, poverty and lack of knowledge. Benign conditions of the breast are important because of the discomfort they produce and frequent confusion with neoplastic disease. Anatomy nd • The protuberant part of the human breast is generally described as overlying the 2 th to 6 ribs, • It extends from the lateral border of the sternum to the anterior axillary line, between th th clavicle and to the 7 and 8 ribs below. The nipple contains smooth muscle fibers arranged concentrically and longitudinally. These could be secondary to either benign disease conditions, or fatal carcinomas. Students should be familiar with some of differentiating mechanisms between malignant and benign breast lumps. Breast cysts This is a rare condition which may occur in the last decade of reproductive life due to a non- integrated involution of stroma and epithelium. If there is residual lump after aspiration, if fluid is blood stained, or if cyst recurs, local excision for histological diagnosis is advisable. Fibroadenoma Usually occurs during 15-25 years of age and arises from hyperplasia of a single lobule. Most fibroadenomas can be excised through periareolar incision with good cosmetic result. Phyllodes Tumor • Are benign tumors • Usually occur in women over 40 years but can appear in younger woman. Ductectasia/ periductal mastitis Definition: This is dilatation of the breast ducts associated with periductal inflammation. Pathogenesis: Dilatation of lactiferous ducts that will be subsequently filled with a stagnant brown or green secretion. The fluid sets up an irritant reaction in surrounding tissue leading to periductal mastitis, even abscess or fistula formation. When the diagnosis of carcinoma is in doubt There are cases where one cannot be sure whether the particular lump in the breast is area of mammary dysplasia, benign tumor or an early carcinoma. If there is doubt on clinical, cytological or radiological examination, it is essential to obtain a tissue diagnosis. Bacterial mastitis is the commonest variety of mastitis and nearly always commences acutely. It is associated with lactation in the majority of cases 136 Cause Most cases are caused by staphylococcus aureus. Clinical presentation o Pain o Swelling o Redness o Tenderness and hotness of the affected side. Complication: - breast abscess If acute infection of breast doesn’t resolve with in 48 hours, or if after emptied of milk there is an area of tense induration, the inflammation has resulted in an abscess. Unlike majority of localized infections; fluctuation is a late sign so incision must not be delayed. Drainage of breast abscess Under general or local anesthesia, incision is sited in a radial direction over the affected segment. Every part of abscess is palpated against the point of hemostat and its jaw opened, all loculi that can be felt are entered. Finally the hemostat having been removed, a finger is introduced and any remaining septa are disrupted. The wound may then be lightly packed with gauze or drain inserted to allow dependent drainage. Carcinoma of the Breast Breast cancer is the commonest cause of death in middle-aged women in western countries. Risk factors • Geographical - it occurs commonly in the western world accounting for 3-5 percent of deaths but is rare tumor in Far East like Japan. Pathology: Breast cancer may arise from the epithelium of the duct system starting from the nipple to the end of lactiferous ducts which is in the lobule. It may be entirely in situ (with out breaching basement membrane) or may be invasive. The degree of differentiation of a tumor is usually described by three grades well differentiated, moderately or poorly differentiated. It tends to involve the skin and to penetrate the pectoral muscles, and even the chest wall.

The tenth cranial nerve called vagus buy zofran 8 mg on line, give branches to the larynx order zofran 4 mg without a prescription, lungs purchase zofran 4mg mastercard, and heart and digestive organs. The Spinal Cord: The spinal cord is a cord of nervous tissue, the thickness of a little finger and about 12cm long. It connects above with the medulla where the back of the neck joins the skull and extends to the level of the first lumbar vertebrae. Functions of the Spinal Cord: 1) Receives motor impulses from the frontal lobe of the cerebrum, and passes them on to muscles via the spinal nerves. If you touch something hot, the message received in the spinal cord is immediately flashed to the muscles of the arm; before the news reaches the brain you have taken your hand away. It is a loose covering and under is a space called ‘theca’ (sub arachnoid space) containing cerebro spinal fluid (C. A little cerebrospinal fluid is sometimes removed by ‘lumbar puncture’ to help in diag­ nosing disease of the nervous system. Functions of Cerebrospinal Fluid: Ø It acts as a water cushion to protect the brain and spinal cord from shocks and jarring. The Autonomic Nervous Systems It is the second system of the nerves that controls the movements of the involuntary muscles and the secretion of the glands. We have no control over these nerves although they are closely connected with the central nervous system. Sympathetic Systems: This consists of two chains of ganglia (groups of nerve cells) one on each side of the vertebral column. The results of the sympathetic nerve stimuli are: 1) dilated pupils 2) the heart beats quicker 3) breathing is quicker and deeper 4) the blood pressure is raised 5) digestion is slowed down 6) sweating is increased and 7) anal and urethral sphincters tighten up. It is the means by which food, oxygen, water and other requirements are conveyed to the tissue calls, and their waste products are carried away. It is about the size of a person’s clenched fist and weighs around 300 gm in a man and 250gm in a woman. The right and left sides of the heart are totally separated by a muscular wall and there is no communication between them. The right side of the heart receives the deoxygenated (impure) blood collected from the different parts of the body through small and big veins, which enters the lungs. In the lungs the blood is oxygenated and carbon­di­oxide and metabolic waste are removed The left side of the heart receives (pure) blood from the lungs and supplies it to the entire body through the major blood vessel (aorta) and its numerable branches (arteries and capillaries). The left ventricle generates greater pressure than the right ventricle to enable the bold to be pumped throughout the body. The coronary arteries branch out (left and right coronary arteries) from the root of the aorta near its origin from the left ventricle. Both the coronary arteries branch of into smaller vessels, which are distributed all over the surface of the heart. For efficient pumping, it is necessary for the heart to beat at a reasonable rate of 60 – 90 beats per minute, which is achieved through controlled electrical impulses (conductive system). Plasma is important for the life of the tissue cells, conveying to them water and nourishment, and carrying away their waste products. They are very tiny disc with no nucleus, and are filled with haemoglobin, which is made from iron and protein. They can change shape and squeeze through the small bood vessel walls in order to fight gems that have entered the tissues. In acute infection many more leucocytes are produced to help in the fight (leucocytosis) 2) Lymphocytes are produced in the spleen and lymph glands. They are found mainly grouped together in the neck, axilla, and groins and in the pelvic and abdominal cavities. Functions of Lymph: Lymph glands help to protect the body from infection by 1) Filtering the lymph to prevent germs from getting into the blood stream, and fighting to overcome them. Once the food is digested, it must be transferred to the blood stream and the process by which this transfer occurs is called absorption. The Alimentary Canal: The alimentary canal is a long muscular digestive tube extending through the body. Functions of Digestive System: 1) Break down the food substances into small particles 2) Digestion of food substances. The alimentary canal,which is a continuous, passage way beginning at the mouth, where the food is taken in and terminating at the anus where the solid products of digestion, which are not absorbed, are expelled from the body. The accessory organs – which are vitally necessary for the digestive process, do not happen to be the part of the alimentary canal. They are: 1) Mouth – with the help of saliva from three pairs of salivary glands, 2) Stomach – with the help of gastric juice from the stomach wall and 3) Small intestine – with the help of pancreatic juice from the pancreas bile juice from the liver and the intestinal juice from the small intestine. They are (1) Molars – 12 (2) Pre molars – 8 (3) Canines – 4 (4) Incisors – 8 The teeth help to break down the food substances into small particles. The tongue has on its surface a number of taste buds by means of which we can differentiate sensation of taste. Later by associating the sight and smell of food with its taste, the child learns that the food has certain qualities and these very qualities are after wards capable of eliciting salivary secretion.

Other superficial reflexes are not commonly tested generic zofran 8mg overnight delivery, though a series of abdominal reflexes can target function in the lower thoracic spinal segments purchase zofran 4mg overnight delivery. Testing reflexes of the trunk is not commonly performed in the neurological exam discount 4 mg zofran fast delivery, but if findings suggest a problem with the thoracic segments of the spinal cord, a series of superficial reflexes of the abdomen can localize function to those segments. If contraction is not observed when the skin lateral to the umbilicus (belly button) is stimulated, what level of the spinal cord may be damaged? Comparison of Upper and Lower Motor Neuron Damage Many of the tests of motor function can indicate differences that will address whether damage to the motor system is in the upper or lower motor neurons. The clasp-knife response occurs when the patient initially resists movement, but then releases, and the joint will quickly flex like a pocket knife closing. Forceful trauma to the trunk may cause ribs or vertebrae to fracture, and debris can crush or section through part of the spinal cord. The full section of a spinal cord would result in paraplegia, or loss of voluntary motor control of the lower body, as well as loss of sensations from that point down. The ascending tracts in the spinal cord are segregated between the dorsal column and spinothalamic pathways. This means that the sensory deficits will be based on the particular sensory information each pathway conveys. Sensory discrimination between touch and painful stimuli will illustrate the difference in how these pathways divide these functions. On the paralyzed leg, a patient will acknowledge painful stimuli, but not fine touch or proprioceptive sensations. The reason for this is that the dorsal column pathway ascends ipsilateral to the sensation, so it would be damaged the same way as the lateral corticospinal tract. The spinothalamic pathway decussates immediately upon entering the spinal cord and ascends contralateral to the source; it would therefore bypass the hemisection. The motor system can indicate the loss of input to the ventral horn in the lumbar enlargement where motor neurons to the leg are found, but motor function in the trunk is less clear. The likelihood of trauma to the spinal cord resulting in a hemisection that affects one anterior column, but not the other, is very unlikely. Either the axial musculature will not be affected at all, or there will be bilateral losses in the trunk. The pain fibers on the side with motor function cross the midline in the spinal cord and ascend in the contralateral lateral column as far as the hemisection. The dorsal column will be intact ipsilateral to the source on the intact side and reach the brain for conscious perception. The trauma would be at the level just before sensory discrimination returns to normal, helping to pinpoint the trauma. That may be all that is available on the scene when moving the victim requires crucial decisions be made. There is an obvious connection to motor function based on the clinical implications of cerebellar damage. The two are not incompatible; in fact, procedural memory is motor memory, such as learning to ride a bicycle. Significant work has been performed to describe the connections within the cerebellum that result in learning. A model for this learning is classical conditioning, as shown by the famous dogs from the physiologist Ivan Pavlov’s work. This classical conditioning, which can be related to motor learning, fits with the neural connections of the cerebellum. The cerebellum is 10 percent of the mass of the brain and has varied functions that all point to a role in the motor system. The word means “bridge” and refers to the thick bundle of myelinated axons that form a bulge on its ventral surface. Those fibers are axons that project from the gray matter of the pons into the contralateral cerebellar cortex. It includes a copy of the motor commands sent from the precentral gyrus through the corticospinal tract, arising from collateral branches that synapse in the gray matter of the pons, along with input from other regions such as the visual cortex. These connections describe a circuit that compares motor commands and sensory feedback to generate a new output. The cerebellum is divided into regions that are based on the particular functions and connections involved. The midline regions of the cerebellum, the vermis and flocculonodular lobe, are involved in comparing visual information, equilibrium, and proprioceptive feedback to maintain balance and coordinate movements such as walking, or gait, through the descending output of the red nucleus (Figure 16. The lateral hemispheres are primarily concerned with planning motor functions through frontal lobe inputs that are returned through the thalamic projections back to the premotor and motor cortices.