Doctor’s blog

Types of mammography:

Mammography is of two types. One type of mammography is screening mammography and the other type is diagnostic mammography. These two types of mammography should not be confused, as they are separate and their aims are separate. Screening mammography is performed after detection of palpable breast mass. Diagnostic mammography is for evaluating the rest of the breast before biopsy is performed or sometimes it is done as part of the triple-test strategy to exclude immediate biopsy.  

Screening mammography can detect some nonspecific abnormalities (clustered micro-calcifications, densities and new or enlarging architectural distortions) and these should be evaluated carefully by compression or magnified views.

What should be done after mammography?

(a)    If there is no palpable lesion and detailed mammography studies are clearly (unequivocally) benign, the patient should be follow-up routinely, which is appropriate to the patient’s age.

(b)   If breast lesion is not palpable, but some abnormality in the mammogram is seen, ultrasound can be sometimes helpful either to identify the lesion or to guide biopsy.

(c)    If a non-palpable lesion of mammography has a low index of suspicion, it should be followed-up in 3 to 6 months.

(d)   Indeterminate and suspicious lesions should be biopsied, because the procedure can eliminate need of additional surgery.

(e)    If the chance of malignancy is high, open biopsy should be performed with a needle localization technique. But some experts suggest use of core biopsies for non-palpable lesions because they are cost-effective and because diagnosis leads to earlier treatment planning (but after a breast biopsy with needle localization technique, which means local excision, of a diagnosed malignancy, re-excision may still be necessary to achieve negative margins).     

No society or nation is immune to drug addiction problem. Drug addiction is basically a social problem, but the main management of drug addiction is medical management. Society can help to prevent drug addiction and also help in after care of drug addicts, in ways of motivation, providing suitable employment and giving moral support. Without the support of society the chance of relapse of drug addiction after successful drug addiction treatment can be very high.

Treatment of drug addiction can be very difficult. For successful treatment of drug addicts, the most important factor is the motivation of the addict. If the drug addict is motivated the drug treatment can be successful. The drug addict should come in term with a possibility of life without drug (but unfortunately drug addicts have little or no motivation to undergo treatment). The successful drug treatment needs holistic approach which covers all aspects of drug treatment like medical, psychological, social, as well as spiritual aspects of treatment. An ideal drug treatment center should have a drug treatment programs that is based on individual requirements where each patient (drug addict) is individually addressed, for a wide range of therapeutic interventions to help each patient achieve their specific goals of treatment. Each drug treatment center should have good team of dedicated professionals (doctors), technical staffs and also supporting staff.

There are many drug treatment centers throughout the world United States as there are more drug addicts in United States than anywhere in the world. There are also drug addiction treatment centers throughout the world (as drug addiction is a global problem).

Finally the success of drug addiction treatment depends on the individual addict. The better the cooperation from the addict the more successful is the drug de-addiction treatment. If the drug addict is not motivated the chances of success of treatment of addiction may not be successful in the long run (there may be relapse of drug addiction). To prevent drug addiction relapse the most important is regular review and to provide a proper rehabilitation with a suitable job. 

Chilblain and Immersion Foot are cold injuries that develop in non freezing temperature. Both of these cold injuries are common in compare to frostbite which is the extreme form of cold injury and is not very common. Both these cold injuries cause peripheral injuries and different in their own ways.

Chilblain develops due to dry cold. The cause of chilblain is neuronal and endothelial damage which is induced by repetitive exposure to dry cold. At greater risk of developing chilblain are young females, especially those with a history of Raynaud’s phenomenon (there is constriction of peripheral blood vessels). Persistent vasospasticity and vasculitis (inflammation of blood vessels) can cause erythema, mild edema, and pruritus or itching. All these cause development of plaques, blue nodules, and ulcerations of the affected parts. These lesions typically involve the back side of the hands and feet.

Immersion Foot is also known as “trench foot” as this type of cold injury is due to repetitive exposure non freezing wet cold and was extensively seen in the First World War among soldiers who took position in trenches and were filled with cold water. The feet appear bluish, cold, and edematous at the beginning of cold injury (Immersion Foot). Then subsequently bullae develop which is often difficult to distinguish from frostbite. These bullae rapidly progresses to ulceration and liquefaction gangrene (death of tissue). Patients with milder cases of Immersion Foot complain of hyperhidrosis, cold sensitivity, and painful ambulation that may be seen for many years after cold injury.