Sanomedics International Holdings (Pink Sheets: SIMH) announced a significant donation to Haiti earthquake relief efforts today, consisting of over $35,000 worth of the company’s Non-Contact Infrared Thermometers. Working with the University of Miami Miller School of Medicine, who will be providing immediate air shipment to Haiti and in-country distribution, Sanomedics hopes this donation will assist medical personnel identify potential disease outbreaks as quickly as possible.

The Sanomedics Non-Contact Infrared Thermometer can take a patient’s temperature in less than one second, without requiring physical contact. With proven accuracy comparable to any contact temperature method, Sanomedics’ non-contact products can help limit potential germ spread from patient to patient.

“The situation in Haiti is rapidly evolving, with an increasing possibility of a disease outbreak at any time,” stated Keith Houlihan, CEO of Sanomedics. “Accurate temperature scans, without spreading germs, is a first line of defense in dealing with a situation of such magnitude. Sanomedics looks forward to working with the University of Miami in distributing our equipment as quickly as possible, and helping the people of Haiti any way we can.”

“We sincerely appreciate Sanomedics’ contribution to the Haitian relief efforts, and their devices will be put to immediate use within the affected areas,” said Arthur Fournier, M.D., Professor of Family Medicine and Internal Medicine, Vice-Chairman of Family Medicine and Associate Dean for Community Health at the Miller School. “We look forward to continuing to work with Sanomedics as the situation continues to evolve.”

Source
Sanomedics International Inc.

Bladder cancer refers to any of several types of malignant growths of the tissues of the urinary bladder (the organ that stores urine). It is a disease in which abnormal cells multiply without control in the bladder. The most common type of bladder cancer begins in cells lining the inside of the bladder and is called transitional cell carcinoma (sometimes urothelial cell carcinoma). Other types include squamous cell carcinoma (cancer that begins in thin, flat cells) and adenocarcinoma (cancer that begins in cells that make and release mucus and other fluids). The cells that form squamous cell carcinoma and adenocarcinoma develop in the inner lining of the bladder as a result of chronic irritation and inflammation.

Contents

Signs and Symptoms
Causes
Diagnosis
Pathogenesis/Pathophysiology
Race
Sex
Age
Prevention
Treatment
Complications
Prognosis
References

Signs and Symptoms

Back to Top

Bladder cancer characteristically causes blood in the urine; this may be visible to the naked eye (frank hematuria) or detectable only by microscope (microscopic hematuria). Other possible symptoms include pain during urination, frequent urination (Polyuria) or feeling the need to urinate without results (anuria). These signs and symptoms are not specific to bladder cancer, and are also caused by non-cancerous conditions, including prostate infections and cystitis. Kidney cancer can also cause hematuria.

Other signs and symptoms include back or abdominal pain, and loss of appetite and weight.

Causes

Back to Top

Tobacco smoking is the main known cause of urinary bladder cancer: in most populations, smoking causes over half of bladder cancer cases in men and a sizeable proportion in women. There is a linear relationship between smoking and risk, and quitting smoking reduces the risk. In a 10-year study involving almost 48,000 men, researchers found that men who drank 1.5L of water a day had a significantly reduced incidence of bladder cancer when compared with men who drank less than 240mL (around 1 cup) per day. The authors proposed that bladder cancer might partly be caused by the bladder directly contacting carcinogens that are excreted in urine. Thirty percent of bladder tumors probably result from occupational exposure in the workplace to carcinogens such as benzidine. 2-Naphthylamine, which is found in cigarette smoke, has also been shown to increase bladder cancer risk. Occupations at risk are metal industry workers, rubber industry workers, workers in the textile industry, and people who work in printing. Some studies also suggest that auto mechanics have an elevated risk of bladder cancer due to their frequent exposure to hydrocarbons and petroleum-based chemicals. Hairdressers are thought to be at risk as well because of their frequent exposure to permanent hair dyes.

Diagnosis

Back to Top

Radiology

An Intravenous pyelogram (IVP) is a conventional x-ray test using dye to examine the pelves of the kidneys (where urine collects within the kidneys),ureters, and bladder. This x-ray allows visualization of the upper and lower urinary tract to determine the presence of any abnormality.

Computed Tomography (CT) scanning

It is essentially a detailed X-ray of the body. CT shows cross-sections of the body and allows your doctor to see details of the anatomy that would not be seen on regular x-ray.

Magnetic Resonance Imaging (MRI)

It is more sensitive than CT scanning. CT and MRI have the added benefit of detecting enlarged lymph nodes near the tumors, which can suggest that a cancer has spread (metastasized) to the lymph nodes.

Cystoscopy

Cystoscopy is performed by the urologist. It evaluates the bladder by direct visual examination with a specialized instrument called a cystoscope, which is placed in the bladder via the urethra during the examination. The purpose of routine outpatient cystoscopy is to evaluate the lining of the lower urinary tract. If abnormalities such as tumors, stones, or patches of abnormal appearing tissue are discovered during cystoscopy, a biopsy may be taken at that time.

Pathology

The diagnosis of bladder cancer is based on examining cells from the bladder, either from a urine specimen or biopsy of the bladder. Only a pathologist can diagnose if a bladder cancer is present and the type of bladder cancer, by looking at the bladder tissue. The correct diagnosis is critical, as appropriate treatment of bladder cancer is dependant upon the type of cancer seen. The pathology of the bladder is complex and therefore a second opinion is often advisable and can have a major impact in therapy.

The diagnosis can sometimes be made by examining urine cytology. A cytopathologist looks at individual cells from the urine, which are spread into a thin layer onto glass microscopic slides. These procedures have the benefit of not requiring an operation or general anesthesia.

Biopsy of the bladder, performed through the cystoscope, is the more common means of diagnosing these tumors. The pathologist will examine a small sample (a biopsy) of the bladder tissue under a microscope. The pathologist identifies whether the tumor is benign or malignant and the type of tumor. This is essential because tumors of different types behave very differently and require different treatment regimens.

Pathogenesis/Pathophysiology

Back to Top

Almost all bladder cancers are epithelial in origin. The urothelium consists of a 3- to 7-cell mucosal layer within the muscular bladder. Of these urothelial tumors, more than 90% are transitional cell carcinomas. However, up to 5% of bladder cancers are squamous cell in origin, and 2% are adenocarcinomas. Nonurothelial primary bladder tumors are extremely rare and may include small cell carcinoma, carcinosarcoma, primary lymphoma, and sarcoma.

Bladder cancer is often described as a polyclonal field change defect with frequent recurrences due to a heightened potential for malignant transformation. However, bladder cancer has also been described as a problem with implantation and migration from a previously affected site.

The World Health Organization classifies bladder cancers as low grade (grade 1 and 2) or high grade (grade 3). Tumors are also classified by growth patterns: papillary (70%), sessile or mixed (20%), and nodular (10%). Carcinoma in situ (CIS) is a flat, noninvasive, high-grade urothelial carcinoma. The most significant prognostic factors for bladder cancer are grade, depth of invasion, and the presence of CIS.

Upon presentation, 55-60% of patients have low-grade superficial disease, which is usually treated conservatively with transurethral resection and periodic cystoscopy. Forty to forty-five percent of patients have high-grade disease, of which 50% is muscle invasive and is typically treated with radical cystectomy.

Less than 5% of bladder cancers in the United States are squamous cell carcinomas (SCCs). However, worldwide, SCC is the most common form, accounting for 75% of bladder cancer in underdeveloped nations. In the United States, SCC is associated with persistent inflammation from long-term indwelling Foley catheters and bladder stones. In underdeveloped nations, SCC is associated with bladder infection by Schistosoma haematobium.

Adenocarcinomas account for less than 2% of primary bladder tumors. These tumors are observed most commonly in exstrophic bladders and respond poorly to radiation and chemotherapy. Radical cystectomy is the treatment of choice.

Small cell carcinomas are aggressive tumors associated with a poor prognosis and are thought to arise from neuroendocrine stem cells.

Carcinosarcomas are highly malignant tumors that contain both mesenchymal and epithelial elements.

Primary bladder lymphomas arise in the submucosa of the bladder and are treated with radiation therapy.

Leiomyosarcoma is the most common sarcoma of the bladder.

Rhabdomyosarcomas most commonly occur in children and carry a poor prognosis.

Race

Back to Top

Bladder cancer is more common in whites than in blacks; however, blacks have a worse prognosis than whites.

Sex

Back to Top

The male-to-female ratio is 3:1. Women generally have a worse prognosis than men.

Age

Back to Top

The median age at diagnosis is 68 years, and the incidence increases with age.

Prevention

Back to Top

Bladder cancer cannot be prevented, but it is possible to reduce some of the risk factors that develops it.

• Cigarette smokers are much more likely to develop bladder cancer than nonsmokers.
• Avoid exposure to industrial chemicals, such as benzene substances and arylamines. Occupational exposure from working with dyes, rubbers, textiles, paints, leathers, and chemicals increases the risk of developing bladder cancer.
• Avoid exposure to arsenic. Have your drinking water tested, and/or drink bottled water if you think that your water is contaminated with arsenic.
• Eat a healthy diet. Experts believe that what you eat and drink may help prevent bladder cancer.
  • Eat a low-fat, low-cholesterol diet that includes plenty of fruits and vegetables.
  • Avoid dehydration. Increase your fluid intake, particularly water. Water dilutes cancer-causing chemicals.

Treatment

Back to Top

The treatment of bladder cancer depends on how deep the tumor invades into the bladder wall. Superficial tumors (those not entering the muscle layer) can be “shaved off” using an electrocautery device attached to a cystoscope. Immunotherapy in the form of BCG instillation is also used to treat and prevent the recurrence of superficial tumors. BCG immunotherapy is effective in up to 2/3 of the cases at this stage. Instillations of chemotherapy, such as valrubicin (Valstar) into the bladder can also be used to treat BCG-refractory CIS disease when cystectomy is not an option.

Untreated, superficial tumors may gradually begin to infiltrate the muscular wall of the bladder. Tumors that infiltrate the bladder require more radical surgery where part or all of the bladder is removed (a cystectomy) and the urinary stream is diverted. In some cases, skilled surgeons can create a substitute bladder (a neobladder) from a segment of intestinal tissue, but this largely depends upon patient preference, age of patient, renal function, and the site of the disease.

A combination of radiation and chemotherapy can also be used to treat invasive disease. It has not yet been determined how the effectiveness of this form of treatment compares to that of radical ablative surgery.

The hemocyanin found in Concholepas concholepas blood has immunotherapeutic effects against bladder and prostate cancer. In a research made in 2006 mice were primed with C. concholepas before implantation of bladder tumor (MBT-2) cells. Mice treated with C. concholepas showed a significant antitumor effect as well. The effects included prolonged survival, decreased tumor growth and incidence and lack of toxic effects.

Complications

Back to Top

Bladder cancers may spread into the nearby organs. They may also travel through the pelvic lymph nodes and spread to the liver, lungs, and bones. Additional complications of bladder cancer include:

• Anemia
• Swelling of the ureters (hydronephrosis)
• Urethral stricture
• Urinary incontinence

Prognosis

Back to Top

Patients are closely monitored to see whether the disease gets worse, regardless of which kind of treatment they received. Monitoring may include:

• Bone scan and/or CT scan to check for cancer spread
• Checking for other signs of disease progression, such as fatigue, weight loss, increased pain, decreased bowel and bladder function, and weakness
• Complete blood count (CBC) to monitor for anemia
• Cystoscope evaluations every 3 to 6 months after treatment
  o Urine cytology evaluations (for people whose bladder has not been removed)

How well a patient does depends on the initial stage and response to treatment of the bladder cancer. The outlook for stage 0 or I cancers is fairly good. Although the risk of the cancer returning is high, most bladder cancers that return can be surgically removed and cured.

The cure rates for people with stage III tumors are less than 50%. Patients with stage IV bladder cancer are rarely cured.

Advance Search

Click here to expand your search

References

Back to Top

1. “Mount Sinai Hospital, Bladder Cancer”

2. “National Cancer Institute: Bladder Cancer”

3. “MedicineNet, Bladder Cancer signs and symptoms”

4. Boffetta P (2008). “Tobacco smoking and risk of bladder cancer”. Scand J Urol Nephrol Suppl 42 (S218): 45–54. doi:10.1080/03008880802283664. PMID 18815916.

5. Occupational Risks of Bladder Cancer in the United States: II. Nonwhite Men – Silverman et al. 81 (19): 1480 – JNCI Journal of the National Cancer Institute

6. Walid MS, Heaton RL (2008). “Can posthysterectomy cystoscopy be utilized as a screening test for bladder cancer?”. GMS Ger Med Sci 6: Doc13.

7. “John Hopkins Pathology, Bladder Cancer”

8. “eMedicine Urology, Bladder Cancer”

9. BCG immunotherapy of bladder cancer: 20 years on. 353. 1999. pp. 1689–94.

10. “WebMD, Bladder Cancer – Prevention”

11. “Medline Plus: Bladder Cancer”

Metzenbaum scissors are surgical scissors designed for cutting delicate tissue. They are not only most commonly used for cutting tissue, but they are only designed to be used for that purpose. Because of their specific function, they are sometimes called Metzenbaum dissecting scissors.

Metzenbaum Scissors are sometimes called Metz. The scissor was named after after the American surgeon who designed them. Myron Firth Metzenbaum, M.D.

Features

The scissors come in variable lengths and have a relatively long handle-to-blade ratio. The blades can be either sharp or blunt, but the tips are always blunt. Most Metzenbaum scissors ranges in length from 5.5 inches (about 14 cm) to 14 inches (about 35.6 cm). So-called baby Metzenbaum scissors are only about 4.5 inches (about 11.4 cm) long, considerably smaller than the standard size. The baby size usually makes them more effective for the most delicate procedures.

Uses

The Metz is specifically designed for cutting delicate tissue.

Advance Search

Click here to advance your search

Other names: Tubal Sterilization Reversal, Tubal Ligation Reversal, Reverse Tubal Ligation, Tubal Reanastomosis, Tubal Anastomosis.

Tubal reversal – short for tubal sterilization reversal or tubal ligation reversal – is a surgical procedure that restores fertility to women after a tubal ligation. By rejoining the separated segments of fallopian tube, tubal reversal gives women the chance to become pregnant again. This delicate surgery is best performed by a reproductive surgeon with specialized training and experience in the techniques of tubal ligation reversal.

Contents

Tubal reversal procedures
Essure sterilization reversal
Adiana sterilization reversal
Reasons for tubal reversal
Risks
Videos
References

Tubal reversal procedures

Back to Top

Microsurgery

Tubal ligation reversal utilizes the techniques of microsurgery to open and reconnect the fallopian tube segments that remain after a tubal sterilization procedure. Microsurgery minimizes tissue damage and bleeding during surgery. Essential elements of microsurgical technique include gentle tissue handling, magnifying the operating field, keeping body tissues in their normal state with warmed irrigation fluids, and using the smallest sutures with the thinnest needles capable of holding the tubal ends together to promote proper healing of the rejoined tubal segments.

Tubotubal anastomosis

Following a tubal ligation, there are usually two remaining fallopian tube segments – the proximal tubal segment that emerges from the uterus and the distal tubal segment that ends with the fimbria next to the ovary. After opening the blocked ends of the remaining tubal segments, a narrow flexible stent is gently threaded through their inner cavities or lumens and into the uterine cavity. This ensures that the fallopian tube is open from the uterine cavity to its fimbrial end. The newly created tubal openings are then drawn next to each other by placing a retention suture in the connective tissue that lies beneath the fallopian tubes (mesosalpinx). The retention suture avoids the likelihood of the tubal segments subsequently pulling apart. Microsurgical sutures are used to precisely align the muscular portion (muscularis externa) and outer layer (serosa), while avoiding the inner layer (mucosa) of the fallopian tube. The tubal stent is then gently withdrawn from the fimbrial end of the tube.

Tubouterine implantation

In a small percentage of cases, a tubal ligation procedure leaves only the distal portion of the fallopian tube and no proximal tubal segment. This may occur when monopolar tubal coagulation has been applied to the isthmic segment of the fallopian tube as it emerges from the uterus. In this situation, a new opening can be created through the uterine muscle and the remaining tubal segment inserted into the uterine cavity. This microsurgical procedure is called tubouterine implantation, uterotubal implantation, or, simply, tubal implantation. Tubal implantation is performed when tubal anastomosis is not possible due to the absence of a proximal tubal segment and interstitial tubal lumen.

Ampullary salpingostomy

Fimbriectomy is an uncommon type of tubal ligation that is performed by removing the fimbrial portion of the fallopian tube next to the ovary, leaving the tubal segment attached to the uterus. After fimbriectomy, the remaining tubal segment can be opened by the technique ampullary salpingostomy. A microsurgical electrode is used to open the tubal end and expose the internal lining. When the opening has been enlarged sufficiently and the internal lining or endothelium has extruded from the tubal end, sutures are placed to keep the endothelium folded outward over the edge and to prevent the tube from closing again.

Mini-laparotomy tubal reversal

Mini-laparotomy for tubal reversal surgery involves making a small incision in the abdominal wall just above the pubic bone after shaving the hair with a sterile hair clipper. The size and location of the incision as well as the plastic surgery techniques used to close it make the hair-line scar invisible when it has healed. Atraumatic surgical techniques involve the use of local anesthesia at the incision site and other tissues operated upon. This makes the surgery comfortable and minimizes post-operative pain. As opposed to standard operative methods, avoiding the use of surgical retractors and packs, constantly irrigating tissues to keep them moist and at body temperature, and operating under magnification throughout the procedure results in very rapid patient recovery. Operating with microsurgical instruments allows precision in suturing of the tubal segments than is possible with longer needle holders and other instruments such as are used in laparoscopic surgery. In the experience of a tubal reversal doctor who has performed more than 8000 outpatient reversal procedures, this is the preferred method of minimally invasive surgery for tubal ligation reversal. After the mini-laparotomy approach, patients may attempt to become pregnant as soon as they are fully recovered from their surgery.

Laparoscopic tubal reversal

Laparoscopic Tubal Reversal is a minimally-invasive surgical procedure (laparoscopy), using small, specially-designed instruments to repair and reconnect the fallopian tubes.

After general anesthesia has been administered, a 10mm (less than ½-inch) tube (trocar) is inserted just at the lower edge of the navel, and a special gas is pumped into the abdomen to create enough space to perform the operation safely and precisely. The laparoscope (a telescope), attached to a camera, is brought into the abdomen through the same tube, and the pelvis and abdomen are thoroughly inspected. The tubes are evaluated and the obstruction (ligation, burn, ring, or clip) is examined. Three small instruments (5mm each, less than ¼-inch) are used to remove the occlusion and prepare the two segments of the tube to be reconnected.

One technique involves the use of a tubal cannulator, which is inserted into the uterus through the cervix, allowing the tube to be threaded with a fine stent. This allows for improved alignment of the tubes, so a much better connection can be accomplished. Tiny sutures (less than a hair in thickness) are carefully and meticulously placed to connect the two segments.

Once the connection (anastomosis) is completed, a blue dye is injected through the cervix, traveling through the uterus and tubes, all the way to the abdomen. This is to make sure the tubes have been aligned properly and that the connection is working well.

All instruments are removed, the gas is extracted from the abdomen, and the patient is awakened and taken to the recovery room to be watched and cared for by the nurses, as well as by the anesthesiologist who makes sure the patient is comfortable and without pain. On the average, two to four hours later most patients are ready to be discharged.

Patients are seen between 5-7 days after the operation to look at the small incisions and remove any stitches if necessary. Most of the time, the few stitches that were placed will be under the skin and will be absorbed by the body, without need for removal.

Patients should wait two to three months prior to attempting pregnancy in order to give the tubes a chance to heal completely. Trying to conceive before could result in an increased risk of ectopic pregnancy (pregnancy inside the fallopian tube instead of in the uterus).

When performed by a trained laparoscopic or outpatient tubal reversal surgeon, laparoscopic tubal reversal combines the success rates of micro-surgical techniques with the advantages of minimally-invasive surgery – namely faster recovery, better healing, less pain, fewer complications, and no large disfiguring scars.

Robotic assisted tubal reversal

Robotic assisted tubal reversal surgery is a surgical procedure in which the fallopian tubes are repaired by a surgeon using a remotely controlled, robotic surgical system.

The robotic system involves two components: a patient side-cart (also referred to as the robot) and a surgeon’s console. The robot is placed adjacent to the patient and has several attached arms. Each arm has a unique surgical instrument and performs a specialized surgical function. The surgeon sits near the patient at the surgeon’s console and visualizes the surgery through a monitor. The surgeon performs the entire reversal surgery using controllers located inside the surgeon’s console.

Robotic surgery experts have suggested robotic tubal ligation reversal offers the advantage of smaller incisions when compared to traditional laparotomy tubal reversal surgery. These smaller incisions have been reported to result in less pain and quicker return to work after robotic tubal reversal when compared to traditional tubal ligation reversal using larger abdominal incisions. Robotic experts have also suggested the robotic system offers a greater range of motion and more surgical dexterity than a surgeon can obtain during laparoscopic tubal ligation reversal. The potential disadvantages to robotic surgery are longer operating times and higher costs.

Essure sterilization reversal

Back to Top

Essure sterilization is a hysteroscopic tubal occlusion procedure and was approved by the FDA in 2002 (see FDA, Essure System). Essure sterilization can be done as a simple, outpatient procedure. The Essure procedure requires a small camera (hysteroscope) be inserted through the cervix and into the uterine cavity. Two small, metallic coils are then inserted into each tubal ostia and into the isthmic portion of the fallopian tube. The coils cause the isthmic portion of the fallopian tube to scar (or heal) closed. To confirm tubal closure, a HSG x-ray should be performed three months after the Essure procedure. If either fallopian tube is open after the Essure procedure, then the Essure procedure should be repeated or another type of tubal occlusion method should be performed.

Essure sterilization can be reversed and does not have to be permanent. Reversal of Essure sterilization requires the blocked isthmic portion of the tube be bypassed. The procedure to bypass the blocked portion of the tube is called a tubouterine implantation.

Tubouterine implantation requires the reversal surgeon to make an incision into the uterus and reinsert the healthy portion of the tube through the uterine muscle and into the uterine cavity. Experts who specialize in tubal reversal surgery and tubouterine implantation are able to perform this type of reversal as an outpatient procedure and provide success rates comparable, if not better, than IVF pregnancy success rates.

Adiana sterilization reversal

Back to Top

Adiana sterilization was approved by the FDA in 2009. Adiana sterilization is a hysteroscopic tubal occlusion procedure, which is very similar to Essure sterilization. The Adiana procedure is a outpatient procedure performed by inserting a small camera (hysteroscope) through the cervix and into the uterine cavity. A smaller catheter is inserted into the tubal ostia. The catheter emits radiowaves (microwaves). The radiowaves cause injury to the tubal lining and will result in the tube gradually healing closed. Prior to removal of the catheter a small silicone stent is left inside the isthmic portion of the tube and this promotes tubal closure by the acceleration of the tubal scarring. To confirm tubal closure, a HSG x-ray should be performed three months after the Adiana procedure. If either fallopian tube is open, then the Adiana procedure should be redone or another type of tubal occlusion method should be performed.

Adiana sterilization can be reversed and does not have to be permanent. Reversal of Adiana is similar to reversal of Essure sterilization and requires the blocked isthmic portion of the tube be bypassed. The procedure to bypass the blocked portion of the tube is called a tubouterine implantation.

Tubouterine implantation requires the reversal surgeon to make an incision into the uterus and reinsert the healthy portion of the tube through the uterine muscle and into the uterine cavity. Experts who specialize in tubal reversal surgery and tubouterine implantation are able to perform this type of reversal as an outpatient procedure and provide success rates comparable, if not better, than IVF pregnancy success rates.

Reasons for tubal reversal

Back to Top

Women give many reasons for having a tubal ligation reversal. The most common reasons are:

• Remarriage with desire to have children with new spouse
• Same marriage with desire to have more children
• Death of a child
• Relief of symptoms of “Post Tubal Ligation Syndrome”
• Religious or spiritual concerns

Risks

Back to Top

• Injuring a blood vessel, resulting in bleeding
• Complications associated with anesthesia
• The possibility of infection
• Tubal pregnancy (ectopic pregnancy)

Videos

Back to Top

References

Back to Top

1. “Tubal Ligation Reversal by Dr. Berger”

2. “Surgical Reverse of Tubal Ligation, FAQ”

External Links

Wikipedia, Tubal Reversal
Dan Martin MD, Tubal Reversal
Chances of getting pregnant after Tubal Reversal

The Nightingale Pledge was composed by Lystra Gretter, an instructor of nursing at the old Harper Hospital in Detroit, Michigan, and was first used by its graduating class in the spring of 1893. It is an adaptation of the Hippocratic Oath taken by physicians.

~~~

Original Nightingale Pledge

I solemnly pledge myself before God and in the presence of this assembly, to pass my life in purity and to practice my profession faithfully. I will abstain from whatever is deleterious and mischievous, and will not take or knowingly administer any harmful drug. I will do all in my power to maintain and elevate the standard of my profession, and will hold in confidence all personal matters committed to my keeping and all family affairs coming to my knowledge in the practice of my calling. With loyalty will I endeavor to aid the physician, in his work, and devote myself to the welfare of those committed to my care.

~~~

References

1. “ANA, Florence Nightingale Pledge”

External Links

Another version of the Nightingale Pledge

Nipple discharges are among women’s top concerns, most especially when they are not pregnant or breastfeeding. Women wonder what causes such discharges, and why it’s happening. This would oftentimes make them feel anxious. But is this really a major concern, or something that should be taken lightly?

Before jumping into conclusions, let’s know what are nipple discharges, what causes it, and what it indicates.

According to experts, nipple discharges refers to any fluid that seeps out of the nipple in a nonlactating woman. Nonmilk discharges may also come out of the breasts through the same nipple openings that carry milk.

One or both breasts may produce a nipple discharge, either spontaneously or when squeezed. A nipple discharge may look milky, or it may be yellow, green, brown or bloody. The consistency of nipple discharge varies from thick and sticky to thin and watery.

While breast milk is expected in pregnancy and after child birth, other secretions from the breast may also occur in women of any age. Young women may experience nipple discharge without any cause for concern but persistent discharge in older women may be a sign of an underlying condition. And also, a nipple discharge in a man, under any circumstances, is problematic and should be investigated.

Secretions from the breast usually occur from the nipple and nipple discharge should be differentiated from fluids secreted through a breast fistula. A breast or mammary duct fistula is an abnormal passage that forms between a mammary duct in the breast to the surface of the skin, usually near the areola. While a mammary fistula is not very common, it may occur after a prolonged infection and the presence of a fistula should not be considered as nipple discharge. A breast fistula requires further investigation and appropriate treatment.

Types of Nipple Discharge

There are different types of nipple discharge and the type of breast secretion may be an indication of the cause of the discharge.

• Milky discharge may be breast milk production even in women who are not pregnant or breast feeding and is often due to elevated hormonal levels, specifically prolactin.
• Clear discharge and sticky discharge may be a sign of inflammation or infection.
• Bloody discharge may be a sign of severe trauma, infection or cancer.
• Mucus that is yellow or brown and may be mixed with blood could be due to severe infection, especially if accompanied by breast pain.

Evaluating the type of nipple discharge is not usually sufficient to make a conclusive diagnosis. The presence of other signs and symptoms as well as thorough diagnostic investigation by a medical practitioner should determine the underlying cause of the breast discharge.

Signs and Symptoms of Nipple Discharge

Nipple discharge may occur on its own with no other sign or symptoms or may be accompanied by other symptoms which is indicative of certain conditions.

• Nipple discharge may occur from both breasts (bilateral) or one breast (unilateral)
• Breast tenderness or breast pain
• Swollen breasts or breast lumps
• Fever
• Irregular menstrual cycle

Causes of Nipple Discharge

In most cases, breast discharge is not a cause for concern but any persistent discharge associated with other changes requires investigation.

Nipple discharge may be related or caused by:

• Galactorrhea is breast milk production in women who are not pregnant or nursing and is often due to elevated prolactin levels (hyperprolactinemia). Hyperprolactinemia may occur as a result of many conditions including:
  • 1. Stimulation of the breasts
  • 2. Pregnancy
  • 3. Stress
  • 4. Injury to the breast
  • 5. Sexual intercourse.
  • 6. Pituitary disorders
  • 7. Thyroid disorders particularly hypothyroidism
  • 8. Kidney or liver failure
  • 9. Certain drugs like oral contraceptives, antidepressants or antihypertensive drugs.
• Breast abscess or breast infection due to bacterial, viral or fungal causes is usually accompanied by breast pain, tenderness, redness of the skin with a white to yellow discharge. A painful breast lump may be felt in the case of an abscess. Infections of the breast are usually one sided and may also cause breast swelling.
• Benign breast disorders:
• 1. Intraductal papilloma is a small benign tumor of the milk ducts in the breast. It is the most common cause of nipple discharge and usually affects only one breast. The secretion may be bloody or a clear discharge may be noted.
• 2. Fibrocystic breast disease (FBD) is the most common cause of breast lumps in women, particularly older women. It may affect one or both breasts and the presence of multiple small lumps may be noticed along with breast tenderness.
• 3. Mammary duct ectasia is the blockage of the milk duct and may affect one breast or both sides. Blockage of the duct often occurs as a result of inflammation due to hormonal changes and may be prone to bacterial infections. Smoking is a predisposing cause for mammary duct ectasia. The nipple discharge in mammary ectasia may vary in color and consistency.
• Breast cancer, usually intraductal carcinoma, may cause a bloody breast discharge. A breast lump is usually present and swollen lymph nodes (lymphadenopathy) may be noticed.
• Hormonal disorders affecting the female sex hormones which may occur in perimenopause, premature ovarian failure and polycystic ovarian syndrome. Changes in the menstrual cycle are usually evident, with irregular menses, sudden cessation of periods or changes in menstrual flow. Infertility may also accompany these hormonal disorders.
• Gynecomastia is the enlargement of the male breast which may be normal during puberty. Persistent enlargement with breast tenderness and/or nipple discharge should be investigated although breast secretions in gynecomastia is not common.

Diagnosis of Breast Discharge

While nipple discharge may occur frequently in women who are not pregnant or breastfeeding, persistent breast secretions should be investigated. Persistent breast discharge is of particular concern in women over 40 years of age, where the discharge is from only one breast, bloody discharge with the presence of breast lumps.

After physical examination and a case history, the medical doctor may consider a mammogram, fine needle aspiration and cytology. If the prolactin levels are elevated, further blood tests may be conducted to evaluate the functioning of the thyroid gland, particularly by testing the thyroid stimulating hormone (TSH).

If you are using any hormone replacement therapy or related drugs for menopause, as contraception or for infertility, the medical doctor may discontinue or change the drugs if the breast discharge is severe and accompanied by other symptoms like breast swelling, tenderness or pain.

Women experiencing nipple discharge with a personal or family history of recurrent breast lumps, even benign lumps. should undergo extensive investigation to exclude breast cancer.

References

1. “Merck, Nipple Discharge”

2. “National Cancer Institue, Intraductal Carcinoma”

3. “Healthtype.com, Causes of Breast Secretion, Nipple Discharge”

4. “Wrongdiagnosis, Common causes of Nipple Discharge”

When it comes to giving medications to patients, nurses must heed the five “R”s: right patient, right drug, right dose, right route, right time.

St. John Medical Center this week began using a new electronic tracking system to ensure the staff gets all those “rights”, well, right.

In its intensive care unit, the hospital began using the Bar Code Medication Administration, which has been proven to reduce hospital medication errors, St. John officials say.

“It’s just yet another tool, another safety net to cut down on human error,” Peggy Malone, St. John clinical nurse specialist and nurse educator, said Wednesday.

When patients are admitted to St. John, a bar-coded identification band is placed on their wrist. The bar code includes the patient’s name, date of birth and medical record number. After a doctor has determined what medications the patient needs, the pharmacy enters that information into the patient’s electronic file.

When it’s time to give medications , the nurse uses a hand-held scanner to scan the bar code on the patient’s wrist, then scans the bar code on the medication packaging. The system electronically compares the patient’s identity and medication information. Alerts will appear any time any of the five rights are jeopardized, alerting the nurse of any potential discrepancies or mismatches.

After the medication is given, BCMA automatically records it on the patient’s electronic chart, eliminating the need for the nurse to manually chart the effort – another area of potential human error.

Malone said using the intensive care unit as a start-up for BCMA will put the system to a tough test.

“We figured if we could do it successfully here, because of the complexity (with patients’ medications), it would easily work elsewhere,” she said.

Training of the nurses using BCMA takes only about 30 minutes, Malone said. “It’s not much different than what we’re already doing. It’s a matter of noting where this new information is on the computer screen.”

BCMA was first implemented in the Veteran Medical Center in Topeka, Kan., in 1995. It was conceived of by a nurse who was inspired by a car rental service using bar code technology.

Use of the technology at the patient’s bedside has shown gains in reducing medication errors, which may account for as many as 7,000 deaths per year in U.S. hospitals, according to the Institute of Medicine. Studies in VA hospitals in the 1990s showed use of bar codes reduced medication administration error rates by up to 86 percent.

St. John’s birthing center will be online with BCMA the first part of February, Malone said, followed by other inpatient floors. “I think everybody will be actually using it by March 30,” she said.

St. John Medical Center is the second PeaceHealth hospital to use BCMA. Ketchikan, Alaska, has been using the system since October.

Source
http://www.tdn.com