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Sonoelastography

This diagnostic procedure is complementary to classical ultrasound, providing, in addition, information about breast tissue elasticity, being a newer non-invasive and non- irradiated diagnostic method that measures the elasticity of breast tissue or tumour formations detected.

In addition to the classical ultrasound, providing additional information about the structure, hardness or elasticity of the lesions, the sonolelastography is an ultrasound technique, using an ultrasound with a sonoelastography mode, through which the elasticity of mammary tumours can be quantitatively and qualitatively measured.

The elasticity of cancerous tumours is reduced compared to that of non-cancerous tumours, so the method can differentiate, with an accuracy that can reach 90%, malignant (cancerous) tumours from benign (non-cancerous) tumours.

The sonoelastography is a valuable method of investigation, both in that it is applicable to small tumours under 1 cm (which implies an early diagnosis of breast cancer and early stage treatment) and by significantly reducing the need for mammary biopsy punctures.

The sonoelastography can be performed in routine ultrasound scanning as a painless method.

 

Assist. univ. dr. BALABAN Daniel Vasile, gastroenterologist, doctor of medicine

What is the screening?

The screening is the method by which a person is investigated to detect the presence of breast cancer before this person has cancer symptoms.

The screening helps early detection of cancer before it is at an advanced stage. When the tumour tissue is discovered early, treatment is more effective and easier to apply. Since the onset of cancer symptoms, chances are that cancer cells have spread throughout the body.

Currently, ongoing studies aim to find the people who are predisposed to certain types of cancer. Also, these studies investigate both the environmental and lifestyle factors that can trigger breast cancer.

This information helps the doctor determine the category of people who needs to participate in the screening, as well as the type of screening that needs to be used and the frequency with which this screening is to be performed.

If the doctor recommends a screening test for breast cancer, it is very important for the person undergoing screening to understand that the doctor recommends this screening without considering that the person has cancer. Screening tests are performed in people who do not have cancer symptoms. If the result of screening tests is not within normal limits, further testing is needed to determine if the person has cancer or not. These additional tests are called diagnostic tests.

 

What is the role of family doctor in breast cancer screening?

 

The family doctor is the first step in the senologic assessment. He will examine the breast and recommend further investigations. A woman should contact the family doctor once a year for a general evaluation. At that time, the family doctor will indicate her a set of general tests: blood, urination, cervical cancer screening, senologic assessment, an ultrasound or mammography, depending on the age of the patient, and other investigations of the symptoms she has.

Thus, the role of the family doctor is extremely important because he has to establish a breast-tracking protocol, both in a young patient and in a patient over 40 years old or in an elderly woman. The family doctor may refer women to mammography and ultrasound free of charge, in the instance in which he can assess the presence of a formation through palpation, or the women he wishes to have a screening check-up.

In urban areas, as a result of higher education, women are addressing more often to the doctor, thus preventing cancer or early diagnosis. Unfortunately, in rural areas, addressability to the family doctor is greatly reduced, and as a result, the proportion of breast cancer in these women is higher.

Pain, nausea, vomiting! How to treat gallstones

Gallstones (bile stones) are a common illness among patients, risk factors for its appearance are obesity, over 40 years of age, hyper caloric or low calorie diet, a positive family history of this illness, and so on.
Hence the need for cholecystectomy (gall bladder surgery) or surgical extraction of the bile vesicle, which is the only treatment for biliary cholelithiasis, responsible for the pain and inflammation.

The gallbladder is a reservoir for the bile that is produced in the liver and is useful in food digestion. The formation of cholelithiasis may block the exit of the bile from the gallbladder and thus an abdominal pain occurs in the right subcostal region, nausea, vomiting, bitter taste in the morning, making it necessary to consult a specialist surgeon.

Symptoms include pain in the upper abdomen, especially on the right side, nausea, bile vomiting (gall, which is a yellow-green and bitter fluid). Sometimes, the presence of the gallstones does not provide any symptoms, the diagnosis being exclusively made through ultrasound.

However, even in this situation, you should ask your doctor, because the presence of stones in the gallbladder can lead to the appearance of serious, sometimes life-threatening complications, “said Dr. Mihai Hriţcu, surgeon.

The specialist noted that the main complication is infection (acute cholecystitis), which can go as far as complete necrosis of the colecist’s wall, leading to biliary peritonitis.

Then you can talk about mechanical jaundice, caused by the prevention of eliminating the bile from the liver and the overflow of some compounds from it (bilirubin) into the blood and as a consequence, the person turning yellow in colour. At this stage, the joint channel (bile duct) is blocked by a stone or more.

Acute pancreatitis, also caused by the blocking or just the passing of the stones at the level of the pancreatic duct, can worsen the patients’ health.

This is why the treatment of gallstones is exclusively surgical, consisting in removing the entire colecist, along with the biliary calculi from it. The laparoscopic technique is the standard indication for this intervention, the visibility being optimal, and abdominal wall trauma being minimal. According to Dr. Hriţcu, surgery is necessary in the case of ultrasound diagnosis of cholestatic lithiasis (stones or calculi); acute lithiasis cholecystitis and alithiasis cholecystitis (cholecystitis inflammation other than lithiasis – cholesterolotic achenes, polyps), spontaneous traumas; gallbladder cancer.

In most cases, laparoscopic cholecystectomy is a surgical intervention that is performed under schedule, but there are also cases (acute cholecystitis) in which surgery is an emergency.

Recommended Investigations

Among the investigations the patient has to do for a proper diagnosis, the most important are the abdominal ultrasound (which visualizes the presence of stones and the signs of inflammation – the cholecist wall is thickened) and blood tests (blood count, bilirubin, hepatic enzymes, coagulation tests, etc.) “, he added.

He also said most of the patients are being released 24 hours after surgery, and can return to daily activities in less than a week.

However, patients need to avoid foods containing fat, improve their fibre intake in the first few weeks after surgery, in order to prevent discomfort and diarrheal after eating.

Thyroid ultrasound

The thyroid is the largest endocrine gland, it is in the shape of a butterfly, located in the neck, in the anterior cervical area, between the sternocleidomastoid muscles, consisting of two lobes located on either side of the trachea, joined by a small tissue bridge called isthmus, weighing approximately 15-25 g.

It plays an important role in the balanced functioning and development of the body, it is responsible for the secretion of two hormones: triiodothyronine (T3) that acts faster and is more metabolically active and thyroxine (T4), their name coming from the presence of 3, respectively 4 atoms of iodine.

Thyroid hormone secretion is controlled by TSH or thyrotropin (another hormone), being released from the previous pituitary. In turn, thyrotropin is stimulated by TRH, secreted by the hypothalamus. The thyroid does not work solitary and is not autonomous in the body, so it is an entire system of regulation between the encephalus, pituitary and thyroid (feed-back mechanism).

Why is thyroid ultrasound performed?

Identifying thyroid problems as quickly as possible is favoured by ultrasound, which clearly and easily ascertains whether there are changes in the structure of the gland (cysts, inflammation, nodules, hypertrophy). This investigation takes between 15-20 minutes, no special training is required, the patient can drink, eat, or take medication normally.

It is good to know that the thyroid ultrasound does not pose any risks, can be repeated as often as necessary, is not invasive, it is painless in the region of the throat, does not radiate, and is used to diagnose nodules, lymphadenopathy, or the differentiation between goitre and adipose or muscular tissue.

Hyperthyroidism (excess of function) or hypothyroidism (through deficiency) are disorders of the thyroid. Symptoms of hypothyroidism are: weight gain, lack of appetite, constipation, muscle and joint pain, dry skin, drowsiness, thinking and slow speech.

Causes of hypothyroidism: inflammation caused by the immune system (autoimmune thyroiditis / Hashimoto); after radioactive iodine treatment, in the case of goitre or other thyroid diseases, too many cells (thyroid follicles) are destroyed following partial surgery, and the remaining part of the gland does not produce enough thyroid hormones.

Hyperthyroidism (excess thyroid hormone) occurs when the thyroid secretes a larger amount of thyroid hormones, evolving rapidly and aggressively.

Symptoms of hyperthyroidism: nervousness, abdominal sweating, tachycardia. Causes of hyperthyroidism: Among the risk factors of this disease are gender (especially in women), age (occurs with a higher frequency in adults), hereditary factor (in Basedow’s disease), neuropsychiatric factors (stress).