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Breast cancer is a malignant tumor that develops from the cells of
the breast. It is the most common type of cancer among women in
the United States. It is most often curable when found early. The
normal breast consists of three main components: the lobules
(milk-producing glands), the ducts (thin tubes that connect the
lobules to the nipple) and the stroma (fatty tissue and ligaments
surrounding the ducts and lobules, blood vessels, and lymphatic
vessels). About 80% of breast cancers start in the ducts.
PARASITE REMOVED FROM THE EYEBALL OF A YOUNG N, NOT FOR THE SCREAMISH!Loa Loa worms (also known as the "eye worm") are classified as filarial worms, meaning they thrive in human tissue. The Loa Loa worm is also called the "eye worm" because they often migrate through the eye and surrounding subsurface areas. At one time, prior to the 1920s, loa loa worm infections occurred in the United States. Today, however, they mainly infect people who are native to Sudan, and those who live in or near Central and West Africa's swamps and rain forests.
Loiasis is the infestation of loa loa worms in humans. The larvae are first collected from an infected individual when a mango fly (horsefly) or a deer fly bites the individual, and acquires the larvae. The larvae then progress through the fly's body, finally reaching the feeding tube. They are then transferred to a human host when the fly bites the human. The larvae may remain unnoticed for months or years before becoming an adult, mating, and producing offspring.
Adult female Loa Loa worms can reach a length of 2 1/2 inches while males are approximately half that size. Loa Loa worms can live approximately fifteen years inside their human hosts. They travel continuously through connective and deep tissue, often without the victim experiencing any sensation other than occasional itching.
It is when the worm slows or reaches a sensitive spot that a person will often feel the greatest discomfort. At this point, immune reactions may also include localized redness and a condition called "Calabar" swelling. Skin eruptions and muscle pain may be evident.
When the Loa Loa worm reaches the eye tissue, it can be easily seen and felt within the eyeball for up to an hour. It is usually removed under local anesthesia if the patient is within proximity of a qualified physician. When an adult worm dies, the surrounding tissue may abscess and require excision. Encephalitis can occur if the worm reaches the brain.
After mating, the female will deposit eggs - called microfilariae. These tiny organisms then travel in a worm-like fashion in the bloodstream during daytime hours, when potential host flies are most abundant. They congregate in the lungs at night.
A Loa Loa worm infection is rarely fatal and treatments often cause more life-threatening side effects than the actual infestation, especially if the worms are widespread. The most common treatments are DEC (diethylcarbamazine) and Ivermectin
The exam should be performed in an orderly fashion as follows: 1. Have the patient stick out their tongue so that you can examine the posterior pharynx (i.e. the back of the throat). Ask the patient to say "Ah", which elevates the soft palate, giving you a better view. If you are still unable to see, place the tongue blade � way back on the tongue and press down while the patient again says "Ah," hopefully improving your view. This causes some people to gag, particularly when the blade is pushed onto the more proximal aspects of the tongue. It may occasionally be important to determine whether the gag reflex is functional (e.g. after a stroke that impairs CNs 9 or 10; or to determine if a patient with depressed level of consciousness is able to protect their airway from aspiration). This is done by touching a q-tip against the posterior pharynx, uvula or tongue. It is not necessary to do this during your routine exam as it can be quite noxious!
2. Note that the uvula hangs down from the roof of the mouth, directly in the mid-line. With an "Ah," the uvula rises up. Deviation to one side may be caused by CN 9 palsy (the uvula deviates away from the affected side), a tumor or an infection. CN9 Pasly Cranial Nerve 9 Dysfunction: Patient has suffered stroke, causing loss of function of left CN 9. As a result, uvula is pulled towards the normally functioning (ie right) side. 3. The normal pharynx has a dull red color. In the setting of infection, it can become quite red, frequently covered with a yellow or white exudate (e.g. with Strep. Throat or other types of pharyngitis).
4. The tonsils lie in an alcove created by arches on either side of the mouth. The apex of these arches are located lateral to and on a line with the uvula. Normal tonsils range from barely apparent to quite prominent. When infected, they become red, are frequently covered by whitish/yellow discharge. In the setting of a peritonsilar abscess, the tonsils appear asymmetric and the uvula may be pushed away from the affected side. When this occurs, the tonsil may actually compromise the size of the oral cavity, making breathing quite difficult.
5. Look carefully along the upper and lower gum lines and at the mucosa in general, which can appear quite dry if the patient is dehydrated.
6. Examine the teeth to get a sense of general dentition, particularly if the patient has a dental complaint. Pain produced by tapping on a tooth is commonly caused by a root abscess. Tooth Abscess: Tooth abscess involving left molar region. Associated inflammation of left face can clearly be seen. 7. Have the patient stick their tongue outside their mouth, which allows evaluation of CN 12. If there is nerve impairment, the tongue will deviate towards the affected side. Any obvious growths or abnormalities? Ask them to flip their tongue up so that you can look at the underside. If you see something abnormal, grasp the tongue with gauze so that you can get a better look. Left CN 12 Dysfunction: Stroke has resulted in L CN 12 Palsy. Tongue therefore deviates to the left.
8. Make note of any growths along the cheeks, hard palate (the roof of the mouth between the teeth), soft palate, or anywhere else. In particular, patients who smoke or chew tobacco are at risk for oral squamous cell cancer. Any areas which are painful or appear abnormal should also be palpated. Put on a pair of gloves to better explore these regions. What do they feel like? Are they hard? To what extent does a growth involve deeper structures? If the patient feels something that you cannot see, try to get someone else to hold the light source, freeing both your hands to explore the oral cavity with two tongue depressors.
Watch as Dr. Benjamin Carson performs risky brain surgery on young Payton to remove a brain tumor. Dr. Carson, director of pediatric neurosurgery, is just one of the many reasons why Johns Hopkins Children's Center was recently ranked #1 in neurology and neurosurgery in America's Best Children's Hospitals 2008