Archive for May 12th, 2009
Let’s see how close we could get to this for, say, lung cancer. Screening tests we could consider are sputum cytology, X-rays and bronchoscopy. Sputum cytology is simple, safe and convenient for the patient. However, each specimen takes quite a few minutes to examine thoroughly and this must be done by a specially trained technician, so it is not cheap. There are false negatives— not all cancers shed cells into the sputum to be coughed up. Some do so erratically—there may be no cancer cells in the specimen that goes to the laboratory even if there were the day before and the day after. False positives are rare but occasionally other abnormal cells are mistaken for cancer cells. The test can pick up very tiny cancers at a stage when surgical removal would have a good chance of curing the patient. To pick up very early cancers, specimens would have to be examined every few months, which obviously would make it extremely expensive in the long run. Another problem occurs if the cancer is so small that it can’t be seen on X-ray. It then has to be located by bronchoscopy or special types of X-ray before it is possible to go ahead with surgical removal.
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Tests that allow us to ‘see’ the liver are not necessary in every person with cancer. They are usually only recommended when there are clues from symptoms, clinical examinations or blood tests that there is liver abnormality. A radionuclide liver scan shows us the size of the liver and whether there are any areas in it that are not functioning normally. Normal X-rays do not show up the liver. A CT scan does and it may also pick up cancer deposits as they let through less X-rays than the normal liver. In some cases, the combination of symptoms, clinical findings, blood tests and scans build up a picture so typical of liver secondaries that a biopsy for conclusive proof may not be recommended. However, when there is something unusual or unexpected about the situation, or when it is very important to be quite certain, a liver biopsy should be considered.
This can be done with a special type of needle through the skin, under local anaesthetic. Because the liver moves up and down as you breathe, it is important to try hard to hold your breath when the doctor asks you to. Before doing a liver biopsy, your doctor should make quite sure that your blood can clot normally. If not, injections can be given to correct this. Even so, it is possible to bleed internally after a liver biopsy. This is unusual, but has to be watched for carefully. After the biopsy you will be kept lying still for some hours while the tiny hole in the liver seals over. During this time your pulse rate and blood pressure should be checked regularly. The main danger of bleeding is right after the biopsy. Sometimes transfusion is necessary. Very rarely, an operation is needed to stop the bleeding.
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Many children develop a habit, spasm or tic which involves movements which are fast, sudden, unexpected and serve no purpose. The child appears to have no control over them.
The movements can include blinking, twitching of the nose or shrugging of the shoulders. Most of these habits spasms are minor and seem to disappear after several months.
However, in some children these tics are both severe and prolonged. They can involve grunting, throat-clearing and occasionally, uttering obscene words. Sometimes these children repeatedly touch themselves or others in the genital area or on the breast.
This bizarre behavior is extremely distressing to the child suffering from the problem and also to his parents. It is called the Tourette syndrome.
The cause is unknown, it is three times more common in boys than girls and there is some family tendency to it. Onset is usually before the age of 15.
Not all cases of mild habit spasms or tics can properly be labelled the Tourette syndrome, but those who have verbal spasms, particularly the uttering of obscene words, are diagnosed under this classification.
Sometimes children grow out of this, sometimes it persists. Fortunately one of the major tranquillising drugs, haloperidol, has proved of great value in treating this disorder.
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