The Breast

The Anatomy

General borders-

·         Upper border – second rib

·         Lower border – sixth rib

·         Medial border – lateral border of the sternum

·         Lateral border – anterior axillary line

Actual borders –

o   Upper border – clavicle

o   Lower border – seventh or eighth rib

o   Medial border – midline

o   Lateral border – edge of latissimus dorsi

Important parts of the breasts

·         Breast lobe

·         Ductile

·         Lactiferous duct and ampulla

·         Areola

·         Cooper ligament

·         Axillary tail

·         Lobule – structural unit of the mammary gland

1.      Lobule à Ductules à lactiferous duct à terminal papilla

·         Ligaments of Cooper

o   Apices are attached to the superficial facial

o   Account for the dimpling of skin overlying carcinoma

·         Areola

o   Contain involuntary muscles

o   Epithelium contains sweat glands and sebaceous glands

o   Sebaceous glands enlarge during lactation. Then it is called “Montgomary tubercle”

·         Nipple

o   An erectile structure pointing upwards

·         Lymphatics

o   To axillary and internal mammary lymph nodes

o   Axillary lymph nodes have six groups

1.      Lateral – along the axillary vein

2.      Anterior – along lateral thoracic vessels

3.      Posterior – along the sub capsular vessels

4.      Central

5.      Interpectoral

6.      Apical à Supraclavicular nodes à Subclavian lymph trunk à Thoracic duct or Jugular trunk

·         Sentinel node is the first node draining the tumour bearing area of the breast

EXAMINATION OF BREAST

Do you have Leukaemia? Diagnose Yourself

Even though the exact diagnosis of any disease is done by proper investigation, one can assume the disease they have only by concentrating on the symptoms he/she has. Considering leukaemias, there are many subtypes. The 2 major broad categories of leukaemias are acute and chronic leukaemias.

What are the symptoms of acute leukaemia? What are things that you will or experience if you have acute leukaemia?

The symptoms that patient have are the same regardless of the subtype of the disease. They all are attributing to the inadequate blood cell production in the bone marrow. The blood cell production becomes less as the abnormally proliferating cells infiltrate the surrounding bone marrow.

1.      Symptoms of anaemia – Red blood cells are produce by the bone marrow. In leukaemia red blood cell production is reduced giving rise to anaemia(less haemoglobin in blood).

a.      Feeling of weakness

b.      Becoming breathless on effort

c.       Exercise tiredness

2.      Symptoms of leucopenia (reduced white blood cells in blood) –

a.      Recurrent infection – If you are getting more diseases than usual that means your immunity has reduced. The major cells that are involved in immunity are white blood cells. In leukaemia the number of normally functioning white blood cells reduces giving rise to leucopenia. So, you may have cold, fever and other infectious diseases more often than usual.

3.      Thrombocytopenia (reduced thrombocytes in the blood)- Thrombocytes or the platelets are another constituent of blood. They are also produced in the bone marrow. These are important in blood clotting. They are also reduced in leukaemia and cause bleeding disorders. So, you may have gum bleeding, etc.   

4.      Symptoms due to marrow infiltration – The proliferating cells infiltrate in to the marrow. This causes bone pain. The patient may feel pain in their limbs and joints.

Above are the symptoms you may have. But there are more signs, you may have indicting leukaemia, but you should observe carefully to detect these symptoms. They are listed below.

1.      Pallor – This is seen in the eyes. To see it you have to pull the lower eyelid downwards and see the conjunctiva. It should be bright pinkish closer to red in colour. It becomes pallor when the colour becomes pale and closer to whitish colour.

2.      Fever – You can measure your temperature by a thermometer. There are thermometers in most of the houses these days. If the reading is higher than 37⁰  C, your are having fever. This is due to increase activity of the abnormally proliferating cells. This results in increased basal metabolic rate in leukaemic individuals.

3.      Petechiaea, purpura, bruises – look carefully in your skin and look for bruises which may result from bleeding in to the skin.

4.      Lymphadenopathy (enlargement of the lymph nodes) – to detect these you should know where the lymph nodes are and how to palpate for them. I will discuss about the method in a later article.

5.      Hepatosplenomegally – the method of observing will be discussed later.

What is Philadelphia Chromosome

Philadelphia chromosome is abnormal chromosome 22, which is created by reciprocal translational between the long arm of the chromosome 22 and the chromosome 9. How the translocation occurs is described in illustrations below.

The description of the resulting kryotype: t(9;22)(q34;q11)

 This is a very famous chromosomal abnormality found in nearly 97% of the cases of chronic myeloid leukaemia. It is also found in the acute lymphocytic leukaemia especially when it occurs in the latter part of life.

Exposed to Radiation? Can you get Leukaemia?

Ionizing radiation is a one of the main aetiological factors of leukaemia. So, if you have exposed to higher amount of radiation, you can get leukaemia. The good news is that everybody who get exposed to radiation does not develop leukaemia. Only a proportion does. It has been found that only a  1 per 60 heavily irradiated patients have developed leukaemia.

What are the ways that you can get exposed to radiation? Who are the people that get exposed to radiation?

There are different kinds of radiation, at different levels in the environment we live. But, all of these radiations are not powerful enough to cause leukaemia in our body. The body should get exposed to a very high amount of radiation to develop leukaemia. There are people who were exposed to full body radiation who did not develop leukaemia. Following are some major ways of getting exposed to radiation.

·         Survivors of nuclear bomb explosions.

·         Patients with ankylosing spondylitis. They are treated with radiation therapy to the spine.

Such people do not develop leukaemia right after. There is a latent period of about 5 years.

Out of the four types of leukaemia, only three are caused by irradiation. They are,

1.      Acute lymphoblastic leukaemia

2.      Acute myeloblastic leukaemia

3.      Chronic myeloid leukaemia

Chronic lymphcytic leukaemia is not caused by irradiation.

How radiation cause leukaemia?

Leukaemia is a cancer of white blood cells. Cancers are abnormally proliferating cells. The white cells in our body, just like many other cells in our body age and die. So, there are cells which proliferate and generate new cells to replace the dead cells. This process occurs in the bone marrow, which is situated within the cavities of the bones. In leukaemia these cells proliferate abnormally, so they produce a lot of cells more than the normal number. This abnormal proliferation is triggered by radiation.

To understand this more clearly you should have a general idea about how the cell proliferation is controlled. The velocity of a division is controlled by the genes, which are present is the nucleus of the cells. When these genetic material gets exposed to radiation, their structure changes. So, the genes that stop cell division becomes defective. This allows the cells to proliferate abnormally.

Does Smoking Cause Leukaemia

Leukaemia is caused by various factors. They are,

• Chemicals
• Radiations
• Genetics

It has been found that smoking also cause Leukaemia. This is only a one disease which adds to the whole list of diseases caused by smoking. Therefore, people who smoke must be reminded that they are not only putting themselves in danger, but also the people around them.

Leukaemia is a cancer of blood cells and people who develop leukaemia will have to undergo a whole series of treatment, which are very exhausting and distressing. Even after treatment some of the patients may not have a good outcome.

The Famous Hat - This book has been designed to help children with leukaemia (or other forms of cancer) to prepare for treatment, namely chemotherapy, and a stay in hospital. 

Leukaemia - My Marathon for Love 

How to Differentiate a Male Pelvis from a Female Pelvis

Sex determination only by looking at the pelvis plays a major role in forensic anthropology. It is very easy to differentiate a male pelvis from a female pelvis as female pelvis has developed special features for child bearing. Following features are used in differentiating male and female pelvises.

	Female	Male
General Built	Thin	Thick
Weight	Light	Weight
Greater Pelvis	Shallow	Deep
Lesser Pelvis	Wide, shallow, cylindrical	Narrow, deep
Pelvic Inlet	Oval shape	Kidney Shape
Pelvic Outlet	Wider	Smaller
Pubic Arch	>800	<700

 Flesh and Bone: An Introduction to Forensic Anthropology 

Introduction to Forensic Anthropology (4th Edition) (Pearson Custom Anthropology) 

Bones: A Forensic Detective's Casebook