Medicurio

Raynaud’s phenomenon is a vasospastic disorder that affects the hands triggered by cold or emotional stress resulting in symptoms of pain, pallor progressing to cyanosis, and coolness of the distal extremities. These changes are thought to be due to intimal layer hypertrophy and inflammation; collagen disposition and fibrosis resulting in vessel lumen occlusion. These vascular alterations have been described in the digital arteries, superficial palmar arch and ulnar artery. Angiographic studies have demonstrated little or no collateral circulation distal to the fibrotic vessels. Radiographic findings in the hands may include soft tissue calcifications when the patient has Raynaud’s as part of CREST syndrome, atrophy of the finger tips, acroosteolysis and intercarpal joint space narrowing. The differential diagnosis for acroosteolysis includes: psoriasis, injury (frostbite or thermal burns), neuropathy (diabetes, leprosy, myelomeningocele), collagen vascular disease, hyperparathyroidism, polyvinyl chloride (PVC) exposure, snake/scorpion venom and familial forms (Hadju-Cheney syndrome).

The importance of the family to family physicians is inherent in the paradigm of family medicine. Family medicine does not separate disease from person or person from environment. It recognizes the strong connection between health and disease, and personality, way of life, physical environment, and human relationships. It understands the strong influence that human relationships have on the outcome of illness and recognizes the family as the crucible of the development of the person. Clinicians can be minimally involved with a patient’s family; they may provide the family with information and advice; they may provide emotional support to help family members deal with the feelings aroused by having a family member with an illness; or they can carry out a systematic assessment of family function and plan an intervention designed to help a family deal with its problems. Cultural norms, differences in the form and function of “family,” and an understanding of the family life cycle, together with an understanding of individual development, must be taken into consideration by the practitioner.

Bringing and building social science theory to understand the social and cultural determinants of health, how society produces health and the lived experience.

The Society, Culture and Health theme contributes new thinking using social science theory to the social and cultural determinants of health. We seek to understand how health is experienced and produced within an ecological public health framework. Much of our research incorporates a focus on health inequalities and questions of health equity.

Our members – who are drawn from sociology, anthropology, epidemiology, economics and psychology – employ novel combinations of qualitative and quantitative methods as part of their own research projects as well as contributing to cross-disciplinary approaches to research within RSPH.

Our research in health, culture and society encompasses many aspects of the social and behavioural sciences in medicine. We are interested in how various psychological and sociological concepts are applied in practice and contribute to our understanding of health, disease and the care they require.

We have a wide range of methodological expertise, including qualitative and quantitative approaches, and specialise in ethnographic research as well as undertaking behavioural and neuroscientific studies.

Our specific interests include:

• Mental health and wellbeing
• Healthcare work practices and cultures
• Health and social inequalities
• Experiences of healthcare
• Psychosocial development

Our work is often collaborative and we engage with a wide range of NHS and third sector organisations. We work with patients, families and carers, healthcare practitioners, and policy makers. Our focus is on improving the practices of care as well as furthering insights across health and medicine.

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Breast cysts are fluid-filled sacs that are among the most common breast lumps a woman may have. They may also be a cause of other breast symptoms—from pain to, potentially, nipple discharge.

Many women develop noncancerous changes in their breast tissue. It’s one of the conditions known as fibrocystic breast disease, which includes fluid-filled cysts. A cyst may show up in one or both breasts at the same time and in different parts of the breast. Some cysts are so small that patients don’t feel a lump.

For many patients, breast cysts don’t have symptoms: Only about 7 percent of women have a breast cyst that may be felt with the hand.

Simple fluid-filled cysts form from fluid buildup in the breast glands. Microcysts are tiny and may only be spotted under a microscope. Macrocysts, on the other hand, may span from 1 to 2 inches.

Then there are complex cysts, which are either solid or filled with fluid and solids. A complex breast cyst may require a biopsy and drainage to check the cells, a procedure designed to determine whether the cyst is cancerous. On rare occasions, complex cysts are cancerous or increase the risk of breast cancer later.

Symptoms

Breast cysts may be found in one or both breasts. Signs and symptoms of a breast cyst include:

• A smooth, easily movable round or oval lump that may have smooth edges — which typically, though not always, indicates it’s benign
• Nipple discharge that may be clear, yellow, straw colored or dark brown
• Breast pain or tenderness in the area of the breast lump
• An increase in breast lump size and breast tenderness just before your period
• A decrease in breast lump size and resolution of other symptoms after your period

Having breast cysts doesn’t increase your risk of breast cancer. But having cysts may make it harder to find new breast lumps or other changes that might need evaluation by your doctor. Your breasts may feel lumpy and painful when you’re menstruating, so it’s important to be familiar with how your breasts feel throughout your menstrual cycle so that you’ll know if something changes.

When to see a doctor

Normal breast tissue often feels lumpy or nodular. But if you feel a new breast lump that doesn’t go away, gets bigger or persists after one or two menstrual cycles, see your doctor right away. Also see your doctor if you have new skin changes on one or both of your breasts.

Causes

Each of your breasts contains lobes of glandular tissue, arranged like petals of a daisy. The lobes are divided into smaller lobules that produce milk during pregnancy and breast-feeding. The supporting tissue that gives the breast its shape is made up of fatty tissue and fibrous connective tissue. Breast cysts develop as a result of fluid accumulation inside the glands in the breasts.

Breast cysts may be defined by their size:

• Microcysts may be seen during imaging tests, such as mammography or ultrasound, but are too small to feel.
• Macrocysts are large enough to be felt and can grow to about 1 to 2 inches (2.5 to 5 centimeters) in diameter.

Experts don’t know exactly what causes breast cysts. They may develop as a result of hormonal changes from monthly menstruation.

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Diagnosis

Diagnosis of a breast cyst usually includes a breast exam; imaging tests, such as a breast ultrasound or mammogram; and possibly fine-needle aspiration or a breast biopsy.

Breast exam

After discussing your symptoms and health history, your doctor will physically examine the breast lump and check for any other breast abnormalities. Because your doctor can’t tell from a clinical breast exam alone whether a breast lump is a cyst, you’ll need another test. This is usually either an imaging test or fine-needle aspiration.

Imaging tests

Needed tests may include:

• Mammography. Large cysts and clusters of small cysts can usually be seen with mammography. But microcysts can be difficult or impossible to see on a mammogram.
• Breast ultrasound. This test can help your doctor determine whether a breast lump is fluid filled or solid. A fluid-filled area usually indicates a breast cyst. A solid-appearing mass most likely is a noncancerous lump, such as a fibroadenoma, but solid lumps also could be breast cancer.

Your doctor may recommend a biopsy to further evaluate a mass that appears solid. If your doctor can easily feel a breast lump, he or she may skip imaging tests and perform fine-needle aspiration to drain the fluid and collapse the cyst.

Fine-needle aspiration

During a fine-needle aspiration, your doctor inserts a thin needle into the breast lump and attempts to withdraw (aspirate) fluid. Often, fine-needle aspiration is done using ultrasound to guide accurate placement of the needle. If fluid comes out and the breast lump goes away, your doctor can make a breast cyst diagnosis immediately.

• If the fluid is not bloody and has a straw-colored appearance and the breast lump disappears, you need no further testing or treatment.
• If the fluid appears bloody or the breast lump doesn’t disappear, your doctor may send a sample of the fluid for lab testing and refer you to a breast surgeon or to a radiologist — a doctor trained to perform imaging exams and procedures — for follow-up.
• If no fluid is withdrawn, your doctor will likely recommend an imaging test, such as a diagnostic mammogram or ultrasound. The lack of fluid or a breast lump that doesn’t disappear after aspiration suggests that the breast lump — or at least a portion of it — is solid. A sample of the tissue may be collected to check for cancer.

Treatment

No treatment is necessary for simple breast cysts — those that are fluid filled and don’t cause any symptoms — that are confirmed on breast ultrasound or after a fine-needle aspiration. Many cysts will disappear with no treatment. If a cyst persists, feels firmer or you notice skin changes on the skin over the cyst, follow up with your doctor.

Fine-needle aspiration

Fine-needle aspiration may be used to diagnose and treat a breast cyst if all the fluid can be removed from the cyst during the procedure, and then your breast lump disappears and your symptoms resolve.

For some breast cysts, however, you may need to have fluid drained more than once. Recurrent or new cysts are common. If a breast cyst persists through two to three menstrual cycles and grows larger, see your doctor for further evaluation.

Hormone use

Using birth control pills (oral contraceptives) to regulate your menstrual cycles may help reduce the recurrence of breast cysts. But because of possible significant side effects, birth control pills or other hormone therapy, such as tamoxifen, is usually recommended only for women with severe symptoms. Discontinuing hormone therapy after menopause may also help prevent breast cysts.

Surgery

Surgery to remove a breast cyst is necessary only in unusual circumstances. Surgery may be considered if an uncomfortable breast cyst recurs month after month or if a breast cyst contains blood-tinged fluid or shows other worrisome signs.

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