Woman's Era - - Contents -

I AM A 25- YEARS-OLD WORK­ING WOMAN. SINCE LAST SIX MONTHS I am suf­fer­ing from dry­ness of the nose, headache, sen­sa­tion of nasal ob­struc­tion and some­times epis­taxis. I have con­sulted an E.N.T. sur­geon for the prob­lem. He told me that you are suf­fer­ing from at­rophic rhini­tis. I want to know about the dis­ease in de­tail.

At­rophic rhini­tis is a con­di­tion in which the nasal mu­cosa and turbinates un­dergo at­ro­phy. It is com­monly found in fe­males of the younger age group. It is the re­sult of the lo­cal dis­ease in one or the other of the praranasal air si­nuses. Ow­ing to some dis­tur­bances of the en­docrine sys­tem the dis­ease is very com­mon at the age of pu­berty and menopause. The ac­cepted view is that the dis­ease is due to some hered­i­tary or en­docrine fac­tor. Symp­toms of the dis­ease are dry­ness of the nose, headache, a sen­sa­tion of nasal ob­struc­tion due to the for­ma­tion of crusts, anos­mia (in­abil­ity to smell), epis­taxis (bleed­ing from the nose) af­ter sep­a­ra­tion of the crust, a foul odour is the out­stand­ing symp­tom and it may be so se­vere as to ren­der the suf­ferer an out­cast from so­ci­ety. The nasal cav­ity will be widened, green­ish crusts may fill the nasal cav­i­ties. Med­i­cal treat­ment con­sists of the re­moval of crusts by nasal douches with warm iso­tonic or al­ka­line so­lu­tions. Paint­ing of the nasal cav­ity with 25 per cent an­hy­drous glu­cose in glyc­erin. This pre­vents ad­her­ence of crusts and in­hibits the growth of or­gan­isms. Af­ter cleans­ing, a spray of oestra­diol in oil has been found ben­e­fi­cial. Sur­gi­cal treat­ment of si­nus in­fec­tion may be prop­erly treated. Lat­est de­vel­op­ment in the treat­ment of this dis­ease is clo­sure of one or both nos­trils by plas­tic surgery. The nasal mu­cosa be­comes nor­mal on re­open­ing of the nos­tril af­ter a few months or years but any treat­ment should be taken only with con­sul­ta­tion by a doc­tor.

● I AM A 30- YEAR-OLD WORK­ING WOMAN. SINCE LAST ONE YEAR, I am suf­fer­ing from itch­ing on my skull and have dry scales or only yel­low­ish scurf, in­fec­tions are also present oc­ca­sion­ally. I have con­sulted a skin spe­cial­ist for this prob­lem. He told me that you are suf­fer­ing from se­b­or­rheic der­mati­tis and dan­druff of the scalp. He ad­vise me to use a sham­poo and a so­lu­tion for this prob­lem. I want to know in de­tail about this dis­ease.

Se­b­or­rheic der­mati­tis is an acute or chronic papu­losqua­mous der­mati­tis. Se­b­or­rheic der­mati­tis may rep­re­sent an in­flam­ma­tory re­ac­tion to malassezia fur­fur yeasts. Pru­ri­tius (itch­ing over skin) is an in­con­stant find­ing. The scalp (skin over skull) has dry scales or only yel­low­ish scurf. Fis­sur­ing and sec­ondary in­fec­tion are oc­ca­sion­ally present. Pa­tients with Parkin­son's dis­ease, pa­tients who be­come acutely ill and are hos­pi­talised and pa­tients with HIV in­fec­tion of­ten have se­b­or­rheic der­mati­tis. Scal­ing of the scalp due to tinea ca­pi­tus may sim­u­late dan­druff or se­b­or­rheic der­mati­tis but alope­cia (ab­sence of hair in a par­tic­u­lar area) is usu­ally present in tinea capi­tis. Treat­ment of se­b­or­rhea and dan­druff of the scalp con­tains sham­poos that con­tain zinc pyrithione or se­le­nium are used daily if pos­si­ble. These may be al­ter­nated with ke­to­cona­zole sham­poo (1 per cent or 2 per cent) used twice weekly. A com­bi­na­tion of sham­poos is used in re­frac­tory cases. Tar sham­poos are also ef­fec­tive for milder cases and for scalp pso­ri­a­sis. Top­i­cal cor­ti­cos­teroid so­lu­tions or lo­tions are then added if nec­es­sary and are used twice daily. MY DAUGH­TER IS 19 YEARS OLD AND OBESE. I WANT TO KNOW about the health con­se­quences of obe­sity.

Obe­sity is as­so­ci­ated with sig­nif­i­cant in­creases in both mor­bid­ity and mor­tal­ity. A great many dis­or­ders oc­cur with greater fre­quency in obese peo­ple. The most im­por­tant and com­mon of these are hy­per­ten­sion, type II di­a­betes mel­li­tus, hy­per­lipi­demia, coro­nary artery dis­ease, de­gen­er­a­tive joint dis­ease and psy­choso­cial dis­abil­ity. Cer­tain can­cers (colon, rec­tum and prostate in men and uterus, bil­iary tract, breast and ovary in women), throm­boem­bolic dis­or­ders, di­ges­tive tract dis­eases (gall­stones, re­flux Oe­sophagi­tis) and skin dis­or­ders are also more preva­lent in the obese. Sur­gi­cal and ob­stet­ric risks are greater. Obese pa­tients also have a greater risk of pul­monary func­tional im­pair­ment en­docrine ab­nor - mal­i­ties, pro­tein­uria and in­creased haemoglobin con­cen­tra­tion. The rel­a­tive risk as­so­ci­ated with obe­sity, how­ever, de­creases with age and weight is no longer a risk fac­tor in adults over age 75. I AM A 35- YEAR- OLD HOUSEWIF., SINCE LAST ONE YEAR I FEEL pain and dif­fi­culty dur­ing sex­ual in­ter­course. I want to know about this prob­lem in de­tail. Pain or dif­fi­culty with in­ter­course is known as dys­pare­u­nia. Its causes may be briefly sum­marised as any painful ob­struc­tive le­sion at the vagi­nal in­troi­tus or in the vagi­nal canal, painful in­flam­ma­tory con­di­tions in these two sit­u­a­tions and deeper seated le­sions such as en­dometrio­sis of the uterosacral lig­a­ments and retro­ver­sion of the uterus with ten­der pro­lapsed ovaries. When the his­tory of pain is be­ing taken, these points must all be borne in mind. The pa­tient must first be asked if she has any pain and if so the re­la­tion of the pain to men­stru­a­tion must be in­ves­ti­gated as must also be the sit­u­a­tion, sever­ity and date of de­vel­op­ment of the pain. It is al­ways in­struc­tive to re­quest the pa­tient to point out with her fin­ger the ex­act sit­u­a­tion of the spot of max­i­mum pain. Quite of­ten she is able to do this with anatom­i­cal ex­ac­ti­tude – eg in ovar­ian pain – she will in­di­cate a spot one inch above the mid point of pu­part's lig­a­ment. A vague ges­ture which en­com­passes the up­per ab­domen usu­ally in­di­cates an ex­tra gen­i­tal ori­gin and sug­gests the pos­si­bil­ity of func­tional over­lay. – Dr San­jay Teo­tia.

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