MY DAUGHTER IS 11 YEARS OLD. I WANT TO KNOW about the earliest indication of the onset of puberty and their stages also. Enlargement of breasts is the earliest indication of the onset of puberty. Breast development occurs in five stages. In the first stage is increased vascularisation of the areola and nipple. In second stage the palpable nodule of the mammary tissue enlarges to form a mammary bud and the diameter of areola increases. In the third stage the breast and areola enlarge further. There is no apparent difference in their level or contours. In the fourth stage the areola and nipple form a secondary mound which is slightly raised above the level of the breast. In the fifth stage the breast becomes fully mature, in the fully mature breast, only the nipple projects and the areola recedes to conform to the general contour of the breast.
MY 16 YRS OLD DAUGHTER IS SUFFERING FROM GENERALISED bodyache. We have consulted a doctor for this problem. After investigations doctor told us that she is suffering from calcium deficiency. I want to know about the diet rich in calcium and how much it is required for body.
The body of an adult normally contains about 1200 gm of calcium. At least 99 per cent of this is present in the skeleton, where calcium salts ( Chiefly hydroxyapatite), held in a Cellular matrix provide the hard structure of the bones and teeth. Obviously all of this calcium comes from the diet. Among common foods, the calcium containing protein of milk (caseinogen) is much the richest source, which is one reason why milk and cheese are especially valuable for growing children. Half a litre of cow's milk contains about 0.6 gm of calcium. Most other foods contribute much smaller amounts. However, peas, beans, other vegetables are particularly cereals grains are frequently the chief contributors because of the large amounts eaten. Drinking water can provide significant amounts of calcium. 70 to 80 per cent of the calcium in the food is normally excreted in the faeces. Calcium absorption may be impaired either by lack of Vitamin- D, by any conditions causing small intestinal hurry, by the combination of calcium with excess fatty acids to form insoluble soaps in steatorrhoea or by certain substances in the diet which can form insoluble salts with calcium. W. H. O. recommends a daily intake of 500 mg for adult men and women, rising to 1200 mg during pregnancy and lactation. For adolescent boys and girls the recommended intake is 600 to 700 mg daily. Deficiency of calcium and Vitamin D go hand in hand and are best considered together.
MY DAUGHTER IS ABOUT 27 YRS OLD. BECAUSE of abortion last month, she is suffering from continuous vaginal bleeding. We have consulted a gynecologist, she told that in case of abortion there is a history of missed periods followed by excessive bleeding. I want to know in detail about the continuous Vaginal bleeding. Some patients suffer from continuous uterine bleeding so that the normal cyclical bleeding can no longer be distinguished. Continuous bleeding of this kind occurs in the case of an abortion, ectopic gestation, cancer of cervix or endometrium, metropathia haemorrhagica and with some uterine polypi. In abortion there is a history of missed periods followed by excessive bleeding. In case of abortion when some piece of foetus left in uterus than continuous bleeding occurs until the piece of foetus is removed.
In ectopic gestation ( fertilised ovum become implanted other than uterus) the vaginal bleeding is small in amount and usually consists of dark altered blood. In most ectopic gestations the bleeding per vagina starts about six weeks after the last normal period and almost invariably the patients give a history of severe abdominal pain. With cancer of the cervix continuous bleeding is often accompanied by an offensive discharge.
MY MOTHER IS ABOUT 65 YRS OLD, SHE IS SUFFERING FROM diabetes since last ten years. She recently developed an ulcer in her leg around the ankle joint and the dorsum of the foot. We have consulted a doctor, he told us that she is suffering from trophic ulcers and adviced some medicines and skin grafting also. I want your opinion about this disease.
Trophic ulcers are due to an impairment of the nutrition of the tissues, which depends upon an adequate blood supply and also a properly functioning nerve supply. Ischaemia (inadequate blood supply) and anesthesia will therefore cause these ulcers. In the leg, painful ischaemic ulcers occur around the ankle or on the dorsum of the foot, ulcers due to anaesthesia (diabetic neuritis, spine bifida, leprosy or a periferal nerve injury) are often called perforating ulcers.
Starting in a corn or bunion, they penetrate the foot and the suppuration may involve the bones and joints and spread along fascial planes upwards even involving the calf.
Treatment consists of any underlying cause is treated like diabetes and arterial disease. Many lotions and nonadhesive applications are used to aid the separation of sloughs, hasten granulation and stimulate epithelialisaton.
Skin grafting is required in many cases but broad spectrum antibiotics in propylene glycol solution helps to clean an ulcer prior to skin grafting. Chronic and indolent ulcers often respond to infra-red radiation, short-wave therapy or ultra-violet light.