Woman's Era - - Contents - – Dr San­jay Teo­tia.

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.

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