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Definition
Burns are injuries caused to the skin or underlying tissues by direct heat or
extreme cold; scalds are burns caused by hot liquids or gases (such as steam).
The severity of burns is measured in two ways: by the depth of the
burn (see sidebar) and by the size of the affected area. Doctors use the
(TBSA) has been burned. In adults, the head and neck together count as
9 percent of the body; each arm also counts as 9 percent. The front of the
trunk, the back, and each leg are considered to each represent 18 percent
of the TBSA. Doctors count only second- and third-degree burns in estimating
the affected areas of the body.
Thermal burns (and scalds) are defined as burns caused directly by
heat or by chemical reactions that release heat. They are divided into several
categories according to the specific cause:
rule of ninesto evaluate how much of a persons total body surface area
fire. Flame burns may take the form of a sudden flash burn produced
by a flammable liquid or gas igniting. Pouring lighter fluid
on burning charcoal is a common cause of flash burns.
Flame burns. This type of burn results from direct contact with
like a heated iron or cooking pan. Scalds are contact burns caused
by hot liquids or gases.
Contact burns. These burns are caused by touching a hot object
wire or in rare cases by lightning. Electrical burns are serious
because they can cause serious injury to internal organs that is not
obvious from the size of the skin burn.
caused by welding equipment, radiation
therapy for cancer, or overexposure to
sunlight or tanning equipment. Sunburn
is a common form of radiation burn.
Radiation burns. Radiation burns can be
caused by either strongly alkaline materials
like lye, or by strong acids like sulfuric
acid and nitric acid. Some acids are
strong enough to eat through the skin and
muscles down to the underlying bone.
Thermal burns affecting a person
be as dangerous as burns affecting the surface of
the body. The tissues of the airway can be burned
by breathing in superheated air from a fire, toxic
gases, smoke, or steam. In the United States, most
people who die in house or office fires die from
smoke inhalation rather than from skin burns.
Skin can also be burned by exposure to cold,
either by lengthy exposure to cold outdoors
(frostbite) or by brief exposure to extremely cold
materials like dry ice.
Chemical burns. Chemical burns can bes airway can
Description
The experience of a burn varies considerably
depending on the cause of the burn, the parts
of the body that are affected, the severity of the
burn, and the situation in which the burn
occurred. Human soft tissue will burn at any
temperature above 115°F (46°C). Most burns
are accidental; however, about 10 percent of
cases of child abuse involve intentional burning
or scalding of the child.
Demographics
Burns are commonplace injuries worldwide, partly because they have so
many potential causes. In the United States, about one million people
seek treatment for burns in hospital emergency rooms each year. This
figure actually represents a decline from the early 1960s, when the
number was about two million. About 40,000 people are hospitalized for
burn injuries each year rather than being treated as outpatients; of those
admitted to hospitals, 60 percent, or 25,000 people, are sent to one of
the 125 hospitals in the United States with specialized burn centers.
According to the American Burn Association, there are about 4,000
deaths from burns each year in the United States, 3,500 from house fires
and the remaining 500 from automobile and aircraft crashes, contact
with electricity, chemicals or hot liquids and substances. About 75 percent
of these deaths occurred at the scene of the accident or on the way to the
hospital.
Burn injuries vary according to age group:
and younger are caused by scalds (65 percent) and contact burns
(20 percent). These injuries often occur when children pull
pots and pans containing hot food or boiling water from a stove
top.
Infants and children: most burn injuries in children four years
about 88,000 are treated in hospital emergency rooms each year.
The most common causes in this age group are hair curlers, curling
irons, room heaters, ovens and ranges, clothing irons, gasoline,
and fireworks.
Adolescents and children between the ages of four and fourteen:
injuries than women; 70 percent of patients admitted to specialized
burn centers are male. Forty-three percent of these severe injuries
occurred at the person
8 percent in the workplace; and 32 percent in other locations.
Among adults, men are more likely to require hospitalization for burns home; 17 percent on the street or highway;
Causes and Symptoms
Burns are caused by exposure to a source of heat, whether direct flame,
electricity, radiation, contact with a hot object, or chemicals. Airway
burns are caused by breathing in steam, heated air from a fire, or smoke
and toxic gases.
Symptoms of first-degree burns include pain and reddening of the
affected area. Second-degree burns produce blisters as well as reddened
skin and pain. Third-degree burns are painless because the nerve endings
in the affected area have been destroyed. The affected skin may be white
or charred, and is usually dry or leathery.
The symptoms of airway burns include:
Charred or burned mouth and lips; burns on the face or neck
Wheezing and difficulty breathing
Singed nose hairs or eyebrows
Coughing
Dark soot-colored mucus being coughed up
Changed voice
Diagnosis
The diagnosis of burns and scalds is usually obvious from the patient
situation and the appearance of the injury. Patients taken to the emergency
room will usually be given a chest x ray to check for evidence of
smoke inhalation or other injury to the airway.
Most of the evaluation in the hospital consists of determining the
extent of the patient
area of body surface covered by second- or third-degree burns. Another
quick measurement that can be used to estimate the size of the burn is
the area covered by an adult
body area. Emergency room doctors use these rules to tell whether a
patient should be sent to a specialized burn center:
ss injuries. The rule of nines is used to estimate thes palm, which is about 1 percent of total
area (BSA)
Third-degree burns covering more than 5 percent of body surface
Second-degree burns covering more than 10 percent of BSA
or skin covering a major joint
Any second- or third-degree burn on the face, genitals, hands, feet,
Burns caused by electrical currents, lightning, or chemicals
broken bones, etc.)
Burns occurring together with other major injuries (head trauma,
Burns in patients with inhalation injuries
Treatment
Minor first-degree burns can be treated at home by cooling the injured
part by holding it under cool tap water for several minutes. Ice should not
be used because it can make the injury to the skin worse. Butter or margarine
should not be applied because oily substances will not help heal
the burn and may increase the danger of infection. Aspirin or Tylenol can
be taken to ease pain, and an antibiotic ointment can be applied to the
skin to reduce the risk of infection.
If a person
and roll
object or open flame and their clothing removed if possible. Burned
clothing that is stuck to the skin should not be removed, however. The
burned person should be doused with water and covered with a clean
sheet or other cloth while emergency services are called. Severe burns
should never be treated with ointments or other household remedies
while waiting for emergency help.
Treatment of severe burns in the hospital begins with an evaluation of
the patient
burned clothing and careful inspection of the burns. After the patient
burns have been washed with sterile solution, he or she will be given
intravenous fluids to prevent shock and dehydration. Painkillers are also
given intravenously to relieve the patient
The next step in burn treatment is surgical debridement (cutting
away) of open blisters and dead tissue. If the person
enough to require transfer to a burn center, they will be kept in the hospital
overnight to make sure that their airway has not been injured.
s clothing is on fire, they should be told to stop, drop,to put out the fire. They should be pulled away from the hots airway and their blood circulation. The next step is removal ofss pain as quickly as possible.s burns are not severe
Prognosis
The prognosis of burns and scalds varies from excellent to poor
depending on the location of the burn, its cause, the patient
overall health, and how quickly they received treatment. Minor burns
rarely cause long-term complications. Second-degree burns, however, can
become infected and the infection can spread into the bloodstream if not
treated promptly. Patients can also become dehydrated after a burn
injury. Anyone with a burn who notices red streaks or pus in the burned
area, increased pain, swollen lymph nodes near the burn, or fever; or
anyone who feels dizzy, lightheaded, extremely thirsty, or cannot urinate
after a burn should see their doctor at once.
According to the American Burn Association, 95 percent of patients
treated in specialized burn centers survive their injuries.
s age and
Prevention
Prevention is one of the most important aspects of burn care, as public
health doctors estimate that 75 percent of burns are preventable. The
Centers for Disease Control and Prevention (CDC) recommend the following
preventive steps:
regularly.
Install smoke detectors in the home and check their batteries
matches and fireworks.
Teach small children about fire safety, including the dangers of
accidental scalding in the tub or shower.
Set the household water heater at 120°F (49°C) or lower to prevent
of pots and frying pans toward the back of the stove to prevent
children from grabbing them.
Keep small children from climbing up on the stove; turn the handles
Place fire extinguishers in key locations in the home and workplace.
off the floor.
Keep electrical appliances in good repair and keep electrical cords
Practice fire escape routes in the home, school, and workplace.
The Future
Burns are likely to continue to be a common form of accidental injury.
Better education as well as further research into burn treatment may
help to lower the number of injuries and deaths caused by burns. One
of the most important factors in lowering the rate in the last twenty years
is the increased use of smoke detectors. A major new area of research is
the development of skin substitutes for covering major burns instead of
using grafts taken from the patient
s own skin.
SEE ALSO
Child abuse; Frostbite; Smoke inhalation; Smoking; Sunburn
For more information
BOOKS
American Academy of Pediatrics (AAP).
MA: Jones and Bartlett Publishers, 2008.
Cook, Allan R.
Various Types of Burns and Scalds
Pediatric First Aid for Parents. Sudbury,Burns Sourcebook: Basic Consumer Health Information about. Detroit, MI: Omnigraphics, 1999.
PERIODICALS
Nagourney, Eric.
January 4, 2005. Available online at http://www.nytimes.com/2005/01/04/
health/04haza.html?_r=1&oref=slogin (accessed September 7, 2008).
WEB SITES
American Academy of Family Physicians (AAFP).
Available online at http://familydoctor.org/online/famdocen/home/healthy/
firstaid/after-injury/638.html (accessed September 6, 2008).
American Burn Association.
Sheet
(accessed September 6, 2008).
American College of Emergency Physicians (ACEP).
Available online at http://www3.acep.org/patients.aspx?id=25990 (accessed
September 6, 2008).
Centers for Disease Control and Prevention (CDC).
Fact Sheet
(accessed September 6, 2008).
eMedicine Health.
www.emedicinehealth.com/thermal_heat_or_fire_burns/article_em.htm
(accessed September 7, 2008).
National Institute of General Medical Sciences (NIGMS).
Available online at http://www.nigms.nih.gov/Publications/Factsheet_Burns.
htm (accessed September 6, 2008).
National Library of Medicine (NLM).
nlm.nih.gov/medlineplus/tutorials/burns/htm/index.htm (accessed September
6, 2008). This is an online tutorial with voiceover; viewers have the
option of a self-playing version, a text version, or an interactive version with
questions.
Nemours Foundation.
kidshealth.org/parent/firstaid_safe/sheets/burns_sheet.html (accessed
September 6, 2008).
Burns: Taking Care of Burns.Burn Incidence and Treatment in the US: 2007 Fact. Available online at http://www.ameriburn.org/resources_factsheet.phpAvoiding Household Burns.Fire Deaths and Injuries. Available online at http://www.cdc.gov/ncipc/factsheets/fire.htmThermal (Heat or Fire) Burns. Available online at http://Burns Fact Sheet.Burns. Available online at http://www.Burns Instruction Sheet. Available online at http://
Hazards: Of Hot Pots and Back Burners.New York Times,
Electrical burns. These can be caused by contact with a live electrical

Burns and Scalds

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Bulimia is defined as an eating disorder characterized by recurrent episodes
of binge eating followed by self-induced vomiting, laxative or
diuretic abuse, vigorous exercise, or fasting.
Description
The
(DSM-IV), the reference that doctors use to diagnose mental illness, specifies
that a person must have an eating binge and try to compensate for
it on average twice a week for three months to meet the diagnostic criteria
for bulimia. A binge is an episode in which someone consumes a
larger amount of food within a limited period of time than most people
would eat in similar circumstances. Most bulimics report feelings of loss
of control associated with bingeing. A second criterion of bulimia is
excessive concern with one
There are two subtypes of bulimia, purging and nonpurging,
according to the methods used by the patient to prevent gaining weight
after a binge. People who have the purging subtype use vomiting, laxatives,
enemas, or diuretics to keep from gaining weight; in the nonpurging
subtype, the person fasts or overexercises to prevent weight gain. The
important point is that bulimics do something after a binge to compensate
for their eating. There is another type of eating disorder called
binge eating disorder, in which the person has eating binges but does not
try to vomit, exercise, or do anything else to prevent gaining weight.
Demographics
There is some disagreement about the demographics of bulimia, partly
because the rules for diagnosing it have changed over time. The usual
figure given for bulimia in the United States is 1
school- and college-age women. Many doctors think, however, that
bulimia is underdiagnosed because most people with the disorder are of
average weight or only slightly overweight. In addition, there are large
numbers of teenagers and young adults who have disordered eating patterns
but do not meet the full criteria for bulimia; there may be twice as
many young people in this second group as those who meet the full
DSM-IV definition.
The gender ratio is usually given as ten females to every one male
affected, but some people think that as many as 15 percent of bulimics
are male. Gay men appear to be at greater risk of developing bulimia than
heterosexual men.
At one time bulimia was thought to affect mostly Caucasian women,
but the rates among African American and Hispanic women have risen
faster than the rate of bulimia for the female population as a whole, at least
in the United States. Occupation appears to be a major risk factor for bulimia.
Women whose careers depend on appearance or a certain body build, such as
ballet dancers, models, and professional athletes, are reported to be four times
as likely to develop bulimia as women in the general population.
Causes and Symptoms
The causes of bulimia are not known for certain, but are thought to be a
combination of genetic factors (possibly unusual sensitivity to foods high in
carbohydrates); the emotional climate in the patient
in the wider society to live up to a standardized image of beauty. In terms
of family patterns, people with bulimia often describe their families as conflicted
and their parents as either distant and uncaring or hostile and critical.
Bulimia is associated with a number of physical symptoms. Binge
eating by itself rarely causes serious medical complications, but it is associated
with nausea, abdominal bloating and cramping, slowed digestion,
and weight gain.
Bulimics who force themselves to vomit after a binge may develop
serious medical problems, including:
s family; and pressures
vomited material.
Erosion of the enamel on the teeth, caused by stomach acid in the
Enlargement of the salivary glands.
teeth.
Scars and calloused areas on the knuckles from contact with the
Irritation of the throat and esophagus.
can deplete the body
sodium, and magnesium. The loss of these chemicals in turn can
sometimes affect heart rhythm.
Electrolyte imbalances. The loss of fluids from repeated vomitings stores of hydrogen chloride, potassium,
Diagnosis
Bulimia is usually diagnosed during an office visit to the patient
care doctor, although she or he may be sent to a psychiatrist for
an additional evaluation. Primary care doctors are now encouraged to
give a screening test to an adolescent or young adult who seems unusually
concerned about their weight or asks the doctor a lot of questions
about weight loss. These screeners are short sets of five questions about
eating habits that the patient can quickly answer. If the doctor thinks
that the patient may have bulimia, he or she can look for some of the
physical signs that accompany the disorder, such as whether the teeth
and salivary glands are normal. In most cases the doctor will order laboratory
tests of the patient
chemistry is normal. Most doctors will also give the patient an electrocardiogram
(ECG) to check the patient
because some types of chemical imbalances in the blood (from
vomiting or using diuretics) can lead to irregular heart rhythms.
Another important part of evaluating a patient for bulimia is a
mental status examination. The doctor will need to check the patient for
signs of anxiety disorders or depression, because a high proportion of
bulimics have a mood disorder. In addition, people with bulimia are
more likely to be treated successfully for their eating disorder when their
anxiety or depression is also being treated.
s primarys blood and urine to make sure that her bloods heart rhythm. This test is important
Treatment
Treatment for bulimia consists of psychotherapy combined with medications.
The type of psychotherapy most often recommended for bulimics
is cognitive-behavioral therapy (CBT), along with interpersonal therapy.
In CBT, the patient is helped to recognize the distortions in their mental
image of their body and to correct irrational beliefs about food and
eating. Family therapy may be recommended if the patient
appears to be a major cause of his or her emotional distress; as of late
2007, there was some evidence that family therapy is more helpful for
some patients with bulimia than individual therapy. Some bulimics also
benefit from group therapy or support group meetings.
The medications most often prescribed for bulimics are antidepressants,
in particular such drugs as fluoxetine (Prozac) and sertraline
(Zoloft). Scientists do not fully understand how these drugs help in
treating bulimia, but some think that they help to regulate chemical
imbalances in the patient
s central nervous system.
Prognosis
The prognosis of bulimia depends on several factors, including the
patient
close friendships that she or he has. Patients who are diagnosed early,
have good relationships with their parents, and have several close friends
are more likely to recover. About half of bulimics have good outcomes
after treatment, 18 percent have intermediate outcomes, and 20 percent
have poor outcomes.
s age at diagnosis, the quality of family life, and the number of
Prevention
While it is difficult to change an entire society and its overly high valuation
of physical attractiveness, parents can certainly lower a child
bulimia in later life by creating a warm and loving home. It is important
to convey to children that they are loved as whole persons with minds
and spirits, not just outwardly pleasing faces and bodies.
s risk of
The Future
It is not known with certainty whether bulimia is increasing in the
United States, partly because it overlaps with other eating disorders in
some people and partly because doctors are looking more closely at men
who may be bulimic but were not diagnosed with the disorder in the
past. Although doctors are looking for better treatments of bulimia,
including new medications, further research in the chemistry of the brain
is needed.
SEE ALSO
Anorexia; Depression; Obesity
For more information
BOOKS
Hall, Lindsey, and Leigh Cohn.
CA: Gürze Books, 1999.
Hornbacher, Marya.
HarperPerennial, 1999.
PERIODICALS
Bakalar, Nicholas.
Therapies: Family Sessions Found to Help Treat Bulimia.
New York Times
nytimes.com/2007/09/04/health/04ther.html?_r=1&sq=bulimia&st=
nyt&adxnnl=1&oref=slogin&scp=2&adxnnlx=1207166511-3dUW3ny1
e8NabVf2POt6Ow (accessed March 2, 2008).
, September 4, 2007. Available online at http://www.
WEB SITES
Gürze Books.
publisher that specializes in books and other educational materials on
bulimia.
National Eating Disorders Association (NEDA).
edap.org/p.asp?WebPage_ID=286&Profile_ID=41141.
Public Broadcasting Service (PBS).
Family
website to a PBS series of programs on bulimia and other eating
disorders.
Bulimia.com. http://www.gurze.com/. This is the website of aBulimia Nervosa. http://www.Perfect Illusions: Eating Disorders and the. http://www.pbs.org/perfectillusions/index.html. This is the companionSomething Fishy: Website on Eating Disorders. http://www.something-fishy.org/
Bulimia: A Guide to Recovery. 5th ed. Carlsbad,Wasted: A Memoir of Anorexia and Bulimia. New York:
s family
Low blood pressure and slowed heart rate.
3 percent of high
Diagnostic and Statistical Manual of Mental Disorders, fourth editions body shape and weight.
Bulimia

Definition

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Definition
Bronchitis is a condition in which the tissues lining the bronchi
two main divisions of the airway that lead into the right and left
lungs
a temporary illness that clears up in three weeks or less; or chronic, a
recurrent condition in which the person suffers coughing attacks for
at least three months over two successive years. Chronic bronchitis is
grouped together with emphysema as a form of chronic obstructive
pulmonary disease (COPD).
thebecome inflamed. Doctors define bronchitis as either acute,
Description
Bronchitis can be caused by a wide range of disease organisms and other
irritants that inflame the tissues of the bronchi, including viruses, bacteria,
parasites, smoking, chemical pollutants, or dust particles. Acute
bronchitis is caused most often by viruses, while chronic bronchitis is
caused most often by smoking.
In acute bronchitis, the tissues lining the bronchi become swollen
and irritated by the disease organism or chemical. The air passages slowly
become clogged by dead cells and leaking tissue fluid, which further irritates
the bronchial tissues. The tissues begin to secrete mucus in response
to the inflammation. As the mucus accumulates
in the airways, the person starts to cough in
order to clear the breathing passages. The
coughing, the sputum (mucus and other matter)
that is brought up by coughing, and wheezing or
shortness of breath are classic symptoms of acute
bronchitis. Chest pain may develop after several
days of severe coughing.
Demographics
According to the National Center for Health Statistics,
about 14 million Americans have chronic
bronchitis. In an average year, there are 12
cases of acute bronchitis reported in the United
States, compared to 91 million cases of influenza,
66 million cases of the common cold, and 31 million
cases of other acute upper respiratory infections.
Acute bronchitis is more common in the
winter months in most parts of the United States.
Children are more likely to develop acute
bronchitis, while chronic bronchitis is largely a
disease of adults. The male/female ratio for
chronic bronchitis is about three to two. As far
as is known, both acute and chronic bronchitis are
equally common in all races and ethnic groups.
Some people are at increased risk of developing
bronchitis:
13 million
Smokers and people who live with smokers.
(GERD). GERD is a condition in
which stomach acid backs up into the esophagus,
which can trigger the coughing reflex.
People with gastroesophageal reflux disease
that irritate the airway. These may include cotton and
other textiles, wheat and other grains, ammonia, sulfur dioxide,
chlorine, and a few other strong chemicals.
People whose jobs expose them to chemicals, dust, or other substances
People exposed to high levels of automobile exhaust.
Causes and Symptoms
The basic cause of bronchitis, whether acute or chronic, is a disease
organism or substance that irritates the tissues lining the bronchi.
The symptoms of acute bronchitis are similar to those of a bad cold
or other upper respiratory infection:
Sore throat
A feeling of tightness or congestion in the chest
Overall feeling of tiredness
Low-grade fever and chills
Difficulty breathing
Wheezing
Diagnosis
Acute bronchitis is essentially a diagnosis of exclusion, which means that
the doctor must rule out such other illnesses as influenza, strep throat,
pneumonia, whooping cough, or tonsillitis. The diagnosis is based on a
combination of the patient
respiratory tract infections or exposure to others with such infections,
and a physical examination. During the physical examination, the doctor
will listen to the patient
may be ordered to rule out pneumonia.
The doctor will sometimes collect a sample of the patient
there is reason to suspect that the bronchitis is caused by bacteria. Most
cases of acute bronchitis are caused by the same types of virus that cause
the common cold and cannot be treated with antibiotics; however, bacterial
infections can be effectively treated by antibiotic medications. If the
patient has a severe sore throat in addition to wheezing and coughing, the
doctor may order a rapid strep test to rule out the possibility of strep
throat, another type of bacterial infection.
If the patient has had several episodes of acute bronchitis or the
doctor has other reasons for suspecting chronic bronchitis, the doctor
will order pulmonary function tests (PFTs). These are tests in which the
patient is asked to breathe into a device called a spirometer. The spirometer
measures how much air the patient
air moves in and out of the lungs. It can also be used to determine how
well the lungs are exchanging oxygen and carbon dioxide. Another way
the spirometer can be used is to test the effectiveness of inhaled medications
in treating chronic bronchitis.
Treatment
Acute bronchitis is usually treated at home with a combination of bed
rest; over-the counter pain-relievers like aspirin, Advil, Tylenol, or
Motrin to lower the fever; and over-the counter cough medications.
Some of these medications (Robitussin, Mucinex) are intended to loosen
the mucus in the bronchial passages while others (Benylin, Pertussin) are
intended to suppress (quiet) the coughing. Patients should drink plenty
of clear fluids to loosen the mucus and use a humidifier or cool-mist
vaporizer to reduce the irritation in the bronchi.
Because the overuse of antibiotics can create drug-resistant organisms,
the doctor may not prescribe an antibiotic for acute bronchitis
unless he or she has test results indicating that the patient
caused by a bacterium and not a virus.
People with chronic bronchitis may need stronger medications:
s illness is
up the airways, which allows for more efficient exchange of carbon
dioxide and oxygen. Some are taken in tablet form while others are
dispensed in inhalers.
Bronchodilators. Bronchodilators are drugs that work by opening
in the tissues lining the airways. These drugs can also be
taken in pill form or through inhalers.
Steroids. This type of medication works by lowering the inflammation
to lower the risk of developing complications.
Antibiotics. People with chronic bronchitis may be given antibiotics
need to go to the hospital for oxygen therapy. There are also oxygen
tanks that can be used in the home; some of these are portable units.
Oxygen. Patients who have severe attacks of chronic bronchitis may
Prognosis
Most cases of acute bronchitis clear up completely in two to three weeks with
no long-term complications. Chronic bronchitis, however, increases a person
risk of permanently weakened lungs, heart disease, and a shortened life span.
s
Prevention
The best way to prevent chronic bronchitis is to quit smoking; parents
can protect their children from bronchitis by quitting or by not smoking
in the first place. In some cases, people whose jobs expose them to
chemicals, dust, or other materials that irritate the breathing passage may
benefit from changing their occupation.
Acute bronchitis is more difficult to prevent because its most
common cause is upper respiratory viruses that are hard to avoid. Regular
hand washing and the use of hand sanitizers can reduce the spread of
these viruses within a family, school, or day care center. Some people can
lower the risk of bronchitis by getting annual flu shots. In addition,
people who are over sixty-five or who have diabetes or emphysema may
benefit from getting immunized against the most common cause of
bacterial pneumonia.
The Future
Acute bronchitis is likely to continue to be a commonplace health problem
because the viruses that are its most common cause are widespread,
particularly during cold and flu season. Chronic bronchitis is expected to
affect an even larger proportion of the adult population in the years
ahead because many long-term smokers are now reaching the age at
which the symptoms of chronic obstructive pulmonary disease are most
likely to appear.
SEE ALSO
disease; Pneumonia; Smoking; Tonsillitus; Whooping cough
Asthma; Common cold; Emphysema; Gastroesophageal reflux
For more information
BOOKS
Jacoby, David B., and Robert M. Youngson.
ed. Tarrytown, NY: Marshall Cavendish, 2004.
Matthews, Dawn D.
Detroit, MI: Omnigraphics, 2002.
WEB SITES
American Academy of Family Physicians (AAFP).
online at http://familydoctor.org/online/famdocen/home/common/infections/
common/mulitsource/677.html (updated January 2006; accessed June
19, 2008).
American Academy of Family Physicians (AAFP).
online at http://familydoctor.org/online/famdocen/home/articles/280.html
(updated April 2008; accessed June 20, 2008).
Children
childrenshospital.org/az/Site561/mainpageS561P0.html (accessed June 19, 2008).
eMedicine Health.
bronchitis/article_em.htm (updated February 22, 2008; accessed June 20, 2008).
Mayo Clinic.
bronchitis/DS00031 (updated April 20, 2007; accessed June 20, 2008).
TeensHealth.
common/bronchitis.html (updated October 2007; accessed June 19, 2008).
Acute Bronchitis. AvailableChronic Bronchitis. Availables Hospital Boston. Bronchitis, Acute. Available online at http://www.Bronchitis. Available online at http://www.emedicinehealth.com/Bronchitis. Available online at http://www.mayoclinic.com/health/Bronchitis. Available online at http://kidshealth.org/teen/infections/
Encyclopedia of Family Health. 3rdLung Disorders Sourcebook: Basic Information for Consumers.
s history, including a history of recent uppers breathing through a stethoscope. A chest x rays sputum ifs lungs can hold and how fast the
Infants, elderly people, and others with low resistance to infections.

Bronchitis

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Description
Breast cancer is one of the most feared cancers for women, not
only because it is potentially fatal but also because it can lead to disfigurement
and worries about the loss of femininity. It can also develop
for a long time before obvious symptoms appear. One reason why periodic
screening for changes in breast tissue is so important for women
over the age of twenty is that breast cancer is highly treatable when
caught early.
In the early stages of breast cancer, a woman (or man) may not
notice any differences in the size and shape of the breasts. The most
noticeable symptom of breast cancer is a lump or thickened area in the
breast. Not all such lumps are cancerous; many women notice that the
texture of their breasts changes during pregnancy or their menstrual
periods. Lumps in the breast can also be caused by noncancerous cysts.
Nonetheless, a woman (or man) who notices a lump in the breast
should tell their doctor.
Demographics
Breast cancer is one of the most common cancers in women, affecting
one in every eight women in the United States in the course of her lifetime.
According to the American Cancer Society, there are about
68,000 cases of carcinoma in situ (noninvasive
or stage 0 breast cancer) in the United States
each year, and 183,000 cases of invasive breast
cancer (stages I through IV). About 2,000 American
men will be diagnosed with breast cancer.
Breast cancer is the second leading cause
of death from cancer among women in the
United States; only lung cancer is deadlier.
About 41,000 American women and 450 men
die each year from breast cancer. The death
rate has decreased in recent years, largely as a
result of earlier detection. There were an estimated
2.5 million survivors of breast cancer
in the United States as of 2008.
Risk factors for breast cancer include:
cancer is 99:1.
Sex. The female/male ratio for breast
are found in women over fifty-five.
Age. Two out of three invasive breast cancers
of breast cancers are thought to be
caused by inherited mutations in two
genes known as BRCA1 and BRCA2. Women with either of
these mutations have an 80 percent chance of developing breast
cancer in their lifetime.
Genetic mutations. Between 5 and 10 percent
or daughter with breast cancer has double the risk of developing
breast cancer herself.
Family history of breast cancer. A woman who has a mother, sister,
cancer than women of other races; however, breast cancers in
African American women are often more aggressive. The reason
for this difference is not known.
Race. Caucasian women are slightly more likely to develop breast
age fifty-five).
Early menstruation (before age twelve) or late menopause (after
First pregnancy after age thirty or no pregnancy.
Obesity.
Exposure to radiation during adolescence.
menopause.
Use of birth control pills or hormone replacement therapy after
Heavy drinking.
History of precancerous changes in the breast.
Causes and Symptoms
The cause of breast cancer is not known. Most researchers think that the
disease results from a combination of genetic factors and environmental
influences.
Breast cancer has no symptoms in its earliest stages. The first noticeable
symptoms may include:
during a breast self-examination.
A lump or thickened area in the breast large enough to be felt
A watery, bloody, or yellowish discharge from the nipple.
A change in the shape or size of the breast.
A flattened, puckered, or indented area in the skin of the breast.
An orange-peel appearance to the skin of the breast.
Diagnosis
Regular screening for breast cancer is important. All women over twenty
should learn to perform breast self-examination and check their breasts
once a month after the menstrual period. Other screening tests include
a breast examination by the doctor as part of a routine office visit, and
a mammogram, which is an x-ray study of the breast. Imaging studies
(magnetic resonance imaging [MRI] or ultrasound) are done when a
mammogram yields abnormal findings.
The definitive test for diagnosing breast cancer is a biopsy. The
doctor may remove some tissue through a fine needle (aspiration biopsy)
or if a larger sample is needed, through a larger needle (core biopsy). The
most accurate technique is a surgical biopsy, in which the surgeon
removes all or part of a lump for examination under a microscope.
Treatment
The first step in treating any kind of cancer is staging. Staging is a
description of the location of the cancer, its size, how far it has penetrated
into healthy tissue, and whether it has spread to other parts of the body.
Breast cancer is classified into five stages:
beyond it. Breast cancer in this stage is called carcinoma in situ.
This type of breast cancer is considered noninvasive.
Stage 0: The cancer is in a lobule or a duct but has not spread
across and has not spread beyond the breast.
Stage I: The cancer is no more than three-quarters of an inch
across and may have spread to the lymph nodes under the arm.
Stage II. The cancer is between three-quarters and two inches
the breast, is larger than two inches across, and has spread to
lymph nodes behind the breastbone and under the arm.
Stage III. The cancer has grown into the chest wall or the skin of
Surgery is usually the first line of treatment for breast cancer. Complete
removal of the breast and underlying chest muscle, called a radical
mastectomy, while more common in the past, is now rarely performed.
Surgeons are more likely to recommend one type or another of breastsparing
surgery:
Stage IV. The cancer has spread to other parts of the body.
cancer itself and a small amount of tissue around it.
Lumpectomy. In this type of surgery, the surgeon removes the
tissue surrounding it, and some of the underlying muscle.
Partial mastectomy. The surgeon removes the cancer, the breast
Simple mastectomy. The surgeon removes the entire breast.
breast and nearby lymph nodes but leaves the chest muscles
in place.
Modified radical mastectomy. The surgeon removes the entire
time as a mastectomy or as a later operation to restore the shape
of the original breast. The surgeon may use an artificial implant
or the patient
Other treatments for breast cancer that may be used after surgery
include:
Reconstruction. Many women have plastic surgery at the sames own tissue to reconstruct the breast.
outside the body or from implanted plastic tubes containing a
radioactive substance. The tubes remain in place for several days
and are removed before the patient leaves the hospital.
Chemotherapy.
drugs by mouth to block the production of estrogen and other
female hormones. Estrogen encourages the growth of some breast
cancers, and hormone blockers are effective in slowing these
tumors in some patients.
Hormone therapy. This approach to treatment involves taking
the body
attacking them directly. It can also be used to control side effects
from chemotherapy and radiation therapy, which often include
nausea, vomiting, hair loss, and fatigue.
Biological therapy. Also called targeted therapy, this approach stimulatess immune system to fight cancer cells rather than
Prognosis
The prognosis for breast cancer depends on its stage at the time of diagnosis
and the number of lymph nodes that were involved when the cancer was
discovered. Women whose tumors were smaller than three-quarters of an
inch with no lymph node involvement have a survival rate of 96 percent
five years after diagnosis; those with tumors larger than two inches with several
lymph nodes involved have a five-year survival rate of only 45 percent.
Prevention
There are no guarantees that a specific woman will not get breast cancer,
but there are some steps women can take to reduce their risk:
get tested for a mutation in the BRCA gene. They can then consult
their doctor about their own risk of developing breast cancer.
Genetic testing. Women with a family history of breast cancer can
cancer. These include tamoxifen and raloxifene.
Taking drugs that have been shown to reduce the risk of breast
cancer can develop is a treatment sometimes undertaken by
women who are at very high risk of breast cancer or who have been
diagnosed with a lobular carcinoma in situ.
Preventive mastectomy. Surgical removal of both breasts before
of estrogen in a woman
recommended for women with a known BRCA mutation.
Other preventive measures recommended by the American Cancer
Society include getting regular exercise, limiting alcohol intake, keeping
weight at a healthy level, and avoiding the use of hormone replacement
therapy after menopause.
The Future
Researchers are investigating different types or combinations of hormone
therapy as a treatment for breast cancer. One large clinical trial is known
as the Study of Tamoxifen And Raloxifene or STAR trial. Other research
involves new diagnostic techniques for catching breast cancer early.
SEE ALSO
Alcoholism; Klinefelter syndrome; Obesity; Prostate cancer
For more information
BOOKS
American Cancer Society.
Answered / from the Experts at the American Cancer Society
American Cancer Society Health Promotions, 2008.
Brown, Zora K., and Karl Boatman.
Cancer
Willis, Jack.
University of Oklahoma Press, 2008.
Breast Cancer Clear and Simple: All Your Questions. Atlanta, GA:100 Questions and Answers about Breast. Sudbury, MA: Jones and Bartlett Publishers, 2009.Saving Jack: A Mans Struggle with Breast Cancer. Norman, OK:
PERIODICALS
Harmon, Amy, Alissa Krimsky, and Kassie Bracken.
Hoping for the Best.
http://video.on.nytimes.com/?fr_story=0aff7eb1147f98a41e989541f3fc114
c8e71dcd2 (accessed on September 23, 2008). This is an online video about
a
when she learned she has a high risk of developing breast cancer. It takes
about six and a half minutes to play.
Preparing for the Worst,New York Times, September 2007. Available online atprevivor,a young woman who chose to have a preventive mastectomy
WEB SITES
American Cancer Society (ACS).
online at http://www.cancer.org/docroot/CRI/CRI_2_3x.asp?dt=5 (updated
September 11, 2008; accessed on September 23, 2008).
Centers for Disease Control and Prevention (CDC).
Available online at http://www.cdc.gov/cancer/breast/ (updated July 11,
2008; accessed on September 23, 2008).
KidsHealth.
grownup/conditions/breast_cancer.html (updated June 2007; accessed on
September 23, 2008).
Mayo Clinic.
health/breast-cancer/DS00328 (updated September 26, 2007; accessed on
September 23, 2008).
National Cancer Institute (NCI).
Available online at http://www.cancer.gov/cancertopics/wyntk/breast/
allpages (updated November 1, 2007; accessed on September 23, 2008).
National Library of Medicine (NLM).
www.nlm.nih.gov/medlineplus/tutorials/breastcancer/htm/index.htm
(accessed on September 23, 2008). This is an online tutorial with voiceover;
viewers have the option of a self-playing version, an interactive version with
questions, or a text version.
Breast Cancer Home Page.Breast Cancer. Available online at http://kidshealth.org/kid/Breast Cancer. Available online at http://www.mayoclinic.com/What You Need to Know about Breast Cancer.Breast Cancer. Available online at http://
Detailed Guide: Breast Cancer. Available
Surgical removal of the ovaries. Since the ovaries are the main sources body, this type of operation is sometimes
Radiation therapy. The radiation may come from a large machine
Smoking.

Breast Cancer

Definition

Breast cancer is cancer that starts in the tissues of the human breast. It is
the second most common cancer in women, but can also affect men.
There are two main types of breast cancer. The more common of the
two, ductal carcinoma, begins in the ducts, or tubes, that carry milk from
the interior of the breast to the nipple. The other major type is lobular
carcinoma. It begins in the lobules, which are the parts of the breast that
secrete milk.

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