Medical Forum No. 265
Breast Conservation Surgery for Early Breast Cancer
Derrick Chua, M.D.
January 12, 2015
Breast Cancer: Second most common life-threatening cancer in women
Prolonged estrogen exposure (hormone replacement and oral contraceptive)
Heredity or genes
Avoid adult weight gain
Limit use of hormone replacement and oral contraceptive
Limit alcohol intake
Medication (Tamoxifen/Raloxifene/Exemestane) or Surgery
Genetic Profiling with Micro-arrays
Magnetic Resonance Imaging (MRI)
Clinical Breast Exam
I: Confined to Breast
II: Early Lymph node spread
Pathologic: Invasive ductal carcinoma is most common
Luminal A: Most common in age 70’s
Basal-like: Most aggressive type and is linked to ovarian cancer
Surgery: for early cancer
Breast Conservation Therapy: Removal of tumor plus radiotherapy
Mastectomy: Removal of breast with or without reconstruction
Axillary Dissection: Biopsy of Sentinel lymph node subsequently comprehensive node removal with or without radiotherapy
Outright Axillary Dissection: Higher risk of arm swelling
Radiotherapy: Loco regional treatment for the remaining breast or depending on stage of cancer
Hormonal Therapy: Response predicted by hormone receptors assays
Tamoxifen: Most affordable
Aromatase Inhibitors: More effective for postmenopausal
Chemotherapy: Combinations of agents given for early stage but molecularly aggressive subtypes
Herceptin (Traztuzumab) and similar antibodies to tested molecular targets: very expensive but effective
Meditation, Yoga, Stress management: Supportive care that improves mood, fatigue and quality of life
Twice a year physical exam for 5 years, yearly mammogram and with gynecology exam if on Tamoxifen
Other tests (e.g. chest x-ray) depends on symptoms
Medical Forum No. 266
Updates on Allergic Rhinitis
Johanna Co, M.D.
February 9, 2015
Allergic Rhinitis: Common form of Chronic non-infectious inflammatory rhinitis caused by high lgE level
Symptoms: Come and go but inflammatory will persist
Puffy eye bags
Denny Morgan lines
Clear and not muco-purulent mucus
House dust mites
Exposure to new allergens
n Skin allergy test
n Total IgE
n Fiberoptic rhinoscopy
n CT scan
Complications (if left unthreatened):
n Upper respiratory tract infection
n Otitis media
n Avoidance of allergens
n Oral Antihistamines
n Intranasal and oral corticosteroids: good but have side effects in some cases
n Oral and Intranasal Decongestants
Medical Forum No. 267
Luinio S.Tongson, M.D.
March 2, 2015
Foot Ulcer: A non-healing or poorly healing full thickness wound, through the dermis, below the ankle in an individual with diabetes, critical in the natural history of the diabetic foot.
60-70% of diabetes patients will develop peripheral neuropathy, or lose sensation in their feet.
More than 50% of all foot wounds require hospitalization, 20% will require an amputation.
People with a history of diabetic foot ulcer have 40% 10 year mortality.
Treatment of Diabetic Foot Ulcers:
n Determine its severity, vascularity and infection.
Wagner Classification: most widely used grading system
n Grade 0: No ulcer in a high risk foot.
n Grade 1: Involves full skin thickness
n Grade 2: Penetrate ligaments and muscle, but no bone involvement.
n Grade 3: Deep ulcer with cellulitis or abscess formation, often with osteomyelitis.
n Grade 4: Localized gangrene.
n Grade 5: Extensive gangrene involving the whole foot.
n Obtain wound closure
n Allow prompt healing of the lesion
n Prevent recurrence and amputation
Focus of Management Programs:
n Aggressive Intervention
n Optimal Use of Therapeutic Footwear
n Regular Foot Examinations
Medical Forum No. 268
Overcoming Barriers and Optimizing Care for Children with ADHD and Autism
Elizabeth Go-Tan, M.D.
April 13, 2015
Developmental and Behavioral Disorders: Children who have developmental delays or behave in ways that seem very different from others.
New physical stimulus, perception, and reaction may cause fear, anxiety and discomfort that may significantly affect children’s social, play and participation in daily lives.
A kind of chronic pediatric conditions causing functional impairment, and is common than childhood cancers or cardiac and renal problems.
Attention deficit hyperactivity disorder (ADHD): most common neurobehavioral disorder seen in children ages 4 to 18.
Symptoms: Inattention, hyperactive or impulsive, academic or behavioral problems.
Childhood Autism Spectrum Disorder (ASD): Children with difficulty in social interaction and communication; restricted interest or repetitive motor behavior or activity.
Evaluation: Primary care Physicians should routinely perform developmental and behavioral screening at regular intervals
Developmental Screening Tools: Aid in identifying disordered expressive and receptive language; deficits in gross and fine motor skills, self-help skills, and cognitive milestones.
General Development: Use standardized validated tools at9,18.24, or 30 months
ASD: at 18 and 24 months or whenever a parent or caregiver has concern
Behavioral and Emotional Screening Tools: help identifies problems like social-emotional regulation, attention, changes in mood and affect, and interpersonal skills.
Parents and caregivers should not only depend on the screening results, but should also observe closely on child’s behavior and overall development.
Health professionals should carefully listen and attend to their concerns, to ensure proper management and early intervention to take place without delay.
Medical Forum No. 269
James L. Angtuaco, M.D.
May 11, 2015
Dengue: A common mosquito-borne disease that can cause thrombocytopenia (abnormally decrease in the number of blood platelets)
n Symptomatic: fever, headache, decreased appetite, vomiting, joint muscle aches
n Asymptomatic: Experiencing no symptoms at all
n Blood Examination: To observe the number of platelets in the blood
Intravenous Fluids: Mainly treat symptoms and also aims to prevent dengue shock
Dengue Shock Syndrome: Acute, severe and potentially deadly stage caused by the spread dengue virus to the circulatory system or other vital organs
Treatment: use of Intravenous Fluids
Myocarditis (inflammation of heart muscles): One of the possible causes of dengue shock and its symptoms may also be present in asymptomatic dengue patients
Symptoms: Chest pain, Short breath, fatigue, fluid accumulation in the lungs, heart rhythm irregularities (bradycardia or slow heart rate)
n Intravenous Fluids
n Cardiac Support
n Course or Management: benign or mild type but favorable to treatment
Adolescent: Dilated Cardiomyopathy (heart becomes weakened and enlarged and can’t pump blood efficiently)
Adult: Still unknown
Medical Forum No. 270
Allergic Rhinitis, Asthma and Sinusitis: How Are They Linked?
Nanneth Tiu, M.D.
Allergic Rhinitis: Common, Chronic and progressive genetic disease that can cause inflammation of the inside nose due to allergen.
Symptoms: Occurs more than one hour most of the time and persist for more than weeks, months, and years.
Sneezing, dripping, snorting, sniffing, and snoring
Treatment: Manipulate the environment so allergy can be prevented
Complication: Affect quality of life
n Nasal Swelling
n Upper Respiratory infections
n Otitis Media
Sinusitis: obstruction of sinus opening due to swelling leading to stagnant of mucus and secondary bacterial infection
n Sleep apnea: daytime fatigue and sleepiness
n Polyp formation