Breast cancer is the leading cause of death among women with cancer in the world. Breast cancer in the elderly (over 70 years) should be being taken care of properly, following the latest recommendations of the International Society of Geriatric Oncology. Breast cancer can be treated either by hormone therapy, either surgery or radiotherapy. We will discuss here the question of surgery for breast cancer in older women.

Stages of completion

1. The question of surgery problem always arises when we talk about breast cancer in the elderly, especially over 70 years. But with the current progress, whether in terms of anesthesia (para-vertebral block) or surgical technique, currently it is recommended to treat these elderly women with surgery, combined with hormonal therapy.
2. Previously, the trends were to do a total mastectomy for older women, but currently, this kind of surgery is indicated only if the tumor is large or if conservative treatment has failed.
3. Whenever possible, conservative surgery (lumpectomy, partial mastectomy or simple) should also be performed on older women, even more than 70 years, because according to studies, survival is the same compared to young women, and this type of surgery also improves their quality of life.
4. According to the latest recommendations even if the tumor volume is quite small and the lymph nodes are not clinically palpable, it is unnecessary to axillary dissection (nodal) complete, in favor of a simple biopsy of a sentinel node.

Tips & Warnings

• This surgical decision obviously depends on factors such as life expectancy of older women or conditions associated with this breast cancer.
• Surgery on breast cancer in elderly should not got benefit from the same surgical treatment than younger women.
• Any decision is taken after a discussion between an oncologist and geriatrician, without forgetting the woman if she is able to express themselves.

Older women with breast cancer in early stage live as women of the same age without the disease. Most breast tumors detected are very small and are diagnosed at a very early stage in older adults especially those cancers with a favorable prognosis.

Each year in the United States more than 200,000 diagnosed cases of breast cancer and a woman’s risk of developing the disease increases with age.

In a new study, researchers compared the life expectancy and causes of death in women over 67 years with and without breast cancer.

After consulting a register of diagnoses of breast cancer Medicare patients, the team of Dr. Mara Schonberg, of Beth Israel Deaconess medical center in Massachusetts, identified breast cancer in elderly women nearly 65,000 diagnosed at any stage between 1992 and 2003.

The control group consisted of about 170,000 women of similar age, Medicare patients, but without the disease. There were followed for eight years.

Women with ductal carcinoma in situ (DCIS), which is the earliest stage of breast cancer, tumor stage 1 were just as likely to stay alive until the end of the study as women without the disease.

And under 80 years with a solarium-an DCIS have something more likely to survive for at least five years than healthy women of similar age.

This could attribute to the “healthy user effect” (women with a diagnosis of a disease are more aware of your health).

Women with Stage I breast cancer and those over 80 with DCIS had the same survival rate during the study than women without breast cancer.

In the group of under 80 year ± os, survived five years after diagnosis 89 percent of women with DCIS and 87 percent of women with stage I cancer

In those aged 80, 70 percent kept alive, to five years of diagnosis of DCIS, compared with 66 percent of the group with stage I breast cancer

Between 6 and 18 percent of women with early cancer who died within five years of diagnosis are died of breast cancer. Cardiac disease here was the most common cause of death among women with an early tumor.

The chances of survival were higher in women with early cancer treated with mastectomy or surgery plus radiation therapy-a conservative, when they were treated with surgery alone, a conservative or without surgery-a.

When older adults were diagnosed with stage II cancer or higher, did not survive as long as the group of women without cancer.

This diagnosis meant that women were 1.5 times less likely to survive during the study than healthy women. Stage II cancer decreased three times the chance of survival.

The results, as the authors suggest that doctors should talk to their elderly patients about the risks and benefits of breast preventive control because it could detect a tumor early. The treatment, in that case, would prevent the tumor progress.

The main message is that “the preventive control is useful even in the elderly. The important thing is not necessarily the woman’s age, but their overall health and life expectancy … and that is true at any age” Elkin said.

Consumption during early pregnancy containing opioid analgesics such as codeine, oxycodone or hydrocodone, may increase the risk of birth defects in children.

That’s the conclusion of a study conducted by the Centers for Disease Control and Prevention U.S.

The research, published in American Journal of Obstetrics and Gynecology (American Journal of Obstetrics and Gynecology), analyzed the records of some 17,500 women who participated in the National Study for Prevention of Birth Defects.

According to scientists, although the increase was observed is relatively small, between 2 and 3% – found an association “Consistent” among mothers who took opioids in the first months of pregnancy and birth defects in their children.

Serious disorders

Research, the largest ever conducted on the effects of analgesics during pregnancy was conducted among mothers who gave birth in ten states across the country between 1997 and 2005.

We found that among the 17,449 women whose babies showed a birth defect, 454 (2.6%) reported having used some type of opioid drug a month before becoming pregnant or during the first three months after conception.

Among the drugs most commonly used by participants included codeine and hydrocodone (Vicodin).

And the principal was observed congenital hypoplastic left heart syndrome, in which the left side of the body fails to develop fully.

This was followed by spina bifida, in which the neural tube fails to fuse and the spinal cord is bare bone, gastroschisis, in which the intestines develop outside the abdomen, hydrocephalus, cerebrospinal fluid accumulation in the brain, and congenital glaucoma, a form of blindness.

According to investigators, “Women who took prescribed opioids, just before or during the first months of pregnancy showed nearly twice the risk of having a baby with hypoplastic left heart syndrome than those who did not use these drugs”.

According to the CDC, congenital heart disease is among the most common birth defects. Only in the United States the disease affects about 40,000 babies each year. Most of them die during the first year of life and those who survive must undergo numerous surgeries and hospitalizations.

Researchers believe that the rates of birth defects associated with the use of opioids may be higher due to illicit or prescription of these substances.

“It is important to recognize that the increased risk of some types of congenital diseases due to exposure to opioid analgesics in relatively modest “Says Dr. Cheryl Broussard, who led the study.

“However, due to the serious and life threatening diseases such as congenital hypoplastic left heart syndrome, prevention of even a small number of cases is very important.”

“Ask your doctor if you are pregnant or plan to become pregnant and have taken or are considering taking any medication, whether prescription drugs, over-the-counter and dietary or herbal products,” advises Dr. Broussard.

Mixtures of cereals act against Helicobacter pylori and the bacteria that live in the stomach and cause many ulcers and gastritis. Those skilled in the digestive system, recommend to include grains and other natural foods in the diet.

In one corner of the ring, the ‘helicobacter pylori (HP) is moving spiral bacteria that causes most stomach and duodenal ulcers and has been present in humans for over 60,000 years. Is acquired in childhood and lived many years within the stomach cavity.

In the other corner of the ring, the ‘muesli’, This word comes from German and means something like “porridge”: in fact, a cocktail of fruits, nuts and grains rich in fiber, vitamins, minerals and fatty acids healthy, easy to prepare and digest, not is only one of the best ways to start your day with a complete and balanced meal, but also a way to enrich the daily diet with nutrient quality, experts say nutritionists.

Imagine a boxing course in which the ‘ring’ out the digestive system and one of the two contenders, a microscopic infectious agent and pathogen, invisible to the naked eye and created by nature, and his opponent, tasty food and energy manufactured by humans and consumed by millions of people.

In that fight imaginary, the ‘breakfast food’ (muesli) could ever win on points, or at least be able to deal it a few good shots to the ‘bacteria from ulcers’ (the “helicobacter pylori”).

This is what is apparent from various studies about how to combat these bacteria, presented by Dr. Henry King and Raquel García Sánchez-both the Service of Gastroenterology, Hospital Clínico San Carlos (Madrid, Spain) – during a recent conference on treatment of digestive diseases, sponsored by Tomás Pascual Sanz Institute for Nutrition and Health.

According to these and other experts and health professionals, the regular intake of a preparation of muesli has activity against ‘Helicobacter pylori, a bacterium that causes ulcers and gastritis, so it could become a natural aid in the fight against stomach ailments.

“While it is generally understood as muesli mixture of grains, nuts and fruits, its main component, with this name also refers to a product with more ingredients that also includes milk, fruit juices and sweeteners,” says Dr. Esther Peace, medical expert in complementary medicine nutritionist.

The most comprehensive Muesli

According to this expert, “some versions of muesli include ingredients beyond its original conception, such as sesame, sunflower or flax, as well as chocolate, coconut, vegetable oils and other foods.”

For Dr. De la Paz, “one of the most complete version of muesli consisting of cereal flakes (more comprehensive and so its nutrients are complete), fresh fruits (especially biological ones, grown without fertilizers or chemicals ) and nuts and dried (except coconut fat which behave in the body as saturated as well as grapes and other fruits, which contain sulfur-based preservatives). ”

According to recent research the muesli has activity against ‘helicobacter pylori, a bacterium that lives only in the stomach and causes many ulcers and some types of gastritis. It is estimated that over two thirds of the world’s population are affected by this bug.

Dr. Henry King has set out a study with people infected with this bacteria, who underwent a trial of intake of muesli type cereals, flavored with an egg with activity against bacteria.

The result showed how those who ate muesli type cereals active experienced an improvement compared to those who took cereal business.

As he explained to Efe-reports Dr. King, “the effect against the HP it produces an egg with a group of immunoglobulins (proteins in the human body’s defense system) specially designed and obtained from chickens treated with biotechnology techniques.”

“In our study we found that the muesli is a dining car or ideal way to get this” special egg “to the body, as it has a pleasant taste is palatable and retains its immunological properties, keeping his defense before the HP without degraded, “he argued.

“Thus, muesli type cereals may have activity against HP and reduce gastric colonization of this bacterium, but not cure the infection”, said Dr. King.

According to Manuel Diaz Rubio, Chief of Gastroenterology, Clinical Hospital of Madrid, “it is too early to jump to conclusions, but this type of cereal acts as a kind of antigen against HP.”

“It could be effective, but perhaps at a concentration greater than that taken with these substances,” he said.

For his part, Dr. Raquel García Sánchez, in response to the question of whether “there are natural products that can kill the bacteria,” said that “there are many studies that have evaluated different products and their possible role as agents against the bacteria. ”

“Among these natural products include antioxidants such as vitamin C, wine, garlic, honey phytomedicines as red ginseng and green tea,” says the doctor.

According to this research, these products have decreased in some degree the colonization of the bacteria but have not been eradicated in most cases.

Dr. García Sánchez notes that “the intake of these foods by the combination of antibiotics and a proton pump inhibitor (drug intended to lasting reduction in the production of acid in gastric juice) lead to a further reduction of the effects of the bacteria, allowing a better adherence. “

The cleft lips have the same prevalence in the general population as trisomy 21 is about 1 / 700, this frequency varies by race: 3.6 / 1000 among American Indians against 0.3 / 1,000 among blacks.
The cleft lip and palate and maxillofacial bilateral clefts are more common in boys than in girls. There is a bilateral cleft slots for 4 unilateral, when isolated. The cleft lip associated with cleft palate in 70% of unilateral clefts and 85% of bilateral clefts.
These are not exceptional anomalies associated with malformation in a context less than 10% of cases of cleft lip, this rate increases if the slot is bilateral, it is 15 to 50% if the palate is cleft. These malformations are most often isolated, rarely inherited.
Outside the contexts malformation, prenatal diagnosis of major interest to the slot to prepare parents and carers at home and the child’s disability.

Positive cleft lip diagnosis
Unilateral cleft lip alone
The lip: break Cupid’s bow, the slot is lateralized, usually closely related to the still lower edge of the lip, nostril up to the threshold that may be involved. The nose is more or less deformed, the nostril is slightly flattened on the side of the slot, the partition is slightly deflected. If the threshold is not affected nostril, one can note a decrease in the thickness of soft tissue on the side of the slot.
The maxillary dental alveoli are tidy, the cavity of the lateral incisor on the side of the slot may be a little set back.

Alveolar cleft lip, unilateral.
Lip: the slot is wider, with a thick rim median, under the nose prominent sagittal section.
The nose is definitely bent, the nostril on the side of the slot is enlarged and flattened, the tip is deflected toward the slot, and the wall is oblique. The maxilla: the alveolar cleft between the groups, with opening of the maxillary arch side of the slot.

Cleft lip and palate maxillary unilateral.

Lip: the slot is wide.
The nose is deformed. The maxillary bone slot is even clearer that the amniotic fluid passes the nasal cavity in the mouth, noting the defect at a mouth opening and if the slot is wide, the tongue gets into the nasal cavity during swallowing movements. Cleft palate can be objectified on a cutting plane axial oblique.
Only the bony cleft palate can be visualized by ultrasound.
Symmetric bilateral cleft lip
Lip: the slots are symmetrical with respect to the nostrils, with a median bud is not bone, prominent in the nose, the septum is in short, the nose is small, flattened, the partition is not deflected, the nostrils are small.
The maxilla: no disturbance in the tooth sockets

Alveolar cleft lip and bilateral and symmetrical

Lip: the slots are wider, the median process is very prominent, sometimes exceeding the tip of the nose, it has a component containing the bone cells of the central incisor germs.
The nose is flat, the nostrils are difficult to distinguish, in deck stretched forward slots.
The maxillary bone defect is the median, broad, since the cells of the central incisors are in the median labial bud.
Cleft lip and palate maxillary bilateral and symmetrical
Lip and nose abnormalities are identical, the deviated septum is not perfectly visible and because its lower edge is in contact with the tongue when the mouth is closed, it is emphasized by the amniotic fluid in the mouth opening.

Asymmetric bilateral cleft
It can be isolated from a labial side and lip-jaw-palate of the other. It looks like a unilateral cleft, only the careful study of the lip can see cleft lip contralateral.

Corresponds to agenesis of the premaxilla

There is one opening the mouth and nose, 4 shoots lip and nasal primitive form the edges of the single cavity. On a sagittal median, there’s no relief no nasal nasal bone.

Isolated cleft palate

The ultrasound is more often faulted.
The only sign of Appeal may be a discrete retrognathia sometimes a simple shift of the lower lip on a sagittal section plane. The study of tongue position during swallowing movements shows a high position and back of the tongue.

Contribution of 3D ultrasound

Surfacing technique provides a better limit the height of the slot relative to the threshold nostril. The study of the block volume is an undeniable contribution in cleft palate, to objectify them and appreciate their importance and depth.

Slots and malformation syndrome

The association is not unique, a thorough review is needed. Into cracks or bilateral median, the association with brain abnormalities is common; they are anomalies of the midline: holoprosencephaly, median cleft for, agenesis of the corpus callosum bilateral.  Slots for a systematic search for disease amniotic bands, imposes a fine and meticulous study of the ends, in this case the slots are often large and decaying with a loss of substance complicating considerably the possibilities for surgical repair.
The associations are the most common malformations:
Heart in 3-7% of cases
Esophageal atresia: 5%
Cervical vertebral anomalies: 13%
Small size is 4 times more frequent than in the general population
Chromosomal abnormalities: 8%

a) A slot in the lip
The mouth is composed of two lips, upper (under the nose) and lower.
Only the upper lip is affected and is separated into two parts or the right side of the nose or the left side (unilateral cleft lip right or left) or in some cases on each side of the nose, thereby, the nostrils are flattened ( bilateral cleft lip).

b) Cleft palate
The inside of the mouth consists of a cap (called a palace) and a floor within which the tongue. The roof of the mouth that is to say the palace extends back and forth from the incisors. It is first bone, extended posteriorly by a flexible membrane and mobile terminated by a uvula (called the velum). This membrane allows close communication with the nose.
So either the hard palate or soft palate are split (cleft palate total) or whether the soft palate only.

All these defects can exist in isolation or completely. There are:

• Unilateral cleft lip left or right without cleft palate,
• Bilateral cleft lip palate without division,
• Cleft lip with G or D division of hard and soft palate,
• Bilateral cleft lip with division of hard and soft palate,
• Slots of the soft palate (without division of the lip)
• Of submucosal cleft palate that spot only by the division of the uvula because the hard palate is split, or else by an abnormality of speech from 4 years.

Generally, the cleft lip is a lack of fusion of embryonic tissue of the face leading to a loss of substance of the upper lip. Similarly, the cleft palate is an absence of the substance of the arch leading to oral communications between the nose and mouth.

Indeed, cleft lip and / or cleft palate are common malformations of the face that appear early in embryonic development. The cleft lip is more common than cleft palate. In 80% of cases, cleft lip is unilateral and occurs two times more left than right.

However, prevention of folic acid supplementation during pregnancy whether food or drug would reduce by nearly one third the risk of occurrence of this type of malformation. To address these defects, we can do cleft lip and palate surgery. Indeed, surgery is needed to repair the cleft lip and palate.

As for plastic surgery, it can intervene to reduce the scars left by the operation and give the face a “normal”. In addition, sessions at the therapist will sometimes be necessary at the onset of language in order to mitigate potential problems of phonation (voice production and spoken language).

Similarly, orthodontic treatments are also needed to correct a possible malocclusion. Malocclusion is present mainly in those with cleft palate and those with cleft lip with involvement of alveolar bone.

In addition, monitoring by a psychologist is recommended so that the child accepts their differences and be prepared for operations as well as in cases of disability associated. In sum, it is worth noting that only 3% of slots are related to a genetic mutation. Therefore, it is important to diagnose as specific as possible in case of discovery of a crack.

Definition: The cleft lip and palate, more commonly known as “cleft lip” is an anomaly for an average of one child in every thousand Europeans. It is against more common among Japanese and more rare among black Americans. Girls are twice as affected as boys.

There are two types of cleft: cleft lip and cleft palate.

Cleft lip, which concerns most often boys, corresponds to an interruption of the lip, often associated with cleft of the maxilla, which is to say a crack between the second incisor and canine. The nostril on the same side of the cleft lip is sometimes enlarged.

Cleft palate, she is more prevalent among girls. It is situated on the palate. This consists of two different parts that we feel in passing the language on the palate: the veil, a membrane behind, and the bone, located in front, behind the teeth. Cleft palate is concerned the veil or the entire palace.

The cleft lip and palate combines both types of slots: lip and palate. It may be one or both sides. In 30% of cases, it is associated with other malformations – cardiac, digestive or the brain.

The origin of these abnormalities was in the pregnancy when the fetus’s face grows. Between 35e and 40e day of pregnancy, two parts, called buds, coalesce: the maxillary bud which is the lower face, and the naso-frontal bud forms the nose and forehead.

The causes and consequences

These two buds should merge to get a harmonious face. If this is not the case, a slot more or less formed. Ultrasound can see the anomaly in the sixth month.

In 11% of cases, maternal smoking is involved and 5%, the consumption of alcohol. But mostly, we did not find any event, even if the risk of cracking increases if there is already an anomaly in a close relative.

In addition to the aesthetic displeasure, it may be difficult to talk and eat. To prevent food from passing into the nose, the newborn is fed with a special nipple, and a palace artificial resin, is asked to remove the communication between the mouth and nose.

Tabuse committee

The surgeon must act quickly. If only the lip is affected, the operation takes place in the first three months of life. Slots for more complex, it is possible from the sixth month. One or more operations are needed to close the palate, the veil and the lip.

But the food and cosmetic problems are not the only consequences of cleft lip and cleft palate. The hearing is sometimes disrupted and a balance must take place quickly.

The language learning is also disrupted, so a followed by a speech therapist is essential, in addition to surgery. Balances are held every six months, between the ages of 1 and 3 years, because it is a key period in the development of speech. Until adolescence, consultations do at least once every year.

Exercises with the mouth or physical therapy are also needed because some letters are difficult to pronounce.

Finally, the teeth can cause problems. A slot may hinder the development of the jaws because the palace is too narrow. The position of the teeth may be abnormal, when a missing incisor. Orthodontics plays an essential role through the apparatus.

The threshold is the basis of the nostril nose is formed by the lip. Therefore caused cleft lip deformity of the nose and justifies speaking of cleft lip and nostril.

The lips surgery during the primary surgery if it fixes what threshold, corrects many of the deformities of the nose and deserves the name chéilo-primary rhinoplasty i.e. repair of the lip and nose. Distortions that persist despite primary repair may be a gesture of secondary surgery. Surgery of the nose will have two objectives: functional and aesthetic.

Chéilo-rhinoplasty primary

This is the first operation after birth, when the repair of the lip.
All repairs are acting on the lip of the nose, rhinoplasty addition of the term indicates the importance that it attaches to the muscle repair in the correction of the nose.
In this action basal functional repositioning, some surgeons add gestures dissection and repositioning more or less extensive on the cartilages of the tip of the nose (alar) and the partition and set up temporary means of restraint: Point Mac Coomb and derivatives.

Rhinoplasty Aesthetic

The term aesthetics should be replaced here by restorative technically but we use it to be understood as denoting the sake of normalcy and even beauty to the patient.
It occurs around adolescence, when demand Morphological will appear. This lip cosmetic surgery will differ depending on the case. It can be a:

* Correction of isolated tip of nose
* Comprehensive rhinoplasty with modification of the dorsum, alar cartilage repositioning for cosmetic improvement of the nasal tip, and this almost always includes surgery septoplasty (Repositioning of the nasal septum) in the interests morphological straighten a crooked nose, but also in a functional purpose (improvement of respiratory flow and symmetrization).

The Rhinoplasty Functional

It is considered, in part wrongly, by many doctors that the rhinoplasty must be made as late as possible. When a child is not breathing through your nose, That it breathes through the mouth due to a deviation of the nose and nasal septum: Recovery nose surgery and septum (Septo-rhinoplasty) is required under pain of severe functional disorders exacerbating an imbalance of facial growth.

The Rhino-Cheiloplasty

When at the time of rhinoplasty, there are still imperfections of the lip, the combination of a revision (the latter with the act of correction of the various elements of the nose) to get as good a balance as possible.

According to multidisciplinary team of Paediatric Surgery Hospital St Vincent de Paul and Robert Debre in Paris:

It is now accepted that the primary repair of the cartilage of the ala of the nose (alar cartilage) is not a drag on growth, quite the contrary, is not allowed to become permanent deformation with time. This requires placing a nasal conformer (Small silicone tube) holding the position of the nostril during the healing time, ideally 6 weeks.

In case of Cleft Lip and Palate associated we are for the use of a Shutter neonatal (Upper plate). The plate (which is now known that it did not, probably, orthopedic or orthodontic role), gives the child the feeling of the integrity of the palate, tongue positioned harmoniously in the oral cavity, but also avoids during feeding, the passage of milk into the nasal cavity, to obtain a satisfying comfort food for the child.

On the other hand, using this plate is very useful to allow breastfeeding, we are very supportive Breastfeeding.

If you want to breastfeed, it is useful to meet lactation consultant(If possible even before birth), and put the child in as soon as possible after birth because it is at this time that he has the potential to suck the most important and he’s okay stimulate lactogenesis. Other assistive devices will be detailed at the Lactation tab.

In case of bilateral cleft, we prefer to operate the 2 sides of the slot during separate interventions to 5 and 7 months in order to optimize the height and mobility of the lip.

If we operate a simple cleft lip in 1 to 2 months time, this age we are recommended by anesthesiologists and neonatologists as safer, in terms of respiratory maturation of the child.
.
If 5 or 7 months treatment called “primary surgical” your child is finished, the ongoing management by the multidisciplinary team.

The soft palate being made, it must stimulate its function during the first year of life and ensure its proper functioning is the role of the SLP. The outbreak of the teeth on a dental arch, which presented a slot may be disturbed, so it is important to be supported by the orthodontist to optimize both the palate and growth also “clean tooth.” These multidisciplinary consultations are held once a year on average.

“To speak well, you have to hear”, so your child will be seen by a ENT that tracks the risk of sero-mucous otitis which may require the installation of aerators trans-tympanic (diabolos) and it is not advisable to ablate adenoids given the risk the stability of the web palate.

If you wish, consult with a Psychologist you may be offered from prenatal diagnosis, it is indeed difficult to be parents of a different child and is very difficult to be oneself a different child and Psychologists are available at any time of treatment.

Finally, sometimes for cracks reaching the alveolus (Gingiva), the contribution is not enough bone to growth and / or lateral incisor is missing. It may be necessary during growth to produce a bone graft to stabilize the bone fragments, allowing the descent of the permanent teeth and, eventually, ask a dental implant where a tooth is missing.

The assistance of a Pediatric dentist (Dentist specific children) is important because these children may have teeth more brittle, care must be less traumatic and more gentle as possible so that dental hygiene is respected and that children work together to care, quality smile depends on it.

Feel free to ask questions, it’s your child, and your participation in all phases of treatment is important; tab Hospital, childcare assistants and nursery nurses will give you useful information about your stay at the hospital that lasts on average 4 to 5 days (the time to get used to baby care and gain weight).