Nipple Discharge

Bloody nipple discharge and spontaneous unilateral clear nipple discharge merit imaging and clinical evaluation, with malignancy found in 13% of patients on average (range, 1% to 23%) across multiple series.80 Papilloma is the most common cause of nipple discharge, found in 44% to 45% of patients,80,81 with fibrocystic changes accounting for the rest. Milky discharge is almost always physiologic or due to hyper-prolactinemia80 and does not warrant imaging workup. Injection of contrast into the discharging duct, followed by magnification craniocaudal and true lateral mammographic views (galactography), has been the standard for imaging evaluation of nipple discharge.82 US is an alternative method for evaluating nipple discharge and has the advantage of being noninvasive. A few studies have compared US and galactography (Table 28.4), with promising but limited evidence for the utility of US in this setting. The visualization of intraductal masses on US is facilitated by distension of the duct. Whether the full extent of multiple intraductal lesions is well depicted on US has not been systematically studied. MRI has also been used to evaluate nipple discharge with some success,83 and further study is warranted.

A Disquistion On The Evils Of Using Tobacco

A Disquistion On The Evils Of Using Tobacco

Among the evils which a vitiated appetite has fastened upon mankind, those that arise from the use of Tobacco hold a prominent place, and call loudly for reform. We pity the poor Chinese, who stupifies body and mind with opium, and the wretched Hindoo, who is under a similar slavery to his favorite plant, the Betel but we present the humiliating spectacle of an enlightened and christian nation, wasting annually more than twenty-five millions of dollars, and destroying the health and the lives of thousands, by a practice not at all less degrading than that of the Chinese or Hindoo.

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