First intervention to address this health concern is to change your diet and lifestyle, but sometimes and especially with high (<200 mg/dL) and very high lab values, medicine and supplements may be indicated or may be a good addition for faster and better results.

Best Supplements to lower triglycerides

There are a wide variety of supplements available on the market that promise to help lower your triglycerides levels, but not all of them have been proved effective. The following are the ones with real science backing up their claims.

Remember to always consult your physician before taking any supplement as they may have risks, side effects and may interact with drugs or may not be indicated according to your medical history.

Omega-3 Fatty acids (EPA and DHA)

Daily supplementation of omega-3 supplements can effectively reduce triglycerides levels. Different sources of omega-3 contain different ratios of EPA and DHA (two of the three omega-3 fatty acids, the other being ALA) although it is not yet clear which one may be the best ratio. Most supplements contain fish oil, cod liver oil, or krill oil with the latter appearing to have higher bioavailability than the previous two.

Dosage varies between 1 g/day and 5 g/day but supplementation of more than 1-2 g/day should be started only after talking to your GP or if advised by another specialist. High doses of omega-3 interfere with blood clotting.

Niacin: vitamin B3

Niacin is a water soluble vitamin that is capable of decreasing bad cholesterol (LDL) and increasing good cholesterol (HDL) while also lowering triglycerides by up to 50%. It is particularly effective at high doses, at 1,500 mg/day and above, for which a prescription is required. Risks of high dose supplementation include liver damage and hyperglycemia in diabetic patients.

Berberine

Berberine is a plant-derived chemical that appears to be effective at lowering both triglycerides and cholesterol as well as improving fasting glucose and glycated hemoglobin and reducing insulin resistance in type 2 diabetes patients. Recommended dosage is 500 mg to 1,500 mg /day and it may cause some gastrointestinal side effects.

Red Yeast Rice

Red yeast rice is a popular supplement that was originally used in traditional Chinese medicine. Red Yeast rice contains Monacolin K, a chemical which is identical to lovastatin, a serum lipids lowering prescription medication. For this reason, red yeast rice has been banned by the FDA in the USA, although it is still available as a supplement in many countries worldwide. The suggested dose is usually 10 mg/day, but it is important to note that it poses the same risks as taking a statin medication and for this reason you should consult your GP before using it.

Medications to lower triglycerides

Before starting to use prescription medications or prescription-grade/dose supplements, a risk benefit analysis should be done. Depending on your medical history and on your triglycerides levels, your GP may prescribe you one or more of the following drugs.

Statins

Statins are a class of drug used as first line treatment for high cholesterol, but they are also effective at lowering triglycerides. Commonly sold medication in this class are:

• Atorvastatin (Lipitor)
• Fluvastatin (Lescol XL)
• Lovastatin (Altoprev)
• Pitavastatin (Livalo)
• Pravastatin (Pravachol)
• Rosuvastatin (Crestor)
• Simvastatin (Zocor)

Among the possible risks and side effects, statins may cause muscle pain (potentially rhabdomyolysis), constipation, nausea and elevation of liver enzymes.

Fibrates

Fibrates are a class of drugs that lower lipids in the bloodstream, both cholesterol and triglycerides. Commonly sold medications in this class are:

• Fenofibric acid (Trilipix)
• Fenofibrate (Antara, Fenoglide, Lipofen, TriCor, Triglide)
• Gemfibrozil (Lopid)

People with liver, kidney or gallbladder issues should not take this medication. Some other drugs may interact with fibrates: when taken in combination with statins there is an increased risk of rhabdomyolysis, a severe condition in which muscles break down causing pain and potentially leading to kidney failure.

Take-home message on supplements and medication for high triglycerides

Studies show that it is important to monitor lipid levels in blood: triglycerides, HDL and LDL cholesterol are important factors when it comes to cardiovascular health.

It is also important the way you decrease such levels when they are elevated: lowering your cholesterol or triglycerides without changing diet, exercising and modifying your lifestyle may not reduce your risk of heart disease and stroke; so while supplements and medications are an important tool in improving your health, they should not be seen as a shortcut or easy way to improve the lab results without making any effort.

Sources 

• Omega-3 Fatty Acids – Fact Sheet for Health Professionals
  US National Institute of Health – Office of Dietary Supplements
  https://ods.od.nih.gov/factsheets/Omega3FattyAcids-HealthProfessional/
• Triglyceride Lowering Drugs
  KR Feingold – Endotext, 2020
  https://www.ncbi.nlm.nih.gov/books/NBK425699/
• Management of Hypertriglyceridemia: Common Questions and Answers
  RC Oh, ET Trivette – American Academy of Family Physicians, Sep 2020
  https://pubmed.ncbi.nlm.nih.gov/32931217/
• Management of hypertriglyceridemia
  V Simha – British Medical Journal, Oct 2020
  https://doi.org/10.1136/bmj.m3109
• Fibrates
  US National Library of Medicine – MedlinePlus
  https://medlineplus.gov/ency/patientinstructions/000789.htm

The post Medications and supplements to lower triglycerides serum levels appeared first on MedTravel Asia.

High levels of triglycerides can lead to clogged arteries and for this reason they increase the risk of cardiovascular disease such as coronary artery disease and stroke, therefore it is important to keep their level under control. Other risk factors for cardiovascular disease (CVD) include:

• Family history of CVD
• Smoking
• Being overweight
• Lack of exercise
• Diabetes
• High Blood Pressure

Normal levels of serum triglycerides

Triglycerides are measured with a blood test and are generally part of the lipid panel, also known as lipid profile, which includes testing for HDL and LDL cholesterol levels as well. To perform the test, you’ll have to be fasting for at least 10-12 hours but drinking water is allowed. Alcohol should also be avoided in the 24 hours preceding the test.

• 40-100 mg/dL or (0.45-1.13 mmol/L) is considered the optimal level of fasting triglycerides
• < 150 mg/dL (< 1.7 mmol/L): normal triglyceride range
• 150-199 mg/dL (1.8-2.2 mmol/L): borderline high triglyceride range
• 200-499 mg/dL (2.3-5.6 mmol/L): high triglyceride range
• >500 mg/dL (>5.7 mmol/L): very high triglyceride range

Your lipid profile is not only influenced by your diet and lifestyle, but also by your genetics. Some medications such as estrogens or some health conditions may also lead to increased serum triglycerides.

Diet for high triglycerides

To quickly lower your high triglyceride levels with diet you should implement the following dietary changes:

1. Eliminate refined sugars and added sugars. These sugars should be limited to a maximum of 5-10% of your total daily calories. The less, the better.
2. Reduce refined carbohydrates. Choose whole grains over refined grains. Carbs should represent around 50% of your daily calories.
3. Reduce saturated fat. Choose healthy polyunsaturated and unsaturated fats over saturated and trans fats. Fats should represent 25-35% of your total daily calories.
4. Choose plant-based over animal-based product. Plant based foods are naturally low in fats or sugars and high in fibers.
5. Increase daily fiber intake. Fibers increase the feeling of satiation making you eat less; moreover fiber-rich products are generally low in sugars and fats.
6. Eliminate alcohol. Alcohol consumption, with or without a meal, increases serum levels of triglycerides.

Foods that help lower triglycerides

A few weeks of healthy diet choices can already show results and improvement in your triglycerides levels. A healthy diet to lower high triglycerides should include the following foods.

Omega-3 fatty acids in food

Omega-3 fatty acids are “good fats”. Omega-3 rich foods can help lower your triglycerides levels.

• Eat at least 2-3 portions of fatty fish per week. Fish rich in omega-3s include salmon, mackerel, sardines, tuna, herring and trout.
• Eat a daily portion of seeds and nuts. Walnuts, chia seeds and flaxseed are naturally high in good fats such as omega-3.
• Include legumes and dark leafy green vegetables in your daily meals. Although they don’t contain much fat, these products favor the healthy ones such as the omega-3s. Arugula, romaine and spinach are some of the best dark leafy greens, while beans, soybeans, edamame (green soybeans) and mung bean are among the many legumes that you can include in your diet to also increase protein intake and fibers.
• Use healthy plant oils for cooking. Flaxseed oil, soybean oil or canola oil should be favored and used instead of other saturated fat or trans-fat sources.

There are also a wide range of fortified foods containing omega-3s such as some brands of eggs and yogurts.

Plant based proteins

Plant based proteins should be consumed instead of animal proteins. Beef and pork in particular have lots of saturated fats, while chicken breast may still be ok. Dried beans, peas and all soy products are high in proteins and should replace meat in your diet.

Fiber-rich foods

Besides legumes, fruits, and vegetables, try to consume more whole grain products swapping them out with your usual refined grains like white flour or white bread: brown rice, quinoa and whole grains are better alternatives.

Foods to avoid when having high triglycerides

After seeing the foods to favor in your diet, here are the food to try and avoid when your triglycerides are high.

Foods and drinks with simple sugars or added sugars

Sodas, ice-creams, desserts, baked products, sweet and flavored yogurts, breakfast cereals, candies are some of the many everyday products that should be avoided. Check product labels for added fructose, corn syrup, cane syrup, honey, sucrose, dextrose, glucose, lactose, maltose or malt sugar, molasses, which are all sugars.

Saturated fats

Cheese and red meat are high in saturated fats. Baked product made with butter are also high in saturated fats. Whole milk should be limited. Coconut oil, palm oil and coconut butter although low in cholesterol are high in saturated fats.

High-fructose fruits and juices

We always associate fruits with something healthy. Unfortunately, too much of anything, even water, may be harmful. Fruits that are high in fructose, which is a simple sugar, increase serum triglycerides. Both juices and fruits like mangoes and grapes are high in fructose and should be avoided or consumed in very low quantities.

Lifestyle changes to lower elevated triglycerides

Lifestyle changes can also help lower high triglyceride levels and together with dietary changes they can quickly improve your lipid profile.

1. Lose weight. If you are overweight, you should not only make some changes in what you eat as seen in the previous paragraphs, but also in how many calories you ingest during your day. Eating healthy foods does not mean you can’t get fat, it’s the overall daily calorie intake that determines weight gain and weight loss. Losing 5-10% of your body weight will lead to a significant reduction in serum triglycerides as well as an overall improvement in your lipid profile.
2. Avoid alcohol. Alcohol consumption, especially in high quantities and/or on a daily basis can dramatically increase your triglyceride levels.
3. Increase physical activity. Exercising or even just a 30-minutes daily walk is beneficial to your overall health and will help in losing weight and decreasing triglyceride levels.

If your levels are very high you may also consider consulting your doctor about taking supplements or medication to lower triglycerides.

 Sources

• Triglycerides Test
  US National Library of Medicine – MedlinePlus
  https://medlineplus.gov/lab-tests/triglycerides-test/
• Triglycerides: Frequently Asked Questions
  American Heart Association (AHA)
  https://www.heart.org/idc/groups/ahamah-public/@wcm/@sop/@smd/documents/downloadable/ucm_425988.pdf
• Mosby’s Diagnostic & Laboratory Test Reference, 14^th edition
  K Pagana – Elsevier, 2018
  ISBN: 9780323609678

The post How to lower triglycerides quickly? Diet and best foods to reduce triglycerides appeared first on MedTravel Asia.

All women undergoing breast augmentation with implants will require at some point in their life a revision surgery: this is because implants don’t last forever and it is usually advised to change them with new ones after 10 to 15 years, although they may be able to last far longer than that.

Background photo created by nensuria – www.freepik.com

Reasons to remove breast implants

Reasons to request the implant explantation procedure vary from patient to patient and the exact procedure(s) performed on each patient vary accordingly. The following are some of the many reasons why patient ask for the removal of their breast implants.

Capsular contracture

Capsular contracture is the most common complication of breast augmentation procedures, with an incidence averaging 7-15%; we have a better understanding of this complication now than we had a decade ago and because of this some surgeons have been able to lower the incidence in their practices significantly to just 1-2% of cases. The management of capsular contracture is just surgical with the removal of part or the totality of the fibrous capsule; in some cases, the patients ask for a new implant to be placed, while in other cases they just want the implants removed.

Implant rupture

The rupture of a breast implant requires surgical management; after both the implant and the silicone gel are removed, a new implant may or may not be placed in exchange according to patient’s preference.

Dissatisfaction with the cosmetic result of the augmentation

Poor outcome from a primary cosmetic augmentation is one of the reasons patients request a breast revision. Rippling and wrinkling in underfilled saline implants, oversized implants, and malpositioned implants are some of the many causes of dissatisfaction with a breast augmentation. In these cases, breast revision surgery may involve repositioning of the implant, or removal of the old implant with selection of a more appropriate one, or in some cases just the removal of the implant without augmentation.

Implant pocket infection

Breast implant infection rates vary according to different sources from 1-35%. By following the latest infection control protocols, the rate of infection following breast augmentation can be effectively minimized to around or below 1%. Pre-Peri-Post Op antibiotic treatment, implant pocket irrigation with antiseptics and/or antibiotic solutions, the use of an introduction sleeve to avoid contact between the patient skin and the implant, and minimizing the time between the opening of the sterile implant packaging to the placement in the surgical pocket are just some of the many preventive strategies to minimize the risk of infection when performing a breast augmentation. In most cases, breast implant pocket infection can be successfully treated with an early antibiotic combination therapy; when antibiotics are not successful, breast implant removal is indicated, and it may or may not be replaced with a new implant according to patient’s preference.

Breast Implant Illness

Breast implant illness is an increasingly reported unofficial diagnosis for a diverse range of symptoms that may be linked to breast implants and to the immune response to foreign material inside the body. Some women request breast implant removal to address this issue.

Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) worries

Although not recommended by any medical associations or government agencies, awareness of the slightly increased risk of developing BIA-ALCL in patients who have a textured breast implant has led to patients requesting implant removal for peace of mind. In some cases, they are swapped with smooth implants, while in others they simply opt for no augmentation anymore.

Patient Preference

Age related changes in the body or in the mindset, pregnancies, weight gain or weight loss, trends concerning the public opinion on breast implant and women’s image are some of the non-medical reasons for which a patient may choose to have her implant removed.

Other reasons

• Mammograms. Women at average risk for breast cancer are encouraged to get a yearly mammogram since age 40. This may prove difficult depending on implant size, implant placement and fibrous scar tissue formation.
• Pain due to the weight. Large natural breast is a known cause of upper back pain. The same can result from large implants in breast augmentation patients.
• Saving from recurrent costs. The FDA recommends performing implant rupture screenings for all patients with breast implants. An MRI is advised in all asymptomatic patients 5 years after surgery and then every two years. An MRI is also recommended when the patient experiences any symptom that may be due to implant rupture. Previous recommendations were to perform an MRI at year 1, 2, 4, 6, 8, and 10 post-surgery. Depending on your geographical location, MRIs may be quite costly.

Breast Implant removal procedures

Depending on the characteristics of the patient and the reason for undergoing the breast implant removal surgery, different procedures may be performed. When there are no symptoms or complication and the capsule is thin, it is generally left in place. Depending upon symptoms, complications and additional procedures to be performed, the fibrous capsule may be partially or totally removed.

Capsulotomy

A capsulotomy involves cutting into the capsule of fibrous tissue that formed around the implant living it in place. Usually, the implant pocket is accessed by performing an incision in the same place where the old scar from the augmentation is. This is the simplest and safest procedure for implant removal.

Partial Capsulectomy

A partial capsulectomy involves the excision of part of the fibrous capsule around the implant. The anterior section of the capsule is most commonly the one excised.

Total Capsulectomy

A total capsulectomy involves the removal of the whole fibrous capsule around the implant. It is more invasive and carries more risks than the previous two techniques. It may be indicated in patients with breast implant illness, or in case of implant rupture or in case of complicated capsular contracture (such as when the capsule is calcified).

En-Bloc Capsulectomy

An en-bloc capsulectomy is the removal of the whole fibrous capsule around the implant in a single piece, without breaking it apart. It requires a larger incision and it’s more invasive. It is generally indicated only in patients diagnosed with BIA-ALCL.

Additional procedures

When the implant is removed and not exchanged with a new one, patients may opt for additional procedures to address the excess breast skin and the ptosis. Some of the most commonly performed procedures are:

• Mastopexy, also known as breast lift.
• Fat graft, also known as fat transfer.
• Breast PRP also known as breast booster or vampire breast lift.

The most appropriate procedure will depend upon the patient’s characteristics and expectations.

Are there any risks to having breast implants removed?

Like any other medical or surgical procedure there are some risks and possible complications associated with this type of surgery. Anesthesia risks, asymmetry, bleeding, DVT, infection, changes in nipple/skin sensation, scarring, bad aesthetic result are some of the possible risks and complications which will be explained in detail by your plastic surgeon.

Breast implant removal cost

Cost of breast implant removal surgery will vary according to what procedure is specifically performed, if new implants are placed or other additional procedures are performed, what clinic and surgeon are chosen and the country where you undergo the procedure. If done for medical reasons it may be covered by your health insurance.

In the US the price for just the breast implant removal is in the 2,500-4,500 USD range.

In Australia it costs around 4,000-7,000 AUD (3,100-5,400 USD).

In the UK the price for removal only is around 3,000-6,000 GBP (4,150-8,300 USD).

In Thailand breast implant removal costs 60,000-100,000 THB (1,900-3,200 USD).

Sources

• 2018-2019 Plastic Surgery Statistics Report
  American Society of Plastic Surgeons  (ASPS)
  https://www.plasticsurgery.org/documents/News/Statistics/2019/plastic-surgery-statistics-full-report-2019.pdf
• Not All Breast Explants Are Equal: Contemporary Strategies in Breast Explantation Surgery.
  N Tanna – Plastic and Reconstructive Surgery, Apr 2021
  DOI: https://doi.org/10.1097/prs.0000000000007784
• Long-term effects of breast aging in patients undergoing explantation: analysis of breast aesthetics from before augmentation to after explantation.
  KZ Paydar – Annals of Plastic Surgery, Apr 2013
  DOI: https://doi.org/10.1097/sap.0b013e31828b7e2c
• Abstract: Breast Implant Infection Can be Successfully Treated with Nonsurgical Therapy.
  M Rivera – Plastic and Recostructive Surgery, Sep 2017
  DOI: https://dx.doi.org/10.1097%2F01.GOX.0000526242.11487.ef
• Breast Implants – Certain Labeling Recommendations to Improve Patient Communication.
  US Food and Drug Administration (FDA), Sep 2020
  https://www.fda.gov/media/131885/download
• The Art of Aesthetic Surgery – Principles and Techniques, 3^rd Edition
  F Nahai – Thieme, 2020
  ISBN: 978-1-68420-036-8

The post Breast implant removal guide – Reasons and Options appeared first on MedTravel Asia.

Woman photo created by gpointstudio – www.freepik.com

What is breast implant illness?

Breast implant illness refers to a wide range of symptoms reported by women who underwent breast augmentation or breast reconstruction with implants. The symptoms may be caused by what is known in medical literature as Human Adjuvant Disease (HAD), an autoimmune syndrome caused by prolonged hypersensitization to foreign materials which are injected or implanted in the body and which was first reported by Dr. Miyoshi in 1964; this syndrome is now also known as autoimmune/inflammatory syndrome by adjuvants (ASIA).

In the early days, the symptoms were associated with the injection of liquid paraffin or silicone for breast augmentation, a practice which is now abandoned due to the many known side effects and complications. Nowadays though, the reports come from patients with breast prostheses.

There is no definitive answer yet on whether the experienced symptoms are caused by breast implants or not; one theory is that some patients may be genetically predisposed to have their immune system overreact when exposed for long periods of time to foreign materials in their bodies. The outer shell of all implant is made of silicone and it has also been demonstrated that silicone particles may “bleed out” from implants even when the shell is intact, not just when it is ruptured; these particles then migrate into surrounding tissues and are captured by macrophages causing an immune reaction.

Is BII linked to breast cancer or to BIA-ALCL?

Breast implant illness is not linked to breast cancer nor it is linked to anaplastic large cell lymphoma (ALCL) a rare type of non-Hodgkin T-Cell lymphoma linked to textured breast implants (which is not cancer of the breast tissue). Unlike BIA-ALCL, breast implant illness is reported in patients with both smooth and textured implants from all manufactures and with both saline and silicone fill as they are both made with a silicone outer shell.

Symptoms of breast implant illness

The symptoms reported by women with breast implant illness may be caused by many other conditions such as menopause, underlying autoimmune diseases, thyroid disfunction and more. Although they cannot be said to be, as of now, related to breast implants, the symptoms are real and should in no case be dismissed or downplayed, but should be carefully evaluated and investigated. Many patients say that the symptoms they experience interfere with their ability to function and have a normal life. Reported symptoms include and are not limited to:

• Joint and muscle pain
• Headache
• Chest and breast pain or burning sensation
• Fatigue
• Memory, concentration or other cognitive issues
• Rashes or skin manifestations
• Dry mouth and/or dry eyes
• Hair loss
• photosensitivity
• Gastrointestinal issues
• Anxiety or depression
• Sleep issues

The onset of symptoms varies greatly as well with some patients reporting symptoms immediately after the procedure while others develop them after many years.

Some patients are diagnosed with autoimmune disorders such as lupus, rheumatoid arthritis or Sjögren’s syndrome, while others have no evidence of autoimmune disease processes.

Is there an actual link between breast implant illness symptoms and breast implants?

Since there is no diagnostic test for breast implant illness and the symptoms reported by BII patients are experienced by the general public on a regular basis, as of now there is no link between the so-called breast implant illness and breast implants, nor there is a calculated risk of developing it following breast augmentation.

There are several studies underway to better understand the symptoms and their possible cause or links.

According to a recent study it seems that silicone breast implants are associated with higher likelihood to develop an autoimmune/rheumatic disease, but more data and studies are needed for a definitive answer.

Tests for suspected BII

If you experience symptoms that you feel may be linked to your breast implants or that have no other explanation according to other specialists, you should book a consult with your plastic surgeon. The first step involves examining the breast and the implants to ensure their integrity. Some of the tests that are suggested when suspecting breast implant illness are:

• Full blood count (FBC)
• Urea and Electrolytes (U & E) and creatinine
• Liver function
• Thyroid function
• C reactive protein
• Erythrocyte sedimentation rate
• Iron and Ferritin
• Serum IgG and IgM
• Autoimmune disease markers, such as anti-Sjogren’s syndrome antibodies, anti-scleroderma antibodies, anti-Smith (anti-SM) antibodies, antinuclear antibodies (ANA), …

The treatment plan should be formulated only after a thorough medical evaluation and after discussing risks and benefits if considering implant removal.

Healing from breast implant illness

In the case of capsular contracture or implant rupture, the removal of the breast implant is indicated according to current guidelines. When it comes to breast implant illness, data currently available says that the removal may or may not improve the symptoms:

1. Patients not diagnosed with autoimmune or rheumatic disease. In these patients, about 80% reported improvement in physical symptoms and about 90% reported improvement in psychological well-being following implant explantation.
2. Patients with rheumatic disease, but no autoimmune disease. These patients report initial improvement which is deemed to be a placebo effect with recurrence of symptoms within 6-12 months following the implant removal procedure.
3. Patients with autoimmune disease. These patients report no improvement in symptoms following the breast implant removal surgery; there is no improvement in antibody levels either.

According to a review of cohort studies and patients reports, about 75% of patients reported improvement after implant removal, but only 16% of patients diagnosed with autoimmune disease reported improvements (alleviation but not complete resolution).

The removal of the breast implant should be discussed with your plastic surgeon: a total or near total capsulectomy may be considered in some cases, while en bloc capsulectomy is currently discouraged and should be reserved only for confirmed breast cancer.

Ultimately, the choice on how to proceed is up to the patient, but it is highly advised to stick to current medical evidence and to the advice of a surgeon with experience in treating breast implant illness patients.

Sources

• Not All Breast Explants Are Equal: Contemporary Strategies in Breast Explantation Surgery.
  N Tanna – Plastic and Reconstructive Surgery, Apr 2021
  DOI: https://doi.org/10.1097/prs.0000000000007784
• Breast Implant Illness: A Way Forward.
  MR Magnusson – Plastic and Reconstructive Surgery, Mar 2019
  DOI: https://doi.org/10.1097/prs.0000000000005573
• Silicone-induced human adjuvant disease?
  CM Baldwin – Annals of Plastic Surgery, Apr 1983
  DOI: https://doi.org/10.1097/00000637-198304000-00002 
• A Case of Human Adjuvant Disease After Augmentation Rhinoplasty.
  A Shiba – Aesthetic Plastic Surgery, May 1999
  DOI: https://doi.org/10.1007/s002669900265
• Breast Implant Illness – Frequently Asked Questions
  American Society of Plastic Surgery (ASPS), Aug 2019
  https://www.surgery.org/sites/default/files/BreastImplantIllness_8-21-2019_FINAL.pdf
• Statement from FDA Commissioner Scott Gottlieb, M.D. and Jeff Shuren, M.D., Director of the Center for Devices and Radiological Health, on efforts to evaluate materials in medical devices to address potential safety questions.
  US Food and Drug Administration (FDA), Mar 2019
  https://www.fda.gov/news-events/press-announcements/statement-fda-commissioner-scott-gottlieb-md-and-jeff-shuren-md-director-center-devices-and-3
• Silicone breast implants and the risk of autoimmune/rheumatic disorders: a real-world analysis.
  A Watad – International Journal of Epidemiology, Oct 2018
  DOI: https://doi.org/10.1093/ije/dyy217
• Silicone breast implants and autoimmune rheumatic diseases: myth or reality.
  JW Cohen Tervaert – Current Opinion in Rheumatology, Jul 2017
  DOI: https://doi.org/10.1097/bor.0000000000000391

The post What is breast implant illness (BII)? Symptoms and treatment appeared first on MedTravel Asia.

Protruding ears, also called prominent ears as well as with many other names, are ears of normal size that stick out far from the sides of the face; unlike other facial features, the unbalance created by protruding ears easily catches the attention and is often cause of teasing and bullying in children. For this reason, the ear pinning surgery is commonly performed on young children around age 6 when the ear is already 85% of its adult size, but there’s still demand for this surgery also in the adult population.

Protruding ears are an autosomal dominant trait and are present in about 5% of the population.

Woman photo created by evening_tao – www.freepik.com

Surgical correction of ear sticking out

Otoplasty for ears of normal size that stick out is preferably performed under sedation or general anesthesia when the patient is a child or teenager, but it can be performed also with local anesthesia which is the usual choice in adults.

There are several different techniques available for ear pinning and the choice of the surgical approach will depend on the patient’s age (younger patients have softer cartilage, while adults have stiffer cartilage) patient’s anatomy and expectations and on the surgeon’s experience. The general approach is to make a half moon or spindle-shaped incision in the back of the ear removing the skin and subcutaneous tissue and exposing the cartilage which is then sutured with resorbable stitches to correct the protrusion; in some cases, it may be indicated to excise part of the cartilage as well or an anterior incision may be needed too, but it will be hidden in the inner folds of the ear. The whole procedure generally takes less than 2 hours. The results are immediate and permanent, although there may be some minor changes over a few weeks due to swelling.

Ear pinning surgery is not recommended in children younger than 4-5 as their ears are still in a development and growth stage.

Risks of otoplasty

The otoplasty for prominent ears is not a risky procedure, but as any other medical or surgical therapy there are always risks. Hematoma, scarring and infection are the main risks, chondritis (inflammation of the cartilage) is very rare but possible. There is also risk of undercorrection or overcorrection resulting in ears still prominent or too flat against the head after surgery; lastly there is the risk of asymmetry between the two ears.

Changes in skin sensation of the ear are normal due to damage to the sensory nerves, but they resolve over time.

Most patients are satisfied and pleased with the outcome after undergoing this surgery.

Recovery from ear pinning surgery

The surgeon may prescribe antibiotics and pain medications. A dressing is left postoperatively for up to a week. After the removal of the dressing, it is advised to wear a sport headband for a couple of weeks during nighttime only. Physical activity and sleeping on the side should be avoided for a few weeks after surgery.

Non-surgical ear pinning

It is possible to modify the shape and position of the ears without surgery by using splints, bandages or tapes; unfortunately, this is possible only during the first weeks of life in newborns when the cartilage is still elastic, soft and malleable.

Another technique, offered in some private practices, is the incisionless otoplasty: it consists of placing stitches to pin back the ears without making any incision and without removing any tissue. It is minimally invasive, has short operative time, low rate of complications and fast recovery. Not every patient is a good candidate for this technique.

Cost of otoplasty

Price for ear pinning surgery (otoplasty) varies depending on the geographical location, surgical technique, and chosen clinic and surgeon.

In the USA, price for otoplasty for both ears is around 4,000 to 8,000 USD.

In the UK, ear pinning surgery starts at around 2,500-3,500 GBP (3,400-4,800 USD)

In Australia the pinnaplasty costs around 5,000-8,000 AUD (3,800-6,100 USD)

In Thailand, price for ear pinning surgery for both ears is about 50,000-90,000 THB (1,600-2,850 USD)

Sources

• The Incisionless Otoplasty Technique.
  A Gantous – JAMA Facial Plastic Surgery, Sep 2018
  DOI: https://doi.org/10.1001/jamafacial.2018.0670
• Essentials of Aesthetic Surgery
  JE Janis – Thieme, 2018
  ISBN 978-1-62623-867-1
• Plastic Surgery, 4^th Edition, Vol 2
  JP Rubin – Elsevier, 2018
  ISBN: 978-0-323-35702-9
• International Textbook of Aesthetic Surgery
  N Scuderi – Springer, 2016
  ISBN 978-3-662-46599-8
  DOI: https://doi.org/10.1007/978-3-662-46599-8
• The Art of Aesthetic Surgery – Principles and Techniques, 2^nd edition
  F Nahai – CRC Press, 2010
  ISBN: 978-1-4822-4166-2

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As a blood thinner, aspirin is prescribed with a lower dose that ranges between 75 and 150 mg and commonly known as baby aspirin: in the USA it is commonly prescribed 81 mg per day, in the UK 75 mg per day, while in Europe it is generally prescribed 100 mg per day.

It has long been used in the prevention of strokes and heart attacks, also in healthy subjects, but new studies and evidence suggest it should not be used by the general population except in high-risk individuals and in those with history of stroke or heart attacks due to blood clots.

Some people with limited medical knowledge may think it is a good idea to take low dose aspirin as prevention strategy without consulting their doctor; it is estimated that over 6 million people in the USA take daily aspirin without history of cardiovascular disease and without their healthcare provider recommendation; if you are among them, you better think twice: not only it has been proven unnecessary in healthy individuals, but daily aspirin use also carries some risks such as an increased risk of bleeding in the brain or in the stomach.

Always consult your physician before taking a medication and take daily aspirin only after a consult and under the guidance of a health care provider.

Is low dose aspirin the same as baby aspirin?

81 mg aspirin tablets were originally intended for use in children and for this reason they were also called baby aspirin. They are not to be used in children anymore unless it’s prescribed by a doctor and under the doctor’s supervision. While some people may still call it “baby aspirin”, a more appropriate name is low-dose aspirin.

Indications for low-dose aspirin (75-81-100 mg)

Daily low-dose aspirin therapy is usually indicated in the secondary prevention of cardiovascular disease (CVD) such as:

• History of heart attack
• History of ischemic stroke
• History of heart by-pass surgery or angioplasty
• History of angina

When it comes to primary prevention of CVD, meaning prevention without history of the disease, a risk/benefit analysis is needed. Some of the risk factors considered are age, sex, smoking, hypertension, diabetes, family history and cholesterol levels. Only use aspirin if clearly indicated by your physician.

Who should not take baby aspirin?

Never give aspirin to any child younger than 16 unless prescribed by a doctor because of a link with Reye’s syndrome.

Aspirin should also be avoided by people affected by some health conditions such as:

• Bleeding and clotting disorders (bleeding easily)
• Allergy to salicylates
• Stomach ulcers
• History of intracranial bleed
• History of serious gastrointestinal bleed
• Already prescribed with another anticoagulant or antiplatelet drug
• Severe Kidney or liver disease

Only take baby aspirin if advised by a doctor.

Baby aspirin during pregnancy

Low dose 81 mg aspirin is recommended and commonly prescribed in pregnant women at high risk of preeclampsia. It is generally started between 12 and 28 weeks of gestation and continued until delivery. Low-dose aspirin is not recommended for the prevention of early pregnancy loss, fetal growth restriction, stillbirth, or preterm birth. Only take baby aspirin when and if advised by your gynecologist. While low-dose aspirin after the first trimester has not been found harmful, high doses of aspirin during the first trimester increase the risk of preterm birth, congenital defects and bleeding in the brain of premature infants.

What are the benefits of daily aspirin use?

A regular low-dose of aspirin decreases the risk of stroke and heart attacks in selected groups of patients by inhibiting platelets from sticking to each other or to blood vessels and causing blood clots. Blood clots can restrict or block blood flow and cause heart attacks, stroke and other serious health problems, including death.

Should you take low dose aspirin daily?

Daily low dose aspirin should only be taken if prescribed by a health care professional. It is generally indicated in people with history of cardiovascular disease (secondary prevention) and in those at high risk of cardiovascular disease and low risk of bleeding who fit into certain parameters (primary prevention).

Baby aspirin dosage and formulations

Depending on your country, there are different dosages and formulations available for low dose aspirin for primary and secondary prevention of cardiovascular events. Common dosages for this purpose are 75 mg, 81 mg and 100 mg.

Available formulations include the standard tablet, chewable tablet, soluble tablet, and coated tablet.

Higher dosages and different formulations are available for other indications of this drug.

Best time to take it

Low dose aspirin should be taken once daily, and it is best taken with or right after a meal. It is not advised to take it on an empty stomach as it will likely upset it.

Daily aspirin side effects

Daily aspirin use, like any other medication, my cause side effects. It commonly may cause upset stomach or mild indigestion. Bleeding more easily than normal such as with nosebleeds, having some bruises and cuts that take longer to stop bleeding are other common complications of this medication. Serious complications are rare and include severe bleeding, liver problems, and allergic reactions.

If you experience any side effect, contact your physician for advice.

Sources

• Effect of Aspirin on Cardiovascular Events and Bleeding in the Healthy Elderly.
  JJ McNeil et al – The New England Journal of Medicine, Oct 2018
  DOI: https://doi.org/10.1056/nejmoa1805819
• Effect of Aspirin on All-Cause Mortality in the Healthy Elderly.
  JJ McNeil et al – The New England Journal of Medicine, Oct 2018
  DOI: https://doi.org/10.1056/NEJMoa1803955
• Effect of Aspirin on Disability-free Survival in the Healthy Elderly.
  JJ McNeil et al – The New England Journal of Medicine, Oct 2018
  DOI: https://doi.org/10.1056/NEJMoa1800722
• Use of aspirin to reduce risk of initial vascular events in patients at moderate risk of cardiovascular disease (ARRIVE): a randomised, double-blind, placebo-controlled trial.
  JM Gaziano et al – The Lancet, Sep 2018
  DOI: https://doi.org/10.1016/S0140-6736(18)31924-X
• Personalized Prediction of Cardiovascular Benefits and Bleeding Harms From Aspirin for Primary Prevention – A Benefit–Harm Analysis.
  V Selak – Annals of Internal Medicine, Oct 2019
  DOI: https://doi.org/10.7326/M19-1132
• 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines.
  DK Arnett et al – Circulation, Mar 2019
  DOI: https://doi.org/10.1161/CIR.0000000000000678 
• American Heart Association
• Update on Aspirin in Primary Prevention.
  American College of Cardiology (ACC), Nov 2019
• Low-Dose Aspirin Use During Pregnancy.
  American College of Obstetricians and Gynecologists (ACOG), Jul 2018
  DOI: https://doi.org/10.1097/aog.0000000000002708
• Low-dose aspirin
  UK National Health Service (NHS)
  https://www.nhs.uk/medicines/low-dose-aspirin/
• U.S. Department of Health and Human Services – Office of Disease Prevention and Health Promotion.
• Aspirin use may be widespread despite new guidelines.
  US National Institutes of Health (NIH), Aug 2019

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Accutane is the brand name of a prescription retinoid, isotretinoin, indicated for the treatment of nodulocystic acne but now often prescribed also for milder forms of acne, for eczema, and for other dermatological conditions.

So how long does it take for Accutane to start working?

Effects of the medication can be seen in as little as 10 days after you start taking Accutane.

Commonly between 2 and 10 weeks after starting the treatment you may notice a worsening of your acne known as a “flare up”.

Most patients will notice the full benefits of taking Accutane between 1 and 3 months after starting the treatment which usually lasts 5 to 6 months.

80% of patients who use isotretinoin capsules will have clear skin after 4 months.

The efficacy of this treatment is also dose-dependent, and many patients are started on a lower dose which is gradually increased over the course of several weeks; your specific therapeutic plan, including isotretinoin dosage and what other medications you are taking or what other treatments you are undergoing, will influence how fast Accutane will produce results on you.

After finishing one Accutane cycle, if acne persists a second course of therapy may be initiated after a period of at least 2 months off therapy.

Refer to your dermatologist for advice tailored to your specific case.

Sources

• Fitzpatrick’s Dermatology, 9^th Edition
  S Kang – McGraw-Hill, 2019
  ISBN: 978-0-07-183783-5
• Daily Routine in Cosmetic Dermatology
  MC Almeida Issa – Springer, 2017
  ISBN: 978-0-07-183783-5
  DOI: https://doi.org/10.1007/978-3-319-12589-3
• UK National Health Service (NHS)
  https://www.nhs.uk/medicines/isotretinoin-capsules/

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The pulse oximeter is the non-invasive instrument that allows to take such measure thanks to the fact that hemoglobin absorbs light differently when it is bound to oxygen: this is also the reason why oxygenated arterial blood is bright red in color, while deoxygenated venous blood is darker.

The saturation of oxygen in blood, taken with a fingertip pulse oximeter, is often considered one of the main vital signs.

What does SpO2 mean?

SpO₂ stands for peripheral oxygen saturation and is the value detected by pulse oximeters.

Another common and more reliable measure of blood oxygen levels is the arterial blood gas analysis or SaO₂. Although more precise, arterial blood gas analysis is an invasive test as it requires a healthcare professional to draw blood from an artery, usually from the wrist (radial artery) in an emergency setting, and it is not immediate as it needs a lab to analyze the sample.

Normal oxygen saturation (SpO2)

In a healthy person, a normal oxygen saturation is above 95%; it is considered abnormal in the 90-94% range and it requires medical attention below 90%.

Obesity, smoking, old age are factors that affect oxygen saturation making it lower.

Pulmonary diseases also may lower the SpO2: COPD patients for example have 88-92% as target saturation.

Are pulse-oximeter readings useful?

In general, symptoms and clinical signs should come before the numbers, with the latter being useful to better understand and to have an objective measure of the former.

Shortness of breath, chest tightness, rapid breathing, feeling tired and weak, wheezing, mental confusion, numbness or tingling of the extremities, cyanosis and the use of accessory respiratory muscles for breathing are some of the clinical signs and symptoms that you may have a respiratory problem.

In some cases though, you may feel ok and have no shortness of breath, but at the same time you may have low blood oxygen levels, a condition known as silent hypoxia which is also associated with the CoViD-19.

Pulse oximeters in COVID-19 patients: silent hypoxia

While in the general healthy population having a pulse oximeter at home may not be useful, for COVID-19 patients this instrument may actually help detect a complication of the disease: silent hypoxia. By measuring the SpO2 a couple of times per day you may be able to detect a lowering of your blood oxygen levels even when this is not reflected by your symptoms, allowing for a timely medical intervention.

Pulse oximeters in patients with chronic pulmonary disease

Patients with COPD may use pulse oximeters when a worsening of the usual symptoms of the disease happen, both to understand the seriousness of the exacerbation and to facilitate home treatment by adjusting the oxygen therapy to reach the target saturation of 88-92%.

Warning about pulse oximeter readings

Pulse oximeters are a very useful tool, but they are not perfect. More expensive oximeters may have more accurate sensors and the ability to provide more reliable readings, while cheaper versions may not even be intended for medical use and may not have passed any accuracy test.

Moreover, some factors may influence the readings such as:

• Nail polish. For a proper reading apply the sensor to a finger where nail polish was removed, or to a toe, or to the ear lobe. You may also try and place the pulse oximeter sideways on the finger.
• Cold fingers. Poor circulation due to cold fingers may influence the reading. Warm up the fingers by placing them in warm water and/or massage them to increase the perfusion to obtain a more accurate reading.
• Skin pigmentation and skin thickness may also influence the reading.
• Ambient light may reduce the accuracy: hospital pulse oximeters have rubber shields on the sides to reduce ambient light input.
• In case of carbon monoxide intoxication (CO), the oximeter may show a normal saturation: this is because the carboxyhemoglobin absorbs light roughly at the same wavelength as oxyhemoglobin.
• SpO2 below 83%. When oxygen levels are too low, the pulse oximeter may not provide an accurate reading. In these cases, an arterial blood gas analysis is usually performed in a hospital setting.

Don’t just rely on the self-measurement of oxygen levels and self-assessment of the symptoms: always consult your GP when you feel something is not right.

Warning about Oxygen Toxicity

Some people having access both to a pulse oximeter and to an oxygen gas cylinder, such as relatives of patients who have it prescribed or scuba divers, may think it is a good idea to get some oxygen when their saturation is on the low-end side.

Supplemental oxygen is a medical therapy and like any other prescription drug it should be used only when directed by a physician and as directed by a physician. Air-oxygen percentage mix (ranging 21-100%) and flow rate (ranging 0.5-15 L/min) should be decided by a doctor according to your specific needs.

Moreover, oxygen is actually toxic to the human organism: we would not survive in an atmosphere with 100% oxygen. Long term exposure to high levels of oxygen causes oxygen poisoning with effects on the central nervous system, on the lungs and in general to all organs and tissues. More oxygen means also more oxidative processes in the body which result in an increased production of reactive oxygen species (ROS) commonly known as free radicals. Oxygen also causes vasoconstriction of the blood vessels in the tissues. In COPD and myocardial infarction patients, high levels of supplemental oxygen are correlated to a worse outcome.

Sources

• Oxygen Saturation
  BB Hafen, S Sharma – StatPearls, US National Library of Medicine, Aug 2020
  https://www.ncbi.nlm.nih.gov/books/NBK525974/
• Predictors of oxygen saturation ≤95% in a cross-sectional population based survey.
  ML Vold, U Aasebø – Respiratory Medicine, Nov 2012
  DOI: https://doi.org/10.1016/j.rmed.2012.06.016
• Silent hypoxia: a frequently overlooked clinical entity in patients with COVID-19.
  A Chandra – BMJ Case Reports, Sep 2020
  DOI: http://dx.doi.org/10.1136/bcr-2020-237207
• Oxygen Toxicity.
  JS Cooper – StatPearls, US National Library of Medicine, Nov 2020
  https://www.ncbi.nlm.nih.gov/books/NBK430743
• Exacerbations in Chronic Obstructive Pulmonary Disease: Identification and Prediction Using a Digital Health System.
  SA Shah, C Velardo – Journal of Medical Internet Research, Mar 2017
  DOI: https://doi.org/10.2196/jmir.7207
• FDA In Brief: FDA warns about limitations and accuracy of pulse oximeters.
  US Food and Drug Administration (FDA) – Feb 2021
  https://www.fda.gov/news-events/fda-brief/fda-brief-fda-warns-about-limitations-and-accuracy-pulse-oximeters
• Emergency Medicine – A comprehensive study guide, 9^th edition
  JE Tintinalli – McGraw-Hill, 2020
  ISBN: 978-1-26-001994-0

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Tinnitus may be nothing to worry about like when:

• You hear a rumbling sound while yawning. This is caused by the contraction of the tensor tympani muscle.
• You hear a popping or hissing sound when there is a rapid change in altitude (ie on the airplane during takeoff or landing).

In this article though, I’ll talk about what may cause tinnitus of the crackling “rice krispies” type and not of the more diffuse ringing type.

Eustachian Tube Dysfunction

The Eustachian tube is the narrow canal that connects the middle ear to the nasopharynx; it allows to drain fluid from the middle ear and to equalize the air pressure inside the ears to that of the environment.

Sometimes, due to allergies, inflammation or infections, the Eustachian tube may swell up not allowing it to function properly. This may cause a feeling of fullness in the ears, some hearing problems and in some cases the crackling sound due to the air working its way through the narrowed passage.

Eustachian tube dysfunction is considered to be the most likely cause for ear crackling.

Impacted Cerumen (Earwax)

Cerumen, commonly known as ear wax, is composed of dead cells and secretions from two different types of glands inside the ear; its function is to keep the ear canal lubricated and clean and it also has some antimicrobial properties. Cerumen is naturally expelled from the ear canal through a physiologic mechanism aided by jaw movements. In 10% of children, 5% of adults and nearly 60% of older people in nursing homes, earwax becomes impacted, meaning it causes symptoms or causes a blockage of the ear canal. This may be because of failure of the self-cleaning mechanism or due to improper self-care (ie. Q-Tips).

If there is a complete blockage of the ear canal, impacted earwax may cause the crackling sound similarly to eustachian tube dysfunction, when the air slowly finds its way through the blockage.

Otitis Media

Otitis media may cause Eustachian tube dysfunction and for this reason it may be a cause of ear crackling. When symptoms of otitis media persist, you should see your GP as antibiotic treatment may be advised.

Crackling in ear when chewing or moving jaw: TMJ

The temporomandibular joint (TMJ) is the joint that connects the jaw to the skull. Like any other join it may cause some problems and can be affected by cartilage degeneration and arthritis. When experiencing issues with the TMJ, patients usually report pain and clicking sounds when moving the jaw but in some cases there may be some crackling too.

Other possible causes

Meniere’s Disease

People suffering from Meniere’s syndrome experience attacks lasting from a few minutes to several hours characterized by vertigo, hearing loss and tinnitus. Although not common, the tinnitus may also be of the crackling type.

Post-surgery crackling

In some cases, people who underwent surgeries such as a mastoidectomy for cholesteatoma removal may hear crackling sounds during the first few weeks after the operation. After healing from surgery, the sound should disappear.

Side effects of medications

Many medications may affect your hearing and cause tinnitus, although this is rarely of the crackling kind. The most common ototoxic medications are antibiotics, some cancer treatments, quinine (malaria treatment), aspirin and diuretics.

Head injury, barotrauma and acoustic trauma

Head trauma, trauma from air pressure changes such as in diving or when flying, and trauma from loud noises may cause tinnitus. Although it is mainly reported as a ringing sound with hearing loss, in some cases patients also report crackling in the ears.

Treatments for crackling ears

Treatment for ear crackling will depend upon the cause of this phenomenon. It is always advised to see you family physician so that he can perform a physical examination and collect all the information needed for a reliable diagnosis such as asking about any other symptom you may experience and what medications you have taken recently. In some cases, you may be referred to an ENT specialist.

When thinking of ear remedies or ear cleaning many people think about Q-Tips (cotton swabs), ear candling or olive oil drops. These methods have been proven ineffective and with the potential to make things worse and cause side effects. Cerumenolytic sprays, which are sprays containing ingredients that make earwax softer and easier to remove, and irrigation with a syringe (without the needle!) are better alternatives.

If you are suffering from a mild upper respiratory tract infection such as the common cold, ear crackling will disappear once the infection heals. You may ask your GP if anti-inflammatories, nasal decongestants, steroids or other medications may be indicated in your specific case.

In some cases, the Valsalva maneuver may solve the issue; to perform the maneuver you should keep your mouth and nostrils closed while attempting to exhale. It is the same maneuver you may have performed to equalize the pressure inside the ears when flying on an airplane (ie. “Popping your ears”).

When to see your doctor?

Occasional or short-lasting ear crackling may be normal but in some cases it is strongly advised to see your GP for a medical examination such as when:

• Symptoms last for weeks
• Symptoms started after a trauma or injury
• Aside from ear crackling you also experience dizziness, nausea, fever, hearing loss, or other symptoms.
• There is discharge from the ear canal that contains blood or has a foul smell

Sources

• Cerumen Impaction: Diagnosis and Management.
  C Michaudet, J Malaty – American Family Physician, Oct 2018
  https://www.aafp.org/afp/2018/1015/p525.html
• ENT – An Introduction and Practical Guide, 2^nd edition
  JR Tysome – CRC Press, 2018
  ISBN: 978-1-138-19823-4
• ENT – Core Knowledge
  P Koltsidopoulos – Springer, 2017
  ISBN: 978-3-319-56330-5
  DOI: https://doi.org/10.1007/978-3-319-56330-5
• ENT in Primary Care – A Concise Guide
  E Cervoni – Springer, 2017
  ISBN: 978-3-319-51987-6
  DOI: https://doi.org/10.1007/978-3-319-51987-6
• American Academy of Otolaryngology
• US National Library of Medicine – MedlinePlus

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What are lucencies?

Radiographs, commonly known as X Rays, are images obtained for diagnostic purposes; in medical radiography, an X-ray generator produces a beam of energy (x-rays) that travels towards the body of the patient: part of these X rays will be absorbed by body structures while some of them will make it through the body and will be captured on a film placed behind the patient. CT Scans employ the same principle but can produce three dimensional images.

The obtained image on film will show radiolucent and radiopaque structures:

• A radiolucent structure has low density and will result in a black color on the radiograph. This means that X-rays made it through the body.
• A radiopaque structure has high density and will result in a white color on the radiograph. This means that X-rays were absorbed and didn’t make it through.

A lucency is an area of low density, hence appearing black in color, often highlighted in the report because unexpected such as in a tissue that is supposed to be radiopaque (white in color).

The opposite of lucency is a density which is an area denser than expected and showing up as a white or brighter spot in the tissues.

What do lucencies indicate?

Lucencies may mean many different things: it may be an artifact or may be due to improper positioning of the patient, it may be something benign not to worry about, or it may be a sign that something is wrong. It is not possible to say that without more knowledge of the specific case and without further information about the finding.

Lucencies in general may indicate things like a cyst, a benign tumor, an infection or cancer. Previous radiographs, the history of the patient, the symptoms and why the exam was prescribed combined with the exact location and details about the lucency such as the type of tissue and what portion of the tissue was it found in, how the margins are, what other changes can be noted in the area, are some of the further details needed for narrowing down the diagnosis. In many cases, for a proper diagnoses further tests will be prescribed such as other medical imaging studies or a biopsy.

Examples of lucency

In an OPG (orthopantomagram), an exam commonly prescribed by dentists, a periodontal or periapical lucency often indicates an infection.

In a mammogram it may indicate a lipid cyst, a harmless lump of fatty tissue.

In a bone radiograph, it may indicate an area of demineralization due to a trauma.

How to interpret the lucency?

Radiologists are physicians specialized in performing medical imaging procedures and diagnosing patients by interpreting the images obtained. You should bring the report of your exam to your referring specialist or to your GP to discuss the results and better understand the findings.

Sources

• Radiological Society of North America (RSNA)
• Thoracic Radiology – A guide for Beginners
  I Carbone – Springer, 2020
  ISBN: 978-3-030-35765-8
  DOI: https://doi.org/10.1007/978-3-030-35765-8

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