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Mark Vrahas: Total Hip Arthroplasty for Acetabular Fractures

Mark Vrahas Trauma Surgeon Mass General HospitalTotal Hip Arthroplasty for Acetabular Fractures
Mark Vrahas, MD
Partners Chief of Orthopaedic Trauma, Department of Orthopaedic Surgery,
Massachusetts General Hospital, Harvard Medical School
Boston, MA.

Grand Rounds presented on October 15th, 2009 at the O’Keefe Auditorium, Massachusetts General Hospital, Boston, MA.
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Lumps & Bumps

Lumps & Bumps: Things to consider when you notice a lump on your body
Download the PDF (220 KB), as it appears in the print edition.

Over the course of a day, we all poke, rub, and scratch. Usually it’s an itch or a sore. Occasionally we notice a lump! What should we do? Rightly, some of us will worry about it and cannot rest until we find out what the lump is. Others will completely ignore it.

Fortunately, the vast majority of lumps and bumps are benign (see box at end) and do not threaten our lives. But some can be dangerous and require immediate medical attention. So which lumps should we worry about? Which lumps and bumps require a doctor’s care, and which ones can be ignored?

We usually discover lumps and bumps about our hands and feet earlier than if they were in our thighs or buttocks, for example. Our hands and feet don’t have as much soft tissue around them, making it easier to notice even small lumps. Our buttocks, thighs and even the upper arms can hide quite a large mass before we notice.

picture of lipoma benign fat tumor in thigh
Magnetic Resonance Image (MRI) of a thigh, identifying a lipoma – a benign fat tumor, adjacent to the thigh bone.

Feel the size of the lump carefully. Small tumors less than 2 cms are more likely to be benign. Is the lump painful? Benign soft tissue tumors tend to be painless. Does the lump move about as you press on it? A tumor that is not fixed in one place is not growing into adjacent bone or organs. Such mobile tumors are less likely to be dangerous. An important characteristic of a tumor is whether or not it is growing. Measure the size of the mass with a measuring tape and record its size.

A 2 cm lump would be considered a small tumor. However, if the tumor expanded from 1 cm to 2 cms in 2 weeks, then the tumor is growing relatively quickly and should not be ignored.

Patients should contact their primary care physician regarding any newly discovered lumps. In the meantime, perform a thorough self-exam of the rest of your body (including the hands and feet). Look for other lumps or bumps, or areas of skin pigmentation that are new. Make sure to look at the soles of your feet and the palms of your hands.

The doctor may order an MRI (magnetic resonance imaging) exam, possibly with the use of a contrast agent. A surgeon can use the MRI information to decide whether the tumor can simply be removed, or if it requires additional tests.

If the lump is greater than 5 cms, painful, or is growing, the doctor may recommend a biopsy. During a biopsy, a small portion of the lump is removed with a needle and analyzed by an experienced pathologist to determine if the lump is benign or malignant. Malignant lumps can be life threatening (see box) and often require sophisticated care and complex surgical excisions.

“It’s never a waste of a doctor’s time to have a lump or bump evaluated,” states Dr Kevin Raskin, Assistant Professor at Harvard Medical School and Tumor Surgeon at the Massachusetts General Hospital, Boston, MA. A physician should evaluate new lumps and bumps, those that have changed over time, or are causing symptoms. “The over-arching theme is ‘don’t be shy.’ Bring up even the smallest worry with your doctor. An ounce of prevention is worth a pound of cure, and peace of mind is priceless,” advises Dr Raskin.

Benign: (beh-NINE); mild, gentle and non-threatening;
Tumors that generally do not threaten the life of the patient. They very rarely spread to other areas of the body, and often do not need to be treated unless they are bothersome to the patient.

Malignant: (muh-LIG-nunt); tending to spread and infiltrate;
Tumors that may threaten a patient’s life. They often spread to distant organs including lymph nodes and lungs. These need to be treated by experienced physicians.

Men are from Mars and Women get Arthritis

Biochemistry, Anatomy and Lifestyle Explain Why more Women Suffer from Arthritis.

Why more women suffer from Arthritis

Titles in bookstores remind us that women think, behave and feel differently than men. Even in health, diseases in women manifest and progress uniquely, and the effectiveness of medications varies. Scientific research informs us that women are also more vulnerable to arthritis. Such differences may be due to hormonal, genetic, biomechanical, and lifestyle differences between genders, contributing to disparities in men and women’s treatments. Understanding these gender-specific differences will help us treat women’s arthritis more effectively.

Cartilage is the tough, slippery tissue covering the ends of long bones. As we move our bodies and go about daily activities, healthy cartilage permits bones to smoothly and painlessly glide over each other.

In patients with arthritis, particularly osteoarthritis (AH-stee-oh-ar-THREYE-tis), the cartilage is worn away, causing the underlying bones to grind against each other, driving the pain.
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