Forehead Lipoma Case Study

Forehead Lipoma Case Study ABSTRACT The lipoma is a relatively rare maxillofacial tumor, although it occurs with considerable frequency in other areas, particularly in the subcutaneous tissues of the neck. Lipomas are common benign soft tissue neoplasms of mature adipose tissue. They have been known to grow to large sizes causing masticatory and speech difficulties. The usual lesions consist of a well circumscribed, lobulated mass of mature fat cells. In other situations the covering mucosa becomes ulcerated and presents a diagnostic dilemma and seldom occurs in the younger age group. We present a case of forehead lipoma affecting 52 year old male patient. KEY WORDS – Lipoma , forehead , surgery INTRODUCTION Lipomas are benign tumors of mesenchymal origin consisting of mature fat cells which usually are involved by a thin fibrous capsule(1) . There are several forms and dimensions of this condition depending on location or evolution time which may cause orofacial deformity in some patients.( 2) Etiology of lipoma remains uncertain, even after pointing endocrine changes and heritance factors as possible causes. It is known that lipomas are mainly present in the fifth and sixth decade of life, being rarely found during childhood .(3,4) Lipoma’s are also seen in intra oral sites such as in lips, tongue, palate, buccal vestibule, floor of the mouth and parotid region(1,3) . Incisional or excisional biopsy can be done in these cases. Yellow coloration of lipoma should be observed as well as fluctuation of the lesion. This lesion will be on the liquid surface due to its lower density than a fixer solution(5,6-8). The treatment of lipomas is surgical removal. The recurrence is rare (1) a nd there is no reported malignant transformation (6) . Although, growth of lipoma is usually limited, it can grow to large proportions which can interfere in the speech, mastication, that reinforce the necessity to realize a surgical removal.(7,8) The present study aims to show a rare case of forehead lipoma in the maxillofacial region. CASE REPORT A 52 year old male reported to the Department of Oral Maxillofacial Surgery with the chief complaint of swelling in the forehead region which patient noticed 1 year back which had been gradually increasing initially but reported rapid growth since 1 month. On examination , a well defined 2 x 2 cm swelling was noticed in the forehead region on the right side just above the right eyebrow (Fig. 1). The skin over the swelling was stretched. No lymph nodes were palpable. On palpation, swelling was soft , fluctuant , non tender , mobile and the margins were slippery under the palpating finger. The swelling was non-pulsatile. The provisional diagnosis of lipoma was established. A differential diagnosis of dermoid cyst was excluded by negative aspiration . Routine blood investigations were carried out and were normal to plan an excisional biopsy under Local Anesthesia . Local anesthetic with adrenaline was infiltrated at the periphery of the lesion. Incision was then given along the crease in forehead to achieve better esthetic closure , crossing the swelling at its greatest bulge. Lesion was then slowly dissected out with the capsule in toto (Fig 2). Hemostasis achieved and subcuticular sutures were given (Fig. 3 4) so that scar is aesthetically acceptable . Histopathology report revealed a capsulated lesion with numerous adipocytes with peripherally placed nuclei. Admixed collagenic streaks were also seen. The entire lesion was excised and no recurrence has been observed for the past 6 months and the patient is under regular follow up. DISCUSSION Lipoma is a benign slow growing neoplasm composed of mature fat cells. Lipomas in the oral cavity are rare. The most common locations of lipoma in the oral cavity have been reported to be in the buccal mucosa, a region abundant in fatty tissue, followed by tongue. The hard palate has very little fatty tissue and the incidence of a lesion here is quite low. [9] Lipoma differs metabolically from the normal fat cells even though they are histologically similar. It has been shown that the fat of lipoma is not used for energy production during starvation period, as it happens with normal adipose tissue, their lipid is not available for metabolism. Adipose tissue is present in two basic forms white fat and brown fat. The clinical features of lipoma vary according to their rate of growth, size, and location. The usual complaint is of a painless palpable esthetically unpleasant mass, and there is seldom dysfunction of an involved muscle. A characteristic feature is a change in consistency and form of many of these lesions during contraction of involved muscle. The tumor is soft and flat when the muscle is relaxed and becomes firm and more spherical when muscle contracts. The etiology varies from the differentiation of multipotent mesenchymal cells in fat tissue, cartilage, and bone to metaplasia of a preexisting lipoma. Mesenchymal cells are modified by systemic and local influences that range from local trauma to prolonged ischemia. [10] Occasionally, the lipoma may invade muscles or grow between them: the so-called infiltrating lipoma. Infiltrating lipoma is an uncommon mesenchymal neoplasm that characteristically infiltrates adjacent tissues and tends to recur after excision. This type of lipoma is extremely rare in the head and neck region , and its congenital type is rare. [11] Lipoma consist of mature fat cells arranged into lobules that are separated by septa of fibrous connective tissue (12). Liposarcoma is important in the differential diagnosis, because well differentiated liposarcoma often contains many areas of lipomatous tissue. Despite the close histological similarity to normal adipose tissue, lipomas, usually have chromosomal aberrations such as translocations involving 12q13-15, locus interstitial deletions of 13q, and rearrangements involving 8q11-13 locus. [13] The clinical differential diagnosis includes ranula, dermoid cyst, thyroglossal duct cyst, ectopic thyroid tissue, pleomorphic adenoma and mucoepidermoid carcinoma, angiolipoma, fibrolipoma and malignant lymphoma. The definitive diagnosis is made by means of microscopic examination which shows adult fat tissue cells embedded in a stroma of connective tissue and surrounded by a fibrous capsule. On some occasions lipoma of the buccal mucosa cannot be distinguished from a herniated buccal fat pad, except by the lack of a history of sudden onset after trauma. Lesions outside the oral cavity could show greater recurrence rates after surgical excision. CONCLUSION Lipomas found in the oral and maxillofacial region are rare and usually slow growing lesions. The clinical course is usually asymptomatic until they get larger in size. Most lipomas develop in the subcutaneous tissues but deeper tissues may be involved as well. Surgical excision is the main treatment for lipoma. The complete excision along with precautions to prevent damage to adjacent structures should be emphasized during the operation, which is the key factor in order to avoid recurrence with least morbidity.

Did the Liberal Welfare Reforms Lay the Foundations of the Welfare State?

Did the liberal Welfare Reforms lay the foundations of the Welfare State? This essay will assess how far reaching the liberal Welfare Reforms were and how far they can be said to represent the foundations of the Welfare State. The Welfare State is when the Government takes care of the health and well-being of all its citizens from â€Å"cradle to grave†. The liberal Welfare Reforms did represent a move away from â€Å"laissez-faire† towards a programme of social reform. The liberal reforms concentrated on five main groups. These were the young, introducing school meals and medical inspections with the Education Act 1906 and 1907, the old with the Old Age Pensions Act 1908, and the sick who were helped with the first part of the National Health Act 1911. The employed were given compensation for injuries sustained at work with the Workmen’s Compensation Act of 1906 and other things such as an eight hour day for miners due to the Coal Mines Act 1908. A half day off was also given to shop assistants following the Shops Act 1911 and there was a minimum wage for â€Å"sweated industry† workers with the Trade Boards Act of 1909. The unemployed were given help to find work with the Labour Exchanges Act 1909 and unemployment insurance which was brought in with the second part of the National Insurance Act 1911. The first social reforms to be carried out by the Liberals were concerned with children and dealt with the provision of school meals and the medical inspection of all pupils. Now that education was compulsory it was made clear that many children were often coming to school hungry, dirty or suffering from ill health. A study carried out in a poor area of Dundee in 1905 showed that children were significantly underweight and under height when compared with the national average. The report said â€Å"†¦ a large number of children who should be under medical supervision† and â€Å"†¦ they cannot apply their minds to lessons while their stomachs are empty†. The Boer War in 1899 had highlighted the problem that Britain had with the physical condition of its citizens. When recruiting soldiers to fight in the war, the height requirement had to be dropped from 5 feet 6 inches to 5 feet 2 inches so that Britain would have enough soldiers. The leader of the Social Democratic Foundation (SDF) claimed at the time that 50% of the working-class recruits from towns and cities had been unfit to fight due to their poor physical condition. To bring Britain back to a good physical state, the Government decided it was best to start with children and did this with the Education (Provision of Meals) Act, 1906. Much of the credit for this Bill lies outside the Liberal Party. There was a lot of public concern created by reports carried out in the wake of the Boer War. One of these was a report carried out by The Royal Commission of Physical Condition in Scotland and the other was carried out by The Interdepartmental Committee on Physical Deterioration. A labour backbencher called William Wilson introduced the school meals proposal which was so popular that the Liberals decided to give it a chance; this was then called the Education (Provision of Meals) Act. The act allowed local authorities to take steps as they saw fit to provide school meals for children either through voluntary work or using the local authority money. Parents were to pay for school meals if they could afford it, however, if they could not the local authority could pay a halfpenny. The number of school meals provided by the Government started at 3 million in 1906 and eventually rose to 14 million in 1914. Within a short period of time a Government funded Welfare system was beginning to replace many of the efforts made by charities. There was still a long way to go though as in 1912, over half of the local authorities had not set up a school meals service. In 1907 there was another Bill passed in order to take care of the health of school pupils. This was the Education (Administrative Provisions) Act which was not popular with the Liberal Government at first as they knew that health inspection in schools would lead to public demand for government funded medical treatment for everyone and the Liberals did not think that they could afford to do this. However, Robert L Morant, the Permanent Secretary of the Education Board during 1906 had been convinced about the need for school medical inspections through contact with a woman called Margaret Macmillan. She said â€Å"for the good of the children and the public, what subjects are taught and how much they are taught do not matter anything like so much nowadays as attention to the physical condition of the scholars†. In 1912 the Board of Education started to give grants to local authorities to set up school clinics to provide all pupils with healthcare. Although this was a huge step towards a Welfare State it was not a foundation as these acts would not have been passed had Elementary education not been made compulsory in previous years. The Old Age Pensions Act in 1908 was the conclusion of over 20 years of debate surrounding the subject of poverty amongst the elderly. Lloyd George the new Chancellor of the Exchequer in April 1908 made it his job to get the Old Age Pensions Bill through the House of Commons and although it passed through the House of Commons with very little opposition. However, the House of Lords was slightly more difficult to tackle as the majority of Lords still believed in â€Å"laissez-faire†. When eventually the Bill passed through all of its stages, it became law in 1908 and came into effect in January 1909. The Act entitled people over the age of 70 to between 1 shilling (5p) a week and 5 shillings (25p) a week of pension. However, this amount of money still fell below what Rowntree considered to be the poverty line by 2 shillings (10p) a week. There were also a few exceptions. Any 70-year-old was entitled to the pension as long as they were British and had been a resident in the UK for over 20 years, they had avoided imprisonment in the past previous 10 years to receiving their pension and they had not regularly avoided work. The Government had miscalculated how many of the public would need a pension as they estimated that there would only be around 500,000 but by 1914 there were 1 million pensioners in Britain. This made the Government very quickly aware of the poverty that the elderly people in the country were facing. Although the Old Age Pensions Act 1908 was a significant step towards the Welfare State, this was not part of the foundations as things such as Friendly Societies had been there before to help the Elderly. The sick created another task for the Liberal Government. On returning from Germany, Lloyd George immediately started work in setting up a way to help people who couldn’t earn money on their own as they suffered from illness. However, he again came up against opposition from friendly societies but also came up against Trade Unions and Doctors. As Lloyd George was Chancellor of the Exchequer he was also very aware of the cost of bringing in National insurance. In order to pay for the National insurance scheme, income tax was made more progressive in that the more money you earned, the more money you paid in tax. Lloyd George had to account for all of this in the 1909 budget, however, this was rejected by the House of Lords and the Parliament Act 1911 had to be passed to limit the power of the Lords. The Peoples Budget was passed in 1910 which meant that the Government now had the money to start its social welfare programme. The health insurance scheme was contained in part 1 of the National Insurance Act 1911, this was a compromised Act and there was a lot of work still to be done to help those at a disadvantage in society. To stop the opposition to the Act from Trade Unions, Lloyd George decided to include them in the system along with Friendly Societies who would help him with his new system. When Lloyd George came out with his proposals, the British Medical Group had very strong objections to them. They did not want what existed between the Doctors and the Friendly Societies on a national scale where the Doctors felt they were being paid too little money to treat working-class patients. When Lloyd George went to meet with the Doctors he had to tell them that Friendly Societies were too powerful for him but offered the Doctors a higher contract fee of 4 shillings (20p) per patient and 2 shillings (10p) to cover any drugs costs, this was much more than the Friendly Societies had been willing to give and therefore, when the Act was passed, many of the poorer Doctors joined and were able to double their income quickly. Although this was a better way of helping the sick, it was not one of the founding principles of the Welfare State as there were Friendly Societies there before who did almost the same thing. Unemployment was still believed to be the fault of the individual who was unemployed up until the 1900s as many people wouldn’t accept that if a worker was unemployed it may be due to circumstances out with their control. The causes of unemployment were hidden by the belief in Samuel Smiles book on ‘Self-help’ which basically said that if a person was unemployed it was there own fault and they had to get themselves out of unemployment by hard work and belief that they could get a job. This was believed for a long time as nobody had accurate information on how bad the problem actually was. Part 2 of the National Insurance Act covered the unemployed. This was a contributory insurance scheme where workers paid 2? d, the employer paid 2? d and the Government paid 3d per week. Insurance was compulsory for trades such as Shipbuilding, building construction and sawmilling as these were seasonal trades which had a repeated pattern of unemployment. Labour Exchanges had two roles, the first was to allow the unemployed to find work and the second was to pay out unemployment benefit to those who were insured. In order to receive unemployment insurance the worker had to go to the Labour Exchanges and register as unemployed, he would then go back there to collect his money. On a weekly basis he would receive 7 shillings (35p) a week for up to 15 weeks of the year. However, if the worker had been dismissed from work following unsatisfactory work or bad conduct then he would not be entitled to any benefit as it was his fault that he was unemployed. Within 2 years of unemployment insurance starting 2. 3 million workers were insured, however, this was still only a small number of the working-class population. Although this was not part of the foundations of the Welfare State as the Conservative Government had passed the Unemployed Workmen’s Act before it left office in 1905, this was seen as a much better way of dealing with the problem of unemployment in Britain. The Liberal Government passed four laws which wanted to improve the conditions of workers. These provided compensation for injuries that happened at work. Shorter hours were given to people who worked in dangerous and difficult jobs such as coal mining. This was a good turning point as miners had been campaigning for this for over 40 years. Minimum wages were given to female workers who were exploited and worked in ‘sweated trades’ such as tailoring, a total of 200,000 workers were affected by The Trade Boards Act of 1909. There was also a half day off and a decent amount of time for meals given to shop assistants who mostly did not have trade unions behind them. The Workmen’s Compensation Act was built on previous Acts of 1897 and 1900, showing that helping the people who were employed had started before the Liberal Government came to power showing that they did not set the foundations of the Welfare State. In conclusion, the Liberal Government did take a lot of steps towards making Britain a Welfare State such as setting up a national insurance system, a pension system for the elderly when they couldn’t work anymore and tried to tackle social issues with Government intervention. However, they did not stop poverty, medical inspections and school meals were not compulsory for local authorities so education was not up to the standard that it should have been, the workhouses were still there although not as widely used and there was no system of family allowance in place. Although some historians think that you can see the origins of the Welfare State in the Liberal Reforms, others believe that the Liberal Reforms failed to deal adequately with the welfare of Britain and were not the origins of the Welfare State. The Liberal Welfare reforms did not lay the foundations of the Welfare State but did improve on measures that were already in place.

Introduction of Green Building Material Essay

Materials are the stuff of economic life in our industrial world. They include the resource inputs and the product outputs of industrial production. How we handle them is a major determinant of real economic efficiency, and also has a major impact on our health and the health of the natural environment The built-environment is also a strategic realm of social, economic and environmental change. Various writers have stated that spatial redesign of the landscape and built-environment may be the single most effective means of achieving new levels of efficiency and sustainability (Lyle, 1994; Mollison, 1983; Alexander, 1977; Van der Ryn & Cowan, 1996). Building materials are also quite important. They have been estimated that building materials make up forty percent of material through-put of entire economy (Milani, 2001). In the book â€Å"Green Building: Project Planning and Cost Estimating†, Keenan and Georges (2002) identified some key characteristics of green building materials. As regards green building materials, they should be healthy for the internal environment, healthy for the natural environment, minimize building energy use, have low embodied energy, be reusable, recyclable and/or biodegradable, and be locally obtained. Embodied energy is a concept that takes into account several factors to determine the energy needed to produce a product and can be used as a comparison between different materials. There is some controversy surrounding embodied energy as there is no internationally agreed method for calculating this value and many times it is not known what has been accounted for (Woolley and Kimmins, 2005). For example, cement has an embodied energy of 7. 8 MJ/kg, while virgin steel is 32. 0, and recycled steel is 10. 1 MJ/kg (Keenan and Georges, 2002). In these values however, consideration is not given to transportation, durability, reuse and recycling. These factors could significantly alter the original values. Building materials are also the stuff of our personal environments. They are all around us, and literally part of the air we breathe. They can damage the biosphere: VOCs from paints alone are responsible for perhaps 9 percent of the damage to the ozone layer. They can also damage us: the US Environmental Protection Agency (EPA), for example, estimates that indoor pollution—caused by materials like paints, plastics and particleboards—is responsible for more than 11,000 deaths each year from cancer, kidney failure, and respiratory collapse (Ligon, 2001). The fact that buildings are all around us means not only that they immediately impact us, but that we can potentially affect them. The building industry is a decentralized one that exists in virtually every community. Not surprisingly, the built-environment is a major venue for ecological and community development alternatives, with materials being an increasing focus of concern over the past decade. The first is the section on Materials and Resources. This section consists of one prerequisite and eight credits. The eight credits focus on reuse and management of construction and demolition waste; using refurbished or reused materials and materials with a recycled content; using regional and rapidly renewing materials; and lastly if new wood must be used, using products certified accordance with the Forest Stewardship Councils principles and criteria The second section which pertains to building materials is Indoor Environmental Quality. The important credit is number four: Low Emitting Materials. For this credit, the Volatile Organic Carbon (VOC) content of adhesives and sealants must be less than the VOC content limits of the State of California South Coast Air Quality Management District’s (SCAQMD) rule number 1168 from October 2003. For paints, the VOC content must be less than the VOC and chemical component limits of the Green Seals Standard GS-11 from January 1997. Composite wood and laminate adhesives must contain no added urea formaldehyde resins. Concrete is a strong and durable material with a high heat storage capacity (Keenan and Georges, 2002). It is good from an indoor air quality standpoint as it is inert. The problems associated with concrete are washout water at concrete plants which can have a high pH, and the use of cement as a binding agent in concrete. Cement is very energy intensive and is a major contributor of greenhouse gases. To counteract this, up to 70% of cement in concrete can be replaced with fly ash. Fly ash is a waste product from coal fired plants. Brick, block and stone have a low embodied energy and are therefore environmentally friendly materials (Keenan and Georges, 2002). To avoid added impacts of transportation, local masonry should be used where available. STRUCTURAL FRAMING An ongoing environmental debate is wood versus steel as components for framing. Both materials have been destructive to the environment and both have advantages and disadvantages. One of the advantages of wood is that it is a natural insulator while steel is a conductor. Steel is 400 times more conductive than wood (Keenan and Georges, 2002). One of the disadvantages of wood is that it needs to be treated with preservatives which can be toxic and render the wood non-biodegradable. Steel on the other hand offers resistance to insects and water rot. Steel is also recyclable. The choice between steel and wood should depend on the application they are being used for. Wood may be more environmentally friendly if you can use non-treated and certified wood. The production process is less energy intensive than for steel, and creates less pollution and environmental degradation than the mining and processing of steel (Keenan, A. , and Georges, D. , 2002). INSULATION Some of the considerations which need to be taken in account when choosing an insulation material are: 1) does it retard airflow, 2) which type will provide the best Rvalue within a reasonable thickness, 3) does it pose health risks, and 4) does it contain ozone depleting chemicals (Keenan and Georges, 2002). In the Green Building Handbook, the authors offered their choices for â€Å"best buys†. Their top three choices were wool, cellulose fiber, and cork. These choices are thermally as good as conventional insulators (Woolley and Kimmins, 2005). Cellulose Fiber is made from processed waste paper, with added borates for fire and pest resistance. It is made into a fluff that can either be placed by hand or sprayed (Woolley and Kimmins, 2005). Insulation corkboard is produced by cooking cork granules at high temperature and pressure. The granules bond themselves together with their own resins (Woolley and Kimmins, 2005). ROOFING For materials used in roofing, durability is critical. One option for materials is metals, such as copper, steel and aluminium. Metal roofs are good because they can be made of recycled material and can be recycled at the end of their life cycle. They also last longer than asphalt (Frej, 2005). Cool roofs are an option that can be useful in both mild and hot climates. The roof material is covered with a reflective coating. This coating prevents the building from getting hot, reduces heat island effects and prolongs the life of a roof (Keenan and Georges, 2002). A non-petroleum based coating should be used. Living â€Å"green† roofs are another option. Green roofs are roofs that are partially or completely covered with soil and vegetation. These roofs provide environmental cooling, habitat, added insulation, storm water management, natural beauty, cleaner air and can extend the life of a roof (Keenan and Georges, 2002). One source suggested two to three times longer than a conventional roof (Frej, 2005) while another suggested they can extend the life up to 100% (Keenan and Georges, 2002). Planted roofs can require more maintenance and require a system to prevent root penetration and water seepage.

Essay on Steroids Not Worth The Risk - 1565 Words

Steroids were first introduced in the 1930, they have a variety of purposes in the muscle building world, cosmetics and even used therapeutically in medicine, they have aroused a great controversy and question in the media, â€Å"Do athletes need to use steroids to become the best in a sport?† The consumption of steroids is not recommended for athletes which their use and distribution is prohibited in the U.S. because they lead to negative effects on a person’s health and public image. Anabolic steroids are similar to the effects of the male testosterone, that buildup cellular tissue in muscles, they also have androgenic effects which will create unfavorable feminine or masculine characteristics, such as, growth of hair and vocal cords, but†¦show more content†¦Unfortunately, many athletes have reportedly confessed or have been accused of using steroids in many different fields of sports, though steroids are banned in all professional sports and in the Olympics . Athlete’s purpose to consume them is to reach a certain competitive level or to recover rapidly from an injury. Results show that they are consumed mainly by males and very prominent in high school for those participating in sports. Adolescents feel and have a tremendous pressure to be stronger, faster and make it to a college or professional level, leading them to consider consuming steroids. For athletes to reach their ideal size and weight, all they would need is a healthy diet and a daily, high-intensity workout. There are numerous personal accounts on ex-steroid users who regret taking steroids because they either lost something physically or lost themselves. Athletes can find other nutrients or supplements in exchange for steroids that instead of building muscles, they boost their testosterone. Still many athletes question whether or not taking steroids is worth the risk of loosing their honors, their public and possibly their job. 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