A hydrocoele is a soft swelling in the scrotum caused by a collection of fluid around the testicle. It does not cause pain. The fluid has been pushed down into the scrotum via a channel connected to the abdominal cavity. A hydrocoele may often be present at birth, and usually disappears after the child is 1 year old. It rarely needs any surgical intervention. If your child has any scrotal swelling, it is advisable to have your doctor check it. Sometimes hernias can be present at the same time as a hydrocoele.

Varicocoele

A varicocoele usually occurs after puberty. It is an abnormal enlargement of the veins around the testicle. It generally presents as a swelling around the testicle, usually the left one. A varicoele feels like a bundle of worms. If not treated sperm production may be affected. Treatment is surgical, and you should consult your doctor if you suspect that your child has a varicocoele.

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Cause

The cause of a twisted testicle is uncertain.

Clinical features

Your child may complain of rapid onset of severe pain in the groin and of a sore lower abdomen. Within several hours the scrotum over the affected testicle may become very tender, hot and swollen.

Treatment

You should see your doctor immediately if your child has a swollen or painful testicle. Torsion of the testicle is a surgical emergency and must be operated on immediately if the testicle is to be saved.

The testicle is straightened and sewn into position to prevent twisting from recurring. The other testicle may be sewn into position at the same time, also as a preventive measure.

Prevention

There is no way to prevent this condition from occurring initially.

UNDESCENDED TESTICLE

Cause

In the developing foetus the testicle forms within the abdomen and later moves down into the scrotum. An undescended testicle is one which does not lie fully within the sac of the scrotum. This is a relatively common condition, and 2% of newborn have one or two undescended testicles. Within a year, these usually slip down to lie within the scrotum.

Treatment

If, after a year, this has not occurred, then surgical intervention is usually necessary to prevent damage to the testicle. Consult your doctor if you suspect your child has an undescended testicle.

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Menstrual cramps are caused by the contraction of the muscles of the uterus, under the influence of hormonal changes occurring at the time of menstruation.

Clinical features

Cramps may begin several hours before the flow of blood appears. They are usually in the lower abdomen and may feel like spasms, occurring frequently and lasting for several minutes at a time. Your daughter may have an associated headache, and even nausea. All these symptoms are usually only present on the first day of the period.

Treatment

A hot water bottle can help ease cramps. Try to encourage your daughter to maintain normal activity if she can. Make sure tampons are changed every 3-4 hours, so that build up of blood (which can lead to severe infection or toxic shock syndrome) does not occur. Sometimes a mild painkiller such as paracetamol may be helpful, but if they become necessary on a continual basis, you should see your doctor. Placing a young girl on the Pill will occasionally improve symptoms of a painful period.

When to see your doctor

• if your daughter’s period pains are significantly interfering with her school attendance;

• if despite the above measures, she has such severe pains that she needs to lie in bed;

• if the pains persist, or she has an offensive vaginal discharge;

• if she has a fever.

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Sometimes baby girls are born with their labia minora (inner lips of the vagina) fused together by a thin membrane. This can also sometimes happen following an infection. The opening of the vagina is sometimes covered over. If you suspect that your daughter has this problem, you should see your doctor to discuss its management.

PENIS, PROBLEMS WITH THE

Hypospadias

Hypospadias is an abnormality of the penis which is present at birth in 1 out of every 350 males. In this condition the opening of the urethra (the tube through which urine is emptied from the bladder) is on the underside of the penis instead of at the tip. If severe, it can be associated with a bent penis (chordee). Surgical repair is essential for hypospadias. Boys with hypospadias should not have a circumcision at birth, because it is sometimes necessary to use this skin to repair the hypospadias. If you notice that your child has hypospadias, it is advisable to seek early medical advice.

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Remember, however, that there is a good deal of variation between children. The times and stages described here serve only as a guide to the range at which most children achieve milestones. Just because your child does not exactly coincide with these times does not mean that anything is wrong. Please do not worry if your child is different.

On the other hand, if you do have any concerns about your child’s growth and development, do not hesitate to seek professional advice. Do not wait — see your doctor or nurse who will be able to reassure you and give you appropriate advice.

Growth and development take place in the context of a continuing transaction between the child and his environment. Both intrinsic factors within the child and environmental influences (such as nutrition, stimulation, family interactions) are important.

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Vitamin D is found in fish oils, dairy products, eggs. It is also produced in the body by the action of ultraviolet light on substances in the skin. And so in Australia a deficiency of this vitamin is rare.

Vitamin D is necessary for the calcium and phosphorous metabolism of the body and, so, the normal structure of bone. As with Vitamin A, an excess intake can cause serious symptoms.

Vitamin Ê also is a fat-soluble vitamin, and it is used in the liver in the manufacture of prothrombin, an essential factor in the clotting of blood.

Vitamin Ê occurs in green vegetables, and also some of the bacteria which normally live in the bowel manufacture this vitamin which we absorb and use.

An excess of Vitamin Ê has not been shown to cause any serious side-effects.

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If this is too fast for the middle-aged man or woman, run 3 km in less than 20 minutes, four times a week.

If you prefer to ride a bicycle, you should ride 8 kms in 20 minutes, six times a week.

Swimming is an excellent way of exercising your heart and lungs. Try 750 metres in 20 minutes, five times a week.

If you are competitive and wish to play squash, IV2 hours squash at least three times a week is necessary to maintain fitness.

If you exercise only twice a week, you cannot hope to get fit or maintain fitness. If you exercise only once a week, this is more dangerous to your heart than no exercise at all.

Exercise burns up energy and will slowly burn up excess weight. It may take a long time to burn off those extra kilos of fat but, combined with a proper diet, it can trim you down to an ideal weight.

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There has been little improvement in the results of treatment of this condition over the last 30 years, despite enormous advances in treatment of other forms of cancer.

Operation remains the treatment of choice. In the past the operation was a radical mastectomy. This removed the affected breast, a large portion of overlying skin, the underlying muscles of the chest wall and the lymph glands under the arms.

The result is disfiguring and makes it hard to fit a prosthesis (breast substitute) under the clothes.

Despite arguments to the contrary suggesting lesser procedures, removal of the breast and the lymph glands is necessary. It is no longer considered necessary to remove the muscles of the chest wall.

Simple mastectomy (removal of the breast alone followed by radiation treatment to the glands under the arm) is advocated by some as an alternative.

Removal of the lump only, the so called lumpectomy, so as to leave a woman with her breast has, in my opinion, no part to play in the proper management of cancer of the breast. The risk of local recurrence is so high, about 60 per cent, that it is not justified.

Apart from operation there is often need for radiation treatment either in the initial treatment of breast cancer or in treatment of recurrences or spread of the tumor.

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