DOCSLIB.ORG

1 BREAST-FEEDING and MATERNAL-CHILD HEALTH Learning

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
1 BREAST-FEEDING and MATERNAL-CHILD HEALTH Learning BREAST-FEEDING AND MATERNAL-CHILD HEALTH 3 CE hours Learning objectives Discuss issues pertinent to breast-feeding. Review the anatomy of the breast. Describe the physiological functioning of the breast. Identify breast changes that occur during pregnancy. Explain how to deal with mastitis and breast engorgement. Discuss the benefits of breast-feeding for mother and child. Identify the economic benefits of breast-feeding. Identify the societal benefits of breast-feeding. Discuss the barriers to breast-feeding. Describe strategies for successful breast-feeding. Offer suggestions for successful breast-feeding in public. Introduction Chris is 32 years old and gave birth to her second child late last night. This morning, she tells Karen, her hospital roommate, that she is looking forward to breast-feeding her baby. Chris had a very positive experience breast-feeding her first child and she tells her roommate, in great detail, about the benefit to both mother and child of breast-feeding. As Chris is speaking, a visitor arrives. The visitor’s name is Lisa and she and Chris have been close friends for years. Karen hesitantly tells both women that she had a very difficult time trying to breast- feed her first child. “My breasts were so sore and I developed a terrible infection in them. I finally had to stop trying to breast-feed, so I don’t know if I should try again.” Both Chris and Lisa express their disapproval, telling Karen that she “had” to breast-feed, and if she cared about her baby, she would not hesitate. Karen becomes tearful. At this point, a nurse arrives and gently but firmly puts an end to the confrontation. The nurse helps Karen to her office and they have a lengthy discussion about breast-feeding and other feeding options. After the conversation, Karen asks the nurse for her help in breast-feeding the baby. “I really do want to try again, but I don’t need someone pressuring me and making me feel guilty.” __________ Breast-feeding provides a multitude of benefits to both mother and baby. However, it is important to provide mothers with support, assistance and adequate education so the experience is positive for both mother and child. This includes discussing not only the benefits but also possible complications and how to deal with them. Persons involved in facilitating breast-feeding must remain objective and nonjudgmental. Although most women can successfully breast-feed, there are some exceptions. Consider the following scenario: Angela is a registered nurse who works on the obstetrics unit of a large community hospital. She loves her work, especially the patient/family education aspects of the job. Despite this, Angela sometimes 1 feels a bit wistful when she helps new mothers to breast-feed. Angela was not able to breast-feed her own child, something she desperately wanted to do. Angela has had a life-long struggle with serious depression, and the medications she needs have the potential to harm babies during breast-feeding. After much discussion with her physician and husband, it was decided that the risk of stopping or changing her medications outweighed the need to breast-feed. Angela had not taken medications during her pregnancy, and it proved to be extremely difficult. In fact, it was so difficult that she and her husband decided not to have any more children. Because of her own problems, Angela has developed a knack for helping women who have problems breast-feeding. __________ The preceding example shows that there are some circumstances that make it dangerous for mother and child if breast-feeding occurs. These kinds of circumstances can have devastating effects on women who want to breast-feed. Health care professionals need to provide empathy and support in such cases. Empathy and support are also needed as women make the choice to breast-feed in public places. Women may experience both support and disapproval if they choose to breast-feed in public. Marlene is the mother of a 6-week-old baby girl. She is breast-feeding her new baby as she did with her first child, a little boy who is now 4 years old. With her first child, Marlene was not comfortable breast-feeding in public. Today, she is more confident and comfortable in her role as mother, and she often discretely breast-feeds her daughter in public. This afternoon, Marlene is with both children at McDonalds. She begins to breast-feed her daughter. An elderly woman passes by and says, “What a lovely family you have.” A few minutes later, a woman about Marlene’s age stops and tells her, “You should be ashamed doing that in public and in a place where children can see you.” __________ The preceding scenario shows that breast-feeding in public can trigger a variety of emotions and behaviors, not all of them productive or appropriate. This education program deals with both the physiological and psychological issues pertinent to breast- feeding. It also addresses the emotions breast-feeding can trigger in family members and friends of the nursing mother and her baby, and even strangers. Anatomy and physiology of the breasts The breasts are paired mammary glands located on either side of the anterior chest wall over the greater pectoral and anterior serratus muscles. They are composed of glandular, fatty (adipose), and fibrous tissues. The breasts are supported by connective tissue. Fibrous bands called Cooper’s ligaments attach the breast to the chest wall and prevent breasts from sagging. The breasts of males and females are similar until puberty, at which time female breast tissue enlarges due to hormonal influences. Normally, the mammary glands function only in the female.2,8,13 2 The areola is the pigmented area of the center of the breast and contains elevated sebaceous glands called Montgomery glands. In the center of the areola is the nipple, which contains erectile tissue that responds to sexual stimulation, friction, and cold.2,13 Each breast contains 15 to 25 lobes that are separated by fat and connective tissue. These lobes branch out around the nipple. The lobes are composed of clusters of acini, very small sac-like duct terminals that are responsible for the secretion of milk during lactation (secretion or production of milk by the mammary glands). 2,13 The ducts that drain the lobules come together to form the lactiferous excretory ducts and sinuses called ampullae. The ampullae store milk during lactation. The ducts drain onto the surface of the nipple through 15 to 20 pores.2,8,13 The female breast undergoes age-related changes in response to hormonal changes. At puberty, the pituitary gland, ovaries, and hypothalamus secrete hormones that stimulate the buildup and shedding of the endometrium during the menstrual cycle. These hormones are estrogen, progesterone, follicle stimulating hormone (FSH), and luteinizing hormone (LH). At puberty, the female breasts enlarge and mature in order to produce milk.2,8,13 The female breasts and reproductive structures are dependent on estrogen. As a woman ages, reduced levels of estrogen and progesterone lead to significant changes in these structures. The fatty, glandular, and supporting tissues of the breast atrophy. Cooper’s ligaments lose elasticity, causing the breasts to become pendulous. Over time, the nipples become smaller and flat and ridges of the breasts become more obvious.2 Breast changes during pregnancy During pregnancy, the female breasts undergo changes in preparation for breast-feeding. During the first trimester of pregnancy, the amount of fatty tissue in the breasts increases as does blood flow to the breasts. These changes occur to promote growth of the mammary glands and the milk ducts. 2,9 As the breasts grow, they generally become tender and heavier. The nipples and veins of the breast become more prominent and the areola become larger and darker. Breasts may have a tingling sensation with changes in temperature. Women may find relief from some of the discomfort by wearing a less constricting bra and limiting sodium intake to reduce water retention.6, 9 Cotton bras allow the skin to “breath” and are usually more comfortable than those made from synthetic material. A maternity bra not only provides some relief from breast tenderness but includes extra rows of hooks so that size can be adjusted as breasts enlarge.6 Patient education alert! Although breast changes can cause discomfort, women should be advised not to take analgesic medications, even over-the-counter preparations, while pregnant unless specifically told to do so by their physicians. Medications have the potential to pass to the baby and adversely affect him or her. 9 During the second and third trimester, the breasts continue to enlarge but breast discomfort generally decreases. Stretch marks may appear on the breasts, and the Montgomery glands of the areola enlarge. There may be some leaking of colostrum, the precursor to breast milk, from the breasts. This leakage is normal. Disposable breast pads may be worn if leaking occurs. As the skin of the breasts stretch, it may become itchy. To reduce the itching, women may use a moisturizer after bathing and at bedtime. The breasts should be allowed to dry thoroughly after bathing and prior to applying moisturizer. Women should avoid using soap on the nipples and over the areola because soap can dry out skin and increase itching.6,9 3 Patient education alert! Females should be educated about the various changes in their breasts throughout the life cycle and during and after pregnancy. They need to know what is normal and what is abnormal. Knowledge of these issues will help women to implement proper breast self-examination. Physiology of lactation Breast milk is widely believed to be the best form of nutrition for neonates and infants.11 Lactogenesis, commonly referred to as milk production, involves all necessary steps for the production and excretion of milk from the mammary glands.11 The first stage takes place about the middle of a woman’s pregnancy.
Load more

Recommended publications
  • Spectrum of Benign Breast Diseases in Females- a 10 Years Study
    Original Article Spectrum of Benign Breast Diseases in Females- a 10 years study Ahmed S1, Awal A2 Abstract their life time would have had the sign or symptom of benign breast disease2. Both the physical and specially the The study was conducted to determine the frequency of psychological sufferings of those females should not be various benign breast diseases in female patients, to underestimated and must be taken care of. In fact some analyze the percentage of incidence of benign breast benign breast lesions can be a predisposing risk factor for diseases, the age distribution and their different mode of developing malignancy in later part of life2,3. So it is presentation. This is a prospective cohort study of all female patients visiting a female surgeon with benign essential to recognize and study these lesions in detail to breast problems. The study was conducted at Chittagong identify the high risk group of patients and providing regular Metropolitn Hospital and CSCR hospital in Chittagong surveillance can lead to early detection and management. As over a period of 10 years starting from July 2007 to June the study includes a great number of patients, this may 2017. All female patients visiting with breast problems reflect the spectrum of breast diseases among females in were included in the study. Patients with obvious clinical Bangladesh. features of malignancy or those who on work up were Aims and Objectives diagnosed as carcinoma were excluded from the study. The findings were tabulated in excel sheet and analyzed The objective of the study was to determine the frequency of for the frequency of each lesion, their distribution in various breast diseases in female patients and to analyze the various age group.
    [Show full text]
  • Lupus Mastitis
    Published online: 2021-07-31 SPECIAL SYMPOSIUM - BREAST Lupus mastitis - peculiar radiological and pathological features Abdul Majid Wani, Waleed Mohd Hussain, Mohamed I Fatani, Bothaina Abdul Shakour Department of Radiology, Hera General Hospital, Makkah-10513, Saudi Arabia Correspondence: Dr Abdul Majid Wani, Hera General Hospital, Makkah-105 13, Saudi Arabia, E-mail: [email protected] Abstract Lupus mastitis is a form of lupus profundus that is seen in patients with systemic lupus erythematosus. It usually presents as a swelling (or swellings) in the breasts, with or without pain. The condition is recurrent and progresses along with the underlying disease, with fat necrosis, calcification, fibrosis, scarring, and breast atrophy. Lupus mastitis is often confused with malignancy and lymphoma and, in our part of the world, with tuberculosis. Confusion is especially likely when it occurs in an unusual clinical setting. In this article, we present a case that presented with unique radiological, pathological, and clinical features. Awareness of the various manifestations of lupus mastitis is essential if unnecessary interventions such as biopsies and surgeries, and their consequences, are to be avoided. Key words: Biopsy; lupus mastitis; lupus profundus; mammography; fine needle aspiration cytology; systemic lupus erythematosus Introduction hospital) was present and the patient reported that she had received antituberculous medication for 1 month at that Systemic lupus erythematosus (SLE) is a multisystem, time. Two 1 × 1.5 cm lymph nodes were present in the left autoimmune disorder. Involvement of the subcutaneous axillary region. The left breast revealed multiple lumps, the fat was termed as lupus profundus by Iregang.[1] Lupus biggest being 4 × 3 cm in size.
    [Show full text]
  • Androgens and Mammary Ca Fer Ster 02
    FERTILITY AND STERILITY௡ VOL. 77, NO. 4, SUPPL 4, APRIL 2002 ANDROGEN EFFECTS ON Copyright ©2002 American Society for Reproductive Medicine Published by Elsevier Science Inc. FEMALE HEALTH Printed on acid-free paper in U.S.A. Androgens and mammary growth and neoplasia Constantine Dimitrakakis, M.D., Jian Zhou, M.D., and Carolyn A. Bondy, M.D. Developmental Endocrinology Branch, National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland Objective: Evaluation of current clinical, experimental, genetic, and epidemiological data pertaining to the role of androgens in mammary growth and neoplasia. Design: Literature review. Setting: National Institutes of Health. Subject(s): Recent, basic, clinical, and epidemiological studies. Intervention(s): None. Main Outcome Measure(s): Effects of androgens on mammary epithelial proliferation and/or breast cancer incidence. Result(s): Experimental data derived from rodents and cell lines provide conflicting results that appear be strain- and cell line–dependent. Epidemiologic studies have significant methodological limitations and provide inconclusive results. The study of molecular defects involving androgenic pathways in breast cancer is in its infancy. Clinical and nonhuman primate studies, however, suggest that androgens inhibit mammary epithelial proliferation and breast growth and that conventional estrogen treatment suppresses endogenous androgens. Conclusion(s): Abundant clinical evidence suggests that androgens normally inhibit mammary epithelial proliferation and breast growth. Suppression of androgens by conventional estrogen treatment may thus enhance estrogenic breast stimulation and possibly breast cancer risk. Clinical trials to evaluate the impact of combined estrogen and androgen hormone replacement regimens on mammary gland homeostasis are needed to address this issue. (Fertil Steril௡ 2002;77(Suppl 4):S26–33.
    [Show full text]
  • Jncyo3aiyvnrbwy7vwtvfwczh
    Neuroendocrinal syndromes in gynecology (Shikhane syndrome, hyperandrogeny, hyperprolactinemia). 1.Relevance Sheehan's syndrome, also known as postpartum pituitary gland necrosis, is hypopituitarism (decreased functioning of the pituitary gland), caused by ischemic necrosis due to blood loss and hypovolemic shock during and after childbirth In a study of 1,034 symptomatic adults, Sheehan’s syndrome was found to be the sixth-most frequent etiology of growth hormone deficiency, being responsible for 3.1% of cases (versus 53.9% due to a pituitary tumor). Hyperandrogenemia (HA) describes the condition of a patient with increased production of a group of steroid hormones known as androgens, from the Greek prefix “andro” meaning “man.” While these hormones play a central role in male physiology, they are also present to a lesser degree in females, with the most predominant androgens including testosterone, dihydrotestosterone (DHT), androstenedione, dehydroepiandrosterone (DHEA), and dehydroepiandrosterone sulfate (DHEA-S). The overall incidence of HA in women is approximately 5%–10%, with polycystic ovarian syndrome (PCOS) accounting for approximately 80% of cases. In general, HA may be caused by exogenous medications, endogenous neoplasms, or via the nonneoplastic overproduction of androgens. Clinical signs of HA include acne, abnormal hair growth (hirsutism), and male pattern baldness (alopecia). Other signs of HA may also be present, including irregular menstrual cycles, virilization (deepening voice, enlarging clitoris, breast atrophy), or insulin resistance. Excessive upper lip hair in a third of women ages 14-45 Hyperprolactinemia may result in hypogonadism, infertility, and galactorrhea, or it may remain asymptomatic Testing for hyperprolactinemia is straightforward, owing to the ease of ordering a serum prolactin measurement.
    [Show full text]
  • Androgens and Breast Cancer in Men and Women
    Androgens and Breast Cancer in Men and Women a,b, Constantine Dimitrakakis, MD * KEYWORDS Androgens Testosterone Breast cancer Hormone therapy Menopause Male breast cancer There has been increasing focus recently on the importance of androgens in human physiology. Supplementation of testosterone in women with hypoactive sexual desire disorder is an area of great interest at present.1 Testosterone treatment in physiologic doses seems to improve sexual desire, responsiveness, and frequency of sexual activity, while at the same time it exhibits favorable effects on bone in postmenopausal women.2 However, the risk-benefit ratio for such treatment remains unclear. Androgen receptors (AR) are found in virtually every tissue in women as well as in men, including breast, bone, and brain, indicating that androgens and their metabo- lites may play an important role in normal tissue homeostasis and possibly in pathol- ogies, such as breast cancer, osteoporosis, decreased libido, and cognitive decline. A continuing area of concern is the notion that excess androgen exposure may increase the risk of breast cancer.3 Over the past decade, there have been major advances in our understanding of the sources of endogenous sex steroids acting on mammary epithelium with the identifi- cation of tissue-specific expression of steroidogenic enzymes capable of converting circulating prohormones, such as dehydroepiandrosterone (DHEA), into potent andro- gens or estrogens. In addition, there have been great strides in the genetic elucidation of these steroidogenic enzymes and the steroid receptors. Diverse clinical and experimental observations indicate that androgens moderate estrogenic effects on mammary proliferation and growth. Experimental data suggest The author has nothing to disclose.
    [Show full text]
  • Pediatric and Adolescent Gynecology Evidence-Based Clinical Practice Endocrine Development
    Pediatric and Adolescent Gynecology Evidence-Based Clinical Practice Endocrine Development Vol. 7 Series Editor Martin O. Savage London Pediatric and Adolescent Gynecology Evidence-Based Clinical Practice Volume Editor Charles Sultan Montpellier 48 figures, 11 in color and 34 tables, 2004 Basel · Freiburg · Paris · London · New York · Bangalore · Bangkok · Singapore · Tokyo · Sydney Prof. Dr. Charles Sultan Unité d’Endocrinologie et de Gynécologie Pédiatriques Service de Pédiatrie I Hôpital Arnaud de Villeneuve Centre Hospitalier Universitaire Montpellier, France Library of Congress Cataloging-in-Publication Data Pediatric and adolescent gynecology : evidence-based clinical practice / volume editor, Charles Sultan. p. ; cm. – (Endocrine development, ISSN 1421–7082 ; v. 7) Includes bibliographical references and index. ISBN 3–8055–7623–4 (hard cover : alk. paper) 1. Pediatric gynecology. 2. Adolescent medicine. 3. Evidence-based medicine. I. Sultan, Charles. II. Series. [DNLM: 1. Genital Diseases, Female–Adolescent. 2. Genital Diseases, Female–Child. 3. Evidence-Based Medicine. 4. Genitalia, Female–abnormalities–Adolescent. 5. Genitalia, Female–abnormalities–Child. WS 360 P37077 2004] RJ478.P433 2004 618.92Ј098–dc22 2003061930 Bibliographic Indices. This publication is listed in bibliographic services, including Current Contents® and Index Medicus. Drug Dosage. The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any change in indications and dosage and for added warnings and precautions.
    [Show full text]
  • Breast Concerns and Disorders in Adolescent Females
    Review Article Page 1 of 8 Breast concerns and disorders in adolescent females Donald E. Greydanus1, Lyubov Matytsina-Quinlan2 1Department of Pediatric & Adolescent Medicine, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA; 2East Cheshire Centre for Sexual Health, East Cheshire NHS Trust, Macclesfield District General Hospital, Macclesfield, Cheshire, SK103BL, UK Contributions: (I) Conception and design: All authors; (II) Administrative support: All authors; (III) Provision of study materials or patients: None; (IV) Collection and assembly of data: All authors; (V) Data analysis and interpretation: All authors; (VI) Manuscript writing: All authors; (VII) Final Approval of manuscript: All authors. Correspondence to: Donald E. Greydanus. Department of Pediatric & Adolescent Medicine, Western Michigan University Homer Stryker M.D. School of Medicine, 1000 Oakland Drive, Kalamazoo, MI 49008-1284, USA. Email: [email protected]. Abstract: Breast disorders are an important aspect of health care for adolescent females and this discussion presents principles for education and management of breast concerns as well as problems for this population of patients. Normal and abnormal breast development are considered. Breast pathology that is reviewed include congenital lesions as well as breast asymmetry, atrophy, tuberous breasts, fibroadenoma, cystosarcoma phyllodes, benign breast disease, mastalgia and other breast disorders. Keywords: Athelia; polymastia; fibroadenoma; mastitis; mammary hyperplasia; fibrocystic change Received: 11 June 2019; Accepted: 17 June 2019; published: 03 July 2019. doi: 10.21037/pm.2019.06.07 View this article at: http://dx.doi.org/10.21037/pm.2019.06.07 Introduction a mother or other close relative has a breast cancer history. In the primary care medical practice, the adolescent female Breast disorders are an important aspect of health care may present with a number of concerns related to the size, for female adolescents (1-7).
    [Show full text]
  • Bilateral Idiopathic Granulomatous Mastitis
    View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by Elsevier - Publisher Connector Asian Journal of Surgery (2016) 39,12e20 Available online at www.sciencedirect.com ScienceDirect journal homepage: www.e-asianjournalsurgery.com ORIGINAL ARTICLE Bilateral idiopathic granulomatous mastitis Mehmet Velidedeoglu a, Fahrettin Kilic b, Birgul Mete c, Mucahit Yemisen c, Varol Celik a, Ertugrul Gazioglu a, Mehmet Ferahman a, Resat Ozaras c, Mehmet Halit Yilmaz b, Fatih Aydogan a,* a Department of General Surgery, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey b Department of Radiology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey c Department of Infectious Diseases, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey Received 1 July 2014; received in revised form 24 February 2015; accepted 25 February 2015 Available online 2 May 2015 KEYWORDS Summary Objectives: Idiopathic granulomatous mastitis (IGM) is a benign rare inflammatory breast cancer; pseudotumor. Bilateral involvement of IGM has been reported in a few cases. To our knowl- cancer; edge, this study is the largest series of bilateral cases to date. The goals of this study were corticosteroids; to present clinical features of bilateral IGM and to evaluate the results of treatments. granulomatous Materials and methods: We performed a retrospective review of the idiopathic granulomatous mastitis; mastitis database from 2010 to 2013. Ten female patients who met required histologic and clin- idiopathic; ical criteria of IGM in both breasts were included in study. Demographic data, clinical findings, tuberculosis medication history, and radiologic findings are presented. Results: The mean age at onset of the disease was 38.4 Æ 8.3 years (range: 29e52 years).
    [Show full text]
  • Patient Educational Brochure Reconstruction
    PATIENT EDUCATIONAL BROCHURE RECONSTRUCTION BREAST RECONSTRUCTION WITH SIENTRA SILICONE GEL BREAST IMPLANTS Revision Date: February 15, 2012 TABLE OF CONTENTS Glossary.................................................................................................................................................. 1 1. How To Use This Educational Brochure ..................................................................................... 12 2. General Information About Breast Reconstruction With Breast Implants .............................. 13 2.1 What Gives The Breast Its Shape? .................................................................................. 13 2.2 What Is A Silicone Gel Breast Implant? ........................................................................... 14 2.3 How Do Breast Implants Work In Breast Reconstruction? ............................................... 14 3. Deciding Whether To Have Breast Reconstruction Surgery With Implants ........................... 15 3.1 Am I Eligible For Reconstruction With Silicone Gel Breast Implants? ............................. 15 3.2 Contraindications .............................................................................................................. 16 3.3 Precautions ....................................................................................................................... 16 3.4 Warnings........................................................................................................................... 17 3.5 What Are The Alternatives To
    [Show full text]
  • Bilateral Idiopathic Granulomatous Mastitis
    + MODEL Asian Journal of Surgery (2015) xx,1e9 Available online at www.sciencedirect.com ScienceDirect journal homepage: www.e-asianjournalsurgery.com ORIGINAL ARTICLE Bilateral idiopathic granulomatous mastitis Mehmet Velidedeoglu a, Fahrettin Kilic b, Birgul Mete c, Mucahit Yemisen c, Varol Celik a, Ertugrul Gazioglu a, Mehmet Ferahman a, Resat Ozaras c, Mehmet Halit Yilmaz b, Fatih Aydogan a,* a Department of General Surgery, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey b Department of Radiology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey c Department of Infectious Diseases, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey Received 1 July 2014; received in revised form 24 February 2015; accepted 25 February 2015 KEYWORDS Summary Objectives: Idiopathic granulomatous mastitis (IGM) is a benign rare inflammatory breast cancer; pseudotumor. Bilateral involvement of IGM has been reported in a few cases. To our knowl- cancer; edge, this study is the largest series of bilateral cases to date. The goals of this study were corticosteroids; to present clinical features of bilateral IGM and to evaluate the results of treatments. granulomatous Materials and methods: We performed a retrospective review of the idiopathic granulomatous mastitis; mastitis database from 2010 to 2013. Ten female patients who met required histologic and clin- idiopathic; ical criteria of IGM in both breasts were included in study. Demographic data, clinical findings, tuberculosis medication history, and radiologic findings are presented. Results: The mean age at onset of the disease was 38.4 Æ 8.3 years (range: 29e52 years). Nine patients had no recurrence during a mean follow-up period of 21 months (range: 11e26 months).
    [Show full text]
  • 1995 © Copyright 1995 by International Lactation Consultant Association
    J Hum Lact 11(2), 1995 © Copyright 1995 by International Lactation Consultant Association. Infant Insufficient Milk Syndrome Associated with Maternal Postpartum Hemorrhage Claire Elizabeth Willis, MB, BCh, and Verity Livingstone, MB BS, IBCLC ABSTRACT - Insufficient milk syndrome is defined as failure to thrive in infants due to insufficient daily breastmilk intake. This discussion examines a possible association between insufficient milk syndrome and maternal postpartum hemorrhage. Ten consecutive cases of insufficient milk syndrome associated with maternal postpartum hemorrhage were identified. The mothers presented between 3 and 35 days postpartum. Maternal postpartum blood loss ranged from 500-1500 ml in eight cases (mean: 963 ml); in two cases, blood loss was noted as 400++ and 200++, respectively. Six mothers experienced a drop of hemoglobin by >30g/L; two had a drop in blood pressure >3OmmHg for >20 minutes. All infants were failing to thrive. Five infants suffered hypernatremic dehydration with serum sodium levels ranging from 148-l66mmol/L. Breastmilk electrolytes were measured in six cases, and elevated sodium levels, ranging from 21-l00mmol/L, in five cases. These data serve to heighten awareness of insufficient milk syndrome as a potential consequence of postpartum hemorrhage. Early postpartum review of all breast-feeding mothers and infants is strongly encouraged. JHL 11:123-126, 1995. KEYWORDS: breastfeeding, hypernatremic dehydration, insufficient milk syndrome, postpartum hemorrhage. INTRODUCTION The insufficient milk syndrome (IMS) and hence failure to thrive in breastfed neonates is an increasingly recognised problem. There may be demonstrable inadequate milk intake or it may be the mother’s perception that her milk supply is inadequate; it may be reversible or irreversible.
    [Show full text]
  • Drug-Induced Endocrinopathies and Diabetes
    2 181 E Diamanti-Kandarakis and Drug-induced endocrinopathies 181:2 R73–R105 Review others and diabetes DIAGNOSIS OF ENDOCRINE DISEASE Drug-induced endocrinopathies and diabetes: a combo-endocrinology overview E Diamanti-Kandarakis1, L Duntas2, G A Kanakis3, E Kandaraki1, N Karavitaki4,5, E Kassi6, S Livadas7, G Mastorakos8, I Migdalis9, A D Miras10, S Nader11, O Papalou1, R Poladian12, V Popovic13, D Rachoń14, S Tigas15, C Tsigos16, T Tsilchorozidou17, T Tzotzas18, A Bargiota19 and M Pfeifer20 on behalf of COMBO ENDO TEAM: 2018 1Department of Endocrinology, Diabetes and Metabolism, Hygeia Hospital, 2Endocrine Clinic Evgenidion Hospital, University of Athens, 3Department of Endocrinology, Athens Naval & VA Hospital, Athens, Unit of Reproductive Endocrinology, Athens, Greece, 4Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, 5Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK, 6Department of Biological Chemistry, First Department of Internal Medicine, Laikon Hospital Medical School, NKUA, 7Endocrine Unit, Metropolitan Hospital, 8Endocrine Unit, 2nd Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, ‘Aretaieion’ University Hospital, 9Second Medical Department and Diabetes Centre, NIMTS Hospital, Athens, Greece, 10Division of Endocrinology Diabetes and Metabolic Medicine, Imperial College London, London, UK, 11Department of Internal Medicine-Endocrine Division, McGovern Medical School, Houston, Texas, USA, 12Department of Endocrinology, MLH University Hospital, Beirut, Lebanon, 13School of Medicine, University of Belgrade, Belgrade, Serbia, 14Department of Clinical and Experimental Endocrinology, Medical Correspondence University of Gdańsk, Gdańsk, Poland, 15Department of Endocrinology, Ioannina University Hospital, Ioannina, Greece, should be addressed 16Harokopio University of Athens and HYGEIA Hospital, Athens, Greece, 17Private Practice, Endocrinologist, Serres, to E Diamanti-Kandarakis Greece, 18St.
    [Show full text]