Interferência do controle glicêmico na transição entre as fases I e II da lactogênese em pacientes com diabetes melito tipo 1 / Interference of the blood glucose control in the transition between phases I and II of lactogenesis in patients with type 1 diabetes mellitus

A lactogênese é constituída pelas fases designadas como I e II. A transição entre essas fases é caracterizada pelo aumento da concentração de lactose no colostro. Este estudo teve como objetivo analisar a interferência do diabetes melito tipo 1 (DM1) na transição entre as fases da lactogênese. A concentração de lactose foi determinada em amostras de colostro de 11 puérperas portadoras de DM1 e de 19 puérperas sem a doença, durante os cinco primeiros dias do puerpério. A determinação da concentração da lactose foi feita pela reação com ácido pícrico. Em ambos os grupos houve aumento progressivo da concentração da lactose em função do tempo; entretanto, o aumento foi significativamente menor no terceiro e no quinto dia no grupo das portadoras de diabetes. A análise da transição de fases da lactogênese revelou que as puérperas portadoras de diabetes melito com controle glicêmico inadequado apresentaram atraso de 18 horas para alcançar a fase II da lactogênese, dificultando o estabelecimento do aleitamento materno.

Lactogenesis is constituted by phases I and II. The transition between those phases is characterized by an increase of the lactose concentration in the colostrum. This study aimed to evaluate the interference of type 1 Diabetes mellitus in the transition between phases I and II of the lactogenesis. The lactose concentration was determined in colostrum samples of 11 puerperal women with pre-gestational Diabetes mellitus and 19 without the disease, during the five first days of the puerperium. The lactose concentration was determined by reaction with picric acid. In both groups there were progressive increases in the lactose levels along the time; however, the increase was significantly lower in the 3rd and 5th days for the group of the women with diabetes. The analysis of the transition between the lactogenesis phases revealed that the puerperal diabetic women with inadequate glycemic control presented a time delay of 18 hours to reach phase II, making difficult the establishment of breastfeeding.

A controlled trial of a new treatment for galactocele.

BACKGROUND: Needle aspiration, followed by excision should it recur, is the standard method of treating galactocele. Villagers in Northeast Thailand traditionally treat galactocele by probing the obstructed duct with double strands of pleated human hair. The aim of the study was to mimic this method in order to scientifically assess its effectiveness. PATIENTS AND METHOD: Sixteen patients were consecutively enrolled between 1995 and 2001. They elected either standard needle aspiration (Group A) or treatment by 6-0 nylon probing (Group B). The results were compared using the Fisher's exact and Mann-Whitney tests at p-value < 0.05. RESULTS: The two groups were similar regarding the children's age, first para, mass size, and duration of symptoms, but patients in the aspiration group were considerably younger than the nylon probing group. Both methods reduced the symptoms completely. Pain from treatment was reported by all patients in the aspiration method while there were none in the nylon probing method (p < 0.001). The aspiration method took 14.8 minutes less time than the nylon probing method (p < 0.001). Recurrence was found in 2 out of 5 patients in the aspiration method, whereas there was none in the 11 patients with the nylon probing method (difference = 40%; 95% CI: -3% to 83%; p = 0.083). CONCLUSIONS: The new treatment of galactocele by nylon probing took longer than aspiration but removed the protein plug that caused obstruction of the duct without pain and had a tendency to reduce the recurrence rate.

Relación entre la incapacidad para la búsqueda y succión del seno y la presencia de trauma perinatal / Relationship between inability for the search and sucking the breast and the presence of perinatal trauma

Dentro de las observaciones hecha en recién nacidos en el Instituto Materno Infantil de Bogotá, se ha encontrado que varios de los niños no realizan el reflejo de búsqueda del seno ni inician la succión, o si lo hacen, es en una forma arrítmica y sin energía. Existen situaciones en las cuales el recién nacido no puede pegarse al seno, privándose así de uno de los mayores placeres de su vida. Tres tipos de factores se relacionan con esta incapacidad: a. Factores relacionados con la madre. b. Factores relacionados con el mismo niño. c. Factores relacionados con el personal de salud y con la misma institución. Entre los factores relacionados con el niño, se pensó que el trauma perinatal, como es el empleo de fórceps y espátulas, podría ser determinante para causar en el niño discapacidad para buscar y succionar. Por la anterior razón, se realizó un estudio de tipo descriptivo en el Instituto Materno Infantil de Bogotá, entre enero y diciembre de 1995, en 331 niños nacidos en la institución y ubicados en los servicios de alojamiento conjunto, cesáreas y cuidados intermedios de pediatría, con el fin de establecer si existe relación entre la presencia de trauma y la incapacidad para búsqueda y succión del seno. Los pacientes pertenecían a familias de bajo nivel sociocultural y eran residentes en áreas aledañas al Instituto. Se practicó examen estomatológico puramente clínico, teniendo en cuenta la integridad de los tejidos bucales y la funcionalidad en relación con la búsqueda, succión-deglución-respiración. Se tomaron como condiciones a examinar, la edad gestacional (38 semanas o más), la integridad de los tejidos bucales, evolución normal del embarazo y la exposición o no a trauma perinatal. Con base en los resultados, se inició la intervención oportuna sobre el niño y se dieron instrucciones a la madre para continuar con la estimulación a fin de alcanzar una feliz lactancia materna