Anquiloglosia neonatal. ¿Existe un exceso de indicación intervencionista? / Neonatal ankyloglossia. Is there an excess of interventionist indication?

Introducción: El objetivo de este estudio es analizar a los pacientes remitidos a cirugía para practicar una frenotomía en el periodo neonatal y revisar su correcta indicación, ya que en la actualidad no existe consenso en el diagnóstico y tratamiento de la anquiloglosia. Material y métodos: Se realizó un estudio retrospectivo de 136 pacientes con anquiloglosia derivados a la consulta de cirugía plástica pediátrica. Se recogieron datos sobre la remisión a la consulta, problemas de lactancia y experiencia anterior y posterior a la intervención. Resultados: Los principales motivos de consulta se relacionaron con problemas en la técnica de lactancia materna (69 pacientes [65,7%]). El dolor durante la toma era el síntoma más habitual, aunque 33 pacientes (31,4%) no presentaban síntomas. En la mayoría de los casos, la remisión a cirugía la realizó el pediatra de zona (85 pacientes [80%]). El tipo más frecuente de anquiloglosia en la muestra fue el tipo II. Sólo se detectó 1 caso de recidiva. La ansiedad debida a la separación durante la frenotomía fue la experiencia negativa más frecuente entre las madres. Discusión: La falta de indicaciones establecidas para la frenotomía, así como la relativa facilidad de la aplicación de la técnica en la edad neonatal y el auge de las campañas de lactancia materna, está derivando en un exceso de indicación quirúrgica como tratamiento de la anquiloglosia. Debe promoverse la creación de guías que definan unos criterios adecuados de tratamiento, así como favorecer la remisión a la consulta de lactancia como un paso previo a la cirugía (AU)

Introduction: The aim of this study is to analyze patients referred to frenotomy surgery during neonatal period and to review their correct indication, as nowadays there is no consensus on the diagnosis and treatment of ankyloglossia. Material and methods: A retrospective study of 136 patients with ankyloglossia referred to pediatric plastic surgery. Data collection was based on the consultation, breastfeeding problems and experiences before and after intervention. Results: The main reasons to attend consultation were related to breastfeeding technique (69 patients [65.7%]), and pain in between takes the more frequent symptom, nevertheless 33 patients (31.4%) had no symptoms. In most cases, referral to surgery was done by the pediatrician (85 patients [80%]). The most common type of ankyloglossia in the sample was type II. Only one case of recurrence was detected. Separation anxiety during frenotomy was the most frequent negative experience among mothers. Discussion: The lack of guidelines established for frenotomy and the relative ease of application of the technique in the neonatal age and the rise of breastfeeding campaigns, is leading to an excess of surgical indication as treatment of ankyloglossia. To create guidelines defining an appropriate criteria of treatment should be promoted, and to facilitate referrals to lactation consultation as a step prior to surgery (AU)

Teat endoscopy (theloscopy) for diagnosis and therapy of milk flow disorders in dairy cows.

Teat endoscopy (theloscopy) is a useful technique for diagnosis and therapy of covered teat injuries. Minimal invasive theloscopic surgery may help to restore milk flow, milk yield, and SCC of the affected quarter. Infection with pathogens may not change significantly, however. Cows treated as described may yield as much milk as their herdmates at a slightly increased udder SCC and stay as long in the herd as their herdmates. Theloscopy also may be used for diagnosis and therapy of various other teat disorders.

Investigations of milk quality from teats with milk flow disorders.

The objective of this study was to investigate the quality of milk from teats with milk flow disorders. Somatic cell count, pathogens, and signs of mastitis (>100,000 cells/ml and pathogens detected) were determined in the milk from all teats of the udder before treatment of the affected teat, as well as 1 and 6 mo later. Teats with milk flow disorders were compared to all of the other teats from the same udder. Before treatment, the SCC from affected teats was 4.3 million higher, the odds of detecting pathogens 6 times higher, and the odds of mastitis 11 times higher than in control teats (when adjusted for other significant explanatory variables). SCC and the risk of mastitis decreased after surgical treatment of the affected teats, whereas the chance of detecting pathogens was not affected. Six months after treatment, the SCC was 1.3 million higher, and the odds of mastitis 6.5 times higher than in control teats. Throughout the study period neither SCC, the odds of detecting pathogens, nor mastitis changed significantly in control teats. It may be concluded from this study that milk quality from teats with milk flow disorders is decreased before treatment and does not reach the milk quality from unaffected teats within 6 mo after treatment.

An unusual cause of breast enlargement in a 5-year-old boy.

A 5-year-old male developed painless enlargement of the left breast and was found to have a soft, mobile, and nontender swelling that was excised. Histological examination revealed a galactocele, which is a very rare cause of breast enlargement in male infants and children.

Comparative evaluation of SIMPL silicone implants and NIT natural teat inserts to keep the teat canal patent after surgery.

The objective of this study was the comparative evaluation of SIMPL silicone implants and NIT natural teat inserts to keep the teat canal patent after teat surgery. The study was performed on 100 teats of 97 cows treated surgically for milk flow disorders. After surgery, 53 teats were administered with SIMPL and 47 with NIT, and rested for several days. Before treatment and 1 and 6 mo later quarter milk flow and milk yield were measured with Lactocorders; quarter milk was examined for somatic cell count (SCC), pathogens, and signs of mastitis (SCC > 100,000 and pathogens detected). Half a year after surgery milk flow, milk yield and SCC were equal from teats that had been inserted with SIMPL or NIT. The odds of detecting pathogens or signs of mastitis in the milk was lower in SIMPL than in NIT teats at this point in time. SIMPL teats stayed in the herd as long as NIT teats. Based on the results, it may be expected that teats inserted with a SIMPL or NIT do not differ long term in regards to milk flow, milk yield, SCC, and risk of removal from the herd. After the use of SIMPL, fewer pathogens may be detected in the milk long term than after the use of NIT.

[The early cosmetic correction of the breast in the surgical treatment of acute lactation mastitis]. / Ranniaia kosmicheskaia korrektsiia molochnoi zhelezy pri khirurgicheskom lechenii ostrogo laktatsionnogo mastita.

An early cosmetic correction was done in 210 patients as the system of measures, directed on prophylaxis and lowering of the occurrence frequency of the mammary gland cosmetic defect while surgical treatment of an acute lactational mastitis.

[Selective galactophorectomy: technic and indications]. / La galactophorectomie sélective: technique et indications.

The authors describe the way of operating the selective galactophorectomy and discuss the indications. Each pathological nipple discharge may reveal a carcinoma. The clinical characteristics of the discharge, the results of the cytology, of the mammography and the galactography help to come to a diagnosis. This can only be confirmed after a thorough histological examination of the involved duct. Selective galactophorectomy is a simple operation that hardly leaves any scars. According to the authors, this method has a real advantage to find the diagnosis and to treat pathological nipple discharge.

Surgical diseases of the breast during pregnancy.

Physicians caring for women with diseases of the breast are well aware of the time lost before many patients consult their physicians. Nowhere is this more apparent than when a breast mass is associated with gestation or lactation. Enlargement of the breast tends to obscure parenchymal masses. Those that are found are too readily attributed to normal hypertrophy, abscess, or resolving fibrocystic disease. In this review we have attempted to focus on the earlier diagnosis and treatment of breast masses in pregnancy. Prompt needle aspiration will elucidate the solid or cystic nature of a mass. A simple cyst or a galactocele can be diagnosed by the fluid obtained. Solid lesions can be further investigated by fine-needle aspiration for cytologic study. Cytologically equivocal lesions should be subjected to excisional biopsy using local anesthesia. Cancerous lesions occurring during pregnancy should be treated promptly by mastectomy. The outlook for these patients, if treated before metastases occur, is comparable to that for nonpregnant patients. Pregnancy need not be terminated unless disseminated cancer is present and chemotherapy is necessary on an urgent basis.

[Treatment of lactation mastitis]. / Lechenie laktatsionnogo mastita.

Results of the hospital treatment of severe purulent mastitis in 127 women after childbirth were analyzed. The authors believe that opening of the purulent cavity and dissection of the purulent focus within the limits of intact tissues do not exclude one another. They should be performed according to corresponding indications. The intensive infusion therapy is thought to be necessary for struggle against toxemia, for correction of the acidic-alkaline state and partial parenteral feeding. Feeding from the diseased breast should be permitted under conditions of sterile milk.

Transsphenoidal microsurgery for prolactin-secreting pituitary adenomas.

The authors present the results of transsphenoidal microsurgery in 100 women with the amenorrhea-galactorrhea syndrome caused by pituitary adenomas associated with hyperprolactinemia (prolactinomas). As the surgical results were closely related to the preoperative levels of serum prolactin, the patients were divided into two groups: patients with preoperative prolactin less than 200 ng/ml (Group 1), and those with preoperative prolactin greater than 200 ng/ml (Group 2). The results in Group 1 (72 patients) were significantly better. In this group, 56 (78%) patients regained normal menstrual cycles, and 55 (76%) had return of elevated prolactin to normal following surgery. In Group 2 (28 patients), however, only 11 (39%) resumed normal menstrual periods postoperatively, and 13 (*46%) had return of elevated prolactin levels to normal. There was good correlation between tumor size and the preoperative level of prolactin. Of the 72 women in Group 1, 58 (81%) had tumors less than 1 cm (microadenomas), whereas of the 28 women in Group 2, only four (14%) had tumors of that size. All patients with visual field deficits preoperatively improved or had a normal visual examination postoperatively; none was made worse by surgery. Four patients (three in Group 2) have required additional surgery and/or irradiation. In the last six patients of the series, contrast-enhanced coronal computerized tomography slices made with the updated General Electric scanner detected five microadenomas. Considering that a relatively high percentage of sellar polytomograms are negative in patients with proven microadenomas (that is, only 40 of 72 patients in Group 1 has abnormal polytomography), it is likely that sellar polytomography will significantly decrease in importance in the diagnostic work-up of these patients. The authors provide a rationale for transsphenoidal microsurgery in these patients as opposed to other forms of management, such as bromocriptine therapy and irradiation.

Galactorrhea-amenorrhea syndrome: follow-up of forty-five patients after pituitary tumor removal.

Forty-five patients with galactorrhea-amenorrhea were followed during a period of 1 to 8 years (mean 3.1) after transsphenoidal prolactinoma removal. The ratios of patients who appear to be cured to the total numbers treated were 20 patients of 27 with grade I tumors; six of 10 with grade II; two of five with grade III; and none with grade IV tumors. Six patients with normal prolactin levels one week postoperatively had relapse later, as did three with normal prolactin levels 2 months postoperatively. A normal prolactin level 6 months postoperatively predicted ultimate cure. The 19 pregnancies that occurred in 15 patients, four with high prolactin levels, were uneventful. Prolactin rose normally with pregnancy and returned to prepregnancy level in all but one patient. Prolactin responses to stimulation tests were blunted for 6 months after successful tumor removal. By 1 year, responses to thyrotropin releasing hormone and metoclopramide tests were returning to normal, although responses to chlorpromazine and hypoglycemia remained blunted. The postoperative inhibition of normal lactotropes for 6 months is suggested. Ultimate cure cannot be determined before 6 months and conception should be deferred until then.