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Purpose: The aim of the study was to explore the association between mastitis and subsequent breast cancer., Methods: This retrospective cohort study included women aged ≥ 18 years with an initial mastitis diagnosis from 315 office-based gynecologists in Germany between January 2005 and December 2021. Women without mastitis were matched to women with mastitis using propensity score matching based on age, index year, average yearly consultation frequency during the follow-up period, and coexisting diseases such as obesity, benign mammary dysplasia, hypertrophy of the breast, unspecified lump of breast, and other disorders of the breast. The 10-year cumulative incidence of breast cancer for the mastitis-cohort and non-mastitis-cohort was studied with Kaplan-Meier curves using the log-rank test. The association between mastitis and breast cancer was studied separately for four age groups with univariable Cox regression analyses., Results: In the follow-up period of 7 months to 10 years after the index date, 2.9% of mastitis patients and 2.4% of matched non-mastitis patients were diagnosed with breast cancer. A Cox regression analysis revealed a significant association between mastitis and subsequent breast cancer (HR: 1.37; 95% CI: 1.11-1.70). According to the age-stratified analyses, a strong and significant association was only observed in the age group > 50 years (HR: 1.73; 95% 1.25-2.40)., Conclusion: The findings of our retrospective cohort study support an association between mastitis and subsequent breast cancer diagnoses in women aged > 50 years. The pathophysiological basis and possibility of confounders however requires further investigation., Competing Interests: Declarations Conflicts of interest The authors declare no competing interests. Institutional review board Ethical review and approval were waived for this study, because the database used for analysis contains anonymized electronic patient records. Patient data were analyzed in aggregated form without individual data being available. Informed consent statement Individual consent forms were not required or obtained, in accordance with national and European legislation., (© 2024. The Author(s).)

Aims: This study aimed to characterize the first complete genome of Corynebacterium parakroppenstedtii and clarify the evolutionary relationship in the Corynebacterium kroppenstedtii complex (CKC) by using comparative genomics analysis., Methods and Results: The genome of isolate yu01 from a breast specimen was sequenced, and 35 CKC genomes were collected. Analysis of 16S rRNA, rpoB, and fusA suggested ambiguous identification, whereas ANI analysis assigned isolate yu01 as Coryne. parakroppenstedtii. The fourth genospecies "Corynebacterium aliikroppenstedtii" was identified in CKC. Comparative genomics analysis suggested that the genomic arrangement in CKC was highly conserved. A total of 43 potential virulence genes and 79 species-specific genes were detected. Most genome-based phylogenetic analysis were incapable of resolving the interspecific evolutionary relationships among CKCs. A total of 20 core genes were found to be distinguishable in CKC., Conclusions: This study suggested the limited divergence and unavailability of normal single gene-based identification in CKC and questioned the precise species of strains associated with mastitis, identified as Coryne. kroppenstedtii in previous studies. The 20 genes showed potential to enhance the methods for the identification and epidemiological investigation of CKC., (© The Author(s) 2023. Published by Oxford University Press on behalf of Applied Microbiology International.)

Diabetic fibrous mastopathy (DFM) is a rare benign fibrotic disease of the breast that develops in patients with longstanding and often uncontrolled diabetes mellitus. Clinically, patients may present with an irregular, firm, palpable mass, which may be solitary or multiple, occurring in one or both breasts. Diabetic fibrous mastopathy occurs most often in premenopausal women with heterogeneously or extremely dense breasts; mammography may show focal asymmetry or, less often, a noncalcified mass with indistinct or obscured margins, but there are usually no discrete findings. On US, DFM may have marked hypoechogenicity and posterior shadowing secondary to extensive fibrosis. Diabetic fibrous mastopathy features on contrast-enhanced MRI are also nonspecific, with gradual persistent nonmass enhancement reported. Because the clinical presentation and US features of DFM overlap with those of breast cancer, histopathologic correlation is needed to confirm diagnosis and exclude malignancy. These findings include collagenous stroma often with keloidal features and chronic perilobular and perivascular inflammation. Histopathologic findings of lymphocytic lobulitis and perivascular inflammation are common to other autoimmune conditions., (© Society of Breast Imaging 2023. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Infectious mastitis is a common condition that affects up to 33% of lactating women. Several risk factors have been suggested to be strongly associated with breast abscess, nipple infection, and non-purulent mastitis associated with childbirth. In this retrospective cohort study, we gathered data from the National Inpatient Sample (NIS) between 2005 and 2014 and utilized data stratification and backward linear regression to analyze the predictive factors associated with patients hospitalized with breast infection after childbirth, with special consideration of risk factors affecting hospital length of stay (LOS). In the ten-year period, 4614 women were hospitalized with a primary diagnosis of breast abscess, nipple infection, or non-purulent mastitis associated with childbirth. Mean (SD) age was 26.75 (6) years. The highest frequency distribution of cases was observed in patients aged 22-30 years (49.82%). Mean (SD) LOS was 2.83 (1.95) days. Mean (SD) LOS in patients with procedure was 3.53 (2.47) days, which was significantly longer than that in those with no procedure (2.39 (1.36) days, p < 0.001). Primary diagnosis of breast abscess and occurrence of a hospital procedure were most significantly associated with prolonged LOS. Factors such as age, socioeconomic position, severity of functional loss, as well as comorbidities were also contributing risk factors to the development of breast infection and increased hospital LOS. Further studies should examine these findings, as they relate to breastfeeding practices and concentrate on establishing best practices for risk reduction and prevention of childbirth-associated breast and nipple infections and hospitalizations.

Breast surgeons are well poised to promote evidence-based recommendations for lactation-related breast disorders and clarify existing misconceptions in traditional care. Surgeons can resolve lactational fluid collections and avoid milk fistula development during drainage and/or other procedures on the breast. Using principles of surgical wound management, they can provide effective care of nipple trauma. They can distinguish between inflammatory and infectious mastitis and promote delicate tissue handling to prevent breast injury and phlegmon. Finally, breast surgeons can debunk the myth of fungal infections occurring on the highly vascularized nipple and recognize common presentations of conditions such as dermatitis., (Copyright © 2022 Elsevier Inc. All rights reserved.)

The precise mechanism by which gut dysbiosis contributes to the pathogenesis of extraintestinal diseases and how commensal microbes mediate these processes remain unclear. Here, we show that cows with mastitis had marked gut dysbiosis, characterized by the enrichment of opportunistic pathogenic Escherichia&#95;Shigella and the depletion of commensal Roseburia. Fecal microbiota transplantation from donor cows with mastitis (M-FMT) to recipient mice significantly caused mastitis and changed the gut and mammary microbiota in mice. Notably, M-FMT facilitated the translocation of pathobiont from the gut into the mammary gland, and the depletion of Enterobacteriaceae alleviated M-FMT-induced mastitis in mice. In contrast, commensal Roseburia intestinalis improved M-FMT-induced mastitis and microbial dysbiosis in the gut and mammary gland and limited bacterial translocation by producing butyrate, which was associated with inflammatory signaling inhibition and barrier repair. Our research suggests that commensal Roseburia alleviates gut-dysbiosis-induced mastitis, although further studies in dairy cows and humans are needed., Competing Interests: Declaration of interests The authors declare no competing interests., (Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.)

Subclinical mastitis (SCM) is an inflammatory state of the lactating mammary gland, which is asymptomatic and may have negative consequences for child growth. The objectives of this study were to: (1) test the association between the dietary inflammatory index (DII®) and SCM and (2) assess the differences in nutrient intakes between women without SCM and those with SCM. One hundred and seventy-seven women with available data on human milk (HM) sodium potassium ratio (Na:K) and dietary intake data were included for analysis. Multivariable logistic regression was used to examine the association between nutrient intake and the DII score in relation to SCM. Women without SCM had a lower median DII score (0.60) than women with moderate (1.12) or severe (1.74) SCM (p < 0.01). A one-unit increase in DII was associated with about 41% increased odds of having SCM, adjusting for country and mode of delivery, p = 0.001. Women with SCM had lower mean intakes of several anti-inflammatory nutrients. We show for the first time exploratory evidence that SCM may be associated with a pro-inflammatory diet and women with SCM have lower intakes of several antioxidant and anti-inflammatory nutrients.

Background: Puerperal mastitis, as well as breast abscess, are common complications that can arise during the breastfeeding period. Acute-onset quadriplegia has been described as a complication of bacterial or viral infections. Here we report a case of puerperal breast abscess with transient acute-onset staphylococcal mediated quadriplegia., Main Issue: A 28-year-old lactating Caucasian woman presented at our tertiary perinatal center 31 days postpartum with weakness of all four limbs, the signs and symptoms of mastitis in her left breast and a possible breast abscess with redness, a painful breast lump, and fever. A few hours after admission, the participant developed a proximal quadriplegia., Management: The participant was admitted to the intensive care unit for monitoring. The neurologists treated her as a possible case of Guillain-Barré syndrome and administered intravenous immunoglobulin therapy for 5 days. The breast abscess was diagnosed via ultrasound and treated by regular aspiration of pus and intravenous antibiotic therapy with ampicillin and sulbactam as Staphylococcus aureus was isolated from breast abscess fluid. Fifteen days after the first symptoms the participant recovered completely and could breastfeed her son exclusively, even though she developed a galactocele on the affected side., Conclusion: We report a possible association between mastitis and abscess formation, common breastfeeding issues, and transient acute onset staphylococcal mediated quadriplegia. To the best of our knowledge this is the only case in the medical literature. Independent of the systemic complications, antibiotic treatment and regular abscess aspirations have proven to be a key strategy to the resolution of puerperal mastitis and breast abscess.

Background: The purpose of this study was to compare the outcomes of vacuum sealing drainage (VSD) and conventional incision and drainage (I&D) for treating acute suppurative mastitis., Methods: Hospital medical records were searched for patients 20-50 years of age who were diagnosed with acute suppurative mastitis from January 2014 to December 2018, and treated with traditional I&D or VSD. Patients were divided into those treated with VSD and I&D, and outcomes including pain, healing time, length of hospital stay, and length of antibiotic course were compared between the groups. Pain was evaluated with a numeric rating scale from 0 (no pain) to 10 (most severe pain). Subgroup analysis of lactating women was also performed., Results: There were 110 women who received traditional I&D, and 105 women that received VSD included. The 2 groups were similar with respect to age (31.1 ± 4.8 vs. 29.9 ± 4.4, p = 0.058), and disease characteristics. The median pain score of women who received VSD (5 [IQR 5-6]) was significantly less than that of women who received I&D (8 [IQR 7-8]) (p < 0.001). The time for healing was significantly less in women who received VSD (40 days [IQR 30-45 days]) compared to I&D (60 days [IQR 45-70 days]) (p < 0.001). The length of hospital say and the length of antibiotic treatment were similar between the 2 groups. Results were similar for lactating women., Conclusions: VSD is effective for treating acute suppurative mastitis with reduced pain and shortening healing time., (© 2022. The Author(s).)

Mastitis is a complication seen in some breastfeeding mothers and is the most common inflammatory lesion of the breast in breastfeeding mothers. In this complication, breast milk undergoes chemical and physical changes. It can lead to a drop in breastfeeding, weight loss, and, consequently, stunted growth of infants. Bacteria are the main cause of breast inflammation. Therefore, in this study, bacterial factors of mastitis were evaluated in lactating women. Also, their effects were considered on the physical properties and chemical composition of mothers' breast milk. For this purpose, 210 breastfeeding mothers referred to health centers were randomly selected, and their milk samples were collected. In addition to collecting mothers' demographic information by a questionnaire, the chemical composition (sugar, protein, and fat) and the physical properties (pH, density, and freezing temperature) of milk were measured. Bacterial evaluations were performed on the milk of these mothers by catalase test, coagulase test, and mannitol salt agar. Data were analyzed by SPSS software, Chi-square, Mann-Whitney U test, and T-test. The results showed that 56 mothers had mastitis, and Staphylococcus aureus and coagulase-negative staphylococci were the main bacteria in the milk of these mastitis mothers. These bacteria caused physical and chemical changes in breast milk so that mothers with Staphylococcus aureus mastitis had less sugar in their milk, and mothers with coagulase-negative staphylococci had less protein in their milk. Therefore, Staphylococcus aureus may reduce milk sugar by consuming milk sugar, and coagulase-negative staphylococci may also target milk protein. But to confirm these results, a larger population of mothers with mastitis is needed. Further studies are also needed to prove this result.

Objectives: Describe the clinical presentation, prevalence, and outcomes of concurrent serious bacterial infection (SBI) among infants with mastitis., Methods: Within the Pediatric Emergency Medicine Collaborative Research Committee, 28 sites reviewed records of infants aged ≤90 days with mastitis who were seen in the emergency department between January 1, 2008, and December 31, 2017. Demographic, clinical, laboratory, treatment, and outcome data were summarized., Results: Among 657 infants (median age 21 days), 641 (98%) were well appearing, 138 (21%) had history of fever at home or in the emergency department, and 63 (10%) had reported fussiness or poor feeding. Blood, urine, and cerebrospinal fluid cultures were collected in 581 (88%), 274 (42%), and 216 (33%) infants, respectively. Pathogens grew in 0.3% (95% confidence interval [CI] 0.04-1.2) of blood, 1.1% (95% CI 0.2-3.2) of urine, and 0.4% (95% CI 0.01-2.5) of cerebrospinal fluid cultures. Cultures from the site of infection were obtained in 335 (51%) infants, with 77% (95% CI 72-81) growing a pathogen, most commonly methicillin-resistant Staphylococcus aureus (54%), followed by methicillin-susceptible S aureus (29%), and unspecified S aureus (8%). A total of 591 (90%) infants were admitted to the hospital, with 22 (3.7%) admitted to an ICU. Overall, 10 (1.5% [95% CI 0.7-2.8]) had sepsis or shock, and 2 (0.3% [95% CI 0.04-1.1]) had severe cellulitis or necrotizing soft tissue infection. None received vasopressors or endotracheal intubation. There were no deaths., Conclusions: In this multicenter cohort, mild localized disease was typical of neonatal mastitis. SBI and adverse outcomes were rare. Evaluation for SBI is likely unnecessary in most afebrile, well-appearing infants with mastitis., Competing Interests: POTENTIAL CONFLICTS OF INTEREST: Dr Andrea Cruz is an associate editor of Pediatrics; the other authors have indicated they have no potential conflicts of interest to disclose., (Copyright © 2021 by the American Academy of Pediatrics.)

Background: Brain-derived neurotrophic factor (BDNF) and nerve growth factor (NGF) play a critical role in neurodevelopment, where breast milk is a significant dietary source. The impact of previous COVID-19 infection and mastitis on the concentration of BDNF and NGF in human milk was investigated., Methods: Concentrations of BDNF and NGF were measured via ELISA in human milk samples collected from 12 mothers with a confirmed COVID-19 PCR, 13 mothers with viral symptoms suggestive of COVID-19, and 22 unexposed mothers (pre-pandemic Ctl-2018). These neurotrophins were also determined in 12 mothers with previous mastitis and 18 mothers without mastitis., Results: The NGF concentration in human milk was lower in the COVID-19 PCR and viral symptoms groups than in the unexposed group, but BDNF did not differ significantly. Within the COVID-19 group, BDNF was higher in mothers who reported headaches or loss of smell/taste when compared with mothers without the respective symptom. BDNF was lower in mothers with mastitis than in mothers without mastitis., Conclusions: Previous COVID-19 and mastitis infections changed differently the secretion of NGF and BDNF in human milk. Whether the changes in NGF and BDNF levels in milk from mothers with infection influence their infant's development remains to be investigated.

Background and objectives : Breast cancer is a common cancer in women and has been the fourth leading cause of death in Taiwanese women. Risk factors for breast cancer include family history of breast cancer, genetic factors, and not breastfeeding. Several studies have reported an association between repeated inflammation at a young age, especially among lactating women, and cancer; however, the number of studies about the association of mastitis and breast cancer in nonlactating women is still limited. Therefore, the aim of this study was to determine the relationship between mastitis in women aged ≥40 years and breast cancer. Materials and Methods: This was a retrospective cohort study design. The data source was the Longitudinal Health Insurance Database 2010 (LHID 2010), comprising data collected by Taiwan's National Health Insurance program. Cases of newly diagnosed mastitis in women aged ≥40 years (ICD-9-CM code = 611.0) were selected from the years 2010 to 2012. Women not diagnosed with mastitis were selected as the control group, and their data for the years 2009 to 2013 were obtained through the database. In addition, the non-mastitis group was matched 1:10 by age. Results : A total of 8634 participants were selected from the LHID 2010, which included 734 cases with mastitis and 7900 cases without mastitis. After adjustment for age, hypertension, hyperlipidemia, diabetes, hypothyroidism, and autoimmune diseases, the Cox proportional hazard model showed that patients with mastitis had a higher risk of breast cancer (aHR = 3.71, 95% CI = 1.9-7.02) compared with the non-mastitis group. The Kaplan-Meier curve also showed that women with mastitis had a higher risk of developing breast cancer. Conclusions : This study confirmed that women with mastitis have a higher risk of developing breast cancer. Therefore, women aged ≥40 years could reduce breast cancer risk by taking precautions to prevent mammary gland infection and mastitis.

We aimed to describe the presentation and treatment of lactational phlegmon, a unique complication of mastitis in breastfeeding women that may require surgical management. We retrospectively analyzed medical charts of breastfeeding women treated by a single breast surgeon for lactational phlegmon or the related conditions of abscess or uncomplicated mastitis (UM) from July 2016 to October 2018. Demographic variables and treatment details were analyzed using ANOVA and Pearson's Chi-square test. Ten women with lactational phlegmon (19.2%), 15 women with abscess (28.8%), and 27 women with UM (51.9%) were identified. Phlegmon presented as a tender, erythematous, and nonfluctuant mass in a ductal distribution. Ultrasonography demonstrated an ill-defined, complex fluid collection. Epidemiologically, women with phlegmon were similar to patients with abscess and UM. Women with phlegmon reported more intense deep breast massage than patients in the other two groups, but significantly lower rates of breast pump use than women with abscess (30.0% vs 80.0%, P < .05). Relative to women with UM, patients with complicated mastitis (CM, defined as phlegmon or abscess) reported greater utilization of nipple shields (36.0% vs 11.1%, P < .05). Treatment of phlegmon entailed effective milk removal, antibiotics (range 10-30 days), and close follow-up until both clinical and radiographic resolution (range 8 days to >3 months), with biopsy of persistent masses. Antibiotic duration was significantly longer for patients with phlegmon compared to those with UM (mean 15.0 days vs 9.7 days, P < .05). Two phlegmons coalesced into abscesses within 1 week of diagnosis. Lactational phlegmon is a complication of mastitis in breastfeeding women that is distinct from abscess and UM. Optimal treatment consists of an extended course of antibiotics and close follow-up to monitor for coalescence into a drainable fluid collection and/or persistence of mass requiring biopsy., (© 2019 Wiley Periodicals, Inc.)

Little is known regarding the association of non-lactational mastitis women with breast cancer risk. This population-based cohort study examined the breast cancer risk in women with non-lactational mastitis. We identified 3,091 women with non-lactational mastitis between 2000 and 2011 using the Taiwan National Health Insurance Research Database. We performed 1:4 propensity score matching by age, socioeconomic status and comorbidities and identified 12,364 women without non-lactational mastitis. The mean age of women with non-lactational mastitis was 37.9 years; these women had a higher breast cancer risk than the comparison group (adjusted hazard ratio = 1.94, 95% confidence interval: 1.30-2.90). The incidence rates of breast cancer in women with non-lactational mastitis and the comparison group were 14.79 and 7.57 per 10,000 person-years, respectively. Furthermore, non-lactational mastitis was a risk factor for breast cancer in women aged <50 years, women with lower socioeconomic status and women with hormonal medication (p < 0.05). Women who had more episodes of non-lactational mastitis had a higher risk of developing a breast cancer. Thus, the risk of breast cancer in women with non-lactational mastitis is significantly higher than those without non-lactational mastitis.

Lactational breast abscess is a serious complication of mastitis and commonly diagnosed in breast-feeding women. The traditional drainage of breast abscess was often performed with incisive technique which may result in prolonged healing time, regular dressings, dressing pain, interfering with breastfeeding and unsatisfactory cosmetic outcome. As minimal invasive alternatives to incisive drainage, needle aspiration or percutaneous catheter placement cannot completely replace incisive drainage for the inability to treat large, multiloculated or chronic abscess. Vacuum-assisted breast biopsy system (VABB) has been successfully applied in the treatment of benign breast diseases with satisfactory cosmetic outcomes. Among VABB devices, EnCor system has some distinctive features that make it an appropriate candidate for the treatment of lactational breast abscesses. In this study, for the first time, we investigated the feasibility, efficacy, and cosmetic results of surgical drainage of lactational breast abscess with US-guided Encor VABB system. Our data suggests this procedure could serve as a promising alternative for women with lactational breast abscess who require incisive intervention with high cure rate, relatively short healing time, low recurrence rate, few complications, satisfactory cosmetics outcome and without interfering with breastfeeding., (© 2019 The Authors The Breast Journal Published by Wiley Periodicals, Inc.)

Aims: To investigate associations between lamb growth to weaning and dam udder and teat scores measured at pre-mating, pre-lambing, docking and weaning. Methods: Mature Romney ewes (n = 1,009) were enrolled from a commercial sheep flock located near Masterton, in the Wellington region of New Zealand in 2017. A range of udder and teat traits were scored in all ewes, using visual assessment and palpation, at pre-mating, pre-lambing, docking and weaning. During the lambing period, each newborn lamb was matched to its dam and lamb sex, birthweight and birth-rank were recorded. A rearing rank was allocated to each live-lamb at weaning, when all lambs were weighed (n = 1,570), allowing calculation of daily growth rates (g/day). Associations between udder and teat scores and lamb growth rates to weaning were examined using multivariable models for each udder-scoring time. Results: Growth rates of lambs whose dams had udder palpation scores of hard, or both teats recorded as abnormal, pre-mating were lower than lambs whose dams had normal scores (229.9 (95% CI = 213.2-246.6) vs. 254.5 (95% CI = 245.6-263.5) g/day; p = 0.011) and (227.4 (95% CI = 208.3-246.6) vs. 247.9 (95% CI = 235.7-260.2) g/day; p = 0.024), respectively. Growth rates of lambs whose dams had clinical mastitis at docking or weaning were lower than those without mastitis (215.8 (95% CI = 199.9-231.7) vs. 235.4 (95% CI = 225.4-255.0) g/day; p = 0.007) and (220.0 (95% CI = 205.2-234.8) vs. 254.7 (95% CI = 248.9-260.5) g/day; p < 0.001), respectively. Growth rates of lambs whose dams had asymmetrical udders at docking or weaning were lower than lambs whose dams had symmetrical udders (204.6 (95% CI = 189.7-219.5) vs. 240.2 (95% CI = 225.4-255.0) g/day; p < 0.001) and (223.3 (95% CI = 213.9-232.7) vs. 242.2 (95% CI = 229.4-255.0) g/day; p = 0.014), respectively. Conclusions and Clinical Relevance: Pre-mating udder palpation and teat palpation scores can be used to identify ewes whose lambs are predicted to have lower growth to weaning. Assuming a mean lamb age at weaning of 84.4 days, lambs born to ewes with a pre-mating score of hard would be expected to have a mean weaning weight that was 2.1 kg less than those whose dams had normal scores. Udder palpation, udder symmetry and clinical mastitis scores during lactation were also associated with lamb growth rates. Abbreviation: CALW: Conceptus-adjusted liveweight.

Infant growth faltering occurs in breastfed infants <6 months of age. The possibility that maternal health status contributes to this growth faltering is underexplored. We investigated whether (a) subclinical mastitis (SCM), an asymptomatic inflammation of the breast, (b) maternal intestinal nematode and protozoan infections, indicators of faecal-oral contamination, or (c) poor breastfeeding practices increased the odds of stunting (length-for-age z-score < -2SD), underweight (weight-for-age z-score < -2SD), or low head circumference (head circumference-for-age z-score < -2SD) in breastfed infants in rural indigenous communities in Guatemala. Mother-infant dyads (n = 105) were subdivided into those with and without SCM (milk Na:K ratio > 0.6). Maternal and infant anthropometry were measured at the time of breast milk collection. Maternal stool samples were examined for the presence of intestinal nematodes and protozoa. Questionnaires were used to characterize breastfeeding practices (exclusivity and frequency) and support, hygiene (latrine use and household faucet), and infant diarrhoea. SCM occurred in 14% of women and was associated with increased odds of infant stunting (odds ratio [OR] = 4.3; confidence interval [CI] [1.1, 15.8]), underweight (OR = 9.2; CI [1.8, 48.0]), and low head circumference (OR = 15.9; CI [2.6, 96.9]). Maternal pathogenic protozoa and nematodes were uncommon (<4%), but nonpathogenic protozoa were common (e.g., Entamoeba coli [39%]). Entamoeba coli increased the likelihood (OR = 3.3; CI [1.02, 10.6]) of low head circumference, whereas higher breastfeeding frequency lowered its odds (OR = 0.74, CI [0.56, 0.97]). Prevention of SCM may improve early infant growth, but public health measures that increase breastfeeding frequency and reduce faecal-oral contamination may be required to minimize low head circumference., (© 2018 John Wiley & Sons Ltd.)

Buffalo mastitis is an important economic problem in southern Italy, causing qualitative/quantitative alterations in milk and resulting in economic losses due to the sub-clinical course and chronic evolution. We investigated 50 udders of slaughtered buffaloes and subjected them to effectual microbiological screening to evaluate macro and microscopic mammary gland changes, immune-characterize the cell infiltrates, and compare the degree of tissue inflammation with somatic cell counts. Numerous Gram-positive and Gram-negative bacteria were isolated from all samples, majority of which were environmental mastitis pathogens. Histological features referable to chronic mastitis were observed in 92% udders. Lymphocytes, plasma cells and macrophages were found to evolve into aggregates in 48% udders, which often organized to form tertiary lymphoid structures (TLSs). A predominance of interstitial CD8+ over CD4+ lymphocytes and, in TLSs, scattered CD8+ lymphocytes in the mantle cells and CD79+ lymphocytes in germinal centers, were evidenced. Environmental pathogens are known to persist and cause chronic inflammatory changes in buffaloes, where CD8+ lymphocytes play an important role by controlling the local immune response. Moreover, the TLSs evidenced here for the first time in buffalo mastitis, could play a role in maintaining immune responses against persistent antigens, thereby contributing in determining the chronic course of mastitis., Competing Interests: The authors declare no conflicts of interest., (© 2019 The Korean Society of Veterinary Science.)

Background: Pre-weaning diarrhea (PWD) in mink, also known as "sticky kits", is a frequently occurring syndrome in suckling mink kits on commercial mink farms. Outbreaks of PWD result in weakened kits, increased mortality and reduced growth and welfare as well as considerable economic losses for the farmers. The syndrome is regarded as multifactorial with a complex etiology, and studies have focused on associations with environment, management and dam characteristics. The present study was conducted from May to June 2015 and included 70 dams with mink litters with and without PWD. The aims were to examine associations between PWD and mastitis (bacterial infection and histological signs of inflammation or other lesions in the mammary gland), and to examine associations between PWD and other dam-related characteristics (age, litter size, body mass index, and weight and number of active mammary glands of the dam)., Results: Using multivariable mixed logistic regression analyses with farm id as a random intercept, we found that the odds for PWD in the litter were significantly higher in 1 year old dams versus > 1 year old (OR = 13.3, CI 2.0-90.2, P = 0.01), higher if litter size observed after birth was > 5 kits versus ≤ 5 kits (OR = 16.5, CI 2.2-123.7, P = 0.01), higher if the number of active mammary glands per kit was ≤ 1.5 versus > 1.5 glands per kit (OR = 6.5, CI 1.2-36.0), P = 0.03), and higher in farms with high prevalence of PWD versus low prevalence (OR = 16.8, CI 2.9-97.6, P = 0.002). There were no significant associations between PWD and bacterial infection, histological signs of inflammation or other lesions of the mammary gland, body mass index or weight of mammary gland per kit., Conclusion: Pre-weaning diarrhea had a statistically significant association with age of the dam, litter size and the number of active mammary glands per kit. However, PWD was not associated with mastitis, body mass index and weight of mammary gland tissue per kit.

A 35-year-old lactating woman with pre-existing polyacrylamide gel (PAAG) implants for 10 years presented on numerous occasions following both her pregnancies with bilateral recurrent breast infection, pain and finally massive breast enlargement with a ruptured galactocoele necessitating surgical intervention. As the safety of PAAG for the breastfeeding baby is not known, breastfeeding with PAAG implants is not recommended., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2018. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Subclinical mastitis (SCM) is relatively common in lactating women and may be associated with HIV shedding in breast milk. The potential association between HIV infection and breast milk immunologic factors and immune response to SCM needs to be addressed., Methods: In this cross-sectional study, SCM (Na/K ratio > 1) was tested in 165 mature breast milk samples collected from 40 HIV-infected women who didn't transmit HIV to their child by breastfeeding and 43 HIV-uninfected women enrolled in an interventional cohort in South-Africa (Vertical Transmission Study). The level of 33 immune markers related to Th1/Th2 related response, inflammation and bacterial exposure were compared in ART-naive HIV-infected versus HIV-uninfected women. The associations between HIV infection and SCM on the concentration of immune factors were tested separately by Wilcoxon rank-sum test and corrected for false discovery rate. To control for potential confounder effects and take into account the clustering of breast milk samples from a single woman, multivariate mixed linear models adjusted on child age at the time of sampling were performed for each immune factor., Results: Subclinical mastitis was detected in 15 (37.5%) HIV-infected women and 10 (23.3%) HIV-uninfected women. In the absence of SCM, the breast milk levels of IP-10 and MIG were higher and IL1-RA lower in HIV-infected women than in HIV-uninfected women (respectively p < 0.001, p = 0.001, p = 0.045). In HIV-uninfected women, SCM was characterized by a robust immune response with higher concentrations of a broad panel of Th1 and inflammatory related immune markers than in samples without SCM. By contrast, in HIV-infected women a limited number of immune markers were increased and lower increases were observed in samples with SCM than without SCM., Conclusion: HIV infection in ART-naïve women was associated with elevated breast milk levels of IP-10 and MIG, which areTh1-related cytokines induced by IFN-γ. During SCM, a lower and narrower immune response was observed in HIV-infected than HIV-uninfected women, suggesting that HIV infection affects the capacity of the mammary gland to respond to SCM.

Inflammation and infection postpartum threaten the mother and her infant. Human milk provides a defense for the infant, but inflammatory complications like mastitis may lead to the cessation of breastfeeding. Antisecretory factor (AF) has a role in the regulation of secretory processes and inflammation. The objective of the study was to describe AF-levels in plasma and breast milk, and in relation to breast complications. Breastfeeding mothers ( n = 95) were consecutively recruited at a Well Baby Clinic in Umeå, Sweden. At inclusion four weeks postpartum, samples of venous blood (10 mL) and breast milk (10 mL) were collected. Active AF was analyzed with ELISA using a monoclonal antibody mAb43, and was detected in all samples of plasma and breast milk with a positive correlation (Spearman coefficient = 0.40, p < 0.001; Pearson correlation = 0.34, p < 0.01). High AF-levels in plasma correlated with high AF-levels in breast milk. The results suggest a co-regulation between active AF in plasma and breastmilk, and/or a local regulation of AF in the breast. Further studies are needed to determine the pathways for the activation of AF-levels in breast milk and plasma.

Breastfeeding is the normative standard for infant feeding. Despite its established benefits, different factors can affect breastfeeding rates over time. The purpose of this study was to evaluate breastfeeding determinants in healthy term newborns during the first three months of life. A prospective, observational, single-center study was conducted in the nursery of Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico in Milan, Italy. The mother-baby dyads that were admitted to the Clinic in January and February 2017 were enrolled. Only healthy term babies with birth weight ≥10th percentile for gestational age were included. Data were collected through medical records and questionnaires administered during the follow-up period. Then, we fitted univariate and multivariate logistic models and calculated odds ratios. 746 dyads were included but 640 completed the study. The factors found to be favoring breastfeeding were a previous successful breastfeeding experience, a higher level of education of the mother, attending prenatal classes, no use of pacifier, rooming in practice, and breastfeeding on demand. Factors acting negatively on breastfeeding were advanced maternal age, non-spontaneous delivery, perception of low milk supply, mastitis, and nipple fissures. This study highlights the need to individualize the assistance provide to breastfeeding mothers, paying special attention to personal experiences., Competing Interests: The authors declare no conflict of interest.

BACKGROUND Brugada pattern on electrocardiogram (ECG) is seen when there are at least 2 mm J-point elevation and 1 mm ST-segment elevation in two or more of the right precordial leads, with right bundle-branch block (RBBB)-like morphology. Elevation of a coved-type shape in leads V1 and V2 is consistent with type I Brugada pattern, whereas elevation of a saddle-back configuration distinguishes type II Brugada. If accompanied by life-threatening arrhythmias or sudden cardiac death, Brugada syndrome (BrS) is diagnosed. The presence of Brugada ECG pattern in absence of the syndrome has come to be known as Brugada phenocopy (BrP). CASE REPORT We introduce a case of both Brugada type I and II patterns unmasked in a 28-year-old female with fever secondary to mastitis. Though fever-induced BrP is a universally known phenomenon, the presentation of both type I and II patterns presenting in a patient during a single hospitalization makes this case unique from others. The patient was brought to the emergency department after experiencing a syncopal episode that appeared classically vasovagal in nature. Once her fever resolved, her baseline ECG showed no abnormalities. CONCLUSIONS Though Brugada ECG pattern may be very alarming, especially after syncope, appropriate management in the case of a fever-induced event would consist of observation with cardiac monitoring, immediate treatment of fever with antipyretics, and antibiotics for suspected infection. Close follow-up by a cardiologist as an outpatient is imperative to further ascertain if the patient is at high risk of life-threatening arrhythmias, significant for BrS.

Background: Subclinical mastitis (SCM) is a frequent, but poorly characterized entity that may influence immune development of breastfed infants. Mechanisms driving the emergence of SCM and changes in immunological content of human milk during SCM remain to be explored. In this study, the breast milk environment was to describe during SCM., Methods: One hundred and ten samples of mature breast milk were collected from 44 healthy, HIV-negative mothers, included in a large infant feeding intervention cohort (ANRS 1271/Vertical Transmission Study). Immune markers related to inflammatory/anti-inflammatory balances and secreted in response to bacterial exposure were explored in SCM breast milk samples (Na/K ratio > 1) and compared to non-SCM controls., Results: SCM was observed in 23% of women (95% confidence interval (CI): 21-24) and associated with higher levels of inflammatory markers (β2 microgobulin, PS100A9, TNF-α, IL-6, IL-8, IL-17, and RANTES) and Th1-related cytokines (IL-2R, IL-12p40/70, IFN-α, IFN-γ, CXCL-9, andIP-10). High levels of factors secreted in response to bacteria and lipopolysaccharide (LPS) exposure were observed in SCM breast milk samples (MIP-1α, MIP-1β, LPS binding protein, α-defensins, and antileukoproteinase 1)., Conclusion: SCM is associated with important changes in breast milk microenvironment, with a proinflammatory/Th1-cytokine predominant profile. During SCM, cytokine imbalances in breast milk may have a notable influence on mucosal immune system of the infant early in life.

The aim of this study was to investigate the effects of mastitis on CL development and function and pregnancy rate in buffaloes. Sixty-six buffaloes (Bubalus bubalus) reared in a commercial farm at El-Beheira governorate, north of Egypt were used in this study. According to the visual observation of milk, physical examination of the udder and actual somatic cell count in milk, buffalo cows were divided into three groups: without mastitis (W), n = 23; subclinical mastitis (SC), n = 18; and clinical mastitis (C), n = 25. All buffalo cows were synchronized by double dose of PGF2α (11-day interval) and inseminated by frozen-thawed semen of fertile bull. Mean CL diameter was ultrasonically examined on Days 5, 9, 12, 16, 21, and 25 after artificial insemination (AI). Blood samples were taken on the days of ultrasonography for progesterone (P4) assay. Results indicated that pregnancy rates were lower (P < 0.05) in C (28.00%) and SC (55.56%) compared with W (69.57%) on Day 25 after first AI. Pregnancy rates reduced to 60.87%, 44.45%, and 16.00% in W, SC, and C, respectively, at Day 45 after insemination. Thus, the embryonic loss was 8.7%, 11.11%, and 12.00 % in W, SC, and C cows, respectively. Pregnancy rates decreased between 44.32% and 50.51% when mastitis occurred during Day -15 before to Day +30 after AI, compared with 59.22% in the uninfected cows. The diameter of CL was greater (P < 0.05) in W than SC and C cows starting at Day 9 postbreeding onward. Likewise, P4 concentrations on Days 9 through 25 after AI were greater (P < 0.05) in W cows as compared to SC and C cows. Positive correlations (P < 0.01) were found on Days 5, 9, 12, 16, 21, and 25 after AI between CL diameter and P4 concentrations. Similar trend was found among CL diameter, P4 concentrations, and pregnancy rate. Accordingly, incidence of mastitis revealed suppression to both CL diameter and function leading to significant reduction in pregnancy outcome of buffalo cows., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Breast lymphedema (BLE) can occur after breast cancer treatments, but there have been no cases of BLE secondary to lymph node transfer (LNT) using an axillary lymph node (ALN). We report the first case of LNT-related BLE successfully treated with supermicrosurgical lymphaticovenular anastomosis (LVA). A 50-year-old female presented with left BLE after LNT harvesting from the left axilla for the treatment of secondary lower extremity lymphedema in another hospital. Although the left breast did not seem edematous, the patient suffered from sensation of tension and frequent episodes of left breast cellulitis. Since conservative treatments were not effective, LVA was performed at the lateral thoracic region. A 0.5 mm lymphatic vessel was found and anastomosed to a nearby 0.35 mm vein in an intima-to-intima coaptation manner. After the LVA, the patient experienced no sensation of tension or further cellulitis attacks. Although rarely encountered, BLE can occur after axillary LNT, and LVA may be a useful therapeutic option.

Background: Although breast abscess is a serious uncommon complication of mastitis with high morbidity rate, there is a lack of high-quality randomized trial to demonstrate the best treatments. We reported a novel way of applying negative suction drain through a mini periareolar incision., Materials and Methods: We retrospectively analyzed and compared the clinical characteristics of 62 patients with lactational breast abscess in our department from August 2012 to April 2015. Thirty-two patients went through traditional incision and drainage (Group A) and 30 patients were placed on negative suction drain through mini periareolar incision (Group B)., Results: There is no significant difference between the two groups in terms of age, white blood cell (WBC) count, size of the abscess cavity, and positive rate of Staphylococcus aureus (SA) or methicillin-resistant Staphylococcus aureus (MRSA). Patients in Group B had a shorter hospitalized stay (p = 0.003) and had a higher rate of continuation of breastfeeding (p < 0.005)., Conclusion: Applying drain with negative suction pressure through a mini periareolar incision is an effective modality for treating lactational breast abscess and maintaining breastfeeding.

Inflammation has multifaceted role in cancer progression including initiation, promotion and invasion by affecting the immune surveillance and associated signaling pathways. Inflammation facilitates the over-expression of cytokines, chemokines and growth factors involved in progression of different cancers including breast cancer progression. Deregulation of biological processes such as oxidative stress, angiogenesis, and autophagy elicit favorable immune response towards chronic inflammation. Apart from the role in carcinogenesis, chronic inflammation also favors the emergence of drug resistance clones by inducing the growth of breast cancer stem-like cells. Immunomodulation mediated by cytokines, chemokines and several other growth factors present in the tumor microenvironment regulate chronic inflammatory response and alter crosstalk among various signaling pathways such as NF-κB, Nrf-2, JAK-STAT, Akt and MAPKs involved in the progression of breast cancer. In this review, we focused on cellular and molecular processes involved in chronic inflammation, crosstalk among different signaling pathways and their association in breast cancer pathogenesis., (Copyright © 2015 Elsevier Inc. All rights reserved.)

A central goal of The Academy of Breastfeeding Medicine is the development of clinical protocols for managing common medical problems that may impact breastfeeding success. These protocols serve only as guidelines for the care of breastfeeding mothers and infants and do not delineate an exclusive course of treatment or serve as standards of medical care. Variations in treatment may be appropriate according to the needs of an individual patient.

IgG4-related orbital disease is a recognised cause for orbital inflammation. As its awareness increases and diagnostic accuracy improves there will be an increased number of cases being identified. This unique case demonstrates for the first time, with histological evidence, a case of a non-lacrimal IgG4-related orbital disease with concurrent IgG4-related mastitis. We describe a 47 year old who presented with a supraorbital swelling and mass. This was initially successfully treated with oral steroids and was later excised on recurrence. Immunohistochemical and blood serum analysis confirmed IgG4-related orbital disease. On systemic enquiry she was found to have a mass of the breast, which was shown to be IgG4-related mastitis. She is currently asymptomatic with no sign of recurrence and is under long-term surveillance. This case highlights the importance of systemic work up in patients presenting with orbital foci of IgG4 disease.

This review explores current concepts surrounding breastfeeding complications including nipple pain and trauma, breast engorgement, mastitis, and breast abscess. The review discusses possible etiologies, risk factors, incidence, differential diagnosis, and suggested treatment strategies. The evidence that supports these management options is discussed.

Introduction: Recent results indicate that human mastitis and painful breastfeeding may be characterized by a mammary bacterial dysbiosis, a process in which the population of potential pathogens increases at the expense of the normal mammary microbiota. The objective of the present study is the evaluation of three different doses of Lactobacillus fermentum CECT5716 to reduce the load of Staphylococcus in the breastmilk of women suffering from painful breastfeeding., Materials and Methods: A randomized double-blinded controlled study with four study groups was performed. Three groups received the probiotic strain for 3 weeks at doses of 3×10(9) colony-forming units (CFU)/day, 6×10(9) CFU/day, or 9×10(9) CFU/day. The fourth group received a placebo of maltodextrin. The main outcome of the study was Staphylococcus counts in breastmilk. The secondary outcomes were Streptococcus, Lactobacillus, and total bacteria counts in breastmilk, immunoglobulin A and interleukin 8 concentrations in breastmilk, and breast pain scores., Results: At the end of the study, a significant decrease in the Staphylococcus load was observed in the probiotic groups compared with the baseline loads (p=0.045), whereas the control group maintained similar levels over time. A significant difference in the pain score was observed among the groups receiving the three probiotic doses compared with the control group (p=0.035, p=0.000, and p=0.028, respectively). A dose-response effect could not be observed because the three doses tested induced similar effects, and no significant differences were detected., Conclusions: We conclude that L. fermentum CECT5716 is an efficient treatment for breast pain during lactation associated with a high level of Staphylococcus in breastmilk.

Chronic inflammation is recognized as a risk factor for the development of several malignancies. Local white adipose tissue (WAT) inflammation, defined by the presence of dead or dying adipocytes encircled by macrophages that form crown-like structures (CLS), occurs in the breasts (CLS-B) of most overweight and obese women. Previously, we showed that the presence of CLS-B is associated with elevated tissue levels of proinflammatory mediators and aromatase, the rate-limiting enzyme for estrogen biosynthesis. The associated increased levels of aromatase in the breast provide a plausible mechanistic link between WAT inflammation and estrogen-dependent breast cancers. Thus, breast WAT inflammation could be relevant for explaining the high incidence of estrogen-dependent tumors with aging despite diminished circulating estrogen levels after menopause. To explore this possibility, we determined whether menopause in addition to body mass index (BMI) is associated with breast WAT inflammation among 237 prospectively enrolled women. The presence of CLS-B and its severity (CLS-B/cm(2)) as indicators of WAT inflammation correlated with menopausal status (P = 0.008 and P < 0.001) and BMI (P < 0.001 for both). In multivariable analyses adjusted for BMI, the postmenopausal state was independently associated with the presence (P = 0.03) and severity of breast WAT inflammation (P = 0.01). Mean adipocyte size increased in association with CLS-B (P < 0.001). Our findings demonstrate that breast WAT inflammation, which is associated with elevated aromatase levels, is increased in association with the postmenopausal state independent of BMI. Breast WAT inflammation, a process that can potentially be targeted, may help to explain the high incidence of estrogen-dependent tumors in postmenopausal women., (©2015 American Association for Cancer Research.)

Intranodal palisaded myofibroblastoma is a rare tumour of the lymph node that may be derived from myofibroblasts. The most usual area of presentation is the inguinal lymph nodes, but occurrence within other areas has also been reported. It is characterised by spindle cells, amianthoid-like fibres, and by the proliferation of hemosiderin-containing histiocytes in the lymph node. Although intranodal palisaded myofibroblastoma is benign, it is frequently confused with metastatic lesions, especially when it occurs in atypical sites. We herein report the second case of axillary intranodal palisaded myofibroblastoma occurring in a woman with a granulomatous chronic mastitis. The salient clinicopathological features of this unusual tumour are presented with emphasis to the pathogenesis of the tumour as well as to its histological and immunohistochemical characteristics. Clinicians and pathologists must be aware of this rare tumour to avoid a misdiagnosis of malignancy and assure patient a correct therapeutic management., (2014 BMJ Publishing Group Ltd.)

Background: Breast tuberculosis (breast TB) is an extremely rare disease, so case reviews are also rare., Methods: This study is a retrospective review of patients with breast TB who were treated between 2002 and 2012 at the Health Center of Gorgan City., Results: All 22 patients were females, their mean age was 32.4 years, and all were new cases. Patients presented with swelling of the breast (22%), lump (55%) and excretion from the involved breast (27%), and breast pain (55%). The highest rate of breast TB occurred in 2011 (27%). All patients received the DOTS regimen for a mean duration of 7.3 ± 0.7 months; in addition, segmental resection was performed on 11 patients (50%)., Conclusions: The findings confirmed that breast TB in Iran should be considered as a differential diagnosis of breast masses. All patients in our study received the daily and 'Directly Observed Treatment Short-course' (DOTS) regimens. Anti-tubercular therapy for six months with or without minimal surgical intervention currently is the main treatment.

Background: The refusal of infants to suckle from a breast that is inflamed with mastitis suggests that the taste of the milk has changed. However, the taste of milk from a breast with mastitis has never been empirically determined. The present study compares the taste of milk from breastfeeding mothers with or without mastitis and identifies specific changes in the taste of milk from mothers with mastitis., Subjects and Methods: The intensity of four basic tastes (sourness, saltiness, bitterness, and umami) of breastmilk from 24 healthy mothers at 3-5 days and at 2-3, 4-5, and 8-10 weeks postpartum and from 14 mothers with mastitis was determined objectively using a taste sensor. The intensity of each basic taste and the concentrations of main taste substances in milk were compared between the inflamed breasts and the normal breasts of control mothers or the contralateral asymptomatic breast of mothers with unilateral mastitis., Results: The transition from colostrum to mature milk was accompanied by changes in the taste of the milk, such as decreased saltiness and umami and increased bitterness and sourness. Umami and saltiness increased in milk from inflamed breasts. Contents of sodium, glutamate, and guanosine monophosphate increased in milk from inflamed breasts., Conclusions: Tastes that were specifically associated with inflamed breasts appeared to include an increase in umami and saltiness, which might have resulted from an increased content in factors associated with umami and sodium.

Unlabelled: Mastitis and breast abscess in lactating women are risk factors for early breastfeeding cessation. This pathology is included in the group of skin and soft tissue infections. A descriptive study was performed with an advanced outlook. As of January 2007 through December 2011 a total of 137 breast abscesses were treated in our institution. We analyzed incidence, parity, postpartum days, risk factors, microbiological isolation and the adequacy of initial antibiotic treatment. In that period we observed a steady and significant increase in breast abscesses. Incidence from 0.19 to 0.84% in lactating women 2007 vs. 2011 p = 0.0001 IC 95% (-0.009; 0.003), 70.6% of them primiparous and a mean interval from delivery to breast abscess of 41.9 ± 35.8 days. The most frequent risk factors were sore nipples and breast engorgement. Staphylococcus aureus was isolated in 82.3 to 95.0%. Methicillin resistance was higher than 60%. These strains were susceptible to erythromycin, clindamycin, gentamicin, rifampicin, ciprofloxacin and trimethoprim-sulfamethoxazol. All the cases were surgically drained; the initial empirical treatment was inadequate in 60% of them, 90% of patients could maintain breast feeding after the procedure., In Conclusion: these data emphasize the need to prevent risk factors associated to breast abscesses: sore nipples and breast engorgement. In order to determine the adequate antibiotic treatment, bacteriological studies are required at every collection because SAMR prevalence varies according to diverse populations and geographic location.

Sclerosing lymphocytic lobulitis (SLL) is a rare inflammatory disorder, which is also known as fibrous mastopathy and lymphocytic mastitis. It is commonly associated with autoimmune disorders, particularly type 1 diabetes and thyroiditis. We report the case of a 28-year-old woman diagnosed as SLL with Hashimoto's thyroiditis, but without diabetes. She presented suspicious microcalcifications without palpable mass in routine mammograms in both breasts. She had been diagnosed as Hashimoto's thyroiditis several years before and had been followed up in endo-clinics., (© 2013 Wiley Periodicals, Inc.)

Background: Lymphocytic mastitis is an uncommon fibroinflammatory disease of the breast which occurs in patients with longstanding diabetes. Various imaging patterns in mammography, ultrasound and magnetic resonance imaging (MRI) have been widely described. This communication wishes to provide some explanation to the variation of imaging findings by a study of follow-up cases and present young nonlactating women who had abscess as the first clinical manifestation of type 1 diabetes., Methods: Five women with pathologically confirmed lymphocytic mastopathy and 8 women with type 1 diabetes who presented with breast abscess at National Guard Hospital, Riyadh were studied. The ultrasound, mammographic and MRI features were analyzed. Follow-up of 2 to 4 years was done. The clinical findings were analyzed in a descriptive way., Results: A total of 13 women were studied. Age ranged from 22-54 years. The clinical presentation was a painless hard breast mass in the 5 cases with lymphocytic mastitis and painful mass in 8 women with breast abscess, 3 of which were non-lactating young women. The common imaging finding at mammography was diffuse or focal stromal distortion unilaterally or bilaterally in 4 cases (80%). Complete clinical and mammographic resolution occurred in 2 (40%) of the cases while it was only partial in the rest with lymphocytic mastopathy. Initial ultrasound showed stromal changes in 3 (60%), mass-like lesion in 1 (20%) and normal in 1 (20%). At follow-up ultrasound examination, all had interval development of dense acoustic shadowing representing the previous lesions between 1-2 years., Conclusion: Lymphocytic mastitis can have various patterns at the initial presentation at ultrasound. However, the chronic change at follow-up in this study was intense acoustic shadowing without any mass in all. Type 1 diabetes is suggested in young non-lactating females presenting with breast abscess.

Group B Streptococcus is a known cause of neonatal sepsis, being more common in the early period by maternal genital tract transmission and less so in the late neonatal period, ascribed to intestinal colonization or horizontal transmission. Although breastmilk transmission of Group B Streptococcus has rarely been reported in the past, most cases are of patients nursed on the mother's breast and less commonly in expressed breastmilk-fed infants. This case describes a preterm infant (born at a gestational age of 24 weeks 6 days) in the neonatal intensive care unit who acquired recurrent late-onset sepsis with Group B Streptococcus with the mother's expressed breastmilk culture growing the same organism that was later matched to the infant's isolate. The mother had presented with features of mastitis only during the second episode of sepsis and was then treated with oral antibiotics. The infant was fed on formula feeds after the second incidence and remained healthy, being discharged on a regular follow-up plan at 39 weeks corrected gestational age.

Postmastectomy radiation therapy (PMRT) has been shown in randomized trials to improve overall survival for patients with locally advanced breast cancer. The standard PMRT clinical target volume (CTV) encompasses the chest wall and undissected regional lymphatics. Conformal isodose distributions covering the standard CTV with acceptable dose limits to normal tissue can typically be achieved with a combination of photon and electron fields. Field borders are marked on the patient's skin using a light field projection of each beam and are subsequently used to verify daily field matching clinically. Initial imaging of a patient with oligometastatic inflammatory breast cancer demonstrated direct extension of disease from the involved internal mammary lymph node chain into the anterior mediastinum as the only site of metastatic disease. The patient achieved a pathologic complete response to neoadjuvant chemotherapy and underwent mastectomy. The initial sites of gross disease, including the anterior mediastinal node was included in the CTV for PMRT, and treatment planning demonstrated a clear advantage to the inclusion of proton fields in this case. The absence of a light source on the proton delivery system that accurately projects proton field edges onto the patient's skin posed a significant challenge for daily verification of proton-to-photon and -electron field matching. Proton field-specific radiographic imaging devices were designed and used such that proton field edges could be delineated on the patient's skin and used for daily matching with photon and electron fields. Manufacture of the imaging devices was quick and inexpensive. Weekly verification of proton field alignment with the proton field delineation on the skin demonstrated agreement within 3-mm tolerance. The patient remains with no evidence of disease 18 months after completing radiation. Other patients with similar indications may benefit from multimodality radiation therapy., (Copyright © 2012 American Association of Medical Dosimetrists. Published by Elsevier Inc. All rights reserved.)