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Nipple stimulation in late pregnancy may cause oxytocin release sufficient to give uterine hypertonus and danger to the fetus. Three patients are described in whom nipple stimulation caused a marked but temporary fetal bradycardia.
BACKGROUND: Nipple soreness is one reason why breastfeeding women wean their infants. This study examined the effectiveness of three topical agents--USP-modified lanolin, warm water compresses, and expressed breast milk with air drying--in alleviating nipple pain, and if early predictors of breastfeeding at six weeks could be determined. METHODS: One hundred seventy-seven breastfeeding, primiparous women were randomly assigned to one of four groups. All women received education about breastfeeding technique. Numeric rating scales were used to discriminate levels of pain intensity, pain affect, and strength of sucking on day 1. Participants were interviewed by telephone on postpartum days 4, 7, and 14, and during week 6 using the same scales. RESULTS: No significant differences were found among groups for pain intensity, pain affect, or duration of breastfeeding. Results of a logistic regression indicated that older mothers and those who were exclusively breastfeeding (no supplemental feeding) were most likely to be breastfeeding six weeks postpartum. Raw scores supported the use of warm compresses. CONCLUSION: Further investigation is required into ways of supporting young mothers and how caregivers provide support to breastfeeding mothers in the early weeks after childbirth.
Erosive adenomatosis of the nipple is a benign lesion that clinically mimics Paget's disease of the nipple but has the histologic features of syringocystadenoma papilliferum. Some cases have been mistaken for intraductal papilloma or well-differentiated adenocarcinoma, and unnecessary mastectomies have been performed. Recognition of this lesion is important because it is benign and conservative excision is curative.
We present an 11-year-old girl, with celiac disease, and a 9- month history of itchy and erythemato-edematous lesions with vesicles and exudation on her nipples and areolas. No other lesions or signs of scratching were present on her face or folds. She had no specific lesions of atopic dermatitis in typical sites nor in other body surface during her life. Patch tests showed a positive reaction to nickel and thimerosal that was not significantly related to the clinical appearance. This presentation documents the clinical relevance of atopic dermatitis minor diagnostic criteria. We discuss the importance of nipple eczema in AD and its differential diagnosis.
A heretofore undescribed localization for solitary keratoacanthoma, namely the skin of the nipple, is reported. The tumor developed in a 69-year-old man who had suffered a trauma in the thorax near the left nipple 5 months before. A possible origin in mammary ducts, considering the breast as a modified sweat gland, is discussed.
It is now well established that oxytocin, as well as stimulating uterine contractions and milk ejection, promotes the development of maternal behaviour and also bonding between mother and offspring. In addition, oxytocin exerts by way of peripheral, circulating as well as by central, neurogenic mechanisms multiple physiological, endocrine and behavioural effects in connection with milk ejection and lactation. Some effects of oxytocin in the nipple and mammary gland appear to be exerted in close collaboration with peptides released from axon collaterals of somatosensory nerves originating in this region. The distribution of peptides localized to the somatosensory afferents in the nipple and mammary gland as well as possible effects by oxytocin and/or local neurogenic peptides in connection with milk ejection and lactation are reviewed in this paper.
An ultrastructural study of the epidermis from eight patients with clinical Paget's disease of the nipple supports the epidermotropic theory. There was no evidence that the Paget's cells originated from keratinocytes. We propose the hypothesis that Paget's cells represent transformed ductal cells, from the subjacent lactiferous ducts of the nipple, which have migrated into the epidermis, either as neoplastic cells or as normal ductal cells with secondary in situ transformation in the epidermis.
The aim of this study was to identify the aerobic and the anaerobic microorganisms which can be related to duct ectasia. The patients were divided into two groups. Group 1 comprised 100 patients with coloured nipple discharge (duct ectasia group), and Group 2 (the control group) was composed of 50 patients without nipple discharge. The culture media used were BHI-PRAS, blood agar, mannitol agar and MacConkey agar. There was a high frequency of bacterial growth in the two groups: 85% in Group 1 and 88% in Group 2. The most prevalent bacteria were Staphylococcus aureus and Staphylococcus epidermidis. There was a statistically significant higher rate of smokers in the duct ectasia group compared with the control group, 25 (25%) patients vs. 5 (10%), respectively (p = 0.03). These findings allow us to put forth the hypothesis that the genesis of duct ectasia may be a non-infectious inflammatory process.
LGR7 is a G-protein coupled receptor with structural homology to the gonadotrophin and thyrotrophin receptors. Recently, LGR7 was deorphanized, and it was shown that relaxin is the ligand for LGR7. To further study the function of this receptor, mice deficient for LGR7 were generated by replacing part of the transmembrane-encoding region with a LacZ reporter cassette. Here we show that LGR7 is expressed in various tissues, including the uterus, heart, brain, and testis. Fertility studies using female LGR7-/- mice showed normal fertility and litter size. However, some females were incapable of delivering their pups, and several pups were found dead. Moreover, all offspring died within 24 to 48 h after delivery because female LGR7-/- mice were unable to feed their offspring due to impaired nipple development. In some male LGR7-/- mice, spermatogenesis was impaired, leading to azoospermia and a reduction in fertility. Interestingly, these phenomena were absent in mutant mice at older ages or in later generations. Taken together, results from LGR7 knockout mice indicate an essential role for the LGR7 receptor in nipple development during pregnancy. Moreover, a defect in parturition was observed, suggesting a role for LGR7 in the process of cervical ripening.
A case of bleeding from the nipple is presented which was due to fragments of hair within breast ducts. It is suggested that these were accidentally introduced through the nipple.
OBJECTIVES: To determine the variability of prostate-specific antigen (PSA) in the breast ductal fluid (nipple aspiration fluid, NAF) during the menstrual cycles of healthy premenopausal women. METHODS: Fifteen female volunteers underwent weekly nipple aspiration of ductal fluid from both breasts for the duration of two menstrual cycles. A highly sensitive and specific Third Generation PSA Assay (IMMULITE); Diagnostic Products Corporation, DPC) was used to detect NAF and serum PSA. Associations between NAF PSA and paired serum hormone levels of the pituitary-ovarian axis were tested using the Spearman rank correlation and the Wilcoxon signed rank test. Analysis of variance on log transformed NAF PSA was used to determine the intra- and intervolunteer variability. RESULTS: NAF PSA ranged from <0.003 to 133,330 ng PSA/g total protein (median 2,030 ng/g). No repeatable pattern of change was observed for individual volunteers and no significant association between NAF PSA and any pituitary-ovarian axis serum hormone was detected. There was no correlation between serum and NAF PSA. CONCLUSIONS: Weekly NAF sampling in healthy premenopausal women to provide adequate volumes for PSA analysis was successfully achieved. Considerable variation was observed for NAF PSA, which may limit the future potential for this tumor marker in NAF. This variability was not associated with hormones of the pituitary-ovarian axis and did not show repeated cyclical variability during the menstrual cycle. Serum PSA does not appear to be an acceptable indicator of NAF PSA levels.
The analysis of 73 cases revealed Paget's disease of the nipple, known as a precancerous state, to be a special form of the intraductal mammary cancers. In the majority of the cases, apart from a superficial exulceration malignant transformation in the glandular substance is present. Thus, the treatment schedules have to be similar to those of other mammary cancers; in cases localized to the nipple, simple mastectomy with axillary block dissection, is suggested; in cases with tumors of the glandular substance, radical mastectomy according to Halsted is suggested. The frequent negligency is partly a result of an earlier attitude of the physicians being too conservative with therapeutic procedures.
Two cases and histological observations of erosive adenomatosis of the nipple are presented in detail, and the literature on the subject is reviewed. Erosive adenomatosis is a rare but clearly delineated pathology of the nipple and seems to be essentially benign. Careful clinical and histological examinations with complete investigation of the breast are required for the diagnosis. Nonmutilating curative surgery can be performed.
Characteristics of intrauterine activity in response to nipple stimulation were studied in 9 healthy pregnant subjects at term. All patients showed an increase in uterine activity varying from 10 to 730%. In 1 subject, marked uterine hypertonus was noted which resulted in profound fetal bradycardia. This response was transient, lasting 5.5 min, and fetal outcome unaffected. We believe that nipple stimulation is associated with a higher incidence of increased uterine activity in terms of frequency, intensity and basal tone, than has been previously recognized. This uterine hypertonus may affect the fetal heart rate adversely indicating the need to exercise caution when adopting this manoeuvre in late pregnancy, particularly when there is already evidence of fetal compromise.
BACKGROUND: Adenoma (papillary adenoma, florid papillomatosis, subareolar duct papillomatosis, erosive adenomatosis) of the nipple is an uncommon lesion and can be mistaken clinically for Paget's disease and pathologically be misinterpreted as an adenocarcinoma. CASE: A case of adenoma of the nipple was studied by cytology and histopathology. CONCLUSION: Recognition of this benign lesion on cytology will prevent unnecessary radical surgery. Local excision alone suffices.
The frequency of accessory nipples in black Americans is almost eight times greater than in white European patients. Association of a wide range of abnormalities with supernumerary nipples in whites has, thus far, not been our experience in black Americans.
This case report describes a situation in which a mother who experienced prolonged nipple pain with her first child sought help from a lactation consultant at the birth of her second child. Despite being very attentive to positioning and latch, similar pain was experienced from the first feeding with the second baby. The mother's history and symptoms were explored, and nipple vasospasms related to Raynaud's syndrome were suspected. After reviewing the literature and consulting with her personal obstetrician, the mother (a pediatrician) chose to treat with nifedipine. The mother was pain free after a 2-week course and nursing without difficulty at 4 months postpartum.
The nipple and surrounding area, like other areas of skin, are subject to irritation, inflammation, and infection. Twenty women with persistent sore nipples were first seen by a lactation consultant and later referred to a dermatologist. The dermatologist successfully treated 18 of the 20 mothers. A lactation consultant should be able to identify those women who will benefit from evaluation and treatment by a dermatologist.