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Journal Club 12

Brief overview of topic. Breast infection commonvarying degrees of severityMastitis to abscess formationTreatment range from OP Abx and continuing of breast feeding to requiring a hospital admission, GA and I D, and mulitple dressingsMastitis incidence in lactating women 2.5%-33% Delayed tr

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Journal Club 12

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    1. Journal Club 12/05/03 Breast Abscesses in Lactating Women Cenap Dener, MD. Aydin Inan, MD World Journal of Surgery 27, 130-133, 2003

    2. Brief overview of topic Breast infection common varying degrees of severity Mastitis to abscess formation Treatment range from OP Abx and continuing of breast feeding to requiring a hospital admission, GA and I+D, and mulitple dressings Mastitis incidence in lactating women 2.5%-33% Delayed treatment leads to abscess in 4.6 - 11%

    3. Choosing the Article Premedline Title word search only Breast, Abscess and Lactational

    4. Aims Assess contributing factors to puerperal breast abscess formation Evaluation of treatment options of breast abscesses

    5. Study Design Criteria for inclusion Self presentation through outpatient with clinical signs of mastitis or abscess Prospective Study Not Randomised - Trial of aspiration

    6. Method 4yrs (May 97 - May 01) 128 Nursing women presented 102 (80%) = mastitis 26 (20%) = abscess USS in all cases Amoxicillin/clavilunate 1g bd orally 1/52 Milk cultures

    7. Method Abscess - 18 gauge needle aspiration with irrigation of sterile saline USS guidance Successful - every second day until USS = clear Unsuccessful = (thick pus) surgical drainage with LA

    8. Results

    9. Results Mastitis All were symptom free after 1/52 of Antibiotics None progressed to Abscess

    10. Results Aspiration Surgical 10 (38%) 16 (62%) Mean healing time days 8.6 (5-12) 10 (6-15) 13 (10.2%) - recurrent breast infection during FU (11 mastitis and 2 abscesses) 9 (7%) Previous mastitis while breast feeding

    11. Conclusions Not clear - incorporated into discussion Mastitis inevitable in some percentage of lactating women due to faulty nursing technique Regularly empty breasts helps to prevent abscess formation - not an end point from this paper Time is a factor in abscess formation. Significant finding in this study. Conclusion = Treat early Treat nipple cracks USS great clinical value for diagnosis and follow up

    12. Conclusions In selected cases the abscess can be drained with needle aspiration. No selection made Clinical significance of 38% reduction in patients requiring surgery

    13. Conclusions

    14. Conclusions Niebyl and co workers mastitis is a subcutaneous cellulitis and isolating organisms form milk may not always be possible, so milk culture is not important in guiding the therapy. Paper from 1978 Better knowledge and application of antibiotics

    15. Strengths and Weaknesses All pts had USS Clinically positive abscesses were not detected by USS in 34% - 50% of patients thought to have one Endpoints not clearly met Not controlled FU of mean 24 weeks

    16. Application of the Study Treat mastitis early Possible trail of aspiration If fails - ?Continuous catheter drainage If fails - Surgical Inscision and Drainage

    17. ATTENTION!!!!! DINNER FOR CONSULTANTS/ REGISTRARS AND RMOS 16th MAY - This Friday FOX STUDIOS PLEASE CONFIRM AND PAY ASAP

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