A Five-step Systematic Therapy for Treating Plugged Ducts and Mastitis in Breastfeeding Women: A Case-Control Study.

PURPOSE: This study aimed to describe the clinical response to five-step systematic therapy (FSST) in the management of plugged ducts and mastitis. FSST was a comprehensive milk stasis dredging treatment, which contained five steps to make the milk out of the plugged duct. METHODS: This retrospective study included 922 breastfeeding women, 714 with plugged ducts, and 208 with mastitis who received FSST from June to September 2017. The breast pain score, swelling degree, and range of breast induration were recorded pre-FSST and post-FSST. RESULTS: After a single FSST, pain score and swelling degree were significantly improved (both p < .001) in all cases. After FSST, the mean breast pain relief score was 1.69 ± 0.70, whereas the mean swelling fade away degree was 1.61 ± 0.62. In the subgroup analysis, pain score and swelling degree were significantly improved (both p < .001) in the plugged ducts group and the mastitis group. The score of pain relief in the plugged ducts group was less than that in the mastitis group (1.63 ± 0.68 vs. 1.91 ± 0.70, t = 5.30; p < .001), whereas improvement of swelling fade away was greater in the plugged ducts group than the mastitis group (1.65 ± 0.64 vs. 1.48 ± 0.56, t = 3.49; p = .001). The composition ratio of changes in induration range between the two groups was statistically different (Pearson χ2 = 137.87, p < .001), of which more obvious improvement in the plugged ducts group than the mastitis group (χ2 = 25.65, p < .001). CONCLUSION: FSST can relieve pain, reduce breast swelling and range of induration, and for plugged ducts or mastitis varied degree differently.

Clinical Factors Affecting the Therapeutic Efficacy of Evening Primrose Oil on Mastalgia.

BACKGROUND: Saturated fatty acid esters may cause mastalgia via hypersensitivity of breast epithelium to circulating hormones. Evening primrose oil (EPO) may restore the saturated/unsaturated fatty acid balance and decrease sensitivity to steroidal hormones or prolactin. Conflicting results exist regarding EPO treatment for mastalgia. The aim of this study was to determine the effectiveness of EPO and factors affecting its efficacy in treatment of mastalgia. METHODS: The study included 1015 patients, ages 14-82 (mean age 42.21 ± 10.8), admitted to Acibadem Breast Clinic between January 2015 and March 2018. The patients were divided into group I (n = 581) treated with EPO (1300 mg, twice a day) and group II (n = 434) treated with paracetamol (500 mg, twice a day). The visual analog scale was used to assess EPO's therapeutic efficacy, compared with paracetamol, measured at admittance, 2 weeks, and 6 weeks. Clinical factors affecting the efficacy of EPO were analyzed. RESULTS: The therapeutic efficacy of EPO on mastalgia was significantly higher than with paracetamol (p < 0.001). Factors significantly affecting the efficacy of EPO treatment were hormone replacement therapy (HRT), IUD-with-levonorgestrel, iron deficiency, overt hypothyroidism, and Hashimoto thyroiditis (p < 0.01). Replacement of iron or thyroid hormone efficiently treated mastalgia in patients that did not respond to EPO treatment. Side effects (allergy, anxiety, blurred vision, constipation, and nausea) were rare and not statistically significant (p = 0.88). CONCLUSION: EPO can be used in the treatment of mastalgia without significant side effects. HRT, IUD-with-levonorgestrel, iron deficiency, overt hypothyroidism, and Hashimoto thyroiditis significantly affect the efficacy of EPO on mastalgia.

Evaluation of the effect of omega-3 fatty acids in the treatment of premenstrual syndrome: "a pilot trial".

INTRODUCTION: Premenstrual syndrome (PMS) refers to a cyclic appearance of somatic and psychiatric symptoms that affect some women. Finding an effective and safe method for the treatment of PMS has always been a serious concern, because approximately 40% of women report PMS, and in 2-10% of cases it is severe enough to affect their life style and job. OBJECTIVE: The purpose of the present study is to evaluate the effect of omega-3 fatty acids on the treatment of PMS. METHOD: A randomized double blind controlled trial was performed on 184 eligible women. The eligible women were randomly assigned into two groups. The number of women who have finalized the study with us was 124. In the case group (omega-3 group = group A, n = 70), omega-3 in an amount of 2 g was prescribed for a one per day basis on a single dosage (two 1 g pearls), and in the control group (placebo group = group B, n = 69) 2 placebo soft gel, which were completely similar to omega-3 soft gels, were prescribed. The severity and duration of each of the symptoms were compared in both groups 1.5 and 3 months after the beginning of treatment. RESULTS: There were no significant differences between the two groups according to age, BMI, level of education, and the severity and duration of primary symptoms. After 45 days from starting omega-3, the mean severity of depression (P = 0.03), anxiety (P = 0.02), lack of concentration (P = 0.03) and bloating (P = 0.02) in the case group, were all significantly lower than in the control group. The duration of depression (P = 0.04) and bloating (P = 0.031) in the case group were less than in the control group. After 90 days from starting the treatment, the mean severity of depression (P = 0.007), anxiety (P = 0.004), lack of concentration (P = 0.009), bloating (P = 0.004), nervousness (P = 0.01) and the duration of depression (P = 0.01), nervousness (P = 0.02), anxiety (P = 0.03), lack of concentration (P = 0.02), bloating (P = 0.004), headache (P = 0.04) and breast tenderness (P = 0.02) were all lower in the case group. CONCLUSION: It appears that omega-3 fatty acids may reduce the psychiatric symptoms of PMS including depression, nervousness, anxiety, and lack of concentration and may also reduce the somatic symptoms of PMS including bloating, headache and breast tenderness. These effects increased by longer duration of treatment.

Effectiveness of external Sanjierupi Gao on mastalgia caused by mammary gland hyperplasia: a placebo controlled trial.

OBJECTIVE: To evaluate the curative effect of external application of the Chinese drug, Sanjierupi Gao, on mastalgia caused by mammary gland hyperplasia. METHODS: This randomized, double-blinded, and placebo controlled study enrolled 260 patients with mammary gland hyperplasia from five hospitals. Patients were randomly and equally divided into a Sanjierupi Gao treatment group and a placebo control group. An adhesive plaster was applied to the most painful area on either breast for 7 h a day. Treatment lasted for two menstrual cycles without application during menstruation. Mastalgia was used as the main index of curative effect. The change before and after treatment in days of mastalgia, the time to alleviate pain, pain extent, and severe pain scores were observed. RESULTS: Compared to the control group, the treatment group had significantly fewer days of mastalgia (P < 0.01), a significantly lower severe pain score (P < 0.01), and significantly less subjective pain and tenderness (P < 0.05 and P < 0.01, respectively). Three days before the follow-up visit, the pain score in the treatment group was significantly lower than that in the control group (P < 0.05). A non-parametric test was used to compare the time to alleviate mastalgia between the two groups and found no statistical difference (Z = -0.313, P = 0.754). CONCLUSION: Application of Sanjierupi Gao can decrease mastalgia duration in patients with mammary gland hyperplasia during menstruation and alleviate the extent of mastalgia. The time to alleviate pain is psychologically influenced.

Enfermedad de zuska. Diagnóstico en atención primaria / Zuska disease. Diagnosis and treatment in primary care

Una fístula es una comunicación anómala patológica que comunica 2 órganos entre sí o con el exterior. Son trayectos fibrosos con revestimiento interno de tejido de granulación, que se extienden desde un orificio interno o primario hasta uno o varios orificios externos o secundarios situados en la piel. La constante recidiva de una mastitis suele ser consecuencia de una fístula entre conductos galactóforos y el límite areola-piel de la mama, llamándose a esto fistulización periareolar recidivante. Para integrar este cuadro en la terminología propuesta, enfermedad de Zuska, es indispensable pensar primero en su existencia para enfocar el tratamiento en su origen. El conocimiento de esta enfermedad y su diagnóstico y tratamiento correctos impedirán las constantes recidivas en forma de mastitis que presentan estas pacientes, evitando así su peregrinaje por distintos especialistas. En este artículo revisamos esta entidad, métodos diagnósticos y tratamiento (AU)

A fistula is an abnormal pathological communication which links two organs together or with the exterior. They are fibrous paths internally coated with granulation tissue, extending from an internal o primary opening to one or more openings located outside or on the skin. The recurrent mastitis that some patients suffer is due to a fistula between a lactiferous duct and the limit of the areola, and this condition is called a recurrent periareolar fistula.To incorporate this clinical condition into the proposed terminology, Zuska disease, is essential to believe in its existence, in order to to treat it from the source. The knowledge of this disease, a proper diagnosis and treatment will prevent the constant recurrence of mastitis as presented by these patients, avoiding their pilgrimage to various specialists. In this article we review this disease, methods of diagnosis and treatment (AU)

Acupuncture for treatment of noncyclic breast pain: a pilot study.

Noncyclic breast pain is a common breast disorder prompting women to seek medical evaluation. We aimed to perform a pilot study on the relief of noncyclic breast pain using acupuncture. Thirty-seven women seen at a diagnostic breast clinic between April 2003 and January 2009 were enrolled. Treatment consisted of four acupuncture sessions over two weeks, with three months of follow-up. Response to treatment was measured with use of a breast pain questionnaire, a quality of life (QOL) questionnaire, and the Cleeland Brief Pain Inventory (BPI) assessed at baseline, end of treatment, and three months after treatment. Data were analyzed using standard descriptive statistics. Twenty-two patients completed four acupuncture sessions. Pain described as throbbing and heavy decreased significantly after acupuncture (p = 0.04 and p = 0.03, respectively). After treatment, pain scores (on the 10-point BPI scale) decreased by an average of 3.5 points for the worst pain during the previous month (p = 0.001), by 2.7 points for average pain (p < 0.001), and by 2.3 points for pain interference (p = 0.002). The percentage of patients reporting a clinically meaningful decrease of 2 points from baseline to the end of treatment included 67% (12/18) for the worst pain, 65% (11/17) for average pain, and 56% (10/18) for pain interference. QOL data showed no improvement in QOL measures (mental, physical, emotional, social, or spiritual well-being). The results of this preliminary study suggest that a randomized controlled trial may be warranted to evaluate the effect of acupuncture on noncyclic breast pain, as well as the optimal frequency of acupuncture treatments.

Dor mamária: propedêutica e terapêutica / Breast pain: propaedeutic and therapeutic

Mastalgia é um dos sintomas mais comuns em mulheres, tendo uma prevalência de 41 a 69% e pode se apresentar como um leve desconforto até dor severa, que interfere na qualidade de vida. A principal preocupação das pacientes que consultam por este sintoma é o medo do câncer. Essa é classificada em mastalgia cíclica, acíclica ou extramamária. Cíclica quando se apresenta no período pré-menstrual; na acíclica não há relação com o ciclo e, geralmente, acomete pacientes na pós-menopausa. A extramamária é a dor referida na mama, porém usualmente é de origem musculoesquelética. Na presença de achados clínicos e radiológicos normais, aproximadamente 85% das pacientes melhoram apenas com orientação e tranquilização, não necessitando de medicação. Foi realizada uma revisão sistemática para avaliar as possibilidades terapêuticas e seus níveis de evidência. Os anti-inflamatórios não esteróides tópico, para mastalgia cíclica ou acíclica, e o fitoterâpico Agnus castus, para mastalgia cíclica, demonstraram boa eficácia e tolerabilidade e podem ser usados como medida inicial. O tamoxifeno e o danazol são medicamentos eficazes, porém apresentam mais efeitos colaterais. Para casos especiais, ainda há a alternativa de usar bromocriptina e goserelina. O manejo da dor mamária pode ser sintetizado em três itens: excluir câncer, orientar e tranquilizar ao máximo e medicar ao mínimo.(AU)

Breast pain or mastalgia is one of the most common symptoms in women, with a prevalence ranging from 41 to 69%. It presents as a mild discomfort to severe pain, that interferes with the quality of life. The main concern of patients consulting for this symptom is the fear of cancer. It is classified as cyclical, acyclical or extra-mammary. When presented during the premenstrual period, it is cyclical; acyclical, when not cycle-related and usually affects patients in post-menopausal. Extra-mammary is the breast referred pain, but it is usually of muscle-skeptical origin. In the presence of normal clinical and radiological findings, approximately 85% of patients improve only with reassurance, not requiring medication. A systematic review was performed to assess the therapeutic possibilities and their evidence levels. Topical non-steroidal anti-inflammatory drugs, for cyclic or acyclic mastalgia, and the phytotherapic Agnus castus, for cyclic mastalgia, showed good efficacy and tolerability and can be used as an initial measure. Tamoxifen and danazol are effective drugs, but they present more side effects. For special cases, there is the alternative of using bromocriptin and goserelin. Breast pain management can be summarized in three items: exclude cancer, maximum reassurance and minimum medication.(AU)