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Journal Club 12/05/03

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Journal Club 12/05/03 Breast Abscesses in Lactating Women Cenap Dener, MD. Aydin Inan, MD World Journal of Surgery 27, 130-133, 2003 Brief overview of topic Breast ... – PowerPoint PPT presentation

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Title: Journal Club 12/05/03


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 ID, 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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