Objective— To study the lactational and hormonal responses to nasal administration of thyrotrophin‐releasing hormone (TRH) in puerperal women with inadequate lactation. Design— Prospective randomized double‐blind placebo‐controlled study. Subjects— 19 puerperal women with inadequate lactation (<50% of normal milk yield) on the 5th day postpartum. Interventions— 10 women were allocated to receive TRH administered by a nasal spray of 1 mg, four times daily, between suckling episodes, for 10 consecutive days starting on day 6 postpartum. Nine women were allocated to receive placebo sprays. Main outcome measures— Daily milk yield, serum levels of prolactin and thyroid hormones. Results— Before treatment all the women had significant prolactin responses to TRH and suckling stimuli. At the end of 10 days of treatment, milk yield increased significantly in the TRH group from a mean of 142–0 (SD 33.9) to 253–0 (SD 105.3) g/day (P = 0.014). There was no significant change in the placebo group. Basal prolactin levels increased from a mean of 117–4 μg/1(SD 45.2) to 173–3 μg/1 (SD 55.5) (P < 0.001) in the TRH group whereas in the placebo group prolactin levels decreased from 137–2 (SD 69.5) to 82–0 (SD 37.7) μg/1. A further rise in prolactin levels and milk yield was seen in seven women in the TRH group who received a second 10‐day course of TRH treatment at their own request. There was no significant change in levels of thyroid stimulating hormone, thyroxine and triiodothyronine during treatment in either of the two treatment groups and no signs of hyperthyroidism. Conclusion— Repeated nasal TRH administration between suckling episodes may improve defective lactation.
Non-puerperal mastitis was diagnosed in 79 patients (aged 12-77 years) over the years 1974-1984. Malignant neoplasm was not present. Bacterial infection in the region of the areola was the most frequent finding (40%), followed by abacterial inflammation without involvement of the nipples (29%). The other cases, bacterial or nonbacterial, occurred at different sites. The histological picture or clinical features of an increased secretory activity of the mammary gland (galactorrhoea, mastodynia) in addition to the mastitis was noted in 54 women. Causative organisms were proven in 53% of cases: Staph. aureus (41%) and coagulase-negative staphylococcus (41%), or anaerobic organisms (11%). Physical measures, antibiotics and bromocriptine were used as treatment. At the onset of treatment abscesses were already present or developed in 34 instances. In 28 cases one to six recurrences set in after the end of the treatment period. In 22 patients treated with bromocriptine prophylactically there were only two recurrences. In the majority of patients an increased alveolar secretion was important in the pathogenesis of the bacterial or abacterial inflammation. Prolactin-lowering treatment seems reasonable by itself in cases of abacterial mastitis, or in combination with antibiotics in bacterial mastitis. Recurrences can be prevented by long-term lowering of the peripheral prolactin level.
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