Plugged Ducts Research Articles

Integrated breast massage versus traditional breast massage for treatment of plugged milk duct in lactating women: a randomized controlled trial

BackgroundPlugged milk duct during lactation is a common problem in breastfeeding. Traditional breast massage (TBM) has been performed in Thailand with reasonable outcomes, but several follow-up sessions are often required. A new massage technique, the integrated breast massage (IBM), was subsequently developed. This study aimed to compare resolution time, reduction in mass size, and pain score after breast massage between the IBM and TBM techniques.MethodsThis randomized controlled trial was conducted at the Lactation Clinic of the Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand during February 2019-July 2020. Women presenting with acute plugged milk duct were enrolled and randomly allocated to the IBM or TBM/control groups. Mass size in square centimeters (cm2) was calculated by multiplying the perpendicular axes of the mass. Pain score was self-scored by participants using a numerical rating scale. Median time (95% confidence interval [CI]) to resolution of plugged milk duct was derived using Kaplan–Meier survival analysis. Intention-to-treat analysis was performed.ResultsEighty-four women (42 per group) were included. All enrolled study participants completed the study and were included in the final analysis. Twenty-six (61.9%) and 25 (59.5%) participants from IBM and TBM, respectively, had mass diameter > 5 cm. The median (interquartile range [IQR]) mass size was 30 (20–48) and 20 (12–14) cm2 in IBM and TBM (p = 0.05), respectively. The median (95% CI) time to resolution of plugged duct was 0 (not available) and 1 (0.47–1.53) day in IBM and TBM, respectively (p < 0.01). After the first breast massage, the median (IQR) size of mass reduction was 30 (20–48) and 10 (10–26) cm2 in IBM and TBM, respectively (p = 0.01). The median (IQR) reduction in pain score was 8 (7–8) and 6 (4–7) in IBM and TBM, respectively (p = 0.01). No participants developed skin bruising or hematoma after breast massage.ConclusionsThe IBM technique resolved plugged milk duct significantly faster, with significantly less pain, and with significantly greater reduction in mass size after the first massage compared to TBM.Trial registrationRetrospectively registered in the Thai Clinical Trials Registry on 25 September 2019 (TCTR20190925001).

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

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. 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. After a single FSST, pain score and swelling degree were significantly improved (bothp<.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 (bothp<.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). FSST can relieve pain, reduce breast swelling and range of induration, and for plugged ducts or mastitis varied degree differently.

Structural organization of the orbital lobe of the human lacrimal gland

Вackground. In the last two decades, interest in the study of the morphology of the human lacrimal glands has increased significantly again and in the conduct of experiments with frequent diagnostics of «dry eye» syndrome in ophthalmology practice in relatively young people. Thus, we believe that this problem is relevant at the present time. Objective. The aim of the study is to study general biological regularities and specific features of the morphology and spatial organization of the excretory duct system and their terminal sections of the human lacrimal gland in syntopic unity with the hemomicrocirculatory bed. Methods. The glands were fixed in a 10% solution of neutral formalin. After traditional embedding in paraffin, histological sections with a thickness of 5 μm were obtained, which were stained with hematoxylin and eosin. A series of histological sections were sequentially photographed, and they served as the basis for the selective study of the necessary structures of the lacrimal gland, as well as two-dimensional photoreconstruction. Results. In our studies, we proceeded from the fact that the lacrimal glands, like the salivary glands, is a polymer organ that has its own specificity of syntopic relationships in three-dimensional space. Therefore, at first research, we needed to identify the level of structural organization of diverse tissues of the human lacrimal gland, which would correspond to the concept of a structural-functional unit. In our opinion, it can be considered a particle of the orbital lobe of the lacrimal gland. Here, the ducts are located radially with respect to the axially intralobular duct. Such a duct is capable of integrating one or another number of alveolar-tubular assemblies resembling typical adenomeres (sublobular unit). Conclusion. Thus, an ordinal analysis of a series of histological sections and a decomposition analysis of photoreconstructions allows us to conclude that the orbital lobe of the human lacrimal gland consists of numerous particles that have practically the same structural principle, and we have previously studied and described lobules of the palpebral lobe jf the lacrimal gland, as well as small salivary glands. Each lobule has several axial excretory intralobular ducts. Their ramifications throughout are surrounded by secretory epithelial components in the form of terminal sections and the smallest terminal lacrimal ducts corresponding to them, which together form the structural elements of the groin-like shape. The longest and largest in caliber ducts of the lacrimal gland are located outside the aisles of particles. As a result of this structure, on some histological sections, we see only relatively large lumens of the ducts and their walls (epithelial zone) in the immediate vicinity of the integumentary epithelium of the conjunctiva, and on others - small-caliber ducts up to their final saccular extensions, forming sublobular units. Since the ducts corresponding to the plugged ducts of the salivary glands in the lacrimal glands are absent, there is no clear visible border between them and the terminal sections. When examining the sections, it seems that the terminal sections of the lacrimal glands do not have a separate connecting segment with the system of excretory ducts.

Current Resources for Evidence-Based Practice, January/February 2020.

Current Resources for Evidence-Based Practice, January/February 2020.

Mastitis and/or plugged ducts? How to differentiate, help and treat?

Mastitis is one of the most common pyoinflammatory processes that occur in the postpartum. The mastitis incidence varies from 0.5% to 33%. Due to lack of standard algorithms, approaches to diagnosis and treatment of lactational mastitis vary between pediatricians and obstetrician-gynecologists. Plugged ducts is the basic factor that predisposes a woman to plugged milk ducts, which can lead to mastitis. Unfortunately, frequently prescribed antibacterial treatment has an adverse effect on human milk microbiota and creates subtherapeutic drug concentration in milk, which leads to antibiotic resistance in infants. Effective expression of breast milk is a key method to prevent and fight mastitis and plugged ducts. Recommendations for preferred method of breast milk expression require a personalized approach, the first of which depends on the assessment of breast nipples condition. According to some reports, 80–90% of breast-feeding women develop soreness and cracked nipples, which cause delayed or missed breastfeeding. Teaching correct breast-feeding techniques can prevent the chain of these adverse events:cracked nipples – plugged duct – lactation mastitis.Ideally, a healthy mature infant with active sucking reflex, who is breastfed effectively with a good technique, may perfectly ensure a problem-free lactation period.

An Alternative Treatment

Mothers with persistent, reoccurring issues with plugged milk ducts in their breasts are usually in great amounts of pain and, therefore, at great risk for premature weaning. Why some mothers struggling with this issue seems unclear, but there is a treatment option that can offer immediate relief and perhaps a permanent resolution of these trouble areas in the breast. Using ultrasound treatment of the affected area of the breast is a highly effective, last resort treatment, but most IBCLCs do not have access to healthcare providers to refer to for this procedure. In this article, plugged duct treatments will be discussed with a focus on the specifics of using ultrasound for resolving this issue.

Six-Step Recanalization Manual Therapy: A Novel Method for Treating Plugged Ducts in Lactating Women.

Plugged ducts are a common, painful condition in lactating women, but no standard treatment is currently available. This study aimed to evaluate the clinical efficacy of a newly established 6-step recanalization manual therapy (SSRMT) for treating plugged ducts. This observational study included 3497 lactating women with plugged ducts. The SSRMT comprised the following well-defined steps: (1) preparation, (2) clearing the plugged duct outlets, (3) nipple manipulation, (4) pushing and pressing the areola, (5) pushing and kneading the breast, and (6) checking for residual milk stasis. The response to the treatment was graded as I (complete resolution), II (marked improvement), III (improvement), or IV (no response). Of the 3497 patients, the mean age was 26.7 years and 3284 (93.9%) patients were primiparas. Fever was present in 1231 (35.2%) patients. After a single SSRMT treatment, 3189 (91.2%), 173 (4.9%), and 83 (2.4%) patients achieved grade I, II, and III responses, respectively, with only 52 (1.5%) showing unresponsiveness. For the 308 (8.8% of total) non-grade I patients, a second SSRMT given 3 days later resulted in grade I, II, and III responses in 267 (7.6% of total), 28 (0.8% of total), and 13 (0.4% of total) patients, respectively, and none were absolutely unresponsive. No complications with clinical significance were observed. Based on this large-scale clinical observation, SSRMT appears to be a useful, safe, low-cost treatment for postpartum plugged milk ducts.

Promoting Breastfeeding Self-Efficacy: Fear Appeals in Breastfeeding Management

Lactation consultants (LC) often use fear appeals when providing anticipatory guidance to mothers about breastfeeding. We mention that improper positioning or latch-on can lead to sore nipples or fissures, or that inadequate or irregular emptying can lead to plugged ducts, mastitis, or a diminished milk supply. Instead of motivating the mother to practice the recommended preventive measures, fear appeals can lead to lack of confidence and fear of failure. Instead, lactation consultants can increase the mother’s confidence in her ability to breastfeed by helping her envision success, manage self-defeating thoughts, and solve problems. This article explores how the Extended Parallel Process Model can be applied to lactation consultation to increase the probability that the lactation consultant’s message will be heeded rather than rejected.

Painful Breast Lumps in Nursing Mothers

Identifying and treating plugged ducts, mastitis, and abscess.Editor's note: AJN has revised this column to provide you with the latest evidence-based interventions to manage your patients' symptoms. If there's a topic you'd like us to address, please e-mail us and let us know.

Renal histopathology of stone-forming patients with distal renal tubular acidosis

To define the renal tissue changes in stone-forming patients with distal renal tubular acidosis (dRTA), we performed intra-operative papillary and cortical biopsies in five patients. The main abnormalities were plugging of inner medullary collecting ducts (IMCD) and Bellini ducts (BD) with deposits of calcium phosphate in the form of apatite; epithelial cell injury and loss was marked. Plugged ducts were surrounded by interstitial fibrosis, but the fibrosis was generalized, as well, and was a main feature of the histopathology even when plugging was not present. In contrast, common idiopathic calcium oxalate stone formers (SF) never manifest intra-tubule crystals or interstitial fibrosis. Patients with brushite (calcium monohydrogen phosphate) stones and those with cystine stones have many fewer IMCD and BD plugged with apatite (or cystine, in cystinuria), and interstitial fibrosis is limited to the regions around plugged ducts. Patients with dRTA often present a radiographic picture of nephrocalcinosis. Our direct surgical observations reveal that these may be surgically removable stones, especially in patients with well preserved renal function. In all, dRTA SF have a more diffuse papillary renal disease than other SF thus studied, and are also unusual for the degree of interstitial fibrosis.

Cystic fibrosis: Spectrum of thoracic and abdominal CT findings in the adult patient

Cystic fibrosis (CF) is an autosomal recessive disorder that is characterized by an abnormality of exocrine gland function. Adult patients represent a rapidly growing percentage of the CF population. Pulmonary changes are seen in nearly every case and are the most serious complication of CF. In advanced lung disease, bronchiectasis, emphysematous bullae, and subpleural blebs can frequently develop. Although pulmonary disease is the most common cause of death and morbidity among CF patients, there also can be involvement of other organs, particularly in adults, which show characteristic signs on CT and spiral CT. Pancreatic abnormalities are present in 85–90% of CF patients. The degree of pancreatic involvement varies, ranging from accumulations of mucus in the small ducts to totally plugged ducts, which can cause atrophy of the exocrine glands and progressive fibrosis. Pancreatic dysfunction on CT is demonstrated as fatty replacement and fibrosis of the pancreas. However, there may be scattered foci of pancreatic calcifications that can be detectable on plain radiographs. Hepatobiliary involvement follows the same pattern as pancreatic abnormalities. Bile canaliculi are plugged by mucinous material and when this plugging is of long duration, biliary cirrhosis with diffuse hepatic nodularity may develop. Such severe hepatic involvement is seen in only about 2–5% of patients, although minor hepatic alterations, such as diffuse fatty changes, are fairly common. Hepatobiliary involvement is characterized by hepatic nodularity, compatible with cirrhosis, splenomegaly, and ascites. Complete obstruction of the ileum by meconium occurs in approximately 10% of newborns with CF. Intestinal findings on CT include obstruction, although this is more common in children. These CT signs should be evaluated carefully in adult patients since they may be suggestive of CF. Computed tomography offers unique information about organ involvement (other than pulmonary) that can alter diagnosis and patient management.

A Descriptive Study of Lactation Mastitis in Long-Term Breastfeeding Women

This descriptive retrospective study surveyed women attending two lactation/breastfeeding conferences about their experiences with mastitis. One-third of the sample reported having mastitis while breastfeeding their last child. Episodes of mastitis occurred most often in the first three months postpartum; however, one-third occurred after six months and nearly one-quarter occurred after one year of breastfeeding. The outer upper quadrants of both breasts were found to be the most frequent sites of infection. The incidence of mastitis in the left and right breasts did not differ. More than one-third of the respondents did not contact their physician when they developed mastitis and and nearly half never used antibiotics for the infection. All respondents reported continuing to breastfeed through the infection. Mothers reported that the following factors (in order of importance) preceded their mastitis: fatigue, stress, plugged duct, change in the number of feedings, engorgement/stasis, an infection in the family, breast trauma and poor diet. Study findings indicate that the most important teaching areas for preventing mastitis are management and control of stress and fatigue.

Breastfeeding Problems Associated with the Early Introduction of Bottles and Pacifiers

Breastfeeding is a natural physiologic process upon which human survival has depended for uncounted generations. Natural selection over millions of years has ensured that breastmilk contains all the nutritional requirements of the newborn period and beyond. In order to prevent problems for the few, modern management of labour, delivery and the postpartum period has subjected most mothers and infants to routines which are contrary to the physiologic principles underlying successful breastfeeding. The early introduction of bottles may render suckling less effective or may result in breast refusal, thus paving the way for failure to thrive, hyperbilirubinemia, "colic" and crying, prolonged and frequent feedings, sore and cracked nipples for the mother, and it may contribute to the onset of plugged ducts and mastitis. Alternatives to bottles can be used when supplementation is thought to be indicated. They include using a lactation aid, finger feeding, or feeding with a cup, spoon, or eyedropper.

The utilization of an alcohol-local anesthetic solution in the treatment of the plugged duct cyst. A preliminary study.

The utilization of an alcohol-local anesthetic solution in the treatment of the plugged duct cyst. A preliminary study.