Dysphoric milk ejection reflex: A case report

Background

Breastfeeding and complementary feeding practices have profound implications for the maternal and child health status of a society. Feeding practices in Pakistan are suboptimal, leading to adverse outcomes on child health. In Pakistan, the Maternal, Neonatal and Child Health (MNCH) Program, in collaboration with several international organizations, including WHO and UNICEF, is working to improve these feeding practices in the country. The aim of this paper is to evaluate the effectiveness of these programs.

Methods

Estimates on the various indicators for infant and young child feeding proposed by WHO were analyzed in light of the Pakistan Demographic and Health Surveys (1990-91 and 2006-07) and several other national studies conducted since 1995.

Results

Nearly half the core and optional indicators have improved over the years, though modestly; the others have demonstrated no statistically significant improvement over the years. Of the five indicators required in the WHO tool for the assessment of infant and young child feeding, introduction of complementary foods, bottle-feeding, and early initiation of breastfeeding, stand in the poor category, while exclusive breastfeeding and duration of breastfeeding fall in the fair category, suggesting an overall poor status.

Conclusions

There is considerable scope to improve breastfeeding and complementary feeding in Pakistan. Further programs should focus on improving the following indicators that have shown no significant development: early initiation of breastfeeding, exclusive breastfeeding under six months, continued breastfeeding at two years, age appropriate feeding, and bottle feeding. Effective implementation of interventions that are known to improve breastfeeding practices is imperative, as is further research to yield data that can lead future endeavors.     

The influence of tactile stimulation of nipples on the milk ejection reflex in the rat

Summary Changes of positive pressure exerted by pups on nipples during sucking were investigated using anesthetized, lactating dams. It was found that, every 50–60 s, individual pups performed bouts of pressure oscillations (3/s) of high amplitude which lasted about 10–12 s and coincided with periods of increased motor activity. During the intervals, when pups were quiet, series of low-amplitude oscillations (3/s) were also observed. Using a strain measuring method to record the activity of sucking pups, synchronization of activity of two or more pups was found to occur periodically every 25–30 s and, most frequently, 10–30 s before the reflex increase of milk pressure. In further experiments, artificial tactile stimulation was applied to the dam's nipples using the joint action of suction and positive pressure. Following a short-term (10–20 s) increase in frequency and amplitude of artificial nipple stimulation, 60%–80% of all reflexive peaks of milk pressure were elicited with a latency of 19 ± 5 s. This suggests that there are specific conditions under which the stimulation of nipples by pups may trigger the formation of the milk ejection reflex in the rat.Abbreviation MER milk ejection reflex     

Dynamics of milk ejection reflex during continuous rhythmic stimulation of areola-nipple complex of the mammary gland

In continuous 10-minute simultaneous action of the vacuum and compression stimuli at a 1 cycle/second frequency, the rate of the milk ejection from the breast was periodically changing in lactating women. The milk flow first peaks latency was 0.5-3.0 minutes, the number of peaks being 2-7 per minute with the inter-peak interval 2-4 minutes during a 10-minute milk ejection. The women revealed an individual pattern of the milk flow peaks. The findings suggest that a central gate mechanism intervenes to set the periodicity of the milk ejection.     

Intestinal malrotation with suspected cow's milk allergy: a case report

ABSTRACT: BACKGROUND: Intestinal malrotation is an incomplete rotation of the intestine. Failure to rotate leads to abnormalities in intestinal positioning and attachment that leave obstructing bands across the duodenum and a narrow pedicle for the midgut loop, thus making it susceptible to volvulus. One of the important differential diagnoses for malrotation is an allergy to cow's milk. Several studies have described infants with surgical gastrointestinal diseases and cow's milk allergy. However, to our knowledge, no study has reported infants with intestinal malrotation who have been symptomatic before surgery was performed and have been examined by allergen-specific lymphocyte stimulation test and food challenge tests with long-term follow-up. CASE PRESENTATION: The patient was a Japanese male born at 39 weeks of gestation. He was breast-fed and received commercial cow's milk supplementation starting the day of birth and was admitted to our hospital at 6 days of age due to bilious vomiting. Plain abdominal radiography showed a paucity of gas in the distal bowel. Because we demonstrated malpositioning of the intestine by barium enema, we repositioned the bowel in a normal position by laparotomy. The patient was re-started on only breast milk 2 days post surgery because we suspected the presence of a cow's milk allergy, and the results of an allergen-specific lymphocyte stimulation test showed a marked increase in lymphocyte response to kappa-casein. At 5 months of age, the patient was subjected to a cow's milk challenge test. After the patient began feeding on cow's milk, he had no symptoms and his laboratory investigations showed no abnormality. In addition, because the patient showed good weight gain and no symptoms with increased cow's milk intake after discharge, we concluded that the present case was not the result of a cow's milk allergy. At 1 year, the patient showed favorable growth and development, and serum allergy investigations revealed no reaction to cow's milk. CONCLUSION: When physicians encounter infants with surgical gastrointestinal disease, including intestinal malrotation, they should consider cow's milk allergy as a differential diagnosis or complication and should utilize food challenge tests for a definitive diagnosis.     

Cytology of urate milk in gouty arthritis: a case report

BACKGROUND: Synovial fluid (SF) analysis is a useful investigative procedure in the evaluation of various types of arthritides, including gouty arthritis. Rarely, gouty arthritis may present with effusion containing thick, milky white fluid. We report a case of gouty arthritis, describing cytologic features of the urate milk. CASE: A 42-year-old man presented with pain and swelling of multiple joints of long duration. Approximately 3 mL of milky white SF was obtained for white blood cell (WBC) count, with a clinical diagnosis of septic arthritis. Due to the gross nature of the sample, the WBC count could not be performed; however, cytologic examination of the sample revealed a massive amount of classic, needle-shaped urate crystals on routinely stained May-Grünwald-Giemsa smears, favoring a cytologic diagnosis of gouty arthritis. CONCLUSION: Gouty synovitis occasionally presents with thick, milky white urate-laden synovial effusions, which clinically may be mistaken for septic arthritis. This gross nature of the specimen may interfere with the performace of a WBC count on SF samples.     

Lipodermoid: A case report

Lipodermoids are epibulbar, developmental growths of normal adipose in an abnormal site, ie. near the lacrimal gland and extending between the superior rectus and lateral rectus muscles posteriorly. Differentiation of benign lipodermoids from non-benign lesions is essential. When other ocular anomalies or systemic conditions are found in conjunction with lipodermoids then Goldenhar-Gorlin syndrome must be considered. This paper presents a case of unilateral lipodermoid and scoliosis in an otherwise healthy adult male.     

Effect of prostaglandins on milk ejection.

Prostaglandins (PGs) of type F2 alpha, E1, and E2 have been reported both, to inhibit or to facilitate posterior pituitary oxytocin release in lactating animals and women, and to suppress or to stimulate the mammary myoepithelium. Prostaglandin-induced milk ejection in women and cows has been attributed to central oxytocin release, but no oxytocin blood levels were determined. Moreover, for lactating cows, sows, rabbits, guinea pigs, and rats a direct PG effect on the mammary myoepithelium resulting in milk ejection has been suggested. On the other hand, PGs were found to antagonize the milk-ejection response to oxytocin in rabbits and rats. The mechanisms involved in PG synergism or antagonism of oxytocin-induced milk ejection are not understood. Studies in lactating rats showed that blood pressure active PG doses of F2 alpha, E1, and E2 largely inhibited the intramammary pressure response to oxytocin. Whereas the oxytocin-antagonistic action of PGF2 alpha was not affected by adrenergic blockers (phenoxybenzamine, propranolol), the anti-oxytocin effects of PGE1 and E2 were eliminated after alpha-receptor blockade while the activity of oxytocin increased. Under beta-receptor or alpha- plus beta-receptor blockade, the oxytocin-inhibitory effects of PGE1 and E2 were almost abolished. Mechanisms of PG-induced inhibition of the oxytocin response may involve mammary vascular changes and/or alterations in myoepithelial activity of cyclic adenosine-3,5-monophosphate (c-AMP), cyclic guanosine-3,5-monophosphate (c-GMP), and phosphodiesterase (PDE). It seems unlikely that PGs bring about significant posterior pituitary oxytocin release in rats.     

Choroidal metastasis: A case report

Choroidal metastases can display a broad spectrum of clinical signs and symptoms. Due to the fact that they often appear similar to a host of other ocular conditions, the diagnosis may be difficult without a prior history of malignancy. In many instances, ocular symptoms may be the patient's first indication of a problem. A 70-year-old black female presented with multiple, bilateral uveal metastases. In addition to a complete report of this case, a discussion of the incidence, appearance, symptoms, differential diagnoses, etiology and treatment of uveal metastases is provided.     

Echocardiographic alterations in a child with cow's milk allergy: a case report

ABSTRACT: INTRODUCTION: Cow's milk allergy is the most frequent food allergy in Europe and western countries and shows a wide spectrum of clinical features, including atopic dermatitis and gastrointestinal disease. To the best of our knowledge, this report is the first to describe Kawasaki disease-like clinical features and echocardiographic alterations which resolved after a cow's milk-free diet. CASE PRESENTATION: We report a case of a 9-month-old Caucasian girl with atopic dermatitis who developed clinical features commonly present in Kawasaki disease (erythematous skin rash, non-exudative conjunctivitis, fissured lips and neck lymph nodes), together with mild echocardiographic alterations (perivascular brightness, pericardial effusion) in the absence of fever. These features resolved within 2 weeks after the beginning of a cow's milk-free diet. CONCLUSION: Kawasaki disease has recently been considered a possible risk factor for subsequent allergic disease secondary to immune dysfunction. This case report suggests that the immune-related alterations which are commonly present in allergic patients could be similar to the antigen-related immune response in Kawasaki disease and thus could lead to similar clinical features.     

Feline sporotrichosis: A case report

The isolation of Sporothrix schenckii from a female European cat it is described. The cat showed lengthened alopecic areas, with prominent nodules in the external surface of the thighs and abdomen. A mycological and histopathological studies of the lesions were carried out. The lesions resolved under treatment with 20% potassium iodide in doses of 0'1 ml/kg oral route in a 8 weeks period.     

A review of the behavioural mechanism of milk ejection of the domestic pig

The domestic pig has complex nursing and suckling behaviour, consisting of several distinct phases of suckling by the piglets and a characteristic pattern of grunting by the sow. A review of observations and experimental findings suggests cause-and-effect relationships between the different elements of sow and piglet behaviour, and the relationship of the behaviour to milk ejection. Characteristic features of pig nursing and suckling behaviour are interpreted as an adaptation promoting even distribution of milk among a number of precocious litter-mates.     

Allergy to lingonberry: A case report

Past few years cranberry/lingonberry products have been incorporated as healthy products to the US and European market as prophylaxis of recurrent urinary tract infections in young women as well as in chronic infections in elderly which because of there are many biological activities attributed to the that fruit is a very popular additive to the new diets. To the best of our knowledge, this is the first case of allergy to lingonberry. We speculate that previous exposure to lingonberry products could be sensitising. The symptoms, timing of the episode, positive skin test, IgE-ELISA and western-blot strongly support the role of lingonberry as the causative agent.     

Straining urethral reflex: description of a reflex and its clinical significance. Preliminary report

The present communication describes a reflex, which I call 'straining urethral reflex', and discusses its clinical significance. The study was performed on 17 healthy volunteers with a mean age of 39.6 years. The intrarectal pressure (representative of the intra-abdominal pressure) was measured by means of a balloon-tipped catheter introduced into the rectum and connected to a pressure transducer. A concentric needle electrode was introduced into the external urethral sphincter. The subject was asked to strain, and the urethral sphincter electromyographic activity and the intrarectal pressure were recorded. Two types of straining were investigated: sudden and slow. The procedure was repeated in 10 subjects after urethral sphincter infiltration with xylocaine or saline. On sudden straining, the external urethral sphincter contracted. The anesthetized sphincter did not respond, while the saline-infiltrated sphincter responded to sudden straining. Slow sustained straining did not evoke the reflex response. The latency of the reflex was calculated. The external urethral sphincter contraction on sudden straining guards against the involuntary opening of the vesical neck and urinary leak under stress conditions of a sudden increase in the intra-abdominal pressure. The reflex may prove significant in the diagnosis of micturition control disorders. It can thus be included as an investigative tool in urologic practice.     

一例皮下脂膜炎样T细胞淋巴瘤的报告

目的分析皮下脂膜炎样T细胞淋巴瘤的临床表现及病理组织学特征,探讨其诊断和治疗方法,提高临床医生对该病的认识。方法对1例面部和下肢浮肿及全身多发硬结1月余,发热1周的患者临床表现的演变、确诊时的组织病理学特点、免疫组织化学结果等多方面进行观察。结果皮肤活检发现组织学病变主要局限于皮下脂肪间质内见核深染的异型细胞弥漫分布或环绕脂肪细胞分布。免疫组化示CD3+,CD8+,CD68+,TiA-1+,G-B+,CD20-,CD7-,TDT-,提示为T细胞来源。治疗(环磷酰胺+长春新碱+表阿霉素)1疗程患者自动出院回家。结论皮下脂膜炎样T细胞淋巴瘤是一种特殊类型的原发性皮肤淋巴瘤,对不明原因的全身皮肤多发硬结伴发热的患者应该考虑该病的可能。病损处皮肤活检是确诊该病的主要手段。治疗常用联合化疗,如CHOP方案。本病预后较差。