[Causes of lactation inhibition in the early puerperium (author's transl)]

In a retrospective study in 213 puerperal women, who had delivered at the 1st Department of Obstetrics and Gynecology of the University of Vienna before 1980, the individual cause for the primary or secondary inhibition of lactation with drugs in the early puerperium was evaluated. In 77.4% the lactation was carried out for maternal, in 22,6% for neonatal indications. Concerning the maternal causes in 23,9% the mother did not want to breast feed, in 17,8% "too little milk" and in 12,7% anamnestic breast-feeding problem at preceding deliveries were found. Maternal diseases were diagnosed in 9,4%, breast-feeding complications, like sore nipples, breast engorgement and mastitis in 5,2%, state after mammasurgery in 2.8%, an important drug therapy in 2,3%, sunken nipples in 1,9%, and several rare causes like adoption or arrest. Concerning the neonatal reasons prematurity was predominating in 16.9%, followed by antenatal fetal death and perinatal death in 3,3% and rarer diseases of the infant with reduced sucking power in 1,9% and one malformation (0.5%). Although several maternal and neonatal conditions still require the suppression of lactation, this could be avoided in a considerable percentage by adequate medical advise and encouragement for the patient. This should be a concern of all obstetricians today.

The acute breast abscess. Practical procedures

The female breast is a delicate organ which is prone to infection during lactation. Although the treatment plan outlined by the author appears simple we do not recommend routine treatment by the occasional operator. The breast should be treated with the utmost care and respect because irreversible distortion can result from the chronic inflammation and persistent discharge associated with delayed or inadequate drainage of the abscess.

[Treatment experience with acute suppurative lactation mastitis]

Results of the treatment of 518 patients with acute suppurative lactation mastitis are analyzed. Lactastasis and nipple cracks are found to be responsible for the appearance and development of the disease. The infiltrative form of mastitis was found in 1,2% of patients, abscess formation in 69,2%, phlegmonous form in 27,2% and gangrenous form in 2%. Sepsis was found to develop in 9,4% of patients. Complex therapy including antibiotics of wide spectrum of effect, infusive therapy with forced diuresis, immunologic drugs are recommended.

[Immunological reactivity of patients undergoing combined treatment of acute suppurative lactation mastitis]

The analysis of treatment of 769 patients with acute mastitis enabled the authors to recommend the method of active surgical treatment which allowed shortening the time of the hospital and following ambulant treatment of the patients. The immune reactivity was found to be decreased in patients with severe and continuous course of the disease. So, the complex therapy of such patients must include immunological drugs.

Prolactin, fluid balance and lactation

The hypothesis that prolactin may play a part in osmoregulation was investigated by given a hypotonic fluid load to two groups of normal lactating women. No changes in serum prolactin, milk yield, serum or breast milk osmolality were noted, suggesting that encouraging women to drink excessively has no effect upon lactation, either in terms of yield or composition of milk.

[Acupuncture therapy of hypogalactia]

Reference is made to the current tendency to reappraise breast feeding in the light of both medical and social-cultural considerations, and attention is called to the current lack of sound treatments for hypogalactia. The physiopathological mechanisms underlying this condition are examined, and an account is given of results obtained with acupuncture reflexotherapy in this field. The conclusion is drawn that the technique is effective, innocuous and well accepted.

[Characteristics of the course and treatment of mastitis]

From the experience with 106 mastitis cases it has been found that this condition occurs in women following pathologic pregnancy and delivery. The leading procedures of the treatment are the following: stimulation of protective forces of the body, control of anemia, broad dissection and drainage of the abscess and, in case of a suppurative-infiltrative form, sectoral resection.

Current management of the amenorrhea-galactorrhea syndrome

Management of the amenorrhea-galactorrhea syndrome has changed considerably in the last 5 years. Better understanding of the neuroendocrine physiology of the central nervous system in general, and of the hypothalamic-pituitary region in particular, have contributed significantly to our understanding of the pathophysiology of this syndrome. Greater awareness by physicians, improved neuroradiologic techniques, and the development of immunoassays for prolactin have markedly improved our diagnostic abilities. Many more patients are being diagnosed as having a pituitary tumor. The recent introduction of microneurosurgical techniques and the new medications (ergolines) are changing the treatment of this syndrome. Women in the childbearing age--who are affected most often--can expect successful treatment in the majority of cases with resumption of normal menstrual function and fertility. However, certain risks are still posed, particularly during pregnancy. In spite of improved diagnosis and treatment, the natural history of prolactin-secreting pituitary tumors and the long-range effects are still not fully appreciated. More experience in time will be needed before the indications for and the efficacy of various treatment regimens are fully known.

Nonpuerperal galactorrhea and hyperprolactinemia. Clinical findings, endocrine features and therapeutic responses in 56 cases

The clinical and endocrine features, and the responses to different treatment modalities, were examined in 56 patients with galactorrhea and/or hyperprolactinemia after a two month to six year follow-up period. A pituitary adenoma was diagnosed in 17 patients. A prolactin-cell adenoma was identified histologically in eight patients. Other etiologic factors were myxedema (two patients), phenothiazine ingestion (six patients) and breast manipulation (four patients). In 27 patients, including three with abnormalities of the sella turcica, no causal factor was found, and their condition was labelled as dysfunctional in origin. Symptoms were preceded by childbirth in 11 patients and by estrogen-progestin contraception in 22; pituitary adenomas were discovered in both groups in approximately the same frequency (30%) as in the over-all study group. Aside from roentgenographic studies, as well as visual field perimetry in a few cases, a serum prolactin level above 100 ng/ml was the only indicator of a pituitary prolactin-cell adenoma. Prolactin-suppression tests (L-DOPA and 2alpha-Br-ergocryptine) were found to be of no value in discriminating between tumoral and dysfunctional conditions. No significant alterations in prolactin levels occurred after water loading irrespective of basal levels or the nature of the pathologic process. Selective pituitary tumor excision (eight patients) was followed by rapid normalization of prolactin levels and disappearance of clinical abnormalities. Conversely, after pituitary irradiation (eight patients), improvement tended to be slower. Treatment of infertility in those patients without an apparent organic lesion was more successful with 2alpha-Br-ergocryptine (three of three) than with clomiphene (two of seven). Pregnancies following the administration of drugs or after surgical treatment were uneventful. Since follow-up resulted in the early diagnosis of pituitary tumors from seven to 56 months after initial investigation, and since no diagnostic tools are currently available which help to discriminate between tumoral and dysfunctional conditions before abnormalities become evident on roentgenograms, prolonged observation of these patients remains essential.