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[Truncated abstract] Mastitis during lactation is a severe illness and approximately one in five breastfeeding women in Australia suffer at least one episode in the first 3-6 months post partum. Despite this, there is little understanding of the physiological and pathological processes occurring before, during and following mastitis. In this study 26 women who, on the basis of my previous research, were assessed to be at risk for developing mastitis, were recruited during the first week post partum and followed prospectively throughout the course of their lactation. Breastmilk, and 24 hour urine samples were collected at Days 5, 14, 30, 60 and 90 post partum and blood was collected at Days 5 and 14 post partum. If participants experienced inflammation of the breast at any time, either during the 90 day reference sampling period or later in their lactation, samples were then collected daily for the duration of symptoms and then, as a follow up, again one week following resolution of symptoms. Breastmilk samples were analysed for a range of biochemical components that reflect immunological (sIgA, lactoferrin) and acute phase (C-reactive protein) response, synthetic activity (lactose, glucose), and permeability of the paracellular pathway (sodium, chloride, lactose and serum albumin) within the breast. Blood and 24 hour urine samples were analysed for lactose, and blood was also analysed for C-reactive protein (CRP). Bacteriological examination of milk samples was undertaken where clinical mastitis was present. Results from these analyses were compared to the severity of breast and systemic symptoms experienced. Twenty-two episodes of mastitis and 13 episodes of blocked duct(s) were identified during the study period. When adjusted for co-existing breast pathology milk composition in the breast affected by blocked duct(s) was generally not different from that of healthy breasts. One mother, who was IgA deficient, experienced six of the 13 episodes of blocked duct(s). It is possible that the absence of sIgA in the milk of this mother increased her susceptibility to inflammation of the breast. During mastitis there was a significant increase in sodium, chloride, and serum albumin to a median concentration of 23 mmol⁄l; (p<0.001); 30 mmol⁄l; (p<0.001) and 0.8g⁄l; (p<0.001) respectively, and a decrease in the median concentration of lactose in milk to 152mmol⁄l; (p<0.016) from the mastitis breast when compared to the contralateral asymptomatic breast. Increased permeability of the paracellular pathway was confirmed by a significant increase in the median daily excretion of lactose in urine to 7.5 mmol⁄24hour (p<0.001). The rate of excretion of lactose in urine over a 24 hour period proved to be, not only a reliable means of assessing breast permeability, but also allowed the researcher to discern whether milk sampled from the breast affected was representative of milk at the site of the inflammation. The changes in lactose in urine were generally consistent with the changes in sodium, chloride and lactose in milk confirming milk expressed for sample analysis was representative of milk from the site of the inflammation

Thesis (M.S.)--University of Michigan, 1983.

Made available in DSpace on 2015-07-22T20:49:31Z (GMT). No. of bitstreams: 0 Previous issue date: 2010-12-02. Added 1 bitstream(s) on 2015-08-11T03:26:14Z : No. of bitstreams: 1 Publico-12911.pdf: 1451194 bytes, checksum: 30932a96c61700c65652119d47fad0a7 (MD5) / Objetivo: o objetivo do estudo foi verificar a prevalência da alteração fibrocística da mama, na sua forma cística, dentre as diversas faixas etárias da população feminina e correlacionar a doença cística com a presença do polimorfismo Msp1 da CYP1A1 do citocromo P450 . Casuística e métodos: Estudo retrospectivo, caso-controle, desenvolvido entre março de 2005 a março de 2007. Submeteram-se a exame ultra-sonográfico, 204 mulheres, sendo divididas em dois grupos: 44 com doença cística mamária (casos) e 149 sem doenças mamárias (controles); 11 mulheres foram excluídas. Foi realizado estudo genético para a detecção do CYP1A1 através de reação em cadeia da polimerase e utilizado o teste de Fisher e c2 para a análise estatística. Resultados: A doença cística mamária diagnosticada pelo ultra-som esteve presente em 22% da população estudada. Os cistos eram do tipo simples em 93%, múltiplos em 75% dos casos, e mediam 4-10 mm em 46%. A mama esquerda no quadrante súpero-lateral foi a localização mais freqüente. O perfil epidemiológico-clínico dessas mulheres foi: branca, faixa etária de 41-50 anos, ciclos menstruais regulares, multípara e com queixa de mastalgia. Na análise genética do CYP1A1, observamos homozigoto selvagem numa freqüência de 68,2% no grupo casos e 66% no controle; heterozigotos 31,28% no grupo estudo e 26,8% no controle.Não houve aparecimento do homozigoto mutado no grupo casos surgindo como 7,2% no controle. Não houve diferença estatisticamente significante entre os grupos (p = 0,42). Conclusão: A prevalência e quase todo o perfil epidemiológico da doença cística mamária foram compatíveis com a literatura. Houve maior freqüência de heterozigotos mutados no grupo de casos, porém não de homozigotos.Não houve associação estatisticamente significante entre o polimorfismo da CYP1A1 e a doença fibrocística mamária na sua forma cística. / TEDE