Milk Fistula: Diagnosis,Prevention, and Treatment

Milk fistula is an uncommon condition which occurs when there is an abnormal connection that forms between the skin surface and the duct in the breast of a lactating woman, resulting in spontaneous and often constant drainage of milk from this path of least resistance. A milk fistula is usually a complication that results from a needle biopsy or surgical intervention in a lactating patient. Here, the authors present an unusual case of a spontaneous milk fistula which developed from an abscess in the breast of a lactating woman. The patient initially presented to the office with a large open wound on her breast, formed from skin breakdown, within which milk was pooling. She was treated with local wound care and cessation of breastfeeding, with appropriate healing of the wound and closure of the fistula with 6 weeks. Diagnosis, prevention, and treatment of milk fistula were reviewed.     

Local thermal injury elicits immediate dynamic behavioural responses by corneal Langerhans cells

Langerhans cells (LCs) represent a special subset of immature dendritic cells (DCs) that reside in epithelial tissues at the environmental interfaces. Although dynamic interactions of mature DCs with T cells have been visualized in lymph nodes, the cellular behaviours linked with the surveillance of tissues for pathogenic signals, an important function of immature DCs, remain unknown. To visualize LCs in situ, bone marrow cells from C57BL/6 mice expressing the enhanced green fluorescent protein (EGFP) transgene were transplanted into syngeneic wild-type recipients. Motile activities of EGFP(+) corneal LCs in intact organ cultures were then recorded by time lapse two-photon microscopy. At baseline, corneal LCs exhibited a unique motion, termed dendrite surveillance extension and retraction cycling habitude (dSEARCH), characterized by rhythmic extension and retraction of their dendritic processes through intercellular spaces between epithelial cells. Upon pinpoint injury produced by infrared laser, LCs showed augmented dSEARCH and amoeba-like lateral movement. Interleukin (IL)-1 receptor antagonist completely abrogated both injury-associated changes, suggesting roles for IL-1. In the absence of injury, exogenous IL-1 caused a transient increase in dSEARCH without provoking lateral migration, whereas tumour necrosis factor-alpha induced both changes. Our results demonstrate rapid cytokine-mediated behavioural responses by LCs to local tissue injury, providing new insights into the biology of LCs.     

Comorbidity of chronic insomnia with medical problems

STUDY OBJECTIVES: Determine the comorbidity of insomnia with medical problems. DESIGN: Cross-sectional and retrospective. PARTICIPANTS: Community-based population of 772 men and women, aged 20 to 98 years old. MEASUREMENTS: Self-report measures of sleep, health, depression, and anxiety. RESULTS: People with chronic insomnia reported more of the following than did people without insomnia: heart disease (21.9% vs 9.5%), high blood pressure (43.1% vs 18.7%), neurologic disease (7.3% vs 1.2%), breathing problems (24.8% vs 5.7%), urinary problems (19.7% vs 9.5%), chronic pain (50.4% vs 18.2%), and gastrointestinal problems (33.6% vs 9.2%). Conversely, people with the following medical problems reported more chronic insomnia than did those without those medical problems: heart disease (44.1% vs 22.8%), cancer (41.4% vs 24.6%), high blood pressure (44.0% vs 19.3%), neurologic disease (66.7% vs 24.3%), breathing problems (59.6% vs 21.4%), urinary problems (41.5% vs 23.3%), chronic pain (48.6% vs 17.2%), and gastrointestinal problems (55.4% vs 20.0%). When all medical problems were considered together, only patients with high blood pressure, breathing problems, urinary problems, chronic pain, and gastrointestinal problems continued to have statistically higher levels of insomnia than those without these medical disorders. CONCLUSION: This study demonstrates significant overlap between insomnia and multiple medical problems. Some research has shown it is possible to treat insomnia that is comorbid with select psychiatric (depression) and medical (eg, pain and cancer) disorders, which in turn increases the quality of life and functioning of these patients. The efficacy of treating insomnia in many of the above comorbid disorders has not been tested, indicating a need for future treatment research.