5.2 lactiferous duct fistula, c.j. mieny, m.b., ch.b., (pret.), f.c.s. s.a

8/3/2019 5.2 LACTIFEROUS DUCT FISTULA, C.J. Mieny, M.B., Ch.B., (Pret.), F.C.S. S.A

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238 S.A. MEDICAL JOURNAL 31 March 1962

EDUCATIONOnce i t has been esl:a!blished tJhat a hearing loss exists,special education methods may be provided to compensatefo r the defect.Ewing14 stated that i f comprehensive provision fo rchildren with cerebral palsy and hearing deficiencies is tobe planned, the following will be found:'(a) The need for special physical training and oftenof special physical conditions with regard to building andfurniture;

'Cb) 1'he need to promote, by trammg, the maximwnuse of residual hearing and reliance upon it ;'Cc) The need for expert assessment and periodic reassessment during the progress of remedial training of thehandicapped child's abilities, temperament, and generaland menta l growth; and'Cd) The need for continuous study of a child's socialdevelopment and the motivation towards learning whichit offers him.'

SUMMARYEarly surveys of hearing defects in children afflicted withcerebral palsy underestimated the true incidence of deafness. This can only be assessed after complete testing byadeciuate methods.A plea is made that all children suffering from cerebralpalsy should have an adequalte hearing test, and thatfacilities be provided for dealing. with those who a re hardof hearing..My thanks are due 10 Miss P. Mal


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31 Maart 1962 S.A. TYDSKRIF VIR GENEESKUNDE 239

Fig. 1. Patient A. M. ote sinus at the margin of the areola andFig. 2. Patient A. M. Lacrimal probe in position.

TABLE I. DETAlLS OF PATIENTS WITH LACTIFEROUS DUCTFISTULAE Recurrences

Case Age Marital status After Withoutincisions incisionsE.H. 47 Unmarried 2D.M. 36 Unmarried 2RB. 49 Unmarried 4M.B. 33 Married. Lactation 3A.M. 40 Married . . 3S.S. 29 Married .. 2"I n al l t he p at ie nt s t he n ip pl es were inverted on the side of the cliseaseonly.

to the common occurrence of inverted nipples in theircases. In Atkins'1 series of 28 patients, 19 had invertednipples. According to these authors and others, invertednipples, either congenital or acquired, are incriminatedas a cause of this condition.sPRESENT SERIES

Six pat ients with lactiferous duct fistulae have been en-countered over a period of 1 year at the JohannesburgGeneral Hospital (Table I).These cases can be divided into 2 clinical groups:1. A group of patients who had subcutaneous abscesses

at the margin of the areola, which discharged spontane-ously with apparent resolution, only to recur again andagain.2. A g roup in which the patients underwent a series of

operations fo r breast abscesses, bu t the condition recurredrelentlessly.The clinical findings were as follows (Fig. 1):1. A small sinus at the margin of the areola.2. A band of dilated duct between the sinus and nipple.3. A pasty secretion fr om the nipple.

4. Frequently an inverted nipple on the side of the sinus.Or, in the second group, in addition, multiple incisionswhich have failed to heal, leaving a inus situated at the

margin of the areola or omewhere along the inc isionalcar.In thi eries 3 of the patients were unmarried and in

only 1 case wa the ab cess a 0 iated with lactation. Allthe pat ients had inverted nipples confined to the side ofthe di ea e. On questioning, all the patients in i ted thatthe inverted nipples were normal before the conditionoccurred. Thus it would eem that inver ted nipples in thisserie might well be a result and no t a cau e of thecondition.

PATHOLOGYThe specimen from p


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240 S .A. MED I CAL J O URNAL 31 March 1962Procedure (Fig. 2)A lacrimal probe is passed through th e sin us to appear

on th e nipple. In so doing , a thick pasty secretion is usuallyext ru ded on the nipple by th e probe. The whole duct isthen excised from the sinus to the opening on th e nipple,and th e wound is then left to granulate. Five pat ients inth e present series were cured by this method. The otherpatient did not undergo operative t reatment.

I should like to thank Prof. D. J. du Plessis fo r pointing ou tthe t rue nature of the condition to me, and fo r permission toublish this report on patients admitted under his ca re; Mr.C. Toker for the pal!hologioai report; The Acting Superinten-

dent of the JohannesbllI1g Hospital, Dr . J. S. Enslin, fo r permi 'on to publish this art ic le ; and Mr. A. J. S. Veenstra fo rthe photographs.REFERE 'CES

1. Zuska. J. J. , Crile. G. and Ayres, W. W. (1951): Amer. J. Surg. , 81,312.2. Deaver. J . B ., McFar land , J. and Herman. L. (1917): The Breast, p. 198.Philadelphia: Blakiston.

3 . Lewis . D. (1937): Prru:tice of Surgery, vo!. 5. p. 20. HagerstoWD, Mary-land: W. F. Prior.4. Foote, F. W. and Scewart, F. W. (1945): Ann. Surg., UI, 6 and 197.5. Patey, D. H. and Thack ray, A . C. (1958): Lancet, 2, 871.6. Kilgore , A. R. and Fleming, R. (1952): Calif. Med., 77, 190.7. Atkins, H. J. B. (1955): Bri t. Med . J . 2, 1473.8. McGrego r. A . L. (1959): Med . P ro c. 5, 86.

AN IMPROVED PIPERAZINE PREPARATIO IN THE TREATMENT OF ASCARIASISS. R. PLATMAN, M.B., B.CH., BAO.

oll ' s ta ted tha t in Afritka lIlearly sixty million people are inwith Ascaris and that in s ome areas it is .the cause ofdisability ilhan any other helminth.The roundwonn feeds on ,the partially digested food in theintestine, although a few WOIiIllS ~ well-nourished inhave apparently little effect on tile general condition.the poorly nourished, however, with a heavy ,infection, theloss of nutrients, particularly protein, can ffead to astate of malnutrit ion. Heavy infections can also proobstruction of the gu t which may require surgical interntion. A fatal outcome is not uncommon.In the absence of adequate sanitation, reinfec tion is comFrom Lwiro, in ilhe Congo, Roels-Broadhurst and2 reported rthat i l l a group of 192 chi ldren , agedyears and initially cleared of roundworms, reinfections rapid. After 3 months, 6% were reinfected; after 4nths, 13'6%; after 5 months, 48'4%; and after 6 months,Regul ar tr ea tmen t was stated by th e authors to bee only practical solution to th e problem.The clinical value of this knowledge has been demonstratedBiagi and Redriguez.' In a vil lage community of 529 perAscaris infection was found in 28%. All members ofe village were then treated by monthly dosage withRegular stool examinations showed a rapid decline

5.2 lactiferous duct fistula, c.j. mieny, m.b., ch.b., (pret.), f.c.s. s.a

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