[Diagnostic image (392). A woman with redness and swelling of the breast]

A 40-year-old woman presented with progressive swelling and red to purple discoloration of the left mamma. A mammary carcinoma had been radically removed two years before. Skin biopsy showed diffuse intralymphatic malignant cells consistent with inflammatory breast cancer.

Early growth of infants of HIV-infected and uninfected Zambian women

OBJECTIVE

Parental HIV infection may affect even those exposed children who remain uninfected. We investigated early growth, an indicator of overall health, of infants born to Zambian mothers recruited for a study of breastfeeding and postpartum health.

METHODS

HIV-infected and uninfected women in Lusaka were followed regularly from late pregnancy to 16 weeks postpartum. Infant weight and length were measured at birth, 6 and 16 weeks. Infant HIV status could not be specifically determined in this cohort so comparisons were between all infants of HIV-uninfected mothers (n = 184) and those infants of HIV-infected mothers who were known to be alive and showed no clinical evidence of HIV infection at age 2-4 years (n = 85).

RESULTS

Most infants were exclusively or predominantly breastfed until 16 weeks. At all time points infants of HIV-infected mothers tended to have lower weight and length standard deviation (Z) scores (significant for weight at 6 weeks; P = 0.04), even after adjustment for their lower gestational age at birth, compared with infants of uninfected mothers. In multivariate analyses the major factors affecting weight or length at 6 or 16 weeks of age were birth weight or length, and maternal subclinical mastitis, primiparity and weight during pregnancy.

CONCLUSIONS

Early growth of infants of HIV-infected mothers is less than that of uninfected mothers, in part associated with subclinical mastitis, and this effect cannot be overcome with intensive support of mothers to follow international recommendations regarding exclusive breastfeeding.

Risk factors for metritis in Danish dairy cows

A retrospective longitudinal study of metritis was conducted in Denmark on data collected during 1993-1994. Data on herd size, breed, parity, and treatment of disease were obtained from the Danish Cattle Database. Management and production-facility data were collected using a questionnaire, conducted as a telephone interview in 1994. The study included 2144 herds from three regions in Denmark (102,060 cows). Herd-level variables included were: herd size, housing, flooring, grazing, calving measures, and calving supervision. Cow-level variables were: parity, breed, calving season and whether the cow had been treated by a veterinarian for dystocia or the diseases: retained placenta, reproductive disease, ketosis, milk fever, or dry cow mastitis. Marginal multivariable logistic-regression analyses were performed. The cow with highest odds of metritis was a first or greater than or equal to third parity cow, of large breed, that calved during November-April, in a zero-grazing herd. The cow had been treated for dystocia, retained placenta, and at least one other reproductive disease, but not for ketosis.

A milk-borne outbreak of food poisoning due to Salmonella heidelberg

A milk-borne outbreak of Salm. heidelberg infection due to unpasteurized milk from tuberculin-tested cows is described. There were 77 cases and 46 symptomless excreters of the organism. There were no deaths. The infection was traced to a cow with a symptomless salmonella mastitis and the origin of the organism was thought to be contaminated animal feeding stuffs.

We are indebted to Dr Joan Taylor, Colindale, for the identification of the salmonella serotypes; to Dr H. R. Cayton, Bristol, for assistance in the examination of animal feeding stuffs; to Dr E. N. Davey, Gloucester, for permission to include his results of milk examinations; and to the following public health inspectors who assisted in the field investigation—Mr A. Furniss, Mr G. Baillie and Mr M. V. Smith, Cirencester Urban District; Mr H. Wheeler and Mr R. Hayward, Cirencester Rural District; Mr P. Hayter, Bristol; and Mr D. S. Smith, Trowbridge.

CYTOLOGICAL DIAGNOSIS OF BREAST TUMOURS BY THE IMPRINT METHOD

Tumour imprints were made from 311 breast tumours at the time of frozen section. Rapid and permanent staining methods were employed and the accuracy of diagnosis was compared with that obtained from frozen and paraffin sections. Two false positives (0.65%) and 16 false negatives (5.15%) were found in the imprint group compared with no false positives and five false negatives (1.6%) in the frozen section group. The cytology of breast imprints is described and the false results are analysed. The possible uses of this technique, both alone and in combination with frozen sections, are discussed.

Benign lesions of the breast other than fibrocystic change

Benign diseases of the breast other than those labeled as "fibrocystic" in nature can be divided into congenital, developmental, inflammatory, neoplastic, and miscellaneous categories. Several of the most common breast lesions in these categories are discussed in this article.

Granulomatous mastitis

Granulomatous mastitis is a benign mammary lesion, which clinically can closely simulate breast cancer. The condition has only recently been recognized, less than a dozen cases being recorded in the English literature. Two further cases are presented, the histological features are illustrated, and the literature is reviewed.