Hay or silage? How the forage preservation method changes the volatile compounds and sensory properties of Caciocavallo cheese.

The aim of this study was to determine the effect of the forage preservation method (silage vs. hay) on volatile compounds and sensory properties of a traditional Caciocavallo cheese during ripening. A brown-midrib sudangrass hybrid was cultivated on a 7-ha field and at harvesting it was half ensiled in plastic silo bags and half dried to hay. Forty-four lactating cows were equally allotted into 2 groups fed a isonitrogenous and isoenergetic total mixed ration containing as the sole forage either sorghum hay (H group) or sorghum silage (S group). Milk from the 2 groups was used to produce 3 batches/diet of Caciocavallo ripened for 30, 60, and 90 d. Milk yield and composition as well as cheese chemical and fatty acid composition were not markedly affected by the diet treatment and ripening time. By contrast, ripening induced increased levels of the appearance attribute "yellowness," along with the "overall flavor," the odor/flavor attributes "butter" and "hay," the "salty," "bitter," and "umami" tastes, and the texture attribute "oiliness," whereas the appearance attribute "uniformity" and the texture attribute "elasticity" were reduced. The silage-based diet induced higher perceived intensities of several attributes such as "yellowness"; "overall flavor"; "butter"; "grass" and "hay" odor/flavors; "salty," "bitter," and "umami" tastes; and "tenderness" and "oiliness" textures. In S cheese we also observed higher amounts of ketones and fatty acids. Conversely, H cheese showed the terpene α-pinene, which was not detected in S cheese, and a higher intensity of the appearance attribute "uniformity." These differences allowed the trained panel to discriminate the products, determined an increased consumer liking for 90-d ripened cheese, and tended to increase consumer liking for hay cheese.

Effect of group size and maize silage dietary levels on behaviour, health, carcass and meat quality of Mediterranean buffaloes.

The effects of different dietary levels of maize silage (10% v. 36% DM) and group size (7 v. 14 animals) were assessed on growth performance and in vivo digestibility of 28 male fattening buffaloes. In addition, the effects of diet on meat quality and group size on behaviour and immune response were separately evaluated. Animals were weighed and assigned to three groups. The high silage - low size group (HL) was fed a total mixed ration (TMR) containing 36% DM of maize silage and consisted of seven animals (age 12.7±2.6 months; BW 382.2±67.7 kg at the start of the study). The low silage - low size group (LL) was fed a TMR containing 10% DM of maize silage and consisted of seven animals (age 13.0±2.7 months; BW 389.4±72.3 kg). The high silage - high size group (HH) was fed the 36% maize silage DM diet and consisted of 14 animals (age 13.9±3.25 months; BW 416.5±73.9 kg). Total space allowance (3.2 indoor+3.2 outdoor m2/animal) was kept constant in the three groups, as well as the ratio of animals to drinkers (seven animals per water bowl) and the manger space (70 cm per animal). Growth performance, carcass characteristics and digestibility were influenced neither by dietary treatment nor by group size, even if the group fed 36% maize silage diet showed a higher fibre digestibility. No effect of diet was found on meat quality. Group size did not affect the behavioural activities with the exception of drinking (1.04±0.35% v. 2.60±0.35%; P<0.01 for groups HL and HH, respectively) and vigilance (2.58±0.46% v. 1.20±0.46%; P<0.05 for groups HL and HH, respectively). Immune responses were not affected by group size.

Antepartum diagnosis of goitrous hypothyroidism by fetal ultrasonography and amniotic fluid thyrotropin concentration.

Ultrasonography of a 26-week-old fetus suggested the presence of a goiter. Amniocentesis was performed at 26 and 38 weeks gestation to evaluate thyroid function. An elevated amniotic fluid TSH level was found on both occasions, though amniotic fluid T4, T3, and rT3 levels were similar to those of euthyroid fetuses. The diagnosis of goitrous hypothyroidism was confirmed at birth. Therapy with thyroid hormone was instituted on the first day of life. Growth and development of the infant have been normal during the first year of his life. We suggest that the measurement of amniotic fluid TSH can be useful in the diagnosis of intrauterine primary hypothyroidism.

Craniofacial, limb, and abdominal anomalies in a distinct syndrome: relation to the spectrum of Pfeiffer syndrome type 3.

Presented are 2 patients with abnormal craniofacial region, limbs, and abdomen, features that may be consistent with Pfeiffer syndrome, type 3. Both patients had bicoronal and bisphenoidal synostosis, extreme exophthalmic midface hypoplasia, and hydrocephalus. The limbs had a fixed flexion deformity of the elbows with broad thumbs which were radiopalmarly deviated; the toes were broad with a varus deformity and syndactyly toes 2-5. Both patients developed bowel obstruction secondary to midgut malrotation, and one of the patients had prune belly syndrome. Review of the literature disclosed an additional patient who, in retrospect, had Pfeiffer syndrome type 3 and midgut malrotation. These patients suggest that intestinal malrotation with or without prune belly syndrome may be a common component of this entity.

Intraoperative autologous blood transfusion in the surgical correction of craniosynostosis.

Transfusion of homologous blood is associated with significant and well-known risks. Reported transfusion rates for pediatric patients undergoing surgical correction of synostotic calvarial sutures vary between 20 and 500% of estimated blood volume. The objective of this study was to ascertain the risks, benefits, and effects on transfusion rates associated with the use of intraoperative autologous transfusion (IAT) in this patient population. The Haemonetics Cell Saver 4 (Haemonetics Corporation, Braintree, MA) autotransfusion system was used to salvage blood in 18 patients undergoing the release of stenosed calvarial sutures. In a prospective, nonrandomized study, these patients were compared with a control group of similar age, gender, weight, and surgical procedures. There were 10 male patients and 8 female patients; the mean age was 7.2 months, the mean weight was 8.67 kg, and the mean surgical time was 3.15 hours. The mean amount of homologous blood transfused to the control group was 189 ml, compared with 87.69 ml for the IAT group, which was a decrease of 46.3%. The mean amount of autologous blood transfused was 150 ml (range, 50-250 ml). Thirty-three percent of the patients in the IAT group did not require homologous blood transfusion. No complications were observed with the use of the Cell Saver in the IAT group. The use of the Cell Saver was associated with a significant decrease in the amount and rate of homologous blood transfusions. Its use appears to be safe in pediatric patients undergoing craniosynostotic surgery.

Temporalis muscle resuspension using titanium miniplates and screws: technical note.

OBJECTIVE: To describe the technique for and results of using titanium miniplates and screws for resuspension of the temporalis muscle after osseous detachment during cranial procedures requiring exposure of and access to the frontotemporoparietal region. METHODS: Thirty-four patients, who were being treated with various cranial procedures, underwent resuspension of the dissected temporalis muscle, using 1.5-mm or 1.3-mm titanium plates and screws, after bone flap replacement. RESULTS: The temporalis muscle was successfully and securely resuspended in all cases, using the plates and screws. There were no infections, muscle tears, dislodgement, fractures, or temporal hollowing in any of the cases. In four cases that required re-exploration, the muscle was observed to be rigidly fixated and scarred to the bone. CONCLUSION: The use of titanium plates and screws is a safe, simple, successful alternative for reattachment of temporalis muscles for patients undergoing cranial procedures.

Endoscopic craniectomy for early surgical correction of sagittal craniosynostosis.

OBJECT: The authors sought to minimize scalp incisions, blood loss, and operative time by using endoscopically assisted strip craniectomies and barrel-stave osteotomies to treat infants with sagittal suture synostosis. METHODS: Four patients, aged 2, 4, 9, and 12 weeks, who presented with scaphocephaly underwent endoscopic midline craniectomies through small midline scalp incisions. The mean operative time for the procedure was 1.68 hours (range 1.15-2.8 hours); the mean blood loss was 54.2 ml (range 12-150 ml). Three patients did not require blood transfusions and were discharged within 24 hours. Postoperatively, all patients were fitted with custom cranial molding helmets. Follow-up evaluation ranged between 8 and 15 months. All patients had successful correction of their scaphocephaly with no mortalities, morbidities, or complications. CONCLUSIONS: The use of endoscopic techniques for early correction of sagittal synostosis is safe; decreases blood loss, operative time, and hospitalization costs; and provides excellent early surgical results.

Endoscopic craniectomy for early correction of craniosynostosis.

Twelve patients between 0.4 and 7.8 months of age were treated by an endoscopic approach to strip craniectomy. Nine patients had sagittal suture involvement. Two patients had a single unilateral lambdoid suture synostosis, and one patient had a combination of a right coronal synostosis and a metopic synostosis. Postoperatively, all patients were placed in cranial remodeling helmets and the results showed that the estimated blood loss ranged from 5 cc to 150 cc, with blood transfusion required in only one patient. All patients were discharged from the hospital by day 2, and all patients had an improvement in their cranial head shape. The specific technique of using the endoscope to aid in performing a strip craniectomy will be discussed. Nine endoscopically treated patients with the diagnosis of sagittal suture synostosis were compared with nine patients treated by using the Marchac remodeling techniques. The mean operative time (1.6 hours versus 3.5 hours), estimated blood loss (43 cc versus 168 cc), hospital costs ($11,671 versus $36,685), and length of stay (1.16 days versus 5.1 days) were less by using the endoscopic technique. All nine patients treated by using the Marchac technique required a blood transfusion, whereas only one patient was transfused in the endoscopically treated group.

Outcome analysis of reduction mammaplasty.

In an attempt to obtain objective analysis of outcome in reduction mammaplasty patients, a retrospective study was done for women having elective bilateral reduction mammaplasty. Participants were chosen from a pool of over 200 consecutive reduction mammaplasty patients at the University of Missouri-Columbia. Of those eligible for inclusion, 72 met the criteria and were available for long-term follow-up. These patients answered a panel of questions regarding weight change, brassiere size, exercise, activity level, symptoms, and a personal appraisal of appearance. Statistical analysis was done to evaluate the change in each variable in relationship to the time of surgery, i.e., before surgery, 6 months after surgery, and at the present time. The findings revealed a significant stable reduction of breast mass. The women reported a significant reduction of symptoms that had been associated with their macromastia. They also reported a significant increase in exercise and other physical and social activities.

Pharyngeal flap revisions: flap elevation from a scarred posterior pharynx.

Twenty-one consecutive patients who had earlier superiorly based pharyngeal flap surgery and persistent velopharyngeal insufficiency were seen between 1976 and 1991. Patients were divided into two treatment groups, depending on the results of videofluoroscopic and nasopharyngoscopic assessment. The first group consisted of 18 patients who had bilateral port insufficiency and required a complete reconstruction of a new superiorly based pharyngeal flap that was elevated from a scarred posterior pharyngeal wall. After an average follow-up of 6.2 years, 15 patients had normal resonance, 2 patients had improvement but continued hypernasality, and 1 patient was hyponasal. The second group consisted of 3 patients who had "patch" flaps to a unilateral port insufficiency. Postoperatively, all 3 of those patients had normal resonance. Indications for the decision to "redo" or patch flaps are described.

Hematomas requiring surgical evacuation following face lift surgery.

This study evaluates hematomas requiring surgical evacuation following a face lift. Twenty-three hematomas occurred with 1236 consecutive face lifts (1.86 percent). All hematomas occurred within 48 hours. Fifty-seven percent were identified at less than 15 hours, 26 percent from 15 to 24 hours, and 17 percent from 24 to 48 hours. The incidence of hematomas for surgeons who performed more than 50 face lifts in this study varied from zero to 3.83 percent. This difference in incidence was statistically significant. A multivariant analysis of predetermined variables was done. Age, preoperative tests, medical history, gender, perioperative medications, type of anesthesia, number and combination of procedures, and treatment of the SMAS did not independently affect the incidence of hematomas. Preoperative and postoperative blood pressure did not affect the incidence. The incidence of hematomas with general anesthesia in this study was 7 of 630 (1.11 percent). In a similar 1973 study at this institution, the incidence with general anesthesia was 3.26 percent. This improvement was attributed to a change in anesthetic technique. Intraoperative hypotension was avoided in the current series. The incidence of hematoma in the local anesthesia group was 3.72 percent, and in the monitored intravenous sedation group it was 0.87 percent. Meticulous hemostasis, done with the patient's blood pressure in a normotensive state, appeared to be of primary importance.

The effects of methylmethacrylate's hyperthermic polymerization on cerebral vascular permeability.

This study was undertaken to analyze the effects of significant hyperthermia (> 100 degrees C) associated with the polymerization of polymethlymethacrylate (PMM) on the permeability of the cerebral vasculature in rats. The method used to visualize the pial vasculature included the open pial window technique and epifluorescence microscopy. Results indicated that there is a significant increase in cerebral vascular permeability following in situ polymerization of PMM over the craniectomy site.

Endoscopy-assisted wide-vertex craniectomy, "barrel-stave" osteotomies, and postoperative helmet molding therapy in the early management of sagittal suture craniosynostosis.

OBJECT: The purpose of this study was to assess the efficacy, safety, associated complications, and outcome in patients with sagittal suture craniosynostosis in whom endoscopy-assisted wide-vertex craniotomy and "barrel-stave" osteotomy were performed. METHODS: During a 4-year period, 59 patients with sagittal suture synostosis underwent endoscopy-assisted wide-vertex craniectomies, barrel stave-like osteotomies, and postoperatively were fitted with custom-made molding helmets. Data on operative time, blood loss, transfusion rates, hospital length of stay, complications, and hospital charges were collected prospectively. The mean patient age at the time of surgery was 3.7 months. The average blood loss was 31.8 ml; and only one patient required an intraoperative blood transfusion. Nine patients received transfusions of donor blood postoperatively. The mean operative time was 50 minutes, and all but three patients were discharged from the hospital the morning following surgery. There were no intraoperative complications. Normocephaly as well as normal cephalic indices were observed at latest follow up. CONCLUSIONS: The authors conclude that early treatment of infants with sagittal suture craniosynostosis by using minimally invasive, endoscopy-assisted wide-vertex craniectomies provides excellent results and a significantly lower morbidity rate than traditional calvarial vault reconstructive procedures.

Preventing infection related to insertion of an intrauterine device.

A study was undertaken to determine whether pelvic inflammatory disease (PID) resulting from the insertion of an intrauterine device (IUD) could be eliminated by inserting the IUD during ovulation and administering prophylactic antibiotics to cover insertion. IUDs, 95% of which were Progestaserts, were inserted within two days of probable ovulation in 288 patients. These study patients were compared with a matched control group of 288 patients not using IUDs. None of the 288 IUD patients (totaling 619 woman-years of IUD use) developed PID after insertion, and only 0.5% per 100 woman-years developed PID later. The incidence of PID seen in these patients was less than that observed in the control group. It was also less than that in the general population or that following legal induced abortion. The expulsion rate of 1% per 100 woman-years in our patients is the lowest ever reported. It probably is related to the low motility of the uterus and expansion of the cervix during ovulation; the latter facilitates insertion during ovulation.

Evaluation of the Unna Boot for lower-extremity autograft burn wounds excoriated by pruritus in pediatric patients.

Six pediatric patients with lower-extremity excoriated autografts secondary to pruritus were treated randomly. Group 1 was treated with application of an Unna Boot that was changed every 7 days; Group 2 was treated with conventional dressing and antihistamines. Average time for complete wound closure was similar in the two groups: 32 days for group 1 versus 36 days for group 2. Treatment of group 1 cost $19.80/wk compared with $30.90/wk for treatment of group 2. The time for dressing change was 15 min/wk for group 1 and 3.5 hr/wk for group 2. The parents in group 1 gave their children better scores when asked about appetite, sleep, and play patterns.

Evaluation of treatment modalities in perioral electrical burns.

A retrospective analysis of 29 patients who sustained perioral electrical burns was undertaken. Children were divided into three groups: (group 1) no surgery and no splint (n = 21), (group 2) nonsurgical management with splint appliance (n = 8), and (group 3) commissuroplasty (n = 9). Mean age was 3 years, and minimum follow-up was 1 year. Subjective evaluation of standard photographs was performed by six surgeons. Group 2 had a less noticeable scar and more normal lip parameters. Group 3 and group 1 had similar percent scar involvement and overall poor subjective scores. All evaluators felt that commissuroplasty (group 3) improved patients' appearance compared with no surgery and no splint (group 1). Therefore the application of our easily constructed splint alone yielded the best cosmetic results.

In vivo visualization of cerebral microcirculation in systemic thermal injury.

We present a model used to describe the effects of systemic thermal injury in cerebral permeability with the use of an open, acute pial window technique. Sprague-Dawley rats were anesthetized, and an open pial window was constructed. The area was then bathed with artificial cerebrospinal fluid with a pH adjusted to 7.4 that was heated to a constant temperature of 37 degrees C, which was allowed to circulate into a reservoir at a rate of 2 cc/min. The fluid was infused with a gas mixture of 5% carbon dioxide and 95% nitrogen. A warming blanket was placed under the animal's ventral surface, and the animal's temperature was maintained at 37 degrees C and monitored with a rectal thermal probe. Experimental animals were submerged to the xiphoid process in 100 degrees C water bath for a total of 6 seconds, which produced a 70% total body surface area third degree burn. Control animals were submerged in 37 degrees C water for 6 seconds. The animals were then injected with a constant infusion of bovine albumin coupled with fluorescein isothiocyanate. Recordings were taken every 15 minutes for 6 hours. The vascular albumin leakage was determined from the ratio of interstitium to vascular fluorescence and expressed as a percentage. The percent albumin leakage in the control group was found to be significantly different from that in the experimental group at all periods measured. The mean increase in permeability ranged from 20% at 15 minutes to 104% at 6 hours. These changes were found to be statistically significant with the use of unpaired t test at a P value of .0001. The model presented is the first to demonstrate changes in cerebral permeability after acute severe systemic thermal injury.

Chemical composition of pig meat from the genetic type 'Casertana' and its crossbreeds.

The meat quality of the autochthonous genetic type Casertana (Ca) and its crossbreeds was evaluated for the production of pork for fresh consumption and/or processing. The chemical composition of the fresh meat was determined on eight muscles of 143 pigs of six genetic types, of both sexes and slaughtered at three different live weights. The most important results of fixed analysis of variance showed that the first order interactions are statistically important in determining most of the analytical data considered; muscle is an important factor for ash content. On average, the dry matter percentage is higher in the Casertana; the opposite is observed in the Ca × [Landrace (L) × Large White (LW)]. The protein content, in relation to dry matter, is lower in the Casertana and higher in Ca × (L × LW) and L × (L × LW). The opposite results were observed for lipid contents and energy value. The ash content ranges from 4.8% in Ca to 5.3% in Ca × Duroc (Du). However, the above trends vary in relation to sex, live weight at slaughter and muscle. Females, compared with males, supply meat with high lipid contents and energy values. The protein content, by contrast, is higher in males. As the live weight at slaughter increases from 80-90 to 120-130 kg, the protein content rises, while the ash value decreases. In meat obtained from females no significant differences are observed in the analytical data from 80-90 to 120-130 kg, while in that from males the protein content increases, and the lipid content and energy value decrease. The Longissimus dorsi muscle (both at thoracic and lumbar level) has the highest content of dry matter, while the Supraspinatus and the Rectus femoris have the lowest. The Rectus femoris has the highest protein content and Semitendinosus the lowest. The opposite holds for lipid content and energy value; such results confirm the histochemical individuality of the muscle. The dry matter content of the 'bacon' cut is higher in the Casertana pigs and lower in L × (L × LW), which is due, in part, to the higher lipid content and lower protein content found in the former.

Effect of dietary energy content on the intramuscular fat depots and triglyceride composition of river buffalo meat.

The production of river buffalo meat in Italy has long been under discussion due to poor acceptance by consumers. In order to understand whether dietary energy content may affect the organoleptic characteristics of buffalo meat, two groups of river buffalo calves were fed on two diets, with high (H) and low (L) energy contents. The animals were slaughtered at 4-monthly intervals starting from 6 months old (10, 14 and 18 months) and five muscles were dissected on the half-carcass: Caput longum tricipitis brachii (CloTB), Gluteobiceps (Gb), Semitendinosus (St), Semimembranosus (Sm) and Longissimus dorsi (LD). The results showed that from 6 to 10 months of age the meat lipid content decreases and protein content increases for both diets. The lipid content increases slowly with both diets from 10 to 14 months. In the last experimental period (from 14 to 18 months) an increase in the percentage of lipids with diet H and a decrease with diet L was observed. At all slaughtering ages the meat from the animals fed on diet H had a higher energy content. The different energy content of the two diets did not significantly influence the composition of triglycerides only formed by SFA and triglycerides with a higher degree of unsaturation. The triglycerides with an unsaturated fatty acid in position sn 2 did not show the same behaviour in relation to age and diet. The energy content of the feed did influence the unsaturated fatty acid composition: MUFA increased with an increased energy level of the diet, while PUFA increased with a reduction in the energy level of the diet. The muscle LD showed a significantly higher (P<0.05) content of SFA and lower (P<0.05) of MUFA and PUFA than the other muscles. On the basis of our results, the better TAG's composition is found in the meat of animals fed on diet H and slaughtered at 4 months of age.

Intrathecal morphine for postoperative analgesia following repair of frontal encephaloceles in children: comparison with intermittent, on-demand dosing of nalbuphine.

STUDY OBJECTIVE: To determine the efficacy of lumbar intrathecal (i.t.) morphine in a dose of 0.02 mg/kg in providing analgesia following repair of frontal encephaloceles. DESIGN: Prospective, open-label investigation of i.t. morphine with secondary comparison to a retrospective cohort. SETTING: Metropolitan hospital in the Philippines. PATIENTS: 24 ASA physical status I and II children undergoing frontal encephalocele repair. INTERVENTIONS: Following induction of general anesthesia. I.t. morphine (Group 1) was administered via single-shot technique or through a lumbar i.t. drain placed for cerebrospinal fluid drainage during the surgical procedure. Postoperative analgesia was assessed by visual analog score in patients greater than 5 years of age or a behavioral score in patients less than 5 years of age. The retrospective cohort received postoperative analgesia with intermittent doses of intravenous nalbuphine (Group 2). MEASUREMENTS AND MAIN RESULTS: Group 1 had decreased postoperative analgesic requirements, decreased intraoperative inhalational anesthetic requirements, and a longer time to the first request for postoperative analgesia than Group 2. The time to the first request for postoperative analgesia was 16.0 +/- 9.1 hours in Group 1 and 1.6 +/- 1.2 hours in Group 2 (p < 0.0001). Six of 12 patients in Group 1 required no analgesic drugs during the first 24 postoperative hours while all 12 patients in Group 2 (p = 0.02) did require analgesic drugs during this period. The patients in Group 1 who did not require supplemental analgesic drugs maintained pain scores of 2 or less throughout the first 24 postoperative hours. CONCLUSION: Lumbar IT morphine provides effective analgesia following repair of frontal encephaloceles in children and adolescents.