The inclusion of fresh forage in the lactating buffalo diet affects fatty acid and sensory profile of mozzarella cheese.

The aim of this study was to determine the effect of inclusion of fresh forage in diet for lactating buffalo on properties of mozzarella cheese under intensive farming conditions. Thirty-two buffalo cows were equally allotted into 2 groups fed diets with (fresh group, FRS) or without (control group, CTL) fresh sorghum. The study consisted of 2 trials. In the first one, animals from group FRS were fed a diet containing 10 kg of fresh sorghum (10-FRS diet) that was doubled to 20 kg (20-FRS diet) in the second trial. All diets were isonitrogenous and isoenergetic, and fresh forage accounted for 13.4 and 26.5 of dietary dry matter, respectively, for the 10-FRS and 20-FRS diet. In each trial, milk from the 2 groups was used to produce 3 batches/diet of Mozzarella di Bufala Campana Protected Designation of Origin cheese. Milk yield and composition were not influenced by dietary treatment. The use of 10-FRS diet did not affect any properties of mozzarella. As the inclusion rate of fresh sorghum doubled to 20 kg, an increment of unsaturated fatty acid percentages and a lowering of short-chain and saturated fatty acids were observed. Moreover, the sensory characteristics of mozzarella were modified, although no effects were observed on consumer acceptance. We conclude that the use of green fodder can represent a low-cost feeding strategy to improve the healthiness of buffalo mozzarella under intensive farming conditions with no detrimental effect on consumer blind acceptance.

Fatty acid and sensory profiles of Caciocavallo cheese as affected by management system.

The effect of season of the year associated with changes in feeding and management system (pasture-based vs. confinement) on milk and cheese fatty acid profile and on sensory properties of Caciocavallo cheese was evaluated on 3 mountain dairy farms. Each farm used a pasture-based feeding system from April to June and from September to October (PS), and a confinement system for the rest of the year (CS). As a consequence of grazing, PS milk showed higher percentages of C18:3, cis-9,trans-11 conjugated linoleic acid, and trans-11 C18:1, and a reduced percentage of C16:0. The fatty acid profile of cheese largely reflected that of the corresponding raw milk from which cheese was made. This led to a significant decrease of atherogenic index in cheeses produced from cows on pasture. Based on sensory analysis, cheese from animals kept on pasture was more yellow and had a lower intensity of butter and smoked odors than did CS cheese. In addition, grazing induced a lower intensity of bitter and a higher intensity of spicy flavors compared with cheese from CS animals. In regard to texture, pasture feeding resulted in higher intensity of friability and graininess. All cheeses performed well in consumer tests; the panel found all samples more than acceptable for overall liking, and for liking according to appearance, taste/flavor, and texture. Overall liking of Caciocavallo cheese, as assessed by slope analysis, was affected primarily by taste/flavor (raw slope k=0.88) and texture (k=0.97), whereas appearance had a lesser effect (k=0.72). The acidic and sensory profiles of cheese were well discriminated, with healthier cheeses produced by grazing cows. Therefore, wider use of pasture should be promoted to accentuate this favorable feature. Based on the specific nutritional and sensory characteristics of mountain Caciocavallo cheese, particularly that obtained from grazing animals, efforts should be made to indicate the quality of this cheese to the consumer and improve product recognition.

The use of 5-aminolevulinic acid fluorescence guidance in resection of pediatric brain tumors.

INTRODUCTION: Whereas in the adult population 5-Aminolevulinic acid (5-ALA) fluorescence guidance has been widely accepted for improving the extent of tumor resection, the application in children remains an off-label use. Even though most pediatric study protocols require a complete resection for improving outcome parameters, only few pediatric patients have been operated with fluorescence guidance, and it remains questionable, whether and which pediatric tumors show useful fluorescence. We present casuistic reports of application of 5-ALA in children collected from three different neurosurgical departments. PATIENTS AND METHODS: In children with suspected malignant intracerebral tumor or recurrence, individual informed consent was obtained in each case from the parents. 5-ALA was administered according to the adult protocol, with 20 mg/kg, 2 h before induction of anesthesia. We retrospectively analyzed 18 patients (13 male, 5 female; age 3-18 years), using the intraoperative neurosurgical protocol, the postoperative MRI results, and the follow-up clinical examinations. RESULTS: The use of 5-ALA fluorescence guidance proved to be safe in our group of pediatric patients. Fluorescence guidance was most useful for recurrent glioblastoma resection. Medulloblastoma tissue displayed fluorescence only inconsistently, and most pilocytic astrocytoma remained without staining. Ganglioglioma showed partial staining in the central tumor areas, without allowing the use for circumferent resection. CONCLUSION: The off-label use of 5-ALA fluorescence guidance in pediatric patients appears to be most useful in recurrent high-grade gliomas. Fluorescence accumulation in other pediatric brain tumor entities is not predictable and should be evaluated in future clinical studies before being integrated into the current treatment protocols.

Amebiasis in the epidemiologic transition in Mexico: its morbidity and mortality trends in the Mexican Institute of Social Security.

Amebiasis is one of the most common parasite-related diseases and one of those with the greatest impact on health. At the Instituto Mexicano del Seguro Social (Mexican Institute of Social Security-IMSS) approximately half a million cases per year are currently treated. Of these, more than 2500 correspond to the form which invades the liver. Within the process of epidemiologic transition which Mexico is undergoing, a progressive reduction has been observed in incidence of, and mortality due to, invading amebiasis in all its clinical forms. In turn, there is a significant decrease in its fatality rate. The social and economic development and improved sanitary conditions observed in Mexico, particularly in the second half of this century, may have conditioned this process. The improvement in availability, accessibility and utilization of medical care services could also explain the reduction which has been noted in its fatality rate and mortality. The model for epidemiologic transition proposed by Omran and adapted for Mexico by Frenk, offers a plausible explanation for the changes observed in the occurrence and mortality of invading amebiasis in Mexico.

[Giant sacral schwannoma with pelvic extension. Therapeutic strategy. Apropos of a case]. / Schwannome sacré géant avec extension pelvienne. Stratégie thérapeutique. A propos d'un cas.

A 48-year-old woman was admitted for acute urinary retention. Clinical pelvic examination disclosed a voluminous retro-rectal mass. Plain X-rays, pelvic echography, computerized tomography and MRI were all consistent demonstrating the presence of a 15cm-diameter lesion in the pelvic space with sacral erosion at S3-S4 and extension in the sacral canal up to S2. After a preoperative embolization, the tumor was removed in a two-stage procedure. First, an anterior transabdominal approach dissected the superior and lateral aspects of the tumor. To make easier the intra-abdominal dissection and to avoid any rectosigmoid necrosis, hysterectomy and rectosigmoid section with an end-colostomy were performed. Lastly, a piecemeal removal of the whole tumor was achieved using a posterior approach. At 6 months postoperatively, she recovered a satisfactory urinary control and the colo-rectal anastomosis was then successfully performed. Clinically only a slight hypesthesia of the left perineum was present. In the recent literature, 21 cases were described with similar clinical presentation and similar technical problems to achieve a complete treatment. In the discussion, details of the surgical anterior and posterior approaches are given. Before deciding the most appropriate surgical approach for such a mass, a biopsy is useful to determine whether total removal is relevant. A preoperative embolization can help to reduce the duration of the procedure and the loss of blood.

[Thoracic spondylotic myelopathies. Apropos of 4 new cases]. / Myélopathies dorsarthrosiques. A propos de 4 nouvelles observations.

Four cases of thoracic spondylotic myelopathy are reported, one man and three women, respectively 61, 66, 67 and 76 years old. Clinical presentation was numbness and weakness in the lower limbs in two cases, weakness alone in one and numbness alone in the last one. Diagnosis was settled by both myelography and CT-myelogram in three cases, by both MRI and CT-scan in the other one. The involved thoracic levels were both T9-T10 and T10-T11 for two cases and T11-T12 for the other one. The stenosis was due to hypertrophic ossification of the ligamentum flavum in three cases and to osteophytic changes in one. A laminectomy was performed for each patient and three patients had a significant recovery and the fourth a mild one. Thoracic myelopathy is an uncommon disease which requires a meticulous study of myelogram and now MRI to be recognized and to be cured by laminectomy. As for cervical myelopathy, it results from mechanical and ischemic factors which can lead to a definitive myelomalacia.

[Amebiasis. Medical treatment. Is there anything better than metronidazole?]. / Amibiasis. Tratamiento médico. Hay algo mejor que el metronidazol?

Since 1961, when Cosar pointed out for the first time that metronidazol was a useful pharmacological agent against E. histolytica, several authors have demonstrated its effectiveness against invasive amebiasis in its colonic or extraintestinal variety. The obtained results with metronidazol were so far better compared with the rest of the known amebecides, that in 1974, Elsdon Dew stated that a new era in the medical treatment of the amebiasis had started with the forthcoming use of the agent. However, the frequent and important adverse collateral effects produced in a good number of patients have forced to look for other nitroimidazole derivates, hopefully more efficient and, of course, better tolerated. Thus, the tinidazole, ornidazole, flunidazole, romidazole, ornidazole, flunidazole, dimetridazole, satranidazole, nitrimidazine, panidazole, have been tried and some others are still subject to experimentation, such as the Ro 7-0207 (alpha-chlorometil-2-metil-5-nitro-1-imidazol), the phexinidazole (HOE 239) and the CG 10213-Go from CIBA-Geigy and no significant advantage has been found over the metronidazol. The phexinidazole turned out to be twice as effective as the metronidazole in the experimental hepatic amebiasis of the golden hamster. This fact must be confirmed or discarded in the human hepatic amebiasis.

[Amebiasis and amebic liver abscess in Mexico: a present-day public health problem]. / La amibiasis y el absceso hepático amibiano en México, un problema de salud pública de actualidad.

BACKGROUND: Amebiasis still remains as a major public health problem in the world. It is one of the most common reasons for medical consult. There are more than half a million cases of amebiasis just at the Mexican Institute of the Social Security. There is still a lack of epidemiologic information on amebiasis in Mexico. AIM: To describe the secular trend fro amebiasis and for amebic liver abscess in the Mexican population, as well as in those covered by IMSS Solidaridad. METHOD: An ecologic trend study was carried on. Incidence rate of amebiasis in all of its forms of presentation, and of amebic liver abscess, were plotted against each year for the 1986-1994 period. RESULTS: Amebiasis incidence in all of its forms of presentation showed a stable trend in this period, as it was seen with amebic liver abscess. Amebiasis is more common in the first years of life. On the contrary, amebic liver abscess showed an inverted 'J' pattern; its occurrence is higher in the extreme years of life. Fatality rates have shown a descendent trend. CONCLUSIONS: Amebiasis reflects socioeconomic conditions in Mexico and the fact that Mexican is still an endless culture. There is a need to promote health education, better diagnostic procedures and detection of asymptomatic carriers. Health policies for mothers that are asymptomatic carriers should be reviewed, due to the high rates of amebiasis and amebic liver abscess in children under one year of age.

[Amebiasis. Has its clinical expression changed?]. / Amibiasis. Ha variado su expresión clínica?

In Mexico, like in other countries, there is an special interest for amebiasis because it represents a Public health problem; there are about 5 million people that in some time of their lives had tissue invasion by this parasite. 1-2% of mexicanas have intestinal amebiasis and probably there are 850,000 to 1,700,000 carriers of entamoeba cysts. 6% of the general population have circulating antiameba antibodies. In 1988 we studied the amebic hepatic abscess seen in the hospitals of the Instituto Mexicano del Seguro Social in the Valley of Mexico. During that year there were 396 patients with such illness (0.19% of hospital admissions) with a 1.01% mortality. Comparing this data with reports of 1969 there was a reduction in the number of patients and deaths. Also amebiasis has decreased in autopsy studies. However, we have not found recent variations in the clinical behavior of amebiasis. Advances in diagnostic methods and more liberal use of metronidazole have reduced the number of severely ill patients.

[Improvement in the quality of medical care]. / Mejoría de la calidad de la atención médica.

UNLABELLED: The object of this research was investigating the existence of programs, as well as the patient's and healthy worker's opinions, concerning the quality of Medical Attention in the representative medical institutions in Mexico City (Distrito Federal). Eighteen directors of medical institutions were interviewed; as well as fifty university graduates, one hundred out patients from health centers and three hundred patients treated at general hospitals. A poll was applied to two hundred and fifty physicians and two hundred and fifty nurses from health centers and general hospitals. RESULTS: The eighteen institutions studied had permanent programs for Supervision and assemend. Other activities were also detected: sixteen had Technical Committees, five had a Department for Complaints, three had Quality Circles, two had programs for Evaluation of Educational Needs, two had Patients Polls, two had Worker's Polls, one had a Shadow Study and two had Quality Control Programs. The 86% of university graduates belonged to the social security system. Among these, 36% attended public services, 36% of them did this selectively and 28% did not use social security. 30% felt that public medical services were good, 14% less than good and 56% bad. 36% felt that public services were better than private ones, 36% said both were equally good and 28% judged the public system as worse than the private ones. The main deficiency reported was a lack of personal warmth. The patients from both the general practice and hospitalization graded the opportunity, warmth and process of medical attention as variables with figures of 80% or more. The frequency of diverse "complications" was 66% in out patients and 36% in the hospitalized ones. The physicians and nurses graded the infrastructure, teaching, laboral motivation and satisfaction, and continuity of services as variables with percentages of 50% to 60%; whereas the variables of warmth, control and supervision with values of 60% to 80%. Hospital nurses were less satisfied. These results show patients to have an acceptable satisfaction whereas the health personnel was unmotivated. Practical actions are suggested to improve the quality of medical attention.