Dietary selection for lysine by the chick.

Broiler chicks were provided choices of synthetic diets (a) adequate or low in lysine, and (b) adequate in or devoid of lysine. In each case, chicks consumed some of each diet offered, but preference was shown for the adequate lysine diet. Growth rates of chicks given choices ranged from 80% of that of chicks fed an adequate lysine diet with no choice for two weeks, then growth rates fell to about 60% of those fed adequate lysine. In another study, chicks were fed a diet devoid of lysine but were offered pure L-lysine HCl in a separate feeder. These chicks selected some of the supplementary lysine, but their body weights were only 68% of the body weight of chicks fed an adequate lysine diet after 21 days. Chicks given a choice of diets prepared with an adequate quantity of either L- or D-lysine preferred with L-lysine diet but did not select sufficient quantity to reach normal growth. These observations indicate that chicks can discern the presence of L-lysine in diets or separately, but will not select sufficient quantity for maximum growth potential. A diet prepared with D-lysine was more acceptable than one completely devoid of lysine, suggesting some sensory recognition for lysine.

Evaluation of the effectiveness of postoperative radiation therapy for the control of local disease.

Although we agree that postoperative irradiation does improve the local and regional control, our findings indicate that the rate of control, especially local control, is somewhat less than 90 percent. Our data reveal a recurrence rate of 32.7 percent in advanced, stage III and IV, squamous cell carcinomas in the head and neck treated by surgery and postoperative irradiation; this rate may be even greater with longer follow-up. We recommend that surgeons avoid "close" surgical margins (less than 5 mm) when resecting primary cancers and not rely too heavily on radiation therapy to control residual subclinical disease. It appears that continued study is needed to establish the true efficacy of irradiation in the control of subclinical disease, and that local recurrence must be differentiated from regional recurrence when reporting these results.

A microbiological approach to nutrition.

Fermentation is known to modify nutritional value of foods positively. A new technique for supplementing traditional fermented foods with limiting amino acids is presented. Normal fermentative bacteria are induced to produce specific amino acids during the fermentation period. Acceptable food products have been prepared using fermented grain. The concept may be applicable to developing countries.

Aspergillosis of the nose and paranasal sinuses.

Aspergillosis is becoming an increasingly recognized pathogen in the sinonasal tract. The courses of two patients, one seemingly healthy and one with a terminal malignancy, are reviewed. These patients illustrate the clinical course, difficulties in diagnosis, and management of patients with aspergillosis of the sinonasal tract. Aspergillus is a common endogenous contaminant of the upper respiratory tract; however, bacterial sinusitis may trigger its growth and proliferation. Aspergillus fumigatus is the most common species implicated in paranasal sinus disease in the United States. The maxillary antrum is the most commonly involved site in the paranasal sinuses. Originally, aspergillosis was described in healthy patients, but it has become increasingly recognized in the immunocompromised and the chronically debilitated. Paranasal sinus Aspergillus infections are classified as non-invasive and fulminant. The treatment is primarily surgical. Antifungal chemotherapeutic agents are used in the treatment of central nervous system involvement and in the fulminant form of the disease.

Metastatic melanoma to the ethmoid sinus.

Malignant melanomas comprise approximately 1.5% of all malignant tumors and one fifth of these will involve the head and neck. The surgeon who operates in this region should be familiar with all aspects of this disease. The most common site of metastasis to the nose and paranasal sinuses is via the maxillary sinus. Often these metastases are of renal origin, with pulmonary metastases being the second most common source. The most frequent presenting symptoms are epistaxis, a nasal mass, or nasal obstruction. Review of the English literature to date has not revealed any reports of isolated metastatic melanoma to the ethmoid sinus. Batson, in 1940, proposed a plausible mechanism of such hematogenous metastasis via a valveless vertebral venous bed.

Squamous carcinoma of the larynx in patients under the age of 35 years.

Laryngeal carcinoma usually occurs in men between the ages of 50 and 70. In general, epithelial malignancies other than those involving the skin are rare in the young adult. Those squamous carcinomas arising in the lip, tongue, and tonsil appear to have a poorer prognosis than in the older adult. This study is a review of the medical records of 33 patients under the age of 35 years with squamous cell carcinoma of the larynx. The follow-up of the entire series was at least 24 months with an overall survival rate of 81%. These results contrast to five-year survival rates of 79%, 45%, and 14% of the lip, tongue, and tonsil, respectively, in patients from a similar age group.

The anatomic location of neck metastasis from occult squamous cell carcinoma.

It has been axiomatic among head and neck surgeons that open biopsy of cervical nodes will jeopardize patients having squamous cell carcinoma. The inappropriate biopsy of a squamous cell carcinoma metastatic to a cervical node will statistically double both the subsequent rates of local recurrence and distant metastasis. There is no reliable method to clearly distinguish a cervical node involved with squamous cell carcinoma from adenopathy of other sources. Because of this, all patients with cervical adenopathy are evaluated with the time honored approach of careful visualization and palpation of the upper aerodigestive tract prior to open biopsy. The extent of this evaluation is often judgmental. A review of patients with cervical adenopathy of unknown origin and who had a tissue diagnosis, shows that node location is the most helpful parameter for predicting eventual histopathology. Nodes in the jugulodigastric, digestive, and anterior cervical regions have a probability of 19% and 12%, respectively, of being a squamous cell carcinoma. Multiple adenopathies in the supraclavicular and posterior cervical areas are frequently malignant (84% and 61% respectively), however, these are usually either lymphoma or infraclavicular metastasis.

Antibiotic prophylaxis in high-risk head and neck surgery: one-day vs. five-day therapy.

Patients who undergo major contaminated surgery of the head and neck benefit from perioperative antibiotic prophylaxis. This study was developed to determine if 5 days of antibiotic administration would be more effective than 1 day. A multi-institutional prospective randomized double-blind study was designed. Patients who were identified as requiring pedicled flap reconstruction were potential candidates for the study. Later, patients were randomly assigned to receive cefoperazone sodium for either 24 hours or 120 hours. In each case, the drug was administered intravenously, beginning 1 to 2 hours preoperatively and continued for the prescribed period. One hundred nine patients were evaluable. Fifty-three patients were assigned to 1 day of perioperative prophylaxis. Wound infection developed in ten patients (18.9%). Fifty-six patients were assigned to 5 days of perioperative antibiotic prophylaxis. Wound infection developed in 14 (25%) of these patients (P greater than .05). These data suggest that no beneficial effect from administration of antibiotics for longer than 24 hours postoperatively can be achieved in patients who undergo myocutaneous flap reconstruction.

Salivary scan after major ablative head and neck surgery with prediction of postoperative fistulization.

Patients with carcinoma of the head and neck undergoing major ablative and reconstructive procedures following periods of prolonged debilitation, chemotherapy, and/or radiation therapy have been identified as having a high risk for postoperative wound complication, most often infection. Does postoperative wound infection arise de novo, does infection result from failure of prophylactic antibiotic coverage, or is it the result of anastomatic salivary leak? To investigate the incidence of unrecognized salivary leak into the neck, 24 patients underwent salivary radioisotope studies using technetium 99m sodium pertechnetate from three to six days postoperatively. The isotope was administered early in the morning with drainage bags empty. Patients and the collection system were scanned for activity between four and six hours later. Nine patients had postoperative evidence of salivary secretion radioactivity in their drainage system. All of these patients developed transient wound infections or fistulas. The remaining 15 had no uptake in their collection systems and no wound complications. We suggest that the preliminary results from this noninvasive, simply administered study indicate that the infected surgical neck wound may be secondary to unrecognized postoperative salivary contamination. This technique can be used to provide early identification of potential wound infection. Alternatively, information generated by this kind of study may be valuable in predicting patients with the highest risk for postoperative infection, thereby offering guidelines for the use of perioperative antibiotic prophylaxis.

Effect of pelleting and beta-glucanase supplementation on the ileal and fecal digestibility of a barley-based diet in the pig.

The influences of pelleting and beta-glucanase supplementation on the digestibility of dietary components in a barley-based diet were investigated in pigs fitted with cannulas in the terminal ileum. The diet contained 49.0% starch, 18.9% crude protein and 14.8% dietary fiber, with arabinoxylans (4.9%), mixed-linked beta-glucans (3.4%) and cellulose (3.3%) as the main fiber components. Pelleting increased mixed-linked beta-glucan solubility from 45 to 62%. Neither treatment influenced the ileal or fecal apparent digestibilities of dry matter (64 and 80%, respectively), energy (62 and 79%), crude protein (53 and 75%), crude fat (26 and 27%) or dietary fiber (58 and 72%). However, pelleting increased (P less than .01) the pre-ileal apparent digestibility of starch from 91.5 to 95.3% and decreased (P less than .03) that of ash from -10 to -23%, while increasing (P less than .005) the fecal apparent digestibility of starch from 98.6 to 99.7%. The solubility of mixed-linked beta-glucans in ileal digesta was lower (P less than .001) in pelleted (26%) than in unpelleted (58%) diets. beta-glucanase supplementation also increased (P less than .05) the ileal apparent digestibility of starch, from 92.6 to 94.3%, and of mixed-linked beta-glucans, from 95.7 to 97.1%. Significant between-pig differences in the apparent digestibility of dietary components were observed. In conclusion, treatments that disrupt the endosperm cell walls in barley can increase the proportion of the diet digested prior to the large intestine.

Reduction of carcass fat in swine with dietary addition of dihydroxyacetone and pyruvate.

Swine weighing 80 to 85 kg were fed a basal corn-soybean meal diet plus a mixture of dihydroxyacetone and pyruvate (3:1) (triose) or Polycose (control), a glucose polymer, as 3.85% of calories (4% of the diet). Twenty-four pigs were pair-fed the triose mixture or control diet for 28 d in litter-mate pairs of the same sex. Weight gain and feed consumption were recorded and carcasses were evaluated for fat and muscle accretion. The right rear leg and rear one-third of the right loin were skinned, deboned, ground and analyzed for protein, fat, moisture and ash content. Average backfat depth and backfat depth at the first, last and 10th rib were reduced by 12, 15, 14 and 12% (P less than .01), respectively, in triose-fed pigs. Loin eye area and untrimmed lean cuts were not altered by diet, but percentage trimmed lean cuts was higher (P less than .02) in triose-fed pigs (57.6 vs 55.3%). Leg and loin tissue samples from pigs fed the triose mixture had a lower (P less than .01) percentage of fat and a corresponding increased (P less than .01) percentage of protein. Organ weights and the blood biochemical profile were not altered by triose feeding. Liver function tests were not altered in animals consuming the trioses, except for an 18% decrease (P less than .05) in serum glutamic pyruvic transaminase. Ingestion of dihydroxyacetone and pyruvate will reduce body fat in limit-fed swine without reducing muscle protein deposition.

Nutritive value of a new hull-less barley cultivar in broiler chick diets.

The hull-less barley mutant Franubet, derived from Betzes (CI 6398), has an unusual starch type, with granules that appear fractured when viewed with an electron microscope. Hull-less Franubet barley from three crops and a hulled barley, Ershabet (CI 15722) were used in a series of 21-day broiler chick feeding studies using 21% protein diets supplemented with 44% protein soybean meal, DL-methionine, minerals, vitamins, and an antibiotic. Barley-containing diets were compared with corn diets in varying proportions as basal grains. Supplemental beta-glucanase added to Franubet diets resulted in improvement in chick growth over that of birds fed diets unsupplemented with beta-glucanase. In some cases, chicks fed Franubet barley with or without the supplemental enzyme had weight gains equal to those fed corn. Feed:gain ratios corresponded to weight gain results. In one trial, Ershabet barley, a hulled cultivar, was compared with Franubet barley, with and without beta-glucanase, and corn as basal grains. Results from feeding both barleys were equal to those of feeding corn when supplemented with enzyme, although performance of the hull-less cultivar tended to be superior with respect to chick body weight gain and feed:gain ratio. Franubet barley appears to have high nutrient digestibility for poultry compared with other barleys.

Unresponsive unilateral serous otitis: harbinger of malignancy?

In adults with persistent (three to five weeks' duration) or recurrent serous otitis media, the possibility of an underlying malignancy in the nasopharynx should be considered. Alertness to this and other clues, such as atypical facial pain, will result in appropriate investigation and earlier diagnosis and treatment.

Abnormalities in and around the ear: congenital, traumatic, inflammatory, and neoplastic.

Lesions on or about the auricle may be of congenital, traumatic, inflammatory, or neoplastic origin. For congenital lesions, appropriate treatment and correction of hearing loss are important concerns. The most common traumatic lesions, subperichondral hematomas and keloids, require accurate diagnosis and appropriate treatment to prevent development of further problems. Inflammatory lesions are usually easy to diagnose from the patient's complaints of recent onset of pain, erythema, and edema. Neoplasms, especially squamous cell carcinoma, should be considered in differential diagnosis of a sore that does not heal. When treatment of a periauricular abnormality involves surgery, biopsy, or incision and drainage, care should be taken not to jeopardize the facial nerve.

Persistent hoarseness: an aggressive approach for early detection of laryngeal cancer.

Persistent hoarseness in a patient should always alert the physician to the possibility of laryngeal carcinoma. Prompt visualization of the larynx is essential, particularly in high-risk patients over 40 years of age without a history of upper respiratory infection. Mirror examination (indirect laryngoscopy) is the usual initial diagnostic procedure, although Hopkins' rod telescope and the fiberoptic laryngoscope may provide more adequate visualization. Direct laryngoscopy and biopsy allow definitive diagnosis.

Effect of a barley breakfast cereal on blood glucose and insulin response in normal and diabetic patients.

Prowashonupana (Prowash) is a shrunken-endosperm, short awn, waxy starch, hulless barley with low starch, high fiber, high protein, and a relatively high concentration of free sugars. The study was designed to compare equivalent breakfast meals (w/w) of Prowash and oatmeal for glycemic response in diabetic and non-diabetic subjects. A commercial liquid meal replacer (LMR) was included as a reference standard. A substantial reduction of the post-prandial glycemic peak following ingestion of Prowash was observed as compared to LMR or oatmeal. In the non-diabetic subjects, the maximal rise in glucose from baseline was 26.3 +/- 3.9 mg/dL after LMR, 41.3 +/- 3.9 mg/dL after oatmeal and 6.4 +/- 2.7 mg/dL after Prowash (p < 0.01). The maximal increase in glucose in the diabetic patients was 69.9 +/- 4.5 mg/dL after LMR, 80.8 +/- 8.8 mg/dL after oatmeal and 28.4 +/- 3.5 mg/dL after Prowash (p < 0.01). The maximal increase in insulin post-LMR was 33.9 +/- 3.6 mIU/ml in the diabetic patients and 54.0 +/- 9.8 mIU/ml in the non-diabetic controls. Oatmeal elicited a maximal insulin increase of 29.9 +/- 4.2 mIU/ml in the control subjects and 21.4 +/- 2.5 mIU/ml in the diabetic patients. In contrast, the maximal insulin increase after Prowash was 8.6 +/- 1.5 mIU/ml in the non-diabetic controls and 6.8 +/- 1.2 mIU/ml in the diabetic patients (p < 0.01).

Oat beta-glucan-amylodextrins: preliminary preparations and biological properties.

Amylodextrins with soluble beta-glucan contents from 1 to 10% were prepared from oats and the hypocholesterolemic properties of the latter were evaluated. The products are called OATRIM and can lower blood cholesterol by replacing animal fats rich in cholesterol in food products and, possibly, by the action of beta-glucan in the body after consumption. In the chick model, decreased total blood cholesterol also resulted in increases of HDL cholesterol and decreases of LDL cholesterol. Processing conditions were found that gave the maximum amount of beta-glucan and desirable fat-replacement qualities with the least amount of color and flavor.