Feeding cows with hay, silage, or fresh herbage on pasture or indoors affects sensory properties and chemical composition of milk and cheese.

In European countries, silage-free feeding is an ancient tradition and has a particularly positive reputation among consumers. In the present study, we compared grass-based forages from the same plot conserved as hay or silage or fed fresh either on pasture or indoors, and we evaluated the differences in sensory properties of milk and uncooked pressed cheese. All herbage from the first cut of a grassland dominated by perennial ryegrass was harvested on the same day and preserved either as hay or silage. The first regrowth of the same plot was used for strip grazing or green feeding indoors. Balanced by breed, 24 Montbéliarde and 24 Holstein cows were allocated to the 4 treatments. Apart from the forages, the late-lactation cows received 3 kg/d of dry matter from concentrate. After 2 wk of dietary adaptation, the bulk milk of 3 subgroups, each with 4 cows, was collected. Part of the milk was pasteurized, and part was left raw and partly transformed to small-sized Cantal-type cheese ripened for 9 wk. Milk and cheese underwent descriptive sensory analysis by a trained sensory panel, as well as analyses of physicochemical traits. Volatile organic compounds of the cheeses were also analyzed. Raw and pasteurized milk from hay-fed cows had less intense odors of cooked milk, cream, and barnyard than milk from grazing cows, whereby the effect of pasteurization did not differ between herbage utilization methods. Cheeses obtained from cows fed fresh herbage (grazing and indoors) were clearly yellower than cheeses from silage- and hay-fed cows, which coincided with the color intensity perceived by the panelists. Moreover, cheeses from cows fed fresh herbage had more intense barnyard and dry fruit flavors, were perceived as creamier and having less lactic odor, and exhibited more fat exudation than those from cows fed conserved herbage. Only a few differences were observed in milk and cheeses from hay-fed compared with silage-fed cows, and those differences were far less pronounced than those of milk and cheeses from cows fed fresh herbage. In conclusion, the present study did not substantiate assumptions of clear sensory differences of milk and uncooked pressed cheese from hay-fed compared with silage-fed cows. For the first time, this study reports that the global flavor intensity of cheeses from indoor green-fed cows is similar to that of cheeses derived from cows fed conserved forages, whereas cheeses from grazing cows have the greatest global flavor intensity.

Pattern II and pattern III MS are entities distinct from pattern I MS: evidence from cerebrospinal fluid analysis.

BACKGROUND: The diagnosis of multiple sclerosis (MS) is currently based solely on clinical and magnetic resonance imaging features. However, histopathological studies have revealed four different patterns of lesion pathology in patients diagnosed with MS, suggesting that MS may be a pathologically heterogeneous syndrome rather than a single disease entity. OBJECTIVE: The aim of this study was to investigate whether patients with pattern I MS differ from patients with pattern II or III MS with regard to cerebrospinal fluid (CSF) findings, especially with reference to intrathecal IgG synthesis, which is found in most patients with MS but is frequently missing in MS mimics such as aquaporin-4-IgG-positive neuromyelitis optica spectrum disorders and myelin oligodendrocyte glycoprotein-IgG-positive encephalomyelitis. METHODS: Findings from 68 lumbar punctures in patients who underwent brain biopsy as part of their diagnostic work-up and who could be unequivocally classified as having pattern I, pattern II or pattern III MS were analysed retrospectively. RESULTS: Oligoclonal bands (OCBs) were present in 88.2% of samples from pattern I MS patients but in only 27% of samples from patients with pattern II or pattern III MS (P < 0.00004); moreover, OCBs were present only transiently in some of the latter patients. A polyspecific intrathecal IgG response to measles, rubella and/or varicella zoster virus (so-called MRZ reaction) was previously reported in 60-80% of MS patients, but was absent in all pattern II or III MS patients tested (P < 0.00001 vs. previous cohorts). In contrast, the albumin CSF/serum ratio (QAlb), a marker of blood-CSF barrier function, was more frequently elevated in samples from pattern II and III MS patients (P < 0.002). Accordingly, QAlb values and albumin and total protein levels were higher in pattern II and III MS samples than in pattern I MS samples (P < 0.005, P < 0.009 and P < 0.006, respectively). CONCLUSIONS: Patients with pattern II or pattern III MS differ significantly from patients with pattern I MS as well as from previous, histologically non-classified MS cohorts with regard to both intrathecal IgG synthesis and blood-CSF barrier function. Our findings strongly corroborate the notion that pattern II and pattern III MS are entities distinct from pattern I MS.

Primary central nervous system vasculitis and its mimicking diseases - clinical features, outcome, comorbidities and diagnostic results - A case control study.

OBJECTIVES: To compare clinical features and outcome, imaging characteristics, biopsy results and laboratory findings in a cohort of 69 patients with suspected or diagnosed primary central nervous system vasculitis (PCNSV) in adults; to identify risk factors and predictive features for PCNSV. PATIENTS AND METHODS: We performed a case-control-study including 69 patients referred with suspected PCNSV from whom 25 were confirmed by predetermined diagnostic criteria based on biopsy (72%) or angiography (28%). Forty-four patients turned out to have 15 distinct other diagnoses. Clinical and diagnostic data were compared between PCNSV and Non-PCNSV cohorts. RESULTS: Clinical presentation was not able to discriminate between PCNSV and its differential diagnoses. However, a worse clinical outcome was associated with PCNSV (p=0.005). Biopsy (p=0.004), contrast enhancement (p=0.000) or tumour-like mass lesion (p=0.008) in magnetic resonance imaging (MRI), intrathecal IgG increase (p=0.020), normal Duplex findings of cerebral arteries (p=0.022) and conventional angiography (p 0.010) were able to distinguish between the two cohorts. CONCLUSION: In a cohort of 69 patients with suspected PCNSV, a large number (64%) was misdiagnosed and partly received treatment, since mimicking diseases are very difficult to discriminate. Clinical presentation at manifestation does not help to differentiate PCNSV from its mimicking diseases. MRI and cerebrospinal fluid analysis are unlikely to be normal in PCNSV, though unspecific if pathological. Cerebral angiography and biopsy must complement other diagnostics when establishing the diagnosis in order to avoid misdiagnosis and mistreatment. CLINICAL TRIAL REGISTRATION: German clinical trials register: http://drks-neu.uniklinik-freiburg.de/drks_web/, Unique identifier: DRKS00005347.

Influence of the calf presence during milking on dairy performance, milk fatty acid composition, lipolysis and cheese composition in Salers cows during winter and grazing seasons.

The milking of Salers cows requires the presence of the calf. The removal of the calf would simplify the milking routine, but it could also modify the milk yield and the milk and cheese composition. Therefore, the aim of this experiment was to evaluate the effect of calf presence during milking during sampling period (winter or grazing periods), on dairy performance, milk fatty acid (FA) composition, lipolysis and cheese yield and composition. Nine and 8 Salers lactating cows were milked in the presence (CP) or absence (CA) of their calves respectively. During winter, the cows were fed a hay-based diet and then they only grazed a grassland pasture. Calf presence during milking increased milk yield and milk 16:0 concentration and decreased milk fat content and milk total odd- and branched-chain FA (OBCFA) concentrations. Calf presence only increased initial lipolysis in milk collected during the winter season. Milk from CP cows compared to CA cows resulted in a lower cheese yield and ripened cheeses with lower fat content. Milk from the grazing season had lower saturated medium-chain FA and OBCFA concentrations and higher 18:0, cis-9-18:1, trans-11-18:1 and cis-9, trans-11-CLA concentrations than that from the winter season. Initial milk lipolysis was higher in the winter than in the grazing season. These variations could be due to seasonal changes in the basal diet. Furthermore, the effect of calf presence during milking on milk fat composition was lower than that on dairy performance, cheese yield and composition. Removing the calf during the milking of Salers cows seems feasible without a decrease in milked milk, and with a positive effect on cheese yield and fat content, under the condition that we are able to select cows having the capacity to be milked easily without the calf.

Contribution of spinal cord biopsy to diagnosis of aquaporin-4 antibody positive neuromyelitis optica spectrum disorder.

Longitudinally extensive transverse myelitis is characteristic but not pathognomonic for neuromyelitis optica spectrum disorders (NMOSDs) and may mimic local tumors. In this retrospective study based on a cohort of 175 NMOSD patients we identified seven patients who initially presented with a longitudinally extensive spinal cord lesion and underwent spinal cord biopsy due to magnetic resonance imaging (MRI)-suspected malignancies. Remarkably, routine neuropathology was inconclusive and did not guide the diagnostic process to anti-aquaporin-4 (AQP4)-seropositive NMOSD. Serious postoperative complications occurred in 5/7 patients and persisted during follow-up in 2/7 patients (29%). Considering these sequelae, AQP4-antibody testing should be mandatory in patients with inconclusive longitudinally extensive spinal cord lesions prior to biopsy.

[Differential diagnosis of lymphoid infiltrates in the central nervous system: experience of the Network Lymphomas and Lymphomatoid Lesions in the Nervous System]. / Differenzialdiagnose lymphoider Infiltrate im Zentralnervensystem : Erfahrungen des Netzwerks Lymphome und lymphomatoide Läsionen des Nervensystems.

The differential diagnosis of lymphoid lesions in the central nervous system covers a broad spectrum of neoplastic and inflammatory disorders. Complex cases benefit from the combined expertise in the fields of hematopoietic and neuroepithelial tumors as well as neuroimmunology. The Network Lymphomas and Lymphomatoid Lesions in the Nervous System (NLLLN) recommends performing a biopsy prior to any therapeutic intervention as a precise diagnosis was impossible in approximately 50 % of patients pretreated with corticosteroids. This is based on the analysis of approximately 1,000 cases in the past 4 years. In addition to total NLLLN experiences the characteristics, pathogenesis and differential diagnosis of primary lymphoma of the central nervous system are discussed.

Milk fatty acid composition and cheese texture and appearance from cows fed hay or different grazing systems on upland pastures.

The objective of this work was to compare milk fatty acid (FA) profile and texture and appearance of Cantal cheeses obtained from cows grazing 2 different upland grasslands: a highly diversified pasture (74 species) of area 12.5 ha managed under continuous mode (C), and a weakly diversified pasture (31 species) of area 7.7 ha (an old temporary grassland) managed under rotational mode (R). A control group of cows fed a hay-based diet (indoors, I) was used. Three equivalent groups of 12 Montbéliarde cows underwent the 3 treatments from May to September 2008. The cheeses were manufactured during 3 consecutive days in early June, early July, and late August (27 cheeses in all). The texture, appearance, and chemical composition of the cheeses were determined after 12 wk of ripening. Concentrations of total saturated FA and monounsaturated FA were higher and lower, respectively, in I milks compared with pasture milks. The concentrations of trans-11-C18:1 and cis-9-C18:1, and polyunsaturated FA as well as yellowness decreased during the season in C-derived milk but remained constant in R-derived milk, through a combined effect of grass development stage and the cows' grazing selection. The I cheeses were, on average, firmer, less creamy, less elastic, and less yellow than the pasture cheeses. Decreasing and increasing trends in texture firmness during the season were observed for C and R cheeses, respectively. The rind of the pasture-fed cow cheese had fewer, less intensely colored, and less prominent spots than did that of I cheeses. This difference was probably due to greater migration of fat to the rind during pressing because of the lower fat melting point of the pasture-fed cow cheeses, which had higher unsaturated FA content. The greater amounts of fat deposited on the rind of the pasture-fed cow cheeses may have partially inhibited the microbial activity responsible for rind appearance. Our trial underlines the importance of the effects of grazing management associated with vegetation type on milk and cheese characteristics.

Yield and sensory properties of cheese made with milk from Holstein or Montbeliarde cows milked twice or once daily.

The aim of this study was to evaluate the milk properties and the yield and sensory properties of Cantal cheese made with milk from Holstein or Montbéliarde cows milked once or twice daily. Sixty-four grazing cows [32 Holstein (H) and 32 Montbéliarde (M) cows] in the declining phase of lactation (157 d in milk) were allocated to 1 of 2 equivalent groups milked once daily (ODM) or twice daily (TDM) for 7 wk. The full-fat raw milk collected during 24 h from the 4 groups of cows (M-TDM, M-ODM, H-TDM, and H-ODM) was pooled and processed into Cantal cheese 4 times during the last 4 wk of the experimental period. In all, 16 cheeses were made (2 milking frequencies x 2 breeds x 4 replicates) and analyzed after a ripening period of 15 and 28 wk. The results showed that for both breeds, the pooled milk content of fat, whey protein, casein, total protein, and phosphorus as well as rennet clotting time and curd firming time were significantly higher with ODM cows, whereas the casein-to-total protein ratio was lower, and lactose, urea, calcium, and free fatty acids contents of milk remained unchanged. The acidification and draining kinetics of the cheese as well as cheese yields and the chemical and rheological properties of the ripened cheese were not significantly modified by milking frequency. For both breeds, the cheeses derived from ODM cows had a slightly yellower coloration but the other sensory attributes, except for pepper odor, were not significantly affected by milking frequency, thereby demonstrating that ODM does not have an adverse effect on the sensory properties of Cantal cheese. Compared with that of Holstein cows, milk from Montbéliarde cows resulted in a higher cheese yield (+1.250 kg/100 kg of milk) and ripened cheeses with lower pH, dry matter, calcium, sodium chloride, and water-soluble nitrogen concentrations. These cheeses had also a less firm and more elastic texture, a more acidic taste, and a yogurt/whey aroma.

Gender differences in the histopathology of MS?

Multiple sclerosis (MS) lesions are histopathologically characterized by inflammation, demyelination/remyelination, axonal damage and gliosis. Animal experimental and in vitro studies suggest that sex hormones influence the immune system and contribute to the increased likelihood in women of developing MS. However, a variety of studies have also shown that remyelination is more marked in female rodents or that female sex hormones are beneficial for myelin repair. To determine whether gender influences the histopathology of MS lesions, we compared the extent of inflammation, axonal damage and remyelination in MS lesions of female and male MS patients. We observed no differences in the composition of inflammatory infiltrates, axonal damage or cortical pathology. Similar numbers of oligodendroglial progenitor cells and mature oligodendrocytes were present in MS lesions. Remyelination is slightly, but not significantly, more extensive in women than men in early MS lesions. The absence of significant differences in lesion pathology between female and male MS patients might be explained by a lack of a gender influence, but also might be due to the limited number of tissue samples available for histopathological analysis.

Clinical and radiographic spectrum of pathologically confirmed tumefactive multiple sclerosis.

Atypical imaging features of multiple sclerosis lesions include size >2 cm, mass effect, oedema and/or ring enhancement. This constellation is often referred to as 'tumefactive multiple sclerosis'. Previous series emphasize their unifocal and clinically isolated nature, however, evolution of these lesions is not well defined. Biopsy may be required for diagnosis. We describe clinical and radiographic features in 168 patients with biopsy confirmed CNS inflammatory demyelinating disease (IDD). Lesions were analysed on pre- and post-biopsy magnetic resonance imaging (MRI) for location, size, mass effect/oedema, enhancement, multifocality and fulfilment of Barkhof criteria. Clinical data were correlated to MRI. Female to male ratio was 1.2 : 1, median age at onset, 37 years, duration between symptom onset and biopsy, 7.1 weeks and total disease duration, 3.9 years. Clinical course prior to biopsy was a first neurological event in 61%, relapsing-remitting in 29% and progressive in 4%. Presentations were typically polysymptomatic, with motor, cognitive and sensory symptoms predominating. Aphasia, agnosia, seizures and visual field defects were observed. At follow-up, 70% developed definite multiple sclerosis, and 14% had an isolated demyelinating syndrome. Median time to second attack was 4.8 years, and median EDSS at follow-up was 3.0. Multiple lesions were present in 70% on pre-biopsy MRI, and in 83% by last MRI, with Barkhof criteria fulfilled in 46% prior to biopsy and 55% by follow-up. Only 17% of cases remained unifocal. Median largest lesion size on T2-weighted images was 4 cm (range 0.5-12), with a discernible size of 2.1 cm (range 0.5-7.5). Biopsied lesions demonstrated mass effect in 45% and oedema in 77%. A strong association was found between lesion size, and presence of mass effect and/or oedema (P < 0.001). Ring enhancement was frequent. Most tumefactive features did not correlate with gender, course or diagnosis. Although lesion size >5 cm was associated with a slightly higher EDSS at last follow-up, long-term prognosis in patients with disease duration >10 years was better (EDSS 1.5) compared with a population-based multiple sclerosis cohort matched for disease duration (EDSS 3.5; P < 0.001). Given the retrospective nature of the study, the precise reason for biopsy could not always be determined. This study underscores the diagnostically challenging nature of CNS IDDs that present with atypical clinical or radiographic features. Most have multifocal disease at onset, and develop RRMS by follow-up. Although increased awareness of this broad spectrum may obviate need for biopsy in many circumstances, an important role for diagnostic brain biopsy may be required in some cases.

Addition of pasture plant essential oil in milk: influence on chemical and sensory properties of milk and cheese.

The aim of this experiment was to study the effect of the addition, to milk, of an essential oil (EO) obtained from the hydrodistillation of plants collected from a mountain natural pasture on the milk and cheese sensory properties. The EO was mainly composed of terpenoid compounds (67 of the 95 compounds identified) as well as ketones, aldehydes, alcohols, esters, alkanes, and benzenic compounds. In milk, the addition of this EO at the concentration of 0.1 microL/L did not influence its sensory properties, whereas at 1.0 microL/L, sensory properties were modified. In cheeses, the effect of adding EO into milk was studied in an experimental dairy plant allowing the production of small Cantal-type cheeses (10 kg) in 3 vats processed in parallel. The control (C) vat contained 110 L of raw milk; in the other 2 vats, 0.1 microL/L (EO1) or 3.0 microL/L (EO30) of EO were added to 110 L of the same milk. Six replicates were performed. After 5 mo of ripening, chemical and sensory analyses were carried out on the cheeses, including determination of the volatile compounds by dynamic headspace combined with gas chromatography-mass spectrometry. The EO did not influence the sensory properties of the cheeses at the lower concentration (EO1). However, the EO30 cheeses had a more intense odor and aroma, both characterized as "mint/chlorophyll" and "thyme/oregano." These unusual odors and aromas originated directly from the EO added. In total, 152 compounds desorbing from cheese were found, of which 41 had been added with the EO; in contrast, 54 compounds of the EO were not recovered in the cheese. Few volatile compounds desorbing from cheeses, other than the added compounds, were affected by EO addition. Among them, 2-butanol, propanol, and 3-heptanone suggested a slight effect of the EO on lipid catabolism. The antimicrobial activity of terpenes is not or is only marginally involved in the explanation of the influence of the botanical composition of the meadows on the pressed cheeses sensory properties.

Massive pulmonary haemorrhage caused by leptospirosis successfully treated with nitric oxide inhalation and haemofiltration.

A patient with leptospirosis who developed oliguric renal failure, massive pulmonary haemorrhage and respiratory failure is described. The patient's clinical condition and arterial oxygenation failed to improve despite vigorous supportive measures. Nitric oxide inhalation and haemofiltration resulted in a marked clinical improvement and subsequent full recovery. We suggest that the addition of haemofiltration and nitric oxide inhalation therapy should be considered in patients with pulmonary haemorrhage and renal failure caused by leptospirosis, in whom conventional therapy fails.

Effect of forage conservation (hay or silage) and cow breed on the coagulation properties of milks and on the characteristics of ripened cheeses.

Forty-two multiparous dairy cows of three different breeds (Holstein, Montbéliarde and Tarentaise) were fed on the same type of forage (natural grassland) preserved in the form of either hay (H) or silage (GS), according to a changeover design (two 4 week periods). The proportion of concentrate in the diet and the energy and nitrogen contents were similar in both treatments. The milk produced by these cows was used for the manufacture of Saint-Nectaire type cheeses, under controlled and identical cheesemaking technological conditions. More cheese was produced with the H treatment milk. The cheeses made with the GS treatment milk were more yellow and tended to be more bitter. The other chemical and sensory characteristics did not differ much between the two treatments. Of the 51 volatile compounds identified, four were in significantly higher proportion in the GS than in the H cheeses. Cheeses produced from Tarentaise cows' milk were more yellow and their pH was higher than those made with the milk of Holstein or Montbéliarde cows. The cheeses from Montbéliarde and Tarentaise cows' milk were firmer, more melting and tastier than those made with the milk of Holstein cows. Although some trends were apparent, there were no significant differences in cheese volatile compounds for different breeds.

[Echography of knee joint cysts (author's transl)]. / Sonographische Diagnostik von Kniegelenkszysten.

Because of a palpable swelling, 57 popliteal fossae were examined echographically. In 24 cases, the echography revealed a probable Baker's cyst. This diagnosis was confirmed by arthrography or at operation in 21 of the 24 cases. Two of the three findings which did not correspond were due to over-interpretation of the echographic picture and can be avoided in future by giving particular intention to the sound intensity. The causes of the discrepancy in the third case are still undetermined. These results show that echography is suitable for the discovery and assessment of Baker's cysts and should be used first as a non-invasive, painless, rapidly reproducible method.

Another case of ovarian pregnancy in a patient with IUD.

PIP: The authors, who reported a case of ovarian pregnancy a year ago, report a second case. The diagnosis was difficult to make because of a typical symptoms. A healthy 27-year-old woman was referred to the Kantonsspital, Liestal, Switzerland, on February 16, 1973. She had been wearing a Lippes loop C since 1970. The patient's last menstruation was on December 11, 1972. She complained of left lower abdominal pain in the middle of January, and a pregnancy test carried out on February 8, 1973, was positive 2 days after the patient received 1 ampule of Lutovocyclin forte. On admission, however, the pregnancy test was negative. At laparoscopy, the left ovary was yellowtinged, partly cystic, and contained blood. It was interpreted as a corpus luteum. After laparoscopy, the bleeding which had occurred before stopped, but the patient still complained of left lower abdominal pain and tiredness. Laparotomy was performed. The left ovary was partly resected, and it was found to contain a blood-filled cyst. The histological diagnosis was recent ovarian pregnancy. The postoperative phase was uneventful.^ieng