Selenium levels in cows fed pasture and concentrates or a total mixed ration and supplemented with selenized yeast to produce milk with supra-nutritional selenium concentrations.

Seventy multiparous Holstein-Friesian cows were fed different amounts of pasture and concentrates, or a total mixed ration (TMR), for 42 d in mid-lactation to test the hypothesis that the concentration of Se in milk would depend on the amount of Se consumed, when the Se is primarily organic in nature, regardless of the diet of the cows. Of the 70 cows, 60 grazed irrigated perennial pasture at daily allowances of either 20 or 40 kg of dry matter (DM)/cow. These cows received 1 of 3 amounts of concentrates, either 1, 3, or 6 kg of DM/cow per day of pellets, and at each level of concentrate feeding, the pellets were formulated to provide 1 of 2 quantities of Se from Se yeast, either about 16 or 32 mg of Se/d. The other 10 cows were included in 2 additional treatments where a TMR diet was supplemented with 1 kg of DM/d of pellets formulated to include 1 of the 2 quantities of supplemental Se. Total Se intakes ranged from 14.5 to 35.9 mg/d, and of this, the Se-enriched pellets provided 93, 91, and 72% of the Se for cows allocated 20 and 40 kg of pasture DM/d or the TMR, respectively. No effects of the amount of Se consumed on any milk production variable, or on somatic cell count, body weight, and body condition score, for either the pasture-fed or TMR-fed cows were found. Milk Se concentrations responded quickly to the commencement of Se supplementation, reaching 89% of steady state levels at d 5. When milk Se concentrations were at steady state (d 12 to 40), each 1mg of Se eaten increased the Se concentration of milk by 5.0 µg/kg (R(2)=0.97), and this response did not seem to be affected by the diet of the cows or their milk production. The concentration of Se in whole blood was more variable than that in milk, and took much longer to respond to change in Se status, but it was not affected by diet at any time either. For the on-farm production of Se-enriched milk, it is important to be able to predict milk Se concentration from Se input. In our study, type of diet did not affect this relationship.

Output of selenium in milk, urine, and feces is proportional to selenium intake in dairy cows fed a total mixed ration supplemented with selenium yeast.

Fifteen rumen fistulated Holstein cows in late lactation and fed a total mixed ration offered ad libitum were supplemented with Se yeast to provide 0, 11, 20, 30, or 42 mg of supplemental Se/day to test the hypothesis that amounts of Se secreted in milk, excreted in urine and feces, and apparently retained in tissues would increase in direct proportion to Se intake. One-half of the yeast supplement was placed directly into the rumen through the fistula of each cow just before milking in the morning and again in the evening, and estimates of average daily excretion of Se were made using total collections of urine and feces from 25 to 31 d after treatments commenced. Amounts of Se secreted daily in milk and apparently retained in tissues increased linearly with average daily intake of Se. The amount of Se excreted in feces and total excretion of Se in urine plus feces increased curvilinearly with Se intake, such that proportionately less Se was excreted as the amount of Se fed increased. On average, total Se excretion accounted for 66%, Se secretion in milk accounted for 17%, and Se apparently retained in tissues accounted for 17% of total Se intake by cows. Thus, in herds fed large amounts of Se yeast, most of the Se will be excreted and retained on-farm. High concentrations of Se will be found where urine and feces accumulate (e.g., yards and effluent ponds), and effluent management practices must be tailored to avoid environmental issues.

Increasing amounts of crushed wheat fed with pasture hay reduced dietary fiber digestibility in lactating dairy cows.

Sixteen cows in mid-lactation (milk yield of 23.8 +/- 2.3 kg/d) were individually fed diets consisting of chopped perennial ryegrass hay, offered at 3 kg of dry matter (DM)/100 kg of body weight (BW), fed either alone or supplemented with amounts of crushed wheat ranging from 0.4 to 1.6 kg of DM/100 kg of BW (increasing at nominal intervals of 0.4 kg of DM/100 kg of BW; 5 nominal treatments in total). Three cows were allocated to each treatment except the mid-range wheat treatment, which had 4 cows. Results were analyzed by regression because the intake of the wheat by cows within treatments varied. The hay was used to reflect the characteristics of summer pastures in southeastern Australia. Feed intake and fecal output were measured to determine digestion coefficients, feeds were incubated in nylon bags in the rumen, and rumen variables were monitored. Estimates of metabolizable energy (ME) of the hay from in vivo or in vitro digestibility were also compared. The digestibility of neutral detergent fiber (NDF) was depressed linearly as the amount of crushed wheat consumed increased to 36% of DM intake. The extent to which negative associative effects on NDF digestion were associated with the hay could not be determined, as it was not possible to distinguish between the NDF from hay and that from wheat. However, acid detergent fiber (ADF) digestion also declined, suggesting that most of the response lay with the hay because ADF was negligible in the wheat. Most data indicated that effects of proportion of wheat in the diet on the utilization of consumed nutrients were small. Despite substitution of wheat for hay reducing the forage intake of cows, there was a positive linear effect on marginal milk responses (1.3 kg of energy-corrected milk/kg of DM wheat). Mean rumen fluid pH declined as the proportion of wheat in the diet increased. The lowest pH for any individual cow during a 24-h period was 5.4, and the amount of time that rumen fluid pH was <6.0 ranged from 0 to 14 h depending on the amount of wheat consumed. It was concluded that these perturbations of the rumen environment were probably sufficient to result in negative associative effects. In addition, estimates of the ME content of the hay were higher when calculated from in vitro compared with in vivo digestibility, which has implications when estimating the amount of feed required for production.

Increasing selenium concentration in milk: effects of amount of selenium from yeast and cereal grain supplements.

Two experiments were conducted to establish responses in milk Se concentrations in grazing dairy cows to different amounts of dietary Se yeast, and to determine the effects of the Se concentration of the basal diet. The hypothesis tested was that the response in milk, blood, and tissue Se concentrations to supplemental Se would not be affected by whether the Se was from the basal diet or from Se yeast. In addition, by conducting a similar experiment in either early (spring; experiment 1) or late (autumn; experiment 2) lactation, we hypothesized that different Se input-output relationships would result. Both 6-wk experiments involved 60 multiparous Holstein-Friesian cows, all of which had calved in spring. They were allocated to 1 of 10 dietary Se treatments that included 2 types of crushed triticale grain (low Se, approximately 165 microg of Se/kg of DM; or high Se, approximately 580 microg/kg of DM) fed at 4 kg of DM/d, and 1 kg of DM/d of pellets formulated to carry 5 quantities of Se yeast (0, 4, 8, 12, or 16 mg of Se). Daily total Se intakes ranged from <2 to >18 mg/cow in both experiments. Milk Se concentrations plateaued after 15 and 7 d of supplementation in experiments 1 and 2, respectively, and then remained at plateau concentrations. Average milk Se concentrations for the plateau period increased as the amount of Se yeast increased, and low- and high-Se grain treatments were different at all quantities of Se yeast, although there was a tendency for this difference to diminish at the greatest concentrations of yeast. There were significant positive, linear relationships between Se intake and the concentrations of Se in milk, which were not affected by the source of Se, and the relationships were similar for both experiments. Therefore, the output of Se in milk in experiment 1 was greater than that in experiment 2 because the milk yield of the cows in early lactation was greater. The estimated proportions of Se partitioned to destinations other than milk and feces increased with the amount of Se in the diet and were greater in experiment 2 than in experiment 1, a result that was supported by Se concentrations in whole blood and plasma and in semitendinosus muscle tissue. If high-Se products are to be produced for human nutrition, it is important to be able to develop feeding systems that produce milk with consistent and predictable Se concentrations so that products can consistently meet specifications. The results indicate that this objective is achievable.

Blindness following retrobulbar haemorrhage--it can be prevented.

Delay in diagnosis and treatment of an elderly woman with a malar fracture that caused retrobulbar haemorrhage resulted in complete loss of vision in the right eye.

The "Chesterfield stent": an aid to the placement of midpalatal implants.

A palatal endosseous implant is a valuable adjunct to orthodontic treatment. Its insertion is considerably simplified by the use of a stent that was designed in our department and that we describe here.

Orthodontic palatal implants: clinical technique.

The aim of this paper is to familiarize the readers with some of the clinical considerations necessary to ensure successful use of mid-palatal implants. Both surgical and technical aspects will be discussed along with a description of impression techniques used.

Surgical management of the renal manifestations of von Hippel-Lindau disease: a review of a United Kingdom case series.

OBJECTIVE: To review the results of nephron-sparing surgery in a group of patients with von Hippel-Lindau (VHL) disease, a rare familial cancer syndrome which is dominantly inherited and predisposes affected individuals to developing various tumours, including haemangioblastomas of the retina and central nervous system, and multicentric renal cell carcinoma (RCC). PATIENTS AND METHODS: The 11 patients (seven men and four women, age range 27-62 years) assessed had been referred for surveillance to the Department of Clinical Genetics, Addenbrooke's Hospital, often having presented with neurological or ocular manifestations of the disease. Their case notes were reviewed to assess the results of conservative surgery. Five patients had more than one parenchymal-sparing operation (either partial nephrectomy or enucleation, i.e. removal of a malignant lesion with a 0.5 cm rim of normal tissue) while four had bilateral procedures. At the time of surgery, co-existent cysts were aspirated to allow a more accurate definition on computed tomography during follow-up. RESULTS: At a mean follow-up of 60 months after surgery, eight patients were alive with good renal function. Three patients were alive with paraplegia or paraparesis from spinal cord lesions. The three patients who died (aged 50, 40 and 31 years) were diagnosed when RCC was already advanced and renal tissue-preserving surgery was not possible. CONCLUSIONS: Nephron-sparing surgery may be justified because morbidity is reduced in patients whose quality of life may already be compromised by neurological and other problems, and because the lesions of RCC are often small, enucleation may also be justifiable in the attempt to conserve renal tissue and delay disease progression.

A review of antegrade stenting in the management of the obstructed kidney.

OBJECTIVE: To review experience in the management of the obstructed ureter using antegrade stenting in a variety of conditions. PATIENTS AND METHODS: Between 1984 and 1993, 41 patients (mean age 57 years, range 9-83) had antegrade stents placed by an experienced interventional radiologist. The causes of obstruction were urological in 27, gynaecological in eight, colorectal in three and miscellaneous in three. RESULTS: The overall success rate for antegrade stent insertion was 83% and the failure rate was greatest (four of six) in cases of ureteric injury following gynaecological procedures. There were no immediate complications. CONCLUSION: Antegrade stenting can be used as a temporary or permanent solution to ureteric obstruction. The technique is safe, acceptable to patients and avoids the need for a general anaesthetic.

Inhibition in the human urinary bladder by gamma-amino-butyric acid.

OBJECTIVE: To investigate the effects of gamma-amino-butyric acid (GABA) on detrusor activity in man to determine whether it has any inhibitory effect on detrusor contraction. The inhibitory neurotransmitter GABA has been found in mammalian urinary bladders and the effects of GABA on detrusor activity in the rabbit bladder has previously been described [1]. MATERIALS AND METHODS: Human detrusor muscle strips, obtained at cystectomy, were made to contract by electrical stimulation of their autonomic nerves or by the addition of carbachol in a superfusion apparatus. GABA and its analogues were added to the superfusion chamber and any changes in the responses were measured. RESULTS: The electrically evoked nerve-mediated contractions in human bladder muscle were exclusively cholinergic. GABA inhibited nerve-mediated contractions in human detrusor muscle-strips by the activation of the GABAB receptor, since baclofen (a GABAB receptor agonist) produced similar inhibition and muscimol (a GABAA receptor agonist) did not. There was no inhibition of carbachol-mediated contractions by GABA. CONCLUSION: This in vitro study shows that GABA has a peripherally mediated inhibitory effect on excitatory neurotransmission in human detrusor muscle. The site of action is on the post-ganglionic nerves and appears to be mediated via the GABAB receptor.

Data collection and complication rates in clinical audit.

Audit data were collected continuously between February 1988 and July 1991. For the initial period (February 1988-June 1990) data were collected by monitoring of ward admission and discharge records and by collecting data from operating theatre records whilst complications were noted in a 'complications book' which was kept on the notes trolley. In July 1991, when a computerized system for storing and processing audit data was introduced into the department, the methods of data collection changed. For each patient a proforma was attached to the clinical notes which was filled in at each stage of the hospital stay. On this proforma was a list of possible complications which were ticked, as appropriate, at the time of discharge from hospital. We have reviewed the results of clinical audit during these two periods. The number of operations performed per month fell slightly in the latter period (p = 0.005). However, there was a significant increase in both the number of complications (p < 0.0001) and in the complication rate (p < 0.0001). Further analysis showed that there was a similar increase in the number of recorded major and minor complications, and that this increase was also seen even when changes in medical personnel were accounted for. We suggest that the increased complication rate recorded in the latter period reflects the change in the method of data collection. This has important implications when comparing outcome measures for clinical departments.

Rectal obstruction secondary to carcinoma of the prostate treated by transanal resection of the prostate.

Rectal obstruction caused by carcinoma of the prostate is uncommon. If the disease does not respond to either hormonal treatment or radiotherapy, the only surgical means of relieving the obstruction has been the formation of a colostomy. We present an alternative treatment, since many of these patients are elderly with a short life expectancy and they may have difficulty coping with a stoma. Seven transanal endoscopic resections of the prostate (TARP) have been performed on 5 patients. The procedure is not without complications, but it does offer simple surgical palliation of the rectal obstruction and obviates the need for a colostomy.

Inhibitory role of gamma-amino-butyric acid in the rabbit urinary bladder.

Gamma-amino-butyric acid (GABA) is an established inhibitory neurotransmitter in the central nervous system (CNS) and it has also been identified in the bladder. We have investigated in the rabbit the effect of GABA on detrusor activity. Rabbit detrusor muscle strips were made to contract by electrical stimulation of their autonomic nerves or by the addition of carbachol. The addition of GABA caused substantial inhibition of muscle contraction. GABA acts on 2 classes of receptors-GABAA and GABAB. The inhibition was mediated via the GABAB receptors as its effect was mimicked by baclofen (a GABAB agonist) and inhibited by 2-hydroxysaclofen (a GABAB receptor antagonist). Inhibition was not prevented by bicuculline (a GABAA receptor antagonist). This inhibition may be due to a direct muscle effect since the inhibition, which occurred with carbachol-induced contraction, was not abolished by the addition of tetrodotoxin. GABA, acting via the GABAB receptor, produces substantial inhibition of muscle contraction in the rabbit urinary bladder. This raises the possibility of using GABAB analogues in the treatment of detrusor instability.