Influence of supplementing a methionine derivative, N-acetyl-l-methionine, in dairy diets on production and ruminal fermentation by lactating cows during early to mid lactation.

The present study investigated production responses and ruminal fermentation characteristics of lactating dairy cows when supplemented with N-acetyl-l-Met (NALM) as a source of rumen-protected Met in metabolizable protein (MP)-deficient (MPD) or MP-adequate diet (MPA). Eight lactating dairy cows (53 ± 10.4 d in milk, average ± standard deviation) were blocked by parity and days in milk, and the experiment was performed in a replicated 4 × 4 Latin square design. Within each square, cows were randomly assigned to a sequence of 4 diets during each of the four 21-d periods (14 d of treatment adaptation and 7 d of data collection and sampling). A 2 × 2 factorial arrangement was used; MPD or MPA was combined without or with NALM: MPD without NALM, MPD with NALM (MPD+NALM), MPA without NALM, and MPA with NALM (MPA+NALM). A NALM product was supplemented in the MPD+NALM and the MPA+NALM at 30 g/cow per d. Supplementation of NALM did not affect dry matter intake (DMI) and milk yield regardless of MP concentration. In addition, supplementing NALM resulted in a similar milk true protein concentration and yield. In contrast, NALM supplementation increased milk fat concentration and yield and 3.5% fat-corrected milk yield and tended to increase energy-corrected milk yield regardless of MP difference. Additionally, trends were observed for increased 3.5% fat-corrected milk yield/DMI and energy-corrected milk yield/DMI, and the positive effects were greater under the MPA than the MPD diet, resulting in trends toward interactions between MP and NALM. Dietary treatments had similar effects on ruminal fermentation characteristics and microbial protein yield. Plasma concentration of Met increased under the MPD but not the MPA diet, leading to an MP × NALM interaction. Overall results in the current study suggest that NALM exerted a minor influence on ruminal metabolism, but increased milk fat concentration, resulting in increases in milk fat yield and feed efficiency. Yet, potential effects of NALM on intermediary metabolism between the gastrointestinal tract, the liver, and the mammary gland need to be explored to understand utilization efficiency for production of dairy cows.

The management of spermatic cord sarcoma.

BACKGROUND: Between April 1963 and July 1991, 18 patients were treated for spermatic cord sarcoma. The histologic subtype distribution was: 7 leiomyosarcoma, 7 liposarcoma, 2 malignant fibrous histiocytoma, and 1 mesothelioma. METHODS: All patients underwent surgical resection: 16 radical orchiectomy and local excision. Nine were treated with orchiectomy alone, and 9 received adjuvant radiation. The radiation fields encompassed the ipsilateral iliac and inguinal lymph nodes, vas deferens, and hemiscrotum in 7 patients, and iliac and inguinal lymph nodes in 2 patients. RESULTS: The actuarial 5 and 8-year disease free survivals for the 18 patients were 77% and 58%, with an overall survival of 78% and 70%, respectively. The 5 and 8-year locoregional control rates were 82% and 61%. Five of 9 patients treated with surgery alone developed locoregional recurrence while none of the nine who had adjuvant radiation relapsed. The median follow-up for the irradiated group, however, was shorter (123 vs 63 months) and staging studies more complete. These potential biases are discussed. CONCLUSION: In this series, relapse was common after orchiectomy alone. Adjuvant radiation therapy may reduce the incidence of locoregional failure.

Radiation therapy for chordomas of the base of skull and cervical spine: patterns of failure and outcome after relapse.

PURPOSE: To determine the patterns of failure and outcome following relapse of chordomas of the base of skull and cervical spine. METHODS AND MATERIALS: Between November 1975 and October 1993, 204 patients were treated for chordoma of the base of skull or cervical spine, of which 63 have developed relapse. These 63 patients constitute the main focus of this study. Forty-five patients presented with base of skull and 18 with cervical spine tumors. All patients received combined proton and photon beam radiation. The median prescribed dose was 70.1 cobalt-Gray equivalent (CGE) (range 66.6-77.4). There were 25 males and 38 females, with a median age of 41 years (range 7-66). Median follow-up was 54 months (range 8-158). RESULTS: Sixty-three of the 204 patients treated (31%) had treatment failure. Among the 63 patients who relapsed, 60 (95%) experienced local recurrence, and in 49 patients (78%), this was the only site of failure. Two of 63 patients (3%) developed regional lymph node relapse and 3 of 63 (5%) developed surgical pathway recurrence (1 left neck, 1 palate and 1 nasal cavity). Thirteen of 204 patients relapsed in distant sites, accounting for 20% (13 of 63) of all patients with recurrence in this series. The most common metastatic sites were lungs and bones presenting in 7 of 13 and 6 of 13 patients, respectively. Only 2 of 13 patients failed with isolated distant metastasis. The actuarial 3- and 5-year survival rates after local relapse (60 patients) were 44 and 5%, respectively. Following distant failure (13 patients), the 3- and 5-year survival rates were 25 and 12%, respectively. After any relapse (63 patients) the corresponding survival rates were 43 and 7%. Following local relapse, 49 of 60 patients underwent salvage therapy consisting of subtotal resection in most patients (46 of 49). The remaining 11 of 60 patients received supportive care only. Salvage therapy resulted in stable or improved status without subsequent disease progression in 26 of 49 (53%), and progressive disease in 16 of 49 patients (33%). The actuarial 2- and 5-year overall survival rates following relapse for the 49 patients who underwent salvage treatment were 63 and 6%, which favorably compared to the 2-year survival rate of 21% for those who received supportive care only (p = 0.001). CONCLUSION: Local relapse is the predominant type of treatment failure for chordomas of the base of skull and cervical spine. Salvage treatment may relieve symptoms; however, most patients will ultimately succumb to their disease. Poor long-term survival rates following relapse emphasize the importance of a combined treatment approach with experienced surgeons and radiation oncologists at the time of primary treatment. For most patients, only permanent local tumor control will offer a chance of cure.

Breast-conserving surgery and definitive radiation: a comparison between quadrantectomy and local excision with special focus on local-regional control and cosmesis.

PURPOSE: Breast-conserving surgery and definitive radiation as an alternative to mastectomy is a well-accepted practice. However, there is limited information addressing the extent of surgical resection. The purpose of this study is to compare the outcome of patients treated with local excision or quadrantectomy, followed by definitive radiation with particular emphasis on local-regional control and cosmetic results. METHODS AND MATERIALS: Between 1978 and 1989, 425 patients with Stage I and II breast cancer underwent conservative surgery followed by definitive radiation. Fifty-four patients had a local excision and 371 had a quadrantectomy. Median follow-up was 42 months. Axillary dissection (levels I/II) was performed in 317 patients, and of these 126 patients had positive axillary lymph nodes. Radiation consisted of 4500-5000 cGy to the breast with Co60 or 4 MV photons, plus a boost to the tumor site (356/425 patients) for a total dose of 6000-6500 cGy. Treatment of the regional lymph nodes was given to patients with undissected or inadequately dissected axillas and usually to patients with multiple positive lymph nodes. Of the patients with positive lymph nodes, 46% received systemic chemotherapy. RESULTS: The 5-year actuarial freedom from local-regional recurrence rates for patients treated with local excision and quadrantectomy followed by definitive radiation were 92% and 93%, respectively (p = 0.7). The 5-year actuarial survival rates for local excision and quadrantectomy were as follows: overall (83% and 82%; p = 0.7), cause-specific disease-free (74% and 71%; p = 0.9), and distant disease-free (82% and 76%, p = 0.4). Estimated 10-year results are also presented. Cosmetic analysis required a minimum follow-up of 5 years. In the local excision, 77% of the patients had excellent-good result, compared to 53% following quadrantectomy (p = 0.03). Excluding patients who received chemotherapy, the excellent-good scores were 76% and 57%, respectively (p = 0.1). The most unfavorable cosmetic results were associated with quadrantectomy followed by radiation with boost dose and chemotherapy, excellent-good in 22%. CONCLUSION: Conservative surgery consisting of local excision or quadrantectomy resulted in comparable local-regional control, overall, disease-free and distant disease-free survival, although cosmetic results were superior in the local excision group.