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Biomedical subjects

G A Broderick

Publications and source records attributed to G A Broderick.

At least 37 records · Page 2Linked to original sources
PubMed2003

Effects of varying dietary protein and energy levels on the production of lactating dairy cows.

Forty-five multiparous and 18 primiparous Holstein cows were fed three levels of crude protein (CP), each at three levels of neutral detergent fiber (NDF), to identify optimal dietary CP and energy. Cows were blocked by parity and days in milk into seven groups of nine and randomly assigned to an incomplete 9 x 9 Latin square trial with four, 4-wk periods. Diets were formulated from alfalfa and corn silages, high-moisture corn, soybean meal, minerals, and vitamins. Forage was 60% alfalfa and 40% corn silage on all diets; NDF contents of 36, 32, and 28% were obtained by feeding 75, 63, and 50% forage, respectively. Dietary CP contents of 15.1, 16.7, and 18.4% were obtained by replacing high-moisture corn with soybean meal. Production data were from the last 2 wk of each period. Spot fecal and urine samples were collected from 36 cows to estimate N excretion using fecal indigestible acid detergent fiber (ADF) and urinary creatinine as markers. There were no interactions (P > or = 0.08) between dietary CP and NDF for any trait; thus, effects of CP were not confounded by NDF or vice versa. Intake of DM and fat yield were lower on 15.1% CP than at higher CP. There were linear increases in milk urea and urinary N excretion and linear decreases in N efficiency with increasing CP. Increasing CP from 15.1 to 18.4% reduced milk N from 31 to 25% of dietary N, increased urinary N from 23 to 35% of dietary N, and reduced fecal N from 45 to 41% of dietary N. Decreasing NDF gave linear increases in BW gain, yield of milk, protein, true protein, lactose, and SNF, and milk/DM intake and milk N/N intake, and linear decreases in milk urea. However, fat yield was lower on 28% than 32% NDF. Reducing NDF from 36 to 28% increased purine derivative excretion by 19%, suggesting increased microbial protein. Increasing CP by adding soybean meal to diets fed cows averaging 34 kg/d of milk increased intake and fat yield but depressed N efficiency. Increasing dietary energy by reducing forage improved milk yield and efficiency and decreased excretion of environmentally labile urinary N.

Animals↗
PubMed2002

Valsalva leak-point pressure changes after successful and failed suburethral sling.

The aim of the study was to investigate whether changes in Valsalva leak-point pressure (VLPP) relate to the success of suburethral sling operations. We retrospectively reviewed the medical records of 31 suburethral sling operations in 30 women with stress urinary incontinence in whom VLPP was quantified before and after the operation. Operative success was determined by documented physical examination and telephone interview. The patients' mean age was 70.7 years (range 51-81). The operation was successful in 24 cases and unsuccessful in 7. VLPP increased significantly after successful operations (mean change 61.1 cmH(2)O; P<0.001) but not after failure (9.7 cmH(2)O); P = 0.226), with a significantly greater change for successful operations ( P = 0.0011). All patients with postoperative VLPP >126 cmH(2)O had successful operations. We concluded that there are significant increases in VLPP after successful suburethral sling operations, but not after unsuccessful operations.

Aged↗
PubMed2002

Efficacy of carbohydrate sources for milk production by cows fed diets based on alfalfa silage.

The effectiveness of three carbohydrate sources, high-moisture ear corn (HMEC), cracked shelled corn (CSC), and a 50:50 mixture of HMEC plus dried citrus pulp (DCP), fed with or without supplemental rumen-undegraded protein as expeller soybean meal (ESBM), was assessed in 48 multiparous dairy cows. All diets contained (dry mater [DM] basis) 50% alfalfa silage, 10% ryegrass silage, 28% NDF, and one of six concentrates: A) 38% HMEC; B) 38% CSC; C) 19% DCP plus 19% HMEC; D) 27% HMEC plus 12% ESBM; E) 27% CSC plus 12% ESBM; or F) 13% DCP, 13% HMEC, and 12% ESBM. Diets A, B, and C averaged 19% crude protein, of which 53% was nonprotein nitrogen (NPN), and diets D, E, and F averaged 22% crude protein, of which 40% was NPN. Cows were fed a high-energy covariate diet for 2 wk, blocked into eight groups of six, based on covariate protein yield, then randomly assigned to diets that were fed for 12 wk. Feeding ESBM increased DM intake, yields of milk, fat-corrected milk, fat, protein, SNF, and milk and blood urea concentration and decreased weight loss. There were no production differences between HMEC and CSC. However, DM intake, yields of milk, fat-corrected milk, fat, protein, lactose, SNF, and milk SNF content all were lower on the diets containing DCP versus HMEC and CSC. A 6 x 6 Latin square trial conducted at the same time with six ruminally cannulated cows showed similar effects of diet on DM intake and milk production. Ruminal ammonia was elevated by ESBM but not ruminal total amino acids and branched-chain volatile fatty acids. Ruminal propionate was highest on HMEC diets and lowest on DCP diets; acetate, butyrate and acetate-to-propionate ratio were lowest on HMEC diets and highest on DCP diets. These results indicated that, compared to HMEC and CSC, feeding the pectin-rich carbohydrate source DCP altered ruminal fermentation but depressed intake and milk production in lactating cows.

Animal Feed↗
PubMed2002

Ryegrass or alfalfa silage as the dietary forage for lactating dairy cows.

Renewed interest exists in using grass forages to dilute the higher crude protein (CP) and lower digestible fiber present in legumes fed to lactating dairy cows. A 3 x 3 Latin square feeding study with 4-wk periods was conducted with 24 Holstein cows to compare ryegrass silage, either untreated control or macerated (intensively conditioned) before ensiling, with alfalfa silage as the sole dietary forage. Ryegrass silages averaged [dry matter (DM) basis] 18.4% CP, 50% neutral detergent fiber (NDF), and 10% indigestible acid detergent fiber (ADF) (control) and 16.6% CP, 51% NDF, and 12% indigestible ADF (macerated). Alfalfa silage was higher in CP (21.6%) and lower in NDF (44%) but higher in indigestible ADF (26%). A lower proportion of the total N in macerated ryegrass silage was present as nonprotein N than in control ryegrass and alfalfa silages. Diets were formulated to contain 41% DM from either rye-grass silage, or 51% DM from alfalfa silage, plus high moisture corn, and protein concentrates. Diets averaged 17.5% CP and 28 to 29% NDF. The shortfall in CP on ryegrass was made up by feeding 7.6% more soybean meal. Intake and milk yields were similar on control and macerated ryegrass; however, DM intake was 8.3 kg/d greater on the alfalfa diet. Moreover, feeding the alfalfa diet increased BW gain (0.48 kg/d) and yield of milk (6.1 kg/d), FCM (6.8 kg/d), fat (0.26 kg/d), protein (0.25 kg/d), lactose (0.35 kg/d), and SNF (0.65 kg/d) versus the mean of the two ryegrass diets. Both DM efficiency (milk/DM intake) and N efficiency (milk-N/N-intake) were 27% greater, and apparent digestibility was 16% greater for DM and 53% greater for NDF and ADF, on the ryegrass diets. However, apparent digestibility of digestible ADF was greater on alfalfa (96%) than on ryegrass (average = 91%). Also, dietary energy content (estimated as net energy of lactation required for maintenance, milk yield, and weight gain) per unit of digested DM was similar for all three diets. Results of this trial indicated that, relative to ryegrass silage, feeding alfalfa silage stimulated much greater feed intake, which supported greater milk production.

Animal Feed↗
PubMed2001

Endoluminal magnetic resonance imaging in the evaluation of urethral diverticula in women.

OBJECTIVES: Accurate determination of the size and extent of urethral diverticula can be important in planning operative reconstruction and repair. Voiding cystourethrography (VCUG) is currently the most commonly used study in the preoperative evaluation of urethral diverticula. We reviewed our experience with the use of endoluminal (endorectal or endovaginal) magnetic resonance imaging (eMRI) in these patients as an adjunctive study to VCUG to evaluate whether the MRI provided anatomically important information that was not apparent on VCUG. METHODS: A retrospective analysis of all patients with a clinical diagnosis of urethral diverticula undergoing MRI at a single institution was performed. Patients were evaluated with history, physical examination, cystoscopy, VCUG, and eMRI. Endoluminal MRI was retrospectively compared to VCUG with respect to size, extent, and location found at operative exploration. RESULTS: Twenty-seven consecutive patients underwent endorectal or endovaginal coil MRI in the evaluation of suspected urethral diverticula. Twenty patients subsequently had attempted transvaginal operative repair of the diverticulum. In 2 patients, eMRI demonstrated a urethral diverticulum, whereas VCUG did not. Operative exploration in these patients revealed a urethral diverticulum. In 14 of 27 patients, the VCUG underestimated the size and complexity of the urethral diverticulum as compared to eMRI and operative exploration. In 13 of 27 patients, the size, location, and extent of the urethral diverticulum on VCUG correlated well with the eMRI and/or operative findings. CONCLUSIONS: We have found endorectal and endovaginal coil MRI to be extremely accurate in determining the size and extent of urethral diverticula as compared to VCUG. This information can be critical when planning the approach, dissection, and reconstruction of these sometimes complex cases.

Adult↗
PubMed2001

Report of the American Foundation for Urologic Disease (AFUD) Thought Leader Panel for evaluation and treatment of priapism.

PURPOSE: Patients with priapism often develop permanent erectile dysfunction and personal sexual distress. This report is intended to help educate the public by reviewing the varied definitions and classifications of priapism and limited literature reports of pathophysiology, diagnosis and treatment outcomes of priapism. The AUA priapism guidelines committee is responsible for creating consensus as to appropriate individual patient management of priapism by physicians. MATERIALS AND METHODS: A multidisciplinary panel, consisting of 19 thought leaders in priapism, was convened by the Sexual Function Health Council of the American Foundation for Urologic Disease to address pertinent issues concerning the role of the urologist, primary care providers and other health care professionals in the education of the public regarding management of men with priapism. The panel utilized a modified Delphi method and built upon the peer review literature on priapism. RESULTS: The Thought Leader Panel recommended adoption of the definition of priapism as a pathological condition of a penile erection that persists beyond or is unrelated to sexual stimulation. Priapism is stressed to be an important medical condition that requires evaluation and may require emergency management. The classification system is categorized into ischemic and non-ischemic priapism. Essential elements of the ischemic classification are the inclusion of: (i) clinical characteristics of pain and rigidity; (ii) diagnostic characteristics of absence of cavernosal arterial blood flow; (iii) pathophysiological characteristics of a closed compartment syndrome; (iv) a time limit of 4 h prior to emergent medical care; and (v) a description of the potential consequences of delayed treatment. Essential elements of the non-ischemic classification are the inclusion of: (i) clinical characteristics of absence of pain and presence of partial rigidity; (ii) diagnostic and pathophysiological characteristics of unregulated cavernosal arterial inflow; and (iii) the need for evaluation but emphasizing the lack of a medical emergency. The panel recommended adoption of a rational management algorithm for the assessment and treatment of priapism where the cornerstone of initial assessment includes a careful clinical history, a focused physical examination and selected laboratory and/or radiologic tests. The panel recommended that specific criteria and clinical profiles requiring specialist referral should be identified. The panel further recommended that patient (and partner) needs and education concerning priapism should be addressed prior to therapeutic intervention, however only in the case of chronic management or post acute presentation evaluation should this delay intervention. Treatment goals to be discussed include management of the priapism with concomitant prevention of permanent and irreversible erectile dysfunction and associated psychosocial consequences. The panel recommended that when specific therapies for priapism are required, a step-care treatment approach based upon reversibility and invasiveness should be followed. CONCLUSIONS: The Thought Leader Panel calls for research to expand our understanding of the prevalence and diagnosis of priapism and education to create awareness among the public of the potential urgency of this condition. Critical areas to be addressed include the multiple pathophysiologies of priapism as well as multi-institutional trials to objectively assess safety and efficacy in the various treatment modalities.

Humans↗
PubMed2001

Production of lactating dairy cows fed alfalfa or red clover silage at equal dry matter or crude protein contents in the diet.

Two Latin square trials, using 21 or 24 multiparous lactating Holstein cows, compared the feeding value of red clover and alfalfa silages harvested over 2 yr. Red clover silages averaged 2 percentage units lower in crude protein (CP) and more than 2 percentage units lower in neutral detergent fiber and acid detergent fiber than did alfalfa silage. In trial 1, diets were formulated to 60% dry matter (DM) from alfalfa, red clover silage, or alfalfa plus red clover silage (grown together); CP was adjusted to about 16.5% by adding soybean meal, and the balance of dietary DM was from ground high moisture ear corn. Nonprotein N in red clover and alfalfa-red clover silages was 80% of that in alfalfa silage. Although DM intake was 2.5 and 1.3 kg/d lower on red clover and alfalfa plus red clover, yield of milk and milk components was not different among diets. In trial 2, four diets containing rolled high moisture shelled corn were formulated to 60% DM from alfalfa or red clover silage, or 48% DM from alfalfa or red clover silage plus 12% DM from corn silage. The first three diets contained 2.9% soybean meal, and the red clover-corn silage diet contained 5.6% soybean meal; the 60% alfalfa diet contained 18.4% CP, and the other three diets averaged 16.5% CP. Nonprotein N in red clover silage was 62% of that in alfalfa silage. Intake of DM was about 2 (no corn silage) and 1 kg/d (plus corn silage) lower on red clover. Yield of milk and milk components was not different among the first three diets; however, yields of milk, total protein, and true protein were higher on red clover-corn silage with added soybean meal. Replacing alfalfa with red clover improved feed and N efficiency and apparent digestibility of DM, organic matter, neutral detergent fiber, acid detergent fiber, and hemicellulose in both trials. Net energy of lactation computed from animal performance data was 18% greater in red clover than alfalfa. Data on milk and blood urea and N efficiency suggested better N utilization on red clover.

Animal Feed↗
PubMed2001

Systematic transperineal ultrasound guided template biopsy of the prostate in patients at high risk.

PURPOSE: A negative biopsy result does not necessarily equate with cancer in specific high risk groups. We describe an alternative systematic biopsy technique for evaluating this subgroup of patients. MATERIALS AND METHODS: From March 1997 to May 1999 a total of 88 men underwent systematic ultrasound guided biopsy using the transperineal template technique. All patients had undergone at least 1 and 75 (85%) had undergone 2 or more previous sets of biopsies. In addition, study inclusion required high risk parameters, including prostate specific antigen (PSA) velocity greater than 0.75 ng./ml., PSA greater than 10 ng./ml. or previous prostatic intraepithelial neoplasia on biopsy, and/or atypical small cell acinar proliferation. RESULTS: Cancer was identified in 38 of the 88 men (43%) in this high risk subgroup undergoing repeat biopsy. A mean of 15.1 previous biopsy cores had been obtained. The most common biopsy grade was 6 (range 4 to 9). Adenocarcinoma was identified in the transition zone area in 29 of 38 cases (76%), including 15 (39%) in which disease was detected in the transition zone only. Persistent PSA acceleration greater than 0.75 ng./ml. was the major indicator for transperineal template biopsy in 83 of the 88 patients (94%). The only significant independent variable predictive of positive biopsy was prostate volume. Mean prostate volume in the positive and negative biopsy groups was 48 and 73 gm., respectively (p <0.001). Complications were rare and self-limiting, consisting primarily of hematuria and urinary retention requiring overnight catheterization in 2 patients. CONCLUSIONS: Systematic transperineal template biopsy of the prostate is a safe and precise repeat biopsy technique in patients who remain at high risk for adenocarcinoma.

Adenocarcinoma↗
PubMed2000

Artificial urinary sphincter for post-prostatectomy incontinence: impact of prior collagen injection on cost and clinical outcome.

PURPOSE: We retrospectively reviewed our experience with the artificial urinary sphincter in men with post-prostatectomy incontinence to determine the impact of prior collagen injection therapy on surgical outcome and overall cost of treatment. MATERIALS AND METHODS: The records and preoperative urodynamic studies of 30 men with post-prostatectomy incontinence who underwent artificial urinary sphincter placement were reviewed. Of these patients 23 (76.6%) had undergone prior collagen injection (collagen group) and 7 had not (noncollagen group). Preoperative and postoperative severity of incontinence was assessed with the American Urological Association quality of life index (scale 0 to 6) and number of pads used daily. Using a Valsalva leak point pressure of less than 60 cm. water as a predictor of failure with collagen injection, we calculated the potential savings had these patients foregone collagen injection and chosen artificial urinary sphincter primarily. RESULTS: Of the 30 patients 24 (80%) were incontinent following radical retropubic prostatectomy and 6 (20%) after transurethral resection. Intrinsic sphincter deficiency was the sole etiology of incontinence in most patients (83.3%) and 5 (16.7%) had concomitant detrusor instability. Six patients alternated the use of pads with the use of clamps or a condom catheter to aid in controlling leakage. Mean number of collagen treatment sessions for the injection group was 2.9 (range 1 to 7). There was a significant difference in mean time from prostatectomy to artificial urinary sphincter between the noncollagen (25.3 months) and collagen (35.8 months) groups (p = 0.04). There were no other statistically significant differences between the groups, including mean age (66.2 years, range 45 to 83), mean followup (26.2 months), mean preoperative pads daily (5.8+/-3.4), median preoperative quality of life index (6, range 3 to 6), median preoperative American Urological Association symptom score (13, range 3 to 35) and mean preoperative Valsalva leak point pressure (42.7+/-21.4 cm. water). For all patients in the study the mean postoperative pads daily was 0.8, mean quality of life index 1 and surgical complication rate 13.3%. There were no statistically significant differences between the collagen and noncollagen groups in any of these parameters. Among the collagen group 17 patients (73.9%) had a Valsalva leak point pressure less than 60 cm. water. Considering the mean additional period of incontinence (time between prostatectomy and artificial urinary sphincter) to be 12.9 months and the additional treatment costs (including pads daily and mean number of collagen syringes per patient), the direct costs of treatment for the collagen group were 85.6% higher than those for patients who chose artificial urinary sphincter primarily. CONCLUSIONS: Prior collagen therapy did not adversely influence the surgical complication rate or compromise effectiveness of the artificial urinary sphincter. However, patients with Valsalva leak point pressure less than 60 cm. water have lower rates of success with collagen injection therapy and could benefit from a more successful, timely and cost-effective treatment of incontinence by choosing the artificial urinary sphincter as primary therapy.

Aged↗
PubMed2000

Efficacy of sildenafil in erectile dysfunction after radical prostatectomy.

Radical retropubic prostatectomy (RRP) is an important cause of iatrogenic erectile dysfunction (ED). While sildenafil has been widely used since its introduction as a new treatment option for ED, its efficacy in post-RRP patients has not been extensively studied. We retrospectively compared the efficacy of sildenafil in post-RRP and non-surgical patients with ED (NSED) using a subset of questions from the International Index of Erectile Function (IIEF) and correlated results with their specific etiology of ED based on penile blood flow study (PBFS). A brief questionnaire regarding satisfaction with sildenafil was administered to 72 consecutive post-RRP patients (nerve sparing status unknown) and 32 consecutive NSED patients who had previously undergone PBFS with pharmacotesting as part of their evaluation for ED. PBFS diagnoses were arterial insufficiency (AI) for peak systolic velocity (PSV) < 25 cm/sec; venogenic (CVOD) for PSV > or = 35 cm/sec, mixed vascular for PV > 25 but < 35 cm/sec and resistive index (RI) < 0.9; a vascular normal diagnosis (neurogenic impotence) required excellent rigidity sustained for 20 min. Differences in the IIEF subscores for the different groups of patients were assessed. Success with sildenafil was defined as moderate or excellent improvement (3/4 or 4/4) with ability for penetration. No differences were found among the different subgroups of RRP patients with respect to IIEF scores or success rates with sildenafil. NSED patients had both significantly higher post-treatment IIEF scores (3.6/3.4 vs 2.5/2.2; t=4.50, P<0.0001) and success rates (63% vs 31%; t=3.11, P < 0.01) with sildenafil treatment than RRP patients. We found that sildenafil is significantly less effective in impotent RRP patients than in age-matched patients with ED (31% vs 63%). We had postulated that sildenafil would be least effective among RRP patients with excellent sustained rigidity to PGE1, as this subgroup is likely to have neurogenic impotence. We found that sildenafil response rates among subgroups of RRP patients were statistically similar regardless of PBFS diagnosis. IIEF scores for the RRP subgroups were similar but statistically lower than in men with ED and no history of RRP. While individuals with normal vascular responses to PGE1 have an increased likelihood of having neurogenic impotence, in RRP patients, we were unable to demonstrate any difference in efficacy of sildenafil, regardless of the PBFS diagnosis.

Aged↗
PubMed2000

Erectile function and quality of life after interstitial radiation therapy for prostate cancer.

Few studies have evaluated erectile function after interstitial radiation therapy for localized prostate cancer. Using a validated quality of life questionnaire, we assessed post-treatment erectile function and its relationship to treatment satisfaction and quality of life. We retrospectively reviewed the records of 171 consecutive patients who underwent Pd-103 or I-125 brachytherapy for prostate cancer between December 1992 and June 1998. Seventy percent of patients received neoadjuvant androgen deprivation therapy. All patients were mailed a validated questionnaire assessing sexual function and overall quality of life (UCLA Prostate Cancer Index and SF-36). Sixty-seven percent of all questionnaires were available for evaluation (114/171). The mean age was 69.1 y with a mean follow-up of 23 months (range 4-72, median 24). Seventy-one percent of patients (81/114) had pre-treatment erections sufficient for sustained vaginal penetration. Of these patients, potency was maintained in 49% of men (40/81). An additional 26% had erections firm enough for foreplay but not penetration (21/81). Erectile dysfunction rates were significantly lower in younger patients (48%) vs older patients (55%). There was no difference in post-treatment potency between men who received neoadjuvant hormonal therapy and those who did not (P>0.05). In addition, there were no differences in physical function (86, scale 0-100), general health perception (78), emotional well-being (83), energy/fatigue (74), and overall satisfaction (84) between men with erectile dysfunction and those without. In summary, two years following brachytherapy 25% of patients complained of complete (20/81) or partial (26%, 21/81) erectile dysfunction, for an overall rate of 51% (41/81). Short-term neoadjuvant hormonal therapy (<3-6 months) did not increase the likelihood of post-treatment erectile dysfunction. Interestingly, overall satisfaction rates among brachytherapy patients were high (84/100) and surprisingly did not correlate with post-treatment sexual function.

Aged↗
PubMed2000

Effect of replacing alfalfa silage with high moisture corn on nutrient utilization and milk production.

Twenty-four multiparous lactating Holstein cows were blocked by days in milk and assigned to treatment sequences in a replicated 4x4 Latin square with 21-d periods. The four diets, formulated from alfalfa silage plus a concentrate mix based on ground high moisture ear corn, contained [dry matter (DM) basis]: 1) 20% concentrate, 80% alfalfa silage (24% nonfiber carbohydrates; NFC), 2) 35% concentrate, 65% alfalfa silage (30% NFC), 3) 50% concentrate, 50% alfalfa silage (37% NFC), or 4) 65% concentrate, 35% alfalfa silage (43% NFC). Soybean meal and urea were added to make diets isonitrogenous with equal nonprotein N (43% of total N). Intake of DM and milk yield indicated that adaptation was complete within 7 d of changing the diets within the Latin square. There were linear increases in apparent digestibility of DM and organic matter, and a linear decrease in neutral detergent fiber (NDF) digestibility with increasing dietary NFC. Solutions of significant quadratic equations yielded estimated maxima for intake of DM, organic matter, digestible organic matter, and NDF at, respectively, 37, 38, 43, and 27% dietary NFC. There were linear increases in yields of milk, protein, lactose, and solids not fat with increasing dietary NFC. Feed efficiency (milk/DM intake) yielded a quadratic response with a minimum at 27% dietary NFC. Maxima for milk fat content, fat yield, and fat-corrected milk yield were estimated to occur at, respectively, 30, 34 and 38% dietary NFC. In this short-term trial, maximal DM intake and fat-corrected milk yield indicated that the optimum concentrate for cows fed high moisture ear corn plus alfalfa silage as the only forage was equivalent to 37 to 38% dietary NFC; however, yields of milk, protein and solids not fat were still increasing at 65% dietary concentrate (43% NFC).

Animal Nutritional Physiological Phenomena↗
PubMed2000

Performance of lactating dairy cows fed alfalfa or red clover silage as the sole forage.

Three Latin square trials, with 20 (two trials) or 24 (one trial) multiparous lactating Holstein cows (four in each trial with ruminal cannulae), compared the feeding value of red clover and alfalfa silages harvested over 3 yr. Overall, the forages contained similar amounts of neutral detergent fiber and acid detergent fiber; however, red clover silage contained more hemicellulose, less ash and crude protein (CP), and only 67% as much nonprotein N, as a proportion of total N, as did alfalfa silage. Diets were formulated with equal dry matter (DM) from alfalfa or red clover silage and contained on average 65% forage, 33 or 30% ground high moisture ear corn, and 0 or 3% low soluble fishmeal (DM basis). Diets fed in the Latin squares contained (mean dietary CP): 1) alfalfa (17.8% CP); 2) red clover (15.1% CP); 3) alfalfa plus fishmeal (19.6% CP); and 4) red clover plus fishmeal (16.9% CP). Although performance varied somewhat among trials, overall statistical analysis showed that replacing alfalfa with red clover reduced yields of milk, fat-corrected milk, fat, protein, lactose, and SNF; these effects were related to the 1.2 kg/d lower DM intake for cows fed red clover. Replacing alfalfa with red clover improved body weight gain and reduced concentrations of milk and blood urea and ruminal NH3. Apparent digestibility of DM, organic matter, neutral detergent fiber, acid detergent fiber, and hemicellulose all were greater when red clover was fed. There were no significant forage x fishmeal interactions for DM intake and yield of milk and milk components, indicating that supplementation with rumen undegradable protein gave similar increases in production on both forages. Net energy of lactation (NE(L)), estimated from maintenance, mean milk yield, and body weight change, in alfalfa and red clover silage were, respectively, 1.25 and 1.38 Mcal NE(L)/kg of DM, indicating 10% greater NE(L) in red clover.

Animal Feed↗
PubMed2000

Potential of fermentation byproducts as nitrogen supplements for lactating dairy cows.

Two feeding trials evaluated several byproducts from commercial amino acid fermentations as N supplements for lactating cows. Trial 1 was a replicated 5 x 5 Latin square that used 2-wk periods and 25 Holstein cows (five with ruminal cannulae) fed diets containing [dry matter (DM) basis] 28% alfalfa silage, 31% corn silage, 28% high moisture ear corn plus 4 percentage units of crude protein (CP) from: soybean meal, urea, commercial fermentation byproduct 1 or 2, or a blend of fermentation byproducts plus wheat middlings. Diets averaged 15.1% CP and 32% neutral detergent fiber. Intake of DM, body weight (BW) gain, and yield of milk and milk components were greatest for cows fed soybean meal; animal performance was similar with urea, byproduct 1 and the byproduct blend. Intake, BW change, and yield of milk and protein when cows were fed byproduct 2 were lower than when fed urea. Urine output (estimated with creatinine in spot urine samples) was greater on fermentation byproduct 1 and the byproduct blend. There were no differences due to N source in microbial synthesis (based on estimated purine derivative excretion), in situ digestion of alfalfa hay DM, or molar proportions of ruminal volatile fatty acids. Trial 2 was a replicated 5 x 5 Latin square using 2-wk periods and 10 Holstein cows fed diets containing (DM basis) 37% alfalfa silage, 28% corn silage, 29% high moisture ear corn plus 2 percentage units of CP from urea, fermentation byproduct 1, or one of three blends of fermentation byproducts plus wheat middlings. Except for greater DM intake in cows fed the byproduct blends, performance and urinary metabolite excretion did not differ because of N supplement. Relative to other fermentation byproducts and urea, byproduct 1 resulted in reduced milk urea N in both trials. Under the conditions of these trials, fermentation byproducts were less effective than soybean meal, and no more effective than urea, as N supplements.

Animal Feed↗
PubMed1999

The effect of androgen deprivation on the early changes in prostate volume following transperineal ultrasound guided interstitial therapy for localized carcinoma of the prostate.

PURPOSE: To determine the change in volume of the prostate as a result of neoadjuvant androgen deprivation prior to prostate implant and in the early postimplant period following transperineal ultrasound guided palladium-103 brachytherapy for early-stage prostate cancer. METHODS AND MATERIALS: Sixty-nine men received 3 to 6 months of androgen deprivation therapy followed by treatment planning ultrasound followed 4 to 8 weeks later by palladium-103 implant of the prostate. All patients had clinical and radiographic stage T1c-T2b adenocarcinoma of the prostate. A second ultrasound study was carried out 11 to 13 days following the implant to determine the change in volume of the prostate as a result of the implant. The prehormonal and preimplant volumes were compared to the postimplant volume to determine the effect of hormones and brachytherapy on prostate volume. RESULTS: The median decrease in prostate volume as a result of androgen deprivation was 33% among the 54 patients with prostate volume determinations prior to hormonal therapy. The reduction in volume was greatest in the quartile of men with the largest initial gland volume (59%) and least in the quartile of men with smallest glands (10%). The median reduction in prostate volume between the treatment planning ultrasound and the follow-up study after implant was 3%, but 23 (33%) patients had an increase in prostate volume, including 16 (23%) who had an increase in volume >20%; 11 of these patients (16%) had an increase in volume >30%. The time course of development and resolution of this edema is not known. The severity of the edema was not related to initial or preimplant prostate volume or duration of hormonal therapy. CONCLUSIONS: Prostate edema may significantly affect the dose delivered to the prostate following transperineal ultrasound guided brachytherapy. The effect on the actual delivered dose will be greater when shorter lived isotopes are used. It remains to be observed whether this edema will affect outcome.

Adenocarcinoma↗
PubMed1999

Sex inventories: can questionnaires replace erectile dysfunction testing?

OBJECTIVES: "Paper and pencil" sexual inventories are widely used by the pharmaceutical industry for categorizing the severity of erectile dysfunction (ED) and for efficacy end points of drug therapy. The International Index of Erectile Function (IIEF) evaluates several domains of male sexual behavior: erection, orgasm, desire, and satisfaction. We compared the subjective IIEF score for erectile function with the severity and etiology of ED as determined by pharmacologic testing with prostaglandin E1 (PGE1) and color duplex Doppler ultrasound testing (penile blood flow study [PBFS]). METHODS: Five questions from the IIEF that require the patient to quantify his erectile performance were compared with PBFS data. Examiners were unaware of IIEF scores during testing. PBFSs were performed after PGE1 injection, privacy, and self-stimulation; dosing was 6 microg (50 to 59 years) or 10 microg (60 years or older). PBFS diagnoses were arterial insufficiency (AI) for peak systolic velocity (PSV) less than 25 cm/s; cavernous venous occlusive disease (CVOD) for PSV greater than 35 cm/s and resistive index (RI) less than 0.9; and mixed vascular erectile dysfunction for a PSV from 25 to 35 cm/s and RI less than 0.9. A normal vascular diagnosis required a PSV greater than 35 cm/s and an RI of 0.9 or greater. Visual ratings of the erectile responses without Doppler assessment (inadequate, adequate, or excellent) were also compared with the IIEF and Viagra Study Group criteria (Q3+4). RESULTS: Eighty-nine patients underwent the complete evaluation. Eight patients (9%) were found to be normal vascularly (mean PSV 40.9 cm/s, mean RI 0.99). Thirty-four patients (38%) had AI (mean PSV 17.5, mean RI 0.74), 33 patients (37%) had mixed vascular ED (mean PSV 29.1, mean RI 0.80), and 14 patients (16%) had CVOD (mean PSV 45.9, mean RI 0.73). The mean IIEF score for the normal responders was 13.3; patients with AI, mixed vascular ED, and CVOD had mean IIEF scores of 6.9, 8.5, and 8.1, respectively. IIEF and Q3+4 values differed significantly between the normal and abnormal groups (P<0.05 and P<0.025, respectively), but no statistically significant differences in IIEF or Q3+4 scores were noted among the subgroups of abnormal responders. Analysis of the visual ratings of erections demonstrated that IIEF scores were significantly different between inadequate and excellent responders (P<0.05). CONCLUSIONS: IIEF scores did not statistically differentiate among the specific etiologies of ED as determined by evidence-based testing with PBFS. Furthermore, patients with normal results after testing with PGE1 (10 microg or less) had surprisingly low self-ratings of erectile performance (13 of 25 points). For the primary caregiver, the IIEF may help in the taking of the male sexual history, but for the specialist, sexual inventory scores will not distinguish among the various etiologies of vascular ED and do not predict the results of pharmacologic testing.

Erectile Dysfunction↗
PubMed1999

Changing practice patterns in erectile dysfunction: a diagnostic algorithm for the new millennium.

In the era when there was only one cause-specific treatment for erectile dysfunction (vasoactive penile injection), most patients could be safely directed to therapy following a good sexual history, assessment of medical risks, and physical examination. Without diagnostic testing, efficacy and satisfaction was a matter of chance. The next millennium will see the development of multiple oral agents for the management of male sexual dysfunction. These agents with their differing mechanisms of pharmacological action (central initiators, central conditioners, and peripheral modulators) present for the first time the possibility of cause-specific therapy. Currently with only 1 pill available, clinicians are compelled to categorize patients as having oral-agent-responsive or oral-agent-resistant erectile dysfunction (ED). For the time being, we may categorize patients as: Viagra (Pfizer Pharmaceuticals, New York, NY) successes or Viagra failures. But when faced with a laundry list of options for ED, the role of erectile function testing will assume a two-fold importance: (1) establishing an etiology specific diagnosis and (2) formulating a treatment plan with a reasonable likelihood of success. Patients failing first-line therapy by primary caregivers will seek the expertise of specialists; they will want to know not only what is wrong with them but also why a specific agent has failed to reverse their ED. We must be prepared to meet these demands; our diagnostic algorithms must incorporate these new pharmacological agents. Our prescribing patterns, to be successful, must have some objective basis. ED testing will need to produce vascular profiles to predict which drug or combination of drugs (oral, cutaneous, urethral, intracavenosal) will effectively restore erection. Conversely, to spare patients the frustration and the potential side effects of empiric trials, ED testing will need to determine whether patients would be better served by a mechanical solution, a vacuum erection device or penile prosthesis.

Algorithms↗