bluuebunny/crossref_metadata_2025 huggingface dataset:
Investigation on the clinical efficacy and tolerability of a 0.4% topical stannous fluoride preparation (MedEquine® Gel) for the treatment of bacterial skin infections in horses: a prospective, randomized, double‐blinded, placebo‐controlled clinical trial
Authors: Marsella Rosanna , Akucewich Lisa
Published: October 2007

The purpose of this prospective, double‐blinded, placebo‐controlled clinical trial was to investigate the efficacy and tolerability of a novel gel containing 0.4% stannous fluoride (MedEquine®) for the treatment of cutaneous bacterial infections in horses. Twenty privately owned horses diagnosed with bacterial skin infections based on physical findings and cytology results were enrolled and randomly assigned to either a placebo or an active ingredient treatment group. The product was applied on affected areas daily for 4 weeks. Cytology and clinical evaluations were done by the same investigator at the beginning and at the end of the treatment. Owners scored pruritus weekly. Both owners and investigators were blinded to the allocation to the groups. At the end of the study, stannous fluoride gel treatment significantly decreased the investigator's clinical scores and owners’ pruritus scores while no significant changes were detected in the vehicle treatment group. At the end of the trial, none of the horses in the stannous fluoride group required additional therapy while four of ten horses in the vehicle group required systemic therapy to resolve the infection. No adverse effects were detected in any of the groups. The gel formulation made compliance easier for owners compared to the traditional bathing regimen and allowed spot treatment, which was particularly helpful in animals with localized infections. These favourable aspects of the treatment were highlighted by the owners of the horses enrolled in the study. In conclusion, 0.4% stannous fluoride gel (MedEquine®) was an effective and safe therapy for the topical management of bacterial skin infections in the horses included in the study.
Successful treatment of a squamous cell carcinoma in a white rhinoceros, Ceratotherium simum
Authors: Goodman Gidona , Rhind Susan , Meredith Anna
Published: October 2007

A captive 33‐year‐old male white rhinoceros with seasonal dermatitis was diagnosed with a malignant squamous cell carcinoma on the right flank. Staphylococcus aureus was cultured from the skin lesions. No fungal or yeast was isolated. The dermatitis was treated with a combination of oral antibiotics (trimethoprim–sulphadiazine) and topically with weekly chlorhexidine washes and a mixture of a zinc oxide, balsam peru and bismuth oxide cream. Under azaperone and butorphanol anaesthesia, the skin tumour was surgically removed. The tumour was excised with wide margins and allowed to heal by secondary intention as primary wound closure was not possible. A post‐mortem performed 2 years later for an unrelated condition revealed no metastases or recurrence of the skin tumour. It was presumed that chronic irritation or trauma may have contributed to the development of the skin tumour. This is the first detailed report of the successful treatment of a squamous cell carcinoma not associated with the horn in a rhinoceros.
Multiple generalized follicular cysts in a stallion
Authors: Ginel Pedro J. , Zafra Rafael , Lucena Rosario , Bautista María J.
Published: October 2007

This case report describes a case of multiple follicular cysts in a 4‐year‐old Spanish purebred stallion. The lesions ranged in size from 0.5 to 3 cm in diameter, and were firm, well circumscribed and nonpruritic. They developed over a 2‐year period with a generalized distribution affecting all body regions. Five nodules were removed and histopathologically corresponded to simple epidermal cysts (infundibular and isthmus‐catagen) with squamous epithelium and a keratin filled cavity. Lesions were not evident at birth but their number, early age of detection, slow growth and lack of previous trauma suggested that they were congenital. To the authors’ knowledge, this condition has not previously been reported either in young horses or in Spanish purebred horses.
Biology of epidermal and hair pigmentation in cattle: a mini‐review
Authors: Seo Kangseok , Mohanty Tushar R. , Choi Tejeong , Hwang Inho
Published: October 2007

Coat colours in cattle have been of interest to both breeders and researchers as genes regulating pigmentation not only affect the phenotype but also have economic implications in the event of genetic mutations. The genes controlling pigmentation act as a complex and interact with each other to cause phenotypic and genotypic variations. Pigmentation of coat broadly depends on the ratio of eumelanin and pheomelanin, the two components of melanin. Increase in eumelanin imparts a black coat colour while raise in pheomelanin is responsible for a yellowish or reddish colour. The main enzymes responsible for melanogenesis are regulated by the genes of the tyrosinase family. It is speculated that the wild‐type gene present in the ancestral breeds of the present day cattle have more pheomelanin content and that, over time, mutations have introduced more variations leading to many shades. This could have occurred either because of interactions or because of deletions in the responsible genes. The environmental conditions have also contributed to mutations in these genes, helping in the adaptability of the animals to different geographical regions. The switching between the syntheses of melanin components depends on several genes like melanocortin‐1receptor gene (MC1r) – also known as melanocyte‐stimulating hormone receptor gene (MSHr)‐, agouti (A), attractin (Atrn) and mahogunin (Mgrn1). The purpose of this review is to summarize the recent advances in the field of pigment biology and to highlight possible areas of research that may benefit a breeder or a farmer in the selection of animals on the basis of phenotype.
First report of multiresistant,mecA‐positiveStaphylococcus intermediusin Europe: 12 cases from a veterinary dermatology referral clinic in Germany
Authors: Loeffler Anette , Linek Monika , Moodley Arshnee , Guardabassi Luca , Sung Julia M. L. , Winkler Margit , Weiss Reinhard , Lloyd David H.
Published: October 2007

Resistance to cephalosporins and/or fluoroquinolones byStaphylococcus intermediushas remained low in Europe, with effective drugs generally available for systemic therapy in pets. However, multiresistant,mecA‐positiveS. intermediusisolated from dogs and cats is now emerging in Europe. TwelveS. intermediusisolates, highly resistant to at least five antimicrobial classes, were isolated from skin and ear infections in 11 dogs and a cat. The 12 isolates represented 23% of allS. intermediussubmissions from one veterinary dermatology referral clinic in northern Germany to veterinary diagnostic laboratories during an 18‐month period and resistance included cefalexin, methicillin and enrofloxacin. The animals had been referred to the clinic with recurrent superficial pyoderma, deep pyoderma, pododermatitis or chronic otitis, all unresponsive to systemic β‐lactam‐antibiotics or fluoroquinolones. Infection resolved in 10 dogs and the cat on a combination of antimicrobial treatment and correction of underlying causes. Four dogs and a cat required systemic and topical therapy; in six dogs topical antimicrobial therapy alone was successful. Phenotypic and genotypic characteristics of theS. intermediusisolates were determined; species identification was confirmed by polymerase chain detection of thermonuclease genes (nuc) and the presence and expression of the gene conferring resistance to all β‐lactam antibiotics (mecA) were demonstrated in all; based on pulsed‐field gel electrophoresis, six were indistinguishable, the others closely or possibly related. The emergence of multiresistant,mecA‐positiveS. intermediusin Europe is alarming. Zoonotic implications, awareness among veterinary laboratories and strategies for the use of antimicrobials in small animal practice need to be considered.
Melanoma in organ transplant recipients: The old enemy finds a new battleground
Authors: Dinh Quan Q , Chong Alvin H
Published: October 2007

Population registry data and published studies have demonstrated that melanomas in the transplant population occur 1.6–2.5 times more commonly compared with the general population. Studies examining possible risk factors have suggested that in this patient population, there is an increased number of melanocytic naevi. Whether this phenomenon is aetiologically related to subsequent melanoma development is currently unclear. Only one study examined the prognosis of melanomas in this population. The Israel Penn International Transplant Tumor Registry has collated patient data voluntarily submitted by transplant physicians throughout the USA since 1968. Analysis of melanomas in this study found that approximately half were Breslow thickness >1.51 mm. Overall, there was a high rate of nodal and distant metastases, with poorer 1‐, 3‐ and 5‐year survival rates compared with the general population. There is a paucity of good‐quality evidence regarding melanoma in organ transplant recipients. Further research involving international collaborative trials, particularly on risk factors and the prognosis of melanomas in this population, could present a more substantial evidence base from which treatment guidelines based on data could be developed.
Pyogenic granuloma in children: Treatment with topical imiquimod
Authors: Fallah Haady , Fischer Gayle , Zagarella Samuel
Published: October 2007

We report the successful treatment of five children with facial pyogenic granuloma using topical imiquimod 5% cream. In all cases, resolution of the lesions was achieved within 2–4 weeks. Local erythema and scaling, consistent with a typical imiquimod response, was the most commonly observed side effect. No systemic complications were observed in any of the patients. There has been no recurrence of any of the lesions to date. Small mildly erythematous or hypopigmented macules remain at this stage of follow up.
Becker's naevus and segmental naevus depigmentosus: An example of twin spotting?
Authors: Afsar F Sule , Aktas Safiye , Ortac Ragıp
Published: October 2007

A 12‐year‐old girl presented with a 1‐year history of a Becker's naevus involving the right posterior thigh and gluteal area. In addition, three hypopigmented macules of naevus depigmentosus distributed in a segmental pattern on the medial aspect of the right posterior thigh had been present since birth. We suggest that their unusual coexistence in close proximity may represent an example of twin spotting.
Childhood sarcoidosis presenting with extensive cutaneous lesions, bilateral hilar lymphadenopathy and severe hypercalcaemia
Authors: Mortimer Neil J , Sladden Michael J , Hill Sarah E , Graham‐Brown Robin AC
Published: October 2007

A 9‐year‐old boy with a history of atopic dermatitis presented with a 4‐month history of an asymptomatic papular eruption. This was predominantly perioral in distribution with lesser involvement of the neck, arms and trunk. Investigations revealed severe hypercalcaemia of 3.77 mmol/L (normal range 2.10–2.60) and bilateral hilar lymphadenopathy. The diagnosis of sarcoidosis was supported by granulomata in skin and lymph node biopsies on histopathological examination. Prednisolone (2 mg/kg/day) rapidly normalized serum calcium.
Pseudochromhidrosis: Blue discolouration of the head and neck
Authors: Hill Sarah , Duffill Mark , Lamont Duncan , Rademaker Marius , Yung Anthony
Published: October 2007

A 57‐year‐old man is presented with blue pseudochromhidrosis affecting the face and neck following combination treatment with lansoprazole, a proton pump inhibitor, and ranitidine, a type two histamine receptor antagonist. The diagnosis was made on the basis of clinico‐histological features and growth of Malassezia furfur, and Bacillus species, not Bacillus cereus, in the absence of lipofuscin. The pseudochromhidrosis resolved on stopping both medications and did not recur on restarting only the proton pump inhibitor.
Eosinophilic ulcer of the tongue
Authors: Ada Simin , Seckin Deniz , Tarhan Erkan , Buyuklu Fuat , Cakmak Ozcan , Arikan Unser
Published: October 2007

A 76‐year‐old woman presented with a 1‐month history of a rapidly expanding painful ulcerated nodule on her tongue following tooth extraction. Triamcinolone acetonide ointment was applied twice daily for 1 month without any benefit. The histopathology of the excision specimen was consistent with an eosinophilic ulcer of the oral mucosa. There has been no recurrence 12 months later.
Osler's nodes and Janeway lesions
Authors: Gunson Todd H , Oliver G Fergus
Published: October 2007

The pathogenesis of Osler's nodes and Janeway lesions remains a mystery despite vigorous debate over the last 113 years. They are given great emphasis among the clinical signs of bacterial endocarditis but are seldom seen in practice. Two cases of subacute bacterial endocarditis are presented. A 66‐year‐old woman with Bartonella henselae endocarditis developed Osler's nodes on the hands postoperatively, and a 23‐year‐old man with Streptococcus oralis endocarditis developed tender macules with an appearance suggestive of Janeway lesions on one heel. The dermatopathology was similar in the two cases, consisting of a leukocytoclastic vasculitis without micro‐abscess formation or visible organisms. Although the appearance is usually consistent, it is not always possible to distinguish Osler's nodes from Janeway lesions based purely on clinical presentation. Furthermore, the histology of both clinical signs can look similar. Further reports are needed before more firm conclusions can be drawn, however, it may be that the histological appearance of Osler's nodes and Janeway lesions is primarily determined by the nature of the causative organism, while the clinical appearance may be determined by anatomical site.
Atypical herpes simplex infection masquerading as recalcitrant pemphigus vulgaris
Authors: Kalajian Andrew H , Callen Jeffrey P
Published: October 2007

A 57‐year‐old woman presented with refractory genital erosive disease. One year earlier she experienced gingival fragility; direct immunofluorescence resulted in the diagnosis of cicatricial pemphigoid, and prednisone therapy led to initial improvement. Initial skin biopsy of her genital erosions demonstrated full‐thickness ulceration with viral cytopathic change and a re‐epithelializing subepidermal separation. Indirect immunofluorescence revealed intercellular IgG staining on monkey oesophagus at a titre of 1:320 consistent with pemphigus, leading to the diagnoses of pemphigus vulgaris with herpetic superinfection. Immunosuppressive treatment initially led to improvement; however, disease subsequently recurred as extensive genital erosions. We diagnosed atypical herpes simplex virus infection and oral candidiasis, discontinued all immunosuppressive medications, and initiated antiviral and antifungal therapy. Dramatic resolution was observed and the patient has remained free of disease for 13 months while taking only prophylactic famciclovir.
Cutaneous Rosai‐Dorfman disease
Authors: Manifold R. , Reid C. , O'Brien V. , Sidhu S. , Ibbetson J.
Published: October 2007

Rosai‐Dorfman disease (RDD), originally designated sinus histiocytosis with massive lymphadenopathy, typically presents in young adults with massive, painless cervical lymphadenopathy, fever, leucocytosis, elevated erythrocyte sedimentation rate (ESR) and hypogammaglobulinaemia.

We present a case of cutaneous RDD with no evidence of lymph node involvement. The initial presentation of disease was in the pituitary gland and the nasal sinuses.

Clinical examination revealed non‐specific skin coloured nodules involving the back and right side of the face. A skin biopsy, however, showed the typical histological and immunohistochemical features of RDD.

Clincial photos and histopathology will be presented with a discussion of RDD, including cutaneous RDD.
Aberrant CD8 positive cutaneous T cell lymphomas
Authors: Tallon Ben
Published: October 2007

2 cases of unusual CD8 positive cutaneous T cell Lymphoma are presented.

A 46 year old woman presents with a five month history of crops of spontaneously resolving crusted papules. Histology shows a wedge shaped lymphocytic infiltrate with marked epidermotropism. The cells were CD30 negative, with CD3, and CD8 positivity. CD56 was strongly represented on cell markers. She has had her lesions controlled on low dose Methotrexate. This CD8 positive CD56 positive type B Lymphomatoid Papulosis followed an indolent clinical course consistent with previous reports.

A 72 year old man presents with a 14month history of persistent erythroderma, palmoplantar hyperkeratosis, ectropion and peripheral oedema. Histology shows a lichenoid T cell infiltrate with epidermotropism, Pautrier microabscesses and the presence of cerebriform cells. Immunohistochemistry was positive for CD3 and CD8, with no CD5 drop out, while CD20, CD30 and CD56 were negative. Clinical behaviour and histology of this epidermotropic red man is most consistent with a CD8 positive mycosis fungoides.

Aberrant immunohistochemistry can make cutaneous lymphoma classification difficult, but the clinical behaviour is predictive.
Linear focal elastosis
Authors: Brennand Sarah , Kalnins Renate
Published: October 2007

Linear focal elastosis (also known as elastotic striae) is an acquired disorder of elastic tissue characterized by horizontal linear, yellow plaques. Burket et al1 originally described the condition in 1989 on the back of three elderly men. There have been 28 cases of linear focal elastosis reported, however it has been suggested that this is an underestimation of the real prevalence of the condition.

We report a case of an 84‐year‐old man with asymptomatic horizontal linear yellow palpable bands on the lower back. A 3 mm punch biopsy was taken from the right lower back. Verhoeff van Gieson staining confirmed the presence of abundant elastin fibres lying between collagen bundles in the dermis, consistent with linear focal elastosis.

Our review of the 28 reported cases in the literature has demonstrated that the majority of cases are reported to occur on the back, however it is also reported to occur on the lower limbs and less frequently on the chin, abdomen and upper limbs. Although it was originally reported to occur in elderly males, it has been described in patients of all ages and in both sexes, but has been reported less frequently in females. The aetiology is unknown, but trauma, UV light and genetic factors have been suggested. It has been postulated that it may be caused by excessive regenerative repair of elastic fibres or “keloidal repair” of striae distensae.
Full thickness squamous atypia of the glans penis on a background of Zoon's plasma cell balanitis
Authors: Starritt Emma , Chan Renee CF , Lee Stephen
Published: October 2007

Erythroplasia of Queyrat (EQ) or squamous cell carcinoma in situ of the glans penis developed in a 79 year old uncircumsised gentleman who had a six year prior history of biopsy proven Zoon's plasma cell balanitis (ZB) affecting the same site on the glans. Prior to the development of clinically evident EQ, the glans had been treated with topical pimecrolimus 1% for one month. The glans was subsequently treated with topical 5‐flourouracil 5% for two weeks which resulted in clinical clearance.

EQ is obviously an important differential for penile plaques because of the potential for progression to squamous cell carcinoma, while ZB is generally regarded as benign. The differentiation can only be reliably made histologically.

There are other case reports of both EQ (1) and carcinoma of the penis (2) arising in patients with ZB, raising the question as to whether ZB may actually reflect a reaction to underlying pre‐existing pathology or even a premalignant state.

The addition of topical pimecrolimus shortly before EQ became clinically evident in this patient is concerning in the light of recent concern regarding the carcinogenicity of topical calcineurin inhibitors (3).

This case highlights the importance of close clinical follow up of persistent penile inflammatory lesions and prompt biopsy of clinically suspicious areas as second and potentially more serious pathology may occur concomitantly.
Sirolimus‐based triple immunosupression with antithymocyte globulin induction in expanded criteria donor kidney transplantation
Authors: USLU ADAM , NART AHMET , TAŞLI FUNDA ALKAN , POSTACI HAKAN , AYKAS AHMET , DOĞAN MURAT , ŞAHİN TAMER
Published: October 2007

Background:  Target of rapamycin inhibitors have presented similar graft and patient outcomes with no evidence of drug‐induced nephrotoxicity when compared with calcineurin inhibitors. The principal aim of this study is to demonstrate the efficacy of sirolimus‐based triple immunosuppression with antithymocyte globulin induction in expanded donor kidney transplantation.

Methods:  Twenty‐seven primary expanded criteria donor kidney transplant recipients were recruited. The severity of kidney damage was qualified by zero‐hour biopsies. Protocol biopsies were performed at 1 year to assess the chronic allograft damage. Death, graft function, proteinuria and adverse events were systematically analysed during the study period.

Results:  The mean follow up was 20.2 months. Patient and graft survival was 100% with a mean glomerular filtration rate (GFR) of 53.1 ± 4.9 mL/min at last follow up. The cumulative incidence of acute rejection was 11% at the last follow up. At 1 year, mean creatinine, GFR and proteinuria were 1.84 mg/dL, 52.3 mL/min, 651.5 mg/day, respectively. Four patients required surgical intervention due to urinary complications and recovered successfully. Two patients developed acute graft dysfunction due to acute tubular necrosis which was presumably drug related. Ten patients developed relapsing urinary tract infections and three patients had pneumonia. No infectious death occurred throughout the study period. Baseline renal structure was preserved in 13 biopsies at 1 year post transplant. Five patients demonstrated progressive but mild tubular atrophy or interstitial fibrosis in their protocol biopsies. The mean chronic allograft damage index scores at baseline and at 1 year from biopsy were 2.57 ± 0.23 and 2.83 ± 0.23, respectively (P = 0.046).

Conclusions:  Low‐dose sirolimus‐based triple immunosuppresion with antibody induction offered a safe clinical outcome in expanded criteria donor kidneys with the achievement of stable renal function and favourable recipient outcomes throughout the short term. However, mild progression of histological damage and increased risk of bacterial infection are a major concern. Additionally, the benefit (if any) of the low acute rejection rate on long‐term graft outcome is still undetermined.
Anti‐IgE in severe persistent allergic asthma
Authors: FOX Howard
Published: October 2007

Abstract:  Omalizumab is an mAb targeted against IgE. It reduces asthma exacerbations and symptoms and has low anaphylactic potential. In the placebo‐controlled double‐blind study, INNOVATE, omalizumab was used in the patient population with the greatest unmet clinical need, who being those meeting the Global Initiative for Asthma 2002 step 4 criteria for severe persistent asthma. When added to existing therapy, patients treated with omalizumab had a 26.2% lower rate of clinically significant asthma exacerbations, after an adjustment to take into account an observed pre‐study imbalance in the exacerbation rate (P = 0.042). The Global Initiative for Asthma has recognized the role of anti‐IgE therapy in treating patients with severe persistent asthma. Initiation of anti‐IgE therapy is now recommended for these patients at step 4. Severe asthma has a major impact on health‐care resource utilization. To date, treatment options have been limited in this target population. Omalizumab reduces symptoms, exacerbations and emergency visits in patients who are not adequately controlled on inhaled corticosteroids and long‐acting beta agonists. It is a valuable therapeutic option, addressing an unmet need in the area of severe asthma.
Omalizumab (Xolair) in patients with steroid‐resistant asthma: Lessons to be learnt
Authors: THOMPSON Philip J. , MISSO Neil L. , WOODS John
Published: October 2007

Abstract:  Very severe asthma and local pulmonary steroid resistance causes major problems for patients, physicians and the health system at large. It usually results in multiple admissions to hospital and high morbidity. Omalizumab was used to treat such patients with success. However, in doing so, it raised a number of issues relating to the best methods of using this treatment in such patients.
Use of omalizumab in a severe asthma clinic
Authors: GIBSON Peter G. , TARAMARCAZ Philip , MCDONALD Vanessa M.
Published: October 2007

Abstract:  There is an urgent need to define new treatment strategies for severe persistent asthma. Using a severe asthma clinic model, it is possible to systematically assess diagnosis, self‐management skills, and treatment efficacy. The addition of single‐patient trials of therapy is useful to detect individual responders to drugs where use is limited because of access, cost, or toxicity. Omalizumab is effective in severe asthma, however access is restricted by cost and availability. We conducted single patient efficacy trials of omalizumab in 12 subjects with severe refractory asthman. There were 2 definite and 6 partial responders. Patients with difficult/therapy resistant or refractory asthma can respond to omalizumab, and this response can be detected in individual patients using a single patient controlled trial conducted in the setting of a severe asthma clinic.
The predictive value of p53 and p33ING1b in patients with Dukes'C colorectal cancer
Authors: Ahmed I. A. M. , Kelly S. B. , Anderson J. J. , Angus B. , Challen C. , Lunec J.
Published: October 2007

Objective  Identification of biological markers that may predict response to chemotherapy would allow the individualization of treatment by enabling selection of patients most likely to benefit from chemotherapy. The aims of this study were to determine whether p53 mutation status and p53 and p33ING1b protein expression can predict which patients with Dukes’ C colorectal cancer following curative surgical resection respond to adjuvant chemotherapy with 5‐fluorouracil (5‐FU).

Method  Patients with Dukes'C colorectal cancer (n = 41) were studied. DNA was extracted and analysed for p53 mutation using PCR‐based direct DNA sequencing. Tumours were analysed for p53 protein expression by immunohistochemistry using DO‐7 monoclonal antibody and for p33ING1b protein expression using GN1 monoclonal antibody.

Results  There was a significant association between p53 mutation status analysed by gene sequencing and overall and metastasis‐free survival (P = 0.03 and 0.004, respectively, log‐rank test). By contrast, no significant correlation was found between p53 and p33ING1b protein expression and overall or metastasis‐free survival.

Conclusion  In patients with Dukes'C colorectal cancer who underwent curative surgical resection of the primary tumour, followed by 5‐FU‐based adjuvant chemotherapy, p53 mutation status as assessed by gene sequencing is a significant predictor of overall and metastasis‐free survival.
Does the laparoscopic colorectal surgery learning curve adversely affect the results of colorectal cancer resection? A 3‐year prospective study in a district general hospital
Authors: Lordan J. T. , Tilney H. S. , Shirol S. , Jourdan I. , Gudgeon A. M.
Published: October 2007

Introduction  Laparoscopic colorectal surgery is slowly being adopted across the UK. We present a 3‐year prospective study of laparoscopic colorectal cancer resections in a district general hospital.

Method  Data relating to premorbid, operative and postoperative parameters were recorded for all patients undergoing laparoscopic, open, planned converted (laparoscopic assisted) and unplanned converted resections prospectively from April 2003 to April 2006.

Results  A total of 238 colorectal resections were performed, 153 of which were for cancer. Of these 44 (29%) were open, 77 (50%) were laparoscopic and 32 (21%) were converted [26 (17%) planned and six (4%) unplanned]. Blood loss was less in the laparoscopic group compared with the open group (P = 0.02) as was intra‐operative fluid replacement (P = 0.01). Time to requiring oral analgesia alone was shorter (P = 0.001) and bowel function returned earlier (P = 0.001) in the laparoscopic group. This is reflected in a trend towards a shorter hospital stay for the laparoscopic group compared with the open group (P = 0.049). The operating time of the laparoscopic group was not significantly longer (P = 0.38). The complication rate was similar between groups (P = 0.31) and the mortality in the laparoscopic group was 1.3%.

Conclusion  Changing from open to laparoscopic dissection for colorectal cancer is safe even during the initial learning curve. There are clear potential short‐term benefits for patients and the technique can be introduced without penalties in terms of reduced surgical throughput.
Is a morphologically intact anal sphincter necessary for success with sacral nerve modulation in patients with faecal incontinence?
Authors: Melenhorst J. , Koch S. M. , Uludag Ö. , Van Gemert W. G. , Baeten C. G.
Published: October 2007

Objective  Sacral nerve modulation (SNM) for the treatment of faecal incontinence was originally performed in patients with an intact anal sphincter or after repair of a sphincter defect. There is evidence that SNM can be performed in patients with faecal incontinence and an anal sphincter defect.

Method  Two groups of patients were analysed retrospectively to determine whether SNM is as effective in patients with faecal incontinence associated with an anal sphincter defect as in those with a morphologically intact anal sphincter following anal repair (AR). Patients in group A had had an AR resulting in an intact anal sphincter ring. Group B included patients with a sphincter defect which was not primarily repaired. Both groups underwent SNM. All patients had undergone a test stimulation percutaneous nerve evaluation (PNE) followed by a subchronic test over 3 weeks. If the PNE was successful, a permanent SNM electrode was implanted. Follow‐up visits for the successfully permanent implanted patients were scheduled at 1, 3, 6 and 12 months and annually thereafter.

Results  Group A consisted of 20 (19 women) patients. Eighteen (90%) had a positive subchronic test stimulation. Twelve patients had a successful SNM implant during middle‐term follow‐up. Group B consisted of 20 women. The size of the defect in the anal sphincter varied between 17% and 33% of the anal circumference. Fourteen (70%) had a positive subchronic test stimulation. Twelve patients had a successful SNM implant during middle‐term follow‐up. In both groups, the mean number of incontinence episodes decreased significantly with SNM (test vs baseline: P = 0.0001, P = 0.0002). There was no significant difference in resting and squeeze pressures during SNM in group A, but in group B squeeze pressure had increased significantly at 24 months. Comparison of patient characteristics and outcome between groups A and B revealed no statistical differences.

Conclusion  A morphologically intact anal sphincter is not a prerequisite for success in the treatment of faecal incontinence with SNM. An anal sphincter defect of <33% of the circumference can be effectively treated primarily with SNM without repair.
Influence of palliative surgical resection on overall survival in patients with advanced colorectal cancer: a retrospective single institutional study
Authors: Kaufman M. S. , Radhakrishnan N. , Roy R. , Gecelter G. , Tsang J. , Thomas A. , Nissel‐Horowitz S. , Mehrotra B.
Published: October 2007

Background  The role of palliative surgical resection in patients presenting with locally advanced or metastatic colorectal cancer (CRC) is unclear. Resection is often limited to symptomatic management of bleeding, obstruction, perforation or for relief of pain, in patients with an adequate performance status and an expected life span of over several weeks. An exploratory analysis to evaluate the influence of a palliative surgical resection on survival outcome in patients with advanced CRC is reported.

Method  A retrospective review of medical records of all patients diagnosed with advanced CRC at our institution between the years 1998 and 2003 was undertaken. Tumour registry data were reviewed to identify age, gender, modalities of therapy [i.e. surgery (S), chemotherapy (C), radiation] and overall survival. IRB approval was obtained for this study.

Results  One hundred and eighty‐five patients were identified. Median age was 67 years (range 30–99). M:F ratio was 1:1. Sixty‐two per cent of patients (115/185) underwent a palliative surgical intervention. Median survival of patients who underwent S and those that did not undergo S was 22 and 3 months respectively (P < 0.0001). Forty‐eight per cent of patients (79/184) underwent systemic C. Median survival of patients who received C + S, and patients who received C alone was 30 and 15 months respectively (P < 0.0004). Fifty‐one per cent of patients who underwent S, received C; 30% of patients who did not undergo S, received C. Chemotherapy data were available on 46 of 79 patients. Patients treated with S + C, and C without S, received a median of 9 and 6 months of therapy respectively. The median number of regimens used were similar in both.

Conclusion  These exploratory data suggest a positive influence of a palliative resection performed during the disease course of patients with advanced CRC. The increased frequency of utilization and the more prolonged duration of C in the surgically treated patients may in part contribute to this improved survival. This may also be reflective of performance status at the time of diagnosis. Future trials enrolling patients with advanced CRC should prospectively stratify for surgical intervention to further clarify the influence of this modality on the outcome of systemic therapy in this disease.
Dissociating Motivational Direction and Affective Valence
Authors: Coombes Stephen A. , Cauraugh James H. , Janelle Christopher M.
Published: October 2007

We aimed to clarify the relation between affective valence and motivational direction by specifying how central and peripheral components of extension movements are altered according to specific unpleasant affective states. As predicted, premotor reaction time was quicker for extension movements initiated during exposure to attack than for extension movements initiated during exposure to all other valence categories (mutilation, erotic couples, opposite-sex nudes, neutral humans, household objects, blank). Exposure to erotic couples and mutilations yielded greater peak force than exposure to images of attack, neutral humans, and household objects. Finally, motor reaction time and peak electromyographic amplitude were not altered by valence. These findings indicate that unpleasant states do not unilaterally prime withdrawal movements, and that the quick execution of extension movements during exposure to threatening images is due to rapid premotor, rather than motor, reaction time. Collectively, our findings support the call for dissociating motivational direction and affective valence.
Rare Targets Are Rarely Missed in Correctable Search
Authors: Fleck Mathias S. , Mitroff Stephen R.
Published: October 2007

Failing to find a tumor in an x-ray scan or a gun in an airport baggage screening can have dire consequences, making it fundamentally important to elucidate the mechanisms that hinder performance in such visual searches. Recent laboratory work has indicated that low target prevalence can lead to disturbingly high miss rates in visual search. Here, however, we demonstrate that misses in low-prevalence searches can be readily abated. When targets are rarely present, observers adapt by responding more quickly, and miss rates are high. Critically, though, these misses are often due to response-execution errors, not perceptual or identification errors: Observers know a target was present, but just respond too quickly. When provided an opportunity to correct their last response, observers can catch their mistakes. Thus, low target prevalence may not be a generalizable cause of high miss rates in visual search.
Contrasting Intellectual Patterns Predict Creativity in the Arts and Sciences
Authors: Park Gregory , Lubinski David , Benbow Camilla P.
Published: October 2007

A sample of 2,409 intellectually talented adolescents (top 1%) who were assessed on the SAT by age 13 was tracked longitudinally for more than 25 years. Their creative accomplishments, with particular emphasis on literary achievement and scientific-technical innovation, were examined as a function of ability level (sum of math and verbal SAT scores) and tilt (math SAT score minus verbal SAT score). Results showed that distinct ability patterns uncovered by age 13 portend contrasting forms of creative expression by middle age. Whereas ability level contributes significantly to creative accomplishments, ability tilt is critical for predicting the specific domain in which they occur (e.g., securing a tenure-track position in the humanities vs. science, technology, engineering, or mathematics; publishing a novel vs. securing a patent).
Childhood Poverty and Health
Authors: Evans Gary W. , Kim Pilyoung
Published: October 2007

A massive literature documents the inverse association between poverty or low socioeconomic status and health, but little is known about the mechanisms underlying this robust relation. We examined longitudinal relations between duration of poverty exposure since birth, cumulative risk exposure, and physiological stress in two hundred seven 13-year-olds. Chronic stress was assessed by basal blood pressure and overnight cortisol levels; stress regulation was assessed by cardiovascular reactivity to a standard acute stressor and recovery after exposure to this stressor. Cumulative risk exposure was measured by multiple physical (e.g., substandard housing) and social (e.g., family turmoil) risk factors. The greater the number of years spent living in poverty, the more elevated was overnight cortisol and the more dysregulated was the cardiovascular response (i.e., muted reactivity). Cardiovascular recovery was not affected by duration of poverty exposure. Unlike the duration of poverty exposure, concurrent poverty (i.e., during adolescence) did not affect these physiological stress outcomes. The effects of childhood poverty on stress dysregulation are largely explained by cumulative risk exposure accompanying childhood poverty.
Neural Correlates of Adaptive Decision Making for Risky Gains and Losses
Authors: Weller Joshua A. , Levin Irwin P. , Shiv Baba , Bechara Antoine
Published: October 2007

Do decisions about potential gains and potential losses require different neural structures for advantageous choices? In a lesion study, we used a new measure of adaptive decision making under risk to examine whether damage to neural structures subserving emotion affects an individual's ability to make adaptive decisions differentially for gains and losses. We found that individuals with lesions to the amygdala, an area responsible for processing emotional responses, displayed impaired decision making when considering potential gains, but not when considering potential losses. In contrast, patients with damage to the ventromedial prefrontal cortex, an area responsible for integrating cognitive and emotional information, showed deficits in both domains. We argue that this dissociation provides evidence that adaptive decision making for risks involving potential losses may be more difficult to disrupt than adaptive decision making for risks involving potential gains. This research further demonstrates the role of emotion in decision competence.
Neuroanatomical Correlates of Handedness for Tool Use in Chimpanzees (Pan Troglodytes)
Authors: Hopkins William D. , Russell Jamie L. , Cantalupo Claudio
Published: October 2007

It has been hypothesized that cognitive mechanisms underlying lateralized complex motor actions associated with tool use in chimpanzees may have set the stage for the evolution of left-hemisphere specialization for language and speech in humans. Here we report evidence that asymmetries in the homologues to Broca's and Wernicke's areas are associated with handedness for tool use in chimpanzees. These results suggest that the neural substrates of tool use may have served as a preadaptation for the evolution of language and speech in modern humans.
The Origins of Cognitive Dissonance
Authors: Egan Louisa C. , Santos Laurie R. , Bloom Paul
Published: October 2007

In a study exploring the origins of cognitive dissonance, preschoolers and capuchins were given a choice between two equally preferred alternatives (two different stickers and two differently colored M&M's®, respectively). On the basis of previous research with adults, this choice was thought to cause dissonance because it conflicted with subjects' belief that the two options were equally valuable. We therefore expected subjects to change their attitude toward the unchosen alternative, deeming it less valuable. We then presented subjects with a choice between the unchosen option and an option that was originally as attractive as both options in the first choice. Both groups preferred the novel over the unchosen option in this experimental condition, but not in a control condition in which they did not take part in the first decision. These results provide the first evidence of decision rationalization in children and nonhuman primates. They suggest that the mechanisms underlying cognitive-dissonance reduction in human adults may have originated both developmentally and evolutionarily earlier than previously thought.
From Terror to Joy
Authors: DeWall C. Nathan , Baumeister Roy F.
Published: October 2007

Reminders of death tend to produce strong cognitive and behavioral responses, but little or no emotional response. In three experiments, mortality salience produced an automatic coping response that involved tuning to positive emotional information. Subjects showed increased accessibility of positive emotional information (Experiments 1 and 3) and gave more weight to positive emotion in their judgments of word similarity (Experiment 2) after contemplating death than after thinking about dental pain. This automatic coping response was found both after a delay (Experiments 1 and 2) and directly after the mortality-salience manipulation (Experiment 3), which suggests that the coping process begins immediately. Tuning to positive emotional information in response to mortality salience was unconscious and counterintuitive (Experiment 3). These findings shed light on the coping process that ensues immediately following mortality salience and help to explain why a delay is often necessary to produce effects in line with terror management theory.
Why Egalitarianism Might Be Good for Your Health
Authors: Berry Mendes Wendy , Gray Heather M. , Mendoza-Denton Rodolfo , Major Brenda , Epel Elissa S.
Published: October 2007

We compared how evaluations by out-group members and evaluations by in-group members affected participants' stress responses—their neuroendocrine reactivity, cognitive appraisals, and observed anxiety—and how participants' implicit racial bias moderated these responses. Specifically, White participants completed measures of racial bias prior to the experiment. During the experiment, participants performed speech and serial subtraction tasks in front of White or Black interviewers. Several saliva samples were obtained, and they were assayed for catabolic (“breaking down”) and anabolic (“building up”) hormones. Interviewers' race and participants' racial bias interacted in predicting stress responses. When interviewers were Black, lower racial bias was linked with more salutary stress responses: lower threat appraisals, less anxiety, and increased levels of anabolic hormones. When interviewers were White, no effect was found for threat appraisals or anabolic hormones, and the reverse effect was observed for anxiety. Egalitarianism may have physical and psychological benefits for people living in a diverse society.
Motion Detection and Motion Verbs
Authors: Meteyard Lotte , Bahrami Bahador , Vigliocco Gabriella
Published: October 2007

Recent theories propose that semantic representation and sensorimotor processing have a common substrate via simulation. We tested the prediction that comprehension interacts with perception, using a standard psychophysics methodology. While passively listening to verbs that referred to upward or downward motion, and to control verbs that did not refer to motion, 20 subjects performed a motion-detection task, indicating whether or not they saw motion in visual stimuli containing threshold levels of coherent vertical motion. A signal detection analysis revealed that when verbs were directionally in-congruent with the motion signal, perceptual sensitivity was impaired. Word comprehension also affected decision criteria and reaction times, but in different ways. The results are discussed with reference to existing explanations of embodied processing and the potential of psychophysical methods for assessing interactions between language and perception.
Innovation Shortfalls
Authors: Maloney William , Rodríguez‐Clare Andrés
Published: October 2007

There is a common perception that low productivity or low growth is due to what can be called an “innovation shortfall,” usually identified as a low rate of investment in R&D. The problem with this analysis is that it fails to see that a low R&D investment rate may be appropriate given the economy's pattern of specialization, or may be just one manifestation of impediments to accumulation more generally. This paper first shows a simple way to estimate the R&D gap that can be explained by a country's specialization pattern, illustrating it for the case of Chile. Second, we show how a calibrated model can be used to determine the R&D gap that should be expected given a country's investment in physical and human capital. If the actual R&D gap is above this expected gap, then one can say that the country suffers from a true innovation shortfall.
Labor Conflict and Foreign Investments: An Analysis of FDI in India
Authors: Menon Nidhiya , Sanyal Paroma
Published: October 2007

This paper analyzes patterns of foreign direct investment in India. We investigate how labor conflict, credit constraints, and indicators of a state's economic health influence location decisions of foreign firms. We account for the possible endogeneity of labor conflict variables in modeling the location decisions of foreign firms. This is accomplished by using a state‐specific fixed effects framework that captures the presence of unobservables, which may influence investment decisions and labor unrest simultaneously. Results indicate that labor unrest is endogenous across the states of India, and has a strong negative impact on foreign investment.
Schumpeterian Growth with Productive Public Spending and Distortionary Taxation
Authors: Peretto Pietro F.
Published: October 2007

Schumpeterian growth theory eliminates the scale effect by positing a process of development of new product lines that fragments the aggregate market in submarkets whose size does not increase with population or the size of the workforce. This entails the sterilization of the growth effects of selected fiscal variables. This insight is applied to shed new light on the role of distortionary taxes on consumption, household labor and assets income, corporate income, and of productive public spending. The framework allows the identification of which of these fiscal variables have permanent (steady‐state) growth effects, and which ones have only transitory effects. It also allows the transitional dynamics to be solved analytically and thus the analysis of the welfare effects of revenue‐neutral changes in tax structure. It is found that replacing taxes that distort labor supply with taxes that distort saving/investment choices raises welfare, and the intuition behind this surprising result is discussed.