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Pikoos TD, Malcolm A, Castle DJ, Rossell SL. A hierarchy of visual processing deficits in body dysmorphic disorder: a conceptual review and empirical investigation. Cogn Neuropsychiatry 2024:1-25. [PMID: 38563811 DOI: 10.1080/13546805.2024.2326243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 02/27/2024] [Indexed: 04/04/2024]
Abstract
OBJECTIVE Abnormal visual processing has been proposed as a mechanism underlying excessive focus on minor appearance flaws in body dysmorphic disorder (BDD). Existing BDD research has not differentiated the various stages of face processing (featural, first-order configural, holistic and second-order configural) that are required for higher-order processes such as emotion recognition. This study investigated a hierarchical visual processing model to examine the nature of abnormalities in face processing in BDD. METHOD Thirty BDD participants and 27 healthy controls completed the Navon task, a featural and configural face processing task and a facial emotion labelling task. RESULTS BDD participants performed similarly to controls when processing global and local non-face stimuli on the Navon task, when detecting subtle changes in the features and spacing of a target face, and when labelling emotional faces. However, BDD participants displayed poorer performance when viewing inverted faces, indicating difficulties in configural processing. CONCLUSIONS The findings only partially support prior work. However, synthesis of results with previous findings indicates that heterogenous task methodologies may contribute to inconsistent findings. Recommendations are provided regarding the task parameters that appear most sensitive to abnormalities in BDD.
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Affiliation(s)
- Toni D Pikoos
- Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia
| | - Amy Malcolm
- Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia
| | - David J Castle
- Department of Psychiatry, University of Tasmania, Tasmania, Australia
- Centre for Mental Health Service Innovation, Tasmania, Australia
| | - Susan L Rossell
- Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia
- Psychiatry, St Vincent's Hospital, Melbourne, Australia
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2
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Affiliation(s)
- Susan L Rossell
- Centre for Mental Health, School of Health Sciences, Swinburne University of Technology, Hawthorn, VIC, Australia
- Department of Mental Health, St Vincent’s Hospital, Melbourne, VIC, Australia
| | - David J Castle
- Centre for Addiction and Mental Health and the Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Toni Pikoos
- Centre for Mental Health, School of Health Sciences, Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Amy Malcolm
- Centre for Mental Health, School of Health Sciences, Swinburne University of Technology, Hawthorn, VIC, Australia
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Phillipou A, Croce S, Abel LA, Castle DJ, Dean B, Eikelis N, Elwyn R, Gurvich C, Jenkins Z, Meyer D, Miles S, Neill E, Ralph-Nearman C, Rocks T, Rossell SL, Ruusunen A, Simpson TN, Urbini G, West M, Malcolm A. Investigating the cause and maintenance of Anorexia Nervosa - The I-CAN study: Protocol and open call for study sites and collaboration. Psychiatry Res 2023; 328:115468. [PMID: 37716319 DOI: 10.1016/j.psychres.2023.115468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 09/05/2023] [Indexed: 09/18/2023]
Affiliation(s)
- Andrea Phillipou
- Orygen, Melbourne, Australia; Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia; Department of Psychological Sciences, Swinburne University of Technology, Melbourne, Australia; Department of Mental Health, St Vincent's Hospital, Melbourne, Australia; Department of Mental Health, Austin Health, Melbourne, Australia.
| | - Scarlett Croce
- Centre for Mental Health & Brain Sciences, Swinburne University of Technology, Melbourne, Australia
| | - Larry A Abel
- School of Medicine, Deakin University, Waurn Ponds, Australia
| | - David J Castle
- Centre for Mental Health Service Innovation, University of Tasmania, Hobart, Australia
| | - Brian Dean
- Molecular Psychiatry, Florey Institute for Neuroscience and Mental Health
| | - Nina Eikelis
- Iverson Health Innovation Research Institute, Swinburne University of Technology, Melbourne, Australia
| | - Rosiel Elwyn
- Thompson Institute, University of the Sunshine Coast, Birtinya, Australia
| | - Caroline Gurvich
- HER Centre Australia, Central Clinical School, Monash University, Melbourne, Australia
| | - Zoe Jenkins
- Department of Mental Health, St Vincent's Hospital, Melbourne, Australia; Iverson Health Innovation Research Institute, Swinburne University of Technology, Melbourne, Australia
| | - Denny Meyer
- Centre for Mental Health & Brain Sciences, Swinburne University of Technology, Melbourne, Australia
| | - Stephanie Miles
- Orygen, Melbourne, Australia; Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia; Department of Psychological Sciences, Swinburne University of Technology, Melbourne, Australia
| | - Erica Neill
- Orygen, Melbourne, Australia; Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | | | - Tetyana Rocks
- IMPACT - the Institute for Mental and Physical Health and Clinical Translation, Food & Mood Centre, School of Medicine, Deakin University, Geelong, Australia
| | - Susan L Rossell
- Department of Mental Health, St Vincent's Hospital, Melbourne, Australia; Centre for Mental Health & Brain Sciences, Swinburne University of Technology, Melbourne, Australia
| | - Anu Ruusunen
- IMPACT - the Institute for Mental and Physical Health and Clinical Translation, Food & Mood Centre, School of Medicine, Deakin University, Geelong, Australia; Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland; Department of Psychiatry, Kuopio University Hospital, Kuopio, Finland
| | - Tamara N Simpson
- Centre for Mental Health & Brain Sciences, Swinburne University of Technology, Melbourne, Australia
| | - Gemma Urbini
- Child Youth Mental Health Service, Austin Hospital, Melbourne, Australia
| | - Madeline West
- IMPACT - the Institute for Mental and Physical Health and Clinical Translation, Food & Mood Centre, School of Medicine, Deakin University, Geelong, Australia
| | - Amy Malcolm
- Centre for Mental Health & Brain Sciences, Swinburne University of Technology, Melbourne, Australia
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Malcolm A, Phillipou A, Neill E, Rossell SL, Toh WL. Relationships between paranoia and body image concern among community women. J Psychiatr Res 2022; 151:405-410. [PMID: 35594600 DOI: 10.1016/j.jpsychires.2022.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 04/13/2022] [Accepted: 05/09/2022] [Indexed: 11/27/2022]
Abstract
Previous research has indicated that lifetime body image concerns are associated with increased odds of paranoid ideation. In this study, we sought to replicate and extend this finding by exploring how paranoia relates to different aspects of body image concern using a comprehensive, cross-sectional design. Women without a mental health diagnosis (n = 119) completed online questionnaires assessing paranoia, shape and weight concerns, and figure ratings for how they "think" their body looks and how they "feel" in their body. Participant's "actual" figure ratings were estimated from height and weight; discrepancy scores were then calculated for "actual-think" and "actual-feel" figure ratings. Correlational analyses, and mediation models testing paranoia as a mediator between "actual-feel" and shape and weight concerns, were conducted. Paranoia was significantly correlated with increased shape and weight concerns, and with "feeling" larger. Paranoia significantly mediated paths from feeling larger to increased shape or weight concerns. There were no significant associations of paranoia with "actual-think" ratings. Limitations include that height and weight data could not be objectively confirmed, and only women were included in the study. Further research is needed to understand mechanisms by which paranoia may influence shape and weight concerns and vice versa, and how "feeling" larger may feed paranoia. Future research should investigate these relationships among clinical eating disorder groups.
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Affiliation(s)
- Amy Malcolm
- Centre for Mental Health, Faculty of Health, Arts & Design, Swinburne University of Technology, Hawthorn, VIC, Australia.
| | - Andrea Phillipou
- Centre for Mental Health, Faculty of Health, Arts & Design, Swinburne University of Technology, Hawthorn, VIC, Australia; Department of Mental Health, St Vincent's Hospital, Melbourne, Australia; Department of Mental Health, Austin Health, Melbourne, Australia
| | - Erica Neill
- Centre for Mental Health, Faculty of Health, Arts & Design, Swinburne University of Technology, Hawthorn, VIC, Australia; Department of Mental Health, St Vincent's Hospital, Melbourne, Australia
| | - Susan L Rossell
- Centre for Mental Health, Faculty of Health, Arts & Design, Swinburne University of Technology, Hawthorn, VIC, Australia; Department of Mental Health, St Vincent's Hospital, Melbourne, Australia
| | - Wei Lin Toh
- Centre for Mental Health, Faculty of Health, Arts & Design, Swinburne University of Technology, Hawthorn, VIC, Australia
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Musić S, Elwyn R, Fountas G, Gnatt I, Jenkins ZM, Malcolm A, Miles S, Neill E, Simpson T, Yolland CO, Phillipou A. Valuing the voice of lived experience of eating disorders in the research process: Benefits and considerations. Aust N Z J Psychiatry 2022; 56:216-218. [PMID: 33715452 DOI: 10.1177/0004867421998794] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Although the inclusion of individuals with lived experience is encouraged within the research process, there remains inconsistent direct involvement in many mental health fields. Within the eating disorders field specifically, there is a very strong and increasing presence of lived experience advocacy. However, due to a number of potential challenges, research undertaken in consultation or in collaboration with individuals with lived experience of an eating disorder is scarce. This paper describes the significant benefits of the inclusion of individuals with lived experience in research. The specific challenges and barriers faced in eating disorders research are also outlined. It is concluded that in addition to existing guidelines on working with lived experience collaborators in mental health research, more specific procedures are required when working with those with eating disorders.
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Affiliation(s)
- Selma Musić
- Centre for Mental Health, Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Rosiel Elwyn
- Sunshine Coast Mind and Neuroscience Thompson Institute, University of the Sunshine Coast, Birtinya, QLD, Australia
| | - Grace Fountas
- Centre for Mental Health, Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Inge Gnatt
- Centre for Mental Health, Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Zoe M Jenkins
- Centre for Mental Health, Swinburne University of Technology, Hawthorn, VIC, Australia.,Department of Mental Health, St Vincent's Hospital, Melbourne, Fitzroy, VIC, Australia.,Department of Psychiatry, The University of Melbourne, Melbourne, VIC, Australia
| | - Amy Malcolm
- Centre for Mental Health, Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Stephanie Miles
- Centre for Mental Health, Swinburne University of Technology, Hawthorn, VIC, Australia.,Department of Mental Health, St Vincent's Hospital, Melbourne, Fitzroy, VIC, Australia
| | - Erica Neill
- Centre for Mental Health, Swinburne University of Technology, Hawthorn, VIC, Australia.,Department of Mental Health, St Vincent's Hospital, Melbourne, Fitzroy, VIC, Australia.,Department of Psychiatry, The University of Melbourne, Melbourne, VIC, Australia
| | - Tamara Simpson
- Centre for Human Psychopharmacology, Swinburne University of Technology, Melbourne, VIC, Australia
| | - Caitlin Ob Yolland
- Centre for Mental Health, Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Andrea Phillipou
- Centre for Mental Health, Swinburne University of Technology, Hawthorn, VIC, Australia.,Department of Mental Health, St Vincent's Hospital, Melbourne, Fitzroy, VIC, Australia.,Department of Psychiatry, The University of Melbourne, Melbourne, VIC, Australia.,Department of Mental Health, Austin Health, Melbourne, VIC, Australia
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Malcolm A, Pikoos T, Castle DJ, Rossell SL. Cross-diagnostic cognitive heterogeneity in body dysmorphic disorder and obsessive-compulsive disorder. J Behav Ther Exp Psychiatry 2021; 73:101674. [PMID: 34242980 DOI: 10.1016/j.jbtep.2021.101674] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 05/03/2021] [Accepted: 06/30/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND AND OBJECTIVES Previous research has indicated that body dysmorphic disorder (BDD) and obsessive-compulsive disorder (OCD) often demonstrate similar cognitive impairments across multiple domains. However, findings for both disorders have not consistently shown impaired cognition. As such, BDD and OCD might share an overlapping pattern of cognitive heterogeneity, characterised by subgroups with different cognitive profiles. METHODS To evaluate this possibility, we compared 26 BDD, 24 OCD, and 26 healthy control participants on a comprehensive eight-domain cognitive battery. Then, cluster analysis was performed on the BDD and OCD participants' combined data to explore for cognitive subgroups. RESULTS No significant differences were found between the three groups' cognitive functioning, except for poorer visual learning in OCD relative to healthy controls. Cluster analysis produced two cognitive subgroups within the combined BDD and OCD data, characterised by intact cognition (52%) and broadly impaired cognition (48%). Each subgroup comprised both BDD and OCD participants, in similar proportions. The subgroups did not differ in clinical or demographic features. LIMITATIONS Sample sizes were moderate. Future research should investigate clustering patterns both in larger groups and separately in BDD and OCD samples to determine replicability. CONCLUSIONS These findings suggest that BDD and OCD may involve similar patterns of cognitive heterogeneity, and further imply that individuals with either disorder can show a wide range of cognitive profiles, thus necessitating a nuanced approach to future cognitive research in BDD and OCD.
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Affiliation(s)
- Amy Malcolm
- Centre for Mental Health, Faculty of Health, Arts & Design, Swinburne University of Technology, Hawthorn, VIC, Australia.
| | - Toni Pikoos
- Centre for Mental Health, Faculty of Health, Arts & Design, Swinburne University of Technology, Hawthorn, VIC, Australia
| | - David J Castle
- Department of Mental Health, St Vincent's Hospital, Melbourne, VIC, Australia; The University of Melbourne, Melbourne, VIC, Australia; Centre for Addiction and Mental Health and the Department of Psychiatry, University of Toronto, Canada
| | - Susan L Rossell
- Centre for Mental Health, Faculty of Health, Arts & Design, Swinburne University of Technology, Hawthorn, VIC, Australia; Department of Mental Health, St Vincent's Hospital, Melbourne, VIC, Australia
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7
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Malcolm A, Pikoos TD, Grace SA, Castle DJ, Rossell SL. Childhood maltreatment and trauma is common and severe in body dysmorphic disorder. Compr Psychiatry 2021; 109:152256. [PMID: 34147729 DOI: 10.1016/j.comppsych.2021.152256] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 04/19/2021] [Accepted: 05/20/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Childhood maltreatment and trauma may be risk factors for the development of body dysmorphic disorder (BDD). However, the limited research to date on these topics has been constrained by either the absence of a matched healthy control group or non-comprehensive assessments. METHODS This study assessed the prevalence and severity of childhood maltreatment and other traumatic events in 52 BDD participants (56% female) and 57 matched controls (51% female) with no history of mental illness, using the Childhood Trauma Questionnaire and a checklist assessing broader traumatic events. RESULTS In comparison with controls, participants with BDD showed a higher prevalence of emotional abuse (61.5% vs. 33.3%) and physical neglect (59.6% vs. 28.1%), as well as more severe overall maltreatment, emotional abuse, and emotional and physical neglect. BDD participants were also more likely to meet cut-offs for multiple types of maltreatment and reported an elevated number and variety of broader traumatic childhood events (e.g., life-threatening illness). In BDD, increasingly severe maltreatment was correlated with greater severity of BDD symptoms, anxiety and suicidal ideation. CONCLUSIONS These data suggest that childhood maltreatment and exposure to other traumatic events are common and severe in BDD and are cross-sectionally associated with the severity of clinical symptoms. Adversity linked to maladaptive family functioning during childhood may therefore be especially relevant to people with BDD and could relate to social and emotional processing problems in the disorder.
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Affiliation(s)
- Amy Malcolm
- Centre for Mental Health, Faculty of Health, Arts & Design, Swinburne University of Technology, Hawthorn, Victoria, Australia.
| | - Toni D Pikoos
- Centre for Mental Health, Faculty of Health, Arts & Design, Swinburne University of Technology, Hawthorn, Victoria, Australia
| | - Sally A Grace
- Centre for Mental Health, Faculty of Health, Arts & Design, Swinburne University of Technology, Hawthorn, Victoria, Australia
| | - David J Castle
- Department of Mental Health, St Vincent's Hospital, Melbourne, Victoria, Australia; The University of Melbourne, Melbourne, Victoria, Australia; Centre for Addiction and Mental Health and the Department of Psychiatry, University of Toronto, Canada
| | - Susan L Rossell
- Centre for Mental Health, Faculty of Health, Arts & Design, Swinburne University of Technology, Hawthorn, Victoria, Australia; Department of Mental Health, St Vincent's Hospital, Melbourne, Victoria, Australia
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Malcolm A, Phillipou A. Current directions in biomarkers and endophenotypes for anorexia nervosa: A scoping review. J Psychiatr Res 2021; 137:303-310. [PMID: 33735721 DOI: 10.1016/j.jpsychires.2021.02.063] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 02/17/2021] [Accepted: 02/26/2021] [Indexed: 12/30/2022]
Abstract
There are currently no validated biomarkers for anorexia nervosa (AN), though recent literature suggests an increased research interest in this area. Biomarkers are objective, measurable indicators of illness that can be used to assist with diagnosis, risk assessment, and tracking of illness state. Related to biomarkers are endophenotypes, which are quantifiable phenomena that are distinct from symptoms and which link genes to manifest illness. In this scoping review, we sought to provide a summary of recent research conducted in the pursuit of biomarkers and endophenotypes for AN. The findings indicate that a number of possible biomarkers which can assess the presence or severity of AN independently of weight status, including psychophysical (e.g., eye-tracking) and biological (e.g., immune, endocrine, metabolomic, neurobiological) markers, are currently under investigation. However, this research is still in early phases and lacking in replication studies. Endophenotype research has largely been confined to the study of several neurocognitive features, with mixed evidence to support their classification as possible endophenotypes for the disorder. The study of biomarkers and endophenotypes in AN involves significant challenges due to confounding factors of illness-related sequalae, such as starvation. Future research in these areas must prioritise direct evaluation of the sensitivity, specificity and test-retest reliability of proposed biomarkers and enhanced control of confounding physical consequences of AN in the study of biomarkers and endophenotypes.
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Affiliation(s)
- Amy Malcolm
- Centre for Mental Health, Faculty of Health, Arts & Design, Swinburne University of Technology, Hawthorn, VIC, Australia.
| | - Andrea Phillipou
- Centre for Mental Health, Faculty of Health, Arts & Design, Swinburne University of Technology, Hawthorn, VIC, Australia; Department of Mental Health, St Vincent's Hospital, Melbourne, Australia; Department of Psychiatry, The University of Melbourne, Melbourne, Australia; Department of Mental Health, Austin Health, Melbourne, Australia
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Malcolm A, Brennan SN, Grace SA, Pikoos TD, Toh WL, Labuschagne I, Buchanan B, Kaplan RA, Castle DJ, Rossell SL. Empirical evidence for cognitive subgroups in body dysmorphic disorder. Aust N Z J Psychiatry 2021; 55:381-390. [PMID: 33637003 DOI: 10.1177/0004867421998762] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Current understanding of cognitive functioning in body dysmorphic disorder is limited, owing to few studies, small sample sizes and assessment across only limited cognitive domains. Existing research has also shown inconsistent findings, with both intact and impaired cognition reported in body dysmorphic disorder, which might point towards cognitive heterogeneity in the disorder. This study aimed to examine the cognitive profile of body dysmorphic disorder in a large sample across eight cognitive domains, and to explore whether cognitive subgroups might be identified within body dysmorphic disorder. METHOD Cognitive domains of inhibition/flexibility, working memory, speed of processing, reasoning and problem-solving, visual and verbal learning, attention/vigilance and social cognition were assessed and compared between 65 body dysmorphic disorder patients and 70 healthy controls. Then, hierarchical clustering analysis was conducted on the body dysmorphic disorder group's cognitive data. RESULTS Group-average comparisons demonstrated significantly poorer cognitive functioning in body dysmorphic disorder than healthy controls in all domains except for attention/vigilance and social cognition. Cluster analysis identified two divergent cognitive subgroups within our body dysmorphic disorder cohort characterised by (1) broadly intact cognitive function with mild selective impairments (72.3%), and (2) broadly impaired cognitive function (27.7%). However, the clusters did not significantly differ on clinical parameters or most sociodemographic characteristics. CONCLUSION Our findings demonstrate considerable cognitive heterogeneity among persons with body dysmorphic disorder, rather than uniform deficits. Poor performances in the broadly impaired subgroup may have driven group-level differences. However, our findings also suggest a dissociation between cognitive functioning and clinical characteristics in body dysmorphic disorder that has implications for current aetiological models. Additional research is needed to clarify why some people with body dysmorphic disorder demonstrate cognitive deficits while others do not.
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Affiliation(s)
- Amy Malcolm
- Centre for Mental Health, Faculty of Health, Arts & Design, Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Sarah N Brennan
- Centre for Mental Health, Faculty of Health, Arts & Design, Swinburne University of Technology, Hawthorn, VIC, Australia.,The Royal Children's Hospital, Melbourne, VIC, Australia
| | - Sally A Grace
- Centre for Mental Health, Faculty of Health, Arts & Design, Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Toni D Pikoos
- Centre for Mental Health, Faculty of Health, Arts & Design, Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Wei Lin Toh
- Centre for Mental Health, Faculty of Health, Arts & Design, Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Izelle Labuschagne
- School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, VIC, Australia
| | - Ben Buchanan
- Centre for Mental Health, Faculty of Health, Arts & Design, Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Ryan A Kaplan
- Centre for Mental Health, Faculty of Health, Arts & Design, Swinburne University of Technology, Hawthorn, VIC, Australia.,Sydney Body Dysmorphic Disorder & Body Image Clinic, Bondi Junction, NSW, Australia
| | - David J Castle
- Department of Mental Health, St Vincent's Hospital, Melbourne, VIC, Australia.,Department of Psychiatry, Faculty of Medicine, The University of Melbourne, Melbourne, VIC, Australia
| | - Susan L Rossell
- Centre for Mental Health, Faculty of Health, Arts & Design, Swinburne University of Technology, Hawthorn, VIC, Australia.,Department of Mental Health, St Vincent's Hospital, Melbourne, VIC, Australia
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Malcolm A, Pikoos TD, Castle DJ, Rossell SL. An update on gender differences in major symptom phenomenology among adults with body dysmorphic disorder. Psychiatry Res 2021; 295:113619. [PMID: 33278744 DOI: 10.1016/j.psychres.2020.113619] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 11/26/2020] [Indexed: 11/30/2022]
Abstract
There has not been a comprehensive comparison of differences between men and women with body dysmorphic disorder (BDD) for approximately two decades. Major social and technological changes over this time may have changed patterns of bodily concerns and symptom profile among men and women with BDD, thus warranting an updated assessment of gender differences. BDD symptomatology, insight, and associated clinical and sociodemographic characteristics were compared between 49 women and 27 men with BDD. Skin was the most common concern for both men and women. Women showed more concerns than men about the appearance of their legs. Men were more concerned about muscularity/body build. Women demonstrated significantly more severe distress associated with BDD behaviours, and poorer illness insight than men. Age at BDD onset, illness duration, as well as mean severity of depression, anxiety, stress, and social anxiety were similar across the genders. These data suggest that the most common body areas of concern in people with BDD have not dramatically changed over the past two decades. However, the finding of worse insight among women is novel, and suggests a need for further investigation.
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Affiliation(s)
- Amy Malcolm
- Centre for Mental Health, Faculty of Health, Arts & Design, Swinburne University of Technology, Hawthorn, VIC, Australia.
| | - Toni D Pikoos
- Centre for Mental Health, Faculty of Health, Arts & Design, Swinburne University of Technology, Hawthorn, VIC, Australia
| | - David J Castle
- Department of Mental Health, St Vincent's Hospital, Melbourne, VIC, Australia; The University of Melbourne, Melbourne, VIC, Australia
| | - Susan L Rossell
- Centre for Mental Health, Faculty of Health, Arts & Design, Swinburne University of Technology, Hawthorn, VIC, Australia; Department of Mental Health, St Vincent's Hospital, Melbourne, VIC, Australia
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11
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Malcolm A, Labuschagne I, Castle D, Terrett G, Rendell PG, Rossell SL. The relationship between body dysmorphic disorder and obsessive-compulsive disorder: A systematic review of direct comparative studies. Aust N Z J Psychiatry 2018; 52:1030-1049. [PMID: 30238784 DOI: 10.1177/0004867418799925] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Current nosology conceptualises body dysmorphic disorder as being related to obsessive-compulsive disorder, but the direct evidence to support this conceptualisation is mixed. In this systematic review, we aimed to provide an integrated overview of research that has directly compared body dysmorphic disorder and obsessive-compulsive disorder. METHOD The PubMed database was searched for empirical studies which had directly compared body dysmorphic disorder and obsessive-compulsive disorder groups across any subject matter. Of 379 records, 31 met inclusion criteria and were reviewed. RESULTS Evidence of similarities between body dysmorphic disorder and obsessive-compulsive disorder was identified for broad illness features, including age of onset, illness course, symptom severity and level of functional impairment, as well as high perfectionism and high fear of negative evaluation. However, insight was clearly worse in body dysmorphic disorder than obsessive-compulsive disorder, and preliminary data also suggested unique visual processing features, impaired facial affect recognition, increased social anxiety severity and overall greater social-affective dysregulation in body dysmorphic disorder relative to obsessive-compulsive disorder. CONCLUSION Limitations included a restricted number of studies overall, an absence of studies comparing biological parameters (e.g. neuroimaging), and the frequent inclusion of participants with comorbid body dysmorphic disorder and obsessive-compulsive disorder. Risks of interpreting common features as indications of shared underlying mechanisms are explored, and evidence of differences between the disorders are placed in the context of broader research findings. Overall, this review suggests that the current nosological status of body dysmorphic disorder is somewhat tenuous and requires further investigation, with particular focus on dimensional, biological and aetiological elements.
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Affiliation(s)
- Amy Malcolm
- 1 Cognition and Emotion Research Centre, School of Psychology, Australian Catholic University, Melbourne, VIC, Australia
| | - Izelle Labuschagne
- 1 Cognition and Emotion Research Centre, School of Psychology, Australian Catholic University, Melbourne, VIC, Australia
| | - David Castle
- 2 Department of Psychiatry, St Vincent's Hospital Melbourne, Melbourne, VIC, Australia.,3 Department of Psychiatry, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, VIC, Australia
| | - Gill Terrett
- 1 Cognition and Emotion Research Centre, School of Psychology, Australian Catholic University, Melbourne, VIC, Australia
| | - Peter G Rendell
- 1 Cognition and Emotion Research Centre, School of Psychology, Australian Catholic University, Melbourne, VIC, Australia
| | - Susan L Rossell
- 2 Department of Psychiatry, St Vincent's Hospital Melbourne, Melbourne, VIC, Australia.,4 Centre for Mental Health, Swinburne University of Technology, Melbourne, VIC, Australia
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Mazor Y, Ejova A, Andrews A, Jones M, Kellow J, Malcolm A. Long-term outcome of anorectal biofeedback for treatment of fecal incontinence. Neurogastroenterol Motil 2018; 30:e13389. [PMID: 29856107 DOI: 10.1111/nmo.13389] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 05/03/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND Long-term outcome data for anorectal biofeedback (BF) for fecal incontinence (FI) is scarce. Our aims were to describe the long-term symptom profile, quality of life, and need for surgery in FI patients following BF. METHODS One hundred and eight consecutive female patients with FI who completed an instrumented BF course were identified for long-term follow-up. In 61 of 89 contactable patients, outcome measures were assessed at short-term (end of BF), mid-term (9 months median), and long-term (7 years median) follow-up after treatment. KEY RESULTS Long-term response rate (50% or more reduction in FI episodes/wk compared to before BF and not requiring surgical intervention) was seen in 33/61 (54%) patients. Thirteen of these had complete continence. Improvement was seen at short, mid, and long-term follow-up for patients' satisfaction and control of bowel function. In contrast, fecal incontinence severity index and quality of life measures, which improved in short and mid-term, were no different from baseline by long-term follow-up. Patients classified as short-term responders were far more likely to display a long-term response compared to short-term non-responders (68% vs 18%, P < .001). CONCLUSIONS & INFERENCES Long-term symptom improvement was observed in more than half of FI patients at 7 year post BF follow-up. Quality of life improvements, however, were not maintained. Patients improving during the initial BF program have a high chance of long-term improvement, while patients who do not respond to BF should be considered early for other therapies.
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Affiliation(s)
- Y Mazor
- Neurogastroenterology Unit, Royal North Shore Hospital, University of Sydney, St Leonard's, NSW, Australia
- University of Sydney, Sydney, NSW, Australia
| | - A Ejova
- Department of Psychology, Macquarie University, NSW, Australia
| | - A Andrews
- Neurogastroenterology Unit, Royal North Shore Hospital, University of Sydney, St Leonard's, NSW, Australia
| | - M Jones
- Department of Psychology, Macquarie University, NSW, Australia
| | - J Kellow
- Neurogastroenterology Unit, Royal North Shore Hospital, University of Sydney, St Leonard's, NSW, Australia
- University of Sydney, Sydney, NSW, Australia
| | - A Malcolm
- Neurogastroenterology Unit, Royal North Shore Hospital, University of Sydney, St Leonard's, NSW, Australia
- University of Sydney, Sydney, NSW, Australia
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Ansite J, Balamurugan AN, Barbaro B, Battle J, Brandhorst D, Cano J, Chen X, Deng S, Feddersen D, Friberg A, Gilmore T, Goldstein JS, Holbrook E, Khan A, Kin T, Lei J, Linetsky E, Liu C, Luo X, McElvaney K, Min Z, Moreno J, O'Gorman D, Papas KK, Putz G, Ricordi C, Szot G, Templeton T, Wang L, Wilhelm JJ, Willits J, Wilson T, Zhang X, Avila J, Begley B, Cano J, Carpentier S, Holbrook E, Hutchinson J, Larsen CP, Moreno J, Sears M, Turgeon NA, Webster D, Deng S, Lei J, Markmann JF, Bridges ND, Czarniecki CW, Goldstein JS, Putz G, Templeton T, Wilson T, Eggerman TL, Al-Saden P, Battle J, Chen X, Hecyk A, Kissler H, Luo X, Molitch M, Monson N, Stuart E, Wallia A, Wang L, Wang S, Zhang X, Bigam D, Campbell P, Dinyari P, Kin T, Kneteman N, Lyon J, Malcolm A, O'Gorman D, Onderka C, Owen R, Pawlick R, Richer B, Rosichuk S, Sarman D, Schroeder A, Senior PA, Shapiro AMJ, Toth L, Toth V, Zhai W, Johnson K, McElroy J, Posselt AM, Ramos M, Rojas T, Stock PG, Szot G, Barbaro B, Martellotto J, Oberholzer J, Qi M, Wang Y, Bayman L, Chaloner K, Clarke W, Dillon JS, Diltz C, Doelle GC, Ecklund D, Feddersen D, Foster E, Hunsicker LG, Jasperson C, Lafontant DE, McElvaney K, Neill-Hudson T, Nollen D, Qidwai J, Riss H, Schwieger T, Willits J, Yankey J, Alejandro R, Corrales AC, Faradji R, Froud T, Garcia AA, Herrada E, Ichii H, Inverardi L, Kenyon N, Khan A, Linetsky E, Montelongo J, Peixoto E, Peterson K, Ricordi C, Szust J, Wang X, Abdulla MH, Ansite J, Balamurugan AN, Bellin MD, Brandenburg M, Gilmore T, Harmon JV, Hering BJ, Kandaswamy R, Loganathan G, Mueller K, Papas KK, Pedersen J, Wilhelm JJ, Witson J, Dalton-Bakes C, Fu H, Kamoun M, Kearns J, Li Y, Liu C, Luning-Prak E, Luo Y, Markmann E, Min Z, Naji A, Palanjian M, Rickels M, Shlansky-Goldberg R, Vivek K, Ziaie AS, Fernandez L, Kaufman DB, Zitur L, Brandhorst D, Friberg A, Korsgren O. Purified Human Pancreatic Islets, CIT Culture Media with Lisofylline or Exenatide. CellR4 Repair Replace Regen Reprogram 2017; 5:e2377. [PMID: 30613755 PMCID: PMC6319648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
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Bral M, Gala-Lopez B, Bigam D, Kneteman N, Malcolm A, Livingstone S, Andres A, Emamaullee J, Russell L, Coussios C, West LJ, Friend PJ, Shapiro AMJ. Preliminary Single-Center Canadian Experience of Human Normothermic Ex Vivo Liver Perfusion: Results of a Clinical Trial. Am J Transplant 2017; 17:1071-1080. [PMID: 27639262 DOI: 10.1111/ajt.14049] [Citation(s) in RCA: 145] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2016] [Revised: 08/28/2016] [Accepted: 08/30/2016] [Indexed: 01/25/2023]
Abstract
After extensive experimentation, outcomes of a first clinical normothermic machine perfusion (NMP) liver trial in the United Kingdom demonstrated feasibility and clear safety, with improved liver function compared with standard static cold storage (SCS). We present a preliminary single-center North American experience using identical NMP technology. Ten donor liver grafts were procured, four (40%) from donation after circulatory death (DCD), of which nine were transplanted. One liver did not proceed because of a technical failure with portal cannulation and was discarded. Transplanted NMP grafts were matched 1:3 with transplanted SCS livers. Median NMP was 11.5 h (range 3.3-22.5 h) with one DCD liver perfused for 22.5 h. All transplanted livers functioned, and serum transaminases, bilirubin, international normalized ratio, and lactate levels corrected in NMP recipients similarly to controls. Graft survival at 30 days (primary outcome) was not statistically different between groups on an intent-to-treat basis (p = 0.25). Intensive care and hospital stays were significantly more prolonged in the NMP group. This preliminary experience demonstrates feasibility as well as potential technical risks of NMP in a North American setting and highlights a need for larger, randomized studies.
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Affiliation(s)
- M Bral
- Department of Surgery, University of Alberta, Edmonton, Canada.,Members of the Canadian National Transplant Research Project (CNTRP), Edmonton, Canada
| | - B Gala-Lopez
- Department of Surgery, University of Alberta, Edmonton, Canada.,Members of the Canadian National Transplant Research Project (CNTRP), Edmonton, Canada
| | - D Bigam
- Department of Surgery, University of Alberta, Edmonton, Canada
| | - N Kneteman
- Department of Surgery, University of Alberta, Edmonton, Canada.,Members of the Canadian National Transplant Research Project (CNTRP), Edmonton, Canada
| | - A Malcolm
- Department of Surgery, University of Alberta, Edmonton, Canada.,Members of the Canadian National Transplant Research Project (CNTRP), Edmonton, Canada
| | - S Livingstone
- Department of Surgery, University of Alberta, Edmonton, Canada
| | - A Andres
- Department of Surgery, University of Alberta, Edmonton, Canada
| | - J Emamaullee
- Department of Surgery, University of Alberta, Edmonton, Canada
| | | | - C Coussios
- Institute of Biomedical Engineering, University of Oxford, Oxford, UK
| | - L J West
- Department of Surgery, University of Alberta, Edmonton, Canada.,Members of the Canadian National Transplant Research Project (CNTRP), Edmonton, Canada
| | - P J Friend
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - A M J Shapiro
- Department of Surgery, University of Alberta, Edmonton, Canada.,Members of the Canadian National Transplant Research Project (CNTRP), Edmonton, Canada
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Mazor Y, Hansen R, Prott G, Kellow J, Malcolm A. The importance of a high rectal pressure on strain in constipated patients: implications for biofeedback therapy. Neurogastroenterol Motil 2017; 29. [PMID: 27647462 DOI: 10.1111/nmo.12940] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Accepted: 08/09/2016] [Indexed: 12/20/2022]
Abstract
BACKGROUND A subset of patients with chronic constipation display a relatively high manometric rectal pressure on strain. We hypothesized that these patients represent a unique phenotype of functional defecatory disorder (FDD) and would benefit from undergoing anorectal biofeedback (BF). METHODS Of 138 consecutive patients with chronic constipation and symptoms of FDD, 19 were defined as having a high rectal pressure on strain, using a statistically derived cut-off of 78 mm Hg. This subset was compared with remaining patients in regard to baseline clinical profile and physiology, and outcome of BF. KEY RESULTS There was a greater representation of males in the high rectal pressure group. Their constipation score, impact of bowel dysfunction on quality of life and satisfaction with bowel habits did not differ from the remaining patients. Eighty-four percent of patients in the high group successfully expelled the rectal balloon and 95% displayed paradoxical anal contraction on strain (P<.05 compared with the remaining patients). Following BF, 89% of patients in the high group reduced their rectal pressure to normal. End of BF treatment outcomes improved significantly, and to a similar degree, in both groups. CONCLUSIONS & INFERENCES We have identified a subgroup of patients with dyssynergic symptoms but without a formal Rome III diagnosis of FDD, who were characterized by a high straining rectal pressure. Although these patients displayed some physiological differences to the patients with lower straining rectal pressure, they suffer similarly. Importantly, we have shown that these patients can respond favorably to anorectal BF.
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Affiliation(s)
- Y Mazor
- Neurogastroenterology Unit, Royal North Shore Hospital, University of Sydney, St Leonards, NSW, Australia
| | - R Hansen
- Neurogastroenterology Unit, Royal North Shore Hospital, University of Sydney, St Leonards, NSW, Australia
| | - G Prott
- Neurogastroenterology Unit, Royal North Shore Hospital, University of Sydney, St Leonards, NSW, Australia
| | - J Kellow
- Neurogastroenterology Unit, Royal North Shore Hospital, University of Sydney, St Leonards, NSW, Australia
| | - A Malcolm
- Neurogastroenterology Unit, Royal North Shore Hospital, University of Sydney, St Leonards, NSW, Australia
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Deeley MA, Chen A, Datteri RD, Noble J, Cmelak A, Donnelly E, Malcolm A, Moretti L, Jaboin J, Niermann K, Yang ES, Yu DS, Dawant BM. Segmentation editing improves efficiency while reducing inter-expert variation and maintaining accuracy for normal brain tissues in the presence of space-occupying lesions. Phys Med Biol 2013; 58:4071-97. [PMID: 23685866 DOI: 10.1088/0031-9155/58/12/4071] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Image segmentation has become a vital and often rate-limiting step in modern radiotherapy treatment planning. In recent years, the pace and scope of algorithm development, and even introduction into the clinic, have far exceeded evaluative studies. In this work we build upon our previous evaluation of a registration driven segmentation algorithm in the context of 8 expert raters and 20 patients who underwent radiotherapy for large space-occupying tumours in the brain. In this work we tested four hypotheses concerning the impact of manual segmentation editing in a randomized single-blinded study. We tested these hypotheses on the normal structures of the brainstem, optic chiasm, eyes and optic nerves using the Dice similarity coefficient, volume, and signed Euclidean distance error to evaluate the impact of editing on inter-rater variance and accuracy. Accuracy analyses relied on two simulated ground truth estimation methods: simultaneous truth and performance level estimation and a novel implementation of probability maps. The experts were presented with automatic, their own, and their peers' segmentations from our previous study to edit. We found, independent of source, editing reduced inter-rater variance while maintaining or improving accuracy and improving efficiency with at least 60% reduction in contouring time. In areas where raters performed poorly contouring from scratch, editing of the automatic segmentations reduced the prevalence of total anatomical miss from approximately 16% to 8% of the total slices contained within the ground truth estimations. These findings suggest that contour editing could be useful for consensus building such as in developing delineation standards, and that both automated methods and even perhaps less sophisticated atlases could improve efficiency, inter-rater variance, and accuracy.
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Affiliation(s)
- M A Deeley
- Department of Radiology and Radiation Oncology, University of Vermont, Burlington, VT, USA.
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Shim L, Hansen RD, Prott GM, Morris LAI, Malcolm A, Kellow JE. Altered temporal characteristics of the rectoanal inhibitory reflex in patients with abdominal distension. Am J Physiol Gastrointest Liver Physiol 2012; 302:G1343-6. [PMID: 22461025 DOI: 10.1152/ajpgi.00400.2011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The rectoanal inhibitory reflex (RAIR) is important in gas and stool evacuation. We examined RAIR features in patients with chronic constipation who exhibited bloating with and without abdominal distension, to determine whether alterations in RAIR may be a factor in the pathogenesis of abdominal distension. Seventy-five female patients with chronic constipation with or without abdominal distension were included in the study. The presence or absence of abdominal distension was assessed according to the Rome II questionnaire. All patients underwent both RAIR and rectal sensitivity testing, and specific RAIR parameters were analyzed. Patients were divided into two groups: abdominal bloating with distension (D, n = 55) and abdominal bloating without distension (ND, n = 20). D had a longer time to the onset of anal sphincter inhibition (latency of inhibition) (P = 0.03) compared with ND. In logistic regression analysis, a combination of age, latency of inhibition and the time measured from onset of inhibition to the point of maximum inhibition predicted abdominal distension (P = 0.002). There were no differences between groups for the time from point of maximum inhibition to recovery and for the percentage of internal anal sphincter relaxation. This is the first study to examine the role of RAIR in patients with abdominal distension. Female patients with constipation and abdominal distension exhibited differences in the temporal characteristics of, but not in the degree of, anal sphincter relaxation compared with patients without distension. Since this study was uncontrolled, further studies are necessary to determine the contribution of altered anorectal reflexes to abdominal distension.
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Affiliation(s)
- L Shim
- Gastrointestinal Investigation Unit, Royal North Shore Hospital and University of Sydney, Australia
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Guida K, Niermann K, Malcolm A, Sternberg P, Munn G, Coffey C. SU-E-T-429: Image-Guided Eye Plaque Brachytherapy Optimization: Implications for Patients at 2-Year Follow-up. Med Phys 2012; 39:3803. [DOI: 10.1118/1.4735518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Guida K, Malcolm A, Niermann K, Sternberg P, Coffey C, Munn G. SU-E-T-589: IGRT-Assisted Episcleral Eye Plaque Brachytherapy. Med Phys 2011. [DOI: 10.1118/1.3612551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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20
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Ding G, Coffey C, Malcolm A. SU-E-T-63: The Unintended Dose to Normal Tissues Resulting from Incorrect Jaw Settings Using Cones in Stereotactic Radiosrurgery (SRS). Med Phys 2011. [DOI: 10.1118/1.3612014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Abstract
BACKGROUND Anorectal biofeedback therapy (BFT) is a safe and effective treatment in patients with constipation. Given the high prevalence of constipation and therefore high demand for BFT, there is a need to prioritise patients. AIMS To explore clinical features and anorectal physiology which predict success or failure of BFT and to derive a statistical model which helps to predict the success of BFT. METHODS A total of 102 patients with constipation referred for BFT were evaluated. All patients underwent comprehensive clinical and anorectal function assessment, including balloon expulsion testing. The BFT protocol consisted of a comprehensive 6-weekly visit programme comprising instruction on toilet behaviour and abdominal breathing, achieving adequate rectal pressure and anal relaxation, and balloon expulsion and rectal sensory retraining. Success of BFT was based on an improvement in global bowel satisfaction. RESULTS Harder stool consistency (P=0.009), greater willingness to participate (P<0.001), higher resting anal sphincter pressure (P=0.04) and prolonged balloon expulsion time (P=0.02) correlated with an improvement in bowel satisfaction score. A longer duration of laxative use (P=0.049) correlated with no improvement in bowel satisfaction score. Harder stools, shorter duration of laxative use, higher straining rectal pressure and prolonged balloon expulsion independently predicted successful BFT. A model (S(i) = (p)∑ β(j)X(ij), where β represents a regression coefficient, X is a given predictive variable and S(i) is the weighted index score for each individual) incorporating these four variables enabled prediction of successful BFT, with sensitivity and specificity of 0.79 and 0.81, respectively. CONCLUSIONS Important clinical and anorectal physiological features were found to be associated with outcome of anorectal biofeedback therapy in patients with constipation. This information and the predictive model will assist clinicians to prioritise patients for anorectal biofeedback therapy.
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Affiliation(s)
- L S E Shim
- Gastrointestinal Investigation Unit, Royal North Shore Hospital and University of Sydney, Sydney, NSW, Australia
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Ding G, Yang E, Coffey C, Malcolm A. Direct Tumor Dose Monitoring: Initial In Vivo Experience of using Implantable DVS-HFT Dosimeters for Hypo-fractionated SBRT Radiation Treatments. Int J Radiat Oncol Biol Phys 2010. [DOI: 10.1016/j.ijrobp.2010.07.1712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Abstract
BACKGROUND Pelvic floor dyssynergia (PFD) within irritable bowel syndrome (IBS) is often overlooked and the relationship between symptoms and physiology is relatively unexplored. Our aims were to determine relationships between clinical features and anorectal function in non-diarrhea predominant IBS (non-D IBS) patients and whether certain clinical or physiological features predict PFD in IBS. METHODS Two groups of patients were evaluated. Group I: 32 female non-D IBS patients with >or=2 symptoms suggesting PFD underwent comprehensive symptom and anorectal function assessment. Group II: 32 female non-D IBS patients recruited from the community underwent symptom assessment. KEY RESULTS Prevalence of PFD symptoms was similar in both groups. In group I patients, increased frequency of digitation was associated with a longer balloon expulsion time (P = 0.03). Higher scores for anal pain were associated with both a low resting anal pressure (P = 0.04) and a shorter duration of maximum squeeze (P = 0.03). Reduced perineal descent was associated with anxiety (P = 0.03) and depression (P = 0.01). A shorter duration of maximum squeeze was associated with higher parity (P = 0.02) and previous hysterectomy (P = 0.047). Duration of PFD symptoms was higher (P = 0.02) and maximum tolerated volume was lower (P = 0.05) in 22 patients with a physiological diagnosis of PFD compared to 10 without PFD. No symptoms independently predicted a physiological diagnosis of PFD. CONCLUSIONS & INFERENCES Important relationships between certain PFD symptoms and disordered anorectal physiology have been demonstrated in these non-D IBS patients. However, symptoms alone could not predict PFD, and certain clinical features should therefore highlight the need for comprehensive anorectal function tests.
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Affiliation(s)
- G Prott
- Gastrointestinal Investigation Unit, Royal North Shore Hospital and University of Sydney, Sydney, NSW, Australia
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Ding G, Coffey C, Malcolm A. SU-GG-T-351: Dosimetric Evaluation of an Implantable DVS-HFT Dosimeter for Hypo-Fractionated Radiation Treatment. Med Phys 2010. [DOI: 10.1118/1.3468748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Abstract
PURPOSE Although functional constipation is known to often manifest concomitant features of pelvic floor dyssynergia, the nature of pelvic floor symptoms and anorectal dysfunction in non-diarrhea predominant irritable bowel syndrome is less clear. This study aims to compare anorectal sensorimotor function and symptoms of patients who have non-diarrhea predominant irritable bowel syndrome with those who have functional constipation. METHODS We studied 50 consecutive female patients referred with constipation and 2 or more symptoms of pelvic floor dyssynergia, who also satisfied Rome II criteria for either non-diarrhea predominant irritable bowel syndrome (n = 25; mean age, 47 +/- 3 y) or functional constipation (n = 25; 49 +/- 3 y). Assessments included the Rome II Integrative Questionnaire, a validated constipation questionnaire, Hospital Anxiety and Depression scale, visual analog scores for satisfaction with bowel habit and for impact on quality of life, and a comprehensive anorectal physiology study. RESULTS Both groups displayed physiological evidence of pelvic floor dyssynergia; but patients with non-diarrhea predominant irritable bowel syndrome exhibited a higher prevalence of abnormal balloon expulsion (P < .01) and less paradoxical anal contraction with strain (P = .045) than patients with functional constipation. These patients with irritable bowel syndrome also reported more straining to defecate (P = .04), a higher total constipation score (P = .02), lower stool frequency (P = .02), a trend toward harder stools (P = .06), and less satisfaction with bowel habit (P = .03) than patients with functional constipation. CONCLUSION Patients with non-diarrhea predominant irritable bowel syndrome with symptoms of pelvic floor dyssynergia exhibit overall pelvic floor dyssynergia physiology similar to that of patients with functional constipation. Certain features, however, such as abnormal balloon expulsion, may be more prominent in the patients with irritable bowel syndrome. Therapeutic modalities, such as biofeedback, that are effective in patients with functional constipation with pelvic floor dyssynergia should therefore be considered in selected patients with irritable bowel syndrome with pelvic floor dyssynergia.
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Affiliation(s)
- V P Suttor
- GI Investigation Unit, Royal North Shore Hospital, University of Sydney, Australia
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Suttor VP, Ng C, Rutkowski S, Hansen RD, Kellow JE, Malcolm A. Colorectal responses to distension and feeding in patients with spinal cord injury. Am J Physiol Gastrointest Liver Physiol 2009; 296:G1344-9. [PMID: 19359420 DOI: 10.1152/ajpgi.90408.2008] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The role of the central nervous system in enteroenteric motor reflexes remains controversial. Our aims were as follows: 1) to evaluate colorectal, rectocolic, gastrocolonic, and gastrorectal reflex responses in patients with cervical spinal cord injury (SCI) and 2) to compare these responses with those in healthy subjects. In six patients with SCI (5 male, 42 +/- 4 yr) and six healthy control subjects (5 male, 36 +/- 5 yr), 2-min phasic distensions were performed randomly via dual-barostat balloons in the colon and rectum. Continuous colonic and rectal balloon volumes were recorded during distensions and after a 1,000-kcal liquid meal. Mean balloon volumes were recorded before, during, and after phasic distensions and over 60 min postprandially. The colorectal response was similar in control subjects and SCI patients (rectal volume reduction = 28 +/- 11% and 15 +/- 5% in SCI patients and healthy subjects, respectively); the rectocolic response was variable. The gastrocolonic response was present in all subjects (colonic volume reduction = 49 +/- 4% and 44 +/- 3% in SCI patients and healthy subjects, respectively), with a time effect in the first 30 min (P < 0.0001) and a group effect in the second 30 min (P < 0.004). The gastrorectal response was present in four SCI patients and five healthy subjects (rectal volume reduction = 38 +/- 4% and 41 +/- 3% in SCI patients and healthy subjects, respectively), with a time effect in the first 30 min (P < 0.0001) but no group effect in the second 30 min. Intact neural transmission between the spinal cord and higher centers is not essential for normal colorectal motor responses to feeding and distension; however, a degree of central nervous system and neurohormonal modulation of these responses is likely.
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Affiliation(s)
- V P Suttor
- Gastrointestinal Investigation Unit, Royal North Shore Hospital, Pacific Hwy., St. Leonards, NSW 2065, Australia
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Pawlowski J, Ding G, Coffey C, Yang E, Malcolm A. SU-GG-J-148: Planned Target Dose Vs. Delivered Target Dose for Prostate IMRT Treatment. Med Phys 2008. [DOI: 10.1118/1.2961697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Abstract
8514 Background: Antiemetic guidelines are based largely on the presumption that vomiting is of greater concern to cancer patients, and impacts their quality of life (QOL) more strongly, than nausea. We examined the relative influence of chemotherapy-induced nausea and emesis on patients’ overall QOL and on the specific domains of social, emotional, physical and functional well-being. Methods: 667 patients enrolled in a three-arm, randomized, controlled Phase III study that detected no difference in the ability of a serotonin receptor antagonist vs. prochlorperazine (given regularly three times daily or taken only as needed for symptoms) to control the severity of nausea, completed the FACT-G before treatment and on the third day following their first infusion of anti-cancer chemotherapy containing doxorubicin (Day 4 of cycle 1). 93% were female, and 90% had breast cancer. Results: There was a significant reduction in overall QOL and in physical and functional well-being, but no significant change in emotional or social well-being, over the four day period. In a stepwise linear regression analysis predicting change in overall QOL, average nausea severity entered first and accounted for 24% of the variance in reduced QOL (p < 0.001). Occurrence of vomiting (yes, no) accounted for a non-significant less than 1% of additional variance (p = 0.240). No other factors (gender, age, the degree to which patients expected to experience nausea or vomiting, whether or not nausea or vomiting occurred, and maximum nausea severity over the four days) were significant predictors of the reduction in QOL. Similar results were obtained when the relative influence of nausea and vomiting on physical and functional decline were studied. Conclusions: Severity of nausea, not the occurrence of vomiting, was the key factor in patients’ perceived decline in quality of life in the days immediately following chemotherapy infusion. Nausea severity should be a primary outcome measure in studies evaluating antiemetic efficacy. Supported in part by NCI Public Health Service grant U10 CA37420 and ACS grant RSG-01–071-PBP No significant financial relationships to disclose.
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Affiliation(s)
- J. T. Hickok
- University of Rochester, Rochester, NY; Greenville CCOP, Greenville, SC; Northwest CCOP, Tacoma, WA; Dayton Clinical Oncology Program, Dayton, OH
| | - J. A. Roscoe
- University of Rochester, Rochester, NY; Greenville CCOP, Greenville, SC; Northwest CCOP, Tacoma, WA; Dayton Clinical Oncology Program, Dayton, OH
| | - G. R. Morrow
- University of Rochester, Rochester, NY; Greenville CCOP, Greenville, SC; Northwest CCOP, Tacoma, WA; Dayton Clinical Oncology Program, Dayton, OH
| | - J. K. Giguere
- University of Rochester, Rochester, NY; Greenville CCOP, Greenville, SC; Northwest CCOP, Tacoma, WA; Dayton Clinical Oncology Program, Dayton, OH
| | - L. K. Colman
- University of Rochester, Rochester, NY; Greenville CCOP, Greenville, SC; Northwest CCOP, Tacoma, WA; Dayton Clinical Oncology Program, Dayton, OH
| | - A. Malcolm
- University of Rochester, Rochester, NY; Greenville CCOP, Greenville, SC; Northwest CCOP, Tacoma, WA; Dayton Clinical Oncology Program, Dayton, OH
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Abstract
In irritable bowel syndrome (IBS), it remains unclear whether rectal hypersensitivity is a 'marker' of colonic hypersensitivity. Our aim was to examine the relation between colonic and rectal sensitivity in IBS patients, comprising phasic and ramp distension techniques. Twenty IBS patients and 12 healthy subjects (N) underwent stepwise ramp and random phasic barostat distensions in the colon and rectum in random order. The sensory threshold pressure (ramp distension) and the visual analogue scale score (VAS, phasic distension), for pain and non-pain, were recorded. Colonic thresholds were lower, and VAS scores were generally higher, for pain and non-pain sensitivities in IBS compared to N. Rectal thresholds were lower, and VAS scores were higher, for pain but not for non-pain, in IBS compared to N. In IBS, for phasic distension, there was good correlation between the colon and rectum for non-pain (e.g. at 16 mmHg, r=0.59, P=0.006) and pain (r=0.60, P=0.006) sensitivities. In contrast, there was no significant correlation between the colon and rectum for ramp distension. In conclusion, colonic and rectal sensitivity in IBS are correlated in response to phasic but not ramp barostat distensions. The rectum serves as a legitimate 'window' for evaluating colonic hypersensitivity in IBS, provided that phasic distensions are employed.
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Affiliation(s)
- C Ng
- Gastrointestinal Investigation Unit, Department of Gastroenterology, Royal North Shore Hospital, University of Sydney, NSW, Australia
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Abstract
UNLABELLED There are conflicting recommendations from consensus groups with regard to the assessment of resting anal sphincter pressure. Our aims were to evaluate and compare the performance of three recognized techniques for the clinical measurement of resting anal sphincter pressure. METHODS In each of 54 patients presenting for anorectal manometry, and suffering from constipation or fecal incontinence, three different techniques for assessment of resting anal pressure were undertaken, namely stationary, stationary pull-through and slow pull-through techniques. Resting anal sphincter pressures were compared between groups and between techniques. RESULTS Mean resting anal sphincter pressure was lower with stationary, compared with stationary pull-through and slow pull-through, techniques (P < or = 0.002). Resting pressure was higher for constipation than incontinence regardless of technique used (P < 0.00001). The techniques were highly correlated with each other (P < 0.0001). The stationary pull-through technique conferred a minor advantage in the discrimination between constipation and incontinence. The stationary technique required significantly less time for completion (P < 0.0001). CONCLUSION Resting anal sphincter pressure varies according to the specific technique employed, yet each technique is valid. The stationary pull-through technique confers a minor advantage in clinical discrimination of patients, but the stationary technique is more time-efficient. Standardized anal sphincter testing should be established to enable inter-laboratory comparisons.
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Affiliation(s)
- G Prott
- Gastrointestinal Investigation Unit, Royal North Shore Hospital and University of Sydney, Sydney, Australia
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McCloskey S, Botnick L, Rose C, Malcolm A, Ozohan ML, Mena R, Tao ML. Long-term outcome after breast conservation (BCT) for early stage breast cancer in a community setting. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- S. McCloskey
- Valley Radiotherapy Associates Medical Group, El Segundo, CA; Providence St Joseph's Hospital, Burbank, CA
| | - L. Botnick
- Valley Radiotherapy Associates Medical Group, El Segundo, CA; Providence St Joseph's Hospital, Burbank, CA
| | - C. Rose
- Valley Radiotherapy Associates Medical Group, El Segundo, CA; Providence St Joseph's Hospital, Burbank, CA
| | - A. Malcolm
- Valley Radiotherapy Associates Medical Group, El Segundo, CA; Providence St Joseph's Hospital, Burbank, CA
| | - M. L. Ozohan
- Valley Radiotherapy Associates Medical Group, El Segundo, CA; Providence St Joseph's Hospital, Burbank, CA
| | - R. Mena
- Valley Radiotherapy Associates Medical Group, El Segundo, CA; Providence St Joseph's Hospital, Burbank, CA
| | - M. L. Tao
- Valley Radiotherapy Associates Medical Group, El Segundo, CA; Providence St Joseph's Hospital, Burbank, CA
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Viramontes BE, Malcolm A, Camilleri M, Szarka LA, McKinzie S, Burton DD, Zinsmeister AR. Effects of an alpha(2)-adrenergic agonist on gastrointestinal transit, colonic motility, and sensation in humans. Am J Physiol Gastrointest Liver Physiol 2001; 281:G1468-76. [PMID: 11705752 DOI: 10.1152/ajpgi.2001.281.6.g1468] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
To characterize alpha(2)-adrenergic control of motor and sensory functions of gastrointestinal tract and colon, we studied dose-related effects of clonidine (placebo or up to 0.3 mg po) by random assignment in 55 healthy humans. Gastrointestinal transit was measured in all subjects; in 35, we assessed colonic compliance, tone, and sensations of gas and pain during phasic distensions. Clonidine did not significantly alter gastrointestinal or colonic transit, but it increased colonic compliance and reduced fasting tone without altering colonic response to a meal. Clonidine significantly reduced aggregate sensation to distensions overall and had significant linear dose-related sensory effects at 8- and 24-mmHg distensions. Effect on pain (including dose-response relationship) was due to 0.3-mg dose for distensions at 24 mmHg. We confirmed that clonidine relaxes fasting colonic tone and reduces sensation of pain. In this study, gut transit was not altered by clonidine, and novel dose-response characteristics and clonidine's effect on gas sensation are provided. Doses as low as 0.05 mg may be effective and potentially useful in reducing colonic tone and gas sensation.
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Affiliation(s)
- B E Viramontes
- Enteric Neuroscience Program, Gastroenterology Research Unit, Mayo Clinic and Mayo Foundation, Rochester, Minnesota 55905, USA
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Abstract
OBJECTIVE Our objective was to evaluate GI motor and sensory function and spinal cord testing in a patient with severe irritable bowel syndrome. METHODS A patient is described who underwent an extensive assessment of GI motor and sensory function including transit studies, colonic and rectal barostat studies, sensory and manometric studies of the small bowel, and colon and anorectal physiology testing. The patient also underwent testing with spinal cord stimulation and spinal drug delivery as part of a pain management assessment. RESULTS The viscerosomatic referral pain pattern resulting from rectal distention was consistent with spinal hyperalgesia. The patient underwent testing for spinal cord stimulation and spinal drug delivery. CONCLUSION This novel finding provides direct clinical evidence for the presence of spinal hyperalgesia in a patient with irritable bowel syndrome, consistent with the existing indirect clinical evidence and animal data.
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Affiliation(s)
- A Malcolm
- Department of Gastroenterology, Royal North Shore Hospital and University of Sydney, Australia
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Hansen R, Kellow J, Malcolm A. Primary esophageal motility disorders. Mayo Clin Proc 2001; 76:864-5. [PMID: 11499831 DOI: 10.1016/s0025-6196(11)63236-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Abstract
Debate continues as to whether the differing shapes of the acromion are congenital or acquired. This has been investigated by neonatal cadaver study, adult cadaver study, radiographic study, magnetic resonance imaging study, or various other means. No one, to our knowledge, has investigated this by histologic study. A macroscopic and histologic study of 22 cadaveric shoulder joints was carried out to establish what, if any, developmental changes occur in the differing patterns of acromion. The cadaveric shoulders were dissected and examined macroscopically. All of the acromion processes were transected and photographed, and the histology of the anterior and inferior surfaces was studied. In all of the curved and hooked types of acromion, a common pattern of degeneration of collagen, fibrocartilage, and bone was observed, consistent with a traction phenomenon. None of the flat acromions exhibited these changes. Extensive histologic changes were noted on the anterior surface of acromion as compared to the inferior surface in curved or hooked acromion. We conclude that the different shapes of acromion are, therefore, acquired as a response to traction forces applied via the coracoacromial ligament and are not congenital in origin.
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Affiliation(s)
- N N Shah
- Orthopaedics Department, King's College Hospital, Denmark Hill, London, United Kingdom
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Dickinson HO, Salotti JA, Birch PJ, Reid MM, Malcolm A, Parker L. How complete and accurate are cancer registrations notified by the National Health Service Central Register for England and Wales? J Epidemiol Community Health 2001; 55:414-22. [PMID: 11351000 PMCID: PMC1731913 DOI: 10.1136/jech.55.6.414] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
STUDY OBJECTIVE To assess the completeness and accuracy of notification of cancers by the National Health Service Central Register (NHSCR) for England and Wales. DESIGN Comparison of 720 cancer registrations ascertained from NHSCR up to May 1999 with those ascertained for the same cohort from six other sources and a pathology review of the NHSCR cancer registrations. PARTICIPANTS People born in Cumbria, north west England, 1950-89, and diagnosed with cancer throughout the UK, 1971-1989. MAIN RESULTS Cancer diagnoses notified by NHSCR differed substantially from those determined by this pathology review for 47 of the 688 notified cases reviewed (7%; 95% CI 5%, 9%). Over one third of these discrepancies were attributable to failures in data capture or coding by the cancer registration system and almost half to changes in diagnosis; 26 of the 47 discrepant cases were reclassified as non-malignant and 21 as malignancies but with a substantially different diagnosis. The 694 confirmed malignancies represented 94% (95%CI 92%, 95%) of the 740 cancers ascertained from all sources. CONCLUSIONS It is estimated that the cancer registration system missed at least 10% (95%CI 6%, 15%) of all incident cases of malignant disease. Without additional ascertainment from multiple sources and diagnostic review, it would be incautious to use NHSCR cancer registrations as the sole basis of an epidemiological study.
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Affiliation(s)
- H O Dickinson
- Department of Child Health, University of Newcastle, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne NE1 4LP, UK.
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Roqué F, Mon G, Belardi J, Rodriguez A, Grinfeld L, Long R, Grossman S, Malcolm A, Zon G, Ormont ML, Fischman DL, Shi Y, Zalewski A. Safety of intracoronary administration of c-myc antisense oligomers after percutaneous transluminal coronary angioplasty (PTCA). Antisense Nucleic Acid Drug Dev 2001; 11:99-106. [PMID: 11334145 DOI: 10.1089/108729001750171335] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
We wished to assess the clinical safety and pharmacokinetics of ascending doses of a synthetic oligodeoxynucleotide (LR-3280) administered after coronary angioplasty. Antisense oligodeoxynucleotides designed to hybridize with target messenger ribonucleic acid (mRNA) in a complementary fashion to inhibit the expression of corresponding protein also have the ability to bind to extracellular growth factors. LR-3280 has been shown to reduce c-myc expression, inhibit growth and collagen biosynthesis in human vascular cells, and reduce neointimal formation in animal models of vascular injury. After successful percutaneous transluminal coronary angioplasty (PTCA), 78 patients were randomized to receive either standard care (n = 26) or standard care and escalating doses of LR-3280 (n = 52) (doses from 1 to 24 mg), administered into target vessel through a guiding catheter. Overall safety was evaluated by clinical adverse events, laboratory tests, and electrocardiograms. Patency was evaluated by quantitative coronary angiography. There were no clinically significant differences between treated and control patients. No adverse effects of LR-3280 on the patency of dilated coronary arteries were observed. Pharmacokinetic data revealed that peak plasma concentrations of LR-3280 occurred at 1 minute over the studied dose range and rapidly decreased after approximately1 hour, with little LR-3280 detected in the urine between 0-6 hours and 12-24 hours. The intracoronary administration of LR-3280 is well tolerated at doses up to 24 mg and produces no adverse effects in dilated coronary arteries. These results provide the basis for the evaluation of local delivery of this phosphorothioate oligodeoxynucleotide for the prevention of human vasculoproliferative disease.
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Affiliation(s)
- F Roqué
- Clinica Olivos, Cardiovascular Department, Buenos Aires, Republica Argentina.
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Malcolm A, Myers L. Challenges and opportunities for speech and language therapists in secondary schools. Int J Lang Commun Disord 2001; 36 Suppl:481-486. [PMID: 11340836 DOI: 10.3109/13682820109177933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Language and communication difficulties experienced by secondary school students are outlined. The challenges that the secondary school environment presents for both children and speech and language therapy services are discussed. Two case studies illustrate how speech and language therapists (SLTs) working for the Newham Education Authority Language and Communication Support Service support students in their secondary schools.
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Affiliation(s)
- A Malcolm
- Language and Communication Support Service, Newham Education Authority, New Tunmarsh Centre, Tunmarsh Lane, London E13 9NB
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Colville RJ, Ramsden A, Malcolm A, McLean NR. Angiosarcoma of the breast after quadrantectomy and postoperative radiotherapy for carcinoma. Br J Plast Surg 2000; 53:622-4. [PMID: 11000082 DOI: 10.1054/bjps.2000.3406] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Angiosarcoma of the breast following conservation surgery and radiotherapy for carcinoma is rare. We report a case occurring after a latent period of 8 years, which required excision with a 5 cm margin and latissimus dorsi flap repair.
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Affiliation(s)
- R J Colville
- Royal Victoria Infirmary, Newcastle upon Tyne, UK
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Malcolm A, Camilleri M, Kost L, Burton DD, Fett SL, Zinsmeister AR. Towards identifying optimal doses for alpha-2 adrenergic modulation of colonic and rectal motor and sensory function. Aliment Pharmacol Ther 2000; 14:783-93. [PMID: 10848663 DOI: 10.1046/j.1365-2036.2000.00757.x] [Citation(s) in RCA: 62] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
RATIONALE Visceral sensation and motility are important in functional gut disorders and are partly controlled by adrenergic innervation. OBJECTIVES To characterize the alpha2-adrenergic control of motor and sensory function of descending colon and rectum. METHODS In 32 healthy volunteers, we assessed compliance, fasting and postprandial tone, and sensations of gas, urgency and pain during phasic distentions. Each subject received one agent at clinically approved doses: clonidine (0.05, 0.1, 0.2 or 0.3 mg p.o. ); or the alpha2 antagonist yohimbine (0.0125 mg, 0.05 mg, 0.125 mg or 0.2 mg intravenously and infusion over 2.5 h). RESULTS Clonidine increased colonic and rectal compliance, and reduced tone, pain, gas sensation and rectal urgency. Clonidine showed large pairwise differences in sensation and motility between 0.05 and 0.1 mg doses, which did not interfere with the colon's motor response to feeding. Conversely, yohimbine dose-dependently altered the compliance curve, increased tone and sensations of gas, pain and urgency. Drug effects in the colon were more marked at low distensions; alpha2 modulation of rectal sensation was observed at all levels of distension. CONCLUSIONS alpha2-adrenergic mechanisms modulate colorectal sensations and motility; at doses as low as 0.05 mg, clonidine reduced colorectal sensation while the tone response to feeding was preserved. These studies provide insight into the potential use of alpha2 agents in disease states.
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Affiliation(s)
- A Malcolm
- Gastroenterology Research Unit, Mayo Clinic and Mayo Foundation, Rochester 55905, USA
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Abstract
During the period of review, work has been ongoing to refine existing techniques and to better define normal patterns of small intestinal motility. Researchers continue to learn more about the established neurohumoral control mechanisms of motility, as well as the effects and potential importance of newly discovered neuropeptides and receptors. There has also been continued interest in alterations in motility in various disease states and in the effects on motility of a number of pharmacologic agents.
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Affiliation(s)
- A Malcolm
- Department of Gastroenterology, Royal North Shore Hospital, Sydney, Australia.
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Abstract
OBJECTIVE The rectoanal inhibitory reflex facilitates defecation by relaxation of the internal anal sphincter during rectal distention by gas or stool. Defecation is sometimes preceded by high-amplitude propagated contractions (HAPCs). Our objective was to seek evidence for motor coordination between human colonic and anal sphincter functions. METHODS As part of a study of alpha2 modulation of colonic and anal motor functions in 32 healthy volunteers, we studied the relationship between high HAPCs and anal sphincter pressure with colonic manometry, barostat, and a Dent sleeve in the anal canal. RESULTS Twenty-two HAPCs were observed; in 19/22 HAPCs there was optimal positioning of the Dent sleeve to assess the anal sphincter. Eighteen of 19 HAPCs occurred postprandially; 14 HAPCs occurred after administration of yohimbine, three after clonidine, and one before any drug administration. Seven followed experimental balloon distention. Anal sphincter relaxation occurred (14 +/- 4 s) before the recorded onset of HAPC in the descending colon and 88 +/- 7 s before the arrival of the HAPC in the rectum. After or during the HAPCs, anal sphincter pressure decreased by 40 +/- 4% and increased by 56 +/- 8% in the postrelaxation phase. CONCLUSIONS The close temporal association between anal sphincter relaxation and onset of HAPC in the descending colon suggests a coloanal reflex that may facilitate defecation during mass movements independently of the rectoanal inhibitory reflex.
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Affiliation(s)
- A Malcolm
- Gastroenterology Research Unit, Mayo Clinic and Mayo Foundation, Rochester, Minnesota 55905, USA
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Abstract
Angioedema usually presents as episodic attacks of swelling of the face, airway and extremities, but it may also involve visceral tissues. A 58-year-old woman with repeated episodes of abdominal pain, nausea and vomiting had two laparotomies and was treated for Crohn's disease for two years before a diagnosis of acquired intestinal angioedema was made. This case provides important insights into the presentation of intestinal angioedema.
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Affiliation(s)
- A Malcolm
- Gastroenterology Research Unit, Mayo Clinic, Rochester, Minnesota, USA.
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Fryer J, Firca J, Leventhal J, Blondin B, Malcolm A, Ivancic D, Gandhi R, Shah A, Pao W, Abecassis M, Kaufman D, Stuart F, Anderson B. IgY antiporcine endothelial cell antibodies effectively block human antiporcine xenoantibody binding. Xenotransplantation 1999; 6:98-109. [PMID: 10431786 DOI: 10.1034/j.1399-3089.1999.00015.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Avian IgY antibodies are structurally different from mammalian IgGs and do not fix mammalian complement components or bind human Fc receptors. As these antibody-mediated interactions are believed to play significant roles in both hyperacute rejection (HAR) and acute vascular xenograft rejection (AVXR), IgY antibodies to xenoantigen target epitopes may inhibit these rejection processes. In this report, we show that chicken IgY antibodies to alpha-Gal antigen epitopes and to other porcine aortic endothelial cell (PAEC) antigens block human xenoreactive natural antibody binding to both porcine and rat cardiac tissues and porcine kidney tissues. Chicken IgY antibodies blocked complement-mediated lysis of PAECs by human serum, and inhibited antibody-dependent cell-mediated lysis of PAECs by heat-inactivated human serum plus peripheral blood leukocytes. Binding of IgY to porcine endothelial cells did not affect cell morphology nor expression of E-selectin. These results suggest that avian IgYs could be of potential use in inhibiting pig-to-human xenograft rejection.
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Affiliation(s)
- J Fryer
- Department of Surgery, North-Western University Medical School, Chicago, IL, USA
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Abstract
BACKGROUND Esophageal motility disorders are usually diagnosed by manometry. We evaluated videoendoscopy as a diagnostic test. METHODS In this study, 20 patients with achalasia, 13 with scleroderma, and 33 control subjects had a standard endoscopic examination followed by protocol videotaping of swallows to observe contractions in the esophagus and in the lower esophageal sphincter. Tapes were later reviewed by 2 blinded observers who recorded their motility findings and diagnoses. RESULTS In the mid esophagus at 25 cm, lumen-occluding peristaltic contractions were identified in 26 of 33 control subjects versus 1 of 20 achalasia (p < 0.001) and 3 of 13 scleroderma patients (p < 0.005). As viewed in the lower esophagus, the lower esophageal sphincter opened normally in 31 of 33 control subjects versus 1 of 20 achalasia (p < 0.001). In scleroderma, the sphincter never closed in 12 of 13 patients (p < 0. 001 versus control subjects). A diagnostic sequence of sphincter opening followed by contraction in the esophageal body and subsequent sphincter closing was seen in 33 of 33 control subjects, 2 of 20 achalasia, and 1 of 13 scleroderma patients (both, p < 0. 001). The observers made the correct diagnosis in 96% of cases. CONCLUSIONS Achalasia and esophageal scleroderma can be identified by endoscopic observation of motility. This procedure may represent an adjunctive diagnostic test to manometry.
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Affiliation(s)
- A J Cameron
- Division of Gastroenterology, Mayo Clinic, Rochester, Minnesota 55905, USA
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Craft A, Cotterill S, Malcolm A, Spooner D, Grimer R, Souhami R, Imeson J, Lewis I. Ifosfamide-containing chemotherapy in Ewing's sarcoma: The Second United Kingdom Children's Cancer Study Group and the Medical Research Council Ewing's Tumor Study. J Clin Oncol 1998; 16:3628-33. [PMID: 9817284 DOI: 10.1200/jco.1998.16.11.3628] [Citation(s) in RCA: 179] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To investigate the possibility that the substitution of ifosfamide for cyclophosphamide therapy for Ewing's sarcoma will improve survival over that seen in the first United Kingdom Children's Cancer Study Group (UKCCSG) Ewing's tumor study (ET-1). PATIENTS AND METHODS Between 1987 and 1993,243 patients (138 men or boys) were entered onto the study. The median age was 13.5 years (range, 1.5 to 27 years). The median follow-up was 58 months. Chemotherapy included four courses of vincristine 2 mg/m2; ifosfamide 9 g/m2; and doxorubicin 60 mg/m2 administered every 3 weeks. Treatment of the primary tumor was with surgery and/or radiotherapy followed by ifosfamide 6 g/m2; doxorubicin 60 mg/m2; and vincristine 2 mg/m2; with actinomycin D 1.5 mg/m2 substituted for doxorubicin after a total dose of 420 mg/m2. RESULTS Two hundred one patients had no metastases. One hundred eighteen patients had tumors of the axial skeleton and 125 patients had limb primary tumors. The major toxicities were hematologic and infective, but there were no toxic deaths. The overall survival rate was 62% (95% confidence interval [CI], 56 to 69) and relapse-free survival (RFS) 56% (95% CI, 49 to 62). For those with no metastases at diagnosis, the RFS rate was 62% and for those with metastases, 23%. Multivariate analysis showed age and site to have a significant effect on RFS. Pelvic sites had the worst RFS rate of 41%; other axial sites, 55%; and extremity tumors, 73%. Age younger than 10 years had an RFS rate of 86% versus 55% for older patients. The local relapse rate for axial tumors was 20% and for limb primary tumors was 2.4%. CONCLUSION The 5-year survival rate of 62% is improved compared with the 44% survival rate achieved in ET-1. This is probably caused by the use of higher doses of ifosfamide compared with relatively low doses of cyclophosphamide in ET-1.
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Affiliation(s)
- A Craft
- United Kingdom Children's Cancer Study Group and the Medical Research Council Bone Sarcoma Working Party.
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49
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Malcolm A, Kellow JE. Irritable bowel syndrome. Med J Aust 1998; 169:274-9. [PMID: 9762068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Affiliation(s)
- A Malcolm
- Department of Gastroenterology, Royal North Shore Hospital, University of Sydney, NSW
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50
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Gilling PJ, Cass CB, Malcolm A, Cresswell M, Fraundorfer MR, Kabalin JN. Holmium laser resection of the prostate versus neodymium:yttrium-aluminum-garnet visual laser ablation of the prostate: a randomized prospective comparison of two techniques for laser prostatectomy. Urology 1998; 51:573-7. [PMID: 9586609 DOI: 10.1016/s0090-4295(97)00642-0] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To directly compare holmium laser resection of the prostate (HoLRP) with neodymium:yttrium-aluminum-garnet visual laser ablation of the prostate (VLAP), which represent two fundamentally different methods of laser prostatectomy. METHODS In a randomized, prospective comparison, a total of 44 men with symptomatic benign prostatic hyperplasia (BPH) were treated with either HoLRP or VLAP. Standard preoperative assessment included American Urological Association (AUA) symptom score, peak urinary flow rates (Qmax), ultrasound prostate volume, and residual urine measurements. Pressure-flow urodynamics were performed preoperatively and at 3 months postoperatively. Intraoperative and perioperative factors were assessed. The patients were followed at 1, 3, 6, and 12 months following the procedure. RESULTS There were no significant differences between the patient groups for any preoperative parameter. The mean total operating time was longer in the HoLRP group (52 minutes) compared with the VLAP group (41 minutes) (P <0.01). The mean catheter times were 1.4 days (HoLRP) and 11.6 days (VLAP) (P <0.001). These times included the 9% of patients undergoing HoLRP and 36% of patients undergoing VLAP who required recatheterization. Immediate postoperative dysuria scores were higher in the VLAP group compared with the HoLRP group. There were no significant differences in AUA scores between the two treatment groups at any postoperative interval. The Qmax values were greater at follow-up in the HoLRP group, but statistical significance was not achieved at 12 months. However, both PdetQmax and Schäfer grade measurements taken at 3 months postoperatively were significantly lower in the patients undergoing HoLRP. Three patients (14%) required reoperation in the VLAP treatment arm but no patient who underwent HoLRP has required reoperation to date. CONCLUSIONS HoLRP results in significantly improved patient outcomes compared to VLAP.
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Affiliation(s)
- P J Gilling
- Department of Urology, Tauranga Hospital, New Zealand
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