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Thursday, February 18, 2010

Celebrity chef Beppe Bigazzi upsets viewers with his cat casserole
Richard Owen
in Rome

A top Italian food writer has been suspended indefinitely from the country’s version of the television programme Ready Steady Cook for recommending stewed cat to viewers as a “succulent dish”.

RAI, the public broadcasting network, said that it had dropped Beppe Bigazzi, 77, for offering the recipe on La Prova del Cuoco, which is broadcast at midday on the main channel. Its switchboard was inundated with complaints from viewers and animal rights groups. Bigazzi said that casserole of cat was a famous dish in his home region of Valdarno, Tuscany.

“I’ve eaten it myself and it’s a lot better than many other animals,” he told viewers. “Better than chicken, rabbit or pigeon.” He said that for optimum flavour the meat should be “soaked in spring water for three days” before being stewed.

Elisa Isoardi, the programme’s presenter — who has a cat called Othello — tried to steer Bigazzi off the subject. Reports said that during the commercial break she and the show’s producers tried to persuade him to apologise to viewers but he refused.

Carla Rocchi, the head of ENPA, the Italian society for the protection of animals, said that killing cats was illegal. Francesca Martini, the Deputy Health Minister, said it was “absolutely unheard of for a public service broadcaster to tell people how delicious cats are to eat”. She called for the producers to be investigated for criminal offences involving incitement to mistreat animals.

Bigazzi, a consumer affairs journalist and author of Cooking with Common Sense, has been one of the stars of La Prova del Cuoco for the past ten years. He is noted for his exuberant style and previously caused uproar by boiling lobsters live on the show. Yesterday he said that he had only been joking about the recipe, and he had been misunderstood.

He added: “Mind you, I wasn’t joking all that much. In the 1930s and 1940s, when I was a boy, people certainly did eat cat

in the countryside around Arezzo.” Food historians said that Italians in cities such as Vicenza devised cat recipes in times of economic hardship. Inhabitants of Vicenza are still nicknamed magnagati (cat eaters), and in some butchers’ shops rabbits are sold with their heads to assure buyers that they are not cats.

From pet to pot

• In his 1529 treatise on cookery, Ruperto de Nola recommended spit-roasting cat basted with garlic and olive oil. He wrote: “Take the garlic with oil mixed with good broth so that it is coarse, and pour it over the cat and you can eat it for it is a good dish”

• The Spanish expression pasar gato por liebre derives from the practice of hunters trying to sell skinned cats as hares. When butchered, the animals are supposed to look almost identical

• In 2007 Australians at a cooking contest in Alice Springs sought to curb the feral cat population by using them in a dish. One judge found the cat casserole so tough that she had to spit it out

• Last month legal experts in China responded to pressure from the country’s middle class and proposed a ban on eating cat and dog meat. Both are traditional Chinese dishes but if the law is passed people caught eating cats could face 15 days in prison

Wednesday, February 17, 2010

City man has world's rarest internal organs
Pratibha Masand,

MUMBAI: Had it not been for the seven-centimetre-long tumour in Ashok Shivnani's right kidney, doctors at Lilavati, who were scheduled to operate on him, would never have stumbled on a case that is rarer than rare in medical history.

Suspecting that something was not quite normal when they viewed the scans and X-rays of the tumour, the medicos ordered a two-dimensional echocardiogram and angiogram of the 64-year-old patient. It was then that they realised, to their shock, that most of his abdominal organs and blood vessels were either reversed or misplaced.

Shivnani's case comes closest to a rare congenital disorder called 'situs inversus', in which the organs of the chest and abdomen
are arranged in a mirror-image reversal of normal positioning. Doctors say that he is, in all probability, the only person in the world to have such a haphazard abdominal structure.

The echocardiogram revealed that the positions of Shivnani's IVC (inferior vena cava, which brings impure blood to the heart and is on its right) and aorta (which takes pure blood from the heart and is on the left) were reversed.

"When I first saw the reports, I actually thought I was holding them wrong. Along with the reversed position of the aorta and IVC, the scans also showed that Shivnani had a second IVC coming out from the tumour-infected kidney, which joined the original IVC at the bottom of his abdomen. It would have been most difficult to proceed with the surgery under these circumstances," said Dr Anoop Ramani, the uro-oncologist surgeon, who performed the surgery on Shivnani.

"Not only was there a duplication of the IVC, but the IVC above the kidney was totally closed. While operating, we are supposed to know the exact location of everything we are going to touch. But in this case, we were not sure which veins were entering where," said Dr Prakash Sanzgiri, cardiologist from Lilavati. Hence, it became necessary to reschedule the surgery from January 29 to February 4, as the doctors needed more time to decide how to deal with the problem.

But that was not all. During the course of the surgery to remove the infected kidney, the doctors came across more startling facts about Shivnani's organ structure. There were three blood vessels which took blood to his infected kidney. He had no small intestine, and his large intestine was very small. His liver had also split into two parts, one on each side.

"We generally perform surgeries laparoscopically for renal cancer. It is difficult to perform the surgery even without the strange organ structure. Thankfully, we did a laparoscopic surgery, in which we could see everything ten times the actual size on the screen," said Dr Ramani. "It is the first time I have seen such a case in my 15-year career," he added.

However, the doctors maintained that Shivnani did not need any treatment for his abnormal organ structure. "Generally, people suffering from situs invertus lead a fairly asymptomatic life. This is also the case with Shivnani. He will not need any surgery to change the positions of the organs and veins," said Dr Desai.

The Shadowy Science of Sex Addiction
Tiger Woods' philandering has talking heads chattering about compulsive sex. But research on sex addiction is fuzzy.
By Matthew Herper, David Whelan and Robert Langreth, Forbes

Can you be addicted to sex?

Nobody really knows for sure—though you can certainly get treated for sex addiction if you think you have it.

Last year, X-Files and Californication star David Duchovny checked into rehab for sexual addiction. After a string of women went public with claims they were mistresses of golfer Tiger Woods (the best-paid athlete on the planet and a married man), it took only days for talking heads to speculate that Woods might be an addict. Reports indicate that he may have attended and completed a rehab program.

The idea of sex as a drug is deeply seductive to journalists and reality TV producers. But the idea of being addicted to sex is actually quite controversial. No such diagnosis is even recognized in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), psychiatry's bible.

The DSM-IV assiduously avoids the word "addiction," preferring to talk about dependence, withdrawal and compulsion. A new condition, called hypersexuality, might be something close, but some psychiatrists bristle at the idea of talking about human sexuality as an addictive force unto itself.

"I don't buy it as a disease ... it is an excuse," says John J. Lucas, a forensic psychiatrist at Weill Cornell Medical College. In modern society, "we have an unfortunate practice of proliferating illnesses ... in response to various practices in terms of reducing the stigma of certain behaviors."

Craig Fabrikant, a clinical psychologist at Hackensack University Medical Center, says that he doesn't believe that sex addiction exists in the same way that alcohol or cocaine addiction does. Real disorders, however, might cause behavior that is interpreted as sex addiction. For example, someone in the manic phase of bipolar disorder can be overly sexual, and a person with obsessive compulsive disorder might look at pornography frequently.

The idea of sex addiction, however, got a big boost in 1983 with the publication of a book called Out of the Shadows by Patrick Carnes, Ph.D., who has treated patients with the disorder at several clinics (he currently works at a Mississippi facility). The idea is that because sex releases dopamine in the brain and provides a momentary high just as many drugs do, problematic sexual behavior could be understood as being very much like a chemical dependency.

"I see guys who start when they are 13, and now they are 30. They've never been able to stop," says David Delmonico, a professor of counseling at Duquesne University in Pittsburgh and author of In The Shadows of The Net: Breaking Free from Compulsive Online Sexual Behavior. In order to have hypersexual disorder, Delmonico says, a person must feel as if he doesn't have the ability to stop, and think about little else but sex. Delmonico favors calling the disorder hypersexuality, and notes that it isn't easy to diagnose: It takes at least two or three hours of discussion with a patient to determine if he or she is hypersexual.

As with other compulsive behaviors like gambling and drinking, Delmonico recommends therapy and 12-step programs, although antidepressants (drugs like Paxil or Zoloft) and antipsychotics (these include Abilify and Zyprexa) may help. There is a report of a single case in which Topamax, an epilepsy drug, reversed hypersexuality. Testosterone suppressors are reserved for criminal sexual offenders.

There isn't a lot of science to back up this path of treatment, though. The National Institutes of Health's PubMed database lists every article published in a major medical journal going back decades. There are 67,700 references for "alcoholism" or "alcohol dependence," but just 286 studies related to "sex addiction," "hypersexuality" or "sexual dependence."

But is compulsive sexuality really similar to pathological gambling or even compulsive shopping? One small brain-imaging study says maybe not. Researchers at the University of Minnesota compared eight people who had been diagnosed with hypersexuality with others who had been diagnosed with impulse-control disorders like gambling or attention deficit disorder. There was also a control group.

The subjects were asked to look at a flashing letter on a screen and quickly press a button if they saw any letter other than "X." Patients who have impulse disorders usually press the button more often; this held true for both the patients who had traditional problems as well as the sexually compulsive people.

Things changed, however, when the researchers had their subjects do this task inside an MRI machine. People with impulse disorders had reduced activity in the bottom front of the brain (as seen in previous experiments), but the people with sexual disorders had reduced activity at the top front of the brain, indicating that something different was going on.

Michael H. Miner, one of the University of Minnesota researchers, cautions that his study is too small to draw any firm conclusions. In his normal work, treating sexual offenders, he says that he does not believe that compulsion and bad behavior necessarily go together, and he's skeptical of calling the increased sexual behavior an addiction.

He would, however, like to do more research on it. That's difficult, he says, because there is no recognized diagnosis for people who seem sexually compulsive.

"There's a lot of conceptual writing; there's a lot of theoretical writing; there's not a great deal of empirical data," Miner says. "If this is a disorder, what is it? Is this really a disorder at all, or is it a series of symptoms that is part of something else?"

Begley: King Tut's DNA Reveals a More Manly Pharaoh
Sharon Begley

Ben Curtis / AP-pool
King Tut, removed from his sarcophagus, in 2007.

A study being published this afternoon trumpets an analysis supposedly revealing how the boy pharaoh, King Tutankhamen, died, but for my money the study’s conclusion about how he looked is more intriguing.

Both results emerge from what the researchers call “molecular Egyptology,” in this case an analysis of DNA extracted from the bones of 11 royal mummies of the New Kingdom. The scientists took two to four DNA samples from each mummy, including Tut, who died at age 19 in about 1324 B.C., the 10th year of his reign. Comparing the genetic fingerprints allowed them to identify one previously unknown mummy as Queen Tiye, mother of the pharaoh Akhenaten and grandmother of Tutankhamen, another as Akhenaten (Tut’s father) himself, and a third as Tutankhamen’s mother, the researchers are reporting in tomorrow’s issue of The Journal of the American Medical Association.

The DNA analysis also turned up genes specific to Plasmodium falciparum, the malaria parasite, in Tut and three other mummies. The scientists, led by the colorful and controversial Zahi Hawass, secretary-general of Egypt’s Supreme Council of Antiquities, infer that Tut suffered from avascular bone necrosis, a condition in which poor blood supply weakens or destroys an area of bone, plus malaria—a fatal combination. Tut’s tomb contained canes and what the scientists call “an afterlife pharmacy,” supporting the idea that he suffered from a condition that hobbled him.

Hawass has made headlines before for his theories of how Tut died, including (in 2006) a thigh fracture that became fatally infected, so the cause-of-death part of this research gives me a sense of déjà vu. (If you want more on this front, however, the Discovery Channel will air King Tut Unwrapped this coming Sunday, Feb. 21, and Monday, Feb. 22. I haven’t seen it, but be forewarned that some of Hawass’s previous TV productions have been more showmanship than scholarship.)

More interesting are the conclusions about the mummies’ appearance in life. Depictions of Tut and other royalty from this period show them as somewhat feminized, or at least androgynous. That led to speculation that the royal family tree was riddled with a hormonal disease that caused gynecomastia (excessive breast development in men), or Marfan syndrome, which causes patients to be tall and thin, with slender, graceful, tapering fingers—like several of the royals. But CT scans showed no signs of either. (Further evidence against a feminizing disorder—and here let me simply quote the paper— is that “the penis of Tutankhamen, which is no longer attached to the body, is well developed.”)

The feminized depictions are therefore likely to be what the researchers call “a royally decreed style most probably related to the religious reforms of Akhenaten. It is unlikely that either Tutankhamen or Akhenaten actually displayed a significantly bizarre or feminine physique.” In other words, the faces and forms so familiar to museumgoers and amateur Egyptologists may be no more than artistic license.

King Tut wasn't the only pharaoh with a penis that wouldn't stay put. Visit our polygyny gallery to learn which Egyptian leader was a staunch supporter—and practitionerof plural marriage.

Thursday, February 04, 2010

Trace of Thought Is Found in ‘Vegetative’ Patient
By Benedict Carey

He emerged from the car accident alive but alone, there and not there: a young man whose eyes opened yet whose brain seemed shut down. For five years he lay mute and immobile beneath a diagnosis — “vegetative state” — that all but ruled out the possibility of thought, much less recovery.

But in recent months at a clinic in Liège, Belgium, the patient, now 29, showed traces of brain activity in response to commands from doctors. Now, according to a new report, he has begun to communicate: in response to simple questions, like “Do you have any brothers?,” he showed distinct traces of activity on a brain imaging machine that represented either “yes” or “no.”

Experts said Wednesday that the finding could alter the way some severe head injuries were diagnosed — and could raise troubling ethical questions about whether to consult severely disabled patients on their care.

The new report, posted online by The New England Journal of Medicine, does not suggest that most apparently unresponsive patients can communicate or are likely to recover. The hidden ability displayed by the young accident victim is rare, the study suggested.

Nor does the finding apply to victims of severe oxygen depletion, like Terri Schiavo, the Florida woman who became unresponsive after her heart stopped and who was taken off life support in 2005 during an explosive controversy over patients’ rights.

Moreover, experts said the new test was not ready for wide use; serious technical challenges remain to be worked out.

Still, the experts agreed that the new study exposed the limits of the current bedside test for diagnosing mental state: checking whether patients’ eyes can track objects, and carefully looking for any signs — eye blinks, finger twitches — in response to questions or commands.

“I’m convinced as an observer that in these few cases, the M.R.I. technique, in these researchers’ hands, gives us a window into human consciousness that we have not had and that potentially adds to the clinical exam we currently use,” said Dr. James L. Bernat, a professor of neurology at Dartmouth Medical School.

In the new paper, researchers in Britain and Belgium studied 54 patients living in states of persistent unconsciousness. Of these, 23 had a diagnosis of “vegetative state,” meaning they were not able to signal any response to commands or questions. (The others were termed “minimally conscious,” meaning they were intermittently able to respond to commands by moving or blinking.)

In 2006, the same research group reported that one of the 23 “vegetative” patients showed on imaging tests that her brain was responding to commands. When doctors asked her to think of playing tennis, areas of her motor cortex leapt to life. When asked to think of being in her house, spatial areas in the brain became active.

In the current experiment, the researchers found that three other patients identified as vegetative showed similar responses. To open a channel of communication, they instructed one of them, the 29-year-old man, to associate thoughts about tennis with “yes” and thoughts about being in his house with “no.”

They then asked questions, repeating the procedure numerous times, switching the associations — tennis with yes, then with no — to make sure the patient was in fact making conscious choices. The researchers had previously tested the technique in healthy volunteers.

“We asked basic biographical questions, like ‘Is your father’s name Thomas?’ and ‘Have you ever been to the United States?’ ” said Adrian M. Owen, a neuroscientist at the Medical Research Council in Cambridge, England, who developed the method and was a co-author of the paper. “We then checked whether the answers were correct. They were.”

Dr. Owen’s co-authors were Martin M. Monti, Martin R. Coleman and John D. Pickard in Cambridge; and Audrey Vanhaudenhuyse, Dr. Mélanie Boly, Dr. Jean-Flory L. Tshibanda and Dr. Steven Laureys of the University of Liège, where the patient was treated.

Over all, only 5 of the 54 patients — four identified as vegetative and one as minimally conscious — showed any meaningful brain activity on the M.R.I. when prompted, perhaps because it was too feeble to be picked up, because the timing was wrong or because the activity simply was not there.

In those rare cases where brain activity is detectable, doctors might be able to ask immobilized patient if they are feeling pain, for example, and, through a series of yes-or-no questions, where.

A two-way channel to an immobilized, severely brain-injured person also opens up a world of ethical challenges.

“If you ask a patient whether he or she wants to live or die, and the answer is die, would you be convinced that that answer was sufficient?” said Dr. Joseph J. Fins, chief of the medical ethics division at Weill Cornell Medical College in New York. “We don’t know that. We know they’re responding, but they may not understand the question. Their answer might be ‘Yes, but’ — and we haven’t given them the opportunity to say the ‘but.’

“We’ve opened up a communication channel with this technique, but in some ways it’s like a very bad cellphone connection.”

In an editorial accompanying the article, Dr. Allan H. Ropper, a neurologist at Brigham and Women’s Hospital in Boston, similarly warned against equating neural activity and identity.

“Physicians and society are not ready for ‘I have brain activation, therefore I am,’ ” Dr. Ropper wrote. “That would seriously put Descartes before the horse.”

Heel. Sit. Whisper. Good dog.
Inhumane or protective? Debarking surgery for noisy pups stirs debate
New York Times

Veterinarian Mike Marder had his dog Nestlé debarked after a neighbor threatened to complain to the co-op board.
Jennifer S. Altman for The New York Times

Nestlé barks when Mike Marder and his wife come home, and he barks when they leave. He barks at delivery boys, he barks at the doorbell, and he barks at the Marders’ new puppy, Truffle.

But for all that effort, the only sound Nestlé makes is a raspy squeak.

Dr. Marder, a veterinarian, tells those who are curious that Nestlé, a dachshund-terrier mix, is hoarse from too much barking.

But that is not true. The Marders had Nestlé’s vocal cords cut by a veterinary surgeon after a neighbor in the family’s apartment building on the Upper East Side threatened to complain to the co-op board about the noisy dog.

Although there is no reliable estimate as to how many dogs have had their vocal cords cut, veterinarians and other animal experts say that dogs with no bark can readily be found — but not necessarily heard — in private homes, on the show-dog circuit, and even on the turf of drug dealers, who are said to prefer their attack dogs silent.

The surgery usually leaves the animal with something between a wheeze and a squeak. The procedure, commonly referred to as debarking, has been around for decades, but has fallen out of favor, especially among younger veterinarians and animal-rights advocates.

Keeping pets in New York City, of course, has always required delicate negotiations between neighbors and species. The city’s 311 line fielded 6,622 complaints about barking dogs last year, while housing officials banned pit bulls, Rottweilers and other large dogs from public housing projects. Real estate experts say that co-op boards large and small always wrestle with pet policies, many of them tied to barking dogs.

Critics of the debarking procedure say it is outdated and inhumane, one that destroys an animal’s central means of communication merely for the owner’s convenience. Many veterinarians refuse to do the surgery on ethical grounds. Those who do rarely advertise it.

New Jersey bans devocalization surgery except for medical or therapeutic reasons, as do Britain and other European countries. Similar legislation is pending in Massachusetts, while Ohio restricts the surgery to nonviolent dogs.

But there are still those who perform the operation, and they and other advocates defend the surgery as a useful option for dog owners facing noise complaints and possible eviction.

Dr. Sharon L. Vanderlip has been performing debarking surgeries for more than 30 years as a small part of her veterinary practice in San Diego County. She calls herself a “big, big, big proponent” of the procedure if it is done the right way, for the right reasons.

“They recover immediately and they don’t ever seem to notice any difference,” she said. “I think that in certain cases it can certainly save a dog from ending up being euthanized. If properly done, they behave totally the same afterwards and don’t seem to have any health problems.”

Rarely practiced
Jennifer S. Altman for The New York Times
Truffle, left, may well face the same procedure, Dr. Marder said.

The surgery can be relatively simple. The doctor anesthetizes the dog before cutting its vocal cords, either through the mouth or through an incision in the larynx. Dogs generally recover quickly, veterinarians say, and while they usually can still make sounds, their barks become muffled and raspy.

Dr. Gary W. Ellison, of the College of Veterinary Medicine at the University of Florida, cautioned that the procedure can lead to complications. He said he has had to operate on debarked dogs after excess scar tissue built up in the throat, making it difficult for the dog to breathe.

“I think it’s probably going to be a procedure that’s done by fewer and fewer veterinarians” in the coming years, said Dr. Ellison, the curriculum director at the University of Florida’s veterinary school. He said professors there do not teach the surgery, and that he has not come across recent veterinary school graduates who have studied the procedure.

Banfield, the Pet Hospital, which has more than 750 veterinary practices across the country, formally banned the surgery last summer, though Jeffrey S. Klausner, the hospital’s senior vice president and chief medical officer, said it was rarely, if ever, practiced before that.

“Debarking is not a medically necessary procedure,” Dr. Klausner said. “We think it’s not humane to the dogs to put them through the surgery and the pain. We just do not think that it should be performed.”

The American Veterinary Medical Association recommends that the surgery only be done “after behavioral modification efforts to correct excessive vocalization have failed.”

Barking out of frustration
People with debarked dogs said they understood animal rights groups’ concerns. But they challenge their critics to spend time with debarked dogs before making a judgment.

“I probably spend more time and money on my dogs in one year than they have in a whole lifetime,” said Paul, a breeder and dog handler in Catskill, N.Y., who asked that his last name not be used because he did not want to be singled out by activists. “I just hate being labeled as someone who’s cruel because I debark.”

Paul usually has more than a dozen dogs at a time, many of them Shetland sheepdogs, a breed known for excessive barking. He said he has had most of them debarked, and requires his clients to debark theirs before sending them to him for dog shows. He said his dogs have lived long, happy lives, and “none of them are any sadder after being debarked.”

David Frei, the longtime co-host of the Westminster Kennel Club Dog Show, acknowledged that some show dogs have had the operation. “There is no question we have some debarked dogs among our entries,” he said.

Experts say there are many nonsurgical methods of keeping a dog from barking, including collars that spray citronella every time the dog barks, or sessions with a trainer or animal behaviorist to better understand the dog’s needs.

“Dogs are usually barking because of some frustration,” said Dr. Louise Murray, director of medicine at the Aspca’s Bergh Memorial Animal Hospital in Manhattan. “It’s frustrating to be a sheepdog with no sheep. What I’d be concerned about is if you’re debarking a dog and it has an underlying unhappiness.”

Dr. Marder said that Nestlé’s surgery stopped the neighbor’s complaints, and “it really did not change the dog’s personality whatsoever,” adding, “He’s certainly a tail-waggy, happy guy.”

Dr. Marder said they will probably debark Truffle unless she quickly learns to play quietly.

Terry Albert, of Poway, Calif., said her life revolved around dogs: she boards them, rescues them, and even paints portraits of them. And she refuses to give them up. She has had two dogs debarked.

“You may think it’s horrible,” she said. “But if I had to give up my dog or get the surgery, I would choose the surgery.”