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PubMed1992

Does metronidazole prevent alveolitis sicca dolorosa? A double-blind, placebo-controlled clinical study.

The effect of a single preoperative dose of metronidazole in the prevention of alveolitis sicca dolorosa (ASD) after surgical removal of one impacted, non-infected mandibular third molar was investigated. A patient sample of 270 were given either 1000 mg of metronidazole or placebo at least 30 min before surgery. The preoperative recordings included gender, age, tooth to be removed, experience of surgeon, time of test medication, and duration of surgery. No difference was found between the metronidazole and placebo groups in the occurrence of ASD. The duration of surgery and the experience of the operating surgeons had no effect on the occurrence of ASD. The present study failed to demonstrate any preventive effect of a single dose of metronidazole on the development of ASD.

Adult↗
PubMed2001

Uterine artery embolization: reduced radiation with refined technique.

PURPOSE: To determine the estimated absorbed ovarian dose (EAOD) and absorbed skin dose (ASD) that occurs during uterine artery embolization (UAE) using pulsed fluoroscopy and a refined procedure protocol. MATERIALS AND METHODS: The absorbed dose was measured in 20 patients who underwent UAE procedures. Radiation was limited by using low frequency pulsed fluoroscopy, bilateral catheter technique with simultaneous injections for embolization as well as pre-and postembolization exposures and focus on limitation of magnified and oblique fluoroscopy. Lithium fluoride dosimeters were placed both in the posterior vaginal fornix and on the skin at the beam entrance site. The vaginal dose was used to approximate the EAOD. Fluoroscopy time and exposures were recorded. The mean values for all patients were calculated and compared to our previous results obtained with conventional fluoroscopy and to threshold doses for the induction of deterministic skin injury. RESULTS: Mean fluoroscopy time was 10.95 min. (range 6-21.3 min.) and the mean number of angiographic exposures was 20.9 (range 14-53). The mean EAOD was 9.5 cGy (range 2.21-23.21 cGy) and the mean ASD was 47.69 cGy (range 10.83-110.14 cGy). This compares to previous results with non-pulsed fluoroscopy of an EAOD of 22.34 cGy (range 4.25-65.08 cGy) and an ASD of 162.32 cGy (range 66.01-303.89 cGy) as well as threshold doses for induction of deterministic radiation injury to the skin (400-500 cGy). CONCLUSION: When pulsed fluoroscopy is used with emphasis on dose reduction techniques, the EAOD and ASD can be substantially reduced to less than 1/2 (P = .017) and 1/3 (P < .0001) when compared to UAE performed with nonpulsed fluoroscopy. These radiation reduction tools should therefore be applied whenever possible.

Arteries↗
PubMed2005

Is the presence of urinary indolyl-3-acryloylglycine associated with autism spectrum disorder?

To test whether the presence of indolyl-3-acryloylglycine (IAG) is associated with autism, we analyzed urine from population-based, blinded cohorts. All children in York, UK with autism spectrum disorders (ASDs), diagnosed using ICD-10 research diagnostic criteria, were invited to participate. Fifty-six children on the autism spectrum (mean age 9y 8mo, SD 3y 8mo; 79% male) agreed to participate, as did 155 children without ASDs (mean age 10y, SD 3y 2mo; 54% male) in mainstream and special schools (56 of whom were age-, sex-, and school-matched to children with ASDs). IAG was found at similar levels in the urine of all children, whether IAG concentrations or IAG:creatinine ratios were compared. There was no significant difference between the ASD and the comparison group, and no difference between children at mainstream schools and those at special schools. There is no association between presence of IAG in urine and autism; therefore, it is unlikely to be of help either diagnostically or as a basis for recommending therapeutic intervention with dietary manipulation. The significance of the presence of IAG in urine has yet to be determined.

Adolescent↗
PubMed2006

Autism spectrum disorders and underlying brain pathology in CHARGE association.

The rate of autism spectrum disorders (ASDs) and brain abnormalities was analyzed in 31 individuals (15 males, 16 females; age range 1mo to 31y, mean age 8y 11mo) with CHARGE association, as part of a multidisciplinary study. A meticulous neuropsychiatric examination was performed, including standardized autism diagnostic interviews. Judgement regarding ASDs was impossible in three infants and three patients who were deaf and blind. Five individuals met diagnostic criteria for autism, five for an autistic-like condition, and seven for autistic traits. Brain abnormalities were indicated in almost three-quarters of examined individuals, and midline abnormalities of the forebrain in one-third. Awareness of the coexistence of CHARGE and ASDs is important in habilitation care in CHARGE. Moreover, the results indicate that a subgroup of ASDs may be associated with errors in early embryonic brain development.

Abnormalities, Multiple↗
PubMed2006

Multiple cognitive capabilities/deficits in children with an autism spectrum disorder: "weak" central coherence and its relationship to theory of mind and executive control.

This study examined the validity of "weak" central coherence (CC) in the context of multiple cognitive capabilities/deficits in autism. Children with an autism spectrum disorder (ASD) and matched typically developing children were administered tasks tapping visuospatial coherence, false-belief understanding and aspects of executive control. Significant group differences were found in all three cognitive domains. Evidence of local processing on coherence tasks was widespread in the ASD group, but difficulties in attributing false beliefs and in components of executive functioning were present in fewer of the children with ASD. This cognitive profile was generally similar for younger and older children with ASD. Furthermore, weak CC was unrelated to false-belief understanding, but aspects of coherence (related to integration) were associated with aspects of executive control. Few associations were found between cognitive variables and indices of autistic symptomatology. Implications for CC theory are discussed.

Autistic Disorder↗
PubMed2006

Developmental dyspraxia is not limited to imitation in children with autism spectrum disorders.

Impaired imitation of skilled gestures is commonly reported in autism. Questions, however, remain as to whether impaired imitation is associated with a more generalized deficit in performance of gestures consistent with a dyspraxia and whether the pattern of errors differs from that observed in typically developing children. To address these questions, praxis in 21 high-functioning children with autism spectrum disorders (ASD) was compared with 24 typically developing controls using a traditional approach in which performance was evaluated through detailed examination of error types. Children with ASD produced significantly fewer correct responses not only during Gesture to Imitation, but also during Gesture to Command and with Tool Use. The pattern of errors in ASD was similar to that of controls with spatial errors being most common in both groups; however, body-part-for-tool errors were more common in children with ASD, suggesting dyspraxia is not entirely attributable to motor deficits. The findings suggest that autism is associated with a generalized praxis deficit, rather than a deficit specific to imitation. In a developmental disorder such as autism, the findings may reflect abnormalities in frontal/parietal-subcortical circuits important for acquisition (i.e., learning) of sensory representations of movement and/or the motor sequence programs necessary to execute them.

Apraxias↗
PubMed2000

Treatment of seizure disorders and EEG abnormalities in children with autism spectrum disorders.

The treatment of seizure disorders EEG epileptiform abnormalities without epilepsy in children with autism spectrum disorders (ASD) is considered within the context of the relationship of epilepsy and epileptiform disorders to language, behavior, and cognition. There is an increased prevalence of both epilepsy and abnormal potentially epileptogenic activity in children with ASD. Anecdotal evidence suggests that the use of anticonvulsants to treat epileptiform discharges thought to be producing dysfunction in selected aspects of cognition, language, or behavior makes a positive difference in a subgroup of children with ASD, but there is inadequate evidence on which to base specific recommendations. There is, at present, no scientific justification for considering epilepsy surgery in children with ASD in the absence of intractable clinical seizures.

Anticonvulsants↗
PubMed1997

Conditioning fluid influences on the surface properties of silicone and polyurethane peritoneal catheters: implications for infection.

Catheter-related infection remains a considerable problem in continuous ambulatory peritoneal dialysis (CAPD). This study examined the adherence of clinical isolates of Staphylococcus epidermidis to commercially available polyurethane and silicone peritoneal catheters in the presence and absence of a proteinaceous conditioning film. In addition, the effects of the conditioning film on the surface properties (advancing and receding contact angles, and surface rugosity) of these biomaterials were investigated. Bacterial adherence to polyurethane and silicone catheters, pre-treated with phosphate-buffered saline (PBS) or artificial spent peritoneal dialysate (ASD) for 1 h at 37 degrees C, was examined using a radiometric (2-3H-adenine) adherence assay. The advancing and receding contact angles and the surface rugosity of ASD- and PBS-treated biomaterials were examined using a dynamic contact angle analyser and an atomic force microscope, respectively. The bacterial isolates were selected to represent high and low cell surface hydrophobicity. The hydrophobic isolate exhibited both a significantly greater rate and a significantly greater extent of adherence than the hydrophilic isolate to both catheter materials, independent of pre-treatment. In general, pre-treatment of the catheter materials with ASD significantly decreased the subsequent adherence of both isolates owing to the deposition of a conditioning film on the surface of the biomaterial. ASD treatment also decreased both the advancing and receding contact angles and the surface rugosity of both catheter materials. This study highlights the influence of both bacterial cell surface hydrophobicity and biomaterial surface conditioning films on bacterial adherence to CAPD catheters. In addition, it is recommended that the effects of proteinaceous conditioning films on biomaterial surface properties should be considered when assessing materials for medical devices and products.

Journal Article↗
PubMed2004

Screening and identifying children with autism spectrum disorders in the public school system: the development of a model process.

Heightened public awareness of autism and increased prevalence estimates of autism spectrum disorders (ASDs) has generated a sense of urgency within the public school system to identify children with these disorders for targeted intervention. Two multidisciplinary groups of professionals, one each from two separate school districts, were identified and trained to provide diagnostic and consultative services. This paper outlines a model process for school personnel to develop a basic level of training and competence in recognizing and serving students who have an ASD by (1) providing an overview of the legal and clinical issues involved in screening for children with ASD within the school system, (2) defining a school-based professional training process and (3) outlining a school-based ASD screening process.

Autistic Disorder↗
PubMed2004

A systematic review of action imitation in autistic spectrum disorder.

Imitative deficits have been associated with autistic spectrum disorder (ASD) for many years, most recently through more robust methodologies. A fresh, systematic review of the significance, characteristics, and underlying mechanism of the association is therefore warranted. From 121 candidates, we focused on 21 well-controlled studies involving 281 cases of ASD. Overall, children with ASD performed worse on imitative tasks (Combined Logit p value < .00005). The emerging picture is of delayed development in imitation, implicating a deficit in mapping neural codings for actions between sensory and motor modalities, rather than in motivation or executive function. We hypothesise that ASD is characterised by abnormal development of these mappings. such that they are biased towards object-oriented tasks at the expense of those required for action imitation per se.

Adolescent↗
PubMed1998

Autobiographical memory in acute stress disorder.

Survivors of motor vehicle accidents with acute stress disorder (ASD) or with no ASD participated in a study on autobiographical memory within a week of their trauma. In Experiment 1, participants were provided cue words to elicit autobiographical memories of both an unconstrained time period and their trauma. Participants with ASD reported fewer specific memories to positive cue words than did non-ASD participants, even when the influence of depression was controlled. In Experiment 2, the same participants were assessed for posttraumatic stress disorder (PTSD) 6 months posttrauma. Poor recall of specific memories of the trauma in Experiment 1 accounted for 25% of the variance of PTSD severity. Accessibility of trauma memories in the acute posttrauma phase may have significant implications for longer term adjustment.

Accidents, Traffic↗
PubMed2002

Reelin gene alleles and susceptibility to autism spectrum disorders.

A polymorphic trinucleotide repeat (CGG/GCC) within the human Reelin gene (RELN) was examined as a candidate gene for autism spectrum disorders (ASDs). This gene encodes a large extracellular matrix protein that orchestrates neuronal positioning during corticogenesis. The CGG-repeat within the 5' untranslated region of RELN exon 1 was examined in 126 multiple-incidence families. The number of CGG repeats varied from three to 16 in affected individuals and controls, with no expansion or contraction observed during maternal (n = 291) or paternal (n = 287) transmissions in families with autistic probands. Although the frequencies of the RELN alleles and genotypes in affected children were not different from those in the comparison group, a family-based association test (FBAT) showed that the larger RELN alleles (> or = 11 repeats) were transmitted more often than expected to affected children (S = 43, E(S) = 34.5, P = 0.035); this was particularly the case for the 13-repeat RELN allele (S = 22, E(S) = 16, P = 0.034). Affected sib-pair (ASP) analysis found no evidence of excess sharing of RELN alleles in affected siblings. The impact of genotypes with large alleles (> or = 11 repeats) on the phenotypes in individuals with ASD was analyzed by ANOVA in a subset of the families for which results of the Autism Diagnostic Interview-Revised were available. Children with large RELN alleles did not show any difference in scores for questions related to the core symptoms of autistic disorder, but there was a tendency for children with at least one large RELN allele to have an earlier age at first phrase (chi(2) = 3.538, P = 0.06). Thus, although the case-control and affected sib-pair findings did not support a role for RELN in susceptibility to ASD, the more powerful family-based association study demonstrated that RELN alleles with larger numbers of CGG repeats may play a role in the etiology of some cases of ASD, especially in children without delayed phrase speech.

Autistic Disorder↗
PubMed2004

Association of the homeobox transcription factor, ENGRAILED 2, 3, with autism spectrum disorder.

Mouse mutants of the homeobox transcription factor Engrailed2 (En2) and autistic individuals display similar cerebellar morphological abnormalities, which include hypoplasia and a decrease in the number of Purkinje cells. Human EN2 maps to 7q36, a chromosomal region that has demonstrated suggestive linkage to autism spectrum disorder (ASD). To investigate EN2 for evidence of association with ASD, four single-nucleotide polymorphisms (SNPs) (rs3735653, rs1861972, rs1861973, rs2361689) that span the majority of the 8.0 kb gene were assessed by the transmission/disequilibrium test. Initially, 138 triads of autistic individuals and their parents were tested. Two intronic SNPs (rs1861972 and rs1861973) demonstrated significant association with autism (rs1861972, P=0.0018; rs1861973, P=0.0003; haplotype, P=0.000005). Flanking exonic SNPs (rs3735653 and rs2361689) did not display association. This analysis was then extended to include 167 small nuclear ASD pedigrees and significant association was again only observed for rs1861972 and rs1861973 under both the narrow and broad diagnostic criteria (narrow: rs1861972 P=0.0290, rs1861973 P=0.0073, haplotype P=0.0009; broad: rs1861972 P=0.0175, rs1861973 P=0.0107, haplotype P=0.0024). These data demonstrate association between a cerebellar patterning gene and ASD, suggesting a role for EN2 as a susceptibility locus and supporting a neurodevelopmental defect hypothesis in the etiology of autism.

Animals↗
PubMed2004

Atrial natriuretic peptide levels in adult patients before and after surgery for correction of atrial septal defects: relationship with atrial arrhythmias.

In the present study, we have examined whether increased N-ANP (N-terminal pro-ANP) levels before and after surgery in patients with ASD (atrial septal defect) along with echocardiographic findings provide a better insight into the pathophysiology and increased morbidity and mortality following corrective surgery. Eighteen adult ASD patients (> 20 years of age; six male and 12 female) with shunts (Qp/Qs > or = 2, where Qp/Qs is the pulmonary blood flow/systemic blood flow) had complete echocardiographic, clinical and laboratory parameters evaluated before and 6 months after surgery. Eight age- and sex-matched individuals (three male and five female) were enrolled as a control group. Blood samples for N-ANP analysis were obtained in both groups. N-ANP levels in the peripheral blood sample from ASD patients before surgery were significantly higher than those in the control group. In patients with ASD, mean N-ANP levels obtained from the pulmonary artery were significantly higher than that obtained from the peripheral vein. RA (right atrial) area, adjusted for body surface area, and RA long-axis and short-axis measurements were significantly higher in the patient group than the control group. N-ANP was correlated significantly with these parameters. Following corrective surgery, N-ANP values and RA area, RA long-axis and short-axis normalization decreased significantly and were accompanied by a decrease in systolic mean pulmonary artery pressure. N-ANP levels were normalized following septal closure in most patients, except in those with atrial fibrillation attacks following corrective surgery. In conclusion, we have shown correlations among variables indicating changes in the architecture of the right atrium along with temporal changes in ANP providing insights into the pathophysiology of post-operative atrial arrhythmias.

Adult↗
PubMed1999

Atrial septal defect in Malta.

OBJECTIVE: To study diagnostic and surgical trends in atrial septal defect (ASD) in a population-based study, and estimate birth prevalence and spontaneous closure rates. METHODOLOGY: All patients in Malta diagnosed as having ASD and born between 1990 and 1994 were identified from various sources. This took place in the setting of a regional hospital supplying diagnostic services for the entire population. Echocardiographic follow-up was also undertaken for lesions not requiring intervention. RESULTS: A total of 190 patients born in this period were diagnosed as having ASD. Age at diagnosis and age at surgery have decreased significantly over the period under study (P < 0.0001). The mode of diagnosis has become entirely noninvasive, and the perioperative mortality decreased dramatically over time. For the period 1990-94, the incidence at birth for defects not requiring intervention was 2.0/1000 live births, defects requiring intervention 0.4/1000 live births. A total of 92% of 50 defects not requiring intervention closed spontaneously, and the remainder had spontaneously decreased in size on follow-up. CONCLUSIONS: ASD is a relatively benign malformation in which early and noninvasive diagnosis can be achieved, with an extremely low interventional mortality.

Cardiac Surgical Procedures↗
PubMed2003

Single-center experience with the HELEX septal occluder for closure of atrial septal defects in children.

Catheter closure of atrial septal defects (ASDs) is an accepted procedure among pediatric cardiologists. We report our early experience with the newest of these devices in clinical trials in the United States. Between April and October 2001, 14 patients were enrolled in an FDA phase II multicenter trial comparing the results of ASD closure using the HELEX Septal Occluder to a surgical control group. Of the 14 patients, devices were placed and left in 13, one being removed for an excessive residual leak despite placing the largest device available. Of the remaining 13 patients, all patients had successful closure of their defects. An average of 1.8 devices/patient were deployed, reflecting the learning curve for this new device and new delivery style. Six devices were replaced because of excessive residual leaks, three for premature lock release, and two for improper seating of the device. There were no procedural complications, however, one patient required device removal 4 months postimplant for possible allergic reaction to nickel. The same patient had removal of stainless steel sternal wires for the same reason. At the 6-month follow-up, 11 of 13 patients had complete closure of the ASD, the other two having small, hemodynamically insignificant left to right shunts. In one of these patients, there was complete closure at the 12-month follow-up, whereas the other patient awaits the 1-year evaluation. Early experience at our institution has demonstrated the ease of use of this device, its complete retrievability, and excellent closure of small to moderate ASDs in children.

Adolescent↗
PubMed2003

Characteristics of 11 neonates with atrial septal defects detected by heart murmurs.

The aim of this prospective study was to investigate, using echocardiography, the relationship between heart murmurs found in the neonatal period and atrial septal defect (ASD). Heart murmurs were detected in 115 of 5124 term neonates within 1 month after birth. The babies were followed by echocardiographic examination with attention to the atrial septal area. Heart murmurs of 11 term neonates (9.6%) were associated with interatrial shunts consistent with ASD. The defect closed spontaneously in 7 out of the 11 neonates by 18 months of age. Two neonates showed evidence of right ventricular overload from early infancy. This study showed that nearly 1 neonate in 10 with a heart murmur up to 1 month after birth had an interatrial shunt associated with ASD. We concluded that the absence of a flap sign (valve-like openings of the defects) affects the development of the heart murmur of ASD found in the neonatal period.

Heart Murmurs↗
PubMed2001

Percutaneous closure with Amplatzer device is a safe and efficient alternative to surgery in adults with large atrial septal defects.

BACKGROUND: In adults with atrial septal defect (ASD) and large right-to-left shunt, closure of the defect is recommended. Percutaneous closure is still rarely used in this population. This study presents the results of transcatheter closure with the Amplatzer occluder in such patients. METHODS AND RESULTS: We studied 44 consecutive adult patients with a secundum ASD and 2 of the 3 following criteria: QP/QS >/=2 by oximetry, echocardiographic right ventricle overload, and ASD size >20 mm. Forty-two patients had a successful implantation. In 1 patient an unstable device was withdrawn; in another one, the device embolized in the pulmonary artery. At 6-month median follow-up, 95% had a complete closure; 2 patients with an additional defect had a small residual shunt. Major complications were the aforementioned embolization and a cerebrovascular accident in a patient with atrial fibrillation treated with aspirin. Others were minor and transitory: premature atrial beats in 3 patients, and paroxysmal atrial fibrillation and pulmonary edema in 1 patient each. CONCLUSIONS: Transcatheter closure of large ASDs with the Amplatzer device is efficient with less morbidity than surgical closure.

Adolescent↗