Brief Report: Sex Differences in ASD Diagnosis-A Brief Report on Restricted Interests and Repetitive Behaviors.

Previous research found repetitive and restricted behaviors (RRBs) were less predictive of Autism Spectrum Disorder (ASD) in females, indicating the diagnostic construct may not adequately describe RRB presentations in females. This mixed-methods study investigated the female presentation of RRBs, namely restricted interests, in a clinic sample of 125 participants (n = 40 female; ages 2-83 years; 75 ASD). RRB severity did not differ between sexes, t = 1.69, p = 0.094, though male participants scored higher on the Restricted Behavior subscale. Qualitatively, females demonstrated a narrower range of restricted interests and expressed them in a socially oriented manner compared to males. The results suggest unique quantitative and qualitative sex differences in RRB profiles that could shed light on the female ASD phenotype.

A novel 13C isotopic labelling strategy for probing the structure and dynamics of glycan chains in situ on glycoproteins.

A protocol is described for uniform 13C labelling of terminal galactose residues of the glycan chains of glycoproteins, using an enzymatic method which does not perturb the protein. The technique is illustrated by application to the biantennary N-linked glycan chains attached at Asn 297 of immunoglobulin G (IgG). Isotope-edited NMR experiments on this glycoprotein yield data which suggest that the galactose residues on the glycan exist in two discrete environments, with the galactose in one environment having greater mobility than that in the other. These data are qualitatively consistent with crystallographic data on an Fc fragment, which suggest that one arm of the glycan is in contact with the protein, while the other projects into the space between the C gamma 2 domains. Quantitatively, however, these data cannot be rationalized with the crystallographic data, which implies subtle differences in oligosaccharide structure and dynamics between the solution and crystal states of Fc.

Primary surgical closure of large ventricular septal defects in small infants.

Herein, a policy of primary surgical closure of large ventricular septal defects in infants is reviewed. Forty-eight infants met criteria for inclusion in the study, and were divided into two groups based on weight: group 1 infants weighted 4 kg or less (n = 23), and group 2 infants weighed more than 4 kg (n = 25). Both groups had similar variation in ventricular septal defect location (paramembranous versus muscular) and number (single versus multiple), as well as incidence of major associated extracardiac diseases. No early deaths occurred in group 1, compared with 1 infant (4%) in group 2. Major complications occurred similarly in both groups (9% versus 12%). There were two late deaths in group 1 (9%) and none in group 2. No surviving patients have required a second ventricular septal defect operation, and the majority no longer receive anticongestive therapies. These results indicate that primary surgical closure of large ventricular septal defects, even multiple muscular defects, can be performed in very small infants with no difference in mortality or serious complication rates compared with larger infants. Protracted medical efforts to achieve larger size before primary repair and palliative pulmonary artery banding are not necessary.

Simplified method for femoral venous cannulation.

A simple method for rapidly achieving femoral venous cannulation is described. We have found this method to be particularly useful for femoral cannulation when the patient is in the thoracotomy position.

Selective nonoperative management of patients referred with abnormal mammograms.

Screening mammography provides a means of detecting clinically occult breast carcinoma, but the question of whether all abnormal mammograms require biopsy remains unanswered. We retrospectively reviewed records of 214 women referred over an 8-year period for abnormal mammograms. They were selectively assigned to biopsy or mammographic follow-up based on specific mammographic criteria. Of 114 women initially observed mammographically, 2 were later found by biopsy to have carcinoma. Initial assignment to mammographic observation delayed the recommendation for biopsy 3 and 12 months, respectively, in these patients, but no effect on outcome was documented. Because they have benign lesions by clinical and mammographic criteria, 102 women (53%) have been spared biopsy; they continue to be monitored closely. We believe these data support the use of a selective approach to biopsy based on specific mammographic criteria.

Management of refractory empyema with early decortication.

One hundred consecutive patients underwent surgical procedures for empyema. Sixty-six patient acquired empyema from pneumonia, 16 from trauma, 11 from abdominal sepsis, and 7 from other causes. If tube thoracostomy failed, computerized tomography and ultrasonography were used to demonstrate a loculated empyema. After a median observation period of 11 days, 91 patients underwent thoracotomy and decortication and 9 patients underwent either rib resection, an Eloesser flap procedure, or both. The mortality rate was 6 percent 30 days postoperatively, the in-hospital mortality rate was 9 percent, and the overall morbidity rate was 17 percent. An excellent result was achieved in 85 percent of the patients with a recurrence rate of 4 percent. Gram-positive aerobes were the most common organisms cultured, but several opportunistic infections were encountered. We have concluded that early thoracotomy and decortication of empyema results in eradication of difficult pleural infections with hospital stays of an acceptable length and reasonably low morbidity and mortality rates.

Quantitative digital subtraction coronary angiography using videodensitometry. An in vivo analysis.

A videodensitometric method for measuring absolute cross-sectional area and diameter has been tested in living dogs with coronary artery stenoses created surgically by placement of small Silastic cuffs. Coronary arteriograms were performed using a circular tomographic unit to provide multiple views of each lesion, and measurements were made from logarithmically subtracted digital images. Dimensions of 13 stenoses of cross section 1 to 5 mm2 and adjacent reference segments (2 to 9 mm2) were determined by histologic sectioning of the segments after injection with a rapidly hardening plastic fixative under physiologic pressure. Two different methods were tested for calculating cross-sectional area. On 238 measurements, 102 of normal vessel segments and 135 of stenoses, both methods showed good correlation with histologic measurements, with slopes of 0.929 + (SD) 0.037 (r = 0.8563) and 0.948 + (SD) 0.037 (r = 0.8554). Multiple measurements of each segment produced values within 30% of the true absolute cross sectional area in most cases. The method shows promise as a means for quantitating absolute dimensions of vessels in clinical arteriography.

The rabbit autoperfusing heart-lung preparation.

The autoperfusing heart-lung preparation holds promise as a method for extended organ preservation. Further understanding of the hemodynamics, metabolism, and quality of tissue preservation of this preparation may increase the number of available organs for heart-lung transplantation. We describe the materials and operative technique for a small animal model of the autoperfusing heart-lung preparation. The method is easy to learn, the materials and animal subjects are inexpensive, and the preparation is fully monitored to provide consistent and reproducible data. The rabbit autoperfusing heart-lung preparation is an excellent vehicle for the investigator studying warm organ preservation.

Screening mammography: a surgeon's strategy for dealing with abnormal mammographic findings.

Screening mammography is a valuable tool in the detection of breast cancer at an early stage. Large numbers of patients are being referred to surgeons for biopsies on the basis of mammographic abnormalities alone. As mammograms are complex studies and the findings often subtle, variation in terms of interpretation and recommendations for biopsy can leave the surgeon in a difficult position. We have reported a systematic method for evaluating patients and mammograms. Eighty-eight patients were referred to a single surgeon solely for an abnormal mammographic finding. Physical examination was repeated and the mammogram reviewed with a single consulting radiologist using specific criteria to define a mammographic abnormality. Through this evaluation, biopsy was avoided in 42 of 88 patients, with follow-up mammograms and physical examinations finding no suspicion of malignancy. By becoming educated in regard to mammographic abnormalities, establishing specific criteria with a consistent radiologist, and following patients carefully who are not biopsied, the surgeon can deal effectively with screening mammography.

Detailed comparison of regional and general anesthesia for carotid endarterectomy.

Forty-one variables were examined in 75 patients who underwent carotid endarterectomy to determine if significant differences were present between 45 patients who had general anesthesia and 30 patients who had regional anesthesia. The two groups were similar in terms of age, existing medical illnesses, neurologic presentation, and angiographic severity of the carotid lesions. There were no differences between the two groups for operative time, anesthesia time, blood loss, maximum or minimum blood pressures, postoperative hemodynamic data, or the requirement for or duration of intravenous pressor or antihypertensive medications. One patient in the regional group had a postoperative neurologic deficit which resolved in 1 month. Three patients in the general group had cardiovascular complications. Postoperative hospital stay was significantly longer in the general anesthesia group (5.6 to 3.2 days, p = 0.003). Regional and general anesthesia produce similar perioperative hemodynamic and surgical outcomes, but regional anesthesia results in a shorter hospital stay and less cardiovascular morbidity in this high risk population.

Rational preoperative evaluation.

Clinical data from two hundred consecutive patients undergoing surgical procedures at the Salt Lake City VA Hospital form the basis of this study. Results of nine commonly ordered preoperative tests (blood count, differential, electrolytes, chemistry panel, urinalysis, prothrombin time, partial thromboplastin time, electrocardiogram, and chest X-ray) were matched with the preoperative history and physical examination and the outcome of surgery in each patient. Each test was examined by the frequency with which it was ordered, the frequency with which it was abnormal, and the frequency with which the abnormal result affected preoperative care. A prevalence of medical illness was found in this population, with 47.5% having a major cardiovascular diagnosis, 35.5% a metabolic or endocrine disease, and 28% a major pulmonary diagnosis. A total of 1271 tests were performed, with 477 (35.5%) showing some abnormality. However, only 76 (5.9%) changed the patient's management before surgery. All but five of these abnormalities were predictable from the clinical evaluation and these five were minor. The overall postoperative complication rate was 9%. No complication was attributed to the omission of a preoperative test. No surgical cases were cancelled during the study period based solely on a preoperative test. We conclude that many preoperative tests can be safely eliminated by ordering only those based on a specific abnormality in the history or physical examination, resulting in more cost-effective surgical care.