Jewish World Review Oct. 19, 2001 / 2 Mar-Cheshvan, 5762

New insights into autism

By Robert A. Wascher, M.D., F.A.C.S. -- The journal Science has reported on new developments in the understanding of autism. Autism is a condition that results in an impaired ability to relate socially with others. Other symptoms often associated with the disorder include language and speech difficulties, an inability to empathize with the feelings of others, and problems with integrating stimuli in a way that that allows autistic people to make sense of the world around them. Mental retardation is also common, though not always present.

Using the latest diagnostic tools, scientists have learned some amazing facts about an often disabling disorder that affects 20 out of every 10,000 people. Using a special magnetic resonance scanner that can identify specific regions of the brain being actively used, researchers have demonstrated that autistic people have fewer connections between the parts of the brain that are involved in "higher order cognition."

In the brains of non-autistic people, the frontal lobes act as a center of integration. This frontal part of the brain receives sensory information and other inputs from throughout the brain, and assembles all of these disparate signals into a meaningful awareness of our surroundings. These higher centers of cognition allow us to make sense out of the constant bombardment of our brains by external and internal stimuli. In autistic patients, these interconnections in the brain appear to be less numerous and less complex.

Other studies seem to show that autistic children have a reduced level of a hormone called oxytocin. In mice who have the oxytocin-producing gene "knocked-out," many of the human-like autistic behaviors have been observed as well. Researchers at the Mount Sinai School of Medicine in New York City have administered autistic adults a synthetic form of oxytocin, and subsequently found that these patients experienced a significant reduction in some autistic behaviors.

While the cause (or causes) of this enigmatic disorder are still not understood, meaningful insights are being developed and, hopefully, effective treatments will be discovered soon.

It has been estimated that 7% of the population will develop appendicitis, making this disease the most common surgical illness involving the abdominal organs. Prior to the advent of antibiotics and modern surgical techniques, appendicitis was frequently a fatal disease.

However, despite the amazing advances in medicine over the past few decades, the diagnosis of appendicitis has continued to vex surgeons and their patients.

Indeed, surgeons are expected to take out a few normal appendices (i.e., to avoid missing appendicitis in the many cases where the disease may not be associated with the textbook symptoms of an inflamed appendix). An acceptable rate of normal appendices has been estimated at about 15% overall, and 20% for female patients.

Over the past 10 years, surgeons have increasingly relied upon advanced diagnostic studies such as CT and ultrasound scans, and upon the more frequent use of laparoscopic appendectomy (where the surgeon places a surgical telescope into the abdomen through a tiny incision near the belly button), to improve their diagnostic accuracy.

However, a new study reported in the Journal of the American Medical Association raises questions regarding the impact of these high-tech approaches to diagnosing appendicitis.

Nearly 86,000 patients who were initially diagnosed with appendicitis were studied over a period of 12 years in the state of Washington. Although the study was performed retrospectively (i.e., by going through the charts of patients after the fact), the authors reported that the increasing use of these technologies appeared to have absolutely no impact in improving the accuracy of surgeons' diagnosis of appendicitis!

The study's authors did not reach any conclusions as to how the diagnosis of appendicitis might be improved. Nonetheless, this study raises questions regarding the value of CT and ultrasound scans, and laparoscopy, in diagnosing this disease. It may be that these tools are still valuable, but are not being optimally utilized at this time. More studies will have to be performed, it would appear, before answers can be found to the questions raised in this study.

JWR contributor Dr. Robert A. Wascher is a senior research fellow in molecular & surgical oncology at the John Wayne Cancer Institute in Santa Monica, CA. Comment by clicking here.


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© 2001, Dr. Robert A. Wascher