Jewish World Review Oct. 19, 2001 / 2 Mar-Cheshvan, 5762
By Robert A. Wascher, M.D., F.A.C.S.
http://www.jewishworldreview.com --
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.
THE WILEY APPENDIX... 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
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.
New insights into autism
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.
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