Impairment in movement skills of children with autistic spectrum disorders

Aim  We undertook this study to explore the degree of impairment in movement skills in children with autistic spectrum disorders (ASD) and a wide IQ range.
Method  Movement skills were measured using the Movement Assessment Battery for Children (M-ABC) in a large, well defined, population-derived group of children ( n =101: 89 males,12 females; mean age 11y 4mo, SD 10mo; range 10y–14y 3mo) with childhood autism and broader ASD and a wide range of IQ scores. Additionally, we tested whether a parent-completed questionnaire, the Developmental Coordination Disorder Questionnaire (DCDQ), was useful in identifying children who met criteria for movement impairments after assessment ( n =97 with complete M-ABCs and DCDQs).
Results  Of the children with ASD, 79% had definite movement impairments on the M-ABC; a further 10% had borderline problems. Children with childhood autism were more impaired than children with broader ASD, and children with an IQ less than 70 were more impaired than those with IQ more than 70. This is consistent with the view that movement impairments may arise from a more severe neurological impairment that also contributes to intellectual disability and more severe autism. Movement impairment was not associated with everyday adaptive behaviour once the effect of IQ was controlled for. The DCDQ performed moderately well as a screen for possible motor difficulties.
Interpretation  Movement impairments are common in children with ASD. Systematic assessment of movement abilities should be considered a routine investigation.     

Cerebral Blood Flow during Experimental Hypoxaemia and lschaemia in the Newborn Piglet

Odden, J.-P., Stiris, T., Hansen, T. W. R. and Bratlid, D. (Neonatal Research Laboratory, Department of Paediatric Research, Institute for Surgical Research and Department of Paediatrics, Rikshospitalet, University of Oslo, Oslo, Norway). Cerebral blood flow during experimental hypoxaemia and ischaemia in the newborn piglet. Acta Paediatr Scand Suppl 360: 13, 1989.
The effect of selective hypoxaemia or ischaemia on cerebral blood flow was studied in 14 newborn piglets with the microsphere method. Surgery and experiments were performed under general anesthesia with 70% nitrous oxide. The spontaneously breathing piglet was then exposed to either low (zero) oxygen in the inspired air (hypoxaemia), or a graded tourniquet (3–5 kg string weight) of the neck above the level of the tracheostomy (ischaemia). Cerebral blood flow was measured at baseline, during the hypoxaemic/ischaemic insult, and 30 and 60 min thereafter. Brainstem blood flow was remarkably stable during both ischaemia and hypoxaemia. The reduction in blood flow to the cerebrum and to the cerebellum was greater during ischaemia than during hypoxaemia. Reactive hyperaemia followed hypoxaemia but was not obvious after selective ischaemia. Ischaemia and hypoxaemia thus seem to have different effects on cerebral blood flow.     

Normal range of fetal transcutaneous carbon dioxide tension during labour

Summary. Fetal transcutaneous carbon dioxide tension (tc-Pco), was monitored during 122 deliveries, using an electrode temperature of 44°C in 80 cases and of 41°C in 42 cases. Significant correlations between tc- P co₂ and umbilical artery blood P co₂ were found using both electrode temperatures, but the regression lines indicated a larger and more inconstant CO₂-contribution from skin metabolism when the low electrode temperature was used. Normal range of tc- P co₂ was calculated at 41°C and 44°C electrode temperatures. Mean values of fetal tc- P co₂ were found to increase during normal labour, and especially in fetuses developing acidosis, but only four of six infants born with acidaemia had tc- P co₂ values exceeding the normal range.     

Endocrine effects of 17 alpha-hydroxyprogesterone caproate during early pregnancy: a double-blind clinical trial

Summary. The clinical and endocrine effects of progestogen therapy in early pregnancy were investigated using a double-blind randomized trial in 64 patients who had a viable fetus at 6 weeks gestation and had an increased risk of miscarriage. The patients were randomly allocated to receive either 17 alpha-hydroxyprogesterone caproate or a placebo between 7 and 12 weeks gestation. Four fetal ultrasonographic variables and 17 maternal endocrine variables were studied in each woman. Only four maternal serum variables (17 alpha-hydroxyprogesterone, prolactin, thyroxin and thyroxin binding globulin) rose significantly. The serum progesterone levels in the hormone supplemented group were on average 20% higher than in the placebo group but the difference was not statistically significant. However, the relation between the progesterone levels and the fetal outcome was not clear. Therefore it is not advisable to prescribe 17-OHP-C during early pregnancy to prevent a miscarriage.     

Pharmacokinetics of Chloral Hydrate Poisoning Treated with Hemodialysis and Hemoperfusion

ABSTRACT In a severe case of chloral hydrate intoxication treated with combined hemodialysis and hemoperfusion the pharmacokinetics of the metabolites trichloroethanol (TCE), trichloroethanol glucuronide (TCE-Glu) and trichloroacetic acid (TCA) were studied. Indications of delayed absorption and some slowing of metabolism were found. At a blood flow rate of 200 ml/min clearances by hemodialysis and hemoperfusion, respectively, in ml/min were estimated to be 188 and 156 for TCE, 184 and 181 for TCE-Glu, 142 and 91 for TCA. Clearance by hemoperfusion declined with time. The half-lives of TCE and TCA were 3.2 and 4.3 hours during combined hemodialysis and hemoperfusion. After termination of treatment the half-life of TCE was 12.8 hours, whereas TCA was metabolized so slowly, that no reliable calculation could be performed. We conclude that hemodialysis and hemoperfusion are equally and highly efficient in the treatment of chloral hydrate poisoning, but hemoperfusion may increase the risk of gastric bleeding more than hemodialysis. Hemodialysis may therefore be preferable and should be tried in spite of low blood pressure.     

The permeability of the blood—brain barrier during electrically induced seizures in man

The blood-brain barrier (BBB) in man was studied during various conditions using the indicator dilution method of Crone [8]. Using 113m In-DTPA as reference substance the extraction, E, of the small test substances 24Na+, 36Cl-, 14C-urea and 14C-thiourea was estimated from the areas under the venous outflow curves following intracarotid slug injection of tracers. Interlaminar diffusion and red cell carriage were taken into consideration when calculating E. Cerebral blood flow (CBF) was measured using the intra-arterial 133Xe-injection method. Twenty-two patients receiving electroconvulsive therapy (ECT) were studied before and during seizures and during hypercapnia. Before seizures the extraction values in % were as follows: ENa+ 1.6, ECl- 1.9, Eurea 3.9 and Ethiourea 7.8; the corresponding values for the permeability-surface area products (PS) in ml/100 g x min were 0.5, 0.3, 0.7, 4.1, respectively. During seizure a decrease of Ethiourea and an increase of PSurea were significant. During hypercapnia PSNa and PSthiourea rose significantly. Due to the similarity of the findings in those two high flow situations it is suggested that the changes of CBF and not the epileptic activity are responsible for the changes in permeability. The mechanism of action may be a stretching of endothelial cells in the cerebral vessels or an opening up of new capillaries, or a combination of both.     

Ambulatory Electrocardiography for the Detection of Pacemaker Lead Failure

The suboptimal performance of some polyurethane bipolar pacing leads has highlighted concern about the optimal method of monitoring pacemaker lead performance. Since the manifestations of premature lead failure may be initially intermittent, we hypothesized that ambulatory electrocardiography (AECG) would be a more sensitive tool for the detection of pacing lead failure compared to increased pacemaker clinic surveillance. Since the Medtronic safety alerts on the 4012, 4082, and 4004 leads, we have followed 261 patients by serial AECG and 165 patients by increased pacemaker clinic surveillance. Lead failures were identified in 75 patients: 68 in the AECG group (31 %) and 7 in the clinic group (4%, P < 0.001). Repeat AECG confirmed the lead failure in 38 (97%) of 39 patients in which it could be done. Pacing lead failure documented by AECG could be confirmed by a subsequent clinic assessment in only 15 (25%) of 60 patients evaluated (P < 0.001). The actuarial survival of the 4012 lead was significantly lower in the AECG group compared to the clinic group (56% vs 87% survival at 8 years, P < 0.002). Similar trends were observed for the 4082 and 4004 leads. AECG is a more sensitive method of surveillance for pacemaker lead function compared to pacemaker clinic assessment. AECG should be incorporated into the routine follow-up of pacemaker patients. (PAGE 1997; 20[Pt. I]:127 4-1282)     

The Effect of Age on the Electrophysiological and Autonomic Correlates of Sudden Death After Acute Myocardial Infarction

To examine the influence of age on the autonomic and electrophysiological correlates of sudden death after myocardial infarction, 223 patients aged <60 and 195 patients aged ≥60 were followed up for a mean of 790 days. The patients had Holter monitoring and a signal-averaged EGG 5–11 days after infarction. A mean ventricular ectopic beat frequency >10 beats/ hour (VE10) was present in 17.0% of young versus 28.2% of old patients (P < 0.01); a low heart heart variability index in 17.9% of young but in 32.3% of old patients (P < 0.001) and late potentials in 17.5% but 32% of young and old patients, respectively (P < 0.01). There was no difference in the incidence of sudden death between young and old patients (3.6% vs 3.1%). However, sudden death accounted for 50%, compared with 24% of all deaths in the young and old groups, respectively (P < 0.01). Sudden death was more closely associated with low heart rate variability and VE10 in the young than in the older group. The predictive values of a heart rate variability index <20 units with VE10 in younger patients were a sensitivity of 50%, a positive predictive accuracy (PPA) of 33% and risk ratio (RR) of 18 (P < 0.001); these values did not reach significance in older patients (16.7%, 4.3% and 1.4%, respectively.) Late potentials had a sensitivity of 50%, a PPA of 12.1%, and an RR of 4.7 in young patients (P < 0.05): the corresponding values in the older group were 80%, 8.9, and 8.4 (P < 0.02). It is concluded that sudden death is a more predominant mode of death and is more strongly associated with lower heart rate variability and with the VE10 incidence in young than in older postinfarction patients. Age should be taken into account when assessing the risk of sudden death after myocardial infarction.