Pubmed du 31/12/08

lundi 5 janvier 2009

1. Markiewicz K, MacQueen BD. The autistic mind : a case study. Med Sci Monit ;2009 (Jan) ;15(1):CS5-13.

BACKGROUND : Despite years of intensive research, there is much about autism that remains theoretically and practically difficult to understand. There are presently three main theories : (1) defect of theory of mind, (2) executive dysfunction, and (3) lack of central coherence, i.e. an inability to integrate sensation and behavior into complex and sensible wholes. CASE REPORT : The patient, Damian S, born 1993, was diagnosed in early childhood with profound autism. He has been closely observed longitudinally by the first author, who is his therapist. Despite the absence of noticeable improvement in standard psychometric tests, he has shown considerable clinical progress. However, he continues to have difficulty in making and maintaining contact with others : he converses spontaneously only with his father and his teacher, and interacts with other persons (including his mother) only in the presence of one of these two persons. However, he has learned to use a computer to communicate. Samples of dialogue are provided to help illuminate how he thinks. CONCLUSIONS : Despite his profound autism, Damian displays awareness of and concern for the thoughts and feelings of others. He is also able to solve problems. On the basis of this and other observations, the authors suggest that the "central coherence" theory better explains the available observations and data.

2. Neufeld RE, Clark BG, Robertson CM, Moddemann DM, Dinu IA, Joffe AR, Sauve RS, Creighton DE, Zwaigenbaum L, Ross DB, Rebeyka IM, Western Canadian Complex Pediatric Therapies Follow-up Group.Five-year neurocognitive and health outcomes after the neonatal arterial switch operation. J Thorac Cardiovasc Surg ;2008 (Dec) ;136(6):1413-1421 e1412.

OBJECTIVES : We sought to assess the 5-year neurocognition and health of an interprovincial inception cohort undergoing the arterial switch operation for transposition of the great arteries. METHODS : Sixty-nine consecutive neonates had operations from 1996-2003 with full-flow cardiopulmonary bypass and selective deep hypothermic circulatory arrest. Outcomes were recorded at 58 +/- 9 months of age. Univariate and multivariate analyses were used to identify outcome predictors, including surgical subtype and preoperative, operative, and postoperative variables. RESULTS : There was 1 (1.5%) operative death. Two children were lost to follow-up, and 1 was excluded because of postdischarge meningitis. Outcomes are reported for 65 survivors. Two (3%) children have cerebral palsy, and 7 (11%) have language disorders, 4 of whom also meet the criteria for autism spectrum disorder. Two of the 4 children with autism have an affected older sibling. Of the 61 children without autism, scores approach those of peers, with a full-scale intelligence quotient of 97 +/- 16, a verbal intelligence quotient of 97 +/- 18, a performance intelligence quotient of 96 +/- 15, and a visual-motor integration score of 95 +/- 16. Mother’s education, birth gestation or weight, and postoperative plasma lactate values account for 21% to 32% of the variance of these scores. Septostomy adds 7% to the variance of visual-motor integration scores. CONCLUSIONS : Most preschool children do well after surgical correction for transposition of the great arteries, including complex forms. Potentially modifiable variables include high preoperative plasma lactate levels and septostomy. A minority of children were given diagnoses of language disorders, including autism, in which familial factors likely contribute to outcome.


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