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Restrepo B, Angkustsiri K, Taylor SL, Rogers SJ, Cabral J, Heath B, Hechtman A, Solomon M, Ashwood P, Amaral DG, Nordahl CW. Developmental-behavioral profiles in children with autism spectrum disorder and co-occurring gastrointestinal symptoms. Autism Res 2020; 13:1778-1789. [PMID: 32767543 PMCID: PMC7689713 DOI: 10.1002/aur.2354] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 05/07/2020] [Accepted: 05/26/2020] [Indexed: 12/21/2022]
Abstract
Gastrointestinal (GI) symptoms are frequently reported in children with autism spectrum disorder (ASD). We evaluated the frequency and severity of GI symptoms in preschool-aged children with ASD compared to participants with typical development (TD). Our goal was to ascertain whether GI symptoms are associated with differences in sex or developmental and behavioral measures. Participants were between 2 and 3.5 years of age and included 255 children with ASD (184 males/71 females) and 129 age-matched TD controls (75 males/54 females). A parent interview was used to assess GI symptoms (abdominal pain, gaseousness/bloating, diarrhea, constipation, pain on stooling, vomiting, difficulty swallowing, blood in stool or in vomit). Children with GI symptoms in each diagnostic group were compared to children without GI symptoms on measures of developmental, behavioral, and adaptive functioning. GI symptoms were reported more frequently in children with ASD compared to the TD group (47.8% vs. 17.8%, respectively). Children with ASD were also more likely to experience multiple GI symptoms (30.6% vs. 5.4%). GI symptoms were equally common in males and females across both diagnostic groups. There were no statistically significant differences in developmental or adaptive measures based on presence of GI symptoms in either ASD or TD children. Co-occurring GI symptoms were, however, associated with increased self-injurious behaviors, restricted stereotyped behaviors, aggressive behaviors, sleep problems and attention problems in both ASD and TD children. In children with ASD, a higher number of GI symptoms was associated with an increase in self-injurious behaviors, somatic complaints, reduced sleep duration, and increased parasomnias. LAY SUMMARY: ASD is characterized by challenges in social communication and repetitive behaviors. But, people with autism have many other difficulties including gastrointestinal problems. Children with ASD were three times more likely to experience GI symptoms than typically developing peers. Increased GI symptoms are associated with increased problem behaviors such as sleep problems, self-injury, and body aches. Since GI symptoms are often treatable, it is important to recognize them as soon as possible. Both clinicians and parents should become more aware of the high occurrence of GI problems in autistic people. Autism Res 2020, 13: 1778-1789. © 2020 International Society for Autism Research and Wiley Periodicals LLC.
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Affiliation(s)
- Bibiana Restrepo
- Division of Developmental and Behavioral Pediatrics, Department of Pediatrics, University of California at Davis School of Medicine, Sacramento, California, USA.,MIND (Medical Investigations of Neurodevelopmental Disorders) Institute, University of California at Davis, Sacramento, California, USA
| | - Kathleen Angkustsiri
- Division of Developmental and Behavioral Pediatrics, Department of Pediatrics, University of California at Davis School of Medicine, Sacramento, California, USA.,MIND (Medical Investigations of Neurodevelopmental Disorders) Institute, University of California at Davis, Sacramento, California, USA
| | - Sandra L Taylor
- Department of Public Health Sciences, School of Medicine, University of California Davis, Sacramento, California, USA
| | - Sally J Rogers
- MIND (Medical Investigations of Neurodevelopmental Disorders) Institute, University of California at Davis, Sacramento, California, USA.,Department of Psychiatry and Behavioral Sciences, University of California at Davis School of Medicine, Sacramento, California, USA
| | - Jacqueline Cabral
- Department of Community Health, Tufts University, Boston, Massachusetts, USA
| | - Brianna Heath
- MIND (Medical Investigations of Neurodevelopmental Disorders) Institute, University of California at Davis, Sacramento, California, USA.,Department of Psychiatry and Behavioral Sciences, University of California at Davis School of Medicine, Sacramento, California, USA
| | - Alexa Hechtman
- MIND (Medical Investigations of Neurodevelopmental Disorders) Institute, University of California at Davis, Sacramento, California, USA.,Department of Psychiatry and Behavioral Sciences, University of California at Davis School of Medicine, Sacramento, California, USA
| | - Marjorie Solomon
- MIND (Medical Investigations of Neurodevelopmental Disorders) Institute, University of California at Davis, Sacramento, California, USA.,Department of Psychiatry and Behavioral Sciences, University of California at Davis School of Medicine, Sacramento, California, USA
| | - Paul Ashwood
- Department of Medial Microbiology and Immunology, University of California Davis, Sacramento, California, USA
| | - David G Amaral
- MIND (Medical Investigations of Neurodevelopmental Disorders) Institute, University of California at Davis, Sacramento, California, USA.,Department of Psychiatry and Behavioral Sciences, University of California at Davis School of Medicine, Sacramento, California, USA
| | - Christine Wu Nordahl
- MIND (Medical Investigations of Neurodevelopmental Disorders) Institute, University of California at Davis, Sacramento, California, USA.,Department of Psychiatry and Behavioral Sciences, University of California at Davis School of Medicine, Sacramento, California, USA
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Aljuboori Z, Ding D, Williams BJ. Contemporaneous Clipping of Unruptured Anterior Cerebral Artery Proximal A1 Segment Aneurysm and Resection of Dural-Based Brain Tumor. Cureus 2020; 12:e8183. [PMID: 32566424 PMCID: PMC7301418 DOI: 10.7759/cureus.8183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The coexistence of brain tumors and unruptured intracranial aneurysms is uncommon, so there is limited data regarding management strategies for these cases. Tumor, aneurysm, and patient factors must be considered in the decision-making process. We present a case of a dural-based left temporal brain tumor with an incidental ipsilateral unruptured anterior cerebral artery (ACA) proximal A1 segment aneurysm. A 56-year-old female presented with progressive headaches and convulsions without focal neurological deficits. Neuroimaging showed a large dural-based left temporal tumor with adjacent vasogenic edema. The patient underwent a cerebral angiography for preoperative tumor embolization, which revealed a small, unruptured intracranial aneurysm arising from the left ACA proximal A1 segment. We performed a left frontotemporal craniotomy for concurrent resection of the dural-based tumor and clipping of the left A1 aneurysm. She elected to proceed, so she underwent a left-sided craniotomy for tumor resection and clipping of the aneurysm. Postoperatively, the patient developed transient, mild right-sided hemiparesis from a left anterior thalamic infarct that resolved before discharge. Follow-up brain magnetic resonance imaging and catheter cerebral angiography showed gross total resection of the tumor and complete aneurysm obliteration, respectively. Patients with dual diagnoses of a brain tumor and intracranial aneurysm can be challenging to manage. When intervention is indicated for each lesion and both can be safely accessed from the same operative approach, contemporaneous surgical treatment of the tumor and aneurysm is reasonable in appropriately selected cases.
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Affiliation(s)
- Zaid Aljuboori
- Neurological Surgery, University of Louisville School of Medicine, Louisville, USA
| | - Dale Ding
- Neurological Surgery, University of Louisville School of Medicine, Louisville, USA
| | - Brian J Williams
- Neurological Surgery, University of Louisville School of Medicine, Louisville, USA
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Irwin RM, Shimozono Y, Yasui Y, Megill R, Deyer TW, Kennedy JG. Incidence of Coexisting Talar and Tibial Osteochondral Lesions Correlates With Patient Age and Lesion Location. Orthop J Sports Med 2018; 6:2325967118790965. [PMID: 30151402 PMCID: PMC6108024 DOI: 10.1177/2325967118790965] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background: The incidence of coexisting osteochondral lesions (OCLs) of the tibia and talus has been negatively correlated with successful clinical outcomes, yet these lesions have not been extensively characterized. Purpose: To determine the incidence of coexisting tibial and talar OCLs, assess the morphologic characteristics of these lesions, and evaluate whether these characteristics are predictive of outcome. Study Design: Case series; Level of evidence, 4. Methods: A total of 83 patients who underwent surgery for a talar OCL were evaluated for coexisting OCLs of the distal tibia with preoperative magnetic resonance images. Size, location, containment, International Cartilage Repair Society (ICRS) grade, patient age, and patient sex were analyzed for predictors of coexisting lesions or patient outcome. The talar and tibial surfaces were each divided into 9 zones, with 1 corresponding to the most anteromedial region and proceeding laterally and then posteriorly. The Foot and Ankle Outcome Score (FAOS) was evaluated pre- and postoperatively. Results: Twenty-six patients (31%) had coexisting tibial and talar OCLs, with 9 (35%) identified as kissing lesions. Age correlated with coexisting lesion incidence, as older patients were more likely to have a coexisting tibial OCL (P = .038). More than half of talar OCLs were found in zone 4 (61%), whereas the majority of tibial OCLs were located in zones 2, 4, and 5 (19% each). Patients with coexisting lesions were more likely to have a lateral talar OCL (P = .028), while those without a coexisting tibial lesion were more likely to have a talar OCL in zone 4 (P = .016). There was no difference in FAOS result or lesion size between patients with and without coexisting OCLs, but patients with coexisting lesions were more likely to have an ICRS grade 4 talar OCL (P = .034). For patients with coexisting lesions, kissing lesions were more likely to be located in zone 6 (P = .043). There was no difference in OCL size or containment between kissing and nonkissing coexisting OCLs. Conclusion: The incidence of coexisting talar and tibial OCLs may be more prevalent than what previous reports have suggested, with older patients being more likely to present with this pathology. The location of a talar OCL correlates with the incidence of a coexisting tibial OCL.
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Affiliation(s)
- Rebecca M Irwin
- Nancy E. and Peter C. Meinig School of Biomedical Engineering, Cornell University, Ithaca, New York, USA
| | - Yoshiharu Shimozono
- Hospital for Special Surgery, New York, New York, USA.,Department of Orthopaedic Surgery, School of Medicine, Teikyo University, Tokyo, Japan.,Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Youichi Yasui
- Department of Orthopaedic Surgery, School of Medicine, Teikyo University, Tokyo, Japan
| | - Robin Megill
- Hospital for Special Surgery, New York, New York, USA
| | | | - John G Kennedy
- Department of Orthopaedic Surgery, School of Medicine, Teikyo University, Tokyo, Japan
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Abstract
Multiple myeloma is a plasma cell dyscrasia characterized by neoplastic proliferation of plasma cells, producing a monoclonal immunoglobulin. Small lymphocytic lymphoma (SLL) is a neoplasm consisting of monoclonal B-cell lymphocyte proliferation. We present an extremely rare case of coexisting multiple myeloma, SLL, and squamous cell carcinoma of the lung in a 74-year-old female patient. She initially presented with a midline mass with pain in the lumbar area. Debulking surgery was performed, and pathology showed plasmacytoma. Further evaluation revealed coexistent IgG kappa myeloma. Imaging revealed extensive abdominal lymphadenopathy, and mesenteric lymph node biopsy confirmed the presence of SLL. The patient was also found to have a mass in the left lower lobe of the lung; biopsy showed squamous cell carcinoma. This patient was treated with lenalidomide and dexamethasone for multiple myeloma, and stereotactic body radiotherapy for limited stage lung cancer. Due to the more indolent course of SLL, watchful waiting was applied.
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Affiliation(s)
- Parth Khade
- Department of Internal Medicine, Louisiana State University Health, Shreveport, LA, USA
| | - Srinivas Devarakonda
- Department of Internal Medicine, Louisiana State University Health, Shreveport, LA, USA
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