Risk factors for endocarditis now include the growing population of adults with congenital heart disease and patients with frequent healthcare contact for other comorbidities, as well as patients who are hemodialysed and immunocompromised or use intravenous drugs. Although transthoracic and transesophageal echocardiography are essential for diagnosis, additional testing (nuclear, computed tomographic, and magnetic resonance imaging) is helpful in selected patients. Early surgical management, even in high-risk patients, has a mortality benefit because eradication of infection with antibiotics alone is difficult and because valve destruction often results in hemodynamic compromise. As part of a broad differential diagnosis, clinicians should consider the diagnosis of endocarditis in patients with risk factors, even when the clinical presentation is nonspecific. Blood cultures and echocardiography are the first steps for diagnosis. Other imaging modalities can enhance diagnosis, particularly in patients with intracardiac devices or prosthetic material. Evidence from observational studies support early surgical intervention to reduce morbidity and mortality from this lethal condition.

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Research suggests that discrepant cognitive abilities are more common in children with autism spectrum disorder (ASD) and may indicate an important ASD endophenotype. The current study examined the frequency of IQ discrepancy profiles (nonverbal IQ > verbal IQ [NVIQ > VIQ], verbal IQ > nonverbal IQ [VIQ > NVIQ], and no split) and the relationship of gender, age, and ASD symptomatology to IQ discrepancy profile in a large sample of children with ASD. The NVIQ > VIQ profile occurred at a higher frequency than expected, had more young males, and showed more autism symptoms than the other groups. Results suggest that the NVIQ > VIQ profile may be less likely to represent a subtype of ASD, but rather a common developmental pathway for children with ASD and other disorders.

To determine the value of sonography in the emergent evaluation of suspected leaking abdominal aortic aneurysms, the authors examined 60 patients in the emergency department using sonography and a protocol involving advance radio notification from the ambulance; arrival of sonographic personnel and equipment in the triage room before patient arrival; and, during other triage activities, rapid sonographic evaluation of the aorta for aneurysm and of the paraaortic region for extraluminal blood. Sonographic findings were correlated with surgical results and clinical outcome. When performed under these circumstances, sonography was accurate in demonstrating presence or absence of aneurysm (98%), but its sensitivity for extraluminal blood was poor (4%). A combination of sonographic confirmation of aneurysm, abdominal pain, and unstable hemodynamic condition resulted in the correct decision to perform emergent surgery in 21 of 22 patients (95%). An abbreviated sonographic examination done in the emergency room can provide accurate, useful information about the presence of aneurysm; this procedure does not significantly delay triage of these patients.

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We correlated endovaginal ultrasound (EVUS) results with laparoscopic findings in 16 patients with opera• tively confirmed acute pelvic inflammatory disease to evaluate the sensitivity and accuracy of EVUS for identification of uterine and adnexal pathology. Laparoscopy confirmed prospective sonographic abnormalities in 25 of 27 inflamed fallopian tubes (sensitivity, 93%) and in 19 of 21 ovaries with periovarian inflammation (sensitivity, 90%). Overall accuracy for EVUS prediction of periovar-E ndovaginal ultrasound (EVUS) is a useful i mag~ ing technique for evaluating the soft tissue anatomy of the female pelvis, having shown value in the assessment of follicular development, ectopic pregnancy, early intrauterine gestation, endometrial abnormalities, and pelvic and adnexal masses. 1 -8 The potential role for EVUS in patients with acute pelvic inflammatory disease (PID) has received little attention. We performed a prospective study to evaluate the accuracy and sensitivity of EVUS in a group of patients with clinically suspected PID, confirmed by diagnostic laparoscopy and endometrial biopsy. ian or tubal disease was 91% and 93

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