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Childhood trauma is associated with premature declines in health in midlife and old age. Pathways that have been implicated, but less studied include social-emotional regulation, biological programming, and habitual patterns of thought and action. In this study we focused on childhood trauma's influence via alterations in social-emotional regulation to everyday life events, a pathway that has been linked to subsequent health effects. Data from a 30-day daily diary of community residents who participated in a study of resilience in Midlife (n = 191, Mage = 54, SD = 7.50, 54% women) was used to examine whether self-reports of childhood trauma were associated with daily well-being, as well as reported and emotional reactivity to daily negative and positive events. Childhood trauma reports were associated with reporting lower overall levels of and greater variability in daily well-being. Childhood trauma was linked to greater reports of daily negative events, but not to positive events. Focusing on emotional reactivity to daily events, residents who reported higher levels of childhood trauma showed stronger decreases in well-being when experiencing negative events and also stronger increases in well-being with positive events. For those reporting childhood trauma, higher levels of mastery were associated with stronger decreases in well-being with negative events and stronger increases in well-being with positive events, suggesting that mastery increases sensitivity to daily negative and positive events. Our results suggest that childhood trauma may lead to poorer health in midlife through disturbances in the patterns of everyday life events and responses to those events. Further, our findings indicate that mastery may have a different meaning for those who experienced childhood trauma. We discuss social-emotional regulation as one pathway linking childhood trauma to health, and psychosocial resources to consider when building resilience-promoting interventions for mitigating the detrimental health effects of childhood trauma.

Fibromyalgia syndrome (FMS) is a chronic musculoskeletal pain condition poorly understood in terms of etiology and treatment by both physicians and patients. This condition of "uncertainty of illness" was examined as a variable involved in the adjustment of FMS patients, relating it to their depression, anxiety, affect, and coping styles. Fifty-one community-residing FMS patients provided self-report information on subsets of adjustment variables. Both cross-sectional and more dynamic longitudinal analyses showed that illness uncertainty was significantly associated with anxiety, negative affect, and avoidant and passive coping. Its positive relationship with depression was eliminated when a control variable, pain helplessness, was included as a covariate. Longitudinally, illness uncertainty interacted with interpersonally stressful daily events in predicting reports of reduced positive affect, suggesting that illness uncertainty acts as a risk factor for affective disturbances during stressful times. Implications of these results for therapeutic interventions are discussed.

A decade ago, Bolger and Zuckerman (1995) incorporated personality into the study of daily life events and psychological distress. Their approach put an entirely new cast on research and theorizing in this area. In their work, they focused on the predominantly negative personality trait of Neuroticism. In this article we extend their work to include theory and measurement of positive events and indicators of well-being. Integrating these research strands offers the possibility of a comprehensive yet highly sensitive and dynamic approach to the study of emotions, stress, and health in everyday life.

Background: Individual differences in adaptation to rheumatoid arthritis are not fully accounted for by illness severity or duration of symptoms.Purpose: In this study, we assessed differences in affect regulation and affect intensity as variables that might be important for identifying women with rheumatoid arthritis who are resilient versus those who have disrupted moods following pain exacerbations.Method: Specifically, affective regulation, affect intensity, active coping, neuroticism and weekly reports of pain, positive affect, and negative affect were assessed in a sample of 81 women diagnosed with rheumatoid arthritis.Results: Our results indicated that affective regulation, affect intensity, and active coping played important but distinct roles in the ebb and flow of negative and positive affect. In particular, active coping was related to positive affect, whereas affective regulation and affect intensity showed interactive effects, moderating the prospective relationship between pain and negative affect and pain and positive affect.Conclusion: Overall, this study suggests that recovery from rheumatoid arthritis pain can be swift, except for those women who have difficulty regulating strong unpleasant affect.

Three studies are presented that examine the effects of stress on the relationship between positive and negative affective states. In the first study, recently bereaved and disabled older adults were compared to matched control groups without these recent stressors. Negative affect was inversely correlated with positive affect to a significantly greater extent for the highly stressed groups compared with controls. In a second study, older adults were exposed to a laboratory stressor, and their positive and negative affective reactions recorded. Immediately following a speech stressor task, the inverse correlation between positive and negative affect was significantly greater than in pre- and postassessments of affects. The third study was an attempt to replicate and extend the findings from Study 2 with a mid-aged sample of women. The speech stressor had the same effects as in Study 2. A second stressor, which induced pain through immersion of an arm into cold water, had no effects on the correlation between affective states. Alternative explanations for these effects and the implications for cognitive interventions are discussed.

Relationships between positive affect, negative affect, and pain were analyzed as a prospective function of stressful events in a sample of rheumatoid arthritis patients and as a cross-sectional function of an information processing disposition in persons with fibromyalgia. Positive affect and negative affect were statistically separate factors overall in both samples. In addition, negative affect and pain were related across all conditions. However, positive affect and negative affect were more negatively correlated during stressful periods and more negatively correlated for patients who processed information in a more simplistic fashion. Also, positive affect predicted pain during stressful times and did so for patients who processed information more simplistically as well. These data suggest positive affect and negative affect are unique factors whose interrelation and external correlates are not static.

Concerning safety and efficiency in surgery of isolated orbital floor fractures, several treatment modalities are being discussed. It is a matter of recent interest that prefabricated titanium meshes provide significant advantages. The purpose of this study was to review the usability of the MatrixORBITAL® plate.In a prospective study we evaluated 10 patients (June 2011 to November 2013) with an isolated orbital floor fracture. All patients in the study group had undergone reconstruction with the MatrixORBITAL® plate. For purposes of analysis were recorded: age, gender, fracture category according to Jaquiéry et al. (2007), duration of surgery, complications, globe motility (Harms wall), exophthalmometry, function of the infraorbital nerve, evaluation of facial symmetry and aesthetic as well as personal contentment of the patient. A reference group received a PDS® sheet, an antral balloon or other materials.In the study group (2 women and 8 men aged between 26 and 83 years) all cases presented a large disruption of the orbital floor ( 2 cm2 bony defect; category II-III). Volume changes were universally associated with diplopia, but only in two cases with an entrapment of the inferior rectus muscle. The mean duration of the operation was 110 minutes (minimum 50, maximum 135 minutes). Postoperatively diplopia was decreasing in all cases. None of the patients had a significant impairment of visus and no reoperation was necessary. The analysis of functional outcomes between the groups mesh, PDS sheet and antral balloon revealed no significant differences.Based on this experience and due to good intraoperative handling, the authors recommend the prefabricated titanium plate in the treatment of isolated orbital wall fractures or in combination with the medial wall despite the material costs.

A retrospective analysis in the period 2007 to 2011 included 71 surgically treated patients for carcinoma of the head and neck region and subsequent reconstruction with 36 pedicled distant flaps and 47 free flaps. Patient specific parameters of data collection with SPSS 17.0 were age and sex distribution, TNM stage and treatment. The specific type of flap reconstruction, duration of surgery, complications, intensive care and inpatient treatment were recorded. The results showed that the healing process was uneventful in 26 (72.2 %) pedicled flaps, 14 (38.9 %) pedicled flaps were transplanted in a preoperatively irradiated area of the head and neck region and in 86.0 % with a positive healing process. Tumor stage, general physical condition of the patient and type of therapy are the key parameters for the choice of reconstruction.

Complex midfacial trauma requires interdisciplinary management. A wide range of reconstructive procedures are needed and if necessary secondary and even tertiary interventions should be performed at the appropriate time. We present the case of a 45-year-old man who was involved in a car accident and presented with severe injuries to the periorbital soft tissue. The focus was on the reconstruction of this sensitive region with regard to functional and aesthetic aspects. In view of the severity of the injuries the final clinical status is considered to be very important. Special issues and pitfalls in the reconstruction of trauma cases and potential management are discussed.

In their Research Article “Reconciling after civil conflict increases social capital but decreases individual well-being” (13 May, p. [787][1]), J. Cilliers et al. found that although reconciliation techniques helped communities in war-torn Sierra Leone recover from conflicts, individuals

Among individuals with rheumatoid arthritis (RA), stress-associated disease flare can severely impact well-being. Psychological factors such as personal mastery may buffer an individual from the negative effects of those flares. We tested the hypothesis that a high sense of personal mastery would prospectively predict stress reactivity. Measures of pain,perceived stress, fatigue, and mean arterial pressure (MAP) were collected before, during, and after two interpersonal stressors conducted on 73 individuals with RA. Factor analysis of the personal mastery scale yielded two independent factors: a 5-item "fatalism" component and a 2-item "control" component. Individuals with high fatalism scores reported overall greater joint pain at baseline and those scoring high on control exhibited lower MAP, and reported less stress and fatigue at baseline. After controlling for baseline differences, those high in control exhibited greater MAP increase during stress, and less drop in pain when compared to those low in control. These results suggest that individuals high in control may be more susceptible to the effects of acute stress; however, the overall beneficial aspects of high control outweigh the acute negative effects. Personal mastery may play a role in the experience of pain, stress, and fatigue for people with RA.

Predicting the everyday life events of people is a relatively unexplored topic, although several major theoretical approaches deal with related issues. The dispositional approach would assign a causal role to personality, while the situational approach would locate causation in the person's environment. Variations on these two extreme themes invoke an interactionist interpretation. Beyond this, a genuinely transactional approach focuses on the enduring person-environment relationship established as people deal with major and everyday life events. This study investigated a wide range of predictors of daily positive, negative, and ill-health events over time in a sample of 206 older adults. Results showed that personality variables played only a minor role in predicting daily events, although an interaction between extraversion and social network size was significant. Background demographic variables and the major stressors of recent conjugal bereavement and physical disability played a role in daily event occurrences. Overall, the strongest degree of predictability of events came from the events themselves: The high degree of event stability over time indicated the value of a genuinely transactional model in understanding the occurrence of everyday events.

This research examined whether cognitive behavioral therapy and mindfulness interventions that target responses to chronic stress, pain, and depression reduce pain and improve the quality of everyday life for adults with rheumatoid arthritis (RA). The 144 RA participants were clustered into groups of 6-10 participants and randomly assigned to 1 of 3 treatments: cognitive behavioral therapy for pain (P); mindfulness meditation and emotion regulation therapy (M); or education-only group (E), which served as an attention placebo control. The authors took a multimethod approach, employing daily diaries and laboratory assessment of pain and mitogen-stimulated levels of interleukin-6 (IL-6), a proinflammatory cytokine. Participants receiving P showed the greatest Pre to Post improvement in self-reported pain control and reductions in the IL-6; both P and M groups showed more improvement in coping efficacy than did the E group. The relative value of the treatments varied as a function of depression history. RA patients with recurrent depression benefited most from M across several measures, including negative and positive affect and physicians' ratings of joint tenderness, indicating that the emotion regulation aspects of that treatment were most beneficial to those with chronic depressive features.

The purpose of the current study was to determine whether the relationship between pain and emotion may be better understood by identifying people who are more vulnerable to emotional dysregulation and those who are able to regulate emotion. Data were collected from 81 women diagnosed with rheumatoid arthritis. We assessed affect intensity, emotion regulation, active coping, neuroticism as well as weekly reports of pain, positive affect, and negative affect. Results indicated that the joint effects of emotion regulation and emotional intensity predicted emotional responses to pain. The current study suggests that the emotional impact of pain is related to emotional intensity which can be tempered by the ability to regulate emotion.

This study examined the role of past episodes of depression on pain reports for patients with rheumatoid arthritis (RA) before and during stress induction. A history of major depressive episodes was assessed by diagnostic interviews for 138 RA patients, 74 who later participated in a set of laboratory procedures designed to induce interpersonal stress. Patients were evaluated by a rheumatologist and then asked to report joint and bodily pain throughout the laboratory study. We found that RA patients with a history of two or more episodes of major depression had more pain at baseline, and exhibited higher pain in response to the stress induction than did RA patients with either only one episode or no history of depression. Such findings provide new insight in the dynamic relationships between depression, stress, and pain.

Objective Fibromyalgia syndrome (FMS) is characterized by uncertainty in diagnosis, treatment, and outcome. This study assessed the role of uncertainty of illness in relationship satisfaction in patients with FMS and osteoarthritis (OA). Methods A total of 51 patients with FMS responded to self-report instruments assessing their uncertainty about their illness, functional ability, average pain, and relationship satisfaction. Their partners independently reported on their sense of caregiver burden and their supportiveness toward the patients. Thirty-two patients with OA and their partners served as a control group. Results Patients' functional ability and pain were related to partner caregiver burden. Partner caregiver burden was related to lower levels of partner supportiveness for the FMS dyads, but not for the OA dyads. Relationship satisfaction of patients with FMS was related to their higher levels of uncertainty of illness in interaction with their functional disability and pain and their partners' supportiveness. Under high levels of uncertainty of illness, low levels of partner supportiveness were related to lower patient relationship satisfaction, whereas low levels of uncertainty of illness were significant interacting variables in the OA sample. Conclusion The results suggest that uncertainty of illness is a prominent feature affecting patients with FMS in their relationships with their partners. Suggestions for additional research to explore the role of uncertainty of illness in social relationships are presented, and the therapeutic implications for patient/partner relationships are explored.

The aim of this prospective study was to evaluate oral surgical procedures performed as day surgery under local anesthesia. We examined patients' general condition, and besides checking for intraoperative complications we analyzed postoperative bleeding in patients with hemostatic disorders.The patient population consisted of 1540 patients (797 female, 743 male), who underwent a total of 2055 minor oral surgical procedures over a 5-year period (1998-2002). Before the treatment started a data file was made for each patient, which contained information on his or her past medical history, concomitant medication, why the operation was indicated, premedication, anesthetic and surgical techniques applied, and postoperative treatment.Systemic pathologies influencing surgical decisions were found in 316 patients (20.5%), affecting 676 interventions (32.9%). In 109 patients (5.3% of the 2055) altered hemostasis was found. The surgical procedures recorded were: (operative) tooth extraction (n=394), interventions for surgical conservation of teeth (n=272), treatment for cysts (n=140), surgical revisions (n=46) and preprosthetic surgery (n=19). Passing complications, mostly systemic in nature, occurred during 27 sessions of local anesthesia (1.3%). There were 87 adverse events intraoperatively (4,2%), most of which were confined to the surgical field; specifically 15% of these complications took the form of hemorrhage. We observed no significant correlation between the occurrence of intraoperative complications and patients' gender, predisposing systemic pathologies including bleeding disorders, or age. Postoperative hemorrhage was observed significantly more frequently in patients with impaired hemostasis and required admission to hospital for inpatient treatment in 2 cases.According to our investigation, oral surgery can be performed in patients with compromised general condition with as few intraoperative complications as in patients with no general medical problems. However, in individual cases specific risk factors can be present and oral surgery may be temporarily contraindicated, at least as day surgery.

This investigation examined the roles of gender and desires for independence and dependence in the support process. We assessed 118 older adults who reported needing help with at least 1 activity of daily living as a result of illness or health problems. Men with a high desire to be independent responded negatively to receiving support from their social network. Women's outcomes were generally unaffected by their independence and dependence desires. These results indicate that gender and desires for independence and dependence should be taken into account when examining the social support process, especially in men with health problems.

In two investigations, we studied vulnerability to the negative effects of stress among women in chronic pain from 2 types of musculoskeletal illnesses, fibromyalgia syndrome (FMS) and osteoarthritis (OA). In Study 1, there were 101 female participants 50 to 78 years old: 50 had FMS, 29 had OA knee pain and were scheduled for knee surgery, and 22 had OA but were not planning surgery. Cross-sectional analyses showed that the three groups were comparable on demographic variables, personality attributes, negative affect, active coping, and perceived social support. As expected, FMS and OA surgery women reported similar levels of bodily pain, and both groups scored higher than OA nonsurgery women. However, women with FMS reported poorer emotional and physical health, lower positive affect, a poorer quality social milieu, and more frequent use of avoidant coping with pain than did both groups of women with OA. Moreover, the perception and use of social support were closely tied to perceived social stress only among the FMS group. In Study 2, we experimentally manipulated negative mood and stress in 41 women 37 to 74 years old: 20 women had FMS, and 21 women had OA. Participantsfrom each group were randomly assigned to either a negative mood induction or a neutral mood (control) condition, and then all participants discussed a stressful interpersonal eventfor 30 min. Stress-related increases in pain were exacerbated by negative mood induction among women with FMS but not women with OA, and pain during stress was associated with decreases in positive affect in women with FMS but not women with OA. These findings suggest that among women with chronic pain, those with FMS may be particularly vulnerable to the negative effects of social stress. They have fewer positive affective resources, use less effective pain-coping strategies, and have more constrained social networks than their counterparts with OA, particularly those who experience similar levels ofpain. They also seem to experience more prolonged stress-related increases in pain under certain circumstances, all of which may contribute to a lowering of positive affect and increased stress reactivity over time.

Suicidal thoughts and attempts have been studied from a number of perspectives, but only recently has an attempt been made to incorporate many different psychological perspectives into one framework. Baumeister (1990) has integrated personality and social psychological perspectives into one sequential model, moving from instigating events to a final stage of suicidal thoughts. Employing a sample of older adult subjects undergoing the stresses of a recent health downturn, this study tested a four-stage model of suicidal ideation based on many of the components proposed by Baumeister. Structural equation modeling achieved a good fit to the data. Results are discussed in terms of the importance of including life events, particularly poor health, and cognitive variables such as confusions in thinking, in understanding suicidal ideation.

Studying and helping couples burdened with a major life stressor such as rheumatoid arthritis (RA) can be enhanced by employing well-understood conceptual and empirical frameworks, in our research person/environment fit (P x E) models. We measured P x E effects in a sample of 62 rheumatoid arthritis (RA) patients with locus of control beliefs, age, and the health status of the subjects as the Person variables and their spouses' control encouragement as the Environment variable. As predicted, externals were most sensitive to their spouses' behavior. Health status and age moderated the effects of the subjects' control beliefs and spouses' control efforts. Control encouragement showed positive benefits, but only for the younger and healthier subjects; it was related to increased psychological distress for externals in poorer health. Although many models of therapy suggest the benefits of increasing personal control, these data suggest the necessity of employing a more complex model integrating both person and social environment variables in understanding mental health.

This article reports on the development and validation of a scale designed to assess a postulated psychological trait in older adults—routinization. Some older adults are thought to be motivated to maintain the daily events of their lives in relatively unchanging and orderly patterns of regularity. Those older adults may resist change, rejecting attempts to alter patterns of daily living, and experience distress at events that require change. This trait of routinization was explored with a 20-item self-report scale. Factor analysis revealed two underlying factors: 1) Having Order and Routine in daily living, and 2) Disliking Disruption. Relationship of the instrument to other standard personality instruments was assessed; it was found that the instrument was only modestly related to other scales. Validity of the scale was tested by relating it to the frequency of occurrence of desirable and undesirable small, everyday events. Also, its relationship to two factors of mental health reported by participants in a multisession experimental intervention to increase personal control and mastery was assessed. Evidence for validity of the scale in both sets of tests was found. Further exploration of the properties of the trait measure appears warranted.

The study analyzed daily event differences between groups experiencing the major stressors of conjugal bereavement and physical disability, and analyzed the association of everyday events with self-reports of mental health for different groups across a 3-month time span. Monthly interviews were conducted with 61 recently conjugally bereaved, 62 recently physically disabled, and 123 matched-comparison older adults between the ages of 60 and 80. The purpose of these interviews was to obtain a comprehensive assessment of the monthly frequencies of everyday life events. Self-reports of mental health were obtained from paper-and-pencil measures filled out after each interview. Causal models were used to analyze the best-fitting structure of event/mental health relationships for the first 3 monthly interviews. Undesirable events showed uniformly adverse effects on mental health. Desirable events benefited the psychological well-being of the disabled the most and had no positive effects on the mental health of the bereaved. The bereaved also evidenced less stability over time than other groups in the frequency of small undesirable events.

Two traditions of research on the concept of control have developed. One tradition involves the experimental manipulation of control, usually with a focus on enhancing control and thus improving adjustment and well-being. The other tradition regards control as a personality or trait variable and has been concerned with the development and validation of scales to measure it. Linking these two traditions would help determine if people differentially react to control-enhancing manipulations because of control predispositions. This study reports on an investigation into this topic. A sample of 209 subjects responded to the Levenson I-E scale and a control-enhancing manipulation (vs placebo contact and no contact control samples) within the context of a longitudinal assessment of stress and mental health in older adults. Variables assessed included personal mastery and mental health. The results showed significant interactions of the trait and manipulated variables. Control enhancement was most effective for those high in control beliefs. Some positive benefits of the placebo contact also were found. Subjects low in control beliefs did not respond strongly to control manipulations, while those high in control did. Directions for additional research are discussed.

A study was conducted to investigate, in alcoholics receiving treatment, the relationships between demographic variables, personality factors, internal-external orientation, drinking history, and willingness to participate in research. The hypothesis was confirmed that in an alcoholic population receiving treatment, research volunteers would differ significantly from nonvolunteers. It was concluded that alcoholics voluntarily in treatment for alcoholism who also elect to participate in research are unrepresentative of the treatment population.

Our subjects were 20 patients with life-threatening or symptomatic ventricular arrhythmias refractory to standard oral antiarrhythmic drugs but responsive to intravenous lidocaine. After evaluation of arrhythmias and treatment with intravenous lidocaine, oral tocainide dosage regimens were based on age, weight, and clinical status. During initial tocainide treatment, six plasma tocainide concentrations were recorded within a single dosing interval in 17 of 20 patients, by which standard kinetic parameters were calculated. Eventual trough steady-state tocainide plasma concentrations were predicted from the derived patient-specific kinetic parameters. Mean daily tocainide dose was 1800 mg (1200 to 2400). Mean daily tocainide doses (milligram per kilogram) did not differ significantly among responders and nonresponders or among patients with or without congestive heart failure. Mean peak and trough plasma concentrations 48 hr after initiation of therapy were 9.8 and 7.5 mcg/ml. Tocainide plasma concentrations did not correlate with responders and nonresponders or identify patients who were developing adverse reactions to tocainide. There were no significant differences in any of the calculated kinetic parameters as a function of response to tocainide or the presence of congestive heart failure, but there was a trend toward smaller volumes of distribution and higher average plasma concentrations at steady state in patients with congestive heart failure. There were no significant kinetic differences among patients with and without congestive heart failure, but a trend toward higher plasma concentrations in patients with congestive heart failure and the small number of patients suggests that further data collection is necessary before dosage recommendations can be made. Clinical Pharmacology and Therapeutics (1983) 34, 596–603; doi:10.1038/clpt.1983.221

Heparin-associated thrombocytopenia has been reported most commonly with bovine lung preparations. We prospectively evaluated the incidence of thrombocytopenia in 43 patients receiving intravenous continuous infusions of either bovine lung heparin, manufactured by a new process, or a standard porcine intestinal mucosa heparin for a minimum of five days in a double-blind, randomized fashion. The decision to continue heparin therapy beyond five days was made by the patient's primary physician. All patients had documented acute thromboembolic disease, pretherapy platelet counts > 150000/mm3, and no evidence of prior coagulation disturbance. No patients had undergone cardiopulmonary bypass or hemodialysis within seven days previous to the initiation of heparin therapy. Thrombocytopenia was defined as a decline in platelet count from the normal range of 150000–350000/mm3 to 3. Thrombocytopenia occurred in one patient (4.6 percent) receiving bovine lung heparin on day nine of therapy and in no patients (0 percent) receiving porcine intestinal mucosa heparin. Adverse reactions occurred in nine patients (42.9 percent) receiving porcine intestinal heparin and five patients (22.7 percent) receiving bovine lung heparin. This difference was not statistically significant. The results of this study indicate that the incidence of thrombocytopenia is low (< five percent) with both bovine lung heparin, manufactured by a new process, and porcine intestinal mucosa heparin when therapy is limited to short therapeutic courses (< 1 week).

Alcoholics attributed an alcoholic's behavior to internal or dispositional factors. Alcoholics identified more closely with alcoholics who could succeed and nonalcoholics who failed than with nonalcoholics who could succeed and alcoholics who failed.

The relationship between activity limitation and self-report on a variety of mental health measures was investigated through a longitudinal study of 124 noninstitutionalized older adults between 60 and 80 years of age, recruited either as recently disabled (N = 62) or as a matched control (N = 62). Fifty-five of these respondents (disabled, n = 28; controls, n = 27) selected persons who could be contacted to provide informant informations. Results showed the relationship between disability and mental health measures to be highly significant and stable across time. Further older adults classified as severely disabled experienced higher levels of anxiety, suicidal ideation, and overall distress than did the moderately disabled participants. Evidence was found for reciprocal causal relationships between health and mental health. Informants' reports supported findings based on self-report.

The clinical history which went back to early childhood is extremely interesting. Also notable is the relative paucity of complaints referable to the growth until it had reached huge proportions. The possibility of a long-standing latent malarial infection may be inferred although no hematologie or pathologic evidence was found in our study. It is interesting to speculate on the possible role of trauma in the initiation of hemorrhages and cystic degeneration in an organ which is the site of capillary and cavernous hemangiomas. These conditions would undoubtedly render the spleen unusually susceptible to injury. Again, however, no definite history of trauma was elicited but forgotten injuries may well have occurred repeatedly during the life of the patient. A comparison of the histologie features of our case with those we have had the opportunity to review in the literature leads us to remark on the unusually striking features of hemangioma depicted in this case. The association of a relatively advanced pregnancy as a troublesome complication is of clinical interest, and the favorable outcome for mother and child indicates to what a degree nature will tolerate a pathologic state and a surgical insult of great magnitude without relinquishing its purpose.

To delineate the effects of affective involvement and frequency of experience on cognitive discrimination of social stimuli, 60 Ss were asked to describe in as many ways as they could persons meeting each of six descriptions, the descriptions entailing both affect and frequency of experience. Ss then grouped those descriptions in a free-sorting task. Results indicated that positive affect and high frequency of contact had a significantly enhancing effect on the quantity of responding but that neutral affect exercised a significantly enhancing effect on the discriminational complexity of the responding. Implications of these results for three contradictory theoretical stances are discussed.

We investigated the role of two major stressors, recent disability and conjugal bereavement, in older adults' self-reports of mental health and recovery from stress. A sample of 246 older adults between the ages of 60-80 was interviewed monthly for 3 months by trained elderly interviewers; Month-10 interview data were also analyzed. Control subjects, who were not experiencing the stressors, were carefully selected from a sample of adults matched on age, sex, and socioeconomic status. Dependent variables were psychological distress and psychological well-being, each with component subscales. The disabled group evidenced significantly lower positive well-being and significantly greater distress than did the other groups. Bereaved subjects demonstrated high levels of depression compared with the disabled subjects, but showed less anxiety. Bereaved subjects showed recovery on several indicators of mental health, but disabled subjects continued to show considerable psychological upset in comparison with the other groups.

Mastitis puerperalis is a severe complication of puerperium. Results of treatment of 70 patients with mastitis by low-dose conventional X-ray irradiation and secondary inhibition of lactation by conservative physical measures are reported. Breast abscesses were observed only in 6 of 70 patients. Therefore the antiinflammatory irradiation with low-dose X-rays is a suitable method of treatment.

Three patients are reported, two of whom had mothers who revealed ingestion of abortifacient drugs during pregnancy. All patients resemble one another and those described earlier with malformations that were probably either aminopterin- or methotrexate-induced. It is likely that Patients I and II have abnormalities associated with the teratogenic action of these folic-acid antagonists. The etiology of Patient III's defects remains uncertain.

The factor structure of positive and negative social ties was studied among 246 older adults who were either recently physically disabled, recently conjugally bereaved, or matched controls. Covariance structure analyses were carried out on a network measure to determine whether positive and negative social ties represent independent domains of social experience, and to assess the degree to which their structure is invariant across groups undergoing major loss transitions. Positive and negative social ties were found to be independent and there was substantial similarity in their factor structure across the three groups. Hierarchical regression analyses revealed that, whereas positive social ties were related to psychological well-being, negative social ties were predictive of both psychological well-being and distress. These results demonstrate the importance of assessing both positive and negative ties in explaining the psychological adjustment of older adults.

In the tissue of 54 ovarian carcinomas and 38 normal human ovaries the activity of cathepsin D was determined by means of the Anson-method. In ovarian carcinomas the mean activity of cathepsin D was 4515 pmol T/s/g tissue, in normal ovarian tissue only 2119 pmol T/s/g. The difference is significant (p less than 0,001). The dependency on age of the activity of cathepsin D suitable for normal ovary, got lost in cancer tissue. There is no relationship between the amount of activity of cathepsin D and the stage of the tumour. Extreme high activities of cathepsin D were found in metastatic ovarian carcinomas. The activity of cathepsin D is higher in endometrioid and papillary than in mucigenous and hypernephroid ovarian carcinomas. The different activities of cathepsin D were discussed with regard to the invasive growth of cancer and to deranged protein metabolism.

Rat spermatozoa are immotile in the cauda epididymidis and are kept quiescent by a protein which increases viscoelasticity of cauda luminal fluid. How species-specific this phenomenon is, is unknown. In the present study, the motility of cauda epididymal spermatozoa of rats, hamsters, guinea pigs, rabbits and humans have been investigated. Sperm motility was observed in undiluted cauda sperm samples and in samples diluted with physiological diluents with or without Ca++, among others. Hamster sperm were studied in further detail to determine if the motility inhibiting factor in hamster cauda lumen fluid had characteristics similar to those previously described in the rat. Cauda fluid protein concentrations and apparent viscoelasticity were also determined and related to cauda sperm motility in all species. The results demonstrated that all species studied except rabbits have immotile sperm in their native cauda fluid and that additional Ca++ is not a factor in the initiation of motility. Cauda sperm immotility is not always related to fluid viscosity, however, so other as yet unknown mechanisms must be called upon in some species. The vigorous motility of rabbit spermatozoa in their native fluid implies that a fundamental difference exists in the relationship between epididymis and spermatozoa in rabbits from that observed in other species.

Diethylstilbestrol (DES) is the first example of transplacental carcinogenesis in humans, as evidenced by an excess of clear cell adenocarcinoma of the vagina and cervix in exposed women. We hypothesize that: 1) in utero DES exposure will be responsible for a broader spectrum of cancer with variable age of onset as a function of latency effects in exposed humans of both sexes; 2) teratogenicity of DES will be more far-reaching than currently recognized and will harbor cancer implications in the face of known associations between teratogenesis and carcinogenesis; and 3) genetic heterogeneity will be a critical etiologic discriminant in DES associated cancer. This hypothesis embraces a prodigious body of data at the infrahuman level, as well as extant pharmacogenetic and ecogenetic observations in humans which signify heritable variations in response to environmental carcinogenic exposures. This hypothesis has important implications for drug testing with appropriate preventive strategies. Herein, particular restraints with monitoring through governmental legal channels must be employed. Past experience has clearly indicated negligence in shouldering this responsibility by both the pharmaceutical industry and government regulatory bodies.