Partners in adversity V: Support,personality and coping behaviour at the time of crisis

This paper presents further results from a study of married women in Edinburgh who had just suffered an adverse experience: either their husband's non-fatal myocardial infartion, their husband's death or their own arrival in a Women's Aid refuge for battered women. Interviews were carried out 4–6 weeks following the adverse experience and, where possible, again approximately 3 months later. Symptoms were assessed using the 30-item General Health Questionnaire and criterion-based measures of depression and anxiety derived from it. The extent and nature of crisis support from household members and from groups of people outside the household, and also of failures in expected support, was measured at first interview. A modified version of Tyrer and Alexander's (1979) personality schedule was administered at the follow-up interview, and the resulting personality data were then reduced to six factors using principal components analysis. An interviewer assessment of how well the subject was coping was made at both interviews. The vast majority of the sample received extensive practical and emotional support from family and friends, and perhaps because such positive support was so prevalent, variations in it seemed to have little effect on symptoms. However, subjects who were unexpectedly let down or criticised by friends or family tended to show higher symptom levels, although, surprisingly, this was less true for the bereaved wives than for the others. The six personality factors that emerged were labellednervousness (similar to neuroticism)impulsivity, social withdrawal, helplessness, inferiority andaggressiveness. There was evidence that subjects high on nervousness remained symptomatic longer following the adverse experience. The aggressiveness factor showed a curvilinear trend with high and low aggressives showing higher symptom levels than middle aggressives. However, for the coronary wives the trend was linear with low aggressives having high symptoms. Subjects low on impulsivity were more affected by being let down by friends and family. The interviewer-assessed coping measure was linearly related to nervousness and showed a curvilinear relationship with aggressiveness.     

Life stress and depressive outcome: Application of a dissipation model to life events

Summary A group of 71 patients were interviewed seven months after they had been screened for a new episode of unipolar depressive illness and the relationship between symptom severity at this time and the life stresses experienced over this period investigated. On the basis of the follow-up assessment, patients were divided into a well and ill group. The mean number of life events experienced during the study period did distinguish patients ill from patients well at follow-up but with less success than has been claimed for onset. Further analysis took into account both the severity of life stress suffered and the time of its occurrence. This improved the discrimination. Both time of event occurrence and event severity were then included in a model of adversity in which it was postulated that event stress dissipates with time. Application of the model to the study data resulted in the statistical relationship between life stress and outcome being somewhat strengthened. The possible implications of this result for further research in life stress are discussed.This work was supported by the Science Research Council, the Mental Health Research Fund (Scottish Division) and the Medical Research Council.     

Neurological outcome of methylmalonic acidaemia

OBJECTIVE: To assess the long term outcome of patients with methylmalonic acidaemia in a cross sectional study. PATIENTS: All 35 patients with methylmalonic acidaemia seen at Great Ormond Street Hospital for Children in London, UK between 1970 and 1996 were studied. They were divided into cobalamin responsive (n = 6) and non-responsive (n = 29), and early and late onset groups. RESULTS: There was a significant difference between cobalamin responsive and non-responsive groups in severity, survival, and incidence of neurological sequelae. Cobalamin responsive patients had mild disease, irrespective of age at presentation, their neurological complications were less severe, and they are all alive. The cobalamin non-responsive group comprised 19 early and nine late onset patients. The early onset patients had more severe disease at presentation and 14 have died; all late onset patients are alive. There was no significant difference in abnormal neurological signs, although early onset patients had a significantly reduced full scale intelligence quotient and poor cognitive outcome. In both groups, abnormal neurological signs continue to increase with age. CONCLUSIONS: Cobalamin responsive patients have a better long term outcome. The outcome in the non-responsive patients, particularly the early onset group, remains poor and alternative treatments should therefore be considered early in this group.     

The immunohistology of follicle lysis in lymph node biopsies from homosexual men

Follicle lysis is a characteristic alteration of B cell follicles described recently in lymph node biopsies from homosexual men. It consists of disruption of germinal centers by aggregates of small mature lymphocytes variably associated with erythrocyte extravasation. We studied the immunohistology of follicle lysis identified in lymph node biopsies from 11 homosexual men. The results indicate that follicle lysis has two principal immunohistologic features: (1) intrafollicular aggregates of small lymphocytes predominantly of polytypic mantle B cell phenotype (T015+/Leu-8+/mu+/delta+/k+ or lambda+), and (2) disruption of the normal, unified follicular meshwork of R4/23+ dendritic reticulum cells by these B cell aggregates. These structural alterations may affect the functional integrity of the germinal center as it pertains to the abnormal B cell effector function and the increased prevalence of B cell lymphoma recently documented in the acquired immunodeficiency syndrome and related disorders. Because dendritic reticulum cells weakly express the Leu-3 (T4) antigen, which is known to be an essential component of the receptor for human T- lymphotropic virus type III/lymphadenopathy-associated virus (HTLV- III/LAV) retrovirus infection, it is possible that retroviral infection of dendritic reticulum cells may play a role in the pathogenesis of follicle lysis.     

Marrow transplantation with or without donor buffy coat cells for 65 transfused aplastic anemia patients

Sixty-five multiply transfused patients with severe aplastic anemia were given cyclophosphamide followed by grafts anemia were given cyclophosphamide followed by grafts from HLA-identical siblings. The effect of the administration of viable donor buffy coat cells following the marrow inoculum was evaluated with regard to graft rejection and survival. Results in 43 patients so treated are presented along with those in 22 concurrent patients given marrow alone. Most patients given buffy coat had positive in vitro tests of sensitization indicating a high risk for graft rejection, while all but one of the patients given marrow alone had negative tests. Thirty of the 43 (70%) patients given marrow and buffy coat are alive between 10 and 61 mo (median 36) after grafting; 4 died after graft rejection and 6 with acute or chronic graft-versus-host disease (GVHD). Eleven of the 22 (50%) patients given marrow alone are alive between 29 and 65 mo (median 52); 7 died after graft rejection and 3 with GVHD. The addition of buffy coat cell infusions to the marrow inoculum reduced the risk of rejection and increased survival in the currently reported transfused patients when compared to patients grafted before 1976. However, there was an increased risk of chronic GVHD. Recipients of marrow from female donors survived slightly better (73%) than recipients of male marrow (58%).     

含栅栏状肉芽肿样小体(巨菊形团)的低度恶性纤维肉瘤--报道1例转移病例

自Ｌａｎｅ等 1997年详细报道了ＨＳＣＴＧＲ后 ,一直没有该肿瘤转移潜能的证据 ,该文报道 1例 2 8岁女性右上臂三角肌内ＨＳＣＴＧＲ(8 7ｃｍ× 5 5ｃｍ× 4 0ｃｍ大小 ) ,术后 4年右肺转移 ,并于 6年后行肺部手术 ,取出 0 6ｃｍ～ 1 2ｃｍ大小转移性结节 3枚。肿瘤从大体形态到超微结构及免疫组化表现与前文相似。本文总结出该病光镜下由梭形细胞为主 ,构成 3种图像 :①纤维瘤样区 ,为肿瘤的主要成分 ,无核分裂象 ;②细胞区 ,细胞丰富 ,核浓染 ,胶原减少 ,罕见核分裂象 ;③特征性病变 (有诊断意义 ) ,即由丰富细胞核环绕的玻璃样变小体 …