Environmental enrichment models a naturalistic form of maternal separation and shapes the anxiety response patterns of offspring.

Environmental enrichment (EE) mimics positive life experiences by providing enhanced social and physical stimulation. Placement into EE following weaning, or in later life, confers beneficial outcomes on both emotional and cognitive processes. However, anxiety-like behavior is also reported, particularly in rats exposed to enhanced housing during early development. Notably, the quality of maternal behavior affects stress regulation and emotional stability in offspring, yet the impact of environmental context on maternal care has not been thoroughly evaluated, or are the influences of EE on their offspring understood. To investigate the role of EE on these factors we analyzed the details of mother-neonate interactions, and juvenile offspring performance on several anxiety measures. Additionally, we evaluated neurochemical differences (i.e. serotonin, corticosterone, GABA, glutamate) in prefrontal cortex and hippocampus as a function of EE, Communal Nesting (CN) and Standard Care (SC). Although EE dams spent significantly less time on the nest and had lower nursing frequencies compared to SC dams, there were no differences in maternal licking/grooming. In offspring, EE increased GLUR1 level and GABA concentrations in the prefrontal cortex of both juvenile male and female rats. A similar pattern for glutamate was only observed in males. Although EE offspring spent less time on the open arms of the elevated plus maze and had faster escape latencies in a light-dark test, there were no other indications of anxiety-like behavior on these measures or when engaged in social interaction with a conspecific. In the wild, rats live in complicated and variable environments. Consequently dams must leave their nest to defend and forage, limiting their duration of direct contact. EE exposure in early development may mimic this naturalistic maternal separation, shaping parental behavior and offspring resiliency to stressors.

Reliability of multimodal evaluation of abnormal screening mammogram results.

OBJECTIVE: Our purpose was to evaluate the effectiveness and reliability of the multimodal evaluation of suspicious or equivocal screening mammogram results by use of ancillary imaging studies and needle biopsies. STUDY DESIGN: This article reports on the experience of the Breast Evaluation Center at Long Beach Memorial Medical Center between 1989 and 1993 where 43,125 screening mammograms were performed. RESULTS: A total of 2866 patients were called back for additional evaluation, which consisted of magnification views and ultrasonography. Since 1990 fine-needle biopsies have been done on selected patients and since 1992 core biopsies have been available. Needle localization excisional biopsies were performed on 344 patients, and 158 cancers were diagnosed. This represents a 46% positive predictive value. Careful follow-up was obtained on the patients seen in 1990 to attempt to determine whether any cancers developed within a year of the time the patients with abnormal screening mammogram results had been evaluated with imaging modalities but no tissue diagnosis made. One cancer may have been missed. The cost savings of this protocol are also examined. CONCLUSION: Multimodal evaluation of patients with suspicious screening mammogram results appears to be a cost effective approach with adequate sensitivity and specificity.

Improved mammographic accuracy.

Use of ancillary imaging studies to evaluate suspicious screening mammograms can improve their positive predictive value for detecting malignant lesions. In 1989 8181 screening mammograms were performed at the breast evaluation center at Memorial Hospital Medical Center in Long Beach. A total of 670 patients were called back for magnification views or ultrasonographic evaluation, and 92 of these patients underwent surgical biopsy. There were 42 cancers diagnosed, yielding an accuracy rate of 46%.

Successful autogenous corticocancellous grafting of a radial defect complicating acute hematogenous osteomyelitis in an infant.

Recurrent osteomyelitis of the radius during infancy after initial hematogenous onset is rare. When encountered, this lesion may result in a segmental defect associated with limitation of forearm motion and progressive deformity. A 10-month-old girl developed distal radial osteomyelitis following bilateral otitis media. A radial defect developed and was treated successfully with autogenous tibial corticocancellous grafting. The surgical management of radial shaft defects is reviewed.

Reproductive significance of changes in the endometrial cavity associated with exposure in utero to diethylstilbestrol.

PIP: Case histories of 2 women who had been exposed to diethylstilbestrol (DES) in utero and who had irregular endometrial cavities and who had complications of pregnancy, possibly related to these abnormalities, are described. 2 reports have suggested an increased frequency of cervical imcompetence in DES-exposed women. Although it is tempting to relate these anecdotal reports of increased pregnancy wastage to the anatomic changes seen in women exposed to DES in utero, conflicting reports lead to the inference that no definite relationship has yet been established. A history of in utero DES exposure is not necessarily reason for alarm in patients who want to become pregnant. None of the studies thus far has reported diminished fertility in these patients. Initial evaluation of all pregnant patients should include inquiry about possible intrauterine exposure to DES.^ieng