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Romantic experiences are more fluid and heterogeneous during middle adolescence than at any other life stage, but current understanding of this heterogeneity and flux is limited because of imprecise measurement. A sample of 531 adolescents (55% female; 28% non-Hispanic White; 32% Black; 27% Hispanic; 14% Other) recruited from an ongoing birth cohort study (Mean age = 16.7 years, SD = 0.358), was administered bi-weekly diaries over 52 weeks to prospectively record transitions in and out of romantic and sexual relationships and to assess links with positive affect (frequency of happiness) and negative affect (frequency of sadness). Relationship statuses considered included not only dating, but also liminal and asymmetrical statuses such as talking/flirting and crushes. Latent profile analyses revealed six relationship status trajectories, or love life profiles, based on the number of intra-year partners and on the extent of involvement in each of the relationship statuses. Approximately half of teens either were in stable dating relationships or uninvolved romantically during the year; however, half experienced variable levels of flux in their love lives. Relationship instability, not romantic involvement per se, was associated with higher levels of sadness and lower levels of happiness. Snapshots of teen romantic involvement based on one or two points in time obscure the extent of relationship heterogeneity and flux and how relationship status trajectories are associated with positive and negative affect., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Prior research has documented an association between adolescents' romantic experiences and poor emotional health. However, lack of intensive longitudinal measurement and an emphasis on negative affect have limited understanding about the extent to which adolescent relationship quality influences the emotional health of adolescents in partnerships, including the potential benefits of high-quality partnerships. Previous research has also been limited in its ability to account for factors that select adolescents into lower or higher quality partnerships. Using biweekly intensive longitudinal data from the mDiary Study of Adolescent Relationships linked to six waves of birth cohort data from the Fragile Families and Child Wellbeing Study, this paper uses multilevel mixed-effects models to address three questions: (1) How are changes in partnership quality (defined as validation, frequency of disagreements, and global quality) associated with changes in both positive and negative affect; (2) Do observed associations persist net of factors that potentially select adolescents into lower or higher quality partnerships (e.g., childhood family experiences); and (3) Do associations between partnership quality and affect differ by gender? Results show that higher quality partnerships are associated with both decreases in negative affect and increases in positive affect. There were no significant gender differences on average. The study's findings highlight the importance of partnership quality as a key source of temporal variation in adolescents' emotional states.

Purpose: Brain monoamine vesicular transport disease is an infantile-onset movement disorder that mimics cerebral palsy. In 2013, the homozygous SLC18A2 variant, p.Pro387Leu, was first reported as a cause of this rare disorder, and dopamine agonists were efficient for treating affected individuals from a single large family. To date, only 6 variants have been reported. In this study, we evaluated genotype-phenotype correlations in individuals with biallelic SLC18A2 variants., Methods: A total of 42 affected individuals with homozygous SLC18A2 variant alleles were identified. We evaluated genotype-phenotype correlations and the missense variants in the affected individuals based on the structural modeling of rat VMAT2 encoded by Slc18a2, with cytoplasm- and lumen-facing conformations. A Caenorhabditis elegans model was created for functional studies., Results: A total of 19 homozygous SLC18A2 variants, including 3 recurrent variants, were identified using exome sequencing. The affected individuals typically showed global developmental delay, hypotonia, dystonia, oculogyric crisis, and autonomic nervous system involvement (temperature dysregulation/sweating, hypersalivation, and gastrointestinal dysmotility). Among the 58 affected individuals described to date, 16 (28%) died before the age of 13 years. Of the 17 patients with p.Pro237His, 9 died, whereas all 14 patients with p.Pro387Leu survived. Although a dopamine agonist mildly improved the disease symptoms in 18 of 21 patients (86%), some affected individuals with p.Ile43Phe and p.Pro387Leu showed milder phenotypes and presented prolonged survival even without treatment. The C. elegans model showed behavioral abnormalities., Conclusion: These data expand the phenotypic and genotypic spectra of SLC18A2-related disorders., (Copyright © 2022 American College of Medical Genetics and Genomics. Published by Elsevier Inc. All rights reserved.)

Concerns about parenting adolescents are not new, but the rapid diffusion of digital technologies has heightened anxieties over digital parenting. Findings are decidedly mixed regarding the impact of digital technologies on adolescent well-being, and parents are left to navigate their concerns without an empirically based road map. A missing link for understanding the state of the science is a clear characterization of how digital parenting is measured, including an evaluation of which areas demand an outsized share of scientific attention and which have been overlooked. To address this gap, we undertook two interdisciplinary systematic reviews of the digital-parenting literature and characterized measurement across (a) quantitative surveys ( n = 145 studies) and (b) qualitative focus groups, interviews, codesign studies, and user studies ( n = 49). We describe previously popular areas of survey measurement that are of decreasing relevance to parenting of digital spaces (e.g., co-use, hovering). We likewise highlight areas that have been overlooked, including consideration of positive uses of digital technologies, acknowledgment of bidirectional influence, and attention to heterogeneity among families and to extraparental social ecologies of support and monitoring. We provide recommendations for the future of digital-parenting research and propose a more comprehensive approach to measuring how modern adolescents are parented.

Digital technology and social media platforms have transformed the ways adolescents communicate and cultivate romantic relationships, but few studies consider whether relationships initiated online are less salutary than those formed in person. A sample of 531 adolescents (Mean age = 16.7 years, SD = 0.358; 55% female) was recruited from an ongoing birth cohort study and administered bi-weekly diaries over a year to evaluate the circumstances associated with adolescents' romantic relationship formation and relationship quality. Two-thirds of respondents initiated one or more romantic relationships during the study, of which 15% were initiated online. Girls who did not fit in well at school and who had difficulty making friends were more likely to initiate romantic relationships online than their more sociable peers who fit in well at school; for boys, however, access to mobile devices increased the odds that romantic relationships were initiated online. The diaries captured considerable flux in the evolution of romantic relationships, but there was limited evidence that relationships initiated online involved greater risks, with the notable exception of greater age asymmetry., (© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Interracial couples cohabit at higher rates than same-race couples, which is attributed to lower barriers to interracial cohabitation relative to intermarriage. This begs the question of whether the significance of cohabitation differs between interracial and same-race couples. Using data from the 2006-2017 National Survey of Family Growth, we assessed the meaning of interracial cohabitation by comparing the pregnancy risk, pregnancy intentions, and union transitions following a pregnancy among women in interracial and same-race cohabitations. The pregnancy and union transition behaviors of women in White-Black cohabitations resembled those of Black women in same-race cohabitations, suggesting that White-Black cohabitation serves as a substitute to marriage and reflecting barriers to the formation of White-Black intermarriages. The behaviors of women in White-Hispanic cohabitations fell between those of their same-race counterparts or resembled those of White women in same-race cohabitations. These findings suggest that White-Hispanic cohabitations take on a meaning between trial marriage and substitute to marriage and support views that Hispanics with White partners are a more assimilated group than Hispanics in same-race unions. Results for pregnancy intentions deviated from these patterns. Women in White-Black cohabitations were less likely than Black women in same-race cohabitations to have an unintended pregnancy, suggesting that White-Black cohabitations are considered marriage-like unions involving children. Women in White-Hispanic cohabitations were more likely than White and Hispanic women in same-race cohabitations to have an unintended pregnancy, reflecting possible concerns about social discrimination. These findings indicate heterogeneity in the significance of interracial cohabitation and continuing obstacles to interracial unions.

Ambulatory assessment (AA) offers one of the most exciting approaches for opening the dynamic "black box" of adolescents' daily lives. In this introduction, we spotlight AA's surprisingly restricted market share within adolescent scholarship. We describe thorny challenges these intense methods can pose when conducting adolescent research "in situ" and underscore that capturing quality AA data means placing adolescents' developmental stage at the forefront. The novel research reported in this special section speaks to these challenges and underscores the promise of AA for conducting developmentally salient science. The nine articles included in the section span multiple disciplines (Sociology, Psychology, Public Health) and reflect diverse viewpoints, approaches, and theories. All provide multiple novel best-practice strategies for conducting AA scholarship with adolescents., (© 2019 Society for Research on Adolescence.)

Partnership formation is an important developmental task for adolescents, but cross-sectional and periodic longitudinal studies have lacked the measurement precision to portray partnership stability and flux and to capture the range of adolescent partnership experiences. This article assesses the promises and challenges of using bi-weekly mobile diaries administered over the course of a year to study adolescent partnership dynamics. Descriptive findings illustrate the potential of bi-weekly diaries for both capturing the longitudinal complexity and fluidity of adolescent partnerships as well as for reducing retrospection biases. Results also underscore several challenges, including those posed by missing data, and highlight several strategies for maximizing participant engagement and reliably tracing adolescent partnerships., (© 2018 Society for Research on Adolescence.)

Objective: This study examines intergenerational continuities in relationship instability, general relationship quality, and intimate partner violence (IPV) between mothers and adolescents., Background: A growing body of literature has observed similarities in relationship quality between parents and their adult offspring. Less attention has focused on whether intergenerational continuities are present in adolescent relationships., Method: Using age 3, 5, 9, and 15 data from the Fragile Families and Child Wellbeing birth cohort study (N=3,162), the authors examined associations between maternal reports of relationship instability, general quality, and IPV in early and middle childhood and similar adolescent reports at age 15. Variations based on timing and persistence of exposures were considered., Results: In general, exposures to low-quality maternal relationships were associated with higher risk of forming adolescent partnerships and lower relationship quality. Intergenerational links in quality were predominantly construct-specific, consistent with observational learning processes. Adolescents exposed to maternal relationships of poor general quality in middle childhood were less likely to report high-quality relationships themselves, and those exposed to any maternal physical IPV victimization during childhood were more likely to perpetrate IPV in their own relationships. Exposure to maternal relationship instability in both early and middle childhood was associated with more adolescent romantic partners., Conclusion: The study illuminates additional pathways through which healthy and unhealthy relationships are reproduced across generations.

Both low birthweight (<2500 g; LBW) and macrosomia (>4000 g) are considered adverse birth outcomes and are associated with later poor health conditions, yet the social determinants of macrosomia are understudied. In this study, we explore patterning of LBW, normal birthweight, and macrosomia by race/ethnicity and nativity. We examined data from all live births between 1999 and 2014 in New Jersey with a non-missing, plausible value of birthweight (n = 1,609,516). We compared the risk for LBW and macrosomia among non-Hispanic White, non-Hispanic Black, Hispanic, and non-Hispanic Asian mothers, and between the US- and native-born. For Hispanics and Asians, we also examined differences by country of origin. The racial/ethnic patterns for macrosomia mirrored those of LBW, suggesting that the factors underlying LBW shift birthweight distributions. For example, non-Hispanic White mothers had the lowest risk for LBW and the highest risk for macrosomia. Nativity patterns differed by subgroup, however, with unique risks for macrosomia among some origin groups, such as foreign-born Cubans. The racial/ethnic and nativity patterns of macrosomia do not completely mirror those of LBW, suggesting some distinct social risk factors for macrosomia. Our findings raise questions about whether and how racial/ethnic and nativity patterning in both low and excess birthweight is retained in later conditions, such as childhood obesity., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Despite a growing literature documenting deleterious intergenerational consequences of incarceration, relatively little is known about how exposure to paternal incarceration is associated with risk behaviors in adolescence. In this article, we use data from the Fragile Families and Child Wellbeing Study (N = 3,405)-a cohort of urban children born around the turn of the 21 st century and followed for 15 years-to examine the relationship between paternal incarceration and one indicator of adolescent risk behavior, early sexual onset. Results from adjusted logistic regression models show that paternal incarceration is associated with a greater likelihood of initiating sexual activity before age 15, in part resulting from externalizing problems that follow paternal incarceration. We also find that these associations are concentrated among boys living with their fathers prior to his incarceration. Given that paternal incarceration is a stressor concentrated among already vulnerable children, paternal incarceration may exacerbate inequalities in adolescent sexual risk behavior.

Although US rates of early fertility have declined, they remain high relative to other high-income countries, and disparities by population group persist. The share of the US youth population with immigrant parents has expanded greatly, yet relatively little is known about generational variations in early fertility. This study used Add Health data to investigate: (1) differences by generational status in the risk of early childbearing; (2) to what extent observed differences reflected timing of sexual onset versus post-onset proximate determinants like contraceptive use; and (3) the influence of individual-, family-, and neighborhood-level social factors. Foreign-born and second-generation young women initiated both sexual activity and childbearing later than those with US-born parents. Sequential hazard models revealed the importance of later sexual onset in explaining delayed fertility among the foreign-born, and of family attributes for their later sexual onset. Post-onset behaviors were central to the delayed childbearing observed among the second generation.

Prospective studies have found unemployment and job loss to be associated with negative psychological and physical health outcomes. For immigrants, the health implications of employment change cannot be considered apart from pre-migration experiences. While immigrants demonstrate relative success in securing employment in the United States, their work is often not commensurate with their education or expertise. Previous research has linked downward employment with adverse health outcomes among immigrants, but with gender differences. We extended this literature by considering a wider range of employment states and accounting for the interdependence of husbands' and wives' employment trajectories. We examined the relationships between personal and spousal post-migration employment changes and self-rated health and depressive symptoms using dyadic data from the 2003 New Immigrant Survey (NIS) (n = 5682 individuals/2841 spousal pairs). We used the Actor Partner Interdependence Model (APIM) to model cross-partner effects and account for spousal interdependence. In general, men's downward employment trajectories were associated with poorer health for themselves. Women's employment trajectories had fewer statistically significant associations with their own or their husbands' health, underscoring the generally more peripheral nature of women's work in the household. However, women's current unemployment in particular was associated with poorer health outcomes for themselves and their husbands, suggesting that unmet need for women's work can produce health risks within immigrant households. Our findings suggest that employment change should be considered a household event that can impact the wellbeing of linked individuals within., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

This study builds on and extends previous research on nativity variations in adolescent health and risk behavior by addressing three questions: (1) whether and how generational status and age at migration are associated with timing of sexual onset among U.S. adolescents; (2) whether and how family instability mediates associations between nativity and sexual debut; and (3) whether and how these associations vary by gender. We find that first- and second-generation immigrant youth initiate sexual activity later than native youth. Foreign-born youth who migrate after the start of adolescence exhibit the latest sexual onset; boys' sexual behavior is particularly sensitive to age at migration. Parental union stability is protective for first- and second-generation youth, especially boys; however, instability in co-residence with parents accelerates sexual debut for foreign-born girls, and dilutes protections from parental marital stability. Use of a non-English language at home delays sexual onset for immigrant girls, but not boys., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Millions of children in Sub-Saharan Africa live with adults, often parents, who are HIV-infected or ill due to AIDS. These children experience social, emotional, and health vulnerabilities that overlap with, but are not necessarily the same as, those of orphans or other vulnerable children. Despite their distinctive vulnerabilities, research aimed at understanding the situation of these children has been limited until very recently. This review summarizes the state of knowledge based on a systematic search of PubMed and Web of Science that identified 47 empirical research articles that examined either the population prevalence of children living with HIV-infected or AIDS-sick adults, or the consequences of adult HIV infection or AIDS illness for child well-being. This review confirms that this population of children is substantial in size, and that the vulnerabilities they experience are multi-faceted, spanning physical and emotional health and schooling. Mechanisms were examined empirically in only a small number of studies, but encompass poverty, transmission of opportunistic infections, care for unwell adults, adult distress, AIDS stigma, lack of social support, maternal breastfeeding issues, and vertical HIV transmission. Some evidence is provided that infants, adolescents, children with infected or ill mothers, and children living with severely ill adults are particularly vulnerable. Future research would benefit from more attention to causal inference and further characterization of processes and circumstances related to vulnerability and resilience. It would also benefit from further study of variation in observed associations between adult HIV/AIDS and child well-being based on characteristics such as age, sex, kinship, severity of illness, TB co-infection, disclosure, and serostatus awareness. Almost one-quarter of the studies reviewed did not investigate variation based on any of these factors. More nuanced understanding of the short- and long-term effects of adult HIV on children's needs and circumstances will be important to ongoing discussions about equity in policies and interventions.

Background: In sub-Saharan Africa many children live in extreme poverty and experience a burden of illness and disease that is disproportionately high. The emergence of HIV and AIDS has only exacerbated long-standing challenges to improving children's health in the region, with recent cohorts experiencing pediatric AIDS and high levels of orphan status, situations which are monitored globally and receive much policy and research attention. Children's health, however, can be affected also by living with HIV-infected adults, through associated exposure to infectious diseases and the diversion of household resources away from them. While long recognized, far less research has focused on characterizing this distinct and vulnerable population of HIV-affected children., Methods: Using Demographic and Health Survey data from 23 countries collected between 2003 and 2011, we estimate the percentage of children living in a household with at least one HIV-infected adult. We assess overlaps with orphan status and investigate the relationship between children and the adults who are infected in their households., Results: The population of children living in a household with at least one HIV-infected adult is substantial where HIV prevalence is high; in Southern Africa, the percentage exceeded 10% in all countries and reached as high as 36%. This population is largely distinct from the orphan population. Among children living in households with tested, HIV-infected adults, most live with parents, often mothers, who are infected; nonetheless, in most countries over 20% live in households with at least one infected adult who is not a parent., Conclusion: Until new infections contract significantly, improvements in HIV/AIDS treatment suggest that the population of children living with HIV-infected adults will remain substantial. It is vital to on-going efforts to reduce childhood morbidity and mortality to consider whether current care and outreach sufficiently address the distinct vulnerabilities of these children.

Rural-to urban migration is increasingly common among youth and could affect sexual activities. We use life history calendar data collected in Kisumu, Kenya, to investigate how the timing and number of rural-to-urban moves are associated with premarital pregnancy. Among sexually experienced young women aged 18-24 (N=226), 39 percent have experienced a premarital pregnancy and 60 percent experienced a move in the last 10 years. Results of the event history analysis show that those who experienced one or two moves or whose most recent move occurred in the last seven to 12 months are at increased risk of premarital pregnancy compared to nonmovers. Those whose last move occurred at age 13 or younger were also at an elevated risk. Migration brings about specific needs for youth, including the need for sexual and reproductive health education and services, which should be made available and accessible to new urban residents.

Social, political, epidemiological, and economic forces have produced family instability during childhood for many young people transitioning to adulthood in South Africa. This study identifies pathways to adulthood for youth in Cape Town that capture the timing and sequencing of role transitions across the life domains of school, work, and family formation. It then uses these pathways to investigate the relationship between childhood family instability and the way young people's lives unfold during the transition to adulthood. Results indicate that changes in co-residence with parents are associated with following less advantageous pathways into adulthood, independent of particular family structure or orphan status. Overall, the findings suggest that family instability influences not only single transitions for youth, but also combinations of transitions. They also indicate the value of a multi-dimensional conceptualization of the transition to adulthood in empirical work.

Epidemiological, economic, and social forces have produced high levels of volatility in family and household structure for young people growing up in sub-Saharan Africa in recent decades. However, scholarship on the family to date has not examined the influence of this family instability on young people's well-being. The current study employs unique life history calendar data from Western Kenya to investigate the relationship between instability in caregiving and early initiation of sexual activity. It draws on a body of work on parental union instability in the United States, and examines new dimensions of family change. Analyses reveal a positive association between transitions in primary caregiver and the likelihood of early sexual debut that is rapidly manifested following caregiver change and persists for a short period. The association is strongest at early ages, and there is a cumulative effect of multiple caregiver changes. The results highlight the importance of studying family stability in sub-Saharan Africa, as distinct from family structure, and for attention to dimensions such as age and recency.

Migration during the formative adolescent years can affect important life-course transitions, including the initiation of sexual activity. In this study, we use life history calendar data to investigate the relationship between changes in residence and timing of premarital sexual debut among young people in urban Kenya. By age 18, 64 percent of respondents had initiated premarital sex, and 45 percent had moved at least once between the ages of 12 and 18. Results of the event history analysis show that girls and boys who move during early adolescence experience the earliest onset of sexual activity. For adolescent girls, however, other dimensions of migration provide protective effects, with greater numbers of residential changes and residential changes in the last one to three months associated with later sexual initiation. To support young people's ability to navigate the social, economic, and sexual environments that accompany residential change, researchers and policymakers should consider how various dimensions of migration affect sexual activity.

In Southern Africa, high adult HIV prevalence has fueled concern about the welfare of children losing parents to the epidemic. A growing body of evidence indicates that parental, particularly maternal, death is negatively associated with child outcomes. However, a better understanding of the mechanisms is needed. In addition, the way orphan disadvantage and the mechanisms giving rise to it are understood on the ground is essential for the successful translation of research into policies and programs. This study employs data from 89 in-depth interviews with caregivers and key informants in Lesotho, a setting where approximately one-quarter of adults is infected with HIV, to elaborate understandings of orphan disadvantage. Our analysis focuses on two questions: (i) Do local actors perceive orphans to be disadvantaged compared to non-orphans, and if so, in what ways; and (ii) How do they explain orphans' differential disadvantage?Analyses suggest that orphans were widely perceived to be disadvantaged; respondents described this disadvantage in material as well as affective domains. Thematic analyses reveal five broad categories of explanation: poverty, love and kin connection, caregiver character, perceptions of orphans, and community norms related to orphan care. These results underscore the need for research and policy to address (i) multiple types of disadvantage, including deficits in kindness and attention; and (ii) the social embeddedness of disadvantage, recognizing that poverty, kinship, and community interact with individual attributes to shape caregiving relationships and child experiences. The findings suggest limited success for programs and policies that do not address the emotional needs of children, or that focus on child or caregiver support to the exclusion of community outreach.

Transactional sex, or the exchange of money and gifts for sexual activities within nonmarital relationships, has been widely considered a contributing factor to the disproportionate prevalence of HIV/AIDS among young women in sub-Saharan Africa. This study applied social exchange theory to premarital relationships in order to investigate the linkages between a variety of young women's resources-including employment and material transfers from male partners-and sexual behaviors. Data on the first month of premarital relationships (N=551 relationships) were collected from a random sample of young adult women ages 18-24 in Kisumu, Kenya, using a retrospective life history calendar. Consistent with the hypotheses, results showed that young women's income increases the likelihood of safer sexual activities, including delaying sex and using condoms consistently. Material transfers from the male partner displayed the opposite effect, supporting the view that resources obtained from within the relationship decrease young women's negotiating power.

1. Shaken baby syndrome can lead to substantial neuropsychological deficits that can alter children's normal developmental course. 2. Clinical acumen can be critical in identifying shaken baby syndrome and preventing further difficulties. 3. Education and treatment for caregivers can be important in reducing the likelihood of shaken baby syndrome.

Objective: Flow cytometry is proving useful in the evaluation of lymphoproliferative disorders. In a case series, the authors investigated the safety of cross-sectional fine-needle aspiration biopsy of the spleen under sonographic guidance, and the usefulness of flow cytometry in analysis of biopsy samples., Methods: Five patients underwent fine-needle biopsy with freehand sonographic guidance. Samples were analyzed on a flow cytometer., Results: Through cytologic examination enhanced by flow cytometry, 2 cases of lymphoma, 1 case of metastatic transitional cell carcinoma, and 1 case of focal splenic hemangioma were diagnosed. Normal lymphocytes were demonstrated in 1 case, in which long-term follow-up of splenomegaly showed that this was related to cirrhosis and portal hypertension in a patient with a history of treated non-Hodgkin's lymphoma., Conclusion: Flow-cytometry-enhanced fine-needle aspiration of the spleen is a safe and useful tool for the interventional radiologist. In our institution, it evolved as the result of effective teamwork between diagnostic radiologists and pathologists. Flow cytometry promises to be increasingly useful in the diagnosis and management of lymphoproliferative diseases.

Objective: We report a case of metastatic ovarian granulosa cell tumor in the mediastinum with a 2-year disease-free interval after treatment with radiotherapy and review the literature regarding the use of radiotherapy in recurrent and metastatic granulosa cell tumor., Methods: The patient's medical records, histological slides, and radiological films were reviewed. The pertinent references were obtained using a Medline search and cross-references., Results: A patient with Stage 1A granulosa cell tumor developed a recurrence in the retroperitoneum 10 years after initial surgery. She was treated with chemotherapy followed by surgical resection. She subsequently developed metastatic tumor in the mediastinum which responded completely to radiotherapy. She has remained disease free for 2 years since the completion of radiotherapy., Conclusion: Radiotherapy is a treatment option that should be considered in localized recurrent or metastatic granulosa cell tumor that is not amenable to surgery as it can potentially control the disease for several years., (Copyright 1999 Academic Press.)

Nontraumatic subcutaneous emphysema is a rare complication of colorectal cancer. To the authors' knowledge, only eight cases have been reported to date. The initiating event was free colonic perforation in seven of the patients and contained colosubcutaneous fistula in the eighth. In nontraumatic subcutaneous emphysema typical fecal flora is cultured, whereas in nontraumatic gas gangrene, a different clinical entity that has a fulminant course, the bacteria are generally clostridial. The authors report a case of nontraumatic subcutaneous emphysema associated with rectal carcinoma and describe the associated computed tomography findings.

The authors present a case of surgical transposition of the left ovary, which presented on computed tomography (CT) as an intraperitoneal cystic mass. To their knowledge, there is only one other report in the radiologic literature of the CT appearance of a transposed ovary, but in that case the ovary appeared as a retroperitoneal mass.

Changes of total blood flow, velocities, and cross-sectional area in the portal vein before and after oral glucose administration were studied using image-directed Doppler ultrasonography. Portal vein cross-sectional area, flow velocity, and total blood flow increased significantly compared with baseline studies. Relative increase in these values compared with baseline studies (95% confidence intervals) are presented, and future applications of this method are discussed.

In this series, ten patients with systemic sarcoidosis presented with retinal changes as the initial manifestation of the disease. The diagnosis was suspected on the basis of the retinal findings, and subsequently substantiated by medical evaluation. Anterior uveitis, the best-known finding in ocular sarcoidosis, was overshadowed by the retinal changes. The retinal findings in this condition are characteristic and should alert the ophthalmologist to evaluate the patient for systemic sarcoidosis.

The clinical characteristics of 75 eyes with congenital pits of the optic nerve head were reviewed, particularly in relation to associated serous retinal detachment. Retinal detachment was found in 52% of all eyes with pits and 63% of eyes with temporally located pits. Of 20 untreated eyes with a pit and coexistent macular retinal detachment followed for more than one year, 55% (11/20) had visual acuity less than or equal to 6/30 and 75% (15/20) had subretinal fluid at the most recent visit. Visual fields and intravenous fluorescein angiographic characteristics of pits are discussed and clinical evidence is presented supporting the theory that the associated subretinal fluid is derived from liquified vitreous.

The clinical, ultrasonographic, fluorescein angiographic, and immunological features of a case of relapsing polychondritis in a 46-year-old female are described. Acute bilateral sclerouveitis with multiple retinal pigment epithelial defects and sensory retinal detachment were present on initial examination. Antibodies to type II collagen were present in serum samples taken from the patient during the acute and convalescent phase of the disease. A possible relationship of this disorder to the phylogenetic development of the eye is discussed.

The records of 27 patients who developed retinal arterial obstruction (RAO) prior to the age of 30 years were studied to ascertain associated systemic and ocular findings as possible etiologic factors. A history of migraine was found in approximately one third of the patients, and coagulation abnormalities wer also common. Trauma, sickle cell hemoglobinopathies, cardiac disorders, use of oral contraceptives, pregnancy, systemic lupus erythematosus and intravenous drug abuse were less frequently encountered. Ocular abnormalities included increased intraocular pressure, subtle buried drusen of the optic nerve head and a congenital prepapillary arterial loop. In contrast to older patients with RAO, there was no clinical evidence of atheromatous disease. In most patients, one or more systemic or ocular etiologic factors could be discerned. Whereas etiologic relationships may be multifactorial and generally differ from those commonly found in older patients with RAO, the visual prognosis in younger and older patients appears to be similar.

Two patients presented with the rare combination of bilateral diffuse choroidal hemangiomas and bilateral facial nevus flammeus. In one eye of one patient, an associated serous retinal detachment was treated with xenon arc photocoagulation in an attempt to delimit the subretinal fluid. Clinicians should be aware of the subtle clinical findings of diffuse choroidal hemangiomas as well as the possibility of bilateral occurrence. Early recognition and treatment may prevent progression of total retinal detachment and neovascular glaucoma.

A series of 12 patients (13 eyes) with neovascular glaucoma in association with arterial obstructive disease is presented. Appropriately characterized as having an ocular ischemic syndrome, the anterior segment findings in each included aqueous flare and rubeosis iridis. Posterior segment manifestations included midperipheral intraretinal hemorrhages (venous stasis retinopathy), narrowed retinal arteries, often a cherry red spot, and neovascularization of the disc and/or retina. Most eyes with the ocular ischemic syndrome have either ipsilateral common carotid artery obstruction or severe bilateral obstruction of the internal carotid arteries.

This paper presents the clinical findings in 12 patients with a peculiar vascular mass of the sensory retina. On the basis of ophthalmoscopy, fluorescein angiography, ultrasonography and other studies, the authors presume that the described lesion is a primary acquired benign vascular tumor, most likely a variant of capillary hemangioma. The features that seem to differentiate clinically this lesion from von Hippel's retinal angiomatosis, other ocular tumors, and pseudotumors are discussed and therapeutic recommendations are presented.

An 8-year-old black boy with sickle cell trait struck his left brow and globe on the edge of a table and had immediate blurring of vision. Six days later visual acuity was light projection, and traumatic iritis with secondary glaucoma and perimacular edema were present. Fluorescein angiography indicated obstructed peripheral and perimacular arterioles and dye leakage from the disk.

In 16 consecutive patients, thrombosis, anastomotic and intragraft stenoses, and residual venous communications (arteriovenous fistulas [AVFs]), after in situ saphenous vein bypass of femoropopliteal and infrapopliteal arteries, were treated with interventional angiographic techniques. Streptokinase infusion for graft thrombosis was performed in four patients, with long-term clinical improvement in two; in the other two, early rethrombosis was treated with surgical thrombectomy. Delayed rethrombosis occurred at 13 months in another patient. Anastomotic (six occasions) and intragraft (four occasions) stenoses in six patients were dilated with percutaneous transluminal angioplasty (PTA). Two grafts subsequently occluded, one 3 weeks and one 3 months after PTA. Residual AVFs were occluded in ten patients. Ten of 16 patients remained clinically improved without further therapy. One complication occurred: A graft stenosis developed at the site where a coil, protruding from the AVF into the graft lumen, was successfully removed and replaced.

Four patients with evulsion of the optic nerve caused by blunt trauma were clinically evaluated. The evulsion was complete in two of the patients and incomplete in the other two. The patients' visual acuity ranged from counting fingers to no light perception. In addition, two eyes were histopathologically studied. Several explanations of the exact cause and the extent of the evulsion are advanced within this report.

Platelets have been shown to be capable of initiating and promoting some of the reactions in intrinsic coagulation and have been implicated in the pathogenesis of vascular lesions in diabetes mellitus. We have examined the contribution of platelets to the coagulation reactions in 39 patients having diabetes mellitus with and without retinopathy [background retinopathy (BR) or proliferative retinopathy (PR)], 18 patients with nonvascular eye diseases (patient controls), and 38 normal subjects. As compared to control patients, significant elevations were noted in four of the five assays for platelet coagulant activities in diabetic patients with PR and in three of five assays in patients with BR. Thus platelet coagulant hyperactivity is present in diabetics with retinopathy. Significant elevations were noted in two of the assays in patients without retinopathy (NR), suggesting that platelet coagulant hyperactivity may not necessarily be secondary to the vasculopathy. The predominant abnormalities noted were in assays reflecting the contribution of platelets to the early stages of intrinsic coagulation rather than to later stages of prothrombin activation. In addition, the mean platelet volume was found to be significantly greater in patients with PR and BR but not NR than in normal controls. A positive linear correlation (r = 0.81) was noted between the mean of the coagulant activities and platelet volume in diabetic subjects, suggesting a hitherto undescribed relationship between platelet coagulant activities and platelet volume.