Management of fractures and exostosis of the metacarpals and metatarsals II and IV in 25 horses

Twenty-five cases of fractures of the second and fourth metacarpal and metatarsal (splint) bones were reviewed. Fourteen fractures involved a thoracic limb and 11 involved a pelvic limb. Fractures of the proximal one-third of splint bones are reported in one of two forms: fractures that are closed, or fractures with a permanent or intermittent draining sinus. Thirteen of the fractures presented were closed fractures and the remaining 12 were open. All of the closed fractures were managed by surgical excision of the distal fragment and the exostosis at the fracture site, followed by primary surgical wound closure. Lag screw fixation of the proximal fragment was used in three cases. All of the open fractures were managed surgically by excision of the distal splint fragment and debridement of the contaminated fracture site. Primary wound closure was used in 11 of the 12 cases. All closed fractures healed by primary intention, and 10 of 13 were free from lameness at one year follow-up. The 11 open wounds which were operated and subsequently closed under suture healed by primary intention. The wound left open healed by granulation, scar contraction, and epithelialisation. Eight of these horses were sound one year later. The remainder of the open fractures were lost to follow-up.

Timing, genetic requirements and functional consequences of somatic hypermutation during B-cell development

While somatic antibody mutants are rare in the preimmune repertoire and in primary immune responses, they dominate secondary and hyperimmune responses. We present evidence that somatic hypermutation is restricted to a particular pathway of B-cell differentiation in which distinct sets of B-cell clones are driven into the memory compartment. In accord with earlier results of McKean et al. (1984) and Rudikoff et al. (1984), somatic mutation occurs stepwise in the course of clonal expansion, before and after isotype switch, presumably at a rate close to 1 X 10(-3) per base pair per generation. At this rate, both selectable and unselectable mutations accumulate in the rearranged V region genes. The distribution of replacement mutations in the V regions shows that a fraction of the mutations in CDRs is positively selected whereas replacement mutations are counterselected in the FRs. By constructing an antibody mutant through site-specific mutagenesis we show that a point mutation in CDR1 of the heavy chain, found in most secondary anti-NP antibodies, is sufficient to increase NP binding affinity to the level typical for the secondary response. Somatic mutation may contribute to the immune repertoire in a more general sense than merely the diversification of a specific response. We have evidence that clones producing antibodies which no longer bind the immunizing antigen can be kept in the system and remain available for stimulation by a different antigen. Somatic mutations are 10 times less frequent in DJH loci than in either expressed or non-expressed rearranged VDJH or VJ loci. We therefore conclude that a V gene has to be brought into the proximity of the DJH segment in order to fully activate the hypermutational mechanism in these loci.

Noradrenergic regulation of alpha 1-receptors during the postnatal development of the guinea pig

In guinea pig brain, alpha 1-noradrenergic receptor concentrations undergo region-specific fluctuations during the first weeks of postnatal life. However, the factors involved in the regulation of these receptors have yet to be identified. In this study, the ontogeny of one possible regulatory factor, norepinephrine, was examined in relation to postnatal changes in alpha 1-receptor levels in several different regions of guinea pig brain. Results from these studies showed that while the activity of the noradrenergic system increased throughout the first weeks of postnatal development in each brain area examined, the concentration of alpha 1-receptors decreased in preoptic area and hypothalamus and increased in cortex. In subsequent experiments, the effects of noradrenergic lesions with 6-hydroxydopamine on alpha 1-receptor levels were assessed to examine the possibility that alpha 1-receptors are differentially sensitive to noradrenergic stimulation in cortex and preoptic area/hypothalamus in immature guinea pigs. Noradrenergic lesions which reduced norepinephrine levels by 87-94% resulted in significant elevations in alpha 1-receptors in all regions examined. These results are discussed with reference to the anatomical distribution of alpha 1-receptors and their regulation by norepinephrine.

Hemorrhagic fibrinonecrotic duodenitis-proximal jejunitis in horses: 20 cases (1977-1984)

Records of 20 horses with small intestinal disease causing acute colic and affecting the proximal portion of the small intestine were examined retrospectively. The disease was characterized by severe to moderate pain, which was replaced by depression, fever, gastric reflux, slight distention of the affected small intestine, leukocytosis, and high concentrations of total protein in the peritoneal fluid. Grossly, the affected intestines were hemorrhagic and had yellow discoloration. Histopathologic findings included submucosal edema, neutrophilic infiltration of the submucosal and laminal propria, and mucosal slough at the villous tips. Advanced lesions were characterized by mucosal sloughing with transmural edema, hemorrhage, fibrin deposition, and necrosis. No cause was determined. In 6 horses, bypass of most of the affected small intestine was helpful by alleviating the severe gastric reflux.

The effects of single doses of alpidem and lorazepam on memory and psychomotor performance in normal humans

Two studies are reported which compare different single doses of alpidem (SL80.0343-00) with lorazepam 2 mg. In the first study, lorazepam and the highest (100 mg) dose of alpidem impaired performance on a range of psychomotor tasks, although the effects of lorazepam were more severe and persisted for longer than those of alpidem. In comparison, alpidem 50 and 25 mg had little effect. The EEG profiles of both drugs were similar.

Surgical management of chronic laminitis in horses: 13 cases (1983-1985)

Thirteen horses with chronic refractory laminitis were evaluated and treated. In each horse, deep digital flexor tenotomy was performed on all affected limbs at the level of the midpastern. Five horses returned to limited athletic endeavors, 6 horses improved and were comfortable on pasture, 1 horse improved clinically, but was euthanatized for economic reasons, and 1 horse improved, but deteriorated 9 months after surgery and was euthanatized. Results of this study indicated that deep digital flexor tenotomy at the level of the midpastern can be used effectively as a salvage procedure in horses with chronic refractory laminitis.

Physicians' attitudes toward pain in children

Physicians' attitudes toward pain in children were assessed in an attempt to explain why adults are administered more analgesics than children while in the hospital. A survey was conducted of all pediatricians, family practitioners, and surgeons in Hartford. Fifty-seven percent of the sample responded (112/195). Seventy-five percent of the sample felt that children experienced adult-like pain by age 2. Thirty-eight percent of the physicians were somewhat or significantly concerned about the risk of addiction when using narcotics in their young patients. Pediatricians were significantly more likely than surgeons or family practitioners to see younger children as having adult-like pain and to prescribe analgesics for children at an earlier age. Many other attitudinal differences were also related to specialty. Other demographic variables (age, sex, mode of practice, and personal experience with pain) had little effect on attitudes. These findings suggest possible explanations for the discrepancy between child and adult analgesic prescribing practices.

Growth of severely impaired children: neurological versus nutritional factors

Nineteen children with cerebral palsy who have had gastrostomies since 1981 and who have been followed for at least six months postoperatively were reviewed to assess the effects of gastrostomy feeding on their growth and to determine whether growth failure was due to neurological or nutritional dysfunction. The children's ages ranged from five to 168 months (mean 60.4 months) and follow-up extended from six to 41 months (mean 23.1 months). All were profoundly handicapped, with involvement of all four limbs. 11 also had seizures and all 19 were severely to profoundly retarded. Heights and weights were recorded during the visit immediately before surgery and at most recent follow-up. Data were recorded as a standard deviation score (Z-score). Before surgery the mean weight/height was -2.71 Z. Postoperatively this improved to -1.18 Z. 16 of the 19 children increased their weight/height ratio. Three children had a weight/height ratio greater than 10th percentile preoperatively. 11 achieved this on follow-up. Seven children were greater than 25th percentile for weight/height. Improvement in weight/height did not correlate with length of follow-up. For severely neurologically impaired children, nutritional factors play a major rôle in growth. By ensuring adequate caloric intake via gastrostomy, a significant number of children achieved adequate growth and better nutritional status.

Alterations in lipid and protein profiles of plasma lipoproteins in middle-aged men consequent to an aerobic exercise program

Thirty-four healthy, untrained middle-aged males (mean = 58.2 years) volunteered for a longitudinal study investigating alterations in lipoprotein profiles consequent to 20 weeks of aerobic training. Twenty randomly selected experimental subjects (E) participated in a walk/run training program 3 d/wk, 48 min/d, at an intensity equal to 65% to 85% of their heart rate reserve, while 14 control subjects (C) remained in an untrained state. Blood samples were obtained in the morning after a 14-hour fast. Plasma lipoproteins were separated by ultracentrifugation and agarose-column chromatography into very low (VLDL), low (LDL), and high (HDL) density lipoprotein fractions. A training effect was evidenced in E by significant increases (P less than 0.001) in absolute VO2 max (15.2%) and relative VO2 max (16.8%). Dietary composition was monitored pretraining and posttraining with no significant change seen in either E or C. Alterations in the lipoprotein profile of E included a significant increase in HDL-cholesterol (16.6%) and significant reductions in VLDL-cholesterol (72.1%), LDL-triglyceride (26.5%), VLDL-protein (33.5%), and LDL-protein (18.7%). Furthermore, no significant changes in the level of HDL-protein and apolipoprotein AI in the HDL fraction were observed in either E or C. These data suggest that aerobic training can significantly increase HDL-cholesterol and alter lipoprotein profiles, which may subsequently reduce the risk of coronary artery disease.

Interaction of test protocol and inclined run training on maximal oxygen uptake

Twenty-two men, 17 to 27 years of age, volunteered to participate in an inclined terrain running program. Men were randomly assigned to a control (N = 10) or an experimental (N = 12) group. The experimental group ran on inclined terrain 4 times/wk for 35 min a session at an intensity of 65 to 85% of maximal aerobic power for 12 wk. The purpose of this study was to analyze the interaction between a subject's VO2max on an inclined protocol (IP) vs a horizontal protocol (HP) before and after training on incline terrain. VO2max, HRmax, VEmax, Rmax, and maximum treadmill time were evaluated on both treadmill protocols (IP and HP). Prior to training, results indicated no difference in VO2max values between protocols. Following training, VEmax, maximum treadmill time, and VO2max increased 8.7, 9.1, and 8.5%, respectively, on the IP and 5.8, 6.8, and 5.3% on the HP respectively. All increases were statistically significant at the 0.05 level. The post-training VO2max on the IP was significantly greater than the value on the HP. These results support the concept of specificity of training and indicate the importance of careful selection of both the test protocol as well as the test mode.

Interaction of test protocol and horizontal run training on maximal oxygen uptake

Twenty-seven untrained college-age males (mean age = 23.1 yr) volunteered for this 12-wk training study, which investigated potential interactions between training specificity and treadmill protocol specificity. The study was designed to analyze the interaction between a subject's maximal oxygen uptake (VO2max) on an inclined protocol (IP) vs a horizontal protocol (HP) before and after training exclusively on flat terrain. Experimental subjects (E, N = 17) trained by running on flat terrain for 12 wk, 4 d/wk, 37 min/d at an intensity equal to 65 to 85% of their heart rate reserve while control subjects (C, N = 10) remained sedentary. All subjects underwent a minimum of four maximal treadmill tests (two with an IP and two with a HP) prior to training and two maximal treadmill tests (one IP and one HP) post-training. Multivariate analysis of variance and post-hoc t-tests using a pooled variance-covariance matrix were used to analyze the data. Alterations in E, consequent to training, included significant increases in VO2max [mean IP = 53.6 to 58.4 (+8.9%) and mean HP = 51.7 to 56.2 ml. kg-1 . min-1 (+8.7%)]. C showed a significant pre- to post-training decrease on the HP for VO2max [mean HP = 52.4 to 50.7 ml . kg-1 . min-1 (-3.2%)], but showed no significant change on the IP. There was no significant pre- to post-training interaction between protocols for VO2max. It was concluded that the post-training results do not support the concept of protocol specificity when evaluating VO2max in subjects trained exclusively on flat terrain.

Factors for prognostic use in equine obstructive small intestinal disease

Twenty horses with small intestinal obstructions requiring surgery were evaluated prospectively. Ten horses lived (group 1) and 10 died (group 2). Eight of the horses in group 1 had simple obstruction and 7 of the horses in group 2 had strangulation obstruction. There was a significant difference (P less than 0.001) between the mean intraluminal hydrostatic pressure in horses of groups 1 and 2 (6.3 cm H2O and 15 cm H2O, respectively). The mean peritoneal fluid protein concentration in horses of groups 1 and 2 (2.8 mg/dl and 5.4 mg/dl, respectively) also differed significantly between groups (P less than 0.01). Histologic evaluation of the intestinal specimens from horses of group 1 (n = 3) and group 2 (n = 6) revealed more severe mucosal lesions in group 2. The measured values that were not significantly different between the 2 groups included PCV, total serum protein content, WBC count, anion gap, and duration of colic before admission. It was concluded that peritoneal fluid protein concentration and intraluminal hydrostatic pressure in small intestinal obstruction may be used as adjuncts to diagnosis and as prognostic indicators.

Crystalloids versus colloids: implications in fluid therapy of dogs with intestinal obstruction

Responses of jejunal transcapillary and transmucosal fluid fluxes to IV infusion of crystalloid or colloid solutions were evaluated in 12 dogs. One isolated intestinal segment in each dog was used as the control segment, and 2 segments were distended to a intraluminal hydrostatic pressure of 10 cm of H2O. The artery supplying 1 of the 2 distended (autoperfused) segments was cannulated and perfused with blood from the femoral artery. One of the 2 distended segments was autoperfused from the femoral artery. Intraluminal pressure was increased in the autoperfused segment and in 1 other segment for three, 20-minute periods after administration of the crystalloid or colloid solution. Net transmucosal fluid flux was estimated, using a volume recovery method. In each autoperfused segment, blood flow, capillary pressure, lymph flow, and plasma protein and lymph protein concentrations were measured during each 20-minute distention period. Systemic arterial pressure was monitored throughout the procedure. Plasma and tissue oncotic pressures were calculated from the plasma protein and lymph protein concentrations. Total vascular resistance and precapillary and postcapillary resistances were determined. Capillary pressure increased after infusion with colloids and crystalloids, with the effects being more prolonged in the colloid group. Plasma oncotic pressure transiently increased after infusion with colloids and decreased after infusion with crystalloids. Lymph flow increased only in crystalloid-treated dogs. Due to alterations in transcapillary fluid filtration, crystalloids induced a net loss of fluid into the intestinal lumen, whereas the fluid absorptive capacity of the jejunum was unaltered by colloid treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

Comparative study of electrophysiological and psychophysical measurement of the contrast sensitivity function in humans

We measured the human contrast sensitivity function (CSF) both electrophysiologically with the steady-state visual evoked potential (VEP) and psychophysically using a method of ascending limits. VEP contrast thresholds were determined using a rapid recording technique in which the contrast of a counterphase modulated sine wave grating was swept logarithmically from 0.5 to 40% over a period of 10 s. For this pattern reversal stimulus the amplitude and phase of the second harmonic response as a function of contrast were measured using a discrete Fourier transform (DFT). Psychophysical thresholds were determined on the same trials used to record the VEP. Near threshold the VEP amplitude vs. contrast function was approximately linear and VEP contrast thresholds were estimated by a linear extrapolation to zero amplitude. The contrast thresholds obtained by the two methods correlated at 0.914 for 5 observers, with a mean discrepancy of only 12%. At higher contrasts, the VEP amplitude vs. contrast function often became nonmonotonic, sometimes showing two amplitude peaks.

An analysis of medical care at mass gatherings

Emergency medical care at public gatherings is haphazard at best and dangerous at worst. The Arizona chapter of the American College of Emergency Physicians, through the Chapter Grant Program, studied the level of medical care provided at public gatherings in order to develop guidelines for emergency medical care at mass gatherings. The study consisted of a survey of medical care at 15 facilities providing events for the public. The results of these surveys showed a wide variation of medical care provided at mass events. Of the 490 medical encounters reviewed, 52.2% were within the realm of care of paramedics, but not basic emergency medical technicians. The most common injuries/illnesses were lacerations, sprains, headaches, and syncope. Problems noted included poor documentation and record keeping of medical encounters, a tendency for prehospital care personnel to make medical evaluations without transport or medical control, and variability of care provided. Based on this survey and a literature review, guidelines for medical care at mass gatherings in Arizona were determined using an objective-oriented approach. It is our position that event organizers have the responsibility of ensuring the availability of emergency medical services for spectators and participants. We recommend that state chapters or National ACEP evaluate the role of emergency medical care at mass gatherings.

A prospective study of mammographic parenchymal patterns and risk of breast cancer

Breast parenchymal patterns have been assessed by the method of Wolfe in a prospective study in Guernsey. Women with P2 or DY grades had approximately four times the risk of developing breast cancer compared with those with N1 or P1 grades. Age, weight, parity and age at birth of first child are all related to the distribution of mammographic patterns. The combination of these variables with Wolfe grades may identify subsets of the population at very high risk.

Electrophysiological assessment of contrast sensitivity in human infants

Contrast sensitivity functions (CSF's) were measured for a group of 6-month-old infants using the visual evoked potential (VEP). Sine-wave luminance gratings were counterphase modulated at 12 contrast reversals per s and simultaneously swept in contrast. Each contrast sweep lasted 10 s, spanning a range of 0.5 to 40% contrast in 19 equal logarithmic steps. The amplitude and phase of the response at the second harmonic were determined by a discrete Fourier transform. Contrast thresholds were estimated from a linear extrapolation to zero-amplitude of the VEP amplitude vs. log-contrast function. Contrast sensitivity was found to be nearly adult-like at 1 c/deg, but was not yet mature at higher spatial frequencies.

Bleomycin-induced lung injury in the rabbit. Analysis and correlation of bronchoalveolar lavage, morphometrics, and fibroblast stimulating activity

We have used a rabbit model of bleomycin-induced lung injury to evaluate the chronological changes in the bronchoalveolar lavage fluid (BALF) constituents. The correlation of these changes with morphologic alterations and measured soluble mediators of fibrosis has also been assessed. Three groups of 8 treated and 8 control New Zealand white rabbits received 10 U/kg bleomycin in normal saline, or equal volumes of saline intratracheally. The animals underwent bronchoalveolar lavage with a balloon tipped catheter localized to the right lower lobe at 3, 8, or 12 wk. Total cell counts and differentials were performed on the BALF. The lungs were examined histologically for inflammatory cells in the interstitium, alveoli, and airways by morphometric techniques. The lungs were also assayed for total hydroxyproline content. Bronchoalveolar lavage fluid supernatants and supernatants from lavaged macrophages cultured for 24 h were assayed for fibroblast stimulating activity (FSA) by 3H-thymidine incorporation into rabbit lung fibroblasts. There was a significant increase in macrophages and neutrophils in the BALF at 3 wk only, although the elevation of macrophages was sustained for longer than that of neutrophils. The numbers of BALF macrophages correlated with the morphometric assessment of the number of intra-alveolar macrophages (p less than 0.001) and interstitial mononuclear cells (p less than 0.001), as well as the extent of airway inflammation (p less than 0.001). The numbers of BALF neutrophils correlated with morphometrically assessed alveolar (p less than 0.01) and interstitial neutrophils (p less than 0.01) but not with any airway inflammation scores.(ABSTRACT TRUNCATED AT 250 WORDS)

A re-evaluation of the role of tracheostomy in Ludwig's angina

Ten cases of Ludwig's angina that required surgical decompression in addition to intravenous antibiotic therapy are reviewed. The vocal cords were visualized in all ten patients following deep inhalational anesthesia to relieve trismus. Only one case required tracheostomy, which has previously been recommended as the treatment of choice for airway management; the other nine were intubated under direct vision.

Age differences in within-session habituation of exploratory behavior: effects of stimulus complexity

The effects of age on the habituation of exploratory behavior of 8-month- and 28-month-old male C57BL/NNia mice were examined under three different stimulus complexity conditions. Increases in the degree of stimulus complexity resulted in an attenuation of between-session habituation and an initial disruption of within-session habituation by 8-month-old mice. Although increases in stimulus complexity also resulted in an increase in the overall level of exploration by aged mice, stimulus complexity was not found to have a systematic effect on between- or within-session habituation by aged mice. No between-session habituation was observed in aged mice under any of the stimulus complexity conditions. Further, aged mice exhibited significant within-session increases, rather than decreases, in exploration under each stimulus complexity condition. This disruption of within-session habituation in aged mice was found to persist over four daily test sessions. In view of the specific patterns of exploration by aged mice, the disruption of within-session habituation was attributed to age-related differences in reactivity to the arousal-inducing properties of novel stimuli.

Are there lessons from abroad for the NHS?

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Zinc intakes of lactating and nonlactating women: analyzed vs. calculated values

The zinc intake of a group of 23 lactating and 13 nonlactating postpartum women was assessed longitudinally from 37 weeks' gestation through six months postpartum. Dietary zinc was determined by chemical analysis of three-day duplicate food and beverage composites and by calculation of three-day records. There was no significant difference between the analyzed and calculated values for daily zinc intake. Both groups of postpartum women consumed 42% or less of the Recommended Dietary Allowance (RDA) for zinc. To attain the RDA within present food selections, both groups of postpartum women would need to eat unreasonably high amounts of calories and protein.

Deoxyribonucleic acid (DNA) content of carcinomas and prognosis in human breast cancer

DNA content was estimated in 705 breast carcinomas from patients with stage I or stage II disease undergoing mastectomy, to investigate whether it would predict the clinical course of the disease. The patients were then followed for up to 84 months during which time 166 of them developed recurrences. There were no statistically significant differences in the DNA content of carcinomas between stage I and stage II patients or between those with various numbers of involved nodes. The tumours from pre-menopausal patients as a group had significantly higher DNA content than those from post-menopausal cases. There was a gradual rise in DNA content with the malignancy grade of the carcinoma which showed significant differences between Grades I and III and between II and III. Life-table analyses showed that the measurement of DNA would not be an aid to prognosis. Furthermore, when the data were stratified according to menopausal status, stage, malignancy grade or numbers of lymph nodes involved, the results indicated that these estimation do not add significantly to the information obtained through established prognostic factors. Survival data were available on III patients with recurrent disease. There were no significant differences in tumour DNA content between short- and long-term survivors. It is concluded that these measurements seem unlikely to be a prognostic factor in human breast cancer.

Hepatic parenchymal cells in cystic fibrosis: ultrastructural evidence for abnormal intracellular transport

Few ultrastructural observations of hepatic parenchymal cells in cystic fibrosis (CF) have appeared in the literature. Utilizing a unique opportunity to examine freshly fixed hepatic tissue by transmission electron microscopy, we studied 12 patients dying with CF at Duke Hospital from 1979 to 1981 in order to identify possible abnormalities of intracellular architecture. The major findings include (1) intracellular fatty vacuoles, (2) distended bile ductules and bile ducts containing increased cellular debris, (3) profiles of distended rough endoplasmic reticulum containing material of medium electron density, and (4) membrane-bound deposits of electron-lucent material containing electron-dense cores resembling mucus. We suggest that the material seen within the cytocavitary network reflects a derangement of intracellular transport.

Maternal and child characteristics associated with mothers' perceptions of their high risk/developmentally delayed infants

Mothers of 46 high risk infants, many of whom were developmentally delayed, were visited in their homes at approximately 9 months post-expected-date-of-delivery. The Perception of Baby Temperament (PBT) scales and the Profile of Mood States were administered and an observation of infant, parent, and parent-infant behavior was made. Infants were most likely to receive higher PBT scores on more than one scale if their mothers were more highly educated and reported lesser degrees of depression and anxiety. Infants who were perceived as more active and approaching by their mothers tended to be rated as more responsive by the observer and to show less developmental delay. Mothers who rated their infants as more active tended to show greater responsiveness to the infant and to participate in reciprocal activities with the infant more frequently during the home visit. These findings demonstrate that mothers' perceptions of high risk/developmentally delayed infant temperament are associated with similar categories of variables found to correlate with maternal perceptions of developmentally normal infant temperament.

High- and low-affinity binding of [3H]imipramine in mouse cerebral cortex

Binding of [3H]imipramine in mouse cerebral cortex was found to be nonhomogeneous. Competition experiments, Scatchard analysis, and Hill plots are compatible with the existence of binding with high (nanomolar) and low (micromolar) affinity. Low-affinity binding could be eliminated by the use of low concentrations of imipramine as the competing ligand. In contrast to the high-affinity binding, the low-affinity binding was found to be unrelated to the neuronal uptake system for serotonin.

Cost of counselling women who undergo mastectomy

The psychiatric morbidity associated with mastectomy and brest cancer was substantially reduced by a specialist nurse who counselled women before and after surgery and monitored their progress. A controlled study was, therefore, carried out to determine what this cost. National Health Service costs were almost wholly covered by savings made because counselled subjects who developed psychiatric problems were recognised and treated much earlier than control patients. Counselled and control subjects suffered considerable financial losses, but these were offset in the counselled group by their relatives' earlier return to work. Such counselling schemes are necessary and effective and may be implemented at little extra cost.

Maternal causal attributions at hospital discharge of high-risk infants

Interviews were conducted at hospital discharge with mothers of 43 infants with severe perinatal complications posing risks to development. Information gathered included mothers' beliefs about the causes of the infant's medical problems, expectations of caretaking difficulties, and self-reported mood on the Profile of Mood States. Of the various demographic characteristics studied, only maternal parity was related to causal attributions, with mothers of later-born infants more likely to blame themselves and mothers of first-born infants more likely to blame others and to attribute the infant's condition to chance. Mothers who blamed others reported greater mood disturbance and greater anticipated caretaking problems than did mothers who attributed the infant's condition to a maternal behavior during pregnancy. These findings were discussed in relation to studies of attributional processes and coping with misfortune.