Investigating risk factors for Internet gaming disorder: a comparison of patients with addictive gaming, pathological gamblers and healthy controls regarding the big five personality traits.

Engaging in online games has become increasingly important as a part of leisure activity in adolescents and adults. While the majority of people use these games in a healthy way, epidemiological studies show that some develop excessive use and symptoms that are related to those of substance-related addictions. Despite increasing research concerning the epidemiology of internet gaming disorder (IGD), predisposing factors have been examined to a lesser extent. Knowing about specific risk factors would help clarify the nosological features of IGD and enhance prevention and intervention. This study aimed to evaluate the relationships between personality traits and IGD. A total of 115 patients meeting the criteria for IGD were compared to 167 control subjects displaying either regular or intense use of online games. Additionally, 115 patients meeting diagnostic criteria for pathological gambling were included. IGD was associated with higher neuroticism, decreased conscientiousness and low extraversion. The comparisons to pathological gamblers indicate that low conscientiousness and low extraversion in particular are characteristic of IGD. An integration of personality variables into an etiopathological model describing presumable mechanisms fostering and maintaining addictive online gaming is proposed. This model could be helpful for the theoretical understanding of addictive gaming, public health campaigns and psychoeducation within therapeutic settings.

Automatic brain response to facial emotion as a function of implicitly and explicitly measured extraversion.

Extraversion/introversion is a basic dimension of personality that describes individual differences in social behavior and sensory sensitivity. Previous neuroimaging research exclusively relied on self reports for assessing personality traits. In recent years, implicit measures of personality have been developed that aim at assessing the implicit self-concept of personality and complement self report instruments which are thought to measure aspects of the explicit self-concept of personality. In the present study functional magnetic resonance imaging was used to examine automatic brain reactivity to facial expression as a function of both implicitly and explicitly measured extraversion in 30 healthy women. Sad, happy, and neutral faces were presented for 33 ms masked by neutral faces beside a no face control condition. Subjects evaluated the briefly shown neutral mask faces. The Implicit Association Test (IAT) and the NEO Five-Factor Inventory (NEO-FFI) were applied as measures of extraversion which were not correlated in our sample. IAT extraversion was negatively correlated with automatic reactivity of the caudate head, thalamus, and inferior frontal cortex to sad faces. NEO-FFI extraversion was negatively correlated with response of the inferior frontal cortex and putamen to sad faces. For masked happy faces, an inverse correlation of the IAT effect for extraversion with activation of the caudate head and superior parietal lobule was observed. NEO-FFI extraversion was inversely correlated with the response of the thalamus to happy faces. Neither NEO-FFI extraversion nor IAT effect were significantly related to brain response to masked neutral faces (compared to the no face condition). Taken together, a specific heightened responsivity of the fronto-striatal-thalamic circuit to facial emotions which are arousing stimuli might underlie introverts' preference for avoiding social interactions. Research on the neurobiology of extraversion could benefit from the application of implicit in addition to explicit measurement instruments when automatic neural responses are investigated.

[Interindividual differences in priming and memory effects of threatening stimuli: effect of cognitive avoidance and vigilant anxiety coping]. / Interindividuelle Differenzen in Priming- und Gedächtniseffekten bedrohungsbezogener Stimuli: Der Einfluss kognitiv vermeidender und vigilanter Angstbewältigung.

This study examined the influence of dispositional coping strategies (cognitive avoidance, vigilance) on priming and memory effects of emotional stimuli. In the first phase of the study participants performed a lexical decision task that involved threat-related and neutral words. Subsequently, a previously unannounced recognition memory test for a subset of the words presented during the first phase was carried out. Repressers (i.e. individuals high in avoidance and low in vigilance) showed stronger emotional priming effects than nonavoiders. Repressers also showed a memory deficit for emotional relative to neutral words, whereas sensitizers (vigilance high, avoidance low) remembered emotional words comparatively well. Results raise the question of whether repressers' memory deficits for threat-related stimuli are actually based on a less differentiated network of emotional information, as assumed by recent theoretical accounts of individual differences in coping.

Repressive emotional discreteness after failure.

The relationship between coping dispositions and emotional responses after failure in an anagram task was examined. Previous research indicated that only repressers' nondominant emotions were less intense compared to nonrepressers', whereas the dominant emotion was of equal intensity. Using an experimental design in which emotions were measured as they were actually felt, the authors were able to demonstrate that this effect, called repressive emotional discreteness, also is apparent during an emotional event. Compared to nonrepressers, repressers reported roughly the same amount of guilt, which was the dominant emotion after failure, but they showed lower self-rated fear, sadness, and hostility. No differential effects were observed regarding positive emotions after success, indicating that repressive discreteness is restricted to negative emotions. The implications of these findings for explaining the mechanism underlying repression are discussed.

Thyroid cancer in Belarus post-Chernobyl: improved detection or increased incidence?

There is debate on whether the reported increase in the number of cases of childhood thyroid cancer in Belarus is real and attributable to radiation released following the Chernobyl nuclear accident, or rather an artefact due to incorrect histological diagnosis, more complete case reporting and mass screening of children after the accident. We have scrutinised the histological slides of 120 (75%) of the 160 cases reported among children aged up to 15 years to the Belarus tumour registry from 1986 to 1992 and examined time trends and geographical patterns in incidence and tumour characteristics. Incidence based on reported cases increased from 0.041 per 100,000 in 1986 to 2.548 in 1992. Carcinoma was confirmed in 94% of reviewed tumours. Except for one medullary carcinoma all histologies were of the papillary type. Most of the tumours had spread beyond the organ capsule and measured over 10 mm in diameter. There was a weak and statistically non-significant trend (p = 0.19) towards smaller tumours in the later years. The proportion of cases with lymphnode or distant metastasis remained unchanged. Incidence based on histologically confirmed cases was highest adjacent and to the west and north of Chernobyl, matching best estimates of iodine-131 contamination. Our data thus strongly suggest that the observed increase is real but more data are needed in order to assess the impact of mass screening and to clarify the possible association with radiation released at Chernobyl in 1986.

Pathomorphological findings in thyroid cancers of children from the Republic of Belarus: a study of 86 cases occurring between 1986 ('post-Chernobyl') and 1991.

Recently, an impressive increase in malignant thyroid tumours has been observed among children less than 15 years of age living in the Republic of Belarus at the time of the nuclear accident of Chernobyl in 1986. More than half of these patients lived in the region of Gomel, nearest to Chernobyl. Because of the very short time interval between the accident and the tumour occurrence an independent review of the available histopathological material was done. Out of 101 cases diagnosed as thyroid cancers, we reviewed slides of 93 cases and agreed the diagnosis of malignancy in 92.5%. Of these tumours 96.5% were papillary carcinomas, 61.5% were moderately or poorly differentiated. Extrathyroidal extension was observed in 60.5%, regional lymph node metastases in 74% and distant metastases in 7%. One of the patients died from lung metastases. Our results confirm that the neoplasms increasingly diagnosed between 1986 and 1991 among children of this region are thyroid carcinomas. In addition, we correlate several histopathological findings with sex and age of the patients and other parameters, and compare the results with data from other studies.

Biliary obstruction: treatment with self-expanding metal prostheses.

The authors percutaneously and endoscopically inserted 58 Wallstent endoprostheses in 42 consecutive patients with benign and malignant obstructive biliary stenoses. The three patients with benign obstructive jaundice were followed up for 48 months. Two of the stents occluded due to sludge formation, prompting percutaneous reentry. The 39 patients with malignant disease were followed up for 18 months. Twenty-six of these patients died 3 days to 1.5 years (mean, 133 days) after the procedure. Thirteen are alive after 2-12 months (mean, 242 days). Recurrent jaundice occurred in 11 patients (28%): in four patients due to tumor growth over the proximal end of the stent, in one patient due to excessive gallbladder hydrops, and in six patients due to liver failure. Although autopsy investigations revealed the possibility of tumor growth onto the inner surface of the stent through the stainless steel mesh of the endoprosthesis, stent occlusion by tumor ingrowth into the lumen was not encountered.

[Acute fatal liver insufficiency due to valproic acid therapy]. / Akute tödliche Leberinsuffizienz unter Valproinsäuretherapie.

Fatal hepatic failure associated with valproic acid therapy is a rare side effect occurring in 1:5000-10,000 of the patients exposed to this antiepileptic drug. Its relevance arises from its fatal outcome and the high number of patients who are treated with this drug (one million worldwide in 1988). 112 cases were published up to 1988. Most of the affected patients were young (less than 10 years old), male, and mentally retarded. Many were under antiepileptic polytherapy. The children of this age group constituted only 23% of the patients treated with valproic acid but 73% of all fatalities. 90% of the patients developed hepatic failure in the first 5 months of therapy. Low doses or therapeutic serum levels of valproic acid do not prevent this dramatic event. Specific therapy is not known. In addition to the case report we review the literature and make recommendations for monitoring therapy with valproic acid.

[Malignant atrophic papulosis (Degos' syndrome) in a suckling infant]. / Maligne atrophisierende Papulose (Degos-Syndrom) bei einem Säugling.

The clinical and histological diagnosis of Degos' syndrome could be made in a 8-month-old infant with scarring skin lesions. Some weeks later the baby developed severe intestinal symptoms and died from perforations of multiple necrotic lesions of the small bowel. Autopsy revealed in addition to the skin and gut lesions a haemorrhagic cortical infarction of the brain and fibrotic areas in the myocardium. In all these lesions characteristic stenotic endovascular proliferations were seen. Malignant atrophic papulosis is an extremely rare disease in infancy (our patient is the fifth reported case) with a well defined clinical picture, characteristic histological appearance of obliterating vasculitis, but unknown aetiology.

The hemangioendothelioma of the thyroid.

65 cases of hemangioendothelioma (HE) of the thyroid were accepted as such after control of slides of surgical or autopsy specimen or both. In a few of the more recent cases material could be examined by electron microscope and in some the search for factor VIII-related antigen (FVIIIRAG) was carried out. The demonstration of Weibel-Palade bodies in tumour cells in two cases and the evidence of FVIIIRAG in tumour cells of at least two cases, including primary tumour and distant metastasis, finally show, that the hemangioendothelioma of the thyroid is not simply an anaplastic carcinoma with some peculiar features; at least some of these tumours are true endotheliomas. The proposal that the term hemangioendothelioma be eliminated from the classification of thyroid tumours is therefore unfounded.

Malignant hemangioendothelioma of the thyroid and factor VIII-related antigen.

Thirty-six malignant hemangioendotheliomas of the thyroid were examined immunohistochemically using antibody probes to factor VIII-related antigen in order to reevaluate the histogenesis of this neoplasia. The 36 cases were reclassified according to their light microscopic features without prior knowledge of the immunohistochemical results. Three different tumor types were discerned: Group I: classical hemangioendotheliomas (20 cases); Group II: borderline cases between malignant hemangioendotheliomas and anaplastic carcinomas (14 cases) and Group III: anaplastic carcinomas with hemangio-endotheliomatous features (2 cases). Factor VIII-related antigen could be demonstrated in 12 (60%) tumors of group I, 3 (21%) tumors of group II and in neither tumor of group III. Five control cases with the typical histological picture of anaplastic carcinoma of the thyroid were negative for factor VIII-related antigen. The results of our study suggest that at least part of the tumors termed as malignant hemangioendotheliomas are in fact derived from endothelial cells.

[Androgen-producing hilus cell tumor (Leydig cell tumor) of the ovary: case contribution to the differential diagnosis of virilization in the adult woman]. / Androgen-produzierender Hiluszelltumor (Leydig-Zell-Tumor) des Ovars: kasuistischer Beitrag zur Differentialdiagnose der Virilisierung der erwachsenen Frau.

Severe hirsutism, deepening of the voice and enlargement of the clitoris developed in the course of two years in a 55-year old hysterectomized woman. Laboratory examinations showed markedly elevated plasma concentrations of testosterone and androstenedione and a moderately increased urinary excretion of 17-ketosteroids. Gaschromatographic analysis of the urinary steroids, revealed that she mainly excreted etiocholanolone, androsterone and pregnanetriol. Plasma androgens and urinary 17-ketosteroids were not suppressed by dexamethasone treatment. During catheterization of the vena cava blood samples were selectively taken from the ovarian veins. Androgen concentrations were the highest in the plasma from the right ovarian vein. However, phlebography as well as adrenal scanning with 131I-adosterol indicated a tumor of the right adrenal gland. During laparoscopy the right ovary was found to be enlarged, and it was subsequently removed. It contained a tumor 2.5 cm in diameter which had the histological features of a hilus cell tumor (Leydig cell adenoma). Two years later, the patient underwent surgery for suspected tumor of the left kidney. A functionless atrophic left kidney was removed. There was a complete thrombosis of the left renal and ovarian veins. Possibly, this severe lesion of the two vessels had been caused by their previous catheterization.

Seminoma with syncytiotrophoblastic giant cells. A special form of seminoma.

Testicular seminomas may occur in various forms, of which the classical and spermatocytic are distinct, the anaplastic or atypical seminomas, however, less clearly defined. Lately, a separate group of particular clinical significance, comprising seminomas with syncytiotrophoblastic giant cells (STGC), has been specified. Although this type of seminoma had been recognized morphologically long ago, recent investigations have shown its ability to secret HCG, a fact that raises serious difficulties in its differential diagnosis with combined seminomas and choriocarcinomas. Two cases of seminomas with STGC are presented and pertinent clinical and morphologic problems discussed.

[Dedifferentiation of chrondrosarcomas (author's transl)]. / Entdifferenzierte Chondrosarkome.

The clinical course and the results of radiographic and histological investigations in three patients with dedifferentiated chondrosarcoma are presented. The tumors were characterized by chondrosarcomatous tumor sections of low grade malignancy adjacent to fibrosarcomatous tissue sections. One to two and one-half year after the onset of the first clinical symptoms pulmonary metastases appeared and in one case a subcutaneous mass presented, which had the histological appearance of a fibrosarcoma. Differentiation of a chondrosarcoma customarily has an adverse effect on the prognosis with both the early appearance of metastases and a rapidly fatal clinical course. Cartilagenous tumors of the axial skeleton and the long bones must be extirpated surgically in an early and radical fashion, particularly if there are radiographic signs of proliferation.