[Mental disorders in women: Natural course during premenstrual phases, peripartum period and perimenopause]. / Psychische Störungen in den reproduktiven Phasen der Frau: Häufigkeiten, Verlauf und Besonderheiten.

Epidemiological studies indicate sex-specific differences in prevalence rates and the natural course of mental disorders. Affective, anxiety, somatoform and eating disorders are more prevalent in women than men, whereas substance use disorders occur more commonly in men, and some disorders are equally distributed in both sexes (e. g. psychotic disorders). The aim of this review is to depict the natural course of mental disorders during the reproductive stages (premenstrual phases, peripartum period, perimenopause) in women, including also neuroendocrine features associated with the menstrual cycle, pregnancy, puerperium and perimenopause. Recommendations for sex-specific diagnostic and therapeutic procedures are provided.

[Development of oculoplastic surgery in Kinshasa (capital of Democratic Republic of Congo)]. / Entwicklung der okuloplastischen Chirurgie in Kinshasa (Hauptstadt der Demokratischen Republik Kongo).

The partnership between Saint Joseph Hospital in Kinshasa (Capital city of DRC) and University Eye Clinic Rostock, Germany exists since 2000. The ophthalmologists from Rostock University performed 12 visits of St. Josef Hospital with the aim to perform oculoplastic surgery in complicated cases as well as to teach the local ophthalmologists. There they performed about 150 surgeries (entropion, ectropion, ptosis, repair of lid injuries, eye lid reconstruction and tumour management, lacrimal surgery) in joint teams. The programme of on-site training was established during this time. Meanwhile, the Kinshasa colleagues are able to perform the basic techniques by themselves. Two colleagues have obtained advanced training in oculoplastics in Rostock. The fruitful cooperation enabled the development of oculoplastic surgery in St. Josef Hospital in Kinshasa. The further education and training proccesses will support the continuous advancement in ophthalmological health care in DRC.

The association between social phobia, social anxiety cognitions and paranoid symptoms.

OBJECTIVE: Previous research suggests high levels of comorbidity between social phobia and paranoid symptoms, although the nature of this association remains unclear. METHOD: Data were derived from the Early Developmental Stages of Psychopathology study, a 10-year longitudinal study in a representative German community sample of 3021 participants aged 14-24 years at baseline. The Munich-Composite International Diagnostic Interview was used to assess social phobia and paranoid symptoms, along with data on social phobia features. Cross-sectional and longitudinal analyses were conducted. Differential associations with environmental risk factors and temperamental traits were investigated. RESULTS: Lifetime social phobia and paranoid symptoms were associated with each other cross-sectionally (OR = 1.80, 95% CI = 1.31-2.47). Lifetime paranoid symptoms were associated specifically with social anxiety cognitions. Lifetime cognitions of negative evaluation predicted later onset of paranoid symptoms, whereas onset of social phobia was predicted by cognitions of loss of control and fear/avoidance of social situations. Lifetime social phobia and paranoid symptoms shared temperamental traits of behavioural inhibition, but differed in environmental risks. CONCLUSIONS: The present study showed that paranoid symptoms and social phobia share similarities in cognitive profile and inhibited temperament. Avoidance appears to be important in the development of social phobia, whereas cannabis use and traumatic experiences may drive paranoid thinking in vulnerable individuals.

[Progressive corneal opacity after autologous keratoplasty]. / Progrediente Hornhauttrübung nach autologer Keratoplastik. Diagnose: Epitheliale Zellaussaat in die Vorderkammer nach autologer Keratoplastik.

A 55-year-old woman underwent autologous keratoplasty because of band keratopathy and corneal decompensation of the left eye. Previously recurring events of uveitis had affected the eye. A vitrectomy had been performed on the left side for tractional retinal detachment of the posterior pole. The visual acuity of the right donor eye had been reduced to hand movements after occlusion of the central retinal artery. Twelve months after the transplantation, a circumscribed opacity appeared on the endothelial side of the cornea. Cells in the anterior chamber were detected, as well as a moderate rise in ocular tension. Despite intensive anti-inflammatory therapy, the membrane extended over the complete cornea. We diagnosed an ingrowth of epithelial cells as responsible for the changes.

[The currently most common causes of childhood blindness in Kinshasa (d. R. Congo)]. / Die gegenwärtig häufigsten Ursachen der Kinderblindheit in Kinshasa (D. C. Kongo).

BACKGROUND: 90 % of blind children live in the developing world. Only limited data are available on the prevalence and causes of blindness. PURPOSE AND METHODS: In order to identify the commonest causes of childhood blindness in the Democratic Republic of Congo, a study was conducted in 81 children (< 16 years old) attending schools for the blind in the capital city Kinshasa. RESULTS: According to WHO criteria, 53 (65.4 %) of the 81 children were classifiable as blind (visual acuity < 3/60), 11 (13.6 %) as visually impaired (visual acuity < 1/18) and 17 (21.0 %) as not impaired. On anatomic and functional classifications the commonest causes of blindness were: corneal opacity/scarring (20.0 %), phthisis bulbi (15.2 %), refractive anomalies (11.0 %), optic nerve atrophy (9.0 %), retinal disorders (7.6 %), glaucoma/buphthalmos (7.6 %), cataract (6.9 %), microphthalmos (3.5 %), vitreous opacity (2.8 %) and aphakia (2.1 %). The aetiology of blindness could not be determined in most of the children. Trauma, measles in conjunction with vitamin A deficiency, and the use of traditional eye medications are presumed to be the commonest causes of corneal opacity/scarring and of resultant phthisis bulbi. CONCLUSION: Childhood blindness would be potentially avoidable in 60 % of cases, either by surgery (for cataract [ 6.9 %]) or by preventive measures (corneal opacity/scarring, phthisis bulbi, glaucoma, refractive anomalies [ 53.0 %]).

Detection of apoptotic cells in cerebrospinal fluid of patients suffering from neurological disease.

Apoptotic elimination of pathogenic immune cells is considered one of several regulatory mechanisms in inflammatory diseases. To explore the potential relationship between detection of apoptotic cells in the cerebrospinal fluid (CSF) and different types of neurological diseases, we examined cellular apoptosis at the stage of DNA fragmentation, defined by morphological criteria and a molecular biology technique (in situ tailing). During a first phase, 3446 CSF samples derived from admitted patients suffering of inflammatory (IND) and non-inflammatory neurological diseases (NIND) were analysed in the course of routine clinical diagnostics. First, all specimens were inspected for cells displaying atypical morphology following established morphological criteria of intact lymphocytes or apoptosis. In a second phase, 76 additional CSF samples collected from individuals according to investigated clinical groups were analysed in parallel by means of in situ tailing, which indicates the advanced degree of apoptotic demise through labelling of controlled DNA fragmentation. No apoptotic processes were detected by either analytical method in CSF of clinically distinct diseases, amongst others multiple sclerosis (MS). This indicates that the detection of apoptotic cells in CSF during clinical routine diagnostics does not have sufficient explanatory power for the investigated conditions. Furthermore, based on immunohistochemistry, the proportion of CSF lymphocytes expressing the pro-apoptotic receptor Fas (CD95) tended to be higher in NIND patients compared to patients with other IND and MS, but the difference was not statistically significant. In contrast, expression of the anti-apoptotic protein Bcl-2 did not differ between investigated patient groups.

[Three-dimensional confocal laser scanning microscopy of the corneal nerve structure]. / 3D-konfokale Laser-Scanning-Mikroskopie der kornealen epithelialen Nervenstruktur.

PURPOSE: The aim of this study was the evaluation of a technology for in vivo visualization of distribution and morphology of corneal nerves by means of 3D confocal laser scanning microscopy (3D-CLSM). METHOD: The anterior corneas of four human volunteers were examined by an in-house developed confocal laser scanning microscope based on a commercially available instrument (Heidelberg Retina Tomograph II, Heidelberg Engineering GmbH, Germany). Raw stacks were converted using ImageJ (NIH, USA) for 3D-reconstruction using AMIRA 3.1 (TGS Inc, USA). RESULTS: The spatial arrangement of epithelium, nerves and keratocytes was visualized by in vivo 3D-CLSM. After 3D-reconstruction of volunteers' corneas, volume rendering and selective oblique sections have been done to demonstrate the nerves in the central human cornea. 3D-imaging shows thick nerve bundles rising out of the deeper stroma. The nerves further divide, resulting in fibers that are arranged parallel to Bowman's layer and are partly interconnected. Branches rising up to the superficial cell layer cannot be visualized. Wound healing following refractive surgery can be evaluated. CONCLUSIONS: 3D-CLSM allows in vivo visualization and analysis of the spatial arrangement of the epithelium, nerves and keratocytes of the human cornea. The developed method provides a basis for further studies on the alterations of the cellular arrangement and epithelial innervation in corneal diseases. This may help to clarify gross variations of nerve fiber patterns under various clinical and experimental conditions.

[Epidemic keratoconjunctivitis. In vivo images of corneal structures with the confocal Rostocker laser scanning microscope (RLSM)]. / Keratoconjunctivitis epidemica. In-vivo-Darstellung kornealer Strukturen mit dem konfokalen Rostocker Laser-Scanning-Mikroskop (RLSM).

PURPOSE: Epidemic keratoconjunctivitis (EKC) is a highly contagious infection caused by adenovirus types 8, 19, and 37. The formation of subepithelial nummular infiltrates may lead to permanent visual disturbance. These infiltrates consist histopathologically of an accumulation of lymphocytes, histiocytes, and fibroblasts. PATIENT AND METHOD: The reasons for the persistence of these nummular infiltrates are not fully understood. We examined a 28-year-old female patient with typical signs of EKC infection clinically and additionally with the RLSM. RESULTS: Nummuli were identified by the RLSM as areas with an accumulation of dendritic cells (supposed to be Langerhans cells) as well as so far unidentified punctiform structures located in the basal cell layer and in the region of the subepithelial nerve plexus. CONCLUSIONS: The RLSM allows us to investigate corneal microstructures in vivo with precise depth localization related to epidemic keratoconjunctivitis. Further investigations may disclose the role of dendritic cells in the pathogenesis of the nummular formation as well as their contribution to the variable persistence of partially threatening vision opacities.