The influence of friendships on the mental health of maltreated youth: A pre-registered systematic review using a developmental psychopathology perspective

Friendships are a potential factor that influence maltreated children's risk for psychopathology. This systematic review examined (1) how friendships influence the association between child maltreatment and psychopathology and (2) developmental differences in how friendships influence this association. Four databases were searched. Inclusion criteria were primary study, quantitative, measures of maltreatment and friendship up to the age of 18 years, measures of psychopathology up to the age of 24 years, and a non-maltreated sample. Exclusion criteria were qualitative, reviews or meta-analyses, no distinction between maltreatment and other trauma, and no differentiation between friendships and other support. Risk of bias was assessed. Data were narratively synthesized. Two hundred thirty-five articles were retrieved for full review. Fourteen met inclusion criteria (N = 98,676 participants). Eleven of the fourteen studies found that some aspect of friendships influenced the association between maltreatment and psychopathology, with positive qualities generally decreasing risk and negative qualities increasing risk for psychopathology. However, peer support exacerbated maltreated children's risk for psychopathology in two studies. Only three studies assessed friendship prior to adolescence, which precluded conclusions regarding developmental differences. Future research should consider developmental differences and use findings and validated measures from the peer relations literature to better understand how friendships influence maltreated youth's vulnerability to psychopathology.

Corneal regrafts

Report on the clarity of 45 corneal regrafts with a minimum follow-up time of 1 year. The results of regrafts in keratoconus are good. In herpetic disease with corneal vascularization and frequent secondary glaucoma the results are poor. In patients with failed grafts for corneal dystrophies or degenerations the regrafts can be beneficial.

[Keratoplasty in private practice]

The problems associated with performing penetrating keratoplasty in private practice are briefly discussed: access to an eye bank, high-risk patients, immunosuppressive therapy, complications, and results. One negative aspect is the relatively high incidence (10%) of primary graft failure, but allograft reactions are less frequent (5%). The best results are obtained in keratoconus cases.

[Landmarks in uveitis research]

The author presents a personal review of the changing approach to the problem of the etiology of uveitis and its treatment during the past 40 years. Goldmann's ingenious idea concerning local antibody formation within the eye was the starting point of many research projects.

Comparative studies of collagens in normal and keratoconus corneas

In this paper we present strong evidence that the aberrations in keratoconus corneas are not directly related to alterations in collagen composition and distribution. This conclusion is based on comparative studies of collagen types I, III, IV, V and the recently described collagen types VI and VII in keratoconus and normal corneas. The data are derived from biochemical analysis of collagen fractions sequentially extracted with pepsin and sodium-dodecylsulphate, from amino acid analysis of hydrolysates of entire corneal tissues as well as from immunoblotting of the extracted collagens with specific antibodies. These antibodies were also used to examine the distribution of the collagens in immunofluorescence experiments on corneal sections. The yields of the collagen extractions were demonstrated to be age dependent but were not altered in keratoconus samples. Apart from one case associated with osteogenesis imperfecta type I, comparative studies of keratoconus and normal corneas showed no differences in collagen composition of the extracts. This was confirmed by amino acid analysis of tissue-hydrolysates. The distributions of collagen types I, III, IV, V, VI and VII in corneal sections were in general unchanged in keratoconus corneas, the only differences being in scar tissues observed in the Bowman layer of some keratoconus samples.

[Reflections of a professor emeritus on the problem of succession]

The organisation of the academic career is incomplete in many ways. Too much emphasis is put on scientific research. Very little instruction is given in teaching and none at all in administration and managing a whole group of people. Therefore, a young physician appointed head of a department is confronted with many duties which he may not be able to cope with. It is suggested that candidates for an academic career should attend special management schools, as do bankers, for example.

[Juvenile uveitis]

Chronic anterior uveitis in children suffering from juvenile rheumatoid arthritis may develop very early, when the patient is as young as two or three years old; it affects twice as many girls as boys. The arthritis is often localized in one joint (pauciarticular or oligoarticular form); Still's syndrome is very rare. Local treatment with cycloplegics and steroids has to be combined with systemic immunosuppressive medication with cyclophosphamide. Chronic intermediate uveitis (pars planitis) usually affects teenagers in good health. Peripheral fundus changes can be detected most easily by biomicroscopy with the three-mirror contact lens. Cystoid macular edema is frequent and, together with vitreous opacities, is responsible for a deterioration in central vision. In most cases local treatment with subconjunctival injection of depot steroids is sufficient. Immunosuppressive treatment or surgical intervention is only indicated in severe cases where there is a risk of complete loss of vision.

[Secondary forms of glaucoma]

The various forms of secondary glaucoma are discussed on the basis of their different pathogenesis. Elevation of IOP is most frequently associated with inflammation of the uveal tract. Vascular changes in the uvea, in particular rubeosis iridis but also angiomatoses of the retina, can cause secondary glaucoma. Tumors of the uvea and retina often lead to increased intraocular pressure; and lastly, blunt and perforating injuries are frequently followed by glaucoma. Treatment of all these different forms of secondary glaucoma is discussed.

Type VI collagen is a major component of the human cornea

Collagen type VI is shown to be present in the human cornea. This finding is based on comparative peptide mapping relative to type VI collagen isolated from placenta and on immunoblotting using antibodies specific for human type VI collagen. Scanning of polyacrylamide gels indicates that type VI collagen comprises as much as one quarter of the dry weight of the cornea. Indirect immunofluorescence shows this collagen to be distributed throughout the corneal stroma. Thus, type VI collagen must be considered a major component of the extracellular matrix of the human cornea.

[Retinal angiomatoses]

The three classical angiomatoses of the retina are described on the basis of the clinical picture. If early diagnosis is possible, the otherwise inevitable progression to exudative retinal detachment and secondary glaucoma may be avoided through extensive coagulation by laser, xenon or cryopexy. - The prognosis is best in Leber's retinitis; it in much poorer in cases of von Hippel-Lindau angiomatosis and primary Coats' disease.

[Retinal angiomatoses]

The three classic angiomatoses of the retina are described according to the clinical picture. If early diagnosis is possible, then the inevitable progression to exudative retinal detachment and secondary glaucoma may be avoided by extensive coagulation with laser, xenon or cryopexy. Prognosis is best with Leber's retinitis, much less so in cases of von Hippel-Lindau angiomatosis and primary Coats' disease.

[Drug treatment of inflammatory and infectious endogenous inflammations of the eye]

In many cases antibiotic treatment is indicated; steroids are not always needed. In special cases of uveitis (Behcet's syndrome, sympathetic ophthalmia, anterior uveitis in children with JRA) cytostatic treatment seems justified. Inflammations of the optic disk and nerve require very extensive diagnostic evaluation. Medical treatment is usually limited to steroids, administered systemically and locally; however, its efficacy is still a matter of debate.

[Ulcerative herpetic keratitis. Clinical and pathological findings and prognosis of the graft]

Between 1971 and 1982 33 corneae were excised for therapeutic keratoplasty because of ulcerative herpetic keratitis. The histologic findings and the clinical course enabled distinction of a nonreactive form with a rather good prognosis for keratoplasty (62% clear grafts) and an inflammatory form with bad prognosis (20% clear grafts) because of many herpetic recurrences. Perforating keratoplasty and first interventions in particular did better than lamellar keratoplasty or retransplantation. Existence of preoperative corneal vascularization compromised the prognosis of the graft. Preoperative perforation of the ulcer occurred rather often in nonvascularized corneae without compromising the prognosis of the graft.

Corneal endothelial changes in primary acute angle-closure glaucoma

In 20 patients, corneal endothelium was examined by specular microscopy after acute angle-closure glaucoma, and before any surgical treatment in order to assess possible damage during pressure induced abnormal hydration of the cornea. The mean intraocular pressure was elevated to 55 mm Hg and had lasted, on an average, 47 (5--192) hours. The mean endothelial cell density in the affected eye was 1534 and in the nonaffected fellow eye 2243 cells/mm2 (mean decrease 33%, P = 0.002). The amount of cell loss correlates with the duration of the intraocular pressure increase. Thirty-five percent of these patients presented a bilateral cornea guttata. This high incidence of endothelial dystrophy was confirmed in a retrospective specular microscopic study in 20 patients with a history of unilateral acute angle-closure glaucoma. The decreased number of endothelial cells after acute angle-closure glaucoma frequently combined with bilateral cornea guttata, accounts for the corneal degeneration in these patients following a later cataract extraction.

[Astigmatis following perforating keratoplasty in keratoconus patients (author's transl)]

Earlier studies of successful keratoplasties in keratoconus patients showed that despite clear healing of transplants, a high degree of regular astigmatism very often results. A series of 28 eyes operated with a double running corneal suture is critically analyzed. It can be seen that, even using this suture technique, the final result after removal of the two sutures is still accompanied by a high degree of astigmatism. The cause of the residual astigmatism is thus probably due to the weakness of the peripheral corneal rim.

[Keratoplasty]

The different indications for penetrating keratoplasty are discussed on the basis of the clinical results of the past five years. Keratoconus is the most important group, followed by other corneal dystrophies, metaherpetic keratitis, graft failures and corneal scars. The results are very good in the first two groups, much less so in the last two. Eyes with repeated keratoplasty have a bad prognosis. One-half of the regrafts become cloudy. The most important postoperative complications, such as wound dehiscence, glaucoma, allograft reaction and anterior synechias are discussed.

[Juvenile nevoxanthogranuloma of the iris]

Juvenile Xanthogranuloma of the iris is a rare but benign disease of infants. The iris is swollen and of yellowish color, there are exsudates in the anterior chamber and occasionally spontaneous hyphema may occur. Secondary glaucoma with edema of the corneal epithelium and hydrophthalmus are often seen. Treatment consists in topical application of steroids, sometimes combined with pressure-lowering medication.

[Specular microscopy of the corneal endothelium (author's transl)]

Specular microscopy enables the examination of the endothelium of the isolated and perfused cornea. It is of great help in evaluating donor material in an Eye Bank. The in vivo observation and microphotography of the corneal endothelium makes it possible to detect early degenerative, traumatic surgical and other pathological changes of the monolayer.

Clinical implications of aqueous humor studies in uveitis

We studied the serologic findings in serum and aqueous humor samples from 693 cases of uveitis. Specimens were tested for the presence of humoral antibodies against tuberculosis, toxoplasmosis, antistreptolysin-O, herpes simplex and herpes zoster viruses, mumps virus, and adenovirus. Serologic analyses rarely indicated tuberculous or streptococcal infections, but frequently showed toxoplasmosis and viral diseases.

[Inflammation of the uvea--the cellular immune response in the iris (author's transl)]

Ultrastructural analyses of iris biopsies in 17 cases of uveitis with different etiology revealed that all cells involved in immunological reactions are present. Many plasmacells and lymphocytes, but also macrophages and mastcells are found. Destruction of cells and even necrosis as well as damage of blood vessels are run. No specific germs could be demonstrated and etiology was not further elucidated. But there remains no doubt on the immunological nature of uveitis.

Innervation of melanocytes in human iris. An electron microscopic study

Contacts between melanocytes and nerve terminals in human iris stroma were investigated by means of electron microscopy. Four distinct types of nerve terminal making synaptic contacts with melanocytes can be distinguished: (1) nerve terminals containing only empty synaptic vesicles (400-800 A in diameter) and with intervening basement membrane material (separation 1000 A); (2) nerve terminals with both empty vesicles and granulated vesicles (600-1100 A in diameter) also with intervening basement membrane material (separation 750 A); (3) nerve terminals containing empty vesicles and forming close contacts with melanocytes (distance about 400 A) without interposed basement membrane material, and (4) nerve terminals containg both empty and granulated vesicles (750 A in diameter) which make closer contacts with melanocytes (distance 270 A) without interposed basement membrane material. Type (1) and type (3) nerve terminals are thought to be cholinergic; type (2) and type (4) nerve terminals appear to be adrenergic. Taking into consideration these morphologic findings and previously reported data, it seems justified to postulate the presence of trophic innervation of melanocytes in the human iris.

Electron-microscopic analysis of iris vessels in two cases of uveitis

Electron-microscopic analysis of iris biopsy material was carried out paying particular attention to vessels and infiltrating cells. Characteristic changes of vessels and cells were found in two cases. One showed abundant lymphodiapedesis, perivascular infiltration, and vessels appearing morphologically normal. The other showed diffuse infiltration of cells and numerous fenestrated newly formed vessels. In the latter, three different types of opening in the endothelium were observed: (1) separation of intercellular junctions; (2) small pores or defects in the endothelium, and (3) large holes or defects in the endothelium. Cell leakage from normal and newly formed vessels was considered. We concluded that lymphocytes may migrate through the cytoplasm within membrane-bounded vesicles in normal vessels, whereas in newly formed fenestrated vessels cells, including small lymphocytes, may pass through three different types of opening in the endothelium.

[Secondary glaucoma and uveitis: hypertensive uveitis (author's transl)]

The secondary rise of i.o. pressure in uveitis may lead to a true secondary glaucoma or to hypertensive uveitis. The etiology of the endogenous inflammation does not seem to play a role. Pathogenetically the occlusion of the pupil with the formation of iris bombé and the obliteration of the chamber angle by exudate are important factors, while the hypersecretion of aqueous humor plays a minor role. Medical treatment consists in mydriatics and steroids. Surgical treatment depends on the pathogenetic mechanism and consists either in sector iridectomy or a filtering procedure.

[Local anesthesia in ophthalmic surgery (author's transl)]

Although there is parctically no contraindication for general anesthesia and the risks for the patient have become considerably less, local anesthesia is still indicated for many ophthalmic surgical interventions. Here different factors have to be considered: The physical and psychological state of the patient, the nature of the intervention (above all cataract and glaucoma operations, as well as lamellar and perforating keratoplasties), the technique of the local anesthesia, the pre-medication, the relationship surgeon-patient, economic factors and possible complications of general anesthesia.

[Cornea preservation in a continuous tissue culture medium at +37 degrees C]

Seven human corneae were preserved 1 or 2 weeks in a continuous tissue culture medium at +37 degrees C. 200 microgram/ml gentamycin and 2.5 microgram/ml amphotericin B were added, and no infection was noted after 2 weeks. Histological and electronmicroscopical findings presented a picture of well-kept cellular and subcellular structures. Comparable electron-optical examinations taken on seven corneae kept at +4 degrees C in a modified medium 199 showed the beginning of endothelial necrobiosis.

Endothelial changes in human donor corneas

The corneal endothelium of intact donor eyes was evaluated by means of a specular microscope. In a series of 278 corneas, different morphologic changes were found in the endothelium. These changes are described and systematically classified. The findings are analogous to results obtained on experimental animals and with light- and electron-microscopic studies of other authors.

Retinal detachment surgery

Retinal surgery commences with careful ophthalmoscopy. The surgeon must be familiar with indirect monocular and binocular ophthalmoscopy, but biomicroscopy is most essential. Buckling procedures can be produced by different techniques and should be adapted to the case. Drainage of subretinal fluid is crucial. One should avoid it if possible, but if it has to be done, care has to be taken to avoid complications. The sealing of retinal holes and tears can be performed by diathermy, cryo- and light coagulation. Each technique has its indication and should be available at the time of surgery. Vitreous surgery is still in the experimental stage, but seems to be very promising, although its main use will most probably lie outside the field of retinal detachment.