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Therese Neumann, from Konnersreuth in Bavaria, developed stigmata at the age of 29 and allegedly lived without any food for 36 years. After a fire accident in 1918, she suffered from paralysis, deafness, and blindness. Later she developed stigmata on her extremities and left side of the thorax, bleeding lesions in the skin, bleeding in the eye region, and altered states of consciousness in the form of "visions" of religious content. On the basis of a report by her physician, Dr. Otto Seidl, to the Bishopric Ordinariate of Regensburg (1927) and a manuscript for presentation before the Catholic Medical Society of the Netherlands (1928) Seidl had no doubt of the authenticity of these phenomena, and he diagnosed hysteria. While under surveillance by four nuns for 14 days, Neumann exhibited no intake of nourishment; weight measurements and urine tests however suggest the opposite. Investigation in a clinic was refused. Her case is interpreted here in the light of contemporary psychiatry. As far as medical records go, Therese Neumann's is one of a series of surprisingly similar cases of stigmata development, conversion disorder, and alleged absence of nutrition. In nosological terms, these would be classified today as dissociative disorders.

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Zoophilia, a sexual preference for animals, has lost its character as a severe mental disorder. In clinical practice it is rarely seen nowadays, particularly since it was decriminalized in 1970. This research is based on three case reports and an anonymous interview over the Internet. Findings from this study do not offer explanations about the causes of zoophilia. It is noteworthy, however, that the subjects in question were socially well adapted and displayed good interpersonal social skills. The authors stress that zoophilia shows a variety of manifestations. The subject's desire to be transformed into the animal he or she has contact with can be understood as a narcissistic compound and is not related to lycanthropia. The authors are optimistic over the possibilities offered by this Internet research methodology.

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With this comes the question: Are there typical relationship patterns and affects, that appear in physicians experience of their relationships to patients with different illnesses? We asked 33 physicians about impressive experiences with one AIDS-, one cancer- and one metabolic disorder patient each. The narratives we received were evaluated with two contentanalytic methods. The relationship patterns were assessed by the Core Conflictual Relationship Theme (CCRT), developed by Luborsky. The affects were assessed by the Gottschalk-Gleser Content Analysis Scales. We found some significant differences between the relationship experience with AIDS- and cancer patients on the one hand, and metabolic disorder patients on the other hand. In relationships with critical ill AIDS- and cancer patients the physicians verbalize more death anxiety and more diffuse or nonspecific anxiety. Furthermore they show more covert hostility against the AIDS- and cancer patient, whereas they verbalize more overt hostility against the metabolic disorder patients. We found also some fine distinction between the relationship experiences with AIDS-patients on the one hand and cancer patients on the other hand. The physicians get more involved with the relationships to AIDS-patients and the closeness-distance-regulation seems to be one central issue in this relationships.

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Caring for people with AIDS physicians and nurses are confronted with special problems. Compared to other severe illnesses there are specific problems in the relationship between doctors and nurses with their patients due to the similarity in age, the risk of infection and that most of the patients belong to stigmatized, marginal groups, that represent despised and threatening impulses (homosexu-ality, promiscuity, addiction). The results of our survey of 85 physicians and 111 nurses suggest, that physicians and nurses react with a typically professional attitude concerning the identification with AIDS-patients. The "concordant identification", that is induced by the same age of many AIDS-patients, is followed by a "complementary identification" with the professional role that serves as a defence and helps in coping with threatening internal conflicts. Wherein physicians have a mainly neutral attitude and delegate their feelings to the nurses, nurses show an unlimited commitment for AIDS-patients delegating their aggressive reactions to the physicians.

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Psychosomatic studies in patients with rheumatic diseases have shown the great importance of physical activity. Both educational and constitutional factors play a major role. The early inhibition of physical activity and the suppression of aggressive impulses are responsible for a typical personality structure of the patients. Physical activity is considered to be a substitute for impaired aggressivity and a defense mechanism against depressivity. These factors are clarified by a case report of a patient with rheumatoid arthritis. Practical implications for the management of patients with rheumatic diseases are demonstrated.

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Among 64 patients with familial hypercholesterolemia (FHC) confirmed by tissue culture of skin fibroblasts (3 homozygotes, 9 heterozygotes) 12 (3 homozygotes, 9 heterozygotes) had signs of atherosclerosis of the carotid arteries and of the peripheral arteries (extracardiac vasculature). 8 heterozygotes as well as the three homozygotes had coronary atherosclerosis. Three of the 12 patients with carotid artery disease suffered from clinical symptoms of cerebrovascular insufficiency. Only five patients with heterozygous FHC had symptomatic peripheral artery disease though 10 including the three homozygotes had signs of atherosclerosis of the abdominal aorta and its peripheral branches. It is concluded that patients with FHC develop generalized atherosclerosis but not always symptoms of peripheral artery disease. Risk factors other than hypercholesterolemia do not seem to contribute essentially to the development of atherosclerosis. It seems important to evaluate patients with FHC regularly for atherosclerosis of the carotid arteries which might be recognized earlier than coronary atherosclerosis.

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A 39-year-old male patient observed an increasing bluish pigmentation of the ear cartilage associated with recurrent back-pain. Darkening of the urine after the addition of sodium hydroxide led to the suspected diagnosis of alkaptonuria. This diagnosis was confirmed by the detection of urinary homogentisic acid by thin-layer chromatography.

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Twenty-three patients with familial hypercholesterolemia (FHC) confirmed by tissue cultures of skin fibroblasts (2 homozygotes, 21 heterozygotes) and 3 patients with sporadic hypercholesterolemia were evaluated for Achilles tendon (AT) thickness by xeroradiography. Both homozygotes had thick ATs and coronary heart disease (CHD), 20 heterozygotes had thick ATs, but only 8 of them had CHD. One heterozygote had a small AT value, but CHD for a long time. The 3 patients with sporadic hypercholesterolemia, one with CHD, had small AT. There was no correlation between serum cholesterol concentration and AT thickness, between age and AT thickness, nor between AT thickness and CHD.

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The measurement of glycolysed hemoglobin as a parameter of longterm monitoring has considerably enlarged the scope of possibilities for diabetic supervision. Retrospective information on the quality of the metabolic stabilization up to three months is possible, independently of the momentary blood sugar. Analyses of fatty tissue permit conclusions on the fat composition of the diet in the past years, the fatty acid pattern of the cholesterol esters are an indicator for the ingestion of unsaturated fatty acids in the last few weeks. No practicable method for longterm monitoring of purine metabolism has yet been developed. The size of the uric acid pool may be such a parameter.

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For any society a timely follow-up of the child's psychosomatic development is of utmost importance. Such a follow-up requires that at the very birth of the child there are adequate records on all phases of pregnancy, on risk factors potentially affecting the child's development, and data on labour and the newborn's functions. All this information should be provided by gynecologists in consultation units for women and in maternity wards, as well as by pediatricians in maternity wards and child dispensaries. In view of this, systematic examinations and the follow-up of children in their first days and years of life are imperative for an early detection of possible health impairments. For the implementation of such a programme a close collaboration of hospital and non-hospital services and the standardization of medical records are essential. At present some recording in this respect exists but its scope is very modest. The setting up of a respective registry is what is actually needed.

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