Anterior chamber cleavage syndrome. A stepladder classification

This paper classifies the abnormalities of the anterior chamber cleavage syndrome (mesodermal dysgenesis of the iris and cornea). The anatomic findings are arranged in a tabular stepladder fashion which builds from simple to more complex combinations, most of which have been previously known by eponyms. There are three groups of anomalies: 1) peripheral, 2) central, and 3) combinations of the two. 1) The peripheral anomalies consist of a prominent Schwalbe's ring, iris strands to Schwalbe's ring, and hypoplasia of the anterior iris stroma. Developmental glaucoma is commonly present. 2) The essential feature of the central anomalies is a defect in the corneal endothelium and Descemet's membrane with an overlying corneal opacity. Additional components include central iridocorneal adhesions, keratolenticular approximation with cataract, and scleralization of the cornea. Chorioretinal anomalies, developmental glaucoma, and systemic malformations may be present. 3) Central and peripheral combinations may exist in the same eye, in both eyes of the same patient, or within the same family.     

Weight loss and fatigue in an elderly patient

We report a recent clinical case of an elderly patient who presented with weight loss and fatigue and who was diagnosed with hyperthyroidism. Some time later, he was discovered to have underlying oesophageal lymphoma. The latter diagnosis was believed to contribute, at least in part, to his symptoms at the time of initial presentation. The case illustrates the potential difficulties associated with establishing the diagnosis of oesophageal lymphoma. Furthermore, symptoms of weight loss and fatigue are commonly encountered in general medical patients. This case reminded us that even when a diagnosis of hyperthyroidism has been established, these symptoms may be attributable to other pathology.     

Pediatric reference intervals for FSH, LH, estradiol, T3, free T3, cortisol, and growth hormone on the DPC IMMULITE 1000

BACKGROUND: We studied serum follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2), triiodothyronine (T3), free T3 (FT3), cortisol and growth hormone (GH) concentrations in a population of pediatric patients. The reference intervals were determined separately for females and males stratified by age groups to assess age- and sex-related differences. Our objective was to obtain reference intervals for the 7 serum analytes for our pediatric population using the IMMULITE 1000 system. METHODS: Serum samples of 800 in- and out-patients, newborn to 19 years old were analyzed using the DPC IMMULITE 1000 chemiluminescent immunoassay system. RESULTS AND CONCLUSIONS: We report pediatric reference intervals for FSH, LH, E2, T3, FT3, cortisol, and GH. These reference intervals provide the basis for clinical interpretation of laboratory results using the IMMULITE 1000 system and the assessment of child development.     

A preventative approach to emotional illness in psychiatric residents

Emotional illness in psychiatric residents and its relationship to psychiatric post-graduate training is examined. First, the pertinent literature is reviewed. Psychological and social factors which predispose, precipitate, and perpetuate these emotional disturbances are discussed. The significance of emotional illness in psychiatric residents to the teaching and learning of psychiatry and to the psychiatric profession is clarified. Second, the currently unresolved dilemma of the psychiatric resident “Teach or Treat?” is presented. It is the author's contention that by redefining “treatment” in terms of the goals and philosophy of public health this dilemma can be resolved to the satisfaction of resident, faculty, and the psychiatric profession.     

The metabolism of phenothiazine in the neonatal calf: identification of drug-polypeptide conjugates from urine

The presence of a polypeptide conjugate fraction in the urine of young calves after oral dosing with phenothiazine has been confirmed. Four different polypeptide conjugates, containing up to six amino acids attached to phenothiazine or leucophenothiazone via the carboxyl terminal of the chain, have been isolated, characterized and sequenced. In addition, several minor polypeptide conjugates have been observed. The literature pertaining to polypeptide conjugates of drugs has been reviewed and the importance of this metabolic route in neonatal animals discussed.