The use of porcine small intestinal submucosa in ten cases of feline corneal disease.

Porcine small intestinal submucosa (SIS) was used as a novel graft material in the management of 10 cases of feline corneal disease. Five cases had stromal ulceration associated with trauma, ocular foreign body and/or suspected infection and required a grafting procedure. Five cases had feline sequestra that were managed by a keratectomy prior to placement of SIS as a graft material. Eight eyes healed with minimal corneal scarring with a very good cosmetic and visual result. One eye with continued aqueous leakage in the immediate postoperative period required a conjunctival pedicle graft to reinforce the SIS graft site. One eye required enucleation 48 h following grafting due to progressive keratomalacia but the SIS material remained intact.

Contrasts in the professional identities of psychiatrists and internists.

Projected manpower shortages in psychiatry have prompted studies identifying factors that influence medical students in career choice. In the present study, the authors compare self-images as individuals with professional images of psychiatrists using subjects from internal medicine as a control group. A total of 353 subjects from two university clinical practices completed questionnaires that utilized the Osgood Semantic Differential to determine attitudes in the areas of evaluation, potency, and activity. The hypothesis that psychiatrists differ significantly in their self-images as individuals and their professional role images was partially confirmed. In the areas of activity and power, significant (p less than .001) differences existed in their attitudes. In the concept of evaluation, the self-images and the professional images were similar. The impact of these discrepancies on students making career choices is discussed.

Diabetic hyperglycemia and glycosuria as a manifestation of bulimia.

This is the first reported case of insulin dose manipulation as a manifestation of bulimia. The patient was diabetic, with fluctuations in control. Despite the guarded prognosis in bulimia, the patient's diabetic control improved with psychotherapy.

Distorted learning from unusual medical anecdotes.

Doctors are encouraged to look upon each patient as a learning experience ( Wyngaarden , 1979). Case-oriented learning begins in the clinical years of medical school and continues throughout the professional career of the doctor. Clinical cases, or anecdotes, have the potential of producing accurate, relevant and meaningful learning for the clinician even though they are uncontrolled in a scientific sense. However, unusual or atypical cases can also result in erroneous learning which can negatively affect patient care. The purpose of this article is to identify difficulties in this form of subjective learning which can lead to suboptimal doctor practice patterns. Six actual clinical cases are briefly described to illustrate how inaccurate learning distorted subsequent clinical problem-solving by doctors. Suggestions are then made for ameliorating this difficulty.

Dementia in elderly outpatients: a prospective study.

We prospectively studied the evaluation of dementia in 107 unselected outpatients; 83 had so-called "irreversible" dementias, including 74 who had an Alzheimer-type dementia. Fifteen patients had potentially reversible dementias, of which hypothyroidism and drug toxicity were the commonest causes. Distinguishing features of reversible dementia were shorter duration, use of more prescription drugs, and less severe dementia. Almost half of the patients had other previously unrecognized treatable medical diseases. Most diagnoses were made from patient history and physical and mental status examination. Patients with reversible dementia improved but rarely reverted to normal. Objective improvement occurred in 25 patients after treating unrecognized coexistent medical and psychiatric diseases, or stopping unnecessary medication. Careful clinical observation is the most useful part of the evaluation and extensive testing may not be required for all patients. Overemphasis on distinguishing reversible from irreversible forms of dementia may detract from recognition of commoner, treatable causes of dysfunction and suffering.

Analysis of selection criteria for medical residents. Differences between primary care and traditional pathway committees.

A self-administered questionnaire was given to faculty members of resident selection committees for traditional and primary care medical residencies at one institution. Results from both committees revealed that applicant performance in medicine clerkships and communication from the applicant's department of medicine faculty, especially the chairman, were key criteria in evaluating the strength of each applicant. Negative personal characteristics were important in determining undesirable resident candidates. Primary care program selectors put more emphasis on the applicant's personal goals, skills, and interests, especially career plans in general internal medicine, than did their traditional program counterparts. Other differences included the tendency of traditional program committee members to value collegial communications and the perceived quality of the applicant's medical school more than the primary care members did.

Angina in thyrotoxicosis. Thyroid-related coronary artery spasm.

Ischemic heart disease is a common complication of thyrotoxicosis, although the exact mechanism has not been defined. A case is reported of angina and thyrotoxicosis in which the angina was reproduced by coronary artery spasm induced by ergonovine maleate, relieved by thyroid ablation, and reactivated by postablative thyroid replacement. Coronary arteriography did not show significant stenoses prior to ergonovine injection. Possible mechanisms of coronary artery spasm in thyrotoxicosis are briefly discussed. Hyperthyroidism should be considered as a cause of angina in any patient with rest pain and normal coronary arteries.

Cerebral ischemia associated with parenteral terbutaline use in pregnant migraine patients.

Two pregnant patients with a history of migraine each developed evidence of cerebral ischemia while being treated with subcutaneous terbutaline, for asthma in one case and for tocolysis in the other. The evidence for cerebral ischemia as well as the occurrence of strokes associated with pregnancy or migraine is discussed. Mechanisms by which a selective beta 2 agonist could affect cerebral vasculature are unknown. Until more is known we recommend that pregnant patients with migraine or vascular headache not be given terbutaline.

Managing infections in immunosuppressed patients.

Various infections are associated with depressed host defenses. Systemic antibiotic therapy is not useful prophylactically but should be instituted immediately in patients with known bacterial infections and in febrile patients with neutropenia. Meticulous patient care and attention to collection and evaluation of microbiologic data are the keys to early detection of infection. Nonbacterial opportunistic infections should be considered in patients with prolonged fever or fever and pulmonary infiltrates. Some ancillary measures, such as patient isolation and reconstitution of the immune system, may help in prevention or treatment of infections in immunosuppressed patients.