[A familial anterior corneal degeneration: clinical aspects, histopathology and differential diagnosis]

BACKGROUND

We report on three cases of a progressive anterior corneal degeneration with clinical characteristics of limbal insufficiency occurring in three persons in three consecutive generations of one family. The disease has not yet been described in literature.

PATIENTS

A woman aged 68, her 51 years old son and his 19 years old son are affected by the disease, which suggests autosomal dominant inheritance. None of the affected family members suffers from any form of collagenosis, endocrine insufficiency, chronic dermatosis, alteration of fat metabolism or other relevant systemic diseases. There is no accompanying disease of lids and conjunctiva except of a keratoconjunctivitis sicca with alteration of the mucin phase. The youngest affected member has a binocular anterior polar cataract. In the eldest affected member we performed penetrating keratoplasty.

HISTOPATHOLOGY

Revealed thinning of corneal epithelium, moderate intra- and subepithelial granulocytary infiltration, a marked hyaline thickening of Bowman's membrane. The adjacent stroma showed accumulation of granulocytes and an increased number of capillaries and fibroblasts. Posterior stroma, Descemet's membrane and endothelium were normal. There were no goblet cells in the central epithelium.

CONCLUSIONS

The appearance of the disease in three consecutive generations (strongly suggesting autosomal dominant inheritance) and the progressivity are characteristics of a dystrophical process. Development of a circular pannus and infiltration of epithelium and stroma with granulocytes however classify the disease as a degeneration, clinically and pathologically similar to Salzmann's nodular degeneration and to autosomal dominantly inherited keratitis.

State access to peer review records: a clash of public policy

Hospital peer review is a process that promotes important public objectives, yet is frequently under attack by persons pursuing private interests. An additional threat to this process has arisen from an unlikely source: state hospital licensing authorities. In this article, the authors discuss the conflict between state laws requiring access to peer review records and the need for confidentiality of such records.

Countersuit litigation

Countersuit litigation brings into sharp focus some difficult and conflicting concepts in law and social policy. A point that seems reasonably self-evident is that the existence of a viable countersuit remedy in most states has not produced the huge volume of litigation that might create a "chilling effect" upon access to the courts, and it is not likely to do so in the future. If our system is actually committed to the idea that all disputes can be submitted to the courts for resolution, it is difficult to conclude that a remedy should not be available to an individual who has been subjected to the very real cost and hardship of defending a frivolous lawsuit. The use of the legal system to provide redress for injuries should be a two-way street. The fact that a remedy should exist, however, does not necessarily mean that is should be encouraged. Most serious-minded people understand that certain types of inconvenience are a necessary part of life in a civilized society. Nevertheless, if litigation is increasingly becoming a mechanism for profit or an instrument to remedy the most minor grievance, some response is mandatory. While litigation is a serious matter and should not be undertaken lightly, it is impossible to overlook the fact that there is a certain percentage of cases that are filed to exploit the system at the expense of innocent defendants. If litigation serves a dual purpose of providing compensation to injured parties and setting appropriate standards for future conduct, it is hard to find a rational basis for denying a countersuit remedy to those who have been victimized in this manner.