Hb Grove City [ß38(C4)Thr→Ser, ACC>AGC; HBB: c.116C>G]: a new low oxygen affinity ß chain variant.

A previously unreported ß chain hemoglobin (Hb) variant, Hb Grove City [ß38(C4)Thr→Ser, ACC>AGC; HBB: c.116C>G], was discovered in a woman who presented with hypoxia and mild anemia. Her young daughter also tested positive for the variant and displayed similar symptoms. Hemoglobin-oxygen dissociation testing confirmed right-shifted oxygen dissociation curves. A corresponding Hb variant was detected by high performance liquid chromatography (HPLC) and intact mass spectrometry (MS) but was not detected by capillary electrophoresis (CE), isoelectrofocusing (IEF) or alkaline or acid electrophoresis. DNA sequencing analysis confirmed a ß-globin gene mutation. All three previous mutations at this locus affect oxygen affinity, as does this new variant. This newly described variant showed variable stability results and therefore may be mildly unstable but is not associated with microcytosis, significant hemolysis or clinically evident cyanosis. It is important to consider hemoglobinopathies in patients who are anemic and have unexplained hypoxia. Arterial blood gas and p50 evaluations may prevent unnecessary diagnostic interventions. Additionally, Hb variants with altered oxygen affinity can be electrophoretically silent; therefore, multiple methods including MS and/or DNA sequencing are warranted when clinical suspicion is high.

Forty years of group psychotherapy at the Menninger Clinic.

Despite the skepticism and indifference to group psychotherapy that existed in the 1950s and 1960s within the psychoanalytic community in general and among the staff and administration of the Menninger Clinic in Topeka, Kansas in particular, a few clinicians there forged ahead in pursuit of incorporating this modality as an accepted treatment. After gaining some acceptance first in the hospital, we experienced a slow rate of growth, except with our trainees who were generally enthusiastic about group work. Many of them were intrigued first by their exposure to the group dynamics seminars and later by the didactic courses and supervised group work that eventually came to be required by the accrediting body for residency programs of the American Psychiatric Association. Visiting senior consultants and teachers, mainly associated with the American Group Psychotherapy Association, as well as an esteemed clinician from the Tavistock Clinic, also lent credibility and legitimacy to our effort. When group treatment began to be adopted by units of the Menninger Hospital in the early 1970s, there was a significant sea change in the attitude of the organization and group psychotherapy became a well established modality.

The capacity to forgive: intrapsychic and developmental perspectives.

The topic of forgiveness, despite its importance for the continuity of relationships and for the mental health of the aggrieved party, is relatively neglected in the psychoanalytic literature, perhaps because it is often seen as the province of religion and carries the connotation of reaction formation and inauthenticity. However, genuine forgiveness involves significant intrapsychic work, conscious and unconscious working through of one's anger, and putting the offense into the context of an integrated view of the whole person of the offender. Early developmental structures are the ground on which the relative ability to let go of a grievance depends. While later motives and defenses (e.g., fear of retraumatization, avoidance of shame) may also play a role, these early structures are primary. They are described here in terms of attainment of the depressive position and the development of a sense of secure attachment, the capacity to mentalize, and the ability to mourn.