Double-orifice mitral valve is a relatively rare congenital abnormality, usually discovered at autopsy or surgery. In most cases, the double-orifice mitral valve causes no hemodynamic effects, sometimes it is regurgitant, and rarely is stenotic. Appreciation of this echocardiographic abnormality is important because double orifice mitral valve is often associated with other congenital anomalies and this echocardiographic findings may be confused with other cardiac abnormalities. The authors report a case of isolated congenital double-orifice mitral valve in a 42-year-old woman. Data from the literature are reviewed and the echocardiographic images of the malformation are described.
Adult ; Autopsy ; Congenital Abnormalities ; Echocardiography ; Female ; Hemodynamics ; Humans ; Mitral Valve*

Under the assumption that people go through stages in making dietary behavior change, this study was attempted to apply the stages of a change model for fat intake by examining the associations of social psychological variables with stages of change in dietary fat reduction. Derived from social psychological theories, 10 social psychological variables on motivational beliefs(6), social influence(3) and self-efficacy(1) related specifically to selecting every day diets low in fat were constructed. Fat and energy intakes were assessed by a short form semi-quantitative food frequency questionnaire. The associations of stages of change with motivational beliefs, social influence, and self-efficacy variables and energy and fat intakes were assessed in 333 female adults from large cities in Korea. Dietary stage groups differed significantly on most of the social psychological variables in ways predicted by theory. Motivational factors that lead to a psychological state of readiness to take action were important in the early stages of the dietary change process. Social influences were more important in the stages as people decide to take action. Self efficacy and motivational beliefs, particularly, reduction of perceived barriers were important in maintaining fat reduction behavior. The results of our study indicate differences in stages of change in fat reduction behavior in terms of nutrient intakes and social psychological correlates and suggests that adding a time dimension to social psychological models increases our understanding of dietary change, which assist us in designing nutrition education interventions that are more appropriately targeted by stage of change.
Adult* ; Diet ; Dietary Fats ; Education ; Female* ; Humans ; Korea ; Models, Psychological ; Psychological Theory ; Self Efficacy ; Surveys and Questionnaires

Coarctation of aorta is a rare cause of secondary hypertension, and premature death will occur if no appropriate treatment is given. The only effective treatment was surgery before 1980, but restenosis was frequent. Several works on percutaneous transluminal angioplasty of the disease were reported. In patients with previously operated recoarctation, there is no doubt that balloon angioplasty is now the first choice of the therapy because of the surgical risks of reoperation. Nevertheless, there has still been some controversy regarding the application of this therapy to native coarctation, because of the potential risk of aortic disruption and the high incidence of restenosis. There have been some clinical reports of successful stent implantation for coarctation without major complications since 1991. We report on our experience with balloon-expandable stent implantation for native coarctation of the aorta in a 23-year-old man with congenital mitral stenosis. Aortogram showed a coarcted aortic segment of 3 mm in diameter and 25 mm long just distal to the left subclavian artery. The peak systolic pressure gradient across the coarctation before stent implantation was 100 mmHg. Stent implantation was performed with 14 X 40 mm balloon with Palmaz P308 stent. The peak systolic pressure gradient decreased to zero and the diameter of the coarctation of aorta increased to 14 mm after stent implantation immediately. The patient tolerated well and no significant complications were encountered during the procedure.
Angioplasty ; Angioplasty, Balloon ; Aortic Coarctation* ; Blood Pressure ; Humans ; Hypertension ; Incidence ; Mitral Valve Stenosis* ; Mortality, Premature ; Reoperation ; Stents* ; Subclavian Artery ; Young Adult

Coarctation of aorta is a rare cause of secondary hypertension, and premature death will occur if no appropriate treatment is given. The only effective treatment was surgery before 1980, but restenosis was frequent. Several works on percutaneous transluminal angioplasty of the disease were reported. In patients with previously operated recoarctation, there is no doubt that balloon angioplasty is now the first choice of the therapy because of the surgical risks of reoperation. Nevertheless, there has still been some controversy regarding the application of this therapy to native coarctation, because of the potential risk of aortic disruption and the high incidence of restenosis. There have been some clinical reports of successful stent implantation for coarctation without major complications since 1991. We report on our experience with balloon-expandable stent implantation for native coarctation of the aorta in a 23-year-old man with congenital mitral stenosis. Aortogram showed a coarcted aortic segment of 3 mm in diameter and 25 mm long just distal to the left subclavian artery. The peak systolic pressure gradient across the coarctation before stent implantation was 100 mmHg. Stent implantation was performed with 14 X 40 mm balloon with Palmaz P308 stent. The peak systolic pressure gradient decreased to zero and the diameter of the coarctation of aorta increased to 14 mm after stent implantation immediately. The patient tolerated well and no significant complications were encountered during the procedure.
Angioplasty ; Angioplasty, Balloon ; Aortic Coarctation* ; Blood Pressure ; Humans ; Hypertension ; Incidence ; Mitral Valve Stenosis* ; Mortality, Premature ; Reoperation ; Stents* ; Subclavian Artery ; Young Adult

No abstract available.
Mitral Valve*

PURPOSE: We analyzed the relationship between MRI patterns and neurologic outcome and explored the effectiveness of MRI as a tool for predicting the outcome. METHODS: We analyzed 23 full term infants with severe HIE retrospectively who were admitted to our NICU from Sep. 1993 to May 1998. Their MRI findings were classified into 4 patterns : type I : deep gray matter injury; type II : cortical, subcortical white matter injury; type III : localized periventricular white matter injury; and type IV : mixed injury. Neurodevelopmental outcome was assessed at a mean age of 30.7 months and the patients were grouped in two - neurodevelopmentally normal(8 cases) and delayed(15 cases, including 4 deaths). RESULTS: All type I patients(n=3) showed severe neurodevelopmental delay. Of seven type II patients, three developed normally(42.9%) and four showed developmental delay(57.1%). All type III patients(n=4) developed normally(P=0.008). Of nine type IV patients, one(11.1%) developed normally and eight(88.9%) showed severe developmental delay. There were twelve patients with lesions including thalamus and basal ganglia injury in MRI(type I+IV) and most of them(n=11, 91.7%) were severely developmentally delayed(P=0.002). Acute total asphyxic insult was documented in 9 of the 23 infants, 8 of 9(88.9%) had patterns of lesions including thalamus and basal ganglia injury. The neurologic outcome was poor for all except one of these patients. CONCLUSION: All the patients with periventricular white matter injury in MRI developed normally whereas all except one patient with subcortical gray matter injury showed severe neurodevelopmental delay. The patterns of brain injury shown in the MRIs of term infants with severe HIE provided significant information about the prognosis for the neurodevelopmental outcome of these infants.
Basal Ganglia ; Brain Injuries ; Brain* ; Humans ; Hypoxia-Ischemia, Brain* ; Infant* ; Magnetic Resonance Imaging* ; Prognosis ; Retrospective Studies ; Thalamus

BACKGROUND: Spontaneous echo contrast (SEC) of the left atrium (LA) is associated with increased risk of thromboembolism in patients with mitral stenosis(MS). The determination of the presence and severity of LA spontaneous echo contrast(SEC) is of prognostic importance in these patients. Harmonic imaging(HI), a novel echocardiographic technique that differs from conventional fundamental imaging(FI) by transmitting ultrasound at one frequency and receiving at twice the transmitted frequency, produces better endocardial border definition and myocardial opacification. However, there are no data about its value on the detection of LA SEC. The purpose of this study was to investigate the utility of transthoracic noncontrast HI in the detection of LA SEC in patients with. METHODS: Seventy-four consecutive patients with MS (49 female, mean age 51) underwent standard transthoracic echocardiograms (TTE) in both HI and FI and transesophageal echocardiography (TEE) to determine the presence and severity of LA SEC. LA SEC was graded by TEE; mild if only seen at high gain, severe if visible in the entire LA at normal gain control of the equipment. Control subjects comprised of 30 patients randomly selected from patients who did not have LA SEC at TEE examination. RESULTS: Atrial fibrillation was found in 46 patients (62.2%). The mean mitral valve area and mean mitral gradient were 1.0+/-0.3cm2 and 8.2+/-4.1mmHg, respectively. Nine patients (12.2%) had episodes of systemic embolism; stroke in 8 and peripheral embolism in 1. LA thrombus was found in 11 patients (14.9%) by TEE. LA SEC was present in all but one patient by TEE (mild in 35, severe in 38 patients). FI of TTE, however, revealed LA SEC in only 5 (6.8%) of the 73 patients. In contrast, in HI, LA SEC could be detected in 63 (86.3%) of the 73 patients. In the detection of severe LA SEC, the sensitivity of FI and HI were 13.2% (5/38) and 100% (38/38), respectively. LA SEC was not observed in control subjects either by FI or HI. CONCLUSION: Transthoracic HI significantly enhances the detection of LA SEC in patients with MS.
Atrial Fibrillation ; Echocardiography ; Echocardiography, Transesophageal ; Embolism ; Female ; Heart Atria ; Humans ; Mitral Valve ; Mitral Valve Stenosis* ; Stroke ; Thromboembolism ; Thrombosis ; Ultrasonography

BACKGROUND: Syphilis is an infection caused by Treponema pallidum (T. pallidum), and this disease is increasing in incidence. However, making the diagnosis of syphilis is sometimes still challenging because of the variable clinical and histopathologic findings and there are cases with negative serologic findings, and especially in the setting of HIV infection and immunosuppressive therapy. OBJECTIVE: In this study, we specifically evaluated the number and distribution patterns of T. pallidum in the skin lesions from patients with primary or secondary syphilis. METHODS: orty eight skin biopsy specimens with the clinical and/or serological diagnosis of syphilis were evaluated by immunohistochemistry (IHC) using primary polyclonal antibodies against T. pallidum. RESULTS: Overall, T. pallidum was identified in 45 specimens (94%). The IHC of the 22 specimens from the patients with primary syphilis were all positive (100%). Twenty three (88%) out of 26 specimens from the patients with secondary syphilis showed positive results. T. pallidum was also identified in three patients with negative VDRL. Although the density of T. pallidum was higher in the specimens from the patients with primary syphilis than in those from the patients with secondary syphilis, the differences were not statistically significant (p=0.32). An epitheliotropic pattern was more frequently observed in the specimens from the patients with secondary syphilis (81%) than in those from the patients with primary syphilis (50%) (p=0.01). The density and distribution patterns of T. pallidum didn't show any correlation with the duration of skin lesions or the VDRL titer. CONCLUSION: IHC using a polyclonal antibody against T. pallidum could be an effective method for making the diagnosis of primary and secondary syphilis.
Antibodies ; Biopsy ; HIV Infections ; Humans ; Immunohistochemistry ; Incidence ; Skin ; Syphilis ; Treponema ; Treponema pallidum

Tuberculosis cutis orificialis (TCO) is a rare manifestation of cutaneous tuberculosis that is caused by auto-inoculation of mycobacteria in patients with advanced internal tuberculosis. TCO occurs in oral, perianal, or genital mucosa and adjacent skin. The tongue is the most frequently affected site, but the perianal area can also be affected. A 39-year-old male presented with a 4-month history of painful ulcers on the perianal area. The histopathologic findings revealed granulomatous infiltrates composed of epithelioid cells and Langhans-type giant cells in the dermis, and a few acid-fast bacilli noted on Ziehl-Neelsen staining. The polymerase chain reaction (PCR) was positive for Mycobacterium tuberculosis and the chest X-ray showed findings consistent with active pulmonary tuberculosis in both upper lung zones. The skin lesion showed complete resolution 2 months after the start of treatment with antituberculosis agents. We report a case of TCO with perianal involvement in a patient with underlying active pulmonary tuberculosis.
Adult ; Dermis ; Epithelioid Cells ; Giant Cells, Langhans ; Humans ; Lung ; Male ; Mucous Membrane ; Mycobacterium tuberculosis ; Polymerase Chain Reaction ; Skin ; Thorax ; Tongue ; Tuberculosis ; Tuberculosis, Cutaneous ; Tuberculosis, Pulmonary ; Ulcer

Porokeratotic eccrine ostial and dermal duct nevus (PEODDN) is an uncommon, benign dermatosis and is characterized by asymptomatic grouped keratotic papules and plaques with a linear pattern on the extremities. Various treatments, including topical steroids, topical calcipotriol, topical 5-fluorouracil, retinoid, cryotherapy, and carbon dioxide laser ablation have been tried for PEODDN, but the results were unsatisfactory. Recently, topical photodynamic therapy (PDT) has been shown to be effective for various cutaneous disorders. We report a case of PEODDN showing partial remission with PDT using topical 5-aminolevulanic acid in a 4-year-old girl.
Calcitriol ; Cryotherapy ; Extremities ; Fluorouracil ; Lasers, Gas ; Nevus ; Photochemotherapy ; Preschool Child ; Skin Diseases ; Steroids ; Triazenes