Thirty-five year-old Amadeus Mozart died in Vienna after an acute illness that lasted only 15 days but no consensus has been reached on the cause of his death. From many letters written by his farther it is almost certain that he experienced at least three episodes of acute rheumatic fever attack in his childhood, and a relapse of rheumatic fever was suggested to have killed Mozart, although death from acute rheumatic fever is very rare in adults. His last illness was characterized by high fever, massive edema, vomiting and skin rash. His last illness can be explained by infectious endocarditis and heart failure. During his last hours, he was given phlebotomy, possibly for the third time in two weeks, and soon after he became unconscious and died. As such, phlebotomy performed on a man dehydrated by high fever and vomiting may have caused systemic shock. In summary, Mozart probably died from chronic rheumatic heart disease complicated by infective endocarditis and heart failure, and repeated phlebotomy-induced hypovolemic shock.
Adult ; Bloodletting ; Consensus ; Edema ; Endocarditis ; Exanthema ; Fever ; Heart Failure ; Humans ; Phlebotomy ; Recurrence ; Rheumatic Fever ; Rheumatic Heart Disease ; Shock ; Unconscious (Psychology) ; Vomiting

To investigate psychopathology and executive functions of attention deficit hyperactivity disorder (ADHD) children according to intelligence level, this study included 197 ADHD children who visited the outpatient department of neuropsychiatry of YeungNam University Medical Center, from July 2000 to June 2002. The children were divided into groups based on their intelligence levels. They were compared by the Personality Inventory for Children (PIC), Conncers' Continuous Performence Test (CPT), and Wisconsin Card Sorting Test (WCST). There were significant differences in PIC, on the subscales of verbal development, socialization and autism. In the CPT, there was no significant difference. In the WCST, there were significant differences in the total number of errors, the number of perseverative errors, the number of completed categories and the number of trials needed to complete the first category. Considering these results, the intelligence level of ADHD children is related to their disabilities and behavioral symptoms. Executive functions such as abstract thinking, categorization, working memory and flexibility had significant relationship to the intelligence levels of ADHD children. Therefore, the intelligence level of children with ADHD influences the higher executive functions of regulating attention and information processing rather than attentional functions and capacity alone.
Academic Medical Centers ; Attention Deficit Disorder with Hyperactivity* ; Autistic Disorder ; Automatic Data Processing ; Behavioral Symptoms ; Child* ; Executive Function* ; Humans ; Intelligence* ; Memory, Short-Term ; Neuropsychiatry ; Outpatients ; Personality Inventory ; Pliability ; Psychopathology* ; Socialization ; Thinking ; Wisconsin

BACKGROUND: Dynamic echoes in the left atrium, spontaneous echo contrast(SEC), represents a marker for thromboembolic risk in patients(pts) with mitral stenosis(MS). The aims of this study were to determine the factors associated with SEC in pts with MS and to observe the immediate effect of percutaneous mitral, valvuloplasty(PMV) on SEC. METHODS: Biplane transesophageal echocardiography(TEE) including Doppler measurement of left atrial appendage flow was performed before and immediately after PMV in 50 pts with MS[32 in normal sinus rhythm(NSR) and 18 in atrial fibrillation(AF)]. Hemodynamic data of left atrial pressure, transmitral pressure gradient, mitral valve area by Gorlin's method(MVA) and cardiac output(CO) by thermodilution method were obtained before and after successful PMV. RESULTS: Before PMV(MVA of 0.9±0.3cm2), SEC was observed in 60%(30/50) of tight MS (13/32 in NSR, 17/18 in AF). The presence of AF(p=0.001), increased left atrial dimension(p=0.001), decreased appendage peak positive velocity(APPV, p=0.03), decreased MVA(p=0.01) and reduced CO(p=0.001) were positive predictive factors for SEC : AF was the most powerful factor among them. In pts with NSR, MVA(p=0.01) was the only factor for SEC before PMV. After successful PMV(MVA of 2.0±0.4cm2) SEC was still observed in 6 pts(12%) with AF. AF(p=0.001), increased left atrial dimension(p=0.06) and decreased APPV(p=0.001) were favorable factors for persistence of SEC after PMV, but hemodynamic indices were not associated with SEC after PMV. New development of mitral regurgitation after PMV was the only predictive factor for disappearance of SEC(p=0.04). In pts with NSR, PMV promptly normalized the APPV with disappearance of SEC. CONCLUSION: In pts with tight MS, different factors may be associated with SEC according to the rhythm. PMV is an effective method to abolish SEC with hemodynamic improvement. Despite the similar MVA and hemodynamic indices, possible preventive effect of thromboembolism after PMV nay be more prominent in pts with NSR compared to those with AF.
Atrial Appendage ; Atrial Pressure ; Heart Atria ; Hemodynamics ; Methods ; Mitral Valve ; Mitral Valve Insufficiency ; Mitral Valve Stenosis ; Thermodilution ; Thromboembolism