Undiagnosed Ebstein's Anomaly in a Pregnant Woman.

Ebstein's anomaly is an uncommon congenital heart defect characterized by an abnormal tricuspid valve. Pregnancy can be well tolerated, although cyanosis, arrhythmias, and cardiomegaly are associated with poor prognosis. An 18-year-old woman with a history of congenital cardiomyopathy presented at 37 weeks of gestation with hypoxia, dyspnea, central cyanosis, and uterine contractions. The patient underwent emergent cesarean delivery. Echocardiography revealed Ebstein's anomaly with patent foramen ovale and right-to-left shunting. Tricuspid valvuloplasty with primary closure of patent foramen ovale was performed. This case is presented, accompanied by a review of the literature.

Thyrotoxic periodic paralysis: diversity in America.

BACKGROUND: Thyrotoxic periodic paralysis (TPP) is a potentially life-threatening complication of thyrotoxicosis, characterized by hypokalemia and muscle paralysis. OBJECTIVE: TPP, although becoming more prevalent in western countries, is still often not recognized due to lack of familiarity and the subtlety of the thyrotoxic symptoms. Early recognition by emergency physicians can prevent potential mortality. CASE REPORT: A 23-year-old Vietnamese male presented with a 2-h history of complete flaccid quadriplegia and chest tightness. Electrolyte studies revealed a critical potassium level of 1.4 mmol/L. The patient was admitted to the intensive care unit where further workup revealed thyrotoxicosis and the patient was subsequently diagnosed with TPP. CONCLUSIONS: TPP should always be considered as a differential in patients, especially in young males of Asian descent with lower-limb paralysis or weakness. We present this case, followed by a review of the literature.

Left ventricular outflow tract obstruction after bioprosthetic mitral valve replacement with preservation of the anterior leaflet.

A 79-year-old woman with a history of bioprosthetic aortic and mitral valve replacement with coronary artery bypass graft surgery presented with pulmonary edema 4 years after surgery. Transthoracic echocardiography and transesophageal echocardiography revealed an obstruction of the left ventricular outflow tract caused by the bioprosthetic mitral valve. We present this case, accompanied by a review of the literature.

Timolol-induced interstitial lung disease.

Timolol maleate is a non-selective beta-adrenergic receptor blocking agent with demonstrated efficacy in the treatment of open-angle glaucoma. A 76 year old female who presented with productive cough, progressive dyspnea and hypoxia after starting timolol maleate opthalamic drops following glaucoma surgery. The patient was diagnosed with interstitial lung disease secondary to timolol treatment and after cessation of the offending agent along with corticosteroid treatment, symptoms improved drastically. Elimination of other possible causes of disease along with evolution of radiological and functional signs left us with a diagnosis of timolol-induced interstitial lung disease. To our knowledge, this is the second reported case of timolol-induced interstitial lung disease.

Effect of dietary restriction and exercise on lower extremity tissue compartments in obese, older women: a pilot study.

BACKGROUND: Accumulating evidence suggests that both dietary restriction and exercise (DR + E) should be incorporated in weight loss interventions to treat obese, older adults. However, more information is needed on the effects to lower extremity tissue composition-an important consideration for preserving mobility in older adults. METHODS: Twenty-seven sedentary women (body mass index: 36.3±5.4kg/m(2); age: 63.6±5.6 yrs) were randomly assigned to 6 months of DR + E or a health education control group. Thigh and calf muscle, subcutaneous adipose tissue (SAT), and intermuscular adipose tissue (IMAT) size were determined using magnetic resonance imaging. Physical function was measured using a long-distance corridor walk and knee extension strength. RESULTS: Compared with control, DR + E significantly reduced body mass (-6.6±3.7kg vs control: -0.05±3.5kg; p < .01). Thigh and calf muscle volumes responded similarly between groups. Within the DR + E group, adipose tissue was reduced more in the thigh than in the calf (p < .04). Knee extension strength was unaltered by DR + E, but a trend toward increased walking speed was observed in the DR + E group (p = .09). Post hoc analyses showed that reductions in SAT and IMAT within the calf, but not the thigh, were associated with faster walking speed achieved with DR + E (SAT: r = -0.62; p = .01; IMAT: r = -0.62; p = .01). CONCLUSIONS: DR + E preserved lower extremity muscle size and function and reduced regional lower extremity adipose tissue. Although the magnitude of reduction in adipose tissue was greater in the thigh than the calf region, post hoc analyses demonstrated that reductions in calf SAT and IMAT were associated with positive adaptations in physical function.