Cor triatriatum sinistrum: a rare congenital cardiac anomaly presenting in an adult with chronic atrial fibrillation

Cor triatriatum is a rare congenital cardiac anomaly in which the left atrium is divided into proximal (dorsal or upper) and distal (ventral or lower) chambers by a fibromuscular septum. The upper chamber receives the pulmonary veins and the lower chamber contains the atrial appendage and the mitral valve. The 2 chambers communicate through a defect in the membrane. Cor triatriatum is often associated with other congenital cardiac anomalies. Most frequently, the upper chamber communicates with the right atrium through a patent foramen ovale or atrial septal defect, and the clinical symptoms simulate anomalous pulmonary venous return. Less commonly, the foramen ovale communicates with the distal chamber and the clinical features mimic mitral stenosis. When cor triatriatum is the only abnormality, the clinical findings are also similar to mitral stenosis with development of pulmonary hypertension and subsequent right ventricular hypertrophy and atrial enlargement. The diagnosis is usually made in infancy or childhood, and the lack of treatment results in death in 75% of patients.We report the case of a woman who presented much later in life. The patient was a 57-year-old female with a clinical history of chronic atrial fibrillation who presented to the emergency department because of a "funny sensation" in her chest, though she denied chest pain, nausea, vomiting, or diaphoresis. EKG revealed atrial fibrillation with a rapid ventricular response and a tachycardic rate of 157. She had a therapeutic level of digoxin, and cardiac enzymes were normal. The patient was admitted and placed on Cardizem drip. Serial EKGs remained normal and heart rate control was achieved. On hospital day 2, the patient became dyspneic and cyanotic. She went into cardiac arrest and died.Autopsy revealed cardiomegaly (610 g) with 4-chamber dilatation. A septum divided the left atrium into 2 chambers. The defect in the dividing membrane measured 1 cm in diameter. No other congenital defects were noted. The large size of the defect in the membrane likely accounted for the late onset of symptoms that allowed this patient to survive into adulthood without previous diagnosis or surgical intervention (which is usually required in childhood).     

Psychological Distress Following Suicidality Among Gay,Lesbian, and Bisexual Youths: Role of Social Relationships

Longitudinal relations between past suicidality and subsequent changes in psychological distress at follow-up were examined among gay, lesbian, and bisexual (GLB) youths, as were psychosocial factors (e.g., self-esteem, social support, negative social relationships) that might mediate or moderate this relation. Past suicide attempters were found to have higher levels of depressive symptoms, anxious symptoms, and conduct problems at a later time than youths who neither attempted nor ideated. Psychosocial factors failed to mediate this relation. The interaction among past suicidality, social support, and negative relationships was associated with subsequent changes in all 3 psychological distress indicators 6 months later. Specifically, high levels of support (either from family or friends) or negative relationships were found to predict increased psychological distress among those with a history of suicide attempts, but not among youths without a history of suicidality. The findings suggest that GLB youths who attempt suicide continue to have elevated levels of psychological distress long after their attempt and they highlight the importance of social relationships in the youths psychological distress at follow-up.Earlier versions of this paper were presented at the biannual meeting of the European Association for Research on Adolescence, Oxford, UK, September 2002; and, at the annual meeting of the American Public Health Association, San Francisco, CA, November 2003.Associate Professor of Psychology, The City University of New York—The City College and Graduate Center. Received PhD in psychology from New York University. Research interests include the relation of identity to health, the intersection of multiple identities, and the relation of violence to health.Doctoral candidate in Social/Personality Psychology and Health Psychology, The City University of New York—Graduate Center. Research interests include the role of social relationships in the preservation of health and well-being.Research Scientist, HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute; and Assistant Professor, Department of Psychiatry, Columbia University. Received doctorate in social welfare (DSW) from The City University of New York—Graduate Center. Research and clinical interests include the design and implementation of interventions for gay, lesbian, and bisexual adolescents.     

Agency Fever? Analysis of an International Policy Fashion

In the last 15 years, the governments of many OECD countries have transferred a wide range of functions to new, agency-type organizations. Allowing for the fact that, for comparative purposes, it is difficult precisely to define agencies, and further acknowledging that in many countries agencies are far from being new, it nevertheless remains the case that there seems to have been a strong fashion for this particular organizational solution.This article investigates the apparent international convergence towards agencification. It seeks to identify the reasons for, and depth of, the trend. It asks to what extent practice has followed rhetoric. The emerging picture is a complex one. On the one hand, there seems to be a widespread belief, derived from a variety of theoretical traditions, that agencification can unleash performance improvements. On the other hand, systematic evidence for some of the hypothetical benefits is very patchy. Furthermore, the diversity of actual practice in different countries has been so great that there must sometimes be considerable doubt as to whether the basic requirements for successful performance management are being met.     

MAKING IT WORK

With the prevalence of divorce in our country, there is a serious need of services for divorcing families to be readily available and offered in a manner to increase the use of the services. Early intervention with the divorcing family is critical to help alleviate levels of parental conflict and decrease potential litigation. This article is an evaluation of the first year of court-mandated parenting psychoeducational workshops. The results demonstrate the positive effects of the workshops for most divorcing parents in terms of levels of ongoing conflict between parents, children's adjustment as observed by the parents, parents' adjustment, and parents' ability to settle the legal issues of the divorce and keep the children out of the middle of the conflict.     

Minority Set-Aside Programs in the States After City of Richmond v. J. A. Croson Co.

In a series of decisions handed down during the 1988–1989term, the U.S. Supreme Court sent clear signals that its equalprotection analysis and affirmative action jurisprudence areundergoing reexamination. The most important affirmative actiondecision during the term was City of Richmond v. J. A. CrosonCo. The Court ruled that Richmond's minority business enterpriseprogram, which set aside 30 percent of the dollar amount ofgovernment construction contracts for minority-owned firms,violated the Fourteenth Amendment. In the wake of Croson, federaland state courts have considered other cases involving set-asideprograms, while a number of other programs have been abandoned,placed under evaluation, or modified to meet the guidelineslaid down by the Court.