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Echocardiographic recordings from a patient with a prosthetic mitral valve revealed echoes within the left ventricular cavity that mimicked the motion pattern of a "normal" anterior mitral leaflet. The echo pattern was continuous, recorded from multiple views, and by two-dimensional images it was localized to the level of the papillary muscles. Although thrombus and vegetation are possibilities, this echo probably originates from a pliable chordal structure severed but not removed at the time of surgery. The apparent responsiveness to hemodynamic influences was striking, and we suggest that the prevalence and pathophysiologic implications of such findings are of potential import.

City : In the last ten years word has gone out from the teaching centers that neuroses are the concern of all physicians. We are trying now to add that the psychoses are also the concern of all physicians. Just as the surgeon likes to treat the patient with appendicitis before peritonitis sets in, just as the internist likes to treat the patient with a failing heart before the stage of decompensation sets in, the psychiatrist likes to treat the psychotic patient before he is climbing up and down the walls. Yet, the psychiatrist is in an odd position. He seldom sees the patient in the early stages ; hence, he often has to resort to the drastic therapies of insulin or electric shock or lobotomy, which are probably the most primitive of all medical treat¬ ments in this day and age. It is hoped that eventually the physician can dispense with such forms of treatment if he can treat these patients in the early stages.

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