Attack Of Rheumatic Fever Research Articles

Observations on the surgical treatment of mitral stenosis by commissurotomy.

The surgery of mitral stenosis has played the primary role in introducing the current principles of intracardiac surgery, and the success of this venture has served to establish it as a background for future developments. Since the first successful operation performed by us, June 10, 1948, there have been a succession of favorable results. These principles have been projected to apply to other defects, such as pulmonic and aortic abnormalities and the septal defects. Nevertheless, efforts in none of these other defects have been more gratifying than the original efforts in mitral stenosis. THE BASIC PROBLEMS The disease itself is an acquired one, mostly following attacks of rheumatic fever. The basic problem has always been a surgical one, leading out of the observation that the fault is a mechanical stricture. Heretofore, correction of this defect has been hampered not only by technical difficulties but also by needlessly perverse reasoning. These

PREVENTION OF RHEUMATIC FEVER BY PROMPT PENICILLIN THERAPY OF HEMOLYTIC STREPTOCOCCIC RESPIRATORY INFECTIONS

The role of the hemolytic Streptococcus in the precipitation of both initial and recurrent attacks of rheumatic fever is now well established. Furthermore, it is general experience that hemolytic streptococcic respiratory infections in children and young adults who have previously had one or more attacks of rheumatic fever cause recurrence of the disease in 40 to 50% of instances. When the usefulness of sulfonamides in the treatment of streptococcic infections was first discovered, attempts were made at the House of the Good Samaritan to prevent such recurrences by prompt treatment of hemolytic streptococcic infections in known rheumatic subjects with a sulfonamide preparation in the hope that, by suppression of the growth of streptococci in the upper respiratory tract, absorption into the blood stream of the streptococcic substance responsible for precipitating the rheumatic process would be reduced to a subeffective level. These attempts were not successful.¹Subsequently, when penicillin became

Rheumatic heart disease in patients over sixty years of age.

Rheumatic fever and rheumatic heart disease are usually considered to be diseases of the young. The average age of onset of rheumatic fever has been calculated in several series of cases with rheumatic heart disease. In 3,129 deceased patients studied by Cohn and Lingg 1 it was 14.5 ± 0.3 years for males and 15.0 ± 0.3 years for females; in 644 patients observed by De Graff and Lingg 2 it was 17 years; in 1,042 children observed by Wilson and Lubschez 3 it was 6.5 years. There are reports, however, of initial episodes of rheumatic fever in the seventh decade. 4 Among 3,741 patients with rheumatic fever entering Bellevue Hospital from 1911 to 1919, Lambert 5 found 91 over the age of 60. Older data on the duration of life after the initial manifestation of rheumatic fever in the course of rheumatic heart disease indicate a poor prognosis. Cohn

Rheumatic fever and rheumatic heart disease

Rheumatic heart disease poses a major challenge to public health and is the most prevalent heart disease in children. The major determinants of rheumatic fever and rheumatic heart disease are poverty, malnutrition, overcrowding, poor housing, and a shortage of health-care resources. Although cost-effective strategies for the prevention and control of these diseases are available, they remain underutilized in most developing countries. A World Health Organization Expert Consultation reviewed the current scientific knowledge of rheumatic fever and rheumatic heart disease, as well as medical and public-health practices, and revised the Jones diagnostic criteria for rheumatic fever and rheumatic heart disease. This revision facilitates the diagnosis of: primary episodes of rheumatic fever, recurrent attacks of rheumatic fever in patients with or without rheumatic heart disease, rheumatic chorea, insidious onset rheumatic carditis and chronic rheumatic heart disease. The present report provides practical recommendations for an evidence-based approach to the prevention and management of rheumatic fever and rheumatic heart disease. It also provides practical guidance for implementing cost-effective programmes for controlling these diseases. The report will be of interest to clinicians, policy-makers and public-health professionals.

Prophylaxis of acute rheumatic fever: By treatment of the preceding streptococcal infection with various amounts of depot penicillin

The prevention of acute rheumatic fever by penicillin therapy of acute streptococcal respiratory infections was attempted in this study. Procaine penicillin G in oil containing 2 per cent aluminum monostearate was injected intramuscularly according to one of three dosage schedules in 1,178 patients with exudative tonsillitis or pharyngitis while 1,162 patients remained untreated and served as controls. There was a total of ten patients who had received penicillin and forty-two patients who received no treatment in whom an illness classified as definite or possible rheumatic fever subsequently developed. Data collected on rheumatic subjects showed that reinfection with a new type of streptococcus frequently occurred when the interval between the onset of the observed attack of exudative tonsillitis or pharyngitis and the onset of rheumatic fever was prolonged. Excluding those cases of rheumatic fever developing after a forty-five-day interval between the two diseases results in two cases of rheumatic fever in the treated group and twenty-eight in the control patients. These data indicate that penicillin therapy of acute streptococcal infections almost completely prevents the subsequent occurrence of acute rheumatic fever. Penicillin therapy was also found to eradicate the streptococcus from the oropharynx of the majority of individuals and to inhibit the formation of antistreptolysin. The most marked inhibition of antibody was that obtained by three injections of penicillin over a ninety-six-hour period totaling 1,200,000 units in comparison to the suppression of antistreptolysin by either a single injection of 600,000 units or two injections of 300,000 units each given seventy-two hours apart.

MULTIPLE PREGNANCIES IN PATIENTS WITH RHEUMATIC OR CONGENITAL HEART DISEASE

Abstract A group of fifty-three cardiac patients who had four or more pregnancies have been studied. All of these women had rheumatic heart disease with the exception of one patient who had idiopathic pulmonary arterial dilatation. These patients had a total of 364 pregnancies or nearly seven pregnancies per patient. The maternal mortality was only 1.3 per pregnancy and only one of the five deaths was related to congestive heart failure. Congestive heart failure occurred in fifteen of the fifty-three patients or in forty-one of the 364 pregnancies (11.3 per cent), an incidence less than that usually reported in cardiac patients. Our findings suggest that these women were able to tolerate the burden of pregnancy better than the average cardiac woman in the childbearing period. Congestive heart failure did not increase in frequency as the number of pregnancies increased, a finding which confirms the belief that parity per se bears no direct relationship to the development of heart failure. The age of the patient, the duration of the rheumatic state, and the number of attacks of rheumatic fever all seem more important factors influencing the course of the pregnancy in the cardiac patient than the actual number of pregnancies she has borne previously. Auricular fibrillation was uncommon in this special group of patients with multiple pregnancies, a fact suggesting they were in a relatively early stage of the natural history of their rheumatic heart disease. Congestive failure occurred much more commonly in the unfavorable (52 per cent) than in the favorable (4.7 per cent) group. In all of the pregnancies which came to full term delivery was accomplished by the vaginal route with the exception of three cesarean sections performed for obstetric reasons. This confirms the belief that in cardiac patients operative delivery should be performed primarily for obstetric indications. The ultimate life span was greater and the incidence of subsequent congestive failure was less in those women who were able to tolerate multiple pregnancies without developing cardiac decompensation than in those who had heart failure. This series of patients indicates that multiple pregnancies are compatible with a considerable life expectancy in some women with heart disease. It is emphasized, however, that in considering the problems of pregnancy every patient with heart disease must be evaluated individually in the light of many factors including her age, the duration of the rheumatic state, the nature of the orginal rheumatic disease, the cardiac reserve, and the course of earlier pregnancies.

Multiple pregnancies in patients with rheumatic or congenital heart disease

A group of fifty-three cardiac patients who had four or more pregnancies have been studied. All of these women had rheumatic heart disease with the exception of one patient who had idiopathic pulmonary arterial dilatation. These patients had a total of 364 pregnancies or nearly seven pregnancies per patient. The maternal mortality was only 1.3 per pregnancy and only one of the five deaths was related to congestive heart failure. Congestive heart failure occurred in fifteen of the fifty-three patients or in forty-one of the 364 pregnancies (11.3 per cent), an incidence less than that usually reported in cardiac patients. Our findings suggest that these women were able to tolerate the burden of pregnancy better than the average cardiac woman in the childbearing period. Congestive heart failure did not increase in frequency as the number of pregnancies increased, a finding which confirms the belief that parity per se bears no direct relationship to the development of heart failure. The age of the patient, the duration of the rheumatic state, and the number of attacks of rheumatic fever all seem more important factors influencing the course of the pregnancy in the cardiac patient than the actual number of pregnancies she has borne previously. Auricular fibrillation was uncommon in this special group of patients with multiple pregnancies, a fact suggesting they were in a relatively early stage of the natural history of their rheumatic heart disease. Congestive failure occurred much more commonly in the unfavorable (52 per cent) than in the favorable (4.7 per cent) group. In all of the pregnancies which came to full term delivery was accomplished by the vaginal route with the exception of three cesarean sections performed for obstetric reasons. This confirms the belief that in cardiac patients operative delivery should be performed primarily for obstetric indications. The ultimate life span was greater and the incidence of subsequent congestive failure was less in those women who were able to tolerate multiple pregnancies without developing cardiac decompensation than in those who had heart failure. This series of patients indicates that multiple pregnancies are compatible with a considerable life expectancy in some women with heart disease. It is emphasized, however, that in considering the problems of pregnancy every patient with heart disease must be evaluated individually in the light of many factors including her age, the duration of the rheumatic state, the nature of the orginal rheumatic disease, the cardiac reserve, and the course of earlier pregnancies.

Oral penicillin prophylaxis of recurrences of rheumatic fever; interim report on method after a 3 year study.

It is generally believed that Lancefield group A hemolytic streptococci are involved in all or part of the pathogenesis of rheumatic fever. 1 Although penicillin is an unsatisfactory therapeutic agent for this disease, 2 this antibiotic should be excellent for prophylaxis of recurrences because of its ability to control the hemolytic streptococcus in vivo. This use of penicillin has been mentioned hopefully in the literature since 1946. 3 The relative infrequency of complications and sequelae are obvious advantages of penicillin in addition to its low toxicity in large dosages. 3a Since penicillin, like the sulfonamide drugs, apparently fails to influence the onset and course of an attack of rheumatic fever if given after the preceding hemolytic streptococcic infection, 3a it becomes mandatory to eliminate hemolytic streptococci entirely during the period preceding a possible recurrence. Massell, Dow and Jones 4 reported a lowered incidence of recurrences of rheumatic fever when they

RECURRING MASTOIDITIS, MENINGITIS AND ABSCESS OF RIGHT TEMPOROSPHENOID LOBE

IN THIS era of antibiotics, brain abscess is apt to occur less frequently than before, but it does occur and must be coped with. A case of recurring mastoiditis, meningitis and abscess of the right temporosphenoid lobe is reported to remind ourselves of this fact and to point out our approach to adequate drainage of this abscess. REPORT OF A CASE E. H., a 12 year old boy, was admitted to the pediatric service of Dr. N. Einhorn, on Jan. 22, 1947, in a stuporous condition of eight hours' duration. Immediate consultation with Dr. A. S. Tornay, of the neurologic service, and one of us (B.H.S.) confirmed the diagnosis of brain abscess of the right temporosphenoid lobe secondary to chronic suppurative mastoiditis. The patient was directly transferred to our service for operation. On his admission the following history was obtained from the parents: Since an attack of rheumatic fever six

STANDARD, UNIPOLAR LIMB AND PRECORDIAL LEADS IN CHILDREN AND ADOLESCENTS WITH INACTIVE RHEUMATIC FEVER

IN CHILDREN the electrocardiogram has proved of value in establishing diagnoses of active carditis and congenital cardiac disease. In the quiescent stage of rheumatic heart disease, however, standard leads often yield normal tracings in children with enlarged hearts and obvious myocardial involvement. In adults, precordial, as well as standard, leads have given valuable information in regard to hypertrophy of individual chambers of the heart.1 It was thought possible, therefore, that this technic might also be useful in studying rheumatic children and adolescents. MATERIAL One hundred and fifty-six rheumatic subjects, 98 boys and 58 girls, were studied. Of these, 144 were children ranging in age from 6 to 15 years, who were observed in a convalescent home for periods of four months to four years, and 12 were adolescents followed in the outpatient department. All the patients gave histories of one or more attacks of rheumatic fever and, with one exception,

The familial incidence of rheumatic fever: I. A discussion of the relationship between a positive family history and the development of rheumatic fever in individuals of military age

Abstract 1.1. Three per cent of those making up the normal control groups had a personal history of rheumatic fever earlier in life. 2.2. An attack of rheumatic fever earlier in life tends to facilitate a later attack, but this difference is not great. 3.3. The occurrence of rheumatic fever in the family increases the risk of the individual developing the disease while still in contact with the family, but not after he is separated from the family. There does not, therefore, appear to be a strong and inherited susceptibility. The occurrence of multiple cases in families could be explained either on the basis of common environment or contagion. In the light of the widely accepted relationship of streptococcal infection to rheumatic fever, and the lack of agreement concerning the roles of social, economic, and geographic factors, we prefer to look on these data as indicating the dominant role of contagion in the development of rheumatic fever.

The familial incidence of rheumatic fever: II. A statistical study of the familial and personal history of rheumatic fever

1. 1. Three per cent of those making up the normal control groups had a personal history of rheumatic fever earlier in life. 2. 2. An attack of rheumatic fever earlier in life tends to facilitate a later attack, but this difference is not great. 3. 3. The occurrence of rheumatic fever in the family increases the risk of the individual developing the disease while still in contact with the family, but not after he is separated from the family. There does not, therefore, appear to be a strong and inherited susceptibility. The occurrence of multiple cases in families could be explained either on the basis of common environment or contagion. In the light of the widely accepted relationship of streptococcal infection to rheumatic fever, and the lack of agreement concerning the roles of social, economic, and geographic factors, we prefer to look on these data as indicating the dominant role of contagion in the development of rheumatic fever.

Heart disease in children in a rural iowa county—particularlyin relation to rheumatic fever

Summary The incidence of rheumatic fever in the school population of a rural countyin Iowa is 0.61 per cent. The average number of children experiencing their first attack of rheumatic fever during each of the six years from 1940 through 1945 is 3.3. The number varied for each year from none to seven children. The incidence of organic heart disease for school children in this rural population is 0.47 per cent. Of those with organic heart disease, 58 per cent have rheumatic heart disease and 42 per cent have congenital heart disease.

THE USE OF PENICILLIN IN RHEUMATIC FEVER

Although the etiology of rheumatic fever is not fully understood, current data indicate that attacks of this disease are generally preceded by infections with group A hemolytic streptococci. The sequence of events is so regular that one is justified in advancing the hypothesis that the streptococcic infection induces rheumatic fever. Whether group A streptococci are the only infectious agents responsible for rheumatic fever or whether they merely activate some other specific micro-organism or virus and possibly act in concert with it to produce the disease has not been determined. The temporal relationship between the hemolytic streptococcic infection and the attack of rheumatic fever is generally not immediate. In fact, the usual sequence of events is streptococcic infection, quiescent period, rheumatic fever. These phases have been designated as I, II and III respectively. It has been shown that if the initiating or inducing streptococcic infection, phase I, is prevented in susceptible

RHEUMATIC FEVER: DIET AS A PREDISPOSING FACTOR

Excerpt Although many careful studies have been made of rheumatic heart disease throughout the world, many misconceptions of the etiologic factors of the disease still exist. If one studies the rep...

HORMONAL PRODUCTION OF ARTHRITIS

Administration of desoxycorticosterone acetate in comparatively high doses causes nephrosclerosis with increased blood pressure and disturbances in electrolyte metabolism, a fact which has been demonstrated in the chick, dog, cat, rat and monkey. Unilateral nephrectomy and a high intake of sodium chloride facilitate the production of these toxic actions of desoxycorticosterone acetate.1In addition to the nephrosclerosis, the most striking features of this overdosage are the formation of Aschoff bodies in the heart and the presence of periarteritis nodosa,2a condition occasionally seen in man following an attack of rheumatic fever. Since in addition choreiform twitches and a few rare cases of arthritis were also encountered in desoxycorticosterone acetate treated animals, it may be said that all the elements of the complex rheumatic syndrome were reproduced in the experimental animal. However, the great frequency of joint manifestations in the spontaneous disease of man and its comparative rarity in

The prognostic significance of age at onset in initial attacks of rheumatic fever

A clinical analysis was made of the incidence of cardiac damage during initial attacks of rheumatic fever. The data presented indicate that first attacks of rheumatic polyarthritis are less likely to be accompanied by clinically evident carditis in adults than in children, and that when carditis does occur it is very much less likely to result in serious cardiac damage in the adults.

SCLERAL DISEASE IN RHEUMATOID ARTHRITIS

Inflammation of the sclera and of the episclera, the latter first called subconjunctivitis by von Graefe, have long been known to be associated with diseases of the articular structures of the body. Hutchinson1in 1885, Fuchs2in 1895 and Wagenmann3in 1897 reported cases of gout in which episcleritis was a notable complication. Wood4in 1936 found crystalline deposits in the sclera of a gouty patient who manifested active scleritis. As recently as 1924, Rateau5reported an interesting case in which sclerotenonitis was the prodromal symptom of an attack of rheumatic fever. In 1938 Verhoeff and King6presented a case of rheumatoid arthritis in which an eye was removed because of an inflammatory perforating scleral lesion. This eye was histologically examined in great detail. These authors analyzed 14 previously recorded cases of a similar nature in which the lesion was designated by the name

Studies of Hemolytic Streptococcal Antibodies in Control Groups, Rheumatic Fever, and Rheumatoid Arthritis

Studies of Hemolytic Streptococcal Antibodies in Control Groups, Rheumatic Fever, and Rheumatoid Arthritis

Acute appendicitis and pseudoappendicitis in rheumatic children

<h2>Summary</h2> Of nineteen rheumatic children admitted to the hospital with the tentative diagnosis of acute appendicitis, ten were subjected to laparotomy. Acute appendicitis was found in four (of minimal degree in two). In a fifth patient a normal appendix (except for <i>Oxyuris</i>) was removed, and no satisfactory explanation of the abdominal signs was found. The remaining fourteen cases were considered to be instances of rheumatic pseudoappendicitis. Of the nineteen children, five gave a history of a previous rheumatic episode and seven had muscle or joint pains at the time of or just before admission. The abdominal symptoms and signs in themselves were not sufficient in many instances to differentiate between rheumatic pseudoappendicitis and acute appendicitis. The erythrocyte sedimentation rate should prove of distinct aid in differential diagnosis. Two additional children developed acute appendicitis, one in the middle of and the other toward the end of an acute attack of rheumatic fever. The abnormal appendices revealed no pathologic findings that were characteristic of rheumatic disease.