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Fatal rheumatic fever
128
THE
AMERICAN
HEART
JOURNAL
In a survey of the literature forty-five definite instances of this defect have been found, together with seven other instances in monstrous births and two doubtful cases. Analysis of these cases reveals that the defect was almost invariably on the left; that in 76 per cent of the cases it was so completely on that side that the heart and the left lung were in a common serous cavity; that in 7’7 per cent of the cases the subject was a male; and that the condition is not incompatible with normal life, having in only one instance been directly responsible for death and having otherwise possibly caused cardiac symptoms in only three cases. Unexplained cardiac enlargement may occur (in about half the cases), but it is apparently not related to the presence or absence of adhesions. The chief danger from the defect lies in exposing the heart to pulmonary infection, with death in 27 per cent of the cases, including our own, associated with pleuropericarditis. Although in no case as yet has the condition been diagnosed ante mortem, this should be possible in some instances on the basis of certain criteria adapted from Maude Abbott. AUTHOR.
Hyperergic Welper, W.: Presence of Eclampsia
Thromboendarteritis in the Lungs of Infants in the of the Mother. Arch. f. Kreislaufforsch. 2: 210, 1938.
In a 3-day-old infant evidence was found of thromboendarteritis in the peripheral arteries of the lung. The changes resemble those seen in allergic disorders and are attributed to the severe eclampsia of the mother, suggesting that eclampsia is allergic in character (8). KATZ.
Waring,
J. I.:
Nutritional
Heart
Disease in Children.
Am.
J. Dis.
Child.
55:
750, 1938. Nutritional heart disease is not uncommon among negro children in Charleston, S. C. Thirteen cases summarized here suggest that the cardiac changes are due.not entirely to a lack of vitamin B but to a rather more general deficiency of dietary materials and that a satisfactory response to dietetic treatment may be expected in cases in which the illness is not too far advanced. AUTHOR.
Bland, Med.
Edward 61:
F., and Jones, T. Duckett:
Fatal Rheumatic
Fever.
Arch.
Int.
161, 1938.
Since 1921 (sixteen years) approximately 1,500 children and adolescents under the age of 21 years have received hospital care at the House of the Good Samaritan for rheumatic fever and chorea. The subsequent course and present We have presented in this report data status of this large group are known. Post-mortem examination was made in relevant to the 306 patients who have died. From a consideration of this group of patients who 74 instances (24 per cent). have died the following conclusions may be cited: 1. Rheumatic fever has been responsible for the fatal issue in 2. The early years after the period. In approximately half during the first three years and years.
the outstanding cause of death and was directly 250 instances (82 per cent). onset of the disease have proved to be a critical (47 per cent) of the fatal cases death occurred in two-thirds (62 per cent) during the initial five
SELECTED
129
ABSTRACTS
3. Thereafter the extent of residual cardiac enlargement (dilatation) and, to a lesser degree, the rapidity with which it developed have served as the most reliable criteria of the severity of the preceding infection as well as an index of the future susceptibility of the individual patient to subsequent fatal rheumatic fever. 4. The age of the during the first fifteen longevity is concerned. with
patient years
at the time of onset of rheumatic of life has been of no significance
5. The manifestations of fatal the generally accepted clinical
rheumatic picture
fever had been of the disease.
fever (or chorea) so far as subsequent
stressed
and
contrasted J\CTHOR.
Bruger, Maurice, and Fitz, Fred: Experimental Atherosclerosis: Prolonged Administration of the Thyrotropic Factor. Arch. Path.
1. Effect of 25: 637, 1938.
The feeding of iodine prevents the deposition of cholesterol in the arteries of Thyroidectomy abolishes this protective action of iodine. rabbits fed cholesterol. This striking relationship between experimental atherosclerosis and the function of the thyroid gland led the writers to learn whether the thyrotropic factor, from the pituitary gland, has an effect on experimental atherosclerosis in rabbits (cholesterolfeeding method). The results were as follows: The aortas of cholesterol-fed rabbits contained several times as much cholesterol as normal controls. The aortas of rabbits receiving injections of thyrotropic factor contained about the same amount of cholesterol as normal controls. The aortas of rabbits being fed cholesterol and receiving injections of thyrotropic factor contained, on the average, nearly twice as much cholesterol as the cholesterol-fed rabbits not receiving thyrotropic factor. In an attempt to explain these findings some theoretical considerations are discussed. MONTGOSCERP.
Immel, R.: 16:
956,
Hemostatic
Pressure Rise and the Arterial
System.
Klin.
Wchnschr.
1937.
When a patient result: so the author
stands states,
up, the pressure in the brachial artery of an increase in tone of the medium-sized
increases arteries.
as a
KATZ.
A New Syndrome Apparently Jones, E. Idrie: Posterior Pituitary. Lancet 1: 11, 1938.
Due to Over-Activity
of the
A patient in whom hypertension, hyperchromic anemia, achlorhydria and abnormal carbohydrate tolerance were present has been observed over a period of eight months. The fact that in animals it is possible to produce hyperchromic anemia and achlorhydria by injection of posterior pituitary extract suggested that the combination of hyperchromic anemia and hypertension was not fortuitous but that the syndrome might be due to overactivity of the posterior pituitary. An extract with pressor and antidiuretic activity was obtained from the urine of this patient. This was considered additional evidence of hyperfunction of the posterior pituitary. Treatment with liver extract resulted in a return of the blood count and hemoglobin to normal, a more normal carbohydrate tolerance curve, and a fall in the blood pressure to normal levels. It is suggested that this is a new syndrome due to hyperfunction of the posterior pituitary. HINES.
THE
AMERICAN
HEART
JOURNAL
In a survey of the literature forty-five definite instances of this defect have been found, together with seven other instances in monstrous births and two doubtful cases. Analysis of these cases reveals that the defect was almost invariably on the left; that in 76 per cent of the cases it was so completely on that side that the heart and the left lung were in a common serous cavity; that in 7’7 per cent of the cases the subject was a male; and that the condition is not incompatible with normal life, having in only one instance been directly responsible for death and having otherwise possibly caused cardiac symptoms in only three cases. Unexplained cardiac enlargement may occur (in about half the cases), but it is apparently not related to the presence or absence of adhesions. The chief danger from the defect lies in exposing the heart to pulmonary infection, with death in 27 per cent of the cases, including our own, associated with pleuropericarditis. Although in no case as yet has the condition been diagnosed ante mortem, this should be possible in some instances on the basis of certain criteria adapted from Maude Abbott. AUTHOR.
Hyperergic Welper, W.: Presence of Eclampsia
Thromboendarteritis in the Lungs of Infants in the of the Mother. Arch. f. Kreislaufforsch. 2: 210, 1938.
In a 3-day-old infant evidence was found of thromboendarteritis in the peripheral arteries of the lung. The changes resemble those seen in allergic disorders and are attributed to the severe eclampsia of the mother, suggesting that eclampsia is allergic in character (8). KATZ.
Waring,
J. I.:
Nutritional
Heart
Disease in Children.
Am.
J. Dis.
Child.
55:
750, 1938. Nutritional heart disease is not uncommon among negro children in Charleston, S. C. Thirteen cases summarized here suggest that the cardiac changes are due.not entirely to a lack of vitamin B but to a rather more general deficiency of dietary materials and that a satisfactory response to dietetic treatment may be expected in cases in which the illness is not too far advanced. AUTHOR.
Bland, Med.
Edward 61:
F., and Jones, T. Duckett:
Fatal Rheumatic
Fever.
Arch.
Int.
161, 1938.
Since 1921 (sixteen years) approximately 1,500 children and adolescents under the age of 21 years have received hospital care at the House of the Good Samaritan for rheumatic fever and chorea. The subsequent course and present We have presented in this report data status of this large group are known. Post-mortem examination was made in relevant to the 306 patients who have died. From a consideration of this group of patients who 74 instances (24 per cent). have died the following conclusions may be cited: 1. Rheumatic fever has been responsible for the fatal issue in 2. The early years after the period. In approximately half during the first three years and years.
the outstanding cause of death and was directly 250 instances (82 per cent). onset of the disease have proved to be a critical (47 per cent) of the fatal cases death occurred in two-thirds (62 per cent) during the initial five
SELECTED
129
ABSTRACTS
3. Thereafter the extent of residual cardiac enlargement (dilatation) and, to a lesser degree, the rapidity with which it developed have served as the most reliable criteria of the severity of the preceding infection as well as an index of the future susceptibility of the individual patient to subsequent fatal rheumatic fever. 4. The age of the during the first fifteen longevity is concerned. with
patient years
at the time of onset of rheumatic of life has been of no significance
5. The manifestations of fatal the generally accepted clinical
rheumatic picture
fever had been of the disease.
fever (or chorea) so far as subsequent
stressed
and
contrasted J\CTHOR.
Bruger, Maurice, and Fitz, Fred: Experimental Atherosclerosis: Prolonged Administration of the Thyrotropic Factor. Arch. Path.
1. Effect of 25: 637, 1938.
The feeding of iodine prevents the deposition of cholesterol in the arteries of Thyroidectomy abolishes this protective action of iodine. rabbits fed cholesterol. This striking relationship between experimental atherosclerosis and the function of the thyroid gland led the writers to learn whether the thyrotropic factor, from the pituitary gland, has an effect on experimental atherosclerosis in rabbits (cholesterolfeeding method). The results were as follows: The aortas of cholesterol-fed rabbits contained several times as much cholesterol as normal controls. The aortas of rabbits receiving injections of thyrotropic factor contained about the same amount of cholesterol as normal controls. The aortas of rabbits being fed cholesterol and receiving injections of thyrotropic factor contained, on the average, nearly twice as much cholesterol as the cholesterol-fed rabbits not receiving thyrotropic factor. In an attempt to explain these findings some theoretical considerations are discussed. MONTGOSCERP.
Immel, R.: 16:
956,
Hemostatic
Pressure Rise and the Arterial
System.
Klin.
Wchnschr.
1937.
When a patient result: so the author
stands states,
up, the pressure in the brachial artery of an increase in tone of the medium-sized
increases arteries.
as a
KATZ.
A New Syndrome Apparently Jones, E. Idrie: Posterior Pituitary. Lancet 1: 11, 1938.
Due to Over-Activity
of the
A patient in whom hypertension, hyperchromic anemia, achlorhydria and abnormal carbohydrate tolerance were present has been observed over a period of eight months. The fact that in animals it is possible to produce hyperchromic anemia and achlorhydria by injection of posterior pituitary extract suggested that the combination of hyperchromic anemia and hypertension was not fortuitous but that the syndrome might be due to overactivity of the posterior pituitary. An extract with pressor and antidiuretic activity was obtained from the urine of this patient. This was considered additional evidence of hyperfunction of the posterior pituitary. Treatment with liver extract resulted in a return of the blood count and hemoglobin to normal, a more normal carbohydrate tolerance curve, and a fall in the blood pressure to normal levels. It is suggested that this is a new syndrome due to hyperfunction of the posterior pituitary. HINES.