Rheumatic heart disease in adolescence

376

THE

AMERICAN

HEART

JOURNAL

cardium. The ten were observed before and after operation with reference to cardiac output by the acetylene method, vital capacity, electrocardiogram, armto-tongue circulation time (Decholin), venous pressure (direct method), roentgenogram of the heart at two meters, and infrared photographs of the peripheral veins. The results of these tests were all abnormal before operation and in every instance approached the normal levels following operation. Operative technique is described. Three patients were cured, five cases improved by the operation. In one case it is too early to foretell results. One died nine months after operation. MCGOVERN.

Marcel,

M.

P.:

Rheumatism. Periodic rheumatic intermittent

Intermittent Cardiolopia

changes polyarthritis. left-sided

in

S-A Block 3: 231, 1939. the

P wave were This is attributed sine-auricular block.”

in

the

Course of Acute

observed in three by the author

Polyarticular

acute attacks to “partial

of and

KATZ.

Struthers, 128,

R. R.:

Rheumatic

Heart Disease in Adolescence.

Canad. M. A. J. 42:

1940.

The author describes the clinical findings and course of thirty-five cases of rheumatic fever of the older school age group from 10 to 16 years. He emphasizes the importance of rheumatic fever and heart disease at this period of life. &k!&JLLOCH.

Klein, Reuben I., Levinson, Samuel A., and Rosenblum, Philip: Weltmann Reaction and Sedimentation Rate During Rheumatic Fever of Childhood. Am. J. Dis.

Child.

59:

45, 1940.

The Weltmann reaction and the sedimentation rate were studied in 110 eases of rheumatic fever of childhood and in ten cases of subacute bacterial endoearditis. The rheumatic fever group was made up of twenty-six cases of chorea. thirty-two cases of acute rheumatic arthritis without carditis, thirty-nine of acute carditis, and thirteen of cardiac decompensation. The sedimentation rate with chorea, although usually normal, may at times be increased. This increased rate may be related to a previous infection. The Weltmann reaction with chorea is almost always either normal or increased. Acute rheumatic arthritis and carditis are characterized by a rapid sedimentaThe coagulation band returns to normal tion rate and a low coagulation band. before the sedimentation rate. In cases of cardiac decompensation the sedimentation rate tends to slow and the coagulation band tends to increase the values, depending on the severity of the decompensation in relation to the degree of infection. The three pathologic stages of rheumatic fever, exudative, proliferative, and fibrotic, are reflected in the Weltmann reaction. An increased sedimentation rate does not always mean that the rheumatic infection is still active. The patient may be convalescing, in a phase which is pathologically termed the proliferative stage, and still have a rapid sedimentation rate. The Weltmann reaction is of value in the study of rheumatic fever, complementing the sedimentation rate; it may be of aid in the differentiation of subacute bacterial endocarditis from acute rheumatic carditis. AUTHORS.