Place of Radiotherapy in Treatment of Cancer of the Larynx
Authors: M. Lederman
Journal: BMJ (1961)

RHEUMATIC FEVER1B3RrISH 1639with none of the U.S.-U.K. series.The bed-rest cases had had no prophylaxis until after this assessment, and the U.S.-U.K. group were given penicillin followed by sulphonamide 1 g.daily in hospital and after discharge.Recurrences were more frequent in the unprotected group: some had more than one, whereas this never occurred in the protected group, and, as has been stated, many unprotected cases were worse after the recurrences whereas there was no deterioration in the protected.The type of case that did worse in the unprotected group, those admitted in second attacks with marked carditis, did not have recurrences while on prophylaxis.We believe, therefore, that the differences in cardiac status at follow-up between the two groups of cases- one treated with salicylate or hormone in hospital and given prophylaxis and the other by bed rest and no prophylaxis-can be explained wholly by the beneficial effect of prophylaxis in reducing the number of recurrences and thereby the ultimate amount of cardiac damage, and that other drug treatment played no significant part.Thus our finding in the acute phase of the disease-that hormone therapy in the dosage we have used, though of value in special circumstances, does not significantly affect cardiac status in the majority of cases -has been borne out by the subsequent course at followup.The results emphasize, however, the value of prophylaxis, and show that this is the most certain method we have at present of reducing morbidity from rheumatic heart disease. SummaryThe follow-up findings over a period of 5 to 10 years in 125 patients with rheumatic fever treated in this unit by bed rest alone and not given prophylaxis are considered separately in 19 who had recurrences and in 106 who did not.Patients without recurrences who had no abnormal heart sign in hospital were normal at follow-up; those with soft (grade 1-2) murmurs were normal or still had soft murmurs (none was worse); with more severe carditis (grade 3 murmurs) there was usually no change at follow-up, but in a few the 'signs were less (and some returned to normal) and in others more marked (increased aortic incompetence or develop- ment of opening snaps in addition to mitral systolic murmurs).With recurrences, however, there was often deterioration and sometimes death, especially in those admitted in second attacks or who had more than one recurrence.Cardiac status on admission to hospital in these cases and subsequently at follow-up has been related to the total number of attacks of rheumatic fever or chorea.On admission in first attacks, most had no or slight carditis ; in second or later ones the majority had marked heart disease.At the last follow-up the majority of those whose cardiac status had deteriorated (including deaths) had had three or more attacks, and mitral stenosis was observed to develop only in such cases.The findings at follow-up in the bed-rest series, who were not given prophylaxis, have been compared with those in 73 other patients admitted in later years and treated with six-week courses of A.C.T.H., cortisone, or aspirin and given prophylactic sulphonamide 1 g.daily in hospital and after discharge.Nineteen of the bed-rest cases had recurrences but only five of the drug-treated series.In patients without recurrences there was no difference between the two treatment groups in regard Lto changes in cardiac status at follow-up.With recurrences, on the other hand, there were marked differences: recurrences were more common in the bed-rest series (no prophylaxis) and deterioration was common after them, whereas in the treated (prophylactic sulphonamide 1 g.daily) recurrences were uncommon and no one was worse after them.It is concluded that treatment in hospital with steroid or salicylate has comparatively little influence in most instances on cardiac status at follow-up, but that prophy- laxis has a beneficial effect and is the most certain way we have of reducing the morbidity and mortality rate from rheumatic fever.