Abstracts
Journal: Annals of the Rheumatic Diseases (1963)

Given adequate recognition and treatment of Group A P-haemolytic streptococcal throat infection, even first attacks of rheumatic fever are preventable.A study of 110 children admitted to La Rabida Sanitarium, Chicago, during 1960-61, all in their first attack of rheumatic fever and all seen consecutively, demonstrated that 84 per cent. of such cases were preventable in the light of modern knowledge.Of the 110 patients, 47 had not been seen by a physician, despite a sore throat in 22 of them.Of those seen by a physician in the 5 weeks preceding the attack of rheumatic fever, throat cultures were taken from only seventeen (27-4 per cent.).The fact that f-haemolytic streptococci were isolated in only six cases (35 per cent.) and grouping was performed in only one instance suggests to the authors a faulty tech- nique of taking the throat swabs.Of the 62 patients seen by physicians, fifty received some form of antibiotic therapy, but in only ten cases was this adequate in form, dosage, and duration as judged by the recommendations of the American Heart Association Committee on Prevention of Rheumatic Fever (benzathine benzylpenicillin 900,000 units or procaine penicillin suspension 300,000 units intra- muscularly at 0, 3, and 6 days, or benzylpenicillin 250,000 units by mouth twice daily for 10 days).In the ten cases apparently given adequate treatment by published standards rheumatic fever still developed, however.The authors compare their experience with that of Czoniczer and his colleagues (New Engl.J. Med., 1961, 265, 951) in Boston, none of whose 105 patients, all in their first attack, had had adequate penicillin therapy for the antecedent streptococcal sore throat.They recom- mend a more vigorous education programme directed towards both the profession and the public.E. G. L. Bywaters.Practical Experience in the Prevention of Relapses of Rheumatic Fever in Childhood.(Praktische Erfahrungen mit der Rezidiv-Prophylaxe des rheumatischen Fiebers im Kindesalter.)LORENZ, E., and WENDLER, H. (1963).Arch.Kinderheilk., 168, 5. 27 refs.The advent of the sulphonamides and, partly, of antibiotics has revolutionized the methods of preventing relapses in rheumatic fever.Oral administration being tedious and unreliable, it has become customary in the United States to give monthly injections of 1,200,000 units of benzathine penicillin.At the University Children's Clinic, Graz, the authors began to use this method in 1957, but soon found that it caused such severe local and even systemic side-effects that it had to be abandoned in a large proportion of cases.It was therefore decided to substitute a combination of 600,000 units benzathine penicillin, 300,000 procaine penicillin, and 300,000 sodium benzylpenicillin.This was tolerated by the tissues far more readily and enabled continuous prophylaxis to be given to 101 children between 1957 and 1962; in only one case was there a slight recurrence, but without any cardiac involvement.All the children had previously had at least one attack of rheumatic fever and 81 had had carditis.D. Preiskel.Characteristic Rheumatic Lesions of Striated and Non- striated or Smooth Muscle Cells of the Heart.Genesis of the Lesions known as Aschoff Bodies and those Myogenic Components known as Aschoff Cells or as Anitschkow Cells or Myocytes.MURPHY, G. E. (1963).Medicine (Baltimore), 42, 73. 128figs, bibl.The cardiac lesions known as Aschoff bodies or nodules that are characteristic of active rheumatic heart disease are shown to be lesions of muscle cells.The lesions of striated muscle cells (fibres) that are generally termed Aschoff bodies are characterized by (I) mono-, multi-, and non-nucleated fragments of muscle fibres;(2) multinucleated myogenic masses that arise beneath the sarcolemma, develop in tracks of 446 copyright.