Abstracts
Journal: Annals of the Rheumatic Diseases (1954)

ACTH, Cortisone, and other Steroids; Other General Subjects.At the end of each section is a list of titles of articles noted but not abstracted.Not all sections may be represented in any one issue.The section "ACTH, Cortisone, and other Steroids" includes abstracts and titles of articles dealing with steroid research which, although not directly concerned with the rheumatic diseases, may make an important contribution to knowledge of the scope and modus operandi of steroid therapy.Acute Rheumatism Clinical and Experimental Studies of the Mode of Action of Heparin in Rheumatic Fever.(Ricerche clinico- sperimentali sul meccanismo d'azione dell'eparina nella malattia reumatica.)MATTEIS, F. DE, and PANIGATTI, F. (1954).Minerva med.(Torino), 45, 58. 1 fig., 33 refs.The inhibitory action of salicylates on hyaluronidase has been attributed to liberation of heparin in the tissues, and favourable results have been reported from the administration of heparin and similar anticoagulants in the treatment of rheumatism.These have been explained as being due to either an anti-exudative effect through osmotic and diffusional regulation, or to an anticoagulant effect diminishing antigen-antibody reactions, an anti- hyaluronidase action, or an anti-anaphylactic action.In this study, carried out at the Institute of Clinical Paediatrics, University of Genoa, three lines of enquiry were pursued:(1) the relative tolerance to heparin of rheumatic and non-rheumatic children;(2) the effect of hyaluronidase on clotting factors in vitro;(3) the relation between hyaluronidase, heparin, and salicylate in regard to intradermal diffusion of coloured substances.Heparin tolerance of non-rheumatic control patients and a group of fifteen salicylate-treated rheumatic children was estimated by comparing the coagulation times at 10, 30, and 60 min.after intravenous injection of 2,000 units of heparin.The non-rheumatic patients showed an average coagulation time of 37 seconds at 10 min., compared with 30 seconds in the rheumatic group.Since five non-rheumatic and two rheumatic patients had coagulation times of 50 seconds or over at 10 min., this estimation was used as a screening test for heparin treatment.The effect of hyaluronidase on clotting factors in vitro was then investigated.Samples of blood from ten children free from haematological disease were examined for prothrombin time (in the presence of progressive dilutions of thrombokinase), for recalcification time, and for antithrombin time, and the effect on these figures of distilled water and hyaluronidase in solutions of 25 and 1-25 units per ml.determined.Prothrombin and recalci- fication times were prolonged and the antithrombin time little affected.(As these results were similar to those obtained with heparin, the effects of a heparin-hyaluronidase mixture were not investigated.)Lastly, the relation between hyaluronidase, heparin, and salicylate in regard to intradermal diffusion of coloured substances was investigated, mixtures of fluorescein and distilled water and fluorescein and hyaluronidase being viewed by ultraviolet light through Wood's glass in two groups of subjects-non-rheumatic children injected with heparin and rheumatic children under salicylate treatment.The figures for increase in areas of spread with hyaluronidase in non-rheumatic cases were 226 to 285 sq.mm., and with distilled water 178 to 224 sq.mm.; in the cases of rheumatism being treated with salicylates the figures were 215 to 264 sq.mm. with hyaluronidase, and 195 to 237 sq.mm. with distilled water.The authors suggest that these differences indicate that salicylate has a greater anti-hyaluronidase effect than heparin.[The differences, however, are not statistically significant.]W. A. Bourne.