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 RheumatismHormone Therapy in Acute Rheumatic Carditis inChildren.(Hormonotherapie dans la maladie de Bouillaud chez 1'enfant.)BARDIER, A., Bouissou, H., and METHOT, -. (1953).Presse mid., 61, 1040. 10refs.The authors compare the results of treatment at the Clinique Medicale Infantile, Toulouse, of 28 children with acute juvenile rheumatic carditis, of whom thirteen were given salicylates and fifteen ACTH (corticotrophin) or cortisone.Details of dosage, types of cases, and follow-up results are given.In the authors' opinion acute attacks of carditis, unless very severe, can generally be treated successfully by the usual salicylate therapy, but recurrences are not infrequent and valvular lesions often persist.Of those treated with the hormones, three, all severe cases, died, but the other twelve responded favourably, although no change was seen in established valvular lesions.It is concluded that treatment with ACTH or cortisone is preferable to that with salicylates, particularly in severe attacks of rheumatic carditis, but that it must be started early in the disease if it is to be effective; if this can be done, permanent cardiac damage may be avoided.Hormone therapy is not advised for patients with chronic valvular lesions, nor as interval treatment between attacks.Kathleen M. Lawther.Treatment of Rheumatic Carditis in Children with Hor- mones and Salicylates.(Il trattamento ormonico- salicilico della cardite reumatica del bambino.)GELLI, G., and MENICHINI, G. (1953).Arch.ital.Pediat., 16, 85.Bibl.The combination of salicylates with cortisone or ACTH (corticotrophin) in the treatment of rheumatic fever allows the use of smaller doses of each substance; it seems probable also from experimental evidence that the two drugs enhance one another's action, and that their use together may prevent the development of adrenal atrophy.At the Paediatric Institute of the University of Pisa, thirteen children with rheumatic fever or chorea have been treated in this way, eight during their first attack.Doses of 25 mg.ACTH or 50 mg.cortisone were given daily for 3 weeks, and the dose was then halved for a further 3 weeks.Simultaneously, 4 to 6 g. sodium salicylate was administered daily, this dose also being halved later.In addition, penicillin and streptomycin were given during the whole period of treatment, partly because of a belief in the initial infective nature of the disease and partly to combat any increased risk of infection resulting from the hormone therapy.A low- salt diet with added ascorbic acid was given, and the usual measures for the relief of cardiac failure were instituted when necessary.All the patients improved rapidly, the most striking effects being noted on the extracardiac manifestations of the disease: one patient with chorea, for instance, lost his symptoms altogether within 10 days.No danger was encountered from fluid retention, and three patients in heart failure-one seriously ill-all responded satis- factorily.The effect of the combined therapy on the cardiac lesions was much more difficult to assess: although the signs of endocardial involvement did not progress, in only two patients did they entirely disappear, and this during their first attack.As might be expected, myocarditis and pericarditis appeared to be more susceptible to treatment than endocarditis, but the electrocardiogram was of little help as a guide to improve- ment because of the changes produced by the electrolyte disturbances accompanying treatment.The authors conclude that while the course of the disease was much shortened and, although several were extremely ill initially, no patient in this series died, it cannot yet be said that a form of treatment has been found which materially alters the results of cardiac involvement in rheumatic fever.A. Paton.