[The efficacy of pneumocalorimetry for the quantitative evaluation of treatment results in patients with pneumoconiosis and rheumocarditis]

The respiratory system conditioning function (CFRS) was evaluated with the aid of pneumocalorimetry by taking account of respiratory thermic losses spent to warm breathing air in the volume of vital capacity. There were 100 patients with pneumoconiosis and 49 ones with rheumatic carditis. In the course of treatment of patients with pneumoconiosis, both occurrence and degree of insufficiency of the conditioning function (CF) got decreased, with reduction in CF insufficiency degree being 60% in those patients faring well owing to the treatments administered, and 40% in those not having benefited much from the treatment. 73% of patients with rheumatic carditis experienced, under the influence of the treatment received, decline in the degree of CF insufficiency. Thus, pneumocalorimetric criterion described above will, we believe, help in quantitating the efficiency of treatment of CF insufficiency.

[The chronocorrection of disorders in the blood coagulation rhythm with kurantil in patients with decompensated rheumatic heart defects]

The circadian pattern of hemocoagulation was studied in patients with decompensated rheumatic heart disease (DRHD) concurrent with stages I-II circulatory failure (CF) during complex treatment or medical treatment with disaggregants. Biorhythmological studies demonstrated that in patients with DRHD and CF chronotherapy with curantyl had some advantages over the traditional therapy during complex drug therapy. In these patients, the chronopatterns of circadian rhythms of hemocoagulative parameters tended to normalize under the influence of curantyl chronotherapy, by diminishing the signs of external desynchronization. Advantages of chronotherapy over the traditional treatment found in patients with DRHD and stages I-II CF, as manifested by its clinical effect in shorter periods (on days 4-5) when small daily and course doses of the drug were used. Based on the biorhythmological studies of hemostatic parameters, a method of curantyl chronotherapy was developed for patients with DRHD and stages I-II CF, which may optimize the therapeutical process in patients with this abnormality.

[The immunomodulating effect of vilozen in the combined treatment of children with rheumatism associated with an allergy]

Effects were traced out of vilosene alone and combination with ketotifene on clinical-and-immunologic parameters in 86 children with rheumatism associated with concurrent allergy. There has been disclosed immunomodulating effect of vilosene in hyposuppressor variant of a secondary immune deficient state in rheumatic children. Antiallergic action of vilosene is more pronounced when employed in combination with ketotifene. The clinical effect was evident 1-1.5 weeks earlier than in controls. The data obtained suggest vilosene and ketotifen to be useful in the treatment of rheumatic children presenting with concurrent allergy.

Effects of high-dose intravenous methylprednisolone in children with acute rheumatic carditis

In order to measure the effects of high-dose intravenous methylprednisolone (HIVMP) and compare its efficiency with that of oral prednisolone (OP), 18 patients with active rheumatic carditis were studied. Ten patients received OP, while eight patients were treated with HIVMP. Clinical and laboratory responses to treatment were followed by sleeping pulse rate, systolic blood pressure, erythrocyte sedimentation rate (ESR), cardiothoracic ratio (CTR), PR interval on electrocardiogram, spectral and color flow imaging and Doppler echocardiographic findings; mitral and aortic regurgitant jet flow area, left atrial area, proximal width of mitral regurgitant jet area and regurgitation fractions. The results of patients in the HIVMP group showed statistically significant changes in ESR and CTR when compared with the patients receiving OP, and the recovery was more rapid. HIVMP therapy can be considered as a new method of treatment for acute rheumatic carditis.

[Time organization of blood coagulation in patients with rheumatic heart disease involving circulation insufficiency]

Daily profiles of blood coagulation were studied in 20 normal subjects and 92 patients with rheumatic heart disease with stages I-III circulatory insufficiency before and after traditional therapy and chronotherapy with heparin and curantyl added to traditional therapy with antirheumatic agents, diuretics, and cardiac glycosides. Time organization of the hemostasis was disordered in patients with decompensated heart disease, but it is possible to correct it by chronotherapy with heparin and curantyl.

Antibodies against proteins of streptococcal hyaluronate synthase bind to human fibroblasts and are present in patients with rheumatic fever

Antibodies directed against the streptococcal 42 kDa hyaluronate synthase and a 56 kDa auxiliary protein bound to the surface of intact human fibroblasts in vitro. Staining was most prominent during the detachment phase of mitosis. In eukaryotic plasma membranes a 52 kDa protein was recognized by the antiserum against the 56 kDa streptococcal protein. Since the cross-reacting proteins could be involved in immunological mimicry between streptococcal and human antigens leading to heart cell necrosis, the reactivity of sera from patients with rheumatic fever was compared with that of sera from healthy or streptococcal infected persons. The sera from patients with rheumatic fever showed a higher reactivity against the 56 kDa protein than those from healthy persons or from patients with an antibiotic treated streptococcal infection. This difference was not observed for the 42 kDa protein. These sera were able to lead to cell lysis in the presence of complement.

Prolonged therapy by the combination of furosemide and thiazides in refractory heart failure and other fluid retaining conditions

The efficacy and side effects of the combination therapy of thiazide and furosemide administered to patients with refractory heart failure, for a prolonged period of time, were assessed. Thirty-two patients were hospitalized during the years 1985-1991. Left heart failure (left ventricular ejection fraction (LVEF = 22.4% +/- 6.6%) was present in 26 patients, right heart failure in 3 patients, chronic renal failure, cirrhosis and bilateral pleural effusion were present each in one patient. Chlorothiazide 0.5 g daily was added to conventional therapy. Patients were monitored closely during hospitalization and later as outpatients. During hospitalization, addition of chlorothiazide caused a reduction of 4.8 +/- 4.0 kg in patients' weight, serum potassium decreased from 4.4 +/- 0.6 to 4.0 +/- 0.5 mmol/l (P < 0.005) and serum sodium from 139.0 +/- 4.7 to 136.8 +/- 5.5 mmol/l (P < 0.05). The duration of the combined therapy was 17.2 +/- 19.1 months. Thirteen patients had short treatment (1.6 +/- 0.8 months) and 19 patients had prolonged treatment (26.5 +/- 19.0 months). No specific characteristics distinguished patients in both groups. Thiazides were discontinued in 19 patients, 10 of which had side effects. In only 5 of the 19 patients treated for the prolonged period had thiazides to be discontinued because of side effects. Addition of thiazides to furosemide is efficacious in severe heart failure. The combination should be started during hospitalization. Many patients can be maintained on this combination for a prolonged period of time on an ambulatory basis.

The treatment of rheumatic carditis: a review and meta-analysis

We performed a meta-analysis of the literature on the treatment of established rheumatic carditis to determine if corticosteroid therapy is superior to salicylates in preventing the sequela of inflammation--valvular damage. We identified 22 reports of comparative trials published since the introduction of corticosteroids in 1949. Five of the 22 studies met the criteria we established for the meta-analysis, which included using randomization and a 1-year follow-up for the presence of a new pathologic apical systolic murmur. Based on the meta-analysis, the advantage of corticosteroid treatment over salicylates in preventing a pathologic murmur at 1 year posttreatment is not statistically significant (estimated odds ratio 0.88; 95% confidence interval: 0.53 to 1.46). However, the meta-analysis is dominated by 1 large negative trial, and there was significant heterogeneity in the results obtained from the studies in the meta-analysis; thus, the question of whether corticosteroid therapy is marginally superior to salicylates for the prevention of valvular heart disease from rheumatic fever remains open.

[Anticoagulation in non-rheumatic atrial fibrillation. Recommendations based on five prospective studies]

Atrial fibrillation is the second most common arrhythmia after ventricular premature beats. For years, prophylactic anticoagulation has been recommended in patients with atrial fibrillation in underlying rheumatic heart disease. With the aim of establishing the risk of embolism in non-rheumatic atrial fibrillation, and the justification for prophylactic anticoagulation therapy, five prospective studies were carried out. The results obtained indicate that all patients with chronic atrial fibrillation should receive anticoagulation therapy wherever possible (INR 2.0 to 3.0). The sole exception are patients aged under 55 years with no other organic heart disease. For this group, the risk of a stroke is appreciably reduced, so that treatment with ASA suffices.

Sedimentation level in intracerebral hematoma in patients receiving anticoagulation therapy

We have described two cases of spontaneous intracerebral hematoma, characterized by sedimentation level seen on unenhanced cerebral CT, in patients receiving anticoagulation therapy. Anticoagulation or coagulopathy may be important in producing sedimentation levels. The "sedimentation level" is a more accurate term than the commonly used "blood-fluid level" or "hematocrit effect."

[Pulse therapy (high doses of venous methylprednisolone) in children with rheumatic carditis. Prospective study of 40 episodes]

PURPOSE

To use corticosteroids in a shorter period to treat rheumatic carditis, keeping the patient in the hospital; and verify the time interval of normalization of rheumatic activity tests with this method.

METHODS

In 36 patients (40 episodes) intravenous methyl-prednisolone (1g/day) was administered. The number of series ranged from two to four, according to severity of the disease. The ages ranged from 6 to 17 years old, all of them fulfilled the criteria of Jones for diagnosis of rheumatic fever. They were submitted to treatment to eradicate the streptococcus, worms, PPD and dental focus extraction, before use of corticosteroids.

RESULTS

In all patients the signals and symptoms of heart failure improved. In six cases occurred complications during pulse therapy that were easily controlled with clinical measures. Two series of methylprednisolone were used in 10 children, three in nine and four in 21 episodes. Eight patients were sent to valve replacement. The interval of time that laboratory tests of rheumatic activity became negative was 41.2 +/- 13.3 days.

CONCLUSION

Using this IV corticotherapy it was possible decrease the amount of days of this medication, keeping the patient in the hospital. In this way we eliminate the problem of interruption of the treatment. There was not significative difference between oral and IV corticotherapy in order to the laboratory tests become negative.

Use of aminocaproic acid (ACA) in extra-amniotic MTP in patients on anti-coagulant therapy

A case of rheumatic heart disease (RHD) with prosthetic mitral valve endocarditis receiving anticoagulation with heparin, underwent medical termination of pregnancy in a second trimester. The following report entails the use of aminocaproic acid (ACA) in preventing excessive bleeding during and after the procedure, while the patient continued to receive anticoagulant therapy.