Acute rheumatic fever in Mississippi: a survey of hospitalized cases, 1964 to 1973

The incidence of acute rheumatic fever in Mississippi was estimated by reviewing the hospital charts of Mississippi residents with a discharge diagnosis of acute rheumatic fever from 1964 through 1973. The average annual incidence was 1.5 cases/100,000 population for primary attacks and 0.4 cases/100,000 population for recurrent attacks. The annual incidence was highest for the group aged 19 to 14 years, with 4.8 cases/100,000 population for primary attacks and 1.4 cases/100,000 population for recurrences. These rates are significantly lower than rates reported from similar surveys in Nashville, Baltimore, New York City, and the Navajo reservation. Age-adjusted rates of primary and recurrent attacks were higher for blacks than for whites, but the proportion of attacks that were recurrences did not differ by race. The proportion of attacks that were severe (cardiomegaly, pericarditis, or congestive heart failure) was significantly greater for blacks than for whites. No significant change in incidence was detected in the ten-year period. Among persons with primary attacks, only 18% are known to have had an antecedent pharyngitis and consulted a physician. Only 21% of persons with secondary attacks are known to have been receiving chemoprophylaxis.

Tetralogy of Fallot with coexisting type II aortopulmonary window

An infant had a coexisting tetralogy of Fallot and type II aortopulmonary window between the ascending aorta and the right pulmonary artery in which the communication acted as a palliative systemic-pulmonary shunt. Surgical repair is described, and the appropriate literature is reviewed.

Physical characteristics and ventilatory function of 404 commercial divers working in the North Sea

The physical characteristics and simple lung ventilatory indices (FVC, FEV 1, FEV 1/FVC) of 404 commercial divers employed by companies operating in the North Sea were analysed. These findings were correlated with the diving experience and maximum operating depth of each diver. All the divers were men of average height 176-9 cm, and weight 77-1 kg which is greater than average for active Western males, but only 6% were more than 120% of their predicted weight. The average duration of commercial diving was 7-1 years, 11% of divers having less than one year's experience. Sixty-seven per cent had worked at a maximum depth of 200 ft (61 m) and only 6% had worked deeper than 500 ft (153 m). The mean forced vital capacity (FVC) was 120-4% of the predicted value which indicated that they could voluntarily move large amounts of gas in and out of their lungs. This was greatest in the divers who when deepest. The mean forced expired volume in one second (FEV 1) was 117% of the predicted value showing that expiratory airflow capacity was also increased, but to a lesser extent than the FVC. Thper and activated by zinc. Plasma protein protected the enzyme from both inhibition and activation. ALAD activity was found to be an indicator of the total metal ion concentration in the blood and was therfore considered to be of doubtful value in screening large population for increased lead absorption.

Arteriovenous malformation of the vein of Galen: treatment in a neonate

Heart failure in a 2-day-old infant was not readily explained by clinical examination. Cardiac catheterization suggested an intracranial arteriovenous (AV) fistula, and cerebral arteriography showed a malformation of the vein of Galen. The major feeding arteries were surgically obliterated. At age 27 months, the boy has normal mentation but moderate left hemiparesis. Review of the literature disclosed 39 other infants with AV malformations of the vein of Galen producing heart failure before age 3 months. Most of them were boys, and had cyanosis, a systolic murmer, cranial bruit, cardiomegaly, and right bentricular hypertrophy. Only three of the 13 who had surgery for their malformation survived. Removal of the malformation is difficult; obliteration of the nutrient vessels, using the operating microscope, is the currently accepted treatment.

Mitral valve replacement in a child during active rheumatic carditis: successful management of sixteen episodes of ventricular fibrillation

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Patent ductus arteriosus: operative treatment of 100 consecutive patients with isolated lesions without mortality

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