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Thickening and sclerosis of the chordae tendineae of the mitral valve are seen fairly frequently in hearts that are not ordinarily considered to be rheumatic. In this report a systematic study of these lesions is presented. Factors involved in their pathogenesis and their significance in the development of the chronic rheumatic deformity are discussed.

Ten cases of cardiac hypertrophy and myocardial failure of unknown origin are presented. Conventional etiologic factors, such as rheumatic fever, hypertension, syphilis, arteriosclerosis, bronchopulmonary disease and congenital abnormalities, were excluded. The clinical course of these patients was rapidly progressive and fatal, and frequently complicated by recurrent pulmonary and systemic thromboembolism. At necropsy the hearts showed striking hypertrophy. Degenerative muscular changes, focal necrosis, patchy fibrosis were found predominantly subendocardially and endocardially, frequently associated with mural thrombosis. There were no significant abnormalities of the pericardium, coronary artery tree, cardiac valves or aorta. A brief review of similar cases previously described is presented. None of the causes heretofore suggested as primarily responsible for this syndrome are believed by us to have been established. Myocardial anoxia, a concomitant of the considerable hypertrophy and dilation, is believed to be an important factor in the intensification of the intracardiac abnormality. Attention is drawn to the importance of considering this entity in all cases of cardiac hypertrophy when a conventional etiology cannot be established.

The serum cholesterol of eighty-six patients with aortic stenosis, forty-three men and forty-three women, and of sixty-seven patients with chronic rheumatic valvular disease, twenty-two men and forty-five women, was determined. Using Keys' standards, 48.8 per cent of the females and 18.6 per cent of the males with aortic stenosis were hypercholesteremic, whereas of those with chronic rheumatic valvular disease 13.3 per cent of the females and 13.6 per cent of the males were hypercholesteremic. By using standards derived from a study of a random sample of a union population in New York City (The Amalgamated Clothing Workers of America), 53.5 per cent of the females and 27.9 per cent of the males with aortic stenosis were hypercholesteremic; and of those with rheumatic valvular disease 20 per cent of the women and 18.2 per cent of the men were hypercholesteremic. Of the patients with aortic stenosis 70 per cent apparently had had previous rheumatic infection. Three patients with xanthomatosis and hypercholesteremia and one with familial hypercholesteremia who also had aortic stenosis were observed. Only one of these had had rheumatic fever. One was a man aged 20. Our material favors the hypothesis that in persons with hypercholesteremia aortic stenosis may be caused by atherosclerosis of a normal aortic valve, but that in most instances it is caused by a secondary atherosclerosis implanted on aortic cusps scarred by ancient rheumatic infection.

Summary1. Hyaluronidase increased the diffusion of fluid across the capillary membrane and cause elevation of the blood hematocrit.2. Rutin, in the amounts used in these experiments, failed to inhibit this reaction in the albino rat.3. Rutin in propylene glycol, given intra-peritoneally to the albino rat, caused the formation of hydro-peritoneum and marked hemoconcentration. Propylene glycol given by the same route had a similar, although lesser, effect. When administered orally, rutin caused little elevation of the hematocrit.The assistance of Miss Elaine Lowry is gratefully acknowledged. The author is indebted to Major Monroe E. Freeman, MSC, for the hyaluronidase preparations.

Forty patients manifesting congestive heart failure have been studied with serial serum determinations for C-reactive protein. This abnormal protein was found in thirty instances. No demonstrable difference in age, sex, or race were noted between the two groups. In those patients in whom C-reactive protein was present, the congestive heart failure appeared to be more severe. Fever, elevated erythrocyte sedimentation rate, and pulmonary abnormalities were more common in the group in which C-reactive protein occurred. In approximately one-half of the group in which C-reactive protein was found, the protein was initially present but disappeared after one to two weeks of treatment. In six patients, the C-reactive protein persisted in the blood throughout the hospital course. Single determinations of C-reactive protein were made in the blood of ten patients in whom congestive heart failure was stationary. In no instance was C-reactive protein present. The presence of C-reactive protein in the blood of patients with congestive heart failure limits the application of C-reactive protein determinations as a measure of rheumatic activity in acute rheumatic fever and in chronic rheumatic heart disease and as a measure of necrosis in acute myocardial infarction.

IN recent years there has been a steady decline in mortality after open intracardiac operations. However, persistent low cardiac output remains one of the prime causes of death, particularly in patients with far advanced myocardial dysfunction at the time of operation. These patients may manifest low output when attempts are made to discontinue cardiopulmonary bypass or 24 to 48 hours later, when cardiac performance is often at its lowest level. In such situations mechanical circulatory assistance may provide the only means of survival. Intra-aortic balloon counterpulsation has been effective in improving the hemodynamic state of patients in low output after . . .

The postcommissurotomy syndrome developed in ten of sixteen patients ten days to seven months following mitral commissurotomy. Seven patients had multiple attacks. The syndrome consisted of chest pain and fever together with less prominent and frequent cough, hemoptysis, dyspnea and arthralgias. Evidence of pericarditis and pleuritis was obtained, with leukocytosis and elevated erythrocyte sedimentation rate. Bacteriologic studies yielded negative results. Penicillin prophylaxis was ineffective and antibiotics failed to modify the course. Salicylates appeared to abbreviate the illness. No significant change in the antistreptolysin-O titer occurred during this illness. The C-reactive protein was found to be the most sensitive laboratory test for the postcommissurotomy syndrome and the most useful in management. The possible etiologic factors are reviewed. It is suggested that the postcommissurotomy syndrome represents a self-limited form of pericarditis and pleuritis induced by the trauma of surgery in patients with rheumatic heart disease. Salicylate suppressive therapy is recommended for all postcommissurotomy patients. The C-reactive protein test is suggested as a useful and sensitive test for the activity of the postcommissurotomy syndrome.

Summary1. Chemical measurements were made of the collagen content of the lungs, liver, kidneys, spleen, heart and skeletal muscle of 58 guinea pigs weighing between 60 and 1000 g. 2. The concentration of connective tissue components varied with different tissues; the lungs contained the greatest proportion, and the liver the least proportion, of collagen. 3. Tissues from older animals usually contained a higher per cent collagen than comparable younger tissues, except for the spleen where the converse was true. 4. The values obtained for guinea pig tissues were in essential agreement with previously reported figures for other species.

Intercurrent febrile illnesses frequently occur during the life history of patients with rheumatic heart disease and may be transitory and of little importance. On the other hand, they may be protracted, associated with severe congestive heart failure, and may terminate fatally. It is essential to determine whether or not the fever is related to the heart disease and to undertake appropriate studies to determine the factors responsible. This study is a clinicopathologic investigation of adult patients with rheumatic heart disease in whom fever was a prominent part of the terminal illness. Materials and Methods This report is an analysis of 6 adult patients seen at The Mount Sinai Hospital between the years 1946 and 1959. The necropsy protocols of all patients during these years were reviewed, and, in those in whom "rheumatic heart disease" was noted, the clinical record was examined. The case was included for study if fever had

Excerpt INTRODUCTION In a previous publication1the clinical and laboratory manifestations of acute rheumatic fever in 30 adult patients were studied. Treatment of these patients consisted of adreno...

Summary In order that we might inhibit their implanted units, 30 patients with permanent R-wave inhibited demand pacemakers underwent chest wall stimulation by impulses delivered from an external pacemaker, first through skin electrodes and then, in the identical positions, through fine platinum subcutaneous pin electrodes of the type used in electroencephalography. A comparison of the suppression characteristics of these electrodes is reported. Both techniques were uniformly successful at low impulse amplitude for the five unipolar pacemakers. In bipolar pacemakers, suppression was achieved in 24 of 25 by pin electrodes, in nine of 25 by skin electrodes, and in one by neither. Of the nine bipolar pacemakers suppressed by both methods, six needed more current amplitude for skin electrodes, while three needed equal current amplitude. In 27 patients the spontaneous rhythm and QRST configuration were determined. One patient had P-waves only and one had no spontaneous electrical activity. Chest wall stimulation through pin electrodes provides a quick, safe, and predictable means of suppressing the R-wave inhibited demand pacemaker.

Excerpt Since the first description of C-reactive protein by Tillett and Francis in 1930, the occurrence of this substance, which is not present in the blood of normal individuals, has been noted b...

THIS REPORT deals with the results of a prolonged follow-up study of 32 patients with acute disseminated lupus erythematosus treated with corticotropin and cortisone. Our initial study commenced 40 months ago, and in our earlier reports we described the results obtained in a limited number of patients with these therapeutic agents.* Our series of patients includes 26 females and 6 males, and the ages of the patients varied from 11 to 60 years (Table 1). The largest incidence of the disease occurred during the second, third, and fourth decades, but almost no age group is immune to the possible onset of this illness. All patients included in the investigation were admitted to the general medical wards of The Mount Sinai Hospital and were followed by the same group of investigators throughout the period of study, both while the patients were in the hospital and, when they were subsequently discharged