[Cardiolipin antibodies in acute rheumatic fever]. / Antitela k kardiolipin pri ostroi revmaticheskoi likhoradke.

The paper presented the results obtained in studying the patients with acute rheumatic fever for antibodies to cardiolipin (ACL). The study resulted in the establishment that the development of immunopathies in the presence of acute rheumatic fever combined with the acute streptococcal infection was accompanied by hyperproduction of ACL (more common IgG versus IgM isotypes). The phenomenon mentioned widened the spectrum of acute infectious diseases associated with an increase in ACL synthesis. It was also stated that increased ACL contents were closely related with the involvement of the cardiac valves. Authentic clinical and echocardiological signs of the heart disease were mainly revealed in the patients with high contents of IgG and IgM isotypes of ACL. A certain relationship between the laboratory activity of the disease and ACL hyperproduction was noted as well. The latter permitted the discussion on the impact of streptococcal infection initiating the development of acute inflammation on the hyperproduction of ACL.

[The serum neopterin level in acute rheumatic fever]. / Uroven' syvorotochnogo neopterina pri ostroi revmaticheskoi likhoradke.

Acute rheumatic fever (ARF) is a systemic inflammatory disease etiologically related to infection with group A streptococcus characterized by a broad spectrum of disorders of cellular and humoral immunity. To estimate the activity of the immunopathological process and to forecast myocardial derangement in ARF patients, measurements were made of neopterin in the serum of ARF patients. Nine men with ARF serving in the armed forces were examined. The control group comprised 24 donors. The reference group included 13 patients with dilated cardiomyopathy and 14 with chronic myocarditis. The mean level of neopterin in ARF patients was equal to 14.5 +/- 12.2 nM/l and was significantly higher than in the donors (5.0 +/- 2.0 nM/l). In patients with dilated cardiomyopathy and chronic myocarditis, it was 9 +/- 6 and 16 +/- 11 nM/l, respectively. On more careful clinical analysis the highest level of neopterin was recorded in 3 patients with impairment of the valvular apparatus of the heart. That level was observable during the whole period of the follow-up of the patients. In other patients, no impairment of the valves was detected, whereas the concentration of neopterin fell to normal. Therefore, the rise of the level of neopterin was described for the first time in patients with ARF. Besides, a relationship was found between the high level of neopterin and impairment of the valvular apparatus of the heart.

[The results of a retrospective examination of patients with acute rheumatic fever]. / Rezul'taty retrospektivnogo obsledovaniia bol'nykh ostroi revmaticheskoi likhoradkoi.

The authors describe the results obtained during retrospective examinations of 45 subjects who suffered from acute rheumatic fever 10-14 years before. Of these, 19 subjects were treated with prednisolone in the acute disease period, 16 with indomethacin, and 8 subjects with voltaren. The examinations were mostly randomized (30 subjects); no differences in the anti-inflammatory effect were discovered. Heart disease was found in 9 persons (20%). Of these, 6 were treated with prednisolone, 2 with indomethacin, and 1 with voltaren. The disease relapses were recorded in 4 of them, the signs of valvulitis in the past were shown only by 2 persons (echocardiographically). 12 persons (27%) had mitral valve prolapse which had not been diagnosed on the first admission to the hospital, with any clinical signs of hypermotility lacking. In 18 persons (40%) having no valve lesions (disease, prolapse), an x-ray examination revealed a slight increase of the heart size, estimated as a manifestation of postmyocardial cardiosclerosis. Thus, it has been shown that modern anti-inflammatory therapy does not prevent the development of heart disease. Apparently, its onset is related to specific proneness in some of the patients.

[Acute rheumocarditis in young men]. / Ostryi revmokardit u molodykh muzhchin.

A study was made of the characteristic features of rheumocarditis in 200 young recruits. Rheumocarditis developed within the first 2-3 days since the onset of migrating polyarthritis and high fever. In many cases, it was accompanied by rhythm and conduction disorders as well as by a moderate increase of the left heart in combination with intracardiac hemodynamic disturbances. In 42 patients (21%), myocardial injury was coupled with mitral valve lesion. Injury to the pericardium was recorded in 20 patients (10%); fibrinous pericarditis was diagnosed in 15 patients, exudative pericarditis in 5 patients. Injury to all 3 heart membranes was ascertained in 5 patients (2.5%) (according to echocardiography). Thus, the clinical and instrumental manifestations of rheumocarditis made it possible to diagnose marked carditis symptoms almost in all the patients (in 96%). Unmarked carditis was only discovered in 7 patients. The above-mentioned characteristics of rheumocarditis in young men may be due to the intensity of the action of streptococcal infection on the heart structures within the first days of the disease as well as due to the action of immunopathological processes. Besides, a definite role may be played by the foregoing physical load.

[The detection of streptococci, the study of their immunobiological properties and the determination of lipoproteinase antibodies and anti-immunoglobulins in patients with acute rheumatic fever]. / Vyiavlenie streptokokkov i izuchenie ikh immunobiologicheskikh svoistv, opredelenie antitel k lipoproteinaze i antiimmunoglobulinov u bol'nykh ostroi revmaticheskoi likhoradkoi.

Bacteriological confirmation of the presence of group A Streptococcus (GAS) in patients with acute rheumatic fever (ARF) by means of the express method was achieved only in 15.1% of the cases and the positive growth of the culture was observed only in 12.1%. Streptococci isolated from the patients showed a low IgG-Fc receptor activity just as in the negative control. The blood serum of patients exhibited the presence of antibodies to 18 OF-serotypes among which serotypes 2, 4, 22, 28, 48, 68, 75, 77, 78, PT 2841 prevailed; their content fluctuated from 12.5 to 48.4%. There were no differences between the nature of distribution of the given antibodies depending on the presence and level of ASL-O in the blood and the presence of concomitant chronic tonsillitis. Antibodies to IgG in titres 1:10-1:40 were revealed in the blood of only 18.1% of the patients; there was some dependence of the frequency of their detection on the markedness of carditis and the presence of cardiac defects.

[The results of the indomethacin treatment of patients with acute rheumatic fever]. / Rezul'taty lecheniia bol'nykh ostroi revmaticheskoi likhoradkoi indometatsinom.

The authors describe the results of studying the anti-inflammatory effect of indomethacin in 102 young men suffering from acute rheumatic fever (ARF). It has been shown that indomethacin has a remarkable anti-inflammatory effect both on the general disease manifestations and on the basic symptoms. For instance, in ARF patients, fever disappeared on days 2-4 of the treatment whereas the signs of arthritis on days 7-8 of the treatment, on the average. Besides, indomethacin produced a marked analgesic effect, since in 84% of the patients, arthralgias diminished on days 2-3 from the onset of indomethacin treatment. Practically, in all the patients, they disappeared simultaneously with arthritis phenomena. Disorders of rhythm and conduction also disappeared on days 2-4 from the treatment onset, while the end part of the ventricular complex returned to normal a little bit later (days 13-15). Subjective symptoms of rheumocarditis disappeared completely by the end of the treatment. Within the same time, dynamic mesodiastolic murmur and additional sounds also disappeared, the deadening of sounds noticeably decreased, the intensity of systolic murmur declined. The overwhelming majority of the patients demonstrated normalization of the heart size. Side effects were recorded in 11 patients. They were largely arterial hypertension, epigastric pains, dizziness and headaches which disappeared as a result of corrective therapy and a short-term reduction of the indomethacin dose.

[Acute rheumatic polyarthritis in young men]. / Ostryi revmaticheskii poliartrit u molodykh muzhchin.

As many as 200 patients with acute rheumatic fever were examined. Impairment of the joints in the form of classic migrating polyarthritic was detected in 96% of the cases. The knee (in 80%), talocrural (in 72%), slightly rare radiocarpal (in 21%), and elbow joints were mostly damaged. In addition to the above-indicated damage to the joints, one could see slightly atypical injuries in the form of monoarthritis (in 4%), arthritis of small articulations of the feet and hands (in 6%), and of the sternoclavicular articulations (in 3.5%). According to the cytological, biochemical and immunological findings, synovial fluid obtained from 11 patients suffering from acute rheumatic fever did not differ, significantly from synovial fluid of patients with reactive arthritis.

[The clinico-echocardiographic signs of rheumocarditis in acute rheumatism in adults and their dynamics under the influence of antirheumatic therapy]. / Kliniko-ékhokardiograficheskie priznaki revmokardita pri ostrom revmatizme u vzroslykh i ikh dinamika pod vliianiem antirevmaticheskoi terapii.

Of 45 patients with acute rheumatic fever 23 manifested enlargement of the left ventricle. Of these, 14 patients had it combined with an increase in the stroke volume, the syndrome of load with the left ventricular volume. These alterations disappeared or lessened by the end of the treatment. They did not correlate with lesions of the valvular apparatus and were likely to be consequent to the underlying inflammatory process. In patients with the syndrome of load with the left ventricular volume, myocardial contractility was, as a rule, increased or normal, indicating that myocardial contractility remained at a satisfactory level at the initial disease period. Comparative studies of the therapeutic effect of corticosteroids and nonsteroidal drugs (indomethacin and voltaren) have demonstrated that they exert a similar effect on the clinicofunctional signs of rheumatic carditis.