Evaluation of the Antimicrobial Effect on Enterococcus Faecalis of Bioceramic Cements with and without Silver Nanoparticles.

OBJECTIVE: To compare the antimicrobial effect of bioceramic endodontic cements with and without silver nanoparticles on Enterococcus faecalis. MATERIALS AND METHODS: Six groups were evaluated (n=8), and divided according to the materials: MTA Flow + AgNP ; MTA Flow Group; Bio C Repair + AgNP; Bio C Repair; PBS Cimmo + AgNP; PBS Cimmo. The groups were maintained for 72 h in the suspension of Enterococcus faecalis in Simulated Body Fluid (SBF). Samples of 100 µL were removed from the suspension at 0, 24, 48 and 72 h and seeded in triplicate in a Petri dish. Colony forming units (CFU) were counted using a colony counter. All procedures described were performed in a laminar flow chamber. Two-way ANOVA followed by Tukey's post hoc test and paired t-test were used for statistical analyses (α = 0.05). RESULTS: The addition of silver nanoparticles resulted in a statistically significant difference for MTA and CIMMO PBS cements (p⟨0.05), with the lowest bacterial growth being shown by the MTA group. For all groups, only the times of 48 and 72 h presented results without differences. CONCLUSION: The addition of silver nanoparticles to bioceramic cements was efficient to promote an acceleration of bacterial death.

Comprehensive germline mutation analysis and clinical profile in a large cohort of Brazilian xeroderma pigmentosum patients.

BACKGROUND: Xeroderma pigmentosum (XP) patients present a high risk of developing skin cancer and other complications at an early age. This disease is characterized by mutations in the genes related to the DNA repair system. OBJECTIVES: To describe the clinical and molecular findings in a cohort of 32 Brazilian individuals who received a clinical diagnosis of XP. METHODS: Twenty-seven families were screened for germline variants in eight XP-related genes. RESULTS: All patients (N = 32) were diagnosed with bi-allelic germline pathogenic or potentially pathogenic variants, including nine variants previously undescribed. The c.2251-1G>C XPC pathogenic variant, reported as the founder mutation in Comorian and Pakistani patients, was observed in 15 cases in homozygous or compound heterozygous. Seven homozygous patients for POLH/XPV variants developed their symptoms by an average age of 7.7 years. ERCC2/XPD, DDB2/XPE and ERCC5/XPG variants were found in a few patients. Aside from melanoma and non-melanoma skin tumours, a set of patients developed skin sebaceous carcinoma, leiomyosarcoma, angiosarcoma, mucoepidermoid carcinoma, gastric adenocarcinoma and serous ovarian carcinoma. CONCLUSIONS: We reported a high frequency of XPC variants in 32 XP Brazilian patients. Nine new variants in XP-related genes, unexpected non-skin cancer lesions and an anticipation of the clinical manifestation in POLH/XPV cases were also described.

Immunohistochemical evaluation of Sonic Hedgehog signaling pathway proteins (Shh, Ptch1, Ptch2, Smo, Gli1, Gli2, and Gli3) in sporadic and syndromic odontogenic keratocysts.

AIMS: The aim of this study was to compare the clinical and demographic features of 62 patients presenting sporadic odontogenic keratocysts (OKCs) or OKCs associated with nevoid basal cell carcinoma syndrome (NBCCS). In conjunction with this, we also evaluated the immunohistochemical expression of Shh, Ptch1, Ptch2, Smo, Gli1, Gli2 and Gli3 proteins in 86 OKCs. By doing this, we add to the understanding of the biology of this type of lesion, providing tools that will help facilitate the early diagnosis of NBCCS in those patients where the first manifestation is that of OKCs. METHODS: This is a retrospective study; patients were classified into two groups: group 1 which consisted of those who were not affected by NBCCS (49 patients and 57 OKCs) and group 2 which consisted of those who were diagnosed with NBCCS (13 patients and 29 OKCs). The clinical and demographic features were studied and the immunohistochemical expression of Sonic Hedgehog proteins (Shh, Ptch1, Ptch2, Smo, Gli1, Gli2, and Gli3) was analyzed in all samples. RESULTS: There was an increase in the expression of three proteins in the syndromic OKC, when compared to that of sporadic cysts. Shh and Gli1 showed higher cytoplasmic expression, while Smo revealed stronger nuclear and cytoplasmic expressions. CONCLUSION AND CLINICAL RELEVANCE: Our findings suggest that the expression patterns of important Shh pathway proteins can represent valuable markers for early diagnosis of NBCCS-associated OKCs, as the major criterion for the diagnosis of NBCCS is currently based on the late appearance of basal cellular carcinomas. Thus, standardizing a new diagnostic tool for diagnosis of NBCCS could be of great importance in the identification of therapeutic targets. We therefore suggest, as based on our findings, that OKCs showing high expression of Shh, Smo, and Gli1 are potentially associated with NBCCS.

Combining abilities for agronomic traits and marker-assisted selection for Potato virus X and Potato virus Y resistance.

Disease-resistant potato cultivars with good tuber appearance and desirable agronomic traits are essential for meeting the demands of producers and the market. Attaining these cultivars is the focus of potato breeding programs whose aim is to benefit the productive chain. The purpose of this study was to estimate combining abilities and evaluate potato clones based on tuber appearance, yield, and resistance to the PVY and PVX viruses. Crosses between four commercial cultivars of potato with good tuber appearance were performed, using eight clones with proven resistance to PVY and PVX from the breeding program of UFLA. The clones obtained were evaluated for agronomic traits, tuber appearance, and the presence of both Ryadg and Rx1 alleles, which confer extreme resistance to the PVY and PVX viruses, respectively. The independent culling level method was used to select genotypes of commercial interest, as well as to estimate the combining abilities of the parents. We identified clones carrying the Ryadg and Rx1 alleles with agronomic traits suitable for the fresh market and for processing. The BRS Ana cultivar and CMA-399 and CMA-385 clones showed positive effects on general combining ability (GCA) for tuber yield, while the Monalisa cultivar showed positive effects on GCA for general tuber appearance.

Short-term clinical of peel-off facial mask moisturizers.

OBJECTIVE: This study aimed to compare the efficacy of a peel-off facial mask based on polyvinyl alcohol (PVA) with an oil-in-water (o/w) emulsion and the effect of a soybean extract fermented by Bifidobacterium animale incorporated in those formulations (5% w/w). METHODS: The formulations were submitted to randomized clinical studies in volunteers to evaluate the measurement effects as (a) tensor by Cutometer® , (b) moisturizing by Corneometer® and transepidermal water loss (TEWL) by Tewameter® . These effects were determined in a short-term study (3 h) in a controlled-temperature room. RESULTS: The tensor effect and TEWL values indicated no significant difference between the use of facial mask and emulsion. On the other hand, the moisturizing effect of the facial mask on the stratum corneum was more significant than that of the emulsion according to Corneometer® measurements. Biometric cutaneous evaluation of peel-off facial masks (short-term study) showed that the masks promoted moisturizing effect of the stratum corneum more effectively than the oil-in-water emulsions. Thus, the facial masks were more efficient than emulsions in relation to moisturizing effects, but this efficiency is not related to the presence of fermented soybean extract. CONCLUSION: The results indicated that peel-off facial masks increase skin hydration in a process related to the occlusive effect.

Breast cancer patient-reported outcomes on level 1 and level 2 oncoplastic procedures using BREAST-Q®.

PURPOSE: In breast cancer management not only mortality and surgical morbidity measurements are important but also patient satisfaction indexes. The authors evaluated the satisfaction and health-related quality of life (HRQOL) using the breast-conserving therapy (BCT) and breast reduction (BR) modules of BREAST-Q®. METHODS: This is a cross-sectional study that analyzed breast cancer patients consecutively submitted to breast surgery between January 2011 and April 2018 using two modules of BREAST-Q®. 968 patients were contacted and 232 answers were gathered: 171 patients submitted to oncoplastic level 1 surgery answered the BCT module and 61 submitted to oncoplastic level 2 surgery answered the BR module. Clinical data were retrieved from patients' medical records. RESULTS: Among the 232 questionnaires received, the median scores for psychosocial well-being, sexual well-being and (postoperative) satisfaction with breasts for BCT and BR modules were, respectively, 77.0 and 73.5 (p = 0.17); 62.0 and 53.0 (p = 0.14); 72.0 and 66.0 (p = 0.66). The median of adverse effects of radiation in the BCT module was 87.0. The median satisfaction with outcome in the BR module was 86.0. Both groups of patients revealed high scores of satisfaction with care. For the BCT patients, satisfaction with breasts strongly correlated with sexual well-being and was moderately correlated with psychosocial and physical well-being. For the BR patients, the satisfaction with outcome strongly correlated with satisfaction with medical team and moderately correlated with the remaining scales. CONCLUSION: Both oncoplastic surgery levels yielded similar satisfaction outcomes when assessed using BCT and BR modules of BREAST-Q®.

Initial experience with targeted axillary dissection after neoadjuvant therapy in breast cancer patients.

BACKGROUND: Targeted axillary dissection (TAD) combines sentinel node biopsy (SNB) with the removal of the previously marked metastatic node. TAD is a promising concept for axillary restaging in node-positive breast cancer patients with pathological complete response (pCR) to neoadjuvant therapy (NAT). We aimed to evaluate TAD feasibility in this context. METHODS: A prospective observational study was conducted in biopsy-confirmed cN1 patients. The removal of the clipped node (CN) was guided by intraoperative ultrasound. SNB used indocyanine green and patent blue V dye. If the CN or sentinel lymph nodes (SLN) had any metastatic foci, or the TAD procedure was unsuccessful, the patient underwent axillary lymph node dissection (ALND). RESULTS: Thirty-seven patients were included. TAD and SNB identification rates were 97.3%. Every retrieved CN was also a SLN. At the individual level, SNB identification rate was 89.2% with indocyanine green and 85.5% with patent blue V dye. The CN identification rate was 81.1%, being higher when the CN was localized on the intraoperative ultrasound (84.4% vs 60.0%). Nodal pCR was achieved by 54.1% of our patients and was more frequent in HER2-positive and triple-negative tumors (p = 0.039). Nineteen patients were spared from ALND. CONCLUSION: TAD with intraoperative ultrasound-guided excision of the CN and SNB with indocyanine green and patent blue V dye is a feasible concept to identify patients without axillary residual disease after NAT, that can be spared from ALND, although the need for marking the biopsied node should be further investigated.

Study of sunless tanning formulas using molted snake skin as an alternative membrane model.

Sunless tanning formulas have become increasingly popular in recent years for their ability to give people convincing tans without the dangers of skin cancer. Most sunless tanners currently on the market contain dihydroxyacetone (DHA), a keto sugar with three carbons. The temporary pigment provided by these formulas is designed to resemble a UV-induced tan. This study evaluated the effectiveness of carbomer gels and cold process self emulsifying bases on skin pigmentation, using different concentrations of a chemical system composed of DHA and N-acetyl tyrosine, which are found in moulted snake skins and their effectiveness was tested by Mexameter(®) MX 18. Eight different sunless tanning formulas were developed, four of which were gels and four of which were emulsions (base, base plus 4.0%, 5.0% and 6.0% (w/w) of a system of DHA and N-acetyl tyrosine). Tests to determine the extent of artificial tanning were done by applying 30 mg cm(-2) of each formula onto standard sizes of moulted snake skin (2.0 cm × 3.0 cm). A Mexameter(®) MX 18 was used to evaluate the extent of coloration in the moulted snake skin at T(0) (before the application) and after 24, 48, 72, 168, 192 and 216 h. The moulted snake skins can be used as an alternative membrane model for in vitro sunless tanning efficacy tests due to their similarity to the human stratum corneum. The DHA concentration was found to influence the initiation of the pigmentation in both sunless tanning systems (emulsion and gel) as well as the time required to increases by a given amount on the tanning index. In the emulsion system, the DHA concentration also influenced the final value on the tanning index. The type of system (emulsion or gel) has no influence on the final value in the tanning index after 216 h for samples with the same DHA concentration.

Assays of genotoxic damage in peripheral blood lymphocytes of individuals occupationally exposed to different x-ray systems in hospital radiology departments.

We obtained peripheral blood lymphocyte samples from individuals occupationally exposed to X-rays in hospital radiology departments that use different radiology systems: analog film (AF), computerized radiology (CR), or digital radiology (DR). The micronucleus test (MNT) and comet assay were performed on the samples. Micronucleus cell counts (means vs. controls, i.e., individuals not occupationally exposed to ionizing radiation) were as follows: AF, 1.96 ± 0.21 vs 1.2 ± 0.25; CR, 1.89 ± 0.15 vs 1.31 ± 0.36; and DR, 1.75 ± 0.11 vs 1.59 ± 0.32. For the comet assay, damage scores were as follows; AF, 0.84 ± 0.22 vs 0.47 ± 0.04; CR, 0.64 ± 0.26 vs 0.43 ± 0.04; and DR, 0.56 ± 0.19 vs 0.49 ± 0035. These findings were consistent with cytogenetic damage due to radiation exposure.

Fatty acid synthase expression in squamous cell carcinoma of the tongue: clinicopathological findings.

BACKGROUND: Overexpression of fatty acid synthase (FAS), the cytosolic enzyme responsible for the conversion of dietary carbohydrates to fatty acids, has been reported in several human malignancies and pointed as a potential prognostic marker for some tumors. This study investigated whether FAS immunohistochemical expression is correlated with the clinicopathological characteristics of oral squamous cell carcinoma (OSCC). MATERIALS AND METHODS: The clinical features of 102 patients with OSCC of the tongue treated in a single institution were obtained from the medical records and all histopathological diagnoses were reviewed. The expression of FAS was determined by the standard immunoperoxidase technique in formalin-fixed and paraffin-embedded specimens and correlated with the clinicopathological characteristics of the tumors. RESULTS: Eighty-one cases (79.41%) were positive for FAS. Microscopic characteristics such as histological grade (P < 0.05), lymphatic permeation (P < 0.001), perineural infiltration (P < 0.05), and nodal metastasis (P < 0.02) were associated with FAS status. A significantly lower survival probability for patients with advanced clinical stage (log-rank test, P < 0.001), lymph nodes metastasis (log-rank test, P < 0.001), presence of vascular permeation (log-rank test, P = 0.05), and perineural invasion (log-rank test, P = 0.01) was observed in the studied samples. CONCLUSION: The expression of FAS in OSCC of the tongue is associated with the microscopic characteristics that determine disease progression and prognosis.

Oncogenic drivers in 11q13 associated with prognosis and response to therapy in advanced oropharyngeal carcinomas.

OBJECTIVES: To identify potential molecular drivers associated with prognosis and response to treatment in advanced oropharyngeal squamous cell carcinomas (OPSCC). MATERIALS AND METHODS: Thirty-three OPSCC biopsies from untreated Brazilian patients were evaluated for human papilloma virus genotyping, genome wide copy number alterations and gene expression profiling. Data were integrated using CONEXIC algorithm. Validation with TCGA dataset and confirmation by RT-qPCR of candidate genes were performed. RESULTS: High-risk HPV positive cases, detected in 55% of advanced OPSCC, were associated with better outcome. Losses of 8p11.23-p11.22, 14q11.1-q11.2 and 15q11.2, and gains of 11q13.2 and 11q13.2-q13.3 were detected as recurrent alterations. Gains of 3q26.31 and 11q13.2 and losses of 9p21.3 were exclusively detected in HPV-negative tumors. Two clusters of expression profiles were observed, being one composed mostly by HPV positive cases (83%). HPV-positive enriched cluster showed predominantly immune response-related pathways. Integrative analysis identified 10 modulators mapped in 11q13, which were frequently cancer-related. These 10 genes showed copy number gains, overexpression and an association with worse survival, further validated by TCGA database analyses. Overexpression of four genes (ORAOV1, CPT1A, SHANK2 and PPFIA1) evaluated by RT-qPCR confirmed their association with poor survival. Multivariate analysis showed that PPFIA1 overexpression and HPV status are independent prognostic markers. Moreover, SHANK2 overexpression was significantly associated with incomplete response to treatment. CONCLUSION: The integrative genomic and transcriptomic data revealed potential driver genes mapped in 11q13 associated with worse prognosis and response to treatment, giving fundamentals for the identification of novel therapeutic targets in OPSCC.

Phase I clinical trial of 9,10-anthracene dicarboxaldehyde (Bisantrene) administered in a five-day schedule.

Bisantrene is a substituted anthracene derivative which preclinically demonstrated a spectrum of activity similar to that of doxorubicin but without associated cardiotoxicity. A Phase I evaluation of the drug has been performed using daily i.v. administrations for 5 days. Sixty courses of treatment were administered to 23 patients at doses from 2.5 to 90 mg/sq m/day. Courses were repeated at 4-week intervals. Dose-limiting toxicities were leukopenia and local cutaneous reactions. The leukopenia was dose related, noncumulative, and of brief duration. Local reactions occurred in 14 of 37 courses administered at doses greater than 60 mg/sq m and in 13 patients resulted in clinical cellulitis of the infused extremity. Gastrointestinal side effects were mild. No alopecia or cardiotoxicity was observed. Two mixed responses were obtained in patients with hypernephromas. Using a daily schedule for 5 days, approximately 40% more drug can be delivered per course than by single-day i.v. administration. However, with this schedule, local cutaneous reactions may prove additionally dose limiting. Phase II studies of Bisantrene in a daily i.v. schedule for 5 days are planned at a dose of 80 mg/sq m/day to be repeated every 4 weeks.

Head and neck mucosal melanoma: clinicopathological analysis of 51 cases treated in a single cancer centre and review of the literature.

Head and neck mucosal melanoma (HNMM) is a rare and aggressive malignancy. The objective of this study was to describe the outcomes of patients with HNMM. Clinical and pathological data from 51 patients with primary HNMM were reviewed. All patients were treated at a single cancer centre between 1954 and 2012. Most tumours involved the nasal cavity (35.3%) and upper gingiva (29.4%). The majority of lesions were ulcerated (54.9%) and pigmented (84.3%). Forty-three patients underwent surgical treatment and 21 (41.2%) underwent adjuvant chemotherapy and/or radiotherapy. Eight patients (15.7%) received palliative treatment. The median follow-up period was 21 months. During this period, 30 (58.8%) patients had tumour recurrences. At the last clinical evaluation, only seven (13.7%) patients were alive with no evidence of disease and three (5.9%) were alive with HNMM. There were significant differences in overall survival probability according to the presence of ulceration (P=0.004), metastatic lymph nodes (P=0.003), and treatment including a radical surgical procedure (P<0.001). On multivariate analysis, ulceration was the only variable associated with an increased risk of death. Despite the poor prognosis, there was significant improvement in overall survival in the most recent years in this sample, mainly due to advances in diagnosis and reconstruction techniques.

Antiviral quinolinehydrazones. A modified Free-Wilson analysis.

Eighty-four 4-quinolinehydrazones were synthesized and tested for antiviral activity. Thirty nine derivatives were active against influenza A2 and/or Coxsackie B1 in mice at a dose of 25 mg/kg sc. Structure-activity relationships of 44 derivatives (21 inactive) were analyzed qualitatively using a modified Free-Wilson approach.

Estrogen and progesterone receptors in human papilloma virus-related cervical neoplasia.

Estrogen (ER) and progesterone (PR) receptors in the normal uterine cervix, cervical intraepithelial neoplasia and invasive carcinoma were studied in consecutive samples from Hospital do Cáncer, São Paulo, between 1996 and 1997. Tissue was collected by removing a fragment of the tumoral area using a 5-mm diameter biopsy punch, followed by removal of a macroscopically normal area as close as possible from the tumor. Histopathological confirmation was obtained for all specimens analyzed. A total of 24 normal tissues, 17 cases of cervical intraepithelial neoplasia and 7 of invasive carcinomas were studied. The ER/PR ratio was determined by immunohistochemistry using monoclonal antibodies specific for each receptor. Adjacent tissue slides were submitted to generic PCR for human papillomavirus (HPV) DNA detection followed by typing by dot blot hybridization. About half (45.8%) of the tumors were HPV DNA positive while 29.1% of the patients were also HPV positive in their respective normal tissue. ER was negative in the tumoral epithelium of 11 HPV-positive patients (P=0.04). There was a trend in the ER distribution in normal tissue that was opposite to that from lesions, but it was not statistically significant (P=0.069). No difference in ER distribution in stromal tissues was observed between HPV-positive and HPV-negative tissues. PR staining was negative in the epithelium of all cases studied. The results obtained from this small number of cases cannot be considered to be conclusive but do suggest that factors related to viral infection affect the expression of these ER/PR cervix receptors.

Clinical results with the Biocor porcine bioprosthesis.

In order to evaluate our clinical results with the use of the Biocor prosthesis, a total of 1,101 patients were studied. Follow-up was from 1 to 96 months (mean 48); cumulative follow-up in the aortic group (385 patients) was 1,230 patient years and in the mitral group (716 patients) 3,018 patient years. Mitral patients had 102 late complications (14.24%), and aortic patients had 51 (13.2%). A total of 220 patients were under 20 years of age (176 mitral, 44 aortic). Intrinsic valve failure in this subgroup was found in 43% of mitral patients and 29% of aortic patients. Prosthetic endocarditis was more frequent in the aortic group (45%) than in the mitral group (29.9%). Sixty-two patients were reoperated, with a hospital mortality of 12.6%. Reoperation was more frequent in the mitral group and in patients under 20 years of age. The actuarial curve free mortality related to the bioprosthesis was 97.1% (32 patients). At the 8-year follow-up, 96.9% of the aortic versus 95.2% of the mitral group were free of valve dysfunction, and the majority were in Classes I or II of the New York Heart Association (NYHA) classification. The incidence of reoperation, although significant, is acceptable, especially since the bioprosthesis offers a safer alternative than mechanical prostheses followed for similar periods. Analysis of our results suggests the need for continued research for an ideal bioprosthesis.

[Transesophageal paracoronal transgastric imaging. Use and indications in pediatric cardiology]. / Corte paracoronal transgástrico transesofágico. Uso e indicações em cardiologia pediátrica.

PURPOSE: To evaluate the contribution and comparative value of paracoronal transgastric view compared with conventional transesophageal examination for morpho-functional assessment of different types of congenital heart disease in a pediatric group. METHODS: Fifteen patients with clinical and echocardiographic diagnosis of congenital heart disease were selected for single plane transesophageal examination. After routine evaluation, the probe was positioned to obtain a paracoronal transgastric view, and images that result from this technique were recorded and compared with those obtained in the conventional way. Eleven procedures were carried out in the cathlab and four in pediatric intensive care unit, under general anesthesia or heavy sedation. The age and weight were 32.0 months and 11.6 kg respectively. No adverse reactions were observed with this method. RESULTS: In comparison with conventional transesophageal study, the paracoronal transgastric view permitted better morpho-functional assessment of the outlets of the right and left ventricles, as well as additional informations about the left pulmonary artery. CONCLUSION: Morphological and hemodynamic informations obtained from paracoronal transgastric view is a safe method which can be used either as an alternative or a complement to conventional examination to assess the outlets of both ventricles, as well as to evaluate the subvalvar, valvar and supravalvar region in different types of congenital heart disease.

[Secondary prophylaxis in rheumatic fever. Oral antibiotic therapy versus benzathine penicillin]. / Profilaxia secundária na febre reumática. Antibioticoterapia oral versus penicilina benzatina.

PURPOSE: To detect problems related to secondary prophylaxis of rheumatic fever in the setting out patient follow-up. METHODS: Among 113 pediatric patients admitted with diagnosis of this disease, in a period of five years, we selected 80 records. They were divided in group 1 (60 cases), that only received prescription of benzathine penicillin for prophylaxis and group 2 (20 patients) to whom it was changed from parenteral to oral antibiotics after the detection problems using the first scheme. RESULTS: In group 1, among 53 who had carditis, 27 (45%) had severe disease; 22 cases (37%) were re-admitted with relapsed carditis following the refusal to use benzathine penicillin. Also, we observed that after discharged 32 (55%) did not return to the out-patient clinic in HUAP. In group 2, from 16 who had carditis, 10 (50%) had severe disease. Only two (10%) did not return to ambulatory control and there was no case of readmission. The difference between the groups was statistically significant. (p < 0.01). CONCLUSION: It was very high the percentage of cases that missed the control visits and abandoned the prophylaxis when it was insisted on parenteral penicillin. We should evaluate every case and remember that oral antibiotics might avoid a major problem.

[Clinical and echocardiographic study of mitral valve in children with severe rheumatic carditis. Aspects of prolapse or rupture]. / Estudo clínico e ecocardiográfico das alterações do aparelho mitral em crianças com cardite reumática grave. Aspecto de prolapso ou ruptura.

PURPOSE: To describe cases of rheumatic carditis with echocardiographic aspects of prolapse or rupture of mitral structures. METHODS: We described 16 cases of acute carditis (ages between 5-15 years). In 10 (group 1) there was aspect of mitral prolapse, in 6 (group 2) aspect of "flail". The measurements of anterior chordae and anuli were compared to the ones of 5 cases of chronic rheumatic fever with dilated left ventricle and aortic regurgitation (group 3) and to 20 normal children of same ages. The same measurements were repeated after treatment. RESULTS: The mean of the measurements in group 1 was; 26.48 +/- 11.46mm-anterior chordae; 32.13 +/- 7.35mm anuli; in the group 2 was respectively 29.63 +/- 4.57mm and 35.63 +/- 7 mm. In the group 3 anterior chordae was 34.52 +/- 6.8mm, anuli: 34.8 +/- 4.61 mm. In the normal group, respectively was: 18.19 +/- 4.26mm and 24.66 +/- 2.85mm. After corticosteroid many cases improved. In the statistical analyses, the measurements among patients of group 1 and 2 compared to normal children, the difference was significant but it was not compared to group 3. Comparing the measurements pre and post treatment the decrease was not significant. CONCLUSION: The acute carditis in these cases lead to significant elongation of anterior chordae and dilatation of anuli, but there was not a significant decrease after treatment.