Thirty-three homosexual patients with thrombocytopenia (mean [+/- SE] platelet count, 50 000 +/- 7000/mm3; range, 7 to 135 000/mm3) have been followed for a mean period of 20 +/- 2 months. Six patients have developed the acquired immunodeficiency syndrome 1 to 37 months after the diagnosis of thrombocytopenia. Six patients spontaneously reverted to normal platelet counts 5 to 27 months (median, 10 months) after the diagnosis of thrombocytopenia, in the absence of splenectomy and while not receiving corticosteroids. Sixteen of seventeen patients had a moderate to excellent response while on corticosteroid treatment. Ten of ten patients had an excellent response to splenectomy which has persisted. Fifteen patients did not require treatment for their thrombocytopenia. Thirteen of fourteen patients had antibody against the retrovirus associated with the acquired immunodeficiency syndrome, as did 4 of 12 homosexual controls without thrombocytopenia. Thrombocytopenia in homosexuals is part of the complex related to the acquired immunodeficiency syndrome.
205 Marjorie E. Tr ipp and Jay M. Levy (Spons. by Russell Chesney) Dept. of p e d i a t r i Z , U n i v e r s i t y of W -R Madison.Changing medical and s u r g i c a l p r a c t i c e s a l t e r the incidence and persistence of GF i n congenital heart disease. C l i n i c records of 900 p e d i a t r i c c a r d i a c p t s . were reviewed t o determine incidence of p a s t and present GF. ~t s .with functional murmurs, primary arrhythmias, and bicuspid a o r t i c valves were excluded. GF was defined a s height, weight, o r weight f o r height more than 2 SD below mean. 300 p t s . had a h i s t o r y of GF. Of these, 133 had resolved GF, 21% of whom had had a probable non-cardiac cause (prematurity, neurologic abnormality, e t c . ) . I n 105 o t h e r s , 41% had had c l o s u r e of a v e n t r i c u l a r s e p t a l defect(VSD), 14% repair of t e t r a l o g y , 11% of a t r i a l s e p t a l defect(ASD), 9% of transposit i o n (TGV). Of 167 p t s . with p e r s i s t e n t GF, 51%(86 pts.) had probable non-cardiac causes: 41 with chromosomal abnormality, 8 with r u b e l l a , 6 with major neurologic d e f i c i t s . Of 81 p t s . remaining, 18 had VSD1s(4pre-op,2post-op,l2 considered small). 14 had had t e t r a l o g y or double o u t l e t r i g h t v e n t r i c l e ; a l l had undergone d e f i n i t i v e r e p a i r . 18 p a t i e n t s had p e r s i s t e n t GF d e s p i t e p a l l i a t i o n for complex cyanotic heart disease.Although GF is common i n congenital heart disease, it may be caused by non-cardiac conditions--which preclude growth d e s p i t e cardiac surgery. Excluding non-cardiac GF, poor growth p e r s i s t s i n l e s s than 10% of p t s . a f t e r repair of VSD, ASD, c o a r c t a t i o n and transposition. It p e r s i s t s in 25% of pts. a f t e r repair of conotruncal abnormalities and i n 75% of p t s . p a l l i a t e d f o r complex cyanotic h e a r t disease. The d i f f e r e n t i a l diagnosis between rheumatic m i t r a l regurgitation(MR) and m i t r a l valve prolapse(MVP) i s important both i n r espect of management and requirements of prophylaxis. I t has been suggested, t h a t MR of rheumatic origin(RF) i s o f t e n associated with echocardiographic(Echo) findings of MVP. Furthermore, s e p t a l / p o s t e r i o r l e f t ventricular(LV) wall r a t i o i s reportedly i ncreased i n p a t i e n t s ( p t s ) with MVP.Twenty echos from p t s with MR with proven RF(median age-1 2 . 5~) and 20 echos of p t s with c l i n i c a l findings of MVP(median age-13y) were studied. MVP was observed i n 4 of 20pts with RF. Of these four, 2pts had evidence of increased l e f t atrial(LA) and l e f t v e n t r i c u l a r end-diastolic(LVED) dimension. LA size(M:S~) i n p t s with RF was 2.9920.66 and f o r p t s with MVP 2.2320.49 (p<0.001). The LVED dimension (MtSD) was 4.58k0.88 f o r p t s with RF and 4.12t0.67 f o r p t s with MVP(pCO.01). Whereas 7 of 20 p t s with rheumatic MR had both increased LA and LVED dimensions, t h i s did not occur i n MVP. S e p t ...
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