SUMMARY Thirteen patients with proven Q fever endocarditis and three additional patients with probable endocarditis are reviewed. The most helpful diagnostic test is the demonstration of a high complement fixing antibody titre to Phase I antigen of Coxiella burneti.The macroscopic pathology of the aortic valve is described and includes aneurysmal pockets in the aortic wall and valve annulus which are demonstrable angiographically.
Thirty five cases of Ebstein's anomaly were diagnosed by cardiac catheter study or echocardiography between 1962 and 1984. The anomaly was an isolated abnormality in 27 patients; the remainder had additional heart lesions. Six patients have died and four of these had other cardiac lesions. Thirteen are currently symptom free. Twelve cases presented with cyanosis and heart murmur on the first day of life. Eight of these had associated thrill which is a rare finding in neonates. As pulmonary vascular resistance fell there was clinical improvement. This was assisted by oxygen treatment. Another two cases presented in the first week of life and 10 in the first decade with a murmur or supraventricular tachycardia. Eleven cases presented as adolescents or adults with a murmur, cardiomegaly, or cardiac symptoms. Three patients were seen initially in the sixth decade. Clinical diagnosis was correct in only one adult. Twenty five patients had cardiac catheterisation. Important arrhythmias occurred in 10 cases, and two required cardioversion. Difficulty was experienced in entering the pulmonary artery in 11 infants and children. Diagnosis at initial catheter study was incorrect in four patients. Echocardiograms were recorded in 29 cases. Earlier M mode measurements of time delay of tricuspid closure compared with mitral closure did not always lead to the correct diagnosis. Cross sectional studies gave good images of tricuspid leaflet displacement, its tethering, and the atrialised portion of the right ventricle and have facilitated the diagnosis of more cases in recent years. Echocardiography is the procedure of choice for diagnosis of Ebstein's anomaly.
Summary: Five hundred and eighty‐eight patients with mitral valve disease were studied. The incidence of systemic emboli was found to be higher in patients with pure mitral stenosis (16‐6%) and mixed mitral stenosis and incompetence (19‐4%) than in patients with mitral incompetence (3‐1%). The patients with mitral stenosis who had episodes of systemic emboli tended to be older than 40 years, with moderate or severe valve lesions, atrial fibrillation and moderate or gross enlargement of the left atrial appendage or left atrium. The following factors were found to be unrelated to systemic embolism–associated aortic valve disease, sex, smoking habit, history of rheumatism, parity, haemoglobin, blood urea, pulmonary hypertension, duration of antifailure treatment, presence of heart failure, and cardiothoracic ratio.
A semiautomated method is described which uses the Abbott ABA-100 bichromatic analyzer to measure the stimulation of erythrocyte transketolase by thiamin pyrophosphate (the thiamin pyrophosphate effect). The method was accurate with a throughput of 30 samples per hour and is suitable for the study of the thiamin status of large populations. A significant proportion (21%) of a total of 1920 individuals of a predominantly Melanesian population were found to have an elevated thiamin pyrophosphate effect (greater than 15% activation). This same proportion with an elevated thiamin pyrophosphate effect was found in an urban hospital patient group of 346 individuals. Statistical analysis indicated a significant inverse correlation between thiamin pyrophosphate effect and plasma potassium concentration (p less than 0.001). Analysis of human fecal samples for thiaminase I activity demonstrated that this enzyme was present in 23 of a total of 46 samples selected from both the Melanesian and urban hospital patient groups. Preliminary findings indicated that the thiaminase originated from a bacterial source.
Objective To establish a program for the prevention of rheumatic fever and rheumatic heart disease In a semi‐Isolated Aboriginal community in far north Queensland and to test its efficacy. Design A prevalence study of acute rheumatic fever and chronic rheumatic heart disease was conducted In the community in 1985 and subjects with possible acute rheumatic fever were assessed. A prophylactic antibiotic program was instituted. Records were kept of the prevalence of acute rheumatic fever for six years after the 1985 survey. A second survey of the community was held in 1991 to detect chronic rheumatic carditis resulting from undetected acute rheumatic fever. Setting The Yarrabah Aboriginal community in north Queensland (latitude 17°S). The program was conducted by the Yarrabah Health Team, a part of the North Queensland Aboriginal Health Division. Participants The whole Yarrabah community (population 1250) was invited to participate. In 1985, after the completion of an educational program, 89% of the community cooperated in the survey. There was no educational program before the 1991 survey and the compliance rate was much lower. Importantly, however, 87% of the vulnerable group (4–16 year olds) were examined. Interventions After the 1985 survey, all community members aged 4–16 years had throat swabs taken three times each year. Those with swabs showing Group A streptococci were treated; their contacts were also swabbed and treated if Group A streptococci were found. Results: Before the institution of the swabbing program there were four new cases of acute rheumatic fever each year in the Yarrabah community. In the six years after the program was introduced only one case of acute rheumatic fever occurred. This was at a time when swabbing had temporarily lapsed for a three‐month period. Conclusions These results support the use of a prophylactic antibiotic program in Aboriginal communities as a cost effective and efficient method for the prevention of rheumatic fever. The cooperation of the community is an integral part of Its success and this can be obtained by community education.
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