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The clinical features of 415 attacks of rheumatic fever observed in 365 adult patients are described, and some of the diagnostic problems are discussed, 102 of the attacks were considered to be initial and 313 recurrent attacks. Pre-existing chronic valvular disease was diagnosed in 184 cases. The attack rate of rheumatic fever by season was found to be highest in late Winter and Spring, with the peak incidence in the months of March and April. A history of preceding sore throat was elicited in 41% of the rheumatic...

The clinical features of 415 attacks of rheumatic fever observed in 365 adult patients are described, and some of the diagnostic problems are discussed, 102 of the attacks were considered to be initial and 313 recurrent attacks. Pre-existing chronic valvular disease was diagnosed in 184 cases. The attack rate of rheumatic fever by season was found to be highest in late Winter and Spring, with the peak incidence in the months of March and April. A history of preceding sore throat was elicited in 41% of the rheumatic attacks, and inflammatory signs in the pharynx and tonsils were observed in 58.6% of the attacks. The antistreptolysin O titer was above 250 units in 80% of the cases examined. Among the clinical manifestations arthritis and carditis were most common, occurring in 55.7% and 49.9% respectively, while arthralgia without frank inflammatory signs was noted in 30% of the attacks. The incidence of arthritis was lower in the cases with chronic valvular defects than in cases without. In 29% of the cases ECG abnormalities constituted the sole clinical evidence of carditis. Since prolongation of P-R interval or higher grades of atrioventricular block are relatively common in rheumatic fever and other manifestations of rheumatic carditis like murmurs, cardiac enlargement, pericarditis and heart failure are equally non-speclfic, it is suggested that a-v block be included as evidence of carditis rather than considered as a minor manifestation if one adopts Jones' criteria for the diagnosis of rheumatic fever. In the presence of chronic valvular disease frank arthritis was uncommon and signs of carditis were often masked by those of valvular defects so that in 38.5% of cases the diagnosis of rheumatic activity had to depend upon a combination of clinical and laboratory signs generally concidered as minor rheumatic manifestations according to Jones' criteria.

1.本文报告成人急性风湿热366例,經住院观察的急性发作共415次,其中102次診断为初发,313次为复发。发作見于已有慢性心瓣缺损者計184例(218次发作),无心瓣缺损証据者182例(197次发作)。对发病季节、与溶血性鏈球菌感染的关系、临床表現、实验室发見、病程及病死率等作了分析。重点討論了本病的診断问題。 2.风湿热在春冬二季的发病率較高,41%的风湿发作前有咽痛,58.6%的风湿发作时咽部尚有炎症表現,仅24.7%的风湿发作前后均无咽炎的証据。約有80%发作中抗鏈球菌溶血素“O”滴定度在250单位以上。以上数字有力地說明了风湿热和鏈球菌感染之间的密切关系。 3.临床表現中以关节炎最为常見,发生率为55.7%,仅有关节酸痛的有30%。已有慢性心瓣缺损的病例中仅37.6%有关节炎,其发生率远低于无慢性心瓣缺损的病例(75.6%)。 4.心炎見于49.9%的发作中,其临床表現有时颇不明显。仅在心电图檢查中发見者有41例,占所有經过心电图檢查的心炎病例的29%。由此可見心电图检查对診断心炎的独特价值。 5.在曾作心电图檢查的250次发作中有82次(32.8%)发見房窒傳导阻滞,其中68次为P-R间期延长。作...

1.本文报告成人急性风湿热366例,經住院观察的急性发作共415次,其中102次診断为初发,313次为复发。发作見于已有慢性心瓣缺损者計184例(218次发作),无心瓣缺损証据者182例(197次发作)。对发病季节、与溶血性鏈球菌感染的关系、临床表現、实验室发見、病程及病死率等作了分析。重点討論了本病的診断问題。 2.风湿热在春冬二季的发病率較高,41%的风湿发作前有咽痛,58.6%的风湿发作时咽部尚有炎症表現,仅24.7%的风湿发作前后均无咽炎的証据。約有80%发作中抗鏈球菌溶血素“O”滴定度在250单位以上。以上数字有力地說明了风湿热和鏈球菌感染之间的密切关系。 3.临床表現中以关节炎最为常見,发生率为55.7%,仅有关节酸痛的有30%。已有慢性心瓣缺损的病例中仅37.6%有关节炎,其发生率远低于无慢性心瓣缺损的病例(75.6%)。 4.心炎見于49.9%的发作中,其临床表現有时颇不明显。仅在心电图檢查中发見者有41例,占所有經过心电图檢查的心炎病例的29%。由此可見心电图检查对診断心炎的独特价值。 5.在曾作心电图檢查的250次发作中有82次(32.8%)发見房窒傳导阻滞,其中68次为P-R间期延长。作者等认为,P-R间期延长或更高度的房室傳导阻滞,若发見于有鏈球菌感染之后的年青患者,应作为急性风湿性心炎的診断依据之一。 6.在已有慢性心瓣病的病例中,有38.5%得根据Jones氏診断标准中的几項次要表現而診断为风湿活动。 7.366例中58.5%有风湿热的复发,其中半数发生子初发以后的第一年內。住院期的当时病死率为6.5%。

Intracardiac phonocardiography was studied both in human beings and animals.The local- made microphone sealed in the tip of a Courn- and's cardiac catheter was used.The phonocar- diogram was recorded through N.E.P.mul- tichannel physiological recorder. Ten noncardiac patients were subjected to the study.To each of them a No.7 phonoca- theter was inserted through the peripheral vein to the right heart.Heart sounds were recorded in the pulmonary artery,the right ventricle and the right auricle.Ordinary phonocardiogram,...

Intracardiac phonocardiography was studied both in human beings and animals.The local- made microphone sealed in the tip of a Courn- and's cardiac catheter was used.The phonocar- diogram was recorded through N.E.P.mul- tichannel physiological recorder. Ten noncardiac patients were subjected to the study.To each of them a No.7 phonoca- theter was inserted through the peripheral vein to the right heart.Heart sounds were recorded in the pulmonary artery,the right ventricle and the right auricle.Ordinary phonocardiogram, limb leads electrocardiogram and carotid pulse tracing were recorded simultaneously.In the animal study,ten dogs were used.Under ex- perimental condition,eight dogs had their hearts exposed through open-chest,No.4 or No.7 phonocatheter was inserted in each heart cham- ber,the ascending aorta and the pulmonary artery either by direct puncture or through in- cision.Additional tracings were recorded when aortic stenosis and pulmonary stenosis had been artificially created.In the remaining two dogs, the phonocatheter being inserted through jugular vein,tracings from right heart were recorded only. All the intracardiac phonocardiographic tracings were carefully analyzed and compared with those ordinary phonocardiograms.The results are presented in detail. The authors believe that:(1) intracardiac phonocardiogram which has been obtained in each heart chamber or great vessel reflects the heart sound produced there;(2) the 2nd com- ponent of the 1st heart sound is likely produced by closure of the atrioventricular valves,while the 3rd component is produced by opening of the semilunar valves;(3) there is always a systolic murmur in the pulmonary artery;(4)cardiac murmur is transmitted in the direction of blood flow,and is not transmitted in the opposite direction of blood flow;(5)when intracardiac phonocardiogram is recorded care is taken not to include the sound produced by friction bet- ween microphone and endocardial surface of the heart.

本文报告应用国产微型心音图微音器,通过心脏插管检查,进行人及狗心腔内心音图检查的结果。认为此微音器可以记录人的一侧心脏腔内的心音,对杂音的起源有定位作用,是诊断心脏病中的一项有价值的工具。文中对10例正常人右心各腔与10只狗左右心各腔的心音图进行分析,并就正常人右心各腔心昔图的特点、第一音的第二、三部分的发生机制、心腔内杂音的传播情况以及本检查应注意的事项等方面,加以讨论。

In order to improve the work of electrocardiography in children, theliterature has been reviewed and 4 points are discussed in this paper. 1. Technique of recording: Direct writing ECG machine with elec-trodes of adequate sizes for different ages, the application of electrodepaste to a limited area and to keep the baby quiet during ECG exami-nation are essential for good recording. In addition to the usual precordialleads, V_3R or V_4R should be recorded. A paper speed of 50mm persecond for newborns and infants...

In order to improve the work of electrocardiography in children, theliterature has been reviewed and 4 points are discussed in this paper. 1. Technique of recording: Direct writing ECG machine with elec-trodes of adequate sizes for different ages, the application of electrodepaste to a limited area and to keep the baby quiet during ECG exami-nation are essential for good recording. In addition to the usual precordialleads, V_3R or V_4R should be recorded. A paper speed of 50mm persecond for newborns and infants is proposed. 2. Normal values of electrocardiography in children: The normalvalues of ECG in children should reflect not only the proper age of thechild examined but also should be simple, clear and easy for clinicalapplication. By using the data of our studies and those of others inChina, a set of normal values has been worked out. 3. The ECG criteria of ventricular hypertrophy for Chinese children:These criteria are proposed with a discussion of their sensitivity andaccuracy in diagnosis. In case of right ventricular hypertrophy, the sensi-tivity is high but accuracy low, and a false positive diagnosis is easilymade. The younger the age, the more difficult the differentiation of thepathologic right ventricular hypertrophy from physiologic right ventricularpredominance. 4. Overloading of ventricles: Based upon the physiology of ventri-cular overloading and the data of clinical and ECG studies, Cabrara pro-posed the ECG criteria of various ventricular overloadings. It is general-ly accepted that the ECG of a child with overloading of the ventriclesis helpful in the diagnosis of congenital heart disease, although some wri-ters do not quite agree with him.

本文作者复习文献并合结自己的研究资料,提出简明实用的小儿心电图正常值及小儿心室肥厚的诊断标准,以供参考。

 
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