Factors favoring the onset and continuation of rheumatic fever

Rheumatic fever is one of the most important of diseases economically, not only because of its acute manifestations, but also because of its rôle in the production of between 30 and 40 per cent of chronic cardiac disease in the latitude of the North Atlantic States. Microscopic findings indicate it to be a widespread disease involving by preference mesenchymal structures or mesenchymal protions of parenchymatous organs. Physiological stress and strain appear to favor localization of its manifestations, although it may be locally active without giving rise to symptoms; and various vulnerable organs may be either simultaneously or independently involved.A number of factors appear to have causative relationships. Climatic conditions such as exist in temperate zones in winter favor its development; while sunny dry summers and tropical weather inhibit or prevent its evolution. Among the poorer classes it is from fifteen to twenty times more prevalent than in persons better housed and fed. Malnutrition and mild toxic states are frequent precursors of characteristic attacks. Most patients, both children and adults, give a history of repeated nonspecific infections of the respiratory tract, tonsils, sinuses, or middle ear, extending over several years, before a typical attack of rheumatic fever is ushered in by a severe focal infection. Persons in intimate contact with patients during acute outbursts of rheumatic fever not infrequently suffer simultaneously from upper respiratory infections, or from typical rheumatic fever; hence there seems to be a distinct communicable factor favoring its spread. Because chronicity and relapses are so frequent, and crippling cardiac damage is of such gradual evolution, and finally because laboratory tests often reveal activity in periods between attacks, it seems justifiable to consider the infection to be characterized by long periods of preparation or sensitization of the tissues, the result of repeated mild infection before a more intense focal infection sets off the violent explosion recognized as acute rheumatic fever. Similar mild infections, more-over, apparently favor the continuation of true rheumatic activity in viscera already involved. It seems logical, therefore, to regard these preparatory periods and mild chronic infections between acute out-breaks as essential parts of the morbid process; hence our therapeutic and prophylactic efforts should be directed against them as well as against the more acute manifestations of the disease.     

REACTION OF RABBITS TO STREPTOCOCCI: COMPARATIVE SENSITIZING EFFECT OF INTRACUTANEOUS AND INTRAVENOUS INOCULA IN MINUTE DOSES

1. Rabbits were rendered very hypersensitive by relatively small doses of green streptococci given intracutaneously, and somewhat less hypersensitive by similar doses of heat-killed vaccine prepared from hemolytic streptococci. 2. Animals receiving the same doses intravenously gave, upon subsequent testing, lesions slightly more marked than normal controls; but these lesions were qualitatively hard and nodular compared with the large edematous lesions in the cutaneously sensitized group. 3. There was no parallelism between the degree of cutaneous or ophthalmic hypersensitivity and agglutinin titer in the blood serum. 4. Bacterial hypersensitivity to whole streptococci appears to depend more upon previously induced focal infection than upon circulating antibodies.     

空回肠间质瘤13例诊治分析

目的　探讨空回肠间质瘤的诊断和治疗经验。方法　对我院 1993年 10月～ 2 0 0 4年 1月收治的有完整资料的 13例空回肠间质瘤病例进行回顾性分析 ,本组患者均经术后病理和免疫组化证实。结果　本组患者主要临床表现为消化道出血、腹痛。发病至确诊时间 2个月至 7年。剖腹探查确诊 7例 ,腹腔镜腹腔探查确诊 4例 ,术前确诊的仅 2例。随访 2个月至 9年 ,除 1例死于其它疾患外 ,余 12例均健在 ,无空回肠间质瘤复发病例发现。结论　小肠间质瘤预后甚好 ,但本病缺乏特征性的临床表现及有效的诊断手段 ,易致长期延误诊治 ;对长期不明原因的消化道出血患者 ,及早行剖腹探查或腹腔镜腹腔探查是避免小肠间质瘤长期延误诊治 ,改善患者预后的关键     

A Complex Negotiation: Women's Experiences of Naming and Not Naming Premenstrual Distress in Couple Relationships

ABSTRACT

Recent research has demonstrated the importance of family relationships in women's experience of premenstrual changes, their construction of these changes as “PMS.” However, the discursive process by which women take up the subject position of “PMS” sufferer through the explicit naming of “PMS” to an intimate partner has received little research attention. Drawing on 60 individual interviews with Australian women, conducted between 2004 and 2006, we examined accounts of naming “PMS” in intimate relationships, women's explanations for naming or not naming, their experiences of their partner naming them as premenstrual. The analysis process identified an overarching theme of naming “PMS,” which was made up of three themes: naming to explain; “PMS” becoming the only explanation for distress; “PMS” as not a legitimate explanation for distress. The findings suggest that clinicians need to be aware of women's complex, often ambivalent, experiences of naming “PMS” within their relationships, when working with women, couples, seeking treatment or support for premenstrual distress.     

Smoking Cessation Programs for Seniors:A Group Model That Works

We describe an intensive group program for older adults, facilitated by a tobacco cessation specialist and a geriatric social worker, designed to focus on factors that maintain smoking behavior. Integral components dealt with issues specific to the older adult such as social isolation or economic need. Pharmacological therapy was provided. Participants with a mean age of 67 years who smoked an average of 19 cigarettes per day completed the program. Sixty-six percent of participants had been treated or were in treatment for depression and/or anxiety. Follow-up was completed at 1, 3, 6, and 12 months. The cessation rate across follow-up points was 68%. This program shows that older adults can maintain smoking cessation when provided with programs designed to address their issues.     

Cough Frequency in a Group of Males

An epidemiologic study by questionnaire was undertaken in Great Britain and the United States, to provide data on diabetes mellitus in Down’s syndrome. Among 20,362 patients with Down’s syndrome, 88 living diabetics were found.

A high prevalence of diabetes in the population with Down’s syndrome, particularly In the younger age groups, was noted. In these age groups the prevalence of diabetes in the population with Down’s syndrome exceeded that of the general population by factors 6.8, 3.3, and 3.0. Insufficient data exist to determine the exact statistical significance of these ratios. Further investigation is necessary. Nevertheless, a definitive association between Down’s Syndrome and diabetes mellitus is suggested. The role of prediabetes, autoimmunity and genetics in this association is discussed.