Harrison F. Wood

A study of C-reactive protein in the serum of patients with congestive heart failure

Abstract Forty patients manifesting congestive heart failure have been studied with serial serum determinations for C-reactive protein. This abnormal protein was found in thirty instances. No demonstrable difference in age, sex, or race were noted between the two groups. In those patients in whom C-reactive protein was present, the congestive heart failure appeared to be more severe. Fever, elevated erythrocyte sedimentation rate, and pulmonary abnormalities were more common in the group in which C-reactive protein occurred. In approximately one-half of the group in which C-reactive protein was found, the protein was initially present but disappeared after one to two weeks of treatment. In six patients, the C-reactive protein persisted in the blood throughout the hospital course. Single determinations of C-reactive protein were made in the blood of ten patients in whom congestive heart failure was stationary. In no instance was C-reactive protein present. The presence of C-reactive protein in the blood of patients with congestive heart failure limits the application of C-reactive protein determinations as a measure of rheumatic activity in acute rheumatic fever and in chronic rheumatic heart disease and as a measure of necrosis in acute myocardial infarction.

Clinical and laboratory manifestations of the postcommissurotomy syndrome

Abstract The postcommissurotomy syndrome developed in ten of sixteen patients ten days to seven months following mitral commissurotomy. Seven patients had multiple attacks. The syndrome consisted of chest pain and fever together with less prominent and frequent cough, hemoptysis, dyspnea and arthralgias. Evidence of pericarditis and pleuritis was obtained, with leukocytosis and elevated erythrocyte sedimentation rate. Bacteriologic studies yielded negative results. Penicillin prophylaxis was ineffective and antibiotics failed to modify the course. Salicylates appeared to abbreviate the illness. No significant change in the antistreptolysin-O titer occurred during this illness. The C-reactive protein was found to be the most sensitive laboratory test for the postcommissurotomy syndrome and the most useful in management. The possible etiologic factors are reviewed. It is suggested that the postcommissurotomy syndrome represents a self-limited form of pericarditis and pleuritis induced by the trauma of surgery in patients with rheumatic heart disease. Salicylate suppressive therapy is recommended for all postcommissurotomy patients. The C-reactive protein test is suggested as a useful and sensitive test for the activity of the postcommissurotomy syndrome.

Laboratory aids in the diagnosis of rheumatic fever and in evaluation of disease activity

T HERE are two ways in which the laboratory might be expected to give assistance in dealing with the problem of rheumatic fever. The first is in the diagnosis of the disease, and the second is in guiding the medical management of the disease by providing an index of rheumatic activity. At the present time completely satisfactory laboratory procedures have not been developed in either of these categories. Thus there is still no specific diagnostic test for rheumatic fever, and there is no test for rheumatic activity that can be relied upon when the patient is under full therapy. However, there are laboratory procedures available which, despite their limitations, can be of great value both in diagnosis and management of the disease. The purpose of this paper is to emphasize the most practical and generally applicable of these procedures and to consider their interpretation and evaluation. The classic and readily recognized cases of acute rheumatic fever represent only a portion of the total cases, and diagnosis frequently presents a difficult clinical problem in the others. Because of the diversity of the manifestations of the disease and the variability of the combinations in which they can occur, it is not possible to apply any simple formula in arriving at a diagnosis. The large number of disease entities that have been confused with rheumatic fever and that must be considered in differential diagnosis emphasize the diagnostic difficulties. It is evident that in a situation of this kind a specific diagnostic test would be of inestimable value. It is not necessary that such a test be based upon a thorough understanding of the pathogenetic mechanisms in rheumatic fever, a fact that is adequately demonstrated by such procedures as the Wassermann test for syphilis and the heterophile antibody test as employed in the diagnosis of infectious mononucleosis. However, up to the present time a procedure of this type has not been developed to assist in the diagnosis of rheumatic fever. In the absence of a specific test for rheumatic fever the laboratory is still able to make an important contribution by supplying evidence concerning the occurrence of recent streptococcal infections. During the past few decades the relationship between group A streptococcal infections, usually streptococcal pharyngitis or tonsillitis, and rheumatic fever has become firmly established. The time relationships between the precursory bacterial infection and the onset of the rheumatic attack have been clearly defined, and the pattern is sufficiently reproducible to provide a basis for diagnostic procedures. The bacteriologic isolation and identification of group A streptococci is of only limited value in this regard. Due to the fact that a period of several days to several weeks intervenes between the acute bacterial infection and the onset of rheumatic fever, the offending organisms are frequently not recoverable after rheumatic symptoms have appeared. This has become increasingly true with the introduction of penicillin and other antibacterial agents, since one of these drugs has often been administered at some time during the prodromal period of the disease. Furthermore, the successful isolation of group A streptococci may give no information about the time of occurrence of an acute infection, because the carrier state can persist for an indefinite period. The demonstration of serum antibodies to individual antigens of group A streptococci has

DETERMINATION OF C-REACTIVE PROTEIN IN THE BLOOD OF PATIENTS WITH HODGKIN'S DISEASE

Excerpt Since the first description of C-reactive protein by Tillett and Francis in 1930, the occurrence of this substance, which is not present in the blood of normal individuals, has been noted b...