Vol 35, No 8 (1939)

The construction of rational therapy presupposes the knowledge of the etiology of the disease. Under this condition, it is possible to raise the question of specific treatment. In this respect, the problem of rational therapy in acute rheumatism presents great difficulties, since there is no consensus on the etiology of the disease. It is undisputed that acute rheumatism is an infectious disease. The view of many researchers that acute rheumatism is caused by a type of streptococcus is not generally accepted. Attempts to obtain a culture of the specific causative agent of acute rheumatism are still in progress. 

We examined 264 rheumatic children aged 4 ½ to 16 years who were under the supervision of the children's clinic and polyclinic of the Kazan State Institute for Advanced Medical Education named after V. I. Lenin. V. I. Lenin. Our patients were distributed by age as follows: 23 children under 10 years of age, 214 from 10 to 14 years of age, and 27 from 14 to 16 years of age. Of these, 76 were inpatients and 188 were observed on an outpatient basis. The observation lasted from May 1937 to May 1939.

The modern view of acute rheumatism as a disease with an underlying allergic state of the organism is shared by most authors. Aschoff first noted in acute rheumatism the formation of specific granulomas in the myocardium. Subsequent studies by Talalaev, Klinge and others made it possible to establish a certain regularity in the development of Aschoff granulomas (stage of disorganization of connective tissue, stage of proliferation and stage of sclerosis development). These anatomo-histological changes observed in acute rheumatism are similar to the changes in the inflammatory focus of sensitized animals, on the basis of which most authors recognize that acute rheumatism has in its basis an allergic character of the disease.

On the basis of a large experimental material A.D. Speransky came to the conclusion that the basis of the development of acute rheumatism, as well as other infectious diseases, such as scarlatina, diphtheria, etc., are the primary pathological changes in the nerve cell, and the rheumatic lesion of organs is already a secondary reflection of this process in the periphery (joints, etc.).

Timely and accurate recognition of myocardial infarction is not only of theoretical interest, but also of great practical importance, as it determines therapy.
The typical clinical picture of myocardial infarction (status anginosas, acute heart failure, pericarditis, temperature and leukocyte reaction, acceleration of erythrocyte sedimentation) is not found in all cases, pain syndrome is sometimes absent, or it is so poorly expressed that it recedes into the background.

As is known, there is a close relationship between blood circulation and respiration, which is what some functional tests are based on. According to Einbrod, with frequent and shallow breathing, the aortic pressure does not change; deep breathing causes fluctuations in blood pressure (Borisova and Lyass). Henderson speaks about the connection of hyperventilation with blood pressure as early as 1908 (citation. by Holden and Priestley). He managed to induce shock in animals by prolonged hyperventilation of the lungs. With increased ventilation, CO₂ is washed out, its content in blood and tissues decreases, as a result, alkalosis occurs, causing changes in blood circulation.

On December 1, 1936, a patient P-ko, 30 years old, a sailor of a fishing vessel, came to an outpatient appointment complaining of pain in the "pit of the stomach" and in the left side and vomiting, regardless of food intake. Of the diseases he has suffered, he remembers recurrent typhus, furunculosis and minor injuries.

The described case of visceral syphilis is of interest from our point of view, both in terms of differential diagnosis and in terms of combined rheumatic and luetic heart disease with simultaneous specific central nervous system involvement.

Patient V., 53 years old, foreman of a tramway park, came to hospital No. 24 on 2/IV-38 with complaints of dyspnea during physical exertion, weakness, chest pains. He felt sick on 15/III-38, when shortness of breath when climbing stairs and pains in the heart area appeared.

The plethora of surgical methods proposed for the treatment of varicocele suggests that no one method is completely reliable. In general, many surgeons question the appropriateness of surgical intervention because the long-term results do not lead to a radical cure. However, the presence of dilated veins of the spermatic cord, in addition to subjective phenomena in the form of discomfort in the scrotum, pulling pain in the testicle, intensified by walking and physical exertion, gives objective changes in the form of sagging testicle, venous stasis and, ultimately, testicular atrophy. These phenomena make us skeptical about the proposals of conservative surgeons and force us to speak in favor of surgical methods of treatment.

The problem of rheumatism is one of the most current and interesting topics of medicine of the last 10-15 years. It is devoted to a large number of works in the world literature, it was and is dealt with by doctors all over the world. There are several reasons for this. The first of them is an excessive number of "rheumatic diseases" among the population of the whole globe; statistics of different countries speak eloquently about it. The second reason that has prompted physicians to study this question is that, until recently, there has been a great deal of confusion about what we mean by "rheumatism". 

The article contains the theses of the dissertation for the degree of Doctor of Medical Sciences, defended on December 28, 1938 in a public meeting of the Academic Council of VIEM in Leningrad.

The author used for prophylactic purposes the injection of placental extract in 80 children (from 1 to 8 years old) who had been in contact with measles patients. This inoculation was done on the 4th-5th day of incubation in 5-10 cm³, depending on age. As a result, it turned out that only two of this group became ill with measles (2.5%) of almost abortive form, and, in the author's opinion, the sick children were vaccinated late. 

In a short time the author observed 5 cases of acute pyuria caused by dysentery bacillus. A. assumes that such patients were carriers of the dysentery bacillus before the disease; only after entering the urinary tract, the bacillus causes an acute inflammatory process. The dysentery bacillus most likely enters the urinary tract by an ascending route, like bact. coli. This is supported by the fact that all 5 cases observed by the author were girls and none of them showed signs of sepsis. 

There are as many as 200,000 girls with gonorrhea in the United States. Diagnosis requires clinical symptoms, smears, and cultures. For smears, vaginal secretions should be collected with a glass catheter containing some saline. The pH of the discharge is of diagnostic value: all girls with gonorrhea have an alkaline reaction. The pH of vaginal discharge from healthy girls is always less than 7. 

An important aid in the diagnosis of gonorrhea in old and atypical cases is the culture method. Observations in recent years show that the best medium for this purpose is McLeod's chocolate agar placed in an atmosphere of 8% carbon dioxide. Using this method, Carpenter and his associates examined 245 women. They also took swabs from them. Of the 223 laboratory tests that were positive, the culture method detected gonococcus in 205 cases, or 91.9%, and the swab method in 107 cases, or 48%. In 18 cases, the smear was positive but the culture was negative, so the combination of the two methods greatly increases the chances of detecting gonococcus.