Story telling of myocarditis.

Myocarditis was discovered as heart disease at autopsy with the use of microscope. In 1900, with the name of acute interstitial myocarditis, Carl Ludwig Alfred Fiedler first reported the history of a sudden cardiac heart failure, in the absence of coronary, valve, pericardial disease or classical specific infections with multiorgan involvement. He postulated a peculiar isolated acute inflammation of the myocardium with poor prognosis due to invisible microorganisms, which years later would have been identified as viruses. Subsequent revision of Fiedler original histologic slides by Schmorl showed cases with either lymphocytic or giant cell infiltrates. The in vivo diagnosis became possible with the right heart catheterism and endomyocardial biopsy. Employment of immunohistochemistry and molecular techniques improved the diagnosis and etiology identification. The mechanism of myocyte injury by coxsackie virus was identified in protease 2A coded by the virus and disrupting the dystrophin in the cytoskeleton. Both RNA and DNA viruses may be cardiotropic, and coxsackie and adenovirus share a common receptor (CAR). Unfortunately, vaccination is not yet available. Cardiac Magnetic Resonance is a revolutionary diagnostic tool by detecting edema, of myocardial inflammation. However endomyocardial biopsy remains the gold standard for etiological and histotype diagnosis, with limited sensitivity due to sampling error. Viral lymphocytic fulminant myocarditis may not be fatal and the employment of mechanical assistant device - ECMO in acute phase for temporary support may be lifesaving with good prognosis.

Your Epoch is not for Trying. It's for Living and for Dying...

The article is devoted to biographies of three Russian physicians of the Silver Age (a period in the History of Russian culture between 1890 and 1917). They made early, significant and internationally recognized contribution into medical science and became eponymous, although social disasters of the twentieth century caused deep impact on their subsequent lives and careers, so their role was shadowed from global medical community. The article analyzes biographies and academic achievements of A-F.K. Siewert (aka: Zivert, Ziwert, von Siewert) (1872-1922), known for first description of the hereditary dyskinesia of cilia (as a triad of: situs inversus of the viscera, abnormal frontal sinuses producing sinusitis and bronchiectasis); S.S. Abramov (1875-1951), discoverer of primary idiopathic myocarditis, and N.I. Taratynov (1887-1919), who was the first in description of a local form of histiocytosis X (solitary eosinophilic granuloma) and predicted the eosinophilic origin of Charcot-Leyden crystals. The contribution of these scientists into Medicine is reviewed in context of historical epoch, on background of their different individual social choices and the fate of their families. Besides their eponymous descriptions, other medical priorities of these scholars are analyzed. Some previously unpublished materials from their family archives are presented, which witness for possible existence of unknown prototype for the main hero of 'Doctor Zhivago' novel by B.L. Pasternak and for probable priorities of doctor Zivert - in active diastole concept, or doctor Abramov - in description of dilated cardiomyopathy. The factors facilitating rapid development of theoretical and practical Medicine in imperial Russia of late XIX - early XX centuries are discussed. The conclusion of the author is that in any epoch, even the most cruel and unfavorable one, the creative activity is a way to social immortality (19 figs, 68 refs).

Some notes on the history of rheumatic carditis

The history of rheumatic heart disease is briefly surveyed. Mitral regurgitation was recognized as the dominant leison in acute carditis in the 1830s. This diagnosis fell out of favour in the early twentieth century. Also valvular leisons were then considered to be less important than myocardial disease as a cause of symptoms in chronic rheumatic heart disease. Successful mitral valvotomies in 1948 corrected this view. Mitral stenosis takes years to develop after acute valvulitis. Studies from the rheumatic fever research unit at Taplow showed absence of cardiac dilatation in first attacks of rheumatic carditis, poor prognosis with pericardial effusions, changing murmurs recorded by phonocardiography and cardiac output studies that satisfied treatment by bed rest. The multicentre trial of cortisone, adrenocorticotrophic hormone (ACTH) and salicylates showed no differences in development of chronic valvular disease. There is need for a more specific test for rheumatic activity than the erythrocyte sedimentation rate (ESR). It is hoped that test can be developed to identify the minority of children at risk from rheumatic fever after a streptococcal throat infection in order to target antibiotic use. The declining prevalence of rheumatic fever is confined to the more prosperous countries. It remains common in the developing world. Penicillin prophylaxis is the sole advance in therapy. Better socio-economic environments are needed to reduce prevalence. (AU)

Some notes on the history of rheumatic carditis.

The history of rheumatic heart disease is briefly surveyed. Mitral regurgitation was recognized as the dominant lesion in acute carditis in the 1830s. This diagnosis fell out of favour in the early twentieth century. Also valvular lesions were then considered to be less important than myocardial disease as a cause of symptoms in chronic rheumatic heart disease. Successful mitral valvotomies in 1948 corrected this view. Mitral stenosis takes years to develop after acute valvulitis. Studies from the rheumatic fever research unit at Taplow showed absence of cardiac dilatation in first attacks of rheumatic carditis, poor prognosis with pericardial effusions, changing murmurs recorded by phonocardiography and cardiac output studies that justified treatment by bed rest. The multicentre trial of cortisone, adrenocorticotrophic hormone (ACTH) and salicylates showed no differences in development of chronic valvular disease. There is need for a more specific test for rheumatic activity than the erythrocyte sedimentation rate (ESR). It is hoped that a test can be developed to identify the minority of children at risk from rheumatic fever after a streptococcal throat infection in order to target antibiotic use. The declining prevalence of rheumatic fever is confined to the more prosperous countries. It remains common in the developing world. Penicillin prophylaxis is the sole advance in therapy. Better socio-economic environments are needed to reduce prevalence.

The selenium-coxsackievirus connection: chronicle of a collaboration.

This review provides a historical account of a collaboration established between a nutritionist and a virologist to investigate the interrelationship of host nutritional status and viral virulence. The parties to this collaboration consider themselves specialists in the fields of antioxidant nutrition and viral immunology, respectively. The advantages of such talent pooling are discussed (rapid startup, well-focused experimentation, ability to visualize the "big picture"), as are some of the disadvantages (limited common scientific vocabulary, proper apportioning of credit, lack of institutional infrastructure to house such efforts). The common perception that some of the most exciting science occurs when the advancing edges of two disparate disciplines intersect is borne out by this project because host nutriture was shown for the first time to influence the genetic make-up of an invading viral pathogen. Encouragement of joint cooperative ventures should have a high priority as demanded by increasingly difficult scientific problems and as desired by scientists themselves who wish to see their research progress more quickly.

Miocarditis viral asociada a bronquiolitis por virus sincitial respiratorio

La bronquiolitis por virus sincitial respiratorio (USR) es una enfermedad de las vías aéreas pequeñas, caracterizada por inflamación y obstrucción de los bronquiolos. El VSR fue aislado por primera vez en 1995, pertenece a la familia de los paramixovirus. Es clara la presentación epidérmica anual que compromete especialmente a lactantes pequeños. La tasa de infección por VSR durante el primer año de vida alcanza el 69 por ciento y el 83 por ciento durante el segundo. La mortalidad en niños previamente sanos es del 0.005 por ciento al 0.002 por ciento; en pacientes hospitalizados es del 1 al 3 por ciento. Aunque se ha descrito que la infección por VSR no altera la función cardíaca en pacientes con corazón sano, se encuentra en la literatura informes aislados al respecto; a continuación presentamos un caso de un paciente con bronquiolitis por VSR, en el que se documentó miocarditis por este mismo germen.

Medico-Chirurgical Transactions. A cardiovascular cluster.

A cluster of papers, important to the history of cardiology and cardiovascular surgery, that were published in volume 1 of Medico-Chirurgical Transactions (1809), are discussed. These include articles by Sir Astley Cooper on ligature of the common carotid artery for aneurysm, John Abernethy on mitral stenosis, and Sir David Dundas on acute rheumatic carditis.