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The Collaborative Clinical Analysis of 985 Cases of Rheumatic Fever and Rheumatic Carditis in Children for 10 Years(1978~1987) in Korea.

Journal of the Korean Pediatric Society 1989;32(12):1621-1631.
Published online December 31, 1989.
The Collaborative Clinical Analysis of 985 Cases of Rheumatic Fever and Rheumatic Carditis in Children for 10 Years(1978~1987) in Korea.
Sung Ho Cha1, Sang Young Jeong1, Du Bong Lee2, Kyong Su Lee2, Sang Bum Lee3, Tae Chan Kwon4, Young Chang Tockgo5, Chang Sung Sohn5, Keun Chan Sohn6, Young Jin Hong6, Chan Young Kim7, Chang Yee Hong8, Yong Soo Yun8, Jung Yun Choi8, Chang Hwi Kim9, Chul Ho Kim10, Tae Ju Hwang11, Jae Suk Ma11, Chan Uhul Joo12, Kyoo Hwan Rhee13, Hahng Lee13
1Department of Pediatrics, College of Medicine, Kyung Hee University, Seoul, Korea
2Department of Pediatrics, Catholic University Medical College, Seoul, Korea
3Department of Pediatrics, College of Medicine, Kyung Buk National University Taegu, Korea
4Department of Pediatrics, College of Medicine, Kei Myung University, Taegu, Korea
5Department of Pediatrics, College of Medicine, Korea University, Seoul, Korea
6Department of Pediatrics, National Medical Center, Seoul, Korea
7Department of Pediatrics, College of Medicine, Pusan National University, Pusan, Korea
8Department of Pediatrics, College of Medicine, Seoul National University, Seoul, Korea
9Department of Pediatrics, College of Medicine, Soon Chun Hyang University, Seoul, Korea
10Department of Pediatrics, In Je Medical College, Pusan Paik Hospital, Pusan, Korea
11Department of Pediatrics, College of Medicine, Chon Nam National University, Kwangju, Korea
12Department of Pediatrics, College of Medicine, Chung Buk National University, Jeonju, Korea
13Department of Pediatrics, College of Medicine, Han Yang University, Seoul, Korea
전국 13 개 종합병원의 10 년 (1978-1987) 간 소아 류마티열 환아의 임상적 고찰
차성호1, 정상영1, 이두봉2, 이경수2, 이상범3, 권태찬4, 독고영창5, 손창성5, 손근찬6, 홍영진6, 김찬영7, 홍창의8, 윤용수8, 최정연8, 김창휘9, 김철호10, 황태주11, 마재숙11, 주찬웅12, 이규환13, 이항13
1경희대학교 의과대학 소아과학교실
2가톨릭대학 의학부 소아과학교실
3경북대학교 의과대학 소아과학교실
4계명대학교 의과대학 소아과학교실
5고려대학교 의과대학 소아과학교실
6국립의료원 소아과학교실
7부산대학교 의과대학 소아과학교실
8서울대학교 의과대학 소아과학교실
9순천향대학교 의과대학 소아과학교실
10인제의대 부산백병원 소아과학교실
11전남대학교 의과대학 소아과학교실
12전북대학교 의과대학 소아과학교실
13한양대학교 의과대학 소아과학교실
Abstract
Acute rheumatic fever and rheumatic carditis were still important disease of the acquired heart disease in children and adults, in spite of improving socioeconomic status in Korea. Recently, many outbreaks of acute rheumatic fever have been reported in the papers from developed countries. We should be aware of such outbreaks of acute rheumatic fever and should pay attention to their treatment of the patients with Streptococcal pharyngitis and their secondary prophylaxis. A retrospective chart review was carried out about incidence, clinical manifestations and labora- tory findings of rheumatic fever and rheumatic carditis. Between 1978 and 1987, 985 cases of rheu- matic fever and rheumatic carditis were seen at 12 university hospitals and one general hospital in Korea. The following results were obtained: 1) The average incidence of rheumatic fever and rheumatic carditis for 10-year period was 4.7 per 1,000 annual pediatric in-ward patients. There was no increased or decreased incidence of rheumatic fever and rheumatic heart disease during study period. 2) There were 558 boys and 427 girls, and 96.3% of total patients were 6 to 15 years old. The most prevalent months of year of outbreaks were January and December. 3) 352 out of 985 patients (35.7%) had no history of preceding infection, and 460 out of 985 patients (46.7%) had preceding tonsillitis and pharyngitis. 4) The incidence of major manifestations were as follows; carditis (69.4%), polyarthritis (41.0%), erythema marginatum (8.5%), chorea (4.5%) and subcutaneous nodule (3.6%). 5) Sites of joint involvement in 404 patients were knee joint (66.1%), ankle joint (45.8%), hip joint (25.0%) and wrist joint (19.3%). 6) Clinical findings of carditis in 683 patients were cardiac murmur (88.9%),cardiomegaly in chest PA (54.9%), congestive heart failure (37.9%),and pericardial effusion and pericarditis (22.0%). 7) The electrocardiographic findings of 616 patients were PR interval prolongation (50.8%),right and left ventricular hypertrophy (27.8%), and prolonged P wave duration (26.1%). 8) Doppler echocardiographic valvular lesions of 233 patients were mitral insufficiency (72.1%), aortic insufficiency (21.9%), and mitral stenoinsufficiency (21.5%). 9) Minor and other clinical manifestations in 968 patients were fever, arthralgia, dyspnea, coughing, palpitation, weakness, sore throat and chest pain in order of frequency. 10) Laboratory findings of 912 patients on admission were increased ASO titer, Todd unit above 251 (68.4%), positive CRP (76.6%), and increased ESR (73.0%). 11) 308 out of 985 patients (31.3%) were recurred more than one times. 12) The most common family size was 4—6 persons in a family (73.0%).
Key Words: Acute rheumatic fever, Rheumatic carditis


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