We studied patients who were eligible for phase II cardiac rehabilitation. Rehabilitation was delivered either conventionally or by telemedicine using videoconferencing. There were 226 participants: 173 at the conventional site and 53 at the telemedicine site. At baseline, blood pressure, anthropometric measurements, lipid profiles, activity levels, dietary intake and behaviours were assessed. Assessments at baseline were repeated after 12 weeks, at the end of the rehabilitation programme. There were no significant differences (P > 0.05) in the change from baseline to post-programme values between the conventional and the telemedicine groups. The results show the suitability of telemedicine for delivering cardiac rehabilitation for risk factor modification and exercise monitoring to patients who otherwise would not have access to it.

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The purpose of this study was to evaluate cellular immune responsivenes.s in patients with acute rheumatic fever (ARF). Peripheral blood lymphocytes were obtained for culture from patients who had ARF within the past 2-3 months. No patient was receiving steroids at the time of the study. Peripheral lymphocytes were also obtained from normal control individuals.Lymphocyte cultures were maintained for 7 days in minimum essential medium with 10% fetal calf serum in a 5% CO2 environment. Cellular responsiveness was checked concomitantly with pokeweed mitogen and/or phytohemagglutinin. Mixed-lymphocyte cultures were studied between patients with ARF and between patients with ARF and normal controls. Normal responses were arbitrarily defined as a threefold increase over baseline counts.ARF cells were capable of stimulating other ARF cells in only three of 14 instances and were able to stimulate control cells in only three of 11 studies. Conversely, ARF lymphocytes were capable of being stimulated by control normal cells in five of 10 experiments. Thus decreased cellular responsiveness and abnormalities in cellular immunity are present in many patients with ARF, since lymphocytes from patients with ARF are usually incapable of stimulating normal or other ARF cells. However, ARF cells are capable of being stimulated by normal control cells in 50% of studies performed. CLOSE HISTOLOGIC inspection of the microscopic cardiac lesions in acute rheumatic fever, such as areas of acute myocarditis or Aschoff bodies themselves, often shows prominent cellular infiltrations with small and medium-sized lymphocytes. It is surprising, therefore, that more attention has not been directed to a study of circulating lymphocytes in individuals afflicted with acute or subacute rheumatic fever. There is indeed a voluminous literature dealing with various

Eight patients with mild to moderate valvular pulmonary stenosis underwent serial physiological studies before surgical intervention. Average pulnwnary valve area at the initial study was o 59 CM.2 and at the second study (average 7-8 serial studies were performed in 8 subjects with mild to moderate valvular pulmonary stenosis to determine how valve area changes with time. These changes are related to normal pulmonary valve growth. Materials and methodsEight patients with mild to moderate valvular pulmonary stenosis (5 male, 3 female) underwent serial cardiac evaluation without surgical intervention. Routine clinical studies included x-rays and electrocardiograms. Right heart catheterizations were performed in the usual manner and hydrogen curves were obtained in the pulmonary artery to exclude any coexistent left-to-right shunt (Vogel, Grover, and Blount, I962). Cardiac output was determined by the Fick method, and pulmonary valve area and pulmonary valve index were calculated using the method of Gorlin (I966). Normal valve areas were calculated from valve circumferences reported by Schulz and Giordano (I962). The valve index was determined from heights and weights obtained from the Children's Research Council.At the time of the initial study the patients ranged in age from 2 months to 28 years (average I0 years). The average interval between studies was 7-8 years (range 3-5 tO I0 years). ResultsPulmonary valve area The average pulmonary valve area at the time of the initial study was 0-59 cm.2 (range OI3 tO I-45) and at the time of the second study I -09 cm.2 (range 0-55-2-I2): an average increase of 0-49 Cm.2+±02I (p>0 05) (Table).In 7 of the 8 patients, pulmonary valve on 12 May 2018 by guest. Protected by copyright.

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