Neuropsychiatric (NP) symptoms are relatively common in patients with SLE. The diverse and dramatic clinical presentations, the unclear pathogenesis, the lack of diagnostic test/s and uncertainties about the optimal management are some problems facing a clinician. When serum anti P antibodies were claimed to be highly correlated to lupus psychosis, this needed confirmation. An ELISA for measuring anti P antibodies was developed and validated. The prevalence of anti P antibodies was determined in different patient groups in a large retrospective study. Although anti P antibodies were highly specific for SLE, there was no correlation between the presence of these antibodies and lupus psychosis or other NP symptoms. Two prospective studies were carried out to eliminate any bias in our retrospective study. In one, none of the patients developed psychosis and these antibodies were not found to be specific for lupus depression or anxiety. In the other, anti P antibodies were measured in Malaysian Chinese SLE patients. No correlation was found between these antibodies and NP-SLE but a high prevalence of these antibodies was demonstrated in this group. Genetic studies showed that there was an increase in HLA-Dr2w16X subtype allele in anti P-positive patients but this did not reach significance. The usefulness of measuring antineuronal antibodies in helping to diagnose NP-SLE was examined but these antibodies were not better indicators of NP-SLE. Although the clinical correlations of anti P antibodies remain controversial, anti P antibodies were found to selectively bind to neuroblastoma cell surfaces <i>in vitro</i> but the nature of the surface antigen was not determined. Finally, sera from patients with lupus psychosis were found to significantly influence the response of neuroblastoma cells to agonist-induced stimulation and if confirmed, would offer an explanation for the reversible changes in cell function associated with psychiatric lupus.

No description available.

Orientador: Julio Defaveri / Resumo: O presente trabalho teve como objetivo principal padronizar o teste de contraimunoeletroforese (CIE) para detecção dos autoanticorpos contra os antígenos SS-A/Ro e SS-B/La. Como complementação, realizou-se a padronização da obtenção dos antígenos Ro e La à partir de baço de cão. Para consecução dos objetivos, foram realizadas as seguintes etapas: 1. Extração dos antígenos Ro e La à partir de baço de cão 2. Padronização da CIE com os antígenos obtidos: 2.1 Padronização da técnica CIE propriamente dita; 2.2 Teste qualitativo dos antígenos Ro e La obtidos com padrão USP-SP e ELISA-kit comercial para esses antígenos. 3. Escolha dos casos de doença reumática (diagnosticados por biópsia - 40 pacientes) e controles (soro de doadores de sangue - 10 doadores). As doenças selecionadas tiveram a seguinte distribuição: 3.1 Lúpus Eritematoso Sistêmico = 29 casos 3.2 Lúpus Eritematoso Discóide = 4 casos 3.3 Esclerodermia = 3 casos 3.4 Síndrome de Sjögren = 4 casos 4. Realização dos testes CIE e ELISA-kit. 5. Obtenção dos resultados dos testes de imunofluorescência indireta (IFI) para fator anti-núcleo (FAN) e anti-DNA, ELISA- RNP e ELISA- Sm, realizados na rotina diagnóstica de doenças autoimunes no Laboratório de Imunopatologia do Departamento de Patologia- FMB-UNESP. 6. Comparação e estatística dos resultados obtidos pela CIE com os demais testes. Os resultados e as conclusões obtidas foram as seguintes: 1. Na padronização e nos testes dos soros dos pacientes reumáticos, a CIE apresentou, em geral, apenas uma linha de precipitação bem definida. Somente em dois casos ocorreram duas linhas de precipitação. A presença de uma linha de precipitação impossibilitou a caracterização da presença de anticorpos anti-Ro e anti-La. A detecção de apenas uma linha de precipitação pode ter sido devida: a) aos baixos níveis de ... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: The main objective of the present work was to standardize the counterimmunoelectrophoresis assay for the detection of autoantibodies to the SS-A/Ro and SS-B/La autoantigens. As a complementary objective, the extraction of both antigens from dog's spleen was also standardized. To accomplish these objectives, the following steps was performed: 1. Extraction of the Ro e La antigens from dog's spleen. 2. CIE standardization with the extracted antigens: 2.1 Standardization of CIE test; 2.2 Qualitative and quantitative analysis of the Ro e La antigens present in the extract of the spleens with a gold-standard (positive serum against Ro and La antigens + Ro and La antigens obtained from spleen dog) obtained from the University of São Paulo-SP and with a commercial ELISA-kit for detection of autoantibodies against these antigens. 3. Selection of the cases with rheumatic disease (diagnosed by biopsys - 40 patients) and normal individual for control serum (blood donors - 10 donors). The diseases and the number of each one in the forty selected cases was distributed as follow: 3.1 Systemic erithematous lupus = 29 cases 3.2 Discoid erithematous lupus = 4 cases 3.3 Scleroderma = 3 cases 3.4 Sjögren syndrome = 4 cases 4. Performance of the CIE e the ELISA-kit tests. 5. Obtaining the results of the following tests: IFI , AAN anti-DNA, ELISA- RNP and ELISA- Sm, registered in the files of the service of autoimmune diseases of the Laboratory of Immunopathology, Department of Pathology - UNESP University - Botucatu Medical School. 6. Statistical analysis and comparison of the results of CIE and other tests. The results and conclusions were the following: 1. In the standardization for the Ro and La antigens in the extract of the spleens and in the tests performed in the serum of rheumatic patients, the CIE in general expressed only one well-defined line of precipitation. Only... (Complete abstract, click electronic access below) / Mestre

Made available in DSpace on 2014-06-11T19:27:57Z (GMT). No. of bitstreams: 0 Previous issue date: 2001Bitstream added on 2014-06-13T19:15:40Z : No. of bitstreams: 1 siqueira_rca_me_botfm.pdf: 744727 bytes, checksum: a3899d53afe3ee28af93a9231f3eaefc (MD5) / O presente trabalho teve como objetivo principal padronizar o teste de contraimunoeletroforese (CIE) para detecção dos autoanticorpos contra os antígenos SS-A/Ro e SS-B/La. Como complementação, realizou-se a padronização da obtenção dos antígenos Ro e La à partir de baço de cão. Para consecução dos objetivos, foram realizadas as seguintes etapas: 1. Extração dos antígenos Ro e La à partir de baço de cão 2. Padronização da CIE com os antígenos obtidos: 2.1 Padronização da técnica CIE propriamente dita; 2.2 Teste qualitativo dos antígenos Ro e La obtidos com padrão USP-SP e ELISA-kit comercial para esses antígenos. 3. Escolha dos casos de doença reumática (diagnosticados por biópsia - 40 pacientes) e controles (soro de doadores de sangue - 10 doadores). As doenças selecionadas tiveram a seguinte distribuição: 3.1 Lúpus Eritematoso Sistêmico = 29 casos 3.2 Lúpus Eritematoso Discóide = 4 casos 3.3 Esclerodermia = 3 casos 3.4 Síndrome de Sjögren = 4 casos 4. Realização dos testes CIE e ELISA-kit. 5. Obtenção dos resultados dos testes de imunofluorescência indireta (IFI) para fator anti-núcleo (FAN) e anti-DNA, ELISA- RNP e ELISA- Sm, realizados na rotina diagnóstica de doenças autoimunes no Laboratório de Imunopatologia do Departamento de Patologia- FMB-UNESP. 6. Comparação e estatística dos resultados obtidos pela CIE com os demais testes. Os resultados e as conclusões obtidas foram as seguintes: 1. Na padronização e nos testes dos soros dos pacientes reumáticos, a CIE apresentou, em geral, apenas uma linha de precipitação bem definida. Somente em dois casos ocorreram duas linhas de precipitação. A presença de uma linha de precipitação impossibilitou a caracterização da presença de anticorpos anti-Ro e anti-La. A detecção de apenas uma linha de precipitação pode ter sido devida: a) aos baixos níveis de... / The main objective of the present work was to standardize the counterimmunoelectrophoresis assay for the detection of autoantibodies to the SS-A/Ro and SS-B/La autoantigens. As a complementary objective, the extraction of both antigens from dog's spleen was also standardized. To accomplish these objectives, the following steps was performed: 1. Extraction of the Ro e La antigens from dog's spleen. 2. CIE standardization with the extracted antigens: 2.1 Standardization of CIE test; 2.2 Qualitative and quantitative analysis of the Ro e La antigens present in the extract of the spleens with a gold-standard (positive serum against Ro and La antigens + Ro and La antigens obtained from spleen dog) obtained from the University of São Paulo-SP and with a commercial ELISA-kit for detection of autoantibodies against these antigens. 3. Selection of the cases with rheumatic disease (diagnosed by biopsys - 40 patients) and normal individual for control serum (blood donors - 10 donors). The diseases and the number of each one in the forty selected cases was distributed as follow: 3.1 Systemic erithematous lupus = 29 cases 3.2 Discoid erithematous lupus = 4 cases 3.3 Scleroderma = 3 cases 3.4 Sjögren syndrome = 4 cases 4. Performance of the CIE e the ELISA-kit tests. 5. Obtaining the results of the following tests: IFI , AAN anti-DNA, ELISA- RNP and ELISA- Sm, registered in the files of the service of autoimmune diseases of the Laboratory of Immunopathology, Department of Pathology - UNESP University - Botucatu Medical School. 6. Statistical analysis and comparison of the results of CIE and other tests. The results and conclusions were the following: 1. In the standardization for the Ro and La antigens in the extract of the spleens and in the tests performed in the serum of rheumatic patients, the CIE in general expressed only one well-defined line of precipitation. Only... (Complete abstract, click electronic access below)

Objectives: 1) Evaluate the risk of atherosclerosis in rheumatic disease compared to healthy controls; 2) Assess the lipid profile of children with systemic lupus erythematosus (SLE) at presentation before treatment with corticosteroids; 3) Compare the lipid profiles of children with juvenile dermatomyositis (JDM), systemic juvenile idiopathic arthritis (SJIA), and SLE; 4) Evaluate the extent of early atherosclerosis in children with JDM, SJIA, and SLE; 5) Investigate the progression of early markers of atherosclerosis in children with SLE. Methods. The methods include a systematic review, a cross sectional study of serum lipid levels of a cohort of children with SLE, an analysis of the first time point of a prospective study of cardiovascular disease risk factors and vascular function measures of a cohort of children with JDM, and SJIA, and SLE and a longitudinal study of vascular function measures of a prospective study of a cohort of children with SLE. Results. Our systematic review demonstrated that carotid intima media thickness (CIMT), a surrogate marker of early atherosclerosis, was significantly increased in rheumatic disease populations. We found that newly diagnosed children with SLE before corticosteroid treatment exhibited a pattern of dyslipoproteinemia of increased triglycerides and depressed HDL-cholesterol. When we measured the lipid profiles in children with the rheumatic diseases of JDM, SJIA, and SLE, one third of children had at least one abnormal lipid value. The most common abnormalities were found for total cholesterol and triglyceride levels and most often in children with JDM. One quarter of all patients were found to have insulin resistance. Lastly, when we considered the effects of treatment in children with SLE, we found that improvement in CIMT was possible and it correlated with a higher cumulative dose of prednisone over the study period. Conclusions. Early markers of atherosclerosis in pediatric rheumatic disease are important for determining the risk of these children in developing heart disease as young adults. Chronic inflammation plays a significant role and should be considered an important predictor of premature atherosclerosis.

Objectives: 1) Evaluate the risk of atherosclerosis in rheumatic disease compared to healthy controls; 2) Assess the lipid profile of children with systemic lupus erythematosus (SLE) at presentation before treatment with corticosteroids; 3) Compare the lipid profiles of children with juvenile dermatomyositis (JDM), systemic juvenile idiopathic arthritis (SJIA), and SLE; 4) Evaluate the extent of early atherosclerosis in children with JDM, SJIA, and SLE; 5) Investigate the progression of early markers of atherosclerosis in children with SLE. Methods. The methods include a systematic review, a cross sectional study of serum lipid levels of a cohort of children with SLE, an analysis of the first time point of a prospective study of cardiovascular disease risk factors and vascular function measures of a cohort of children with JDM, and SJIA, and SLE and a longitudinal study of vascular function measures of a prospective study of a cohort of children with SLE. Results. Our systematic review demonstrated that carotid intima media thickness (CIMT), a surrogate marker of early atherosclerosis, was significantly increased in rheumatic disease populations. We found that newly diagnosed children with SLE before corticosteroid treatment exhibited a pattern of dyslipoproteinemia of increased triglycerides and depressed HDL-cholesterol. When we measured the lipid profiles in children with the rheumatic diseases of JDM, SJIA, and SLE, one third of children had at least one abnormal lipid value. The most common abnormalities were found for total cholesterol and triglyceride levels and most often in children with JDM. One quarter of all patients were found to have insulin resistance. Lastly, when we considered the effects of treatment in children with SLE, we found that improvement in CIMT was possible and it correlated with a higher cumulative dose of prednisone over the study period. Conclusions. Early markers of atherosclerosis in pediatric rheumatic disease are important for determining the risk of these children in developing heart disease as young adults. Chronic inflammation plays a significant role and should be considered an important predictor of premature atherosclerosis.

No description available.

A fim de avaliar o resultado da gestação em pacientes cardíacas foram considerados dois grupos controle: o grupo \"I\" ou clínico e o grupo \"II\" ou cirúrgico. Foram considerados para este estudo todas as pacientes reumáticas matriculadas no Programa de Assistência à Gestante Cardíaca, no período de 01/06/15 a 30/10/79, tomando-se por base a gravidez e a doença reumática como ponto comum a todas as pacientes. Os resultados obtidos nestas gestações estão baseados nos parâmetros a seguir relacionados: idade da paciente no início da gestação, número de gestações, paridade, diagnóstico clínico-cardiológico, tipo funcional segundo a \"New York Heart Association\", idade gestacional, eletrocardiograma, tipo de parto, peso do recém-nascido ao nascer e suas condições de saúde. As pacientes do grupo \"II\" ou cirúrgico foram divididas em três subgrupos a saber: cirúrgico \"1\" (submetidas a comissurotomia valvar); cirúrgico \"2\" (submetidas a implante de prótese valvar-metálica tipo Starr-Edwards; e cirúrgico \"3\" (submetida a implante de prótese biológica de dura-máter). Os filhos das gestantes do grupo \"II\" ou cirúrgico têm peso significativamente menor que os filhos das gestantes do grupo \"I\" ou clínico. Entre as pacientes dos subgrupos cirúrgicos os filhos das pacientes com prótese de Starr-Edwards têm peso menor do que os filhos das gestantes dos outros subgrupos cirúrgicos, o que pode, pelo menos em parte, ser explicado pela ação dos anticoagulantes orais. Em relação ao tipo funcional, as pacientes cardíacas reumáticas clínicas podem engravidar se estiverem classificadas nos tipos funcionais I e II da \"New York Heart Association\", enquanto que as do grupo cirúrgico, com qualquer tipo de procedimento cirúrgico anterior, só poderão engravidar se pertencerem ao tipo funcional I, sem história de descompensação cardíaca anterior. As pacientes com prótese de Starr-Edwards na vigência de anticoagulação oral, devem ser bem orientadas em relação aos riscos do uso de tal medicação e entrarem para o programa especial de acompanhamento, com emprego de heparina subcutânea, principalmente durante a organogênese e ao controle rigoroso do tempo de protrombina, para prevenir o aparecimento de fenômenos trómboembólicos e do síndrome warfarínico fetal. As pacientes com prótese de dura-máter aórtica devem ser desencorajadas a engravidar. O período ideal para uma gravidez em pacientes cardíacas reumáticas, após qualquer tipo de cirurgia cardíaca, é com duração superior a 1 ano e inferior a 6 anos de pós-operatório. O maior número de cesáreas foi uma constante em todos os grupos estudados e realizadas por indicação obstétrica. No cirúrgico \"2\" (ou com prótese de Starr-Edwards) há indicação relativa de parto programado devido ao uso de anticoagulantes orais. Os procedimentos cirúrgicos devem ser realizados preferentemente antes ou apÓs a gestação. Durante o período gestacional,a época teoricamente \"ideal\" é entre a 18a. e 24a. semanas de gestação, ou em qualquer fase da gestação quando este for um procedimento de urgência. A cardioversão elétrica, processo inócuo durante a gravidez pode ser realizado em qualquer período gestacional para reversão da fibrilação atrial a ritmo sinusal. A taxa de óbitos maternos nas 301 gestações estudadas foi de 1,66 por cento , sendo que houve diferença significativa entre as proporções de óbitos nos dois grupos \"I\" e \"II\". As perdas do produto conceptual foram significativamente menores no grupo \"I\" ou clínico (4,48 por cento ) do que no grupo \"II\" ou cirúrgico (12,39 por cento ). Os resultados obtidos permitiram melhor avaliação dos riscos cardiológico e gravídico, bem como possibilitaram a caracterização de diferentes parâmetros que, considerados em conjunto, serão fundamentais para a avaliação do prognóstico destas mulheres com cardiopatia reumática. / With a view to assessing the consequences of pregnancy in rheumatic heart patients this study considered two control groups: the clinical group (I) and the surgical group (II). All the rheumatic patients enrolled, during the period from June 1, 1975 to October 3 O, 1979, in the \"Programme of Assistance to the Cardiac pregnant Woman\" were included in this study. Pregnancy and rheumatic disease were the common factors in all the cases studied. The results obtained during these pregnancies are based on the following parameters: age of the patient at the beginning of pregnancy, number of pregnancies, parity, cardiological clinical diagnosis, functional type according to the \"New York Heart Association\", gestational age, electrocardiogram, type of birth, birth-weight and state of health of the babies. The patients of Group \"II\" (Surgical) were divided into three sub-groups, namely: Surgical \"1\" (composed of those who had undergone Valvotomy); Surgical \"2\" (who had undergone implant of the Starr-Edwards heart valve prosthesis) and Surgical \"3\" (who had undergone implant of the \"dura-mater\" allograft prosthesis). The children of the mothers of group II (Surgical) were found to be of considerably lower weight than the children of mothers of group I (Clinical). With regard to the patients of the surgical sub-groups, the children of those with Starr-Edwards prosthesis are of lower weight than the children of the patients of the other surgical sub-groups which can be accounted for, at least in some measure, as a result of the use of oral anticoagulants. With regard to the functional type, theclinical rheumatic heart patients may become pregnant if classified as of the functional types I and II of the \"New York Heart Association\", while those of the surgical group, with any kind of earlier surgical treatment, may only become pregnant if they belong to the functional type I, with no previous history of cardiac insufficiency. The patients with Starr-Edwards prosthesis must be fully advised about the risks of using oral anticoagulants and must be put onto a special assistance programme, with employment of intradermic heparin, especially during organogenesis. They must also be advised about the necessary rigorous control of the prothrombine time to guard against the appearance of thromboembolic problems and Warfarin embryopathy. Patients with aortic \"dura-mater\" prosthesis should be discouraged from becoming pregnant. The most favorable period for pregnancy in rheumatic heart patients with any kind of cardiac surgical history is that lasting from a minimum of one year to a maximum of six years after operation. A majority of births by ceasarean section was a constant in all groups studied these were carried out on the basis of the obstetrician\'s recommendation. In the surgical sub-group \"2\" (those with Starr-Edwards prosthesis) there is a relatively high probability of programm~d births due to the use of oral anticoagulants. Surgery ought to be carried out, preferably, either before of after pregnancy. During the period of pregnancy the theoretically ideal occasion for surgery is between the 18th and 24th. weeks of pregnancy or, at any time during the pregnancy in urgent cases. Electrical cardioversion is a harmless procedure for the expectant mother and may be carried out at any time during the pregnancy for the reversal of the atrial fibrilation to the sinus rhythm. The maternal death rate for the 301 pregnancies studied was of 1.66 per cent , though there was a significant difference between the proportion of deaths occuring in groups I and II. The loss of the conceptual product was significantly less in Group I (clinical) 4.48 per cent than in Group II (surgical) 12.39 per cent . The result obtained permitted a better assessment of the cardiological and pregnancy risks, as well as making possible the characterization of the different parameters which, considered as a group, will be fundamental to the assessment of the prognosis of women with rheumatic heart disease.

A fim de avaliar o resultado da gestação em pacientes cardíacas foram considerados dois grupos controle: o grupo \"I\" ou clínico e o grupo \"II\" ou cirúrgico. Foram considerados para este estudo todas as pacientes reumáticas matriculadas no Programa de Assistência à Gestante Cardíaca, no período de 01/06/15 a 30/10/79, tomando-se por base a gravidez e a doença reumática como ponto comum a todas as pacientes. Os resultados obtidos nestas gestações estão baseados nos parâmetros a seguir relacionados: idade da paciente no início da gestação, número de gestações, paridade, diagnóstico clínico-cardiológico, tipo funcional segundo a \"New York Heart Association\", idade gestacional, eletrocardiograma, tipo de parto, peso do recém-nascido ao nascer e suas condições de saúde. As pacientes do grupo \"II\" ou cirúrgico foram divididas em três subgrupos a saber: cirúrgico \"1\" (submetidas a comissurotomia valvar); cirúrgico \"2\" (submetidas a implante de prótese valvar-metálica tipo Starr-Edwards; e cirúrgico \"3\" (submetida a implante de prótese biológica de dura-máter). Os filhos das gestantes do grupo \"II\" ou cirúrgico têm peso significativamente menor que os filhos das gestantes do grupo \"I\" ou clínico. Entre as pacientes dos subgrupos cirúrgicos os filhos das pacientes com prótese de Starr-Edwards têm peso menor do que os filhos das gestantes dos outros subgrupos cirúrgicos, o que pode, pelo menos em parte, ser explicado pela ação dos anticoagulantes orais. Em relação ao tipo funcional, as pacientes cardíacas reumáticas clínicas podem engravidar se estiverem classificadas nos tipos funcionais I e II da \"New York Heart Association\", enquanto que as do grupo cirúrgico, com qualquer tipo de procedimento cirúrgico anterior, só poderão engravidar se pertencerem ao tipo funcional I, sem história de descompensação cardíaca anterior. As pacientes com prótese de Starr-Edwards na vigência de anticoagulação oral, devem ser bem orientadas em relação aos riscos do uso de tal medicação e entrarem para o programa especial de acompanhamento, com emprego de heparina subcutânea, principalmente durante a organogênese e ao controle rigoroso do tempo de protrombina, para prevenir o aparecimento de fenômenos trómboembólicos e do síndrome warfarínico fetal. As pacientes com prótese de dura-máter aórtica devem ser desencorajadas a engravidar. O período ideal para uma gravidez em pacientes cardíacas reumáticas, após qualquer tipo de cirurgia cardíaca, é com duração superior a 1 ano e inferior a 6 anos de pós-operatório. O maior número de cesáreas foi uma constante em todos os grupos estudados e realizadas por indicação obstétrica. No cirúrgico \"2\" (ou com prótese de Starr-Edwards) há indicação relativa de parto programado devido ao uso de anticoagulantes orais. Os procedimentos cirúrgicos devem ser realizados preferentemente antes ou apÓs a gestação. Durante o período gestacional,a época teoricamente \"ideal\" é entre a 18a. e 24a. semanas de gestação, ou em qualquer fase da gestação quando este for um procedimento de urgência. A cardioversão elétrica, processo inócuo durante a gravidez pode ser realizado em qualquer período gestacional para reversão da fibrilação atrial a ritmo sinusal. A taxa de óbitos maternos nas 301 gestações estudadas foi de 1,66 por cento , sendo que houve diferença significativa entre as proporções de óbitos nos dois grupos \"I\" e \"II\". As perdas do produto conceptual foram significativamente menores no grupo \"I\" ou clínico (4,48 por cento ) do que no grupo \"II\" ou cirúrgico (12,39 por cento ). Os resultados obtidos permitiram melhor avaliação dos riscos cardiológico e gravídico, bem como possibilitaram a caracterização de diferentes parâmetros que, considerados em conjunto, serão fundamentais para a avaliação do prognóstico destas mulheres com cardiopatia reumática. / With a view to assessing the consequences of pregnancy in rheumatic heart patients this study considered two control groups: the clinical group (I) and the surgical group (II). All the rheumatic patients enrolled, during the period from June 1, 1975 to October 3 O, 1979, in the \"Programme of Assistance to the Cardiac pregnant Woman\" were included in this study. Pregnancy and rheumatic disease were the common factors in all the cases studied. The results obtained during these pregnancies are based on the following parameters: age of the patient at the beginning of pregnancy, number of pregnancies, parity, cardiological clinical diagnosis, functional type according to the \"New York Heart Association\", gestational age, electrocardiogram, type of birth, birth-weight and state of health of the babies. The patients of Group \"II\" (Surgical) were divided into three sub-groups, namely: Surgical \"1\" (composed of those who had undergone Valvotomy); Surgical \"2\" (who had undergone implant of the Starr-Edwards heart valve prosthesis) and Surgical \"3\" (who had undergone implant of the \"dura-mater\" allograft prosthesis). The children of the mothers of group II (Surgical) were found to be of considerably lower weight than the children of mothers of group I (Clinical). With regard to the patients of the surgical sub-groups, the children of those with Starr-Edwards prosthesis are of lower weight than the children of the patients of the other surgical sub-groups which can be accounted for, at least in some measure, as a result of the use of oral anticoagulants. With regard to the functional type, theclinical rheumatic heart patients may become pregnant if classified as of the functional types I and II of the \"New York Heart Association\", while those of the surgical group, with any kind of earlier surgical treatment, may only become pregnant if they belong to the functional type I, with no previous history of cardiac insufficiency. The patients with Starr-Edwards prosthesis must be fully advised about the risks of using oral anticoagulants and must be put onto a special assistance programme, with employment of intradermic heparin, especially during organogenesis. They must also be advised about the necessary rigorous control of the prothrombine time to guard against the appearance of thromboembolic problems and Warfarin embryopathy. Patients with aortic \"dura-mater\" prosthesis should be discouraged from becoming pregnant. The most favorable period for pregnancy in rheumatic heart patients with any kind of cardiac surgical history is that lasting from a minimum of one year to a maximum of six years after operation. A majority of births by ceasarean section was a constant in all groups studied these were carried out on the basis of the obstetrician\'s recommendation. In the surgical sub-group \"2\" (those with Starr-Edwards prosthesis) there is a relatively high probability of programm~d births due to the use of oral anticoagulants. Surgery ought to be carried out, preferably, either before of after pregnancy. During the period of pregnancy the theoretically ideal occasion for surgery is between the 18th and 24th. weeks of pregnancy or, at any time during the pregnancy in urgent cases. Electrical cardioversion is a harmless procedure for the expectant mother and may be carried out at any time during the pregnancy for the reversal of the atrial fibrilation to the sinus rhythm. The maternal death rate for the 301 pregnancies studied was of 1.66 per cent , though there was a significant difference between the proportion of deaths occuring in groups I and II. The loss of the conceptual product was significantly less in Group I (clinical) 4.48 per cent than in Group II (surgical) 12.39 per cent . The result obtained permitted a better assessment of the cardiological and pregnancy risks, as well as making possible the characterization of the different parameters which, considered as a group, will be fundamental to the assessment of the prognosis of women with rheumatic heart disease.

Magister Scientiae (Physiotherapy) - MSc(Physio) / Rheumatic disease is estimated to be one of the most disabling diseases in South Africa and the world. The most common rheumatic diseases are osteoarthritis, fibromyalgia, rheumatoid arthritis, gout and systemic lupus erythematosus. The symptoms of the disease include pain, stiffness, swelling, decreased function. The patient’s functional abilities are severely affected by the pain which in turn, leads to poor quality of life and adverse stress. As a result patients who suffer with one or with a combination of rheumatic disease will experience pain, stress, decreased functional abilities and poor quality of life. The physical properties of water and the therapeutic effects of hydrotherapy, make hydrotherapy an effective form of exercise available to physiotherapists in the treatment of rheumatic disease. The aim of the current study was to determine the effects of a hydrotherapy intervention on the pain, stress, quality of life and functional abilities in patients with rheumatic disease. A quantitative and qualitative research design was employed to meet the objectives. The quantitative aspect involved an A-B-A design and the qualitative part of the study compromised indepth interviews which took place after the intervention. The instruments used were the WHOQOL-BREF instrument, the Visual Analogue Scale (VAS), the Weekly Stress Inventory-Short Form (WSI-SF) and the Health Assessment Questionnaire. (HAQ). The sample consisted of 19 patients who were diagnosed with one or a combination of rheumatic disease. The study was conducted at the hydrotherapy pool at Groote Schuur Hospital in Cape Town. Within the study sample, the majority of the participants were female (84%) with osteoarthritis being common among the participants (53%). The mean age was 60 years. The intervention had a significant impact on pain reduction (p = 0.0001), quality of life (p<0.05). However, the impact of hydrotherapy on stress and the social relationship domain in quality of life was inconclusive. It is thus evident from this study that hydrotherapy as a treatment modality for physiotherapists can be used to impact on the pain, quality of life and functional abilities in patients with rheumatic disease. iv Keywords