Clinical symptoms and age at manifestation of a congenital coronary artery fistula may vary considerably. They depend on the underlying anatomy and also on the size of the fistulous connection to the left or right side of the heart. Using colour Doppler echocardiography for direct visualization of the entire course of the fistulous vessel, including the site of termination, succeeds only in a small number of cases. Furthermore, regular coronary vessels branching off proximally and distally of the coronary artery fistula usually are not recognizable by this method. Only selective angiography provides this information and is unchallenged the most important and indispensable diagnostic technique, especially with regard to surgical treatment. This publication presents physical, echocardiographic, and angiographic data of 15 patients, who were admitted to the German Heart Center Munich between 1970 and 1993. By an invasive diagnostic approach the following arteriovenous fistulous connections were found: from right coronary artery to right atrium (3 patients) or to right ventricle (3 patients), from left coronary artery to right atrium or coronary sinus (3 patients), from left coronary artery to right ventricle (4 patients) and from right and left coronary artery to right ventricle (2 patients). In 5 patients a "proximal" form of coronary artery fistula ("side-to-side pattern") was found, in 8 patients a "distal" form ("end-artery type"), and in 2 patients a combination of both forms. In 14 patients surgical closure was performed (6 symptomatic infants, mean age at surgery = 95 days, and 8 asymptomatic children, mean age at surgery = 7.1 years): 13 patients survived surgery. On an average of 5 years after surgery all of these 13 patients are in excellent condition (NYHA functional class I). The experiences in surgical treatment verify the importance of an exact angiographic visualization of the anatomy of a coronary artery fistula and the regular coronary vessels branching off proximally and distally of the fistula. Closure of coronary artery fistulas at the time of diagnosis is recommended also in asymptomatic patients, since perioperative morbidity and mortality increases in older patients.

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PET with Ringer solution resulted in a haemodilution comparable to PET with serum and a correction of hypervolaemia.

PET with Ringer solution resulted in a haemodilution comparable to PET with serum and a correction of hypervolaemia.

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Aus der Praxis des Kinder-und Jugendarztes D iese Ausgabe der Zeitschrift Kinder-und Jugendmedizin ist als Sonderheft "Aus der Praxis für die Praxis" konzipiert. Es sollen Themen dargestellt werden, die in der pädiatrischen Praxis von Bedeutung sind. Das Autorenteam setzt sich aus einem in der Praxis tätigen Kollegen und Klinikern zusammen. So sollen die Aspekte der kinderärztlichen Tätigkeit in der Praxis aus beiden Blickrichtungen beleuchtet und zugleich die Bedeutung der Kooperation zwischen selbständiger Praxis und Kinderklinik betont werden.Das komplexe Thema der Gerinnungsstörungen in der kinderärztlichen Praxis wird von Stefan Eber, fachärztlicher Kinder-und Jugendarzt, niedergelassen in München, im Rahmen einer Übersichtsarbeit (bestehend aus zwei Teilen) umfassend vorgestellt. Vor allem in der präoperativen Diagnostik ist für den niedergelassenen Kinder-und Jugendarzt die Kenntnis der häufigsten Koagulopathien von Wichtigkeit. Ein aussagekräftiges Vorgehen mit Elternfragebogen wird dargestellt.Zu den häufigen Fragestellungen in der Praxis des Kinder-und Jugendarztes gehört der Verdacht auf eine Infektion des Urogenitalsystems. Die wesentlichen Schwerpunkte zu Diagnostik und Therapie von Harnwegsinfektionen in der kinderärztlichen Praxis werden von Marcus Benz und Lutz Weber, München, dargestellt. Die genaue Kenntnis der Harngewinnung, der Beurteilung des Urinstatus, der Ermittlung der Lokalisation der Infektion und der Nachweis assoziierter Anomalien stellen die Voraussetzung für eine erfolgreiche Therapie in der Praxis dar. Andererseits werden auf dieser Grundlage eine unnötige antibiotische Therapie und Folgediagnostik vermieden.Harnwegsinfektionen stellen einen Schnittpunkt zwischen Praxis und Klinik dar, da Primärdiagnostik und Therapie, mit Ausnahme junger Säuglinge, häufig in der Praxis erfolgen. Diesen schließt sich dann Dr. med.

We studied the possibility to improve lung distensibility by SI during the first hours of a e. Preterm newborn lambs (123-133 days of gestational age, n=78) were used. Initially all lambs were mechanically ventilated with 100% 02, ~e a k inspiratory pressure (PIP) was adjusted for paCO2. For SI he ventilator was disconnected and the lungs were inflated during five seconds at a PIP of 25 or 35 cmH20 with a mixture of 5% C02 and 95% 02. Each inflation was followed by positive end expiratory pressure of 5 cmH20 for 5 seconds. This procedure was repeated three times. SI was applied in three groups: 1) within 15 minutes after birth, 2) within 15 minutes after birth and repeated each hour for 3 hours 3) at 4 hours of age. Two control groups (4 and 5) were formed, 4) as group 1, except that during disconnection the lungs were inflated,at the same pressure as for SI but with ,short inspiratory time, 5) lambs were ventilated widout any manipulation. Blood gas samples were taken every 30 minutes. Compliance (Cl) was calculated from the injected volume of air per kg wet body weight needed to obtain a pressure of 20 cmH20.Results (mean+SEM) at 3 hours after birth: 56 University of Lihurg, Rpts. of Neonatology, Physiclogy* and Biophysics**, Maastricht, The Netherlands. Cerebral blood flow velocity (CsFV) is decreased in plycythemic newborns and it normalizes after PPET. To study the influence of plycythemia on peripheral blood flow velocity (PBEV) we measured PBFV and CBFV in 17 plycythemic newborns.Nine normocythemic infants served as controls.Blood flow velocity was measured prior to and at 3 and 24 hrs after PPET in the study group and at 3 and 24 hrs after birth in the controls. Flow velocities were recorded with a 5MHz bidirectional continuous wave velocimeter. Hct decreased from 72.524.0% to 59.021.5% after PPET. Peripheral mean flow velocity ( W C o ) in polycythemic newborns did not differ from controls. Cerebral mean flow velocity was decreased in plycythemic newborns and normalized after PPET. MEAN RUV vnaCITYcontrol group P &fore PPET after P P m P TPP (g/I) serum 6025 * 5525 5727 saline 5654 *** 4825+ 55+7 **'p<0.001 *'<0.01 *<0.05 (paired t-test);# p=0.05 serumvs saline (unpaired t-test) lsovolumetric HD with saline resulted i n a smaller (p-zO.05) decrease i n Hct than HD with serum and was not associated with an isovolemic substitution of withdrawn blood. out with a decrease of BV at the end and 4h after HD, because saline let the intravascular space already during HD. Conclusion: Rapid loss from the intravascular volume and the decrease of blood volume make saline less effective for HD i n neona:al polycythemia and possibly for volume substitution i n general. We investigated the relation between obesity and lipid and apoprotein levels in 286 children, 6-14 years aged, 133 males and 153 females (16.5% with obesity). Weight, height and skinfolds were calculated for each child. Sg rum samples were collected after 12 hours fast; total cholesterol (TC), triglycerides (TG) and HDL cholesterol (HDLC) were de termin...