The effect of changing attitudes to Down's syndrome in the management of complete atrioventricular septal defects.

OBJECTIVES: To describe the evaluation, decision making, and care of children with a complete atrioventricular septal defect (CAVSD). STUDY DESIGN: Retrospective study of 136 consecutive cases from 1970 to 1996. RESULTS: A total of 115 (85%) children had Down's syndrome. Denial of surgery without obvious medical reasons was more common in the early years, as was parental refusal of offered surgery and institutional care of the children. Improved results in later years encouraged surgical treatment for all these patients, but more liberal attitudes towards patients with Down's syndrome preceded the improved results. The use of echocardiography as a screening method for all newborns with Down's syndrome made it possible to plan for correction within the 1st months of life. CONCLUSIONS: Changing attitudes in society and widespread use of echocardiography have significantly improved the management of children with a CAVSD and Down's syndrome.

Wheezing bronchitis reinvestigated at the age of 10 years.

We have reinvestigated 92/101 children aged 10, who before the age of 2 years were admitted to a paediatric ward due to wheezing bronchitis. At the present time, 70% are symptom-free without medication, 20% have mild asthma, 8% moderate and 2% severe asthma. Persistent asthma correlated significantly to the presence of some other atopic disease in recent years, to early start of wheezing during infancy and to intense obstructive disease as a young child, while initial respiratory syncytial virus infection did not. A clear-cut relationship between smoking in the home in infancy and persistent asthma emerged (not visible at a preschool follow-up). The histamine challenge results correlated to the clinical picture. A normal histamine challenge was seen in 63%, mild hyperresponsiveness in 19%, moderate in 12% and pronounced hyperresponsiveness in 6%. The figures for persistent asthma and bronchial hyperresponsiveness are high compared with the prevalence of asthma in the overall population of schoolchildren.

Furosemide treatment causes age-dependent glucose intolerance and islet damage in obese-hyperglycaemic mice.

The effects of furosemide on fasting serum glucose, glucose tolerance and pancreatic islet morphology were studied in ob/ob mice of two age groups, 3 months and 8 months. A single dose of furosemide (200 mg/kg body weight) induced acute hyperglycaemia in the young (3 months) as well as the old (8 months) ob/ob mice. Two days after the furosemide injection the glucose tolerance was markedly impaired in older animals, whereas it was normal in younger animals. Glucose tolerance in old mice varied markedly between individuals and showed two patterns. Thus, in one group of 8 months old mice, fasting serum glucose was elevated and glucose tolerance was very poor, whereas in the other group it was at least as good as in the saline-injected controls. Histological analysis showed normal islet morphology in furosemide-treatment young mice but an inflammatory reaction in islets from furosemide-injected old animals. A significant correlation between the degree of islet abnormality and glucose tolerance was observed. The data suggest that susceptibility to develop furosemide-induced long-term glucose intolerance is associated with the development of the obese-hyperglycaemic syndrome rather than being linked to the inheritance of the ob/ob genome as such.