Ondine's curse and neurally mediated syncope--a new and important association.

A 6-year-old boy with congenital central hypoventilation syndrome (Ondine's curse) presented with presyncope. Investigation revealed a diagnosis of neurally mediated syncope. This previously unreported association provides strong evidence that autonomic dysfunction is implicated in both these conditions.

Acquired toxoplasma encephalitis.

Toxoplasma was the cause of encephalitis in a 4 year old boy. He recovered completely after treatment with pyrimethamine and sulphadimidine. Toxoplasma encephalitis has a high mortality, and active treatment is recommended.

Interrupted aortic arch type A associated with congenitally corrected transposition of great arteries and ventricular septal defect. Successful direct aortic anastomosis and pulmonary artery banding in an infant.

A case is described of congenitally corrected transposition of the great arteries (atrioventricular discordance, ventriculoarterial discordance) with interrupted aortic arch, a previously unreported association. Aortic continuity was achieved by direct surgical anastomosis. Pulmonary artery banding was subsequently necessary, because of heart failure associated with a large ventricular septal defect. A possible pathogenetic mechanism is suggested.

Reduction of systemic vascular resistance by competitive alpha adrenergic blockage with thymoxamine after cardiopulmonary bypass for cardiac operations.

Fifteen patients with evidence of excessive systemic vasoconstriction following cardiac operations were studied. Serial hemodynamic measurements were made before and during infusion of thymoxamine, a competitive alpha adrenergic blocking drug. Thymoxamine resulted in a full in systemic resistance together with a rise in cardiac index without reflex tachycardia. When thymoxamine was infused at a rate of 1 mg . kg-1, the desired effect was achieved without sudden profound falls in arterial pressure and there were no significant side effects. During the first few hours after bypass, skin temperature measurements do not give an adequate indication of the circulatory state. Measurement of mixed venous oxygen saturation is a most useful, simple method of monitoring the acute effects of treatment during this period.