[The effect of prevention and other factors in the decrease in rheumatic fever]. / Utjecaj prevencije i drugih cinilaca na opadanje reumatske vrucice.

933 children with rheumatic fever hospitalised in Clinic in the period of 40 years (from 1995 to the end of 1994) were analysed in order to establish the fluctuation of patients number and changes in clinical appearance. Patients were divided in 4 groups: I. the patients hospitalised from 1955-1964 (472 patients), II. from 1965-1974 (307), III. from 1975-1984 (135), IV. from 1985-1994 (19). The data for Republic Croatia show the steady fall of the number of hospitalised children with rheumatic fever. Carditis with polyarthritis were present in the largest part of our patients (446 namely 47.8%). The number of recurrences fell equally with the number of patients with rheumatic fever. However, ratio between the number of patients with rheumatic fever and the number of recurrences did not change essentially, that was 11-15.85% in the periods considered. The percent of hospitalised children with fixed rheumatic heart disease was 4.23% in the I. period to as much as 15.5% in the III. period from totally hospitalised children with rheumatic fever. In the last time the disease became mild in its development. All children with suspicion on rheumatic fever should be hospitalised. The prophylaxis, primary or secondary, should be carried out intramusculary with benzithine penicillin G, as proved as the best, in order to ensure that the child virtually received the prophylaxis.

Sex differences in pubertal growth of the heart.

The aim of this study was to determine sex differences in growth of the heart during puberty. Three-year increments of growth of the heart and body structures and functions related to heart size were compared between the sexes. Echocardiographically estimated left ventricular mass (LVM) represented heart size, body surface area (BSA) represented the area supplied by the left ventricle, and diastolic blood pressure (DBP) represented a segment of arterial resistance. Pubertal changes in these and several other parameters were compared in 67 healthy girls and 84 healthy boys followed longitudinally from 11.5 to 14.5 years. Increments were compared by t-tests. Left ventricular mass of boys was larger than in girls. The sex difference was not significant at 11.5 years, but increased during the three pubertal years. LVM increased 26% in girls and 53% in boys (P <.001). During the same period, BSA increased 22% in girls and 29% in boys (P <.001), while DBP increased 6% in girls and 9% in boys (P <.05). The larger increment of BSA and DBP in boys corresponds to the sex difference in the increment of the heart size. These differences account, in part, for the greater increase (P <.001) in physical working capacity in boys compared to girls. Am. J. Hum. Biol. 9:297-302, 1997. © 1997 Wiley-Liss, Inc.

[Problems in adolescents and adults with congenital heart defects]. / Problemi adolescenata i odraslih osoba s kongenitalnom srcanom greskom.

The first palliative operations of congenital heart disease in the 1940s and 1950s, and then open heart surgery in the 1960s, have resulted in survival of patients whose follow-up is now over 30 years. Problems of patients with congenital heart disease are cardiac (pulmonary hypertension, systemic hypertension, dysrhythmias, endocarditis, cerebral insults, etc.), and noncardiac (scoliosis, intrathoracic adhesions, cosmetic problems, pregnancy, physical activity, employment, etc.). A pediatric cardiologist usually follows up such patients until adolescence, however, after that time they remain without physician's care who followed them in their childhood, being transferred for further controls and follow-up to internists-cardiologists. Many difficulties arise since internists-cardiologists are not properly trained in this particular sense, and pediatricians are not trained to follow-up adult patients. The care for a patient should be coordinated. To care for an adolescent, who was the child with congenital heart disease, pediatrician and cardiologist have to work at the same medical centre. The follow-up should continue as a team work, in which, besides pediatrician and cardiologists, cardiosurgeon, psychologist, psychiatrist, obstetrician, specialist for physical medicine and social worker should be included. A correction of educational plan is mandatory.

[Evaluation of the size of the left-right shunt using pulse Doppler echocardiography in children--personal experience]. / Procjena velicine lijevo-desnog santa pulsnom doplerskom ehokardiografijom u djece--nasa iskustva.

The purpose of the present study was to verify the value of a two-dimensional pulsed Doppler echocardiographic method for measurement of pulmonary (QP) and systemic blood flow (QS) in comparison with the radiocardiography in patients with ventricular and atrial septal defects. We reviewed 42 children with ventricular septal defect and 23 children with atrial septal defect. Two-dimensional echocardiography was employed to measure the diameter of the aorta and pulmonary artery and pulsed Doppler for measurement of pulmonary and systemic blood flow velocity in the pulmonary artery and left ventricular outflow tract. By comparing pulmonary and systemic blood flow ratios by pulsed Doppler echocardiography and radiocardiography, the correlation coefficient for children with atrial septal defect and those with ventricular septal defect respectively amounted to r = 0.71 and r = 0.81. The authors conclude that two-dimensional pulsed Doppler echocardiography, although a semiquantitative technique, appears to be a reliable non-invasive method for measuring pulmonary and systemic blood flow in patients with left-to-right sgunt.

[Aortico-left ventricular tunnel]. / Aorto-lijevoventrikulski tunel.

The boy was first admitted to the Department of Pediatric Cardiology at the age of 4 1/2 because of cardiac murmur diagnosed on the third day of life. A diastolic murmur of a grade 4/6, left ventricular hypertrophy as well as left aortal and ventricular dilatation were discovered. The findings showed a tendency of increase with time, but the patient had no symptoms. X-ray in the long axis view revealed a defect within the upper part of the interventricular septum immediately below the aorta, and dilated right coronary sinus. An invasive diagnostic method was undertaken, as well. The operative procedure was done with a total cardio-pulmonary bypass and hypothermia (29 degrees C). A tunnel from the anterior aortal wall through the outflow tract of the right ventricle to the left side of the heart was established intraoperatively. The defect was solved by a "sandwich" technique (two patch technique). Postoperative period was uneventful. A Doppler echocardiogram demonstrated the normal hemodynamic status of the patient without the left-to-right or right-to-left shunt and aortal insufficiency.

[Blood pressure in neonates measured by Doppler ultrasound]. / Krvni tlak novorodencadi mjeren Dopplerovom ultrazvucnom tehnikom.

In order to provide correct care for newborns it is necessary to determine the arterial pressure, since it is an important physiological indicator of body vitality. We measured blood pressure in 50 healthy, full term infants, born in Zagreb. All blood pressure readings were done by using a Doppler ultrasound. The 4 cm width cuff was used. The mean systolic pressure was 78.76 mmHg (SD +/- 8.6) and the diastolic one 35.78 mmHg (SD +/- 6). The level of systolic pressure was associated with body-mass (r = 0.371; p < 0.01), while sex had no effect on it.

[Abortion at 10 to 12 weeks using a plastic syringe or electric aspirator]. / Prekid trudnoce od 10 do 12 tjedna plasticnom strcaljkom ili elektricnim aspiratorom.

The study included 170 women subjected to menstrual regulation. The double-valve band syringe was used in 96 and the electric pump (the vacuum source usually used at the Department) in 74 cases. Nearly all the procedures were performed under general anesthesia, using 8 mm, 10 mm or 12 mm plastic rigid cannulae. Three abortions with the hand syringe also required dilatation and curettage, and all three women suffered blood loss exceeding 100 ml. There was one cervical laceration surgically repaired and a case of adnexitis reported among the hand syringe group. Immediate complications occurred in 7.3% of the cases using the hand syringe and in 4.1% of using the electric pump. The mean procedural time was 4.2 minutes and 4.0 minutes, respectively, with the hand syringe and the electric pump. Only three women reported complications or complaints at the follow-up visit, all of them from the electric pump group.

First trimester abortion by vacuum aspiration.

To compare the efficacy and complications of using the 8 mm diameter metal and flexible plastic cannulae for performing abortions of pregnancies of 7--10 menstrual weeks' gestation by vacuum aspiration, a comparative study was conducted. Both types of cannulae were randomly assigned to 300 subjects in a study design where the physician who performed the abortion was not the same person who evaluated the subject after the abortion or at the time of the follow-up visit. All abortions were performed under paracervical block anesthetic after mechanical dilatation of the cervix to 8.6 mm. The rates of specific complications, blood loss and the need for secondary procedures to complete the abortion were not significantly different for the two types of cannulae. The amount of tissue obtained with a routine curette check following the vacuum aspiration, and the incidence of cannula obstruction were similar for the two types of cannulae.