[Prenatal ultrasound diagnosis of complex heart abnormality in routine screening]. / Antenatale Ultraschall-Diagnose einer komplexen Herzmissbildung im Routine-Screening.

Case report on a severe cardial malformation associated with trisomia 21, diagnosed by ultrasound-screening in the 34th week of gestation. Further diagnostic evaluation of the case and therapeutic management are described. The problems of modern malformation diagnostics by routine ultrasound scanning in pregnancy are discussed.

[Value of myocardial scintigraphy of coronary anomaly in the differential diagnosis of pediatric cardiomegaly]. / Wertigkeit der Myokardszintigraphie bei Koronaranomalie in der Differentialdiagnose der kindlichen Kardiomegalie.

The differentiation between anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) and other causes of cardiomegaly and thereby the decision to operate, as opposed to undertaking conservative therapy is often extremely difficult in clinical practice. Electrocardiographically, signs of myocardial infarction can be missed in ALCAPA, other forms of dilative cardiomyopathy (DCMP) often showing similar clinical features. Up to now aortography alone can make a clear-cut distinction between these two entities. In order to determine the diagnostic value of thallium-201 myocardial scintigraphy in ALCAPA, we investigated 18 children, 7 of them with angiographically or autoptically established ALCAPA and 11 patients with DCMP. The coronary artery anomaly was diagnosed on the basis of the typical myocardial perfusion defects in only 3 of the relevant 7 patients. In 9 of the 11 patients with DCMP ALCAPA was excluded by the homogeneous perfusion pattern or small focal reduction in thallium-201 activity in the left ventricular muscle mass. In view of the overall disappointing results of this method in achieving a specific diagnosis in ALCAPA, all patients with DCMP with or without suspected fibroelastosis should undergo invasive diagnosis with aortography.

[Immunosuppressive treatment of chronic myocarditis]. / Immunsuppressive Behandlung der chronischen Myocarditis.

6 children aged 9 months to 13 8/12 years developed reduced physical capacity, failure to thrive, dyspnoea on effort and heart failure after viral infection. Bed rest and anticongestive therapy did not reduce the severe heart failure. Immunosuppressive therapy with prednisolone 2 mg/kg/d and azathioprine 2 mg/kg/d was added on the assumption of chronic myocarditis (n = 4) or endocardial fibrosis (n = 2). 3 of the 6 children showed a considerable improvement in heart size, ECG and systolic heart function. Interruption of immunosuppressive therapy due to side effects in one child led to cardiac deterioration, which was reversed by renewed prednisolone therapy. Two patients died of progressive congestive heart failure. Heart transplantation was successfully performed in the now 14 year-old girl who was suffering from terminal dilated cardiomyopathy. Since there is no specific test for selecting patients who are likely to benefit from immunosuppressive therapy we feel this regimen would be justified in hopeless cases of congestive cardiomyopathy who have not responded to conventional therapy with anti-congestive drugs.

[First aid for severe burns and scalds in childhood]. / Erstversorgung schwerer Verbrennungen und Verbrühungen im Kindesalter.

A marked increase in the rate of admission of children with burns and scalding has been observed since 1977 at the Paediatric Hospital of Vienna University. The average age of 94 patients admitted between 1982 and 1986 was 2.2 +/- 2.1 years. An analysis of the age group 1 to 2 years revealed that burns with an extent of up to 10% of the body surface were seen in 18% of patients, up to a body surface of 20% in 18%, and more than 30% of the body surface in 5.3%. Among the entire group of 94 patients 32.9% had burns of up to 10% of the body surface, 41.4% of up to 20%. Written information as to primary care at the place of injury or in the nearest hospital was obtainable in only 35 out of 94 patients (38%). 21.1% of all patients had a raised temperature on the day of admission to this hospital as a consequence of a negative fluid balance. However, only 4 patients (4.2%) out of the 94 were transferred because of fever and/or septicaemia. Guidelines are proposed as to primary care at the site of trauma and during transport to hospital on the basis of a survey of the literature.