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Serum digoxin concentration and half-life were radioimmunologically determined in 9 mature newborns after 7 days medication with digoxin. The newborns were in respiratory distress treated with continuous positive airway pressure or were suspected to have serious congenital heart disease. Loading dose was 26 mug/kg body weight intravenously and 35 mug/kg body weight orally, respectively. Maintenance dose corresponded to 1/8th of the digitalization dose twice daily. The serum digoxin level 12 h after the last dose varied between 1.4 and 2.5 ng/ml (mean 2.0 ng/ml, Sx=0.4). The serum half-life of digoxin varied between 21.7 and 42.4 h (mean 30.0 h, Sx=7.7). The mean serum half-life of digoxin of 30 h attained values found in adults without renal disease. This suggests that the serum digoxin levels of newborns which are usually higher if compared with those of adults result from higher digoxin doses per unit body weight and not from diminished digoxin elimination.

We report the development of a double-antibody system for radioimmunoassay of CK-B subunit in isoenzymes CK-MB and CK-BB of creatine phosphokinase. With our method, 4.1 ng/ml of isoenzyme CK-BB can be detected. Within-run and between-run coefficients of variation are respectively 5.3% and 19.6% Analytical recovery of added antigen is 98.9 +/- 14.7%. The CK-B concentration in sera from 20 healthy adults was less than 75 ng/ml. In sera from 25 patients with a rise in CK-total activity, but without CK-MB or CK-BB activity tested with the previous reported immunological methods, we found CK-B concentrations in the range 0--86 ng/ml. In contrast, in 23 sera from patients with acute myocardial infarction within the last 48 hours CK-B concentration was in the range 104--225 ng/ml.

Two newborns with cogestive heart failure due to a congenital arterio-venous fistula involving the great vein of Galen are described. The main diagnostic criteria of this anomaly are a hyperactive heart, bounding carotid artery pulses, and a continuous murmur over the skull. The anomaly was visualized by cerebral angiography. In view of the frequent complications such as the development of hydrocephalus, operative treatment seems indicated.

Two children with exercise-induced syncopes are described. There was no evidence for congenital or acquired cardiac defects, cardiomyopathy or myocarditis in either of them. Both had sinus bradycardia and a consistently normal QT-interval at rest. In both, exercise induced regularly a multiform ventricular tachycardia, additionally in one on occasion a bidirectional, in the other a supraventricular tachycardia. Beta receptor blocking agents prevented tachyarrhythmias in both. Under treatment with beta receptor blocking agents, one child remained without syncopes, the other died suddenly. These cases underline the possiblility that exercise-induced syncopes may be caused by tachyarrhythmias even if the QT-interval of the resting Ecg is normal. In suspicious cases an exercise-Ecg is indicated.

Two groups each consisting of twelve healthy students received Fenoterol (0,03 microgram/kg/min) alone or in combination with Verapamil (1,2 micrograms/kg/min) intravenously. In both groups, heart rate, arterial blood pressure amplitude and echocardiographically determined left ventricular contractility parameters increased significantly and equally. These results suggest that Verapamil does not counteract the positive chronotropic and inotropic effect of Fenoterol.

Postmortem tissue and plasma concentrations of digoxin were studied in 13 premature newborns, 6 mature newborns, and 5 older infants (age 1 to 14 months). The pertinent results of our study are as follows: The tissue digoxin concentrations tend to be higher in premature and mature newborns than in infants. This difference is statisitcally significant with respect to the concentration in myocardium and skeletal muscle. The renal digoxin concentration of premature newborns is significantly lower than that of mature newborns, the tissue concentrations in the other organs examined being essentially equal. In all age groups examined, skeletal muscle contains the greatest portion of digoxin, followed by the liver. The relation of myocardial to plasma digoxin concentration shows no significant difference between the various age groups. Within the groups, the variation is relatively large.

A three months old infant with abnormal origine and course of the left pulmonary artery is described. The course of the left pulmonary artery between oesophagus and trachea causes narrowing of the distal trachea leading to in- and expiratory stridor. A ventral indentation of the oesophagus, visible on the lateral plane of an oesophageal roentgenogram, is characteristic for the anomaly which can be proven by pulmonary angiography.

Since the introduction of echocardiography into paediatrics by Lundström at the end of the 1960's, this noninvasive technique has come a long way. The original m-mode technique was followed by sector-echocardiography, which permits two-dimensional visualization of the heart. By this means cardiac and great vessel anatomy can be studied in real time. Even complex congenital heart defects can be analyzed and, in contrast to angiocardiography, the atrioventricular valves are well visualized. The addition of doppler-echocardiography enables one to examine direction and velocity of blood flow, which helps to reveal shunts within the heart and between the great vessels as to detect valvular stenosis and insufficiency. The principal advantage of echocardiography lies in this ability to rapidly diagnose congenital and acquired heart disease without harm to the patient. In addition, size and dynamics of the cardiac chambers and the great vessels including valves can be adequately studied.

Plasma digoxin concentration during maintenance therapy with digoxin was determined in premature and mature newborns, infants, children and adults. The plasma digoxin concentration of newborns was significantly higher than in adults; in addition, in the group of premature newborns it also was higher than in infants and children. These differences in plasma digoxin concentrations may be explained by differences in dose, volume of distribution and excretion rate of digoxin in the various age groups.

The Thorax-Tube according to Matthys and its successful application in 18 premature and mature newborns and older children is described. The advantages of this new device are discussed.

The aortico-left ventricular tunnel (AOLVT) is a rare abnormal communication between the ascending aorta and the left ventricle. The pathogenetic mechanism of this congenital anomaly is not completely understood. In addition to our 3 observations, 28 cases have been reported to date. In most cases the first symptoms appeared in early infancy. Clinical presentation and hemodynamics are identical to those of an aortic valve insufficiency. The correct diagnosis can be established by echocardiographic and angiocardiographic methods. Since the aortico-left ventricular tunnel is associated with congestive heart failure in infancy, in most cases surgical intervention is indicated in early childhood. The method of choice for surgical correction is a patch closure of the aortic orifice of the tunnel.

We examined the demand for doctorally prepared public health personnel in academia. We developed an unduplicated list of positions advertised during 1983 in several of the nation's public health journals. Based on this, we identified a total of 217 available positions. We surveyed the persons who placed the advertisements regarding their perceptions of the applicant pool, their experiences in filling the positions, and their perceptions of the future supply of doctorally prepared public health personnel. Of the respondents, 93% were in institutions of higher education. Based on their response, it appears that the current supply of doctorally prepared public health personnel is short and is likely to continue to be limited. Respondents had difficulty filling the advertised positions, based on the amount of time necessary to fill the position, and a number of positions had to be modified in order to be filled. Thirty-two percent of the respondents replied that the pool of applicants was low or poor. Thirty-four percent felt there was a shortage of such personnel, and a similar percentage felt there would be a future shortage. Based on our data, we believe that there is now a shortage of doctorally educated public health personnel for academic positions and that this shortage is likely to continue.

The sympathomimetic substance oxedrine (Sympatol) influences, by means of its affinity to alpha- and beta-receptors, cardiac performance and peripheral vascular tone. We studied in 12 healthy male volunteers the influence of intravenous oxedrine on left ventricular contractility parameters as estimated by TM-echocardiography, on cardiac index as well as on arterial blood pressure and peripheral vascular resistance. Under continuous intravenous infusion of 4 mg/min oxedrine the systolic and mean arterial blood pressure increased significantly (p less than 0.005) while the diastolic pressure and heart rate remained unchanged. The cardiac index increased (p less than 0.001) and the peripheral vascular resistance decreased significantly (p less than 0.01). The echocardiographically determined left ventricular contractility parameters, i.e. systolic shortening fraction (SF) as well as maximal velocity of shortening of the left ventricular diameter (VCFmin) also increased significantly (p less than 0.001 and 0.005, resp.). An increase in left ventricular contractility and cardiac index with concomitant decrease of peripheral vascular resistance and without increase in heart rate implies an economical increase in cardiac performance under intravenous infusion of oxedrine.