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In 1981-1987 of 61,420 liveborn children in the districts Bratislava-town and Bratislava-country 480 infants with inborn heart disease were born of whom 135 died. The mean incidence of congenital heart disease is 7.81% and the mean mortality 2.22%. During first week 42% of the 135 infants with congenital heart disease died. From an analysis of the deceased, operated and living candidate for operation the authors estimated 273 cardiological surgical operations for 216 children from the total of 480 with congenital heart disease. The results may serve as a basis for therapeutic and preventive care within the framework of the cardiovascular programme for children.

Endogenous digoxin-like substance (EDLS) in urine has been considered to be the representative of the natriuretic hormone, the endogenous inhibitor of the sodium pump (the sodium-potassium transporting enzyme Na, K-ATPase). Its site of production remains unknown, and so does its chemical nature. It has been suggested however that EDLS and the atrial natriuretic factor represent two distinct natriuretic system. Although the present work does not provide evidence for EDLS to be a natriuretic hormone, it nevertheless supplies data in support of this hypothesis. In preterm neonates, the decreased sodium excretion during the first days of life is accompanied by a parallel decrease in urinary EDLS excretion. The same was observed in a group of children from the infant period through the age of 12-14 years. Both parameters showed in parallel the lowest values in the oldest children examined. Children aged 8-12 years also showed parallel excretion of sodium and ELDS, even if natriuresis was induced in recumbent position and antinatriuresis in upright position. When the children remained recumbent for 24 h there were no differences in sodium and EDLS excretion between daytime and night. Children involved in adequate physical activities during daytime excreted less sodium and EDLS during the day than at night.

The authors assessed changes of the serum level and urinary excretion of an endogenous digoxin-like substance in healthy neonates and parturient women who did not have digitalis therapy. Higher concentrations of the endogenous digoxin-like substance (ESPD) found in the umbilical blood, as compared with parallel samples of venous blood of the mothers (n = 13; p less than 0.01), provide indirect evidence of the secretory autonomy of the neonatal organism. The highest ESPD concentrations in umbilical blood were found in neonates born before the 34th week of gestation (0.5-1.0 ng/ml), whereby with advancing gestational age the ESPD level declined significantly (n = 21; r = 0.62; p less than 0.01). This fact along with the positive correlation between the excretory fraction of sodium and renal ESPD excretion in the group of healthy 1-5-week-old premature babies (n = 10, r = 0.53; p less than 0.01) is consistent with the view on the identity of ESPD and the assumed natriuretic hormone, the circulating endogenous inhibitor of Na+, K+-ATPase.

Karyotypic examinations were carried out in 10 children suffering from Williams-Beuren's syndrome. Chromosomal aberrations were established in two of the children. In one case the mosaic pattern of Klinefelter's syndrome was recorded, evidently presenting an instance of coincidence. In the other case deletion of the long arm of chromosome 6 (q22.2q23) was demonstrated, which according to the authors' hypothesis may represent an alternative localization of the phenotypic traits of Williams-Beuren's syndrome or of its assumed underlying defect, namely derangement of the regulation of calcium metabolism. The value of cytogenetic examination of children with Williams-Beuren's syndrome in elucidating the so far obscure pathogenesis of this disease is being emphasized.

Risk factors for atherosclerosis in children were studied in families where the father had suffered from myocardial infarction before the age of 45 years and in the families of the closest relatives. The values of metabolism of lipids and atherogenic indexes were compared with the findings in a series of children with no positive family history. In children of at risk families cholesterol and triglyceride values were increased in 34.3%, HDLc was decreased in 42.1%, and apoprotein B was increased in 53.1%. Of the atherogenic indexes the LDL/HDL ratio proved to be the most significant. More than half of the children from at risk families can be considered to be threatened with atherogenesis. These children have to be followed up regularly and great care is to be given to a proper regimen.

In 13 children supravalvular aortic stenosis was diagnosed by two-dimensional echocardiography on the basis of a diminished inner diameter of the aorta in the supravalvular region "d2" compared with the inner diameter of the aortic annulus "d1". The differences in the values of "d2" and "d1" were only on the border of statistical significance. The difference in the d2/d1 ratio between the group of patients and healthy controls was statistically significant (p less than 0.001). Two-dimensional echocardiography is a very sensitive method for diagnosing supravalvular aortic stenosis. This sensitivity has been confirmed also by detecting the diminished inner diameter of the aorta in the supravalvular region in children with Williams-Beuren syndrome without clinical signs of a heart defect.

In a group of 20 children with pulmonary arterial valvular stenosis the clinical and routine laboratory data were assessed before surgical correction and at intervals of 4-10 years afterwards. In all children successfully operated upon, the ECG signs of right ventricular hypertrophy disappeared. In 10 children of the group the haemodynamic indicators were determined in the postoperative period with the aid of right-heart microcatheterization at rest and during exercise. A success of the correction was manifested by a normalization of the pressure conditions in the right heart. Exercise did not raise them to pathological levels. A successful removal of the stenosis was also manifested by the actual values of the ejection volume and cardiac index, mainly in their increases during exercise. Heart microcatheterization proved to be an expedient method for determining the haemodynamic indicators at rest and during exercise in the long-term follow-up of patients after surgical correction of congenital pulmonary arterial stenosis as one of defects with a good postoperative outlook.

Juvenile chronic arthritis implies in almost one third of the patients a disease with permanent sequelae--deformities of the joints with subsequent disability or the affection of various organs. To prevent the development of such changes, comprehensive treatment of these patients is necessary comprising coordinated medicamentous rehabilitation and physical therapy as well as psychosocial care. Collaboration of the doctor, patient, parents and social worker is one of the prerequisites of an optimal perspective.