No abstract

This paper reviews the pathophysiology and therapy of the multiorgan failure which occurs with submersion injury of children. First, the influence of hypothermia, the pulmonary, cardiovascular, neurologic and renal changes and the blood gas, acid-base and bloodvolume and serum electrolyte disturbances are discussed in detail. The therapeutic procedures are separated in the cardiopulmonary resuscitation at the scene of the accident and in the management of the children within the hospital where all near-drowned children should be taken. The intensity of the treatment at the hospital depends on the level of consciousness and on the respiratory and cardiovascular problems of the near-drowned child. For the treatment of comatose children with abnormal patterns of respiration and cardiovascular derangements the routine management and a more aggressive approach to therapy are presented. The rational for the aggressive therapy is to improve cerebral salvage. The urgency for an extensive monitoring system is underlined.

In general, there is a falling incidence of rheumatic fever in the Federal Republic of Germany. Data from 1949 to 1977 at the University Children's Clinic Mainz indicate that in the last few years rheumatic carditis and arthritis occurred with the same severity and frequency in relation to the total number of cases as 20--25 years ago. Merely the number of recurrences has been significantly lowered since the introduction of penicillin prophylaxis. The reduction in recurrences is the main reason why acquired heart disease has become less common.

No abstract