A serological survey for leptospiral agglutinins was undertaken between 1980 and 1983 in over 500 Barbadian and 500 Trinidadian school-children aged 7–14 years. The children were selected randomly from urban and rural schools, and examined three times at approximately annual intervals. A total of 12·5% of the Barbadian children and 9·5% of the Trinidadian children were seropositive at a titre of 50 using the microscopic agglutination test. On both islands, seroprevalence was higher in males than females, the difference being significant in rural schools. There was no evidence of a difference in prevalence between urban and rural schools, or between junior and secondary age-ranges. Analysis of the association of serology with socio-economic and behavioural factors showed a significant association in Trinidad with father's occupation, but most other variables on both islands showed only weak non-significant associations. Fourteen children in Trinidad and three in Barbados seroconverted. Seroconversion in Trinidad occurred at a rate of 1·6% per annum and was significantly associated with livestock contact and with absence of a tapped water supply. In Trinidad, Autumnalis was the most commonly recorded serogroup, but this accounted for less than a quarter of seropositives. In Barbados, Panama accounted for over half the seropositives and was about four times more common than the next most common serogroup, Autumnalis. In Barbados, 39 persons aged 19 or less were hospitalized with leptospirosis between November 1979 and December 1986. Average annual incidence rates were 2·2, 4·9 and 13·3 per 100000 in the 5·9, 10·14 and 15·19 age-groups, respectively.

Between December 1982 and April 1991, balloon atrial septostomy was performed in the intensive care unit under echocardiographic control in 60 neonates. Of the patients, 58 had complete transposition. Two patients had double outlet right ventricle with a sub-pulmonary ventricular septal defect. Associated lesions included a patent arterial duct in 19 patients, ventricular septal defect in nine, obstruction of the left ventricular outflow tract in six, aortic coarctation in two and tricuspid atresia in one. The mean age at septostomy was four days (range 4 hours - 25 days) and the mean weight 3.19 kg (range 1.17–4.25 kg). In 39 (65%) patients, an infusion of prostaglandin was in progress prior to the septostomy and 22 (37%) were being ventilated. Standard subcostal four-chamber echocardiographic views were used to show the atrial septum and to guide the catheter used for septostomy. Venous access was obtained via the femoral vein in 43 (by percutaneous puncture in 40 and by cutdown in three) and the umbilical vein in 17. Transient atrial arrhythmias were common during the septostomy but no acute hemodynamic disturbances or deaths occurred during the procedure. The size of the atrial septal defect as measured by echocardiography after the septostomy ranged from three to 12 mm in diameter. In only one patient was this inadequate. Three (5%) patients died between two and 10 days after the septostomy, two due to necrotizing enterocolitis and one from persistent hypoxemia. One patient had a cerebral thrombosis and convulsions immediately after the septostomy but made a good neurological recovery. Corrective surgery was performed in 52 (86.6%), two (3.3%) had palliative surgery and two were considered unsuitable for total correction, of whom one has died. One patient died whilst awaiting correction. We conclude that balloon atrial septostomy using echocardiographic guidance can be safely and effectively performed in the intensive care unit.

Formation of aortic aneurysms is an important and not infrequent sequel of surgical repair of aortic coarctation. Detection is often haphazard and fatal ruptures are reported. We report a series of cases where resonance imaging identified aneurysmal dilatation of the thoracic aorta after either patch aortoplasry or subclavian flap repair of aortic coarctation. In one, rupture of the aneurysm occurred five months following the initial resonance study. Repeat imaging confirmed the clinical suspicion of rupture and successful surgical resection was subsequently performed. Magnetic resonance is a practical and reproducible imaging technique which is particularly valuable in the identification of abnormalities within the thoracic aorta following surgical aortoplasty or interventional procedures for aortic coarctation. As a method of routine surveillance in these groups of patients, it is superior to any alternative technique.