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Forty of 82 patients with recurrent pneumonias and/or clinical asthma were found to have gastroesophageal reflux (GER) by the criteria of two or more of five tests positive for GER. Of 36 patients with GER followed for response to therapy, 32 patients attempted medical therapy and four had fundoplications. Ten of 32 (31%) patients on medical therapy had improvement in symptoms but none became asymptomatic. Twenty patients who failed a trial of medical therapy also had fundoplications for a total of 24 patients surgically treated. Of these, 22 (92%) had improvement or became asymptomatic. All seven patients with diagnosed GER and recurrent pneumonias responded to medical antireflux management or fundoplication. GER is an important treatable cause of recurrent pneumonias and/or chronic asthma in children.

Use of the Broviac silastic catheter totaling 37,039 patient days' experience has been studied at UCLA Hospital. When combined with standardized protocol for performance of parenteral nutrition and line care, and consistently supervised, the Broviac catheter provided inpatient as well as home parenteral nutrition with minimal complications. Catheter-related sepsis occurred once every 1,058 catheter-use days; minor or major complications developed once every 330 days. The benefits of the Broviac catheter appear to stem from the reinforcement of the external portion of the catheter with an outer protective sheath of Teflon, the luer lock connecting apparatus at the end of the catheter, and the dacron cuff which served to anchor the catheter by stimulating adhesion formulation. The ability to repair the catheter by splicing avoided removal of 7% of all catheters. Particularly dramatic results were noted in infants younger than 2 yr; sepsis and dislodgement occurred only once every 1189 catheter-use days. On the basis of these observations, the Broviac silastic catheter should currently be considered the catheter of choice for central venous alimentation.

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High doses of Vitamin A given during parenteral alimentation (PA), even if reduced by adsorption to plastic tubing, could cause toxicity if the retinyl e s t e r (RtE) overwhelms the capacity of the storage mechanism. T o check for significant serum RtE characteristic of Vitamin A toxicity, 9 infants were sampled while on peripheral PA for 1 to 31 d a y s . On the day of sample, the mean dally Vitamin A dose p e r kg body wt: 3677 I .U. (S.D.1750) or 1103 ug (S.D.525). Meangestational age: 30.2 wks (S.D.1.1), birth weight: 1222 g (S.D.264), day of a g e for sample ranged from 5 to 37 d a y s and a total of 13 samples were collected. Serum RtE levels w e r e uniformly low, i .e. 2.1 p g % o r less. Serum Retinol before PA in 5 infants was 6 . 4 p g % (S.D. 3.8) and rose to 1 2 . 7 p g % (S.D. 5.3) d u r i n g PA.Further work needs to b e done to identify the optimal Vitamin A dose, b u t it is reassuring to know that the c u r r e n t dose does not appear to b e excessive. The continuous high tone o f t h e i n t e r n a l anal sphincter rel a x e s on r e c t a l d i s t e n s i o n (rectosphincteric r e f l e x , RSR). This is an important f a c t o r i n allowing outward passage of r e c t a l cont e n t s . W e compared a n a l tone and RSR i n 70 chronically constipated (Pts) and 1 8 healthy (C) 4-12 year old children. Anal tone was measured using a s t r a i n gauge (Honeywell MP-3 esophageal pressure transducer). The rectum was distended by i n j e c t i n g a i r i n t o a 2 . 5~3 cm balloon placed i n t h e rectum. Spontaneous v a r ia t i o n s i n tone were recorded a s pressure waves i n the anal region i n almost a l l individuals. Anal r e s t i n g tone (ART) (mm Hg) was defined a s t h e low points of these waves. ART varied along the l e n g t h of the a n a l canal (LAC) and was highest a t 1-1.5 cm fr,om t h e a n a l verge. This region was used t o study the presence of RSR and t h e amplitude of RSR r e l a x a t i o n (nun Hg) t o 30 cc and 60 cc r e c t a l distension. The lowest volume of a i r t o cause RSR (2 5 mm Hg), t h e RSR threshold (RSRT), and the LAC (cm) (where tone was higher than i n t h e rectum) were a l s o determined. ART and RSR amplitude were s i g n i f i c a n t l y lower (p<0.05) i n P t s than i n C, while the RSRT and LAC were comparable. These findings (mean + S.D.) suggest t h a t p a t i e n t s with chronic constipation have a weaker and l e s s responsive i n t e r n a l anal sphincter than normal.ART RSR Amplitude W e have shown t h a t serum b i l e acid concentrations a r e elevated during e a r l y l i f e i n humans r e f l e c t i n g physiologic immaturity of the enterohepatic c i r c u l a t i o n . To f u r t h e r d e f i n e the ontogeny of b i l e acid metabolism i n mammals, we sought maturational changes i n t h e serum values of t o t a l cholyl conjugates v i a a s e n s i t i v e , spec i f i c radioimmunoassay i n f e t a l , suckling, and mature SpragueDawley r a t s . Results: F e t a l (21st day) b i l e acid l e v e l s were low (1.42 + 0....