Intestinal absorption and its relationship to increased total body water was studied in seven infants with congenital heart disease receiving regular diuretics due to congestive heart failure. All infants and six age-matched healthy controls were studied for a 3-d period during which time all food intake was recorded, stools were collected, and total body water content (TBW) and extracellular water were measured. All the anthropometric measurements were lower in the infants with congenital heart disease compared with healthy controls. Energy and fat excretion in the stools were significantly increased in the group of patients, but when expressed as a percentage of daily caloric intake or as a percentage of the specific intake (e.g. fat excretion1 fat intake x 100). no statistical differences were found. TBW as a percentage of body weight was increased in our patients compared with our controls (84.95 + 5.82% versus 68.65 .t 4.60%;~ = 0.01) and so was extracellular water as a percentage of predicted (200.0 2 18.6% versus 100.9 .t Failure to thrive is commonly observed in infants with CHD (1,2). Different causes have been suggested to play a role in this process, among which are poor caloric intake, increased energy expenditure, and intestinal malabsorption due to intestinal congestion (3). Some patients with CHD fail to gain weight or gain weight insufficiently, in spite of increased energy intake. The question then arises whether one should further increase their energy intake or should look for other causes involved in this process, such as increased malabsorption due to increased caloric content or malabsorption due to congested intestinal wall.The present study was designed to study intestinal absorption in infants with CHD who are on diuretic treatment due t o previous status of congestive heart failure and t o try to correlate intestinal malabsorption with different degrees of increased body water content and different caloric intakes. Increased water content, 7.2%; p = 0.001). A positive correlation was found between energy and fat excretion as a percentage of the intake and TBW as a percentage of predicted; energy and fat malabsorption did not exceed 8% in the patients with the highest body water content (120% of predicted). It is concluded that malabsorption is not a significant factor in failure to thrive of patients with congenital heart disease who are receiving regular diuretics. Based on the significant negative correlation between excess body water and fat and calorie absorption, however, it is suggested to monitor TBW in patients who fail to gain weight. (Pediatr Res 36: [545][546][547][548][549]1994) Abbreviations CHD, congenital heart disease TBW, total body water content ECW, extracellular water reflected by increased TBW and ECW in patients with significant intestinal malabsorption, may indicate a possible relationship between these parameters. METHODSThe study population consisted of seven infants with CHD and six age-matched normal controls. Patients' characteristics are given in Table 1....

worryingly high, I think that the rate of one in three is misleading as it assumes a constant rate of termination throughout ages 15-44. This is not the case at present, as among women aged 35 and over the rate reduces to about 4 terminations per 1000 women. If the number of terminations is calculated on the basis of the three age groups 15-19, 20-34, and 35-44 Topical anaesthesia in upper gastrointestinal endoscopy SIR,-We were pleased to see that Dr S Y Chuah and colleagues found that topical anaesthesia before upper gastrointestinal endoscopy was of no obvious benefit.' Although some potential hazards of premedication with lignocaine spray to the pharynx were mentioned (methaemoglobinaemia, risk of aspiration, and damage to the ozone layer), we believe that the most serious potential hazard was not addressed.Lignocaine is a powerful drug, and overdose can lead to depression of the cardiovascular, respiratory, and central nervous systems.2 Peak blood concentrations of over 5 ig/ml-the level thought to give rise to toxic reactions-may occur after lignocaine has been applied to mucosal surfaces,34 and fatalities and severe reactions have been described after such administration. [5][6][7] Recent studies have shown significant episodes of hypoxia, arrhythmias, and myocardial ischaemia after upper gastrointestinal endoscopy.8 Such events are potentially aggravated by the concurrent administration of lignocaine.Another potentially dangerous factor is that doctors have been shown to be unaware of basic information regarding the amount and maximum recommended doses of local anaesthetics.9 A recent survey that we carried out of 78 medical staff who regularly performed bladder catheterisation showed that all used lignocaine gel and yet only one person was aware of how much he was administering.As no obvious advantage was shown for the patient or practitioner by premedicating patients with lignocaine spray to the pharynx before upper gastrointestinal endoscopy, we believe that this practice, which may be an important factor in morbidity or mortality associated with such a procedure, should now be abandoned. A 28 year old woman presented four hours after attempting to inject into the right femoral artery 80 mg temazepam extracted from liquid filled capsules. She developed a purple macular rash, severe oedema, and exquisite tenderness of the whole of the right leg, which persisted for five days. Serum creatine kinase activity was 5900 IU/l (normal range 10 to 90 IU/1) and rose to 25 000 IU/I five days after the injection before falling to 311 IU/l 16 days after admission. She was treated with intravenous fluids to maintain a diuresis of 100 ml/h, and her renal function did not deteriorate, creatinine concentrations remaining normal throughout. She made a complete recovery.In our case the early rise in creatine kinase activity indicated focal rhabdomyolysis. Although this phenomenon has been noted after an oral overdose ofnitrazepam and doxepin, we believe this to be the first report of rhabdomyolysis after injection of...