The authors' single-site multidisciplinary team has successfully treated complex and recurrent vascular anomalies with acceptable complication and recurrence profiles. These findings represent the authors' experience and provide a reference for the management of these challenging lesions.

We compared the efficacy of the prokinetic agent cisapride with that of Gaviscon (an alginate/alkaline compound) plus Carobel

Thirteen infants who had undergone 24 hour oesophageal pH monitoring to diagnose gastro-oesophageal reflux had a second study carried out to see if the results were reproducible. The studies were done without restricting the babies' activities. Appreciable differences were found, the percentage of the total time during which the pH was less than 4 varying by up to 3-7-fold between the two tests. The differences were largely the result of biological rather than technical variability. From these results estimates were made of the reliability of a single diagnostic study and the size of changes that would be necessary to show the effect of treatment.These findings have a considerable impact on the diagnosis of abnormal gastrooesophageal reflux and its response to treatment whether using 24 hour pH monitoring or any other method of measurement.

The Journal of the British Paediatric Association ANNOTATIONS Gastro-oesophageal reflux and the lung Numerous reports in recent years have described the association of gastro-oesophageal reflux with respiratory symptoms, both among children being treated for gastrooesophageal reflux and in those presenting with lower respiratory tract symptoms or apnoea. These studies, recently reviewed by Orenstein and Orenstein, have tended to focus on small, highly selected groups of children, and raise important questions concerning the nature, scale, and clinical implications of the associations observed, particularly during infancy. ' Despite intensive research interest in the pathophysiology of gastro-oesophageal reflux,2 the development of methods for its detection,2 3 and the elucidation of mechanisms of pulmonary dysfunction resulting from it,' 4the answers to many of the questions remain incomplete. This annotation highlights certain controversial areas and outlines an approach to the evaluation of children with respiratory symptoms and suspected gastro-oesophageal reflux.

Measurements of thoracic gas volume (TGV), airway resistance (Raw), and airway conductance (Gaw) were calculated in a group of 42 normal infants using a whole-body plethysmograph. Maximum expiratory flow at functional residual capacity was measured in a separate group of 108 normal infants. Using data obtained from these infants the following regression equations were calculated: Gaw (L.s-1.cmH2O) = -0.0475 + 0.00164 x length (cm) square root of TGV (mL1/2) = -3.22 + 0.263 x length (cm) VmaxFRC (mL.s-1) = -173 + 5.2 x length (cm). The standard errors of prediction are a measure of the scatter of individual results from the normal population about the true regression line. They were used to define limits of the normal ranges for these tests of lung function, and to develop a scoring system. This approach is preferable to expressing results as percent predicted, which gives no indication of how likely a measurement is to be within normal limits.