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The exact relation between gastro-oesophageal reflux and asthma remains poorly understood. To determine whether gastro-oesophageal reflux in asthmatics results in oesophagitis, endoscopy and oesophageal biopsy were performed on 186 consecutive adult asthmatics. The presence or absence of reflux symptoms was not used as a selection criterion for asthmatics. Endoscopy was performed by two endoscopists using predefined criteria. All asthmatics had discrete wheezing and either a previous diagnosis of asthma or

In patients with both GER and asthma, antireflux surgery (but not medical therapy with ranitidine 150 mg t.i.d.) has minimal effect on pulmonary function, pulmonary medication requirements, or survival, but significantly improves asthma symptoms and overall clinical status.

High - voltage electric burns are very rare in children. This is a report of a seven years old boy, who presented 20 days after severe burns following a contact with a high - voltage electric line during playing. He was treated for the above at another hospital and was referred for further management. His clinical examination revealed; exposed skull bones, a raw area over the right side of the chest wall and a raw area over the right upper limb, which completely exposed the distal radius and the ulnar bones. After properly explaining the purpose of the operation to his parents and getting their consent, the exposed skull bones were covered with multiple pedicle scalp flaps. A bipedicle abdominal flap was used to cover the exposed right forearm bones and a skin grafting was also provided to the chest wall wound at the same time. The abdominal flap was detached safely after three weeks. He withstood the above operations well and was discharged six weeks after the above operations. The bipedicle abdominal flap helped in saving his right forearm and hand and the reason for the publication of this case is its rarity in children.

Lateral clefts are rare in occurrence. The lateral cleft is cause by failure of fusion of the maxillary and mandibular dermatomes. It is also associated with preaurical tags. We present a case of a lateral cleft of the lip with multiple bilateral preauricular tags that was repaired using triangular flaps.

Gastroesophageal reflux is common in asthmatics. To determine whether bronchodilators, the supine position, or eating affect gastroesophageal reflux, we performed ambulatory 24-hr pH monitoring on 44 controls and 104 unselected adult asthmatics. All asthmatics had discrete attacks of wheezing and documented reversible airway obstruction of at least 20%. The presence or absence of gastroesophageal reflux symptoms was not used as a criterion for patient selection. Chronic bronchodilator therapy was required by 71.2% of the asthmatics, and was continued during the test. Asthmatics had significantly worse GER than controls during the 3-hr postprandial period, which continued into the nonpostprandial period up to the next meal. Significant differences were present for esophageal mucosal acid contact time, frequency of reflux episodes, and clearance times. During the nonpostprandial periods asthmatics had four times the acid reflux as controls and 19-fold the frequency of prolonged reflux episodes. There were no differences between asthmatics on bronchodilators and those not on bronchodilators in any of the reflux parameters during the upright (postprandial, nonpostprandial) period or supine (sleep) period (P = NS). We conclude that: (1) regardless of the use of bronchodilator therapy, asthmatics have significant GER when asleep and after meals that continues beyond the postprandial period to the next meal; and (2) asthmatics receiving bronchodilators have similar gastroesophageal reflux patterns after eating, in the nonpostprandial period, and when asleep as asthmatics not receiving bronchodilators.

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