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Summary:Submucosal dissection of the oesophagus is a rare oesophageal disorder. We report a patient who had recurrent episodes of dissection and achalasia. Both recurrence and the association with achalasia are to our knowledge unique.

SummaryA case of relapsing pancreatitis complicated by massive pleural effusion is described and the difficulties in confirming the diagnosis are illustrated. The possibility of a pancreatic encephalopathy is also considered.

inadequate mothers (and hence children at risk) during pregnancy.'4 They showed that women who had been separated from their own parents when they were aged under 11 were more likely than others to have problems with their babies or marriages, and were thus more in need of support.We acknowledge the help of many people not mentioned in the article who have worked hard with us over many of these cases: family doctors, radiologists, registrars, house physicians, casualty officers, casualty sisters, ward sisters, and others.We are grateful to the Chief Constable of Derbyshire for giving his approval for publication. References IntroductionCombined apex cardiography and phonocardiography can reliably measure the isovolumetric relaxation of the left ventricle (IRT).1-3 Since relaxation of skeletal muscle is delayed in hypothyroidism,4 relaxation of cardiac muscle might also be delayed. We therefore measured the IRT in hypothyroid patients before and after treatment with thyroxine.

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