Dysphagia can be caused by a rare anomaly of the subclavian artery. The diagnosis can be overlooked at endoscopy, but barium contrast study of the esophagus will reveal the abnormality. In patients with coexisting esophageal abnormalities the finding may be incidental and specific conservative treatment may be sufficient. Manometry cannot be used to diagnose this condition or to predict surgical outcome. When the symptoms are intractable, surgical correction should be considered even if coexisting esophageal abnormalities are present.

No abstract

The objective of this preliminary study was to evaluate three-dimensional ultrasonographic lung volume measurement in the normally developing fetus in the second half of pregnancy. Total fetal lung volume was determined by subtraction of fetal heart volume from thoracic volume, using the perpendicular transverse, sagittal and frontal planes of the fetus. Technically acceptable lung volume measurements were obtained in 29 out of 34 women with an uncomplicated pregnancy. A statistically significant increase in normal fetal lung volume was established with advancing gestational age and with increasing fetal estimated weight, demonstrating an approximately seven-fold rise in fetal lung volume during the second half of pregnancy. Three-dimensional ultrasonography can be applied for estimation of fetal lung volume. Whether this technique is useful in the prenatal prediction of pulmonary hypoplasia remains to be determined.

Three-dimensional ultrasound allows measurement of fetal liver volume, and this demonstrated an approximately 14-fold increase during the second half of pregnancy. It is speculated that three-dimensional fetal liver volume measurement may identify the fetus at risk of growth restriction.

Sir: Metastatic carcinoid tumours are frequently associated with carcinoid syndrome, which is characterised by episodic flushing of the head and neck and diarrhoea and reduced arterial-mixed venous oxygen saturation due to arterio-venous fistulae. Under certain circumstances profound hypotension or hypertension may occur, an event called ªcarcinoid crisisº.We report a patient who developed a carcinoid crisis during transesophageal echocardiography (TEE).Case report. In a 58-year-old man with a metastatic midgut carcinoid tumour with tricuspid valve stenosis and insufficiency a TEE was made in evaluation for possible surgical intervention. He was sedated with 1 mg of midazolam i. v. After approximately 15 min he developed shortness of breath and peripheral cyanosis, his oxygen saturation dropped to 80 %. His systolic arterial blood pressure dropped 25 mmHg. The echocardiographic examination was terminated. Physical examination showed acrocyanosis and decreased consciousness. He was tachypnoeic (60 breaths/min) with a heart rate of 118 beats/min and blood pressure of 80/50 mmHg. The liver was grossly enlarged and there were signs of ascites. The lower limbs showed pitting oedema. A blood gas analysis showed a PO 2 of 4.8 kPa and a PCO 2 of 3.4 kPa and an arterial oxygen saturation of 73 %. The