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Stenosis of the suprahepatic inferior vena caval anastomosis is a rare but serious vascular complication after liver transplantation. It may cause significant obstruction to venous drainage from the allograft liver and result in the Budd-Chiari syndrome with massive ascites and pleural effusion causing respiratory compromise. The authors report two such cases in which percutaneous transluminal angioplasty (PTA) of the stenotic anastomosis was performed. This nonsurgical approach resulted in resolution of ascites, pleural effusion, and respiratory distress in both patients. They conclude that PTA is a therapeutic alternative with minimal risk compared with surgical repair or retransplantation and should be considered the initial treatment of choice in selected patients.

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Primary cricopharyngeal achalasia (a = absence, chalasia = relaxation) is a rare cause of swallowing disorders in newborns. Two cases are reported which were successfully treated by a myotomy of the cricopharyngeal muscle. A thorough history is essential in differential diagnosis as well as observation of the feeding infant. Presence of anatomical obstruction to swallowing and existence of neurological defects should be ruled out. Cineradiography with lateral views by an experienced radiologist is the best diagnostic technique. Esophageal manometry may provide information regarding other esophageal dyskinetic problems. However, these studies are difficult to perform in neonates and infants. Endoscopy may be helpful to exclude vocal cord paralysis or mechanical obstruction. Balloon dilatation has been reported as being successful in several reports; however no comparison of efficacy has been made in any series between dilatation of the upper esophagus and surgical myotomy which remains in our mind, the optimal treatment of cricopharyngeal achalasia.