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Blood sugar determinations were carried out on 50 pairs of twins before the initiation of first feeds. The mean blood sugar values of 36.69±14.03 mg/dl were observed. Blood sugar values had a definite correlation with birth weight and gestational age, significantly higher values were observed in infants weighing 2250 gm had above and having a gestational age of over 37 weeks. The mean sugar values did not differ between the larger and smaller twin in the 2 groups less than 25 percent discordant, nor were the values influenced by birth order or sex of these infants. Significant hypoglycemia (blood sugar

Summary Cardiac achalasia is a disorder not unknown in the paediatric age-group and may occur even in the neonatal period. This disorder should, therefore, be considered in all cases presenting with persistent vomiting, as well as in those with chronic respiratory disease in whom more common causes have been excluded. It is almost universally accepted that the disorder results from a disturbed function of ganglion cells in the distal oesophagus, as the disease has been reproduced in laboratory animals by denervation of the distal oesophagus. The exact pathogenesis of this degenerative change is not well understood. However, in at least some of the cases congenital absence of the ganglion cells may be responsible for this functional disturbance. This is inferred from the fact that the disease may be found in association with Hirschsprung disease, in which there is a congenital absence of ganglion cells in the terminal colon. Moreover, the occurrence of the disease in the neonatal period itself favours a congenital lesion. Surgery was preferred to other forms of treatment in the paediatric age-group in view of the reported equivocal response to mechanical dilatation and pre-disposition of children to respiratory complications. The results of surgery were satisfactory.