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the total dose of Dysport administered per patient was 500 MU per 2.5 mL of saline. The appropriate conversion factor of Botox:Dysport varies from 1:3 to 1:6 MU in studies using these agents in dystonia. 7 The different potency of these agents in treating sialorrhea in PD is unknown. Therefore, given a conversion factor of 1:6 MU, our dosage of 80 MU appeared to be similar to that used in the report by Nó brega et al. 2 Moreover, our study showed that BTX-A decreased the volume and the frequency of sialorrhea, as demonstrated in other studies, 5,8 whereas in the study by Nó brega et al., only the volume was reduced. We agree with Nó brega et al. 9 on the possibility that in patients with PD, sialorrhea may be secondary to swallowing disorders, although in our study, the effect of the toxin on drooling frequency was less relevant than that on the volume, and it may be linked to the severity of PD in our patients, which was not specified in the report by Nó brega et al. 2 Finally, another important issue to discuss may be the duration of effectiveness of treatment with BTX-A in Parkinsonian-related sialorrhea. Some patients treated with BTX-A develop secondary immune resistance or do not obtain effective control of symptoms. Therefore, given the efficacy and safety of botulinum toxin type B (BTX-B) also in the management of sialorrhea in PD, 8 we propose switching therapy from BTX-A to BTX-B in patients who are nonresponders or poor responders to BTX-A. 10

suMMARY Dissection of th¢ ascending aorta is a rare complication of aortocoronary bypass surgery. A 63-year-old man who had received a double graft was found to have dissection of the ascending aorta, which was shown angiographically four months after operation. Since the patient was asymptomatic, operation was postponed. He has been followed up regularly and two years later his condition is still satisfactory.Aortocoronary bypass surgery has gained wide acceptance in the treatment of symptomatic ischaemic heart disease. Myocardial infarction, pericardial tamponade, pericarditis, and postoperative infection are some of the more frequently encountered complications of the procedure but the occurrence of aortic dissection is rare, and so far only a few cases have been described. This paper reports such a patient who has been followed up for two years.

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A 79-year-old woman was admitted for progressive asthenia and weight loss over a 3-month period. Her past medical history was remarkable for episodes of recurrent chest pain with unobstructed coronaries and a gastric ulcer with oesophagitis leading to upper gastrointestinal bleeding 5 years earlier.Physical examination and standard biological tests appeared unremarkable except for the presence of an aortic ejectional murmur. Transthoracic echocardiography revealed a large wellcircumscribed, heterogeneous and echodense mass, which appeared to be within the left atrium (LA) (panel A, asterisk). Given the patient's presentation, a tumour was suspected and a cardiac magnetic resonance scan was performed for better delineation and tissue characterisation.Steady-state free precession cine revealed an extrinsic, inhomogeneous, large structure posteriorly to, and impinging, the LA consistent with a hiatus hernia without intracardiac mass. Additional T2-weighted short-tau inversion recovery images in two-chamber view showed a normal, hypointense LA partially compressed by the fluid-filled, hyperintense hiatus hernia (panel B, arrow). Resting perfusion imaging, and early and late imaging after gadolinium injection showed lack of abnormal enhancement or mass within the LA.This case highlights a typical echocardiographic pitfall represented by hiatus hernia mimicking LA mass and illustrates the valuable use of cardiac magnetic resonance scan for the investigation of suspected cardiac tumours through its excellent spatial resolution and wide range of sequences allowing for tissue characterisation. 1