Our data support the hypothesis that, in patients with symptomatic Schatzki's rings, acid suppressive maintenance therapy after bougienage may prevent relapse of the ring.

Thyroid nodules may undergo a wide range of degenerative change such as infarction, hemorrhage, or fibrosis, which may be localized or extensive and associated with calcification or even ossification. However, the detection of true bone formation in a thyroid nodule is a very rare occurrence. Extramedullary hemopoiesis (EMH) has been described in almost every organ of the body, mainly in tissues active in hemopoiesis in embryonic life. It is extremely rare for EMH to occur in the thyroid gland especially in patients without known chronic anemia. We describe a case of a cold thyroid nodule with histologically proven extensive bone metaplasia and formation of mature bone with foci of hemopoietic tissue in a young woman without chronic anemia, which, to the best of our knowledge, is the first to be reported in the English language literature.

IntroductionPulmonary artery aneurysm is an uncommon disorder with severe complications. The diagnosis is often difficult, since the clinical manifestations are non-specific and the treatment is controversial, as the natural history of the disease is not completely understood.Case presentationWe describe the cases of two patients with pulmonary artery aneurysms. The first patient was a 68-year-old Caucasian man with an idiopathic low-pressure pulmonary artery aneurysm together with a pulmonary embolism. The patient preferred a conservative approach and was stable at the 10-month follow-up visit after being placed on anti-coagulant treatment. The second patient was a 66-year-old Caucasian woman with a low-pressure pulmonary artery aneurysm also presented together with a pulmonary embolism. The aneurysm was secondary to pulmonary valve stenosis. She received anti-coagulants and, after stabilization, underwent percutaneous balloon valvuloplasty.ConclusionPulmonary embolism may be the initial presentation of a low-pressure pulmonary artery aneurysm. No underlying cause for pulmonary embolism was found in either of our patients, suggesting a causal association with low-pressure pulmonary artery aneurysm.

Primary tumours of the heart are rare, their incidence ranging from 0.0017 to 0.28 per cent in various autopsy series (Colucci and Braunwald, 1992). Thirty per cent of these tumours are cardiac myxomas (McAllister and Fenaglio, 1978). The latter are histologically benign but potentially lethal. Sudden death is reported in 15 per cent of cases and is mainly attributed to massive embolism or mechanical interference to blood flow within the heart by the tumour (Fisher, 1983). This incidence could be due to the absence of clinical manifestations of the disease or to the presence of non-specific or subtle ones that preclude early referral for specialist evaluation (Colucci and Braunwald, 1992). Such a poor prognosis is not altogether justified, however, considering the highly sensitive and accurate diagnostic techniques and the level of surgical treatment which can be offered today (Larsson et al., 1989; Roberts, 1989; Bortolloti et al., 1990; Lyons et al., 1991). We present a case diagnosed at post-mortem of an atrial myxoma which had subtle ante-mortem manifestations. This paper should alert the clinician with regard to the need to be aware of the rather obscure clinical presentation which may accompany this potentially treatable condition.

Single-session graded esophageal dilation with large caliber Savary dilators without fluoroscopic guidance can be safely used for the symptomatic relief in patients with lower esophageal (Schatzki's) rings. GERD should be treated if present in order to prevent a symptomatic recurrence of the ring.