[Acute abdomen caused by enalapril].

This case report describes an unrecognized adverse effect of an ACE inhibitor (enalapril): attack of acute abdominal pain. This symptom was observed 3 times over a period of 5 years in a 43 year old woman, occurring 24 h after she was taking the ACE inhibitor, and disappearing 3 to 5 days after the withdrawal of enalapril.

[Which screening tests should be chosen in 1994 in the cascade of primary hyperaldosteronism (Conn's syndrome)? Apropos of 3 personnel cases].

On the occasion of three cases of primary hyperaldosteronism the author expresses disapproval of the recently published recommendation of a general screening for aldosterone, plasma renin activity and their respective quotient in all hypertensive patients. Compared with the rareness of the disease, this screening seems extremely expensive and mostly useless. Even in view of the possibility of delaying diagnosis of extremely rare cases of normokalemic primary hyperaldosteronism by three to five years--an occurrence without negative consequences--the author recommends as a first step to follow clinical parameters by repeated determination of potassium and to engage highly specific and expensive tests not before strong suspicion for hyperaldosteronism arises.

[A rare clinical form of angioneurotic edema caused by enalapril: acute abdomen].

The authors reports an unrecognised secondary effect, but perhaps not as rare as has been thought, of enalapril: the acute abdomen. Three similar cases have previously been reported. The underlying mechanism is probably the inhibition of degradation of tissue kinins to inactive peptides as in subcutaneous and/or submucous angioneurotic oedema.

[The long QT syndrome: importance of phonocardiography and ergometry].

The chronological relationship between the S2 of the phonocardiogram and the T wave of the ECG, and the behaviour of the QT and QTc intervals, have been investigated in two cases of idiopathic long QT syndrome (LQTS) at rest and during effort. At rest and during effort with heart rates (HR) under 120/min, the S2 is always abnormal before the end of the T wave where the QTc interval is generally prolonged, but is sometimes within normal range (less than or equal to 440 msec). In cases where the QTc interval falls within normal range, the use of Bazett's formula to calculate the QTc interval may mislead and cause the existence of LQTS to be overlooked.

[Spontaneous precordial pain: coronary spasm or esophageal pathology?].

Chest pain due to esophageal spasm or esophagitis may mimic pain of variant angina. Differential diagnosis of the two diseases is often difficult and requires various tests, the value of which is discussed. These problems are illustrated by three cases.