[Vomiting, abdominal pain and weight loss with an acquired anatomical cause: superior mesenteric artery syndrome].

Superior mesenteric artery syndrome (SMAS) is a rare and acquired anatomical condition characterized by vomiting, abdominal distension, weight loss and postprandial distress due to compression of the transverse portion of the duodenum between the superior mesenteric artery (SMA) and aorta, which causes duodenal outflow problems. We report a case series of three patients with SMAS. Diagnosis of the syndrome was made by augmenting a high degree of suspicion with repeat gastroscopies, CT scans and hypotonic duodenal contrast series showing compression of the horizontal part of the duodenum located between the vessels specified above.

Recurrent bacterial cholangitis due to a juxtapapillary diverticulum.

We present a patient with recurrent bacterial cholangitis. Endoscopic retrograde cholangiopancreatography did not show evidence for choledocholithiasis or obstructing abnormalities of the common bile duct. However, a juxtapapillary diverticulum was situated at the edge of the papilla of Vater.

[Two patients with emphysematous pyelonephritis].

A 55-year-old man with diabetes mellitus was sick with shivering, abdominal pain and Escherichia coli in blood and urine cultures; a 40-year-old woman with asthmatic bronchitis had abdominal pain and anaemia. Both had renal dysfunction and the CT scan showed hydronephrosis with a perirenal inflammatory infiltrate and gas in the right and left renal pelvis, respectively. The man had a difficult recovery after treatment with antibiotics and percutaneous drainage.

Deep-vein thrombosis and coumarin skin necrosis associated with a factor V inhibitor with lupus-like features.

We report a 71-year-old man who developed deep-vein thrombosis after major surgery. Coumarin skin necrosis developed after starting oral anticoagulant therapy. An inhibitor to factor V (61 Bethesda units) with lupus-like features was found as well as a low protein C level.

[Hypothermia during use of pipamperone].

Two women aged 84 and 86 years developed hypothermia after use of pipamperone. In one of the patients repeated administration of pipamperone again induced a decrease of body temperature. Although other clinical and environmental factors may have contributed to the development of hypothermia, a causal relationship between the use of pipamperone and the fall in body temperature appears likely considering the close temporal relationship.