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Although the thrombotic risk of heparin-induced thrombocytopaenia (HIT) is well recognized and may affect any vascular bed, the involvement of adrenal veins has been less commonly described. We report the case of a 86-year-old woman who developed bilateral massive adrenal haematoma associated with HIT, resulting in acute adrenal insufficiency. After immediate discontinuation of heparin and starting therapy with danaparoid and hydrocortisone, the clinical evolution was favourable, although adrenal failure was irreversible. When abdominal pain, hypotension and fever occur during heparin therapy, associated with a drop in platelet count, acute adrenal insufficiency secondary to HIT should be considered, as early diagnosis is essential for the treatment of this life-threatening complication.

A 19-year-old man was admitted with acute dyspnoea. Physical examination revealed subcutaneous emphysema in the cervical and thoracic area. This was further confirmed by the total body computed tomography that also demonstrated mediastinal emphysema. Epidural pneumatosis of the thoracis spine was also evident. There was no history of trauma, but well of a recent oral ecstasy consumption during a techno rave party, associated with intense dancing and jumping. Clinical course was favourable with conservative therapy.

Haemangiopericytoma is a rare tumor of vascular origin. We report the case of patient with severe refractory anaemia due to peripheral destruction of red blood cells by spleen metastases. Anaemia was successfully treated by splenectomy. Afterwards, our patient developed liver and lung metastases and was treated, in a clinical trial, with gefitinib that stabilised the disease during nine years. These interesting features are discussed.

Calcifying fibrous pseudotumor (CFPT) is a rare pseudotumoral lesion initially described in the subcutaneous and deep soft tissues. More recently, 3 cases were reported in the pleura. We report an unusual presentation associating miliary pleural lesions with a single soft tissue lesion in a 29-year old, asymptomatic female patient. The multitude of pleural lesions prevented complete excision. Although the present case confirms an indolent process, the pathogenesis and long-term prognosis remain undetermined.

SummaryWe report the case of a patient who presented with cardiac and neurological signs of lithium toxicity as the result of an association with amitriptyline.These manifestations disappeared spontaneously as medication was stopped. We review the possible physiopathological mechanisms that could account for these adverse effects.

SummaryTwo cases of pulmonary complications, caused by Plasmodium falciparum are reported. The first patient presented with an adult respiratory distress syndrome, of favourable evolution with a treatment combining antimalarial drugs, hydric restriction, continuous positive airway pressure and heparin. In the second patient, an asymptomatic interstitial pulmonary oedema was observed. In both cases, the prominent pathophysiological role of diffuse intravascular coagulation and the pronostic value of parasitaemia are outlined.

SummaryIn a retrospective study, the modifications of liver enzymes (SGOT, SGPT, Y glutamyl transpeptidase-Y GT-) and platelet counts have been analyzed in a series of patients treated with heparin administered cither intravenously (Group I, n=ll) or subcutaneously (Group II, n= 11) bccausc of deep-vein thrombosis.In the first group, a progressive increase of serum transaminases developed in all patients, reaching maximal values (3.1 times the baseline values for SGOT, 3.9 times for SGPT) after 7 to 8 days of heparin therapy. In 10 patients, a significant elevation of Y GT (2.3 times the baseline values) was also observed. No concomitant changes in AP levels or in platelet counts were noted. In the second group, similar but less pronounced modifications were observed: increase of SGOT (2.2 times the baseline values) in 7 patients, elevation of SGPT (3 times the baseline values) in 10 patients and of Y GT (2.2 times the baseline values) in only 3 patients. No significant changes in AP levels or in platelet...

SummaryThe authors present a case of self-induced fever by auto-inoculation in a heroin addict. The initial diagnosis was tricuspid endocarditis.Endocarditis in the heroin addict and selfinduced lesions by auto-inoculation are briefly discussed.