A 15-year-old girl was admitted after 1 week of increasing fatigue and pallor. She had no gastro-intestinal complaints. The patient had suffered from four episodes of syncope during the last 3 days prior to admission. Besides pallor and a discrete cardiac murmur, the physical examination was normal. A further thorough investigation revealed an iron deficiency anaemia related to a Helicobacter pylori positive chronic active haemorrhagic gastritis. Treatment consisted of amoxycillin and colloidal bismuth subcitrate (500 mg and 120 mg orally respectively, 3 times daily) during a period of 6 weeks. Iron supplements were not administered. Together with the clearance of H. pylori and healing of the haemorrhagic gastritis, as demonstrated by histology, haemoglobin values returned to normal and the symptoms disappeared. An eradication of the micro-organism was obtained. She has since had no further similar complaints.

Patients with haemophilia appear to have a reduced incidence of coronary artery disease and of its related mortality [1], principally because they are less prone to develop acute occluding thrombi. However, they might not be protected from atherosclerosis as revealed by clinical studies [2] and autopsy of haemophiliacs with fatal myocardial infarction showing extensive atherosclerotic lesions but only rare fresh thrombi [3].In recent decades major advances have been made in the management of haemophilia resulting in an increase in life expectancy which is now estimated to range between 60 and 70 years. The prevalence of cardiac disease in the haemophiliac population is, therefore, likely to increase, which will, in turn, require greater need for cardiac investigation and treatment.At present, 36 cases of myocardial infarction in patients diagnosed with haemophilia A have been reported in the literature [3]. In 25 of these cases the infarction occurred during or after the infusion of one or more of the following products: factor VIII (FVIII) concentrates, activated and non-activated prothrombin complex concentrates, recombinant factor VIIa (rfVIIa), desmopressin and antifibrinolytic drugs.We report here the case of a 57-year-old male patient with a history of severe haemophilia A (W255R mutation of the exon 7) who was referred to our hospital because of an acute coronary syndrome.The day of the hospitalization he had two episodes of severe chest pain radiating to his neck and left arm. The pain occurred after a physical effort and was relieved by sublingual nitroglycerine. He did not receive infusion of recombinant factor VIII (rfVIII), prothrombin complex concentrates or rfVIIa preparations in the previous 2 weeks.The patient was diabetic, obese (body mass index = 31 kg m )2 ) and was treated for hypertension and mild hypercholesterolemia. A recent liver biopsy demonstrated a non-alcoholic steato-hepatitis. When the patient arrived to the emergency room, he was hypertensive (160/100 mmHg) but free of chest pain. The rest of the examination was unremarkable. Initial laboratory analysis showed blood count, creatinin, creatin phosphokinase and troponin I within the normal range. Prothrombin time was normal whereas activated partial thromboplastin time (APTT) was 72 s and FVIII level <1%, consistent with the diagnosis of severe haemophilia A. An electrocardiogram (ECG) revealed an acute ischemia in the inferior territory.During his stay in the emergency room, the patient had a third episode of chest pain. He was therefore transferred to the intensive care unit and treated with aspirin 100 mg day )1 , clopidogrel 300 mg loading dose followed by 75 mg day )1 and continuous intravenous perfusion of heparin. Thirty minutes before the initiation of intravenous heparin, he received a bolus injection of 50 IU kg )1 of rfVIII, 25 IU kg )1 4 h later, and then a continuous intravenous infusion was started with an initial rate of 3 IU kg )1 h )1 , to achieve a FVIII level of 80%. Factor VIII plasma level was measured daily in a...

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Eosinophilic gastroenteropathy in children is a rare, idiopathic disease characterized by eosinophilic infiltration of the gastrointestinal tract. We describe a 10-day-old boy with aspecific clinical manifestations (unconsolable crying). Treatment with a semi-elemental diet was successful, suggesting a "milk-sensitive enteropathy", although he had been exclusively breast fed. Recent literature is reviewed.