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The syndrome X is a clinical disease characterised by anginous pain with the absence of significant and angiographically visible stenosis of the coronary tree. D. P. M., a 61-year-old woman suffering from biliary lithiasis, underwent cholecystectomy. During the immediate postoperative period, the patient showed difficulty in regaining consciousness and there were electrocardiographic signs of extensive anterior ischemia; prior to the operation only a 1st degree atrio-ventricular block and a positive history of occasional precordial pain had been reported. On the 2nd postoperative day the patient complained of violent retrosternal pain irradiated to the left shoulder. Given that the signs of ischemia had regressed, various instrumental tests were performed: echocardiogram, cycloergometric test, dipyridamole test, cold pressure test, Holter's dynamic ECG, all of which were within the normal; moreover, selective coronarography did not reveal significant stenosis of the coronary tree. The patient was therefore diagnosed as suffering from syndrome X. In the light of the present case, the authors conclusion may be summarised as follows: the diagnosis of syndrome X, which is by definition not easy, may sometimes become critical, as in the present case, since rapid intervention would have enabled prophylactic therapy to be performed to combat surgical stress.

After examining the most recent findings on the physiopathology of the renin-angiotensin system, techniques are analysed for the determination of renin activity (PRA). These are still inadequate and imprecise, notwithstanding radioimmunological techniques and stress is laid on the importance of their standardisation. Analysis of the various forms of arterial hypertension shows that PRA measurement has clinical value only: 1) in nephrovascular hypertension; 2) in primary hyper-reninism; 3) in primary hypercorticosuprarenalism; 4) to back up an indication for bilateral nephrectomy in terminal nephropathies with uncontrollable pressure value. At the present time, however, it would appear that PRA does not have any clinical utility for the study of essential hypertension.

The first therapeutic response to cirrhotic ascites should be a salt-free diet and bed rest. Only if this fails should anti-aldosterones, furosemide or mannitol be adopted. After an examination of the reasons for using any of these drugs, either alone or in association, it is emphasised that thiazide should never be used to treat cirrhotic ascites. Its use has been common practice for years on the basis of apparently convincing empirical evidence. Finally it is pointed out that any treatment should be approached with caution with more emphasis on the patient than on the ascites itself.