[Occurrence of hepatic hemangiomas in pregnancy]. / Survenue d'hémangiomes hépatiques au cours de la grossesse.

We report on the case of a 29-year-old woman, who had been on oral contraceptive steroids for 10 years, in whom four liver haemangiomas were found. At least two of them, and probably a third, have occurred during her second pregnancy. To our knowledge, this is the first report suggesting the occurrence of liver haemangioma during pregnancy. This case suggests that sexual hormones, especially estrogens, could play a role in the development or the occurrence of hepatic haemangioma.

[Silent myocardial ischemia during hemodialysis in patients with chronic renal insufficiency]. / L'ischémie myocardique silencieuse au cours de l'hémodialyse des insuffisants rénaux chroniques.

A prospective search for episodes of silent myocardial ischaemia (SMI) was carried out during sessions of haemodialysis in 62 patients with chronic renal failure and was positive in 37.1% of the cases. The occurrence of SMI is correlated with the number of cardiovascular risk factors (p = 0.008) and particularly with diabetes (p = 0.012), smoking (p = 0.007) and age (p = 0.02), as well as with the type of nephropathy that had caused the renal failure (p = 0.02). During a 6-month follow-up two patients died; both had silent myocardial ischaemia on Holter recordings. In these anaemic patients, haemodialysis might sensitize the detection of ischaemia by the concomitant occurrence of hypotensive, hypovolaemic or hypoxic episodes, thus playing a aggravating role. The existence of such episodes characterizes a subgroup of patients at high cardiovascular risk for whom the prognosis and the best therapeutic approach remain to be determined.

[Frequency of painless myocardial ischemia during hemodialysis in 50 patients with chronic kidney failure]. / Fréquence de l'ischémie myocardique indolore au cours de l'hémodialyse de 50 insuffisants rénaux chroniques.

The authors carried out a prospective study to determine the frequency of silent ischemia (SI) in 50 consecutive patients with end stage renal failure during dialysis by Holter monitoring. Twenty patients had SI (40%). This event was related to the number of cardiovascular risk factors (p = 0.0025), principally diabetes, smoking and the underlying renal disease (p = 0.018), and to a history of coronary artery disease (p = 0.0015). Two patients died during the nine months follow-up period and both had SI on Holter monitoring. Dialysis therapy in anaemic patients may predispose to and facilitate the detection of myocardial ischemia by the simultaneous interplay of hypotension, hypovolemia, hypoxia and tachycardia. The detection of these ischemic events may allow identification of a subgroup of dialysis patients with a high cardiovascular risk. The prognosis of these patients and best therapeutic approach require further study.