[Recurrence of common truncus arteriosus. Prenatal diagnosis of a case report]. / Récurrence de tronc artériel commun. A propos d'un cas de diagnostic anténatal.

We report a case of isolated truncus arteriosis diagnosed prenatally which recurred during a subsequent pregnancy. This observation would suggest an increased risk of recurrent single trunk malformation as compared with other congenital heart diseases, in agreement with our understanding of the genetic processes involved. A prenatal screening can be achieved with a systematic examination of the fetal morphology. Prognosis is severe and prenatal diagnosis is difficult.

Efficacy and safety of a perioperative enoxaparin regimen in total hip replacement under various anesthesias.

Four trials in which enoxaparin, a low-molecular-weight heparin, was used in patients having hip surgery are reported. In the first two trials, enoxaparin was given before general anesthesia. The protocol consisted of 40 mg of enoxaparin, 4,000 anti-factor Xa IU, subcutaneously 12 hours before surgery, followed by the same dose 12 hours after surgery and then once daily. In the third trial, this protocol was compared with unfractionated heparin calcium given in a standardized manner and appeared to be significantly superior both in efficacy and tolerance. In the fourth trial, the protocol was adapted for use in spinal subarachnoidal anesthesia; 20 mg of enoxaparin, 2,000 anti-factor Xa IU, was given subcutaneously 1 hour after anesthesia and 40 mg 12 hours later. In all these trials tolerance was good. Excessive bleeding did not occur with the 40 mg once daily regimen. Efficacy was good and compared favorably with other protocols in use.

Once-daily dosing of enoxaparin (a low molecular weight heparin) in prevention of deep vein thrombosis after total hip replacement.

The main results of three successive prospective clinical trials which represent the successive steps in the definition of once-daily dosing of enoxaparin in elective hip surgery are demonstrated. In the first trial, a dose of 40 mg/day (4000 anti-Factor Xa IU), in one or two subcutaneous injections, was preferred to a dose of 60 mg because it gave the same efficacy with a better tolerance. In a second, randomized double-blind trial, the two modes of administration of a dose of 40 mg, in one or two injections daily, were found to be equivalent with regard to tolerance and efficacy. In a third prospective, controlled, randomized, double-blind multicentre trial, once-daily dosing of enoxaparin at the dose of 40 mg was found superior to 5000 IU of unfractionated heparin tds with regard to tolerance and efficacy. It is concluded that the dose of 40 mg/day, begun 12 h pre-operatively, gives the best benefit:risk ratio in elective hip surgery.

[A rare tumour: paravesical pelvic haemangiopericytoma (author's transl)]. / Une tumeur rare: l'hémangiopéricytome pelvien paravésical.

Haemangiopericytomas are vascular tumours derived from Zimmerman's pericytes, the cells surrounding blood capillaries which correspond to the smooth muscle cells in the arterial and venous walls. This rarely observed tumour is usually found in the limbs (more than 50 p. cent of cases) or the face. Pelvic haemangiopericytomas are most frequently observed in women, and are then of uterine origin, their occurrence in men, and in the perivesical space, being exceptionally rare (seven cases reported in the publishing literature). The authors describe such a case, and review the clinical and radiological characteristics of the lesion. Diagnostic difficulties are emphasized, as confusion with a sarcoma can arise, even after histological examination. Surgical excision should be conducted routinely, but local recurrence or pulmonary metastases may occur in view of the potential malignancy of these tumours. Complementary cobalt therapy is therefore justified.