This case report illustrates that the risk of thromboembolism in the treatment of tall girls with high dose oestrogens is not negligible.

The authors report a rare case of leiomyosarcoma of the inferior vena cava (IVC) with an unusually long survival time of more than five years without signs of local or systemic tumor recurrence up to today. The diagnostic and therapeutic problems are discussed and the relevant literature is considered. The diagnosis was assessed by computed tomographic scan. The surgical treatment consisted of resection of the tumor (located in the inferior and middle third of the IVC), together with the right kidney. After proximal ligature of the left kidney vein no reconstruction of the resected segment of the IVC was performed.Owing to an adequate collateral venous drainage the kidney function remained normal. The prognosis of this rare tumor is reported to be quite poor with a resectability rate of about 60% and a mean survival time of two to three years after surgery. Alternative treatment modalities such as irradiation or chemotherapy are considered to be of no additional benefit. Case ReportA so far healthy sixty-nine-year-old woman was admitted to the hospital in the summer of 1985 with a complaint of bilateral edema of the lower extremities and vague abdominal pain since the summer of 1984. The cavography showed a complete obstruction of the inferior vena cava (IVC) and both iliac veins with a well-developed collateral circulation to the superior vena cava such as the lumbar and vertebral plexus and the azygos and hemiazygos veins (Figure 1 ).Results from the laboratory investigations were in the normal ranges. With the diagnosis of a thrombosis of the IVC the patient was anticoagulated and dismissed. She was, however, readmitted to the hospital for a progressive weight loss of more than 30 pounds in January, 1986. The edema of the lower extremities had disappeared. On physical examination a firm mass was palpable in the right lower abdomen. The laboratory findings were normal except for an elevated blood sedimentation rate of 110

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Many surgical patients receive either unfractionated or low-molecular weight heparin in a prophylactic or therapeutic intention. Feared upon the administration of heparin is the heparin-induced thrombopenia (HIT). In HIT type 1, the heparin directly interacts with the platelets. The platelet count rarely falls below 100,000/microliter and normalizes again despite continuous administration of heparin. In HIT type 2 or HIT with thrombosis (HITT) the platelet count usually falls more than 50% and due to an antibody-dependent platelet activation, thromboembolic episodes may occur. Compared to non-surgical patients, the incidence of HITT in the postoperative phase is markedly increased. In suspicion of a HITT, heparins should immediately be stopped and replaced by an alternative coagulant because of a high risk of further thromboembolic complications. Direct thrombin-inhibitors such as the recombinant hirudins are considered to be safe and effective. They have no heparin-like immunological properties and therefore, they seem to become the therapeutic and prophylactic "gold-standard" in patients with HITT.

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