Maurice Morrison

Mediastinal lymphosarcoma in an infant; twelve-year survival following radiation therapy.

Summary 1. A case of primary lymphosarcoma of the mediastinum occurring in a 7-month-old infant is reported. Rapid disappearance of the neoplasm followed 1,360 r. units of x-ray therapy and the child has been asymptomatic and apparently cured for the past twelve years. 2. The diagnosis of lymphosarcomais not a hopeless one. Apparent cures do occur following prompt and adequate therapy.

The prediction of thromboembolism.

The pathogenesis and the natural course of thromboembolic disease have now been elucidated in their main outlines. Similarly, the chief processes of coagulation have also been established though important details are still the subject of much controversy. An extensive literature has arisen in an attempt to correlate changes or aberrations of the coagulative mechanism with clinical thromboembolism. Particularly, a great effort has been made to identify some prethrombotic, or thrombophilic, or hypercoagulable state which might indicate either an imminent thrombosis, or the actual presence of thrombi. Since the diagnosis of these potentially lethal clots is admittedly very difficult on clinical grounds alone, some other mode of diagnosis or prediction is necessary if prophylactic anticoagulant therapy is to be selectively employed. The main approaches to the prediction of thromboembolism have been: 1. Statistical-pathological analysis and 2. Measurements of blood coagulability. A pilot experiment was run by the authors to see whether a battery of tests preand postoperatively could be used under mass testing conditions to ferret out potential clotters. It soon became apparent that these tests, 1) Lee-White Coagulation time, 2) Platelet clustering (1), 3) In vitro heparin tolerance of Waugh-Ruddick (2, 3), 4) Clot retraction time (Hirschboeck) (4, 5), and 5) Onestage prothrombin time, both whole and dilute plasma (6) bore little relation to

Abnormalities in Serum Proteins in Cooley's Anemia

Serum protein fractionation has, during recent years, been performed in many disease states. In some instances, the pattern of protein distribution is virtually diagnostic. In most, however, the changes are at best suggestive of certain disease states. Antibodies generally migrate in the gamma fraction of serum proteins and quantitation of gamma globulin has been one means of studying abnormalities in antibody production.’ Thus, serum protein electrophoretic fractionation has been studied in other situations when an indirect look a t antibody formation has been desired. In this regard, problems in tissue transplantation2 have been studied as well as the more prosaic problems of resistance to infection, allergy, and more recently autoimmune disease.3 The basis for the observations we now present was encountered during an effort to evaluate patients with a variety of diseases noted for their clinical susceptibility to infection and the ability to maintain tissue grafts.‘ Studies were performed to evaluate the degree of delayed cutaneous hypersensitivity to which skin grafting is apparently related! Patients were skin tested with six antigens prepared from organisms to several of which most individuals have been exposed and should therefore show a positive reaction. Patients with Hodgkin’s disease, chronic lymphatic leukemia, carcinomatosis, lymphosarcoma and postsplenectomy states, plus a miscellaneous group of patients and controls were studied.5 In addition, a group of 14 patients with thalassemia major was included, since i t has long been recognized that these patients have great difficulty with infections especially after splenectomy. The skin testing revealed no absolute anergy inasmuch as all reacted to one or more antigens. In conjunction with skin testing, protein electrophoresis was performed. The group of patients with thalassemia was distinct in that all showed high levels of gamma globulin.’ The gamma globulin elevation was striking, for in none of the previously mentioned patient groups of comparable size was any such trend found. These patients who are being managed medically by several physicians nevertheless have been treated with the same philosophy. They were USUally permitted to go without blood transfusions until symptoms of anemia appeared. As a result, most transfusions were given between hemoglobin ranges of four to seven gms. per cent. In recent years, all transfusions have been with packed red cells. Those patients who had undergone splenectomy were chosen because of developing hypersplenism manifested by increas-