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For the past three and a half years postoperative venous thrombosis has been treated at the Lahey Clinic largely by anticoagulation therapy. For the last two and a half years femoral section and ligation have been reserved for cases of ambulatory recurrent calf phlebothrombosis with one or more benign pulmonary emboli or postoperative cases in which a second stage operation must be carried out. So far there have been one death from pulmonary embolism and four recurrent benign pulmonary emboli in 125 cases so treated. This death occurred early in the series after anticoagulation therapyhad been needlessly abandoned to treat anemia with a transfusion. Three of the four recurrent benign pulmonary emboli recurred when the prothrombin time was not adequately reduced owing to insufficient dosage of Dicumarol (3,3'-methylene-bis-[4-hydroxycoumarin] ). In 2 of these cases Dicumarol therapy was continued, with subsequent adequate control of the prothrombin time and no further incident.

Two case-histories involving men aged 40 and 38 years illustrate the occurrence of pulmonary disease after extraction of teeth. In the first case the pulmonary symptoms commenced seven days after the extraction, with a sudden rise of temperature to 40 C on the 10th day marking the development of a pulmonary infarct. In the second case the pulmonary symptoms commenced five days after the extraction, and the subsequent course was marked by two episodes of severe chest pain indicating the development of pulmonary infarcts. Although the connection of the pulmonary symptoms with the dental procedures was not obvious at first, it became clear later that both patients had cervical phlebothrombosis which led to the pulmonary complications. It is concluded that in all cases of unexplained pulmonary infarction the patient's dental history should be considered.

Speculation has been endless in an attempt to determine why thromboembolism is still so prominent a cause of death. As early as 1934, John Homans1popularized the concept of pulmonary embolism originating in the leg veins and its prevention by venous interruption. He made the first clear differentiation of inflammatory from "bland" phlebitis. Ochsner and DeBakey2gave the latter the term phlebothrombosis. Homans also described a clinical test that has been helpful in establishing the diagnosis in doubtful cases. Following this lead, many studies have been made both in clinical and laboratory investigation, and numerous tests have been described. Venography was investigated and found unreliable. The advent of anticoagulant drugs served as an additional stimulus, and the persons studying the means of therapy divided; some favored surgical interruption of the venous system, and others favored the use of anticoagulant drugs. Despite all these advances, the overall incidence of

Though thrombosis of the cavernous sinus is not common, it is not sufficiently rare to warrant reporting isolated cases unless they possess some unusual aspects. In this article we have endeavored to survey the existing literature, both before and since the advent of chemotherapy and the anticoagulants, and to report 3 cases with unusual aspects. The term "cavernous sinus thrombosis" is used in a generic sense and includes cases of phlebitis, thrombophlebitis and phlebothrombosis as well as true aseptic thrombosis. By far the majority of cases reported are of septic origin and would therefore be classified as phlebitic or thrombophlebitic. Aseptic thrombosis and phlebothrombosis are usually secondary to trauma, a failing circulation or to other noninfectious inflammation of the cavernous sinus. Although thrombosis of the cavernous sinus is usually unilateral in its clinical manifestations, there is almost always bilateral involvement histopathologically because of the anatomic communications between the two cavernous

An increasing number of deaths have been attributed to hemorrhagic diathesis complicating bishydroxycoumarin (Dicumarol) therapy. Since its introduction to clinical use in 1941, a variety of indications have been described for the use of orally given anticoagulants.1These include nonfatal pulmonary embolism, primary and postoperative phlebothrombosis and thrombophlebitis, sudden embolic or thrombic arterial occlusion, postoperative venous thrombosis or embolism, and myocardial infarction. The hazards of anticoagulation have also been emphasized. Duff and Shull,2in their review of the first 23 fatalities due to bishydroxycoumarin therapy, summarized the most commonly encountered contraindications. Significant hepatic or renal insufficiency leads their list. Included, too, are ulcerative lesions of the gastrointestinal tract, blood dyscrasias with associated bleeding tendencies, subacute bacterial endocarditis, threatened and incomplete abortions, and obstetric cases near term. Historical Background The basic investigations of Solandt and others3paved the way for the current widespread use of anticoagulants in the