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The rationale for splenectomy in childhood is briefly described, the technique employed is discussed, some complications are elucidated, and the expected mortality is considered.

IN GENERAL, complications of corticosteroid therapy are the same as the manifestations of spontaneous Cushing syndrome. We shall discuss each of these complications. Abnormalities of Fat Distribution.— There is increased deposition of fat in the supraclavicular, cervicodorsal, and the anterior neck areas, as well as in the face, which becomes rounded. These complications produce cosmetic damage only, and cannot be overcome except by reduction of steroid dosage. Generalized obesity tends to occur and should be minimized by caloric restriction. Loss of Muscle Mass Causing Weakness and Fatigue.— The administration of corticotropin rather than of individual glucocorticoids, or the use of adjuvant therapy with an anabolic agent probably reduces muscle wasting but at the frequent expense of causing hirsutism. Skin Changes.— The skin becomes erythematous, especially over the face, becomes thinned (probably because of reduced protein content), loses its elasticity, and shows stretch marks or "striae" in areas overlying large deposits

The detection of platelet isoantibodies by the release of (3H)serotonin from platelets has been evaluated. The conditions for optimal release of (3H)serotonin with platelet isoantibodies using a microtechnique have been defined. A group of cardiac surgery patients were followed pre- and post-transfusions, with 48percent developing a positive serotonin release assay. Of these patients, 16percent also had a platelet complement-fixing and/or lymphocytotoxic isoantibody. There was variation in the degree of correlation between (3H)serotonin release and lymphocytotoxicity using individual National Institutes of Health typing serum. The matching obtained between family members by both techniques showed a close correlation when each technique was evaluated separately using the same NIH typing serum. The detection of iso-antibodies in patients with hematological malignancies correlated with the unresponsiveness to unmatched platelet transfusions in 15 out of 17 cases. The use of the patient's isoantibody to matched platelets of family members by (3H)serotonin release correlated well with the clinical response to transfusion with these platelets. The data suggest that (a) platelet isoantibodies can be detected with increased frequency by (3H)serotonin release; (b) (3H)serotonin release is a specific reaction depending on the surface antigen of the platelet; and (c) the method can be used to match compatible family members for platelet transfusions.

The clinical sign of livedo reticularis derives from stasis of blood in the superficial venous drainage systems of the skin. Many factors can delay the flow of de-oxygenated blood away from the skin, notably hyperviscosity of the blood itself and obstruction due to disease affecting dermal arteries, capillaries, or venules.

The concept that hysterectomy is of value in the management of septic abortion induced by instillation of soap or phenolic antiseptics into the uterus is challenged. Nineteen out of 20 such cases with renal failure were managed with intensive antibiotic therapy, peritoneal dialysis and an absolute minimun of surgical intervention. Seventeen patients recovered, with normal renal function. Of the 11 known to be subsequently exposed to conception seven have achieved normal pregnancies.20 cases of septic abortion were reviewed, all of which had suffered septic shock and renal failure attributed to intrauterine instillation of soap or phenolic antiseptic solutions, which were treated at Hammersmith Hospital from 1965-1972 to determine proper management of such patients. 19 were managed conservatively, from a surgical point of view, with 13 not even having the products of conception removed from the uterus. Intensive antibiotic treatment and peritoneal dialysis were the principles of management. 17 of the 19 recovered; all 17 retain normal renal function. Of these 17 survivors, 7 have had normal pregnancies, but only 11 of the 17 have been exposed to conception.

The lung may be an important endocrine organ in disease. Endocrine dysfunction of the lung may be manifested by (1) syndromes due to ectopic secretion of hormones, usually from bronchogenic tumors; (2) other systemic syndromes, possibly attributable to humoral factors from the lung; and (3) pulmonary and systemic disorders mediated by the release from the lung of biologically active substances. The latter category includes anaphylaxis, and some reactions to pulmonary embolism, hypoxia, pulmonary edema and respiratory alkalosis.

Many reports have associated tuberculosis with haematological abnormalities. These reports suggest that disseminated tuberculosis, if associated with reduced tissue cellular reaction, may cause blood dyscrasias. Eight patients, presenting with features suggesting primary haematological disease, are described in whom investigation confirmed or strongly suggested underlying disseminated tuberculosis. From a study of these reports it is suggested that dissemination of tuberculosis may, in some individuals, provoke blood dyscrasias by altering normal immunological reactions. A classification of possible blood findings in tuberculosis has been made and a policy for management of patients with such abnormality is discussed.

Tolerance of patients receiving 1000 rad total body irradiation at the low dose rate of 5 rad/min prior to bone marrow transplantation is presented. The striking gastrointestinal tolerance is stressed and, as a result of this experience, results in five patients with ovarian carcinoma receiving total abdominal irradiation with similar low dose rate irradiation are presented. Possible explanations for these results are presented and other potential applications of this technique are suggested.

Mycoplasma pneumoniae is a well recognized respiratory pathogen in children and young adults. In addition, M. pneumoniae infections may also involve other organ systems. Reviewed here are the various clinical syndromes in adults caused by this infectious agent, with emphasis on those which have recently been seen at The New York Hospital. Two previously unreported manifestations of M. pneumoniae infection, cranial nerve mononeuropathy and hepatitis, are described, and the laboratory methods for diagnosis are discussed.

Thirty-six coses in which anticoagulants have been turned to nontherapeutic (or “disease”-producing) purposes have been reported. Most patients, referred to as “Dicumarol-eaters,” are women who are members of the medical profession or persons previously treated with an anticoagulant. Other c

It was shown by Pincus and Klebanoff that a correlation existed between leukocytic iodination measured in vivo and microbicidal leukocytic activity. We have analyzed the results of this test in relation to time and in the presence of variable quantities of polymorphonuclear leukocytes (PMN). The values observed per time and PMN unit proved to be equivalent in the presence of 2.5 X 105 PMN or 5.0 x 105 PMN per 0.5 ml of incubation medium, measured after 10, 20 and 30 minutes or in the presence of 1.0 x 106 PMN, measured after 10 minutes. That is to say iodination is proportional to leukocyte concentration and incubation time. Increase of either the quantity of cells or the incubation time, beyond the area we defined, reduced iodination per cell and per unit of time. Concerning the patients with an insufficient iodination, we have studied 2 parameters in the presence of 5.0 x 105 PMN: 1) initial iodination measured after 10 and 20 minutes and 2) stability of iodination measured after 60 minutes. These two parameters were equally affected in two cases with myelofi-rosis, 3 patients with acquired refractory anaemia, one with chronic lymphoid leukaemia, one with erythroleukaemia, one with hairy cell leukaemia, one with systemic mastocytosis and almost complete myeloperoxidase dificiency, one with sickle cell disease, two with liver diseases and two with chronic myeloid leukaemia. The iodination at the 60th minute was more affected than at the 10th minute with a patient with myelofibrosis and 4 other patients with acquired refractory anaemias. The significance of these differences is not well understood; however the meaning of the decrease in the iodination of whatever type is that a PMN anomaly exists directly related to the myeloperoxidase H2O2 halogenation system, or to one of the stages of engulfment and/or metabolic events preceeding it and leading to the production of H2O2. This test, with the alterations we introduced, is suggested as a test for detection of functional PMN abnormalities.

Megakaryocytes from 5 patients and 1 normal person were observed electronmicroscopically. In some pathologic states platelets seemed to be liberated without demarcation membrane system (DMS) and in a normal individual they seemed to be liberated independently of DMS. These findings suggest that DMS is not concerned with platelet liberation and that platelets are liberated through pseudopodia and bleb formation. In mature megakaryocytes vigorous amoeboid movement seems to exist and both pseudopodia and blebs may represent this movement. Structural similarity between surface connected system (SCS) of platelet and DMS of megakaryocyte suggests that the structure called DMS is transported as SCS into platelet.

During the past 27 years from 1944 to 1970 splenectomy was performed on 53 patients including 33 idiopathic thrombocytopenic purpura (ITP), 13 hereditary spherocytosis and 7 hypoplastic anemia. Their clinical and laboratory findings in immediate and late postoperative periods were compared with those received medical treatment alone. In the chronic form of ITP the effect of medical treatment alone is only transitory and not curative. Splenectomy seems to be the treatment of choice in this situation which produces long term favorable results regardless of patient's response to preoperative steroid treatment. In hereditary spherocytosis the improvement in the morphology of red blood cells was limited after splenectomy, but considerable improvement was achieved in hemolytic tendency. Therefore, splenectomy would be the first choice. In hypoplastic anemia splenectomy did not produce, in general, favorable results as compared in ITP or hereditary spherocytosis. However, when the patient responded to steroid treatment preoperatively, splenectomy could have reduced the frequency and amount of blood transfusion. Splenectomy would then be contemplated in such situations.

An autposy case of a 30-year-old house wife with malignant hemangiothelioma of the heart was reported. This case was also accompanied by marked anemia, thrombocytopenia, leukoerythremoid reaction and hypofibrinogenemia. The spread of tumor was so wide that only the alimentary tract and the skin were free from metastases of the tumor. Many of the metastatic foci showed marked hemopoiesis intra tumori. A short discussion was made on the hematological abnormalities associated with vascular tumors.

It was attempted to describe the morphology of the most immature cell of megakaryocytic series. The megakaryocytes were observed with the electron microscope in five cases, being traced back to their immature forms. In two cases the most immature cells of megakaryocytic series were considered to be the cells which were probably identified as lymphocytes under the light microscope, but they were not lymphocytes with the electron microscope. In other two cases it was presumed that neutrophilic and megakaryocytic series were derived from morphologically similar immature cells, since the most immature cells of neutrophilic and megakaryocytic series were not distinguished when they were traced back to their immature forms. These findings suggest that mother cells of mega-karyocytes in the adult bone marrow may be identified as lymphoid cells with the light microscope.

16 patients with chronic liver or haematologic diseases were parenterally given various doses of Desferrioxamine B (DF). Each daily dose of DF (from 1 to 4 g) was given for a 7 days cycle. Liver, kidney and blood functions were investigated at the first and seventh day of each cycle, and 1 and 2 weeks after therapy was stopped. 1 g/day and 2 g/day had no side effects, with the exception of a fall of white blood cell (WBC) count in a single case on 2 g/day. 3 g/day (15 patients) were followed by rises of blood urea, creatinine, alkaline phosphatase and glutamyl-transpeptidase respectively in 4 cases, and by falls of WBC count in 3 cases. 4 g/day (9 patients) caused rises of creatinine, GPT and GOT (1 case) or LDH (1 case), while WBC count dropped in 4 cases. All changes were reversible within one-two weeks. These recorded changes were outside the range of pretreatment values as obtained over the previous four weeks.

Nach intravenoser Injektion von14C-Nikotin wurde bei der normalen Maus mit Hilfe der Ganzkorperautoradiographie im Knochenmark und in der roten Pulpa der Milz eine kraftige und langanhaltende Ansammlung der Radioaktivitat festgestellt. Kombinierte autoradiographische und histochemische Untersuchungen der Milz bestrahlter, mit Knochenmark transplantierter Mause haben weiter gezeigt, dass das radioaktive Nikotin und/oder dessen Metabolite innerhalb des hamatopoietischen Gewebes hauptsachlich in den erythropoietischen Zellen lokalisiert ist.

Ten patients underwent 50–70 percent plasma exchanges using the continuous flow cell separator. The exchange material consisted of Plasma Protein Fraction (PPF) and Lactated Ringer’s Solution (LRS) instead of fresh frozen, modified or lyophilized plasma. No bleeding or other complications were encountered. The coagulation factor activity after exchange was above that required for hemostasis. The procedure is safe, expeditious and efficient.

The relationship between marrow distribution as imaged with 99mTc sulfur colloid and histologic estimate of bone marrow cellularity was examined in 101 patients. The patients were divided into three groups according to marrow cellularity: normocellular, hypercellular or hypocellular marrow. The marrow distribution of these patients was graded as extended, not extended or not visualized. A general association between marrow cellularity and marrow distribution was found. Seventy-seven per cent of patients with normocellular marrow had limitation of marrow within normal sites and a similar number of patients with reactive hypercellular marrow had marrow extension. On analysis of the patients that were exceptions to this generalization the following observations were made. In patients in whom the marrow is hypercellular and infiltrated with abnormal cells or tissue the marrow distribution may not be visualized with radiocolloid. Stimulation of hematopoiesis may result in marrow hypercellularity without marrow extension beyond the usual sites. Stimulation of one or more hematopoietic cell lines may result in marrow extension without marrow hypercellularity, suggesting an impairment of hematopoietic cell response. Peripheral marrow extension as observed with radiocolloid, therefore, is not simply a reflection of marrow hypercellularity but probably represents a response of the bone marrow stroma to situations in which one or more hematopoietic cell lines is stimulated.

The effect of an orally effective adrenergic blocking agent, Dibenzyline, on serum cholesterol levels was studied in human subjects and in monkeys on high-fat diets. In addition, the effect of the phenoxyethyl analogue of Dibenzyline, G-D 131, was also investigated in monkeys. The studies showed that the increase in serum cholesterol level brought about by a high-fat diet in monkeys could be considerably reduced by supplementation with Dibenzyline. This hypocholesteremic action was also observed with the analogue of Dibenzyline, G-D 131, which does not possess the adrenergic blocking property. It appears, therefore, that the hypocholesteremic action of Dibenzyline is independent of its adrenergic blocking activity. When a high-fat diet which also contained a high amount of cholesterol was used, Dibenzyline retarded the increase in serum cholesterol of monkeys for a considerable length of time. Administration of Dibenzyline, 10 mg. daily for 11 days, brought about a fall in serum cholesterol in two of the three human subjects and arrested the further increase in serum cholesterol in the third subject on a high-butterfat diet. All the subjects showed increased fecal elimination of cholic and dihydroxycholanic acids during the Dibenzyline-supplemented period, suggesting that the hypocholesteremic effect of the drug is at least partly mediated through increased elimination of cholesterol as bile acids.

In a retrospective study of 952 skull X-rays taken in a few Lagos hospitals, it was found that the over-all incidence of calcification of the pineal gland was surprisingly low: 5.04% compared with the

Agents reviewed include anticonvulsants, antibiotics, sedatives, thiazides, aspirin, antihistaminics, tranquilizers, and antidepressants.

A model was made for the computation of the liver and spleen volumes from the areas outlined on parallel ultrasonic scanning sections. Liver volume was determined in 20 patients with minor non-hepatic disorders. The mean body weight was 68.9 kg. The mean estimated liver volume was 1611 ml, which agreed well with liver volume calculated from an allometric equation, 1574 ml. The reproduceability was tested in double determinations; SD was 90 ml or 5.5 per cent of the mean. The accuracy of the method was assessed by comparing spleen volumes, evaluated by the ultrasonic method, with organ weights following splenectomy in 9 patients suffering from haematological diseases. The correlation coefficient was 0.98.

Simultaneous determinations of anaerobic glycolysis, hexokinase activity (HxK), glucose-6-phosphate dehydrogenase activity (G6PD) and acetyl-cholinesterase activity (AChE) were made in the whole red cell populations of patients and of healthy subjects, and in the layers of the centrifuged cell packs of selected patients to give regression lines for each parameter plotted against each of the others. Apparently normal interrelationships were found in blood loss and in haemolytic disease of various origins. Abnormalities were revealed which would escape notice if a single parameter were assayed. These were relative, not absolute, deficiency of anaerobic glycolysis in a case of congenital nonspherocytic haemolytic disease with no deficiency of G6PD, HxK or pyruvate kinase; of HxK in a case of unexplained anaemia; and of AChE in a case of Coombs positive haemolytic disease. In a case of paroxysmal nocturnal haemoglobinuria AChE was severely deficient while glycolysis, HxK and G6PD were extraordinarily high and appeared normally interrelated. The patient had been transfused just before these studies, and calculations based on the enzyme data led to the hypothesis that in this case the donor cells were rapidly destroyed. Observations in normal blood showed that values for G6PD and AChE occur as two independent normal distributions. The same was true for glycolysis and AChE. Glycolysis and G6PD were correlated but did not approach a perfect functional relationship. There is evidence that high G6PD unrelated to red cell age occurs in malignant disease, but it is not conclusive.

Summary 100 babies (98 with haemolytic disease of the newborn) have been observed during exchange transfusion. Serial estimations of plasma potassium, sodium, chloride, protein, total calcium, citrate, and certain organic acids have been made in selected cases. We have found a positive correlation but not an absolute one between a high plasma citrate concentration and illness or death during exchange transfusion. It is possible that citrate directly or indirectly is the cause of these crises. We have outlined a plan for conducting exchange transfusion using bank blood collected in ACD which in our hands has proved satisfactory in the past three years. Resume 100 enfants, dont 98 atteints de maladie hemolytique du nouveaune, ont ete observes pendant l'exsanguino transfusion. Des dosages du potassium, du sodium, des chlorures, des protelnes, du calcium total, du citrate et de certains acides organiques ont ete pratiques dans certains cas selectionnes. Nous avons trouve un rapport qui n'est toutefois pas absolu entre une concentration trop forte de citrate plasmatique et des exsanguinotransfusion mal supportees, voire fatales. II est possible que le citrate en soit la cause, directement ou indirectement. Nous avons esquisse notre maniere de pratiquer l'exsanguinotransfusion permettant d'utiliser des sangs ACD qui, durant ces trois dernieres annees, s'est demontre, quant a nous, satisfaisant. Zusammenfassung 100 Neugeborene, wovon 98 einen Morbus haemolyticus neonatorum aufwiesen, wurden wahrend der Austauschtransfusion genauer beobachtet. Bei einzelnen ausgewahlten Fallen wurden Reihenbestimmungen des Plasma-Kaliums, -Natriums, der Chloride und Proteine, des Gesamt-Calciums, des Zitrates sowie gewisser organi-scher Sauren durchgefuhrt. Wir beobachteten eine positive, wenn auch nicht absolute Korrelation zwischen hohen Plasma-Zitrat-Konzentrationen und Schadigungen bzw. Tod des Kindes wahrend der Austauschtransfusion. Es ist moglich, das das Zitrat die direkte oder indirekte Ursache dieser Zwischenfalle darstellt. Wir beschrieben eine Methode zur Durchfuhrung von Austauschtransfusionen unter Verwendung von ACD-Blutkonserven, welche uns wahrend der vergangenen drei Jahre gute Dienste geleistet hat.

A study has been made of 82 histologically verified cases of medulloblastoma under 15 years of age referred for irradiation to the Royal Marsden Hospital between 1950 and 1964. The age range was 11 months to 14 years. The ratio of boys to girls was 2.2:1.The tempo of the disease is faster in children than in adults and the younger the patient the more rapidly will unsuccessful cases die. Survival rates are greater for girls than for boys. In some cases with brain-stem involvement radiotherapy can cure or control locally advanced disease for an appreciable time. There is no correlation between outcome and histologic grade of tumor. The survival rate is greater for patients in whom a "complete" surgical excision of the tumor was performed, compared with lesser procedures.Of 68 unselected cases followed for 5 years, 22 (32 per cent) have survived, and of 34 cases, 9 (26 per cent) are alive at 10 years.The treatment advised for medulloblastoma is surgical exploration with removal of as much of the tumor as po...

methylmalonic acid was first isolated from pooled human urine in 1957 by Thomas and Stalder and convincing evidence has since been obtained to show that in man the isomerization of l-methylmalonyl-Co A to succinyl-Co A is dependent on the B12 coenzyme dimethylbenzimidazolyl cobamide (White, 1962). Indeed, Cannata, Focesi, Mazumder, Warner and Ochoa (1965) showed recently that l-methylmalonyl-Co A mutase bears two molecules of cobamide coenzyme firmly attached to its molecule. In a series of 30 patients Cox and White (1962) detected excessive methylmalonic acid in the urine of all patients with serum vitamin B12 levels below 140 pg./ml., their lower limit of normal. Patients with normal serum B12 levels excreted up to 4 mg. of methylmalonic acid in 24 hours. Their series included six patients who were treated with intramuscular hydroxocobalamin (1000 μg.). In five of these, excretion fell to normal within 3 days, and on the fifth day after injection in the sixth patient. Barness, Young, Mellman, Khan and Williams (1963) reported one vitamin B12 deficient patient in whom the urinary excretion of methylmalonic acid reached 500 mg. in 24 hours. Recently Khan, Williams, Barness, Young, Shafer, Vivacqua and Beaupre (1965) have described seven out of nine patients with pernicious anaemia in whom methylmalonic acid excretion persisted for some months after the institution of B12 therapy. This occurred despite full clinical and haematological remissions and in four patients, normal serum vitamin B12 levels. The present study was undertaken to determine the value of urinary methylmalonic acid excretion as a screening test for vitamin B12 deficiency. The estimation of methylmalonic acid was carried out by a rapid thin layer chromatographic technique, suitable for routine laboratory use. Normal controls and patients suffering from general haematological and medical disorders were screened as well as patients suffering from megaloblastic anaemia. In several patients the excretion of methylmalonic acid was followed for a short period after B12 therapy.

The following conclusions were drawn from the ferrokinetic studies using 59Fe in mice, whose hematological disorders were induced by various treatments. 1. The ferrokinetics in the normal mice were studied. 2. Chloramphenicol (CP) administration in mice first induced ferrokinetics disturbances and then suppressed erythropoiesis. 3. Splenectomy induced hyper-erythropoiesis in the bone marrow, and CP administration after splenectomy suppressed this hyper-erythropoiesis. 4. Human gamma-globulin (H.G.G.) caused hypersplenism and a marked suppression of erythropoiesis in the bone marrow, and Chlorabulin administration suppresed erythropoiesis. Finally, the author has summarized the relationship of the RES function and hematopoiesis in mice as follows. 1. The spleen and liver reacted in the same manner with respect to the RES function to sequestrate 51Cr-labelled heat-damaged erythrocytes when hematological failures were induced. 2. The spleen and bone marrow reacted reversely with regard to the RES function. 3. When the RES function, especially that of the spleen was accentuated, the suppression of hematopoiesis was observed. 4. Chloramphenicol administration was followed by the suppressed hematopoiesis and the accentuated RES function. 5. Splenectomy accentuated the RES function in the bone marrow and liver, and also increased hematopoiesis in the bone marrow. 6. Human γ-globulin hypersensitization induced hyperfunction of the RES, especially of the spleen and suppression of the hematopoiesis.

Summary On the basis of recent findings concerning the chemical nature of serum bilirubin, the authors recommend regular quantitative investigation of serum levels of both direct and indirect bilirubin in newborn infants with hemolytic disease. They distinguish between two forms of hemolytic disease of the newborn, the first with the predominant disturbance of bilirubin metabolism in the transformation of indirect to direct bilirubin by conjugation with glucuronic acid. The second form is presumed to involve associated impairment of the excretion of direct bilirubin from the liver. In the discussion are presented some conclusions for therapy which follow from their observations. A preliminary report is given of the results of therapy with thiocapryllic acid in two cases. Ľimportance du dosage quantitatif de la bilirubine directe et indirecte dans des cas ?une affection hemolytique chez le nouveau-ne. En se basant sur des recherches recentes concernant la nature chimique du serum-bilirubine, les auteurs recommandent de faire regulierement des investigations quantitatives de la teneur en serum de la bilirubine directe et indirecte chez les nouveauxnes avec une affection hemolytique. lis distinguent deux formes ?affection hemolytique chez le nouveau-ne. La premiere est celle avec la perurbation predominante de la bilirubine par la conjugaison avec de ľacide glycuronique. La deuxieme forme est celle dont on suppose qu'elle entraine une diminution associee de ľexcretion de bilirubine directe du foie. La discussion renferme quelques conclusions concernant la therapeutique, qui sont issues de leurs observations. Un rapport preliminaire a ete redige sur les resultats ?une therapeutique avec de ľacide thiocaprylique, appliquee dans deux cas. Die Bedeutung der quantitativen Bestimmung von direktem und indirektem Bilirubin bei hamolytischer Krankheit des Neugeborenen. Auf der Grundlage neuerer, die chemische Natur von Serumbilirubin betreffenden Feststellungen, empfehlen die Verfasser regelmassige quantitative Untersuchungen der direkten sowohl als auch indirekten Bilirubinspiegel im Serum von Neugeborenen mit hamolytischer Krankheit. Sie unterscheiden zwei Formen von hamolytischer Krankheit des Neugeborenen, die erste mit vorherrschender Storung des Bilirubins durch Verbindung mit Glukuronsaure. Die zweite Form schliesst, so wird angenommen, eine zugesellte Beeintrachtigung der Exkretion von direktem Bilirubin aus der Leber ein. In der Erorterung werden einige Schlussfolgerungen fur die Behandlung, welche sich aus ihren Beobachtungen ergeben, dargeboten. Ein vorlaufiger Bericht uber die Ergebnisse der Therapie mit Thiokaprylsaure bei zwei Fallen wird angegeben. Importancia de la determinacyon cuantitativa de la bilirrubina en la enfermedad hemolitica del neonato. Fundandose en hallazgos recientes con respecto a la naturaleza quimica de la bilirrubina serica, recomiendan los autores se investiguen tanto cuantitativa como legularmente, los niveles sericos de ambas bilirrubinas directa e indirecta en los ninos recien nacidos, afectos de enfermedad hemolitica. Se distinguen dos formas de enfermedad hemolitica en el neonato, la primera con perturbation predominante de la bilirrubina en conjugation con el acido glucoronico; la segunda, se infiere esta asociada con excretion deteriorada de la bilirrubina directa, procedente del higado. En la discussion, se presentan algunas conclusiones para fines terapeuticos, como resultado de las observaciones hechas. Casuistica preliminar de los resultados terapeuticos obtenidos con acido tiocaprilico en dos sujetos.

A detailed clinicopathological study of the causes and locations of massive nontraumatic brain hemorrhage in 144 patients is reported. A cause of the hemorrhage, such as an aneurysm, angioma, arteritis, neoplasm or a blood dyscrasia (leukemia, hemophilia), was proved in two-thirds (95) of these patients. Twelve normotensive patients had no cause found to explain their hemorrhage. Systemic hypertension, generally mild, defined as a pre-ictal pressure of > 140/90 or by excessive heart weight, was present in 58 of the 144 patients. Twenty-one of these 58 hypertensive patients had a clear discernible cause for their brain hemorrhage (i.e., leukemia, metastatic carcinoma, angioma, aneurysm), whereas no satisfactory morphological cause could be found in only 37. Thus, in only about one-fourth of our patients could any serious claim be made that hypertension was the cause of the hemorrhage. Our data would indicate the need for a critical study of the causes of intracranial hemorrhages, and re-evaluation of the true relationship of systemic hypertension to such strokes. The widespread dogma that hypertension is the outstanding cause of nontraumatic brain hemorrhage no longer seems warranted.