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Two cases of thrombocytopenic purpura in heroin addicts are described. The laboratory findings in these two cases are detailed, and the management in the emergency room is outlined.

Solutions of reduced hemoglobins from patients with either SS, SC, or CC hemoglobinopathies precipitated when heated for two minutes at 100 degrees C at pH 9.20 in the presence of 3.64 M urea, while hemolysates of normal adult AA and newborns (FA hemoglobin) remained clear. In patients with hemoglobin C trait (AC) having 30% or more C hemoglobin, precipitation also occurred. The conditions of pH and urea concentration affording precipitation of hemoglobin S approximated those observed for hemoglobin C.

A case of acute and spontaneous spinal epidural hemorrhage is described in which there was no history or evidence of trauma, conventional anticoagulant therapy, hemophilia or vascular anomalies. A recent history of excessive ingestion of an aspirin-containing medication was obtained and the clinical and laboratory picture of an aspirin-induced bleeding disorder was documented. We have discussed the mechanism and hematological considerations of the syndrome of aspirin induced bleeding.

Arterial blood pressures (BPs) in 187 adult patients with sickle cell disease, casually recorded during hospitalization or clinic visits, were compared with BPs from age- and sex-matched populations of black Americans. The BPs in those with sickle cell disease were significantly lower than those in the control populations in all ages and did not demonstrate the expected rise with advancing age. In these patients, there was no difference between BP and sex, degree of anemia, or hemoglobin genotype. Four patients had diastolic and two had systolic hypertension. The prevalence of hypertension was significantly less than that in the block population. These BP findings in sickle cell disease may be due to the renal tubular defect responsible for increased sodium and water excretion, which may blunt the plasma volume expansion necessary for sustained hypertension and thus promote lower arterial pressures, similar to that situation observed in patients with salt-losing nephritis.

Headache is a rare symptom in multiple myeloma (MM). A 34-year-old black female presented with severe headache and investigation subsequently led to the diagnosis of non-secretory MM. Non-secretory MM is seen in less than one percent of MM cases. Further-more, less than two percent of MM cases are seen under the age of 40 years. An increasing number of cases of MM are being described in young adults. Attention is drawn to entertaining a diagnosis of MM even in those under age 40 years who may manifest unusual features of the disease.

Two brothers 62 and 70 years old, without evidence of vitamin B12 lack, excreted 12 to 115 mg of methylmalonic acid daily (normal, less than 9 mg per day). Neither had anemia or hepatic dysfunction, and serum vitamin B12 concentrations ranged from 369 to 800 pg per milliliter. The propositus, the younger brother, continued to excrete excessive methylmalonate, 103 to 115 mg per day, after 2000 mug of parenterally administered vitamin B12 at the fifth and 11th months of study. Leukocyte activities of the cobalamin-linked enzyme methylmalonyl coenzyme A mutase were respectively reduced in the propositus and his brother, to 0.04 and 0.11 nmoles of 3-(14)-C Ls methylmalonyl coenzyme A metabolized per hour per milligram of leukocyte protein (normal, 0.286 +/- 0.079 [S.D.]). These activities were not enhanced by 2 mug of 5'-deoxyadenosylcobalamin added to the assays. A heritable benign form of adult methylmalonic aciduria rather than vitamin B12 lack best explains these findings.

Giorgio, Anthony J. (University of Utah, Salt Lake City), G. E. Cartwright, and M. M. Wintrobe. Preparation of a copper-deficient medium for yeast growth. J. Bacteriol. 86:1037-1040. 1963.-A simple, rapid, and effective means was described for removing trace amounts of copper without removal of other growth nutrients from synthetic media. The complete synthetic medium minus added copper was batch-extracted with zinc dibenzyldithiocarbamate in carbon tetrachloride. The concentration of copper in extracted media was 0.3 to 1.7 mug per liter of media as compared with 8 mug per liter before extraction. Yeast growth in extracted media to which copper was added was comparable with growth in unextracted media. Yeast growth in copper-deficient media was significantly impaired. The growth requirement of two different strains of Saccharomyces cerevisiae was of the order of 10 mug of copper per liter of medium.