Obstruction of the Superior Vena Cava of Twenty-Five Years' Duration

Abstract

be beneficial while preparations are being made for splenectomy.Five platelet transfusions given to three subjects with aplastic anemia showed survival times of four to six days. A representative result is charted in figure 6. The effect of the transfused platelets in increasing clot retraction is illustrated in figure 7. Hirsch and Gardner have reported a similar experience.16b These results are good enough to be of practical value in helping to support a patient during periods of temporary depression of platelet formation. They are limited, however, by the fact that platelet antibodies seem to develop, so that with repeated transfusions the platelet survival becomes progressively shorter.16b If platelet types could be determined in a practical manner, so that platelets of the same sérologie type could be given, the therapeutic value of these transfusions might be greatly increased. CONCLUSIONS 1. The plasma of some patients with idiopathic thrombocytopenic purpura contains a thrombocytopenic factor that lowers the level of circulating platelets and damages megakaryocytes. 2. The spleen probably plays at least a dual role in this disease, particularly in the removal of sensitized platelets and sharing in antibody production. 3. Specific platelet groups probably exist; isoimmunization by incompatible platelet transfusions seems to occur. 4. Platelet transfusions are of limited therapeutic importance but may be of value in idiopathic thrombocytopenic purpura immediately prior to splenectomy and in acute aplastic anemias until the bone marrow recovers. Their effectiveness is limited by the fact that platelet survival tends to decrease progressively when repeated transfusions are given. 600 S. Kingshighway Blvd. (Dr. Sprague).Intrinsic Asthma.-We have gotten away from the old idea that the paranasál sinuses were important foci of infection in relation to asthma. While at times this may be true, the sinusitis, especially the hyperplastic form, more often is a result of the allergic processes rather than its cause. Radical operations should not be done unless there exists extensive suppuration which cannot be improved by other methods, especially modern biotherapy. We seldom have had to resort to such procedures in our patients and, as 1 have reported elsewhere, the assumption that asthma is of infectious or intrinsic origin often is based upon the inability to find the specific cause; it then becomes a simple matter to conclude that the patient has a bacterial allergy and to treat him accordingly. While the asthma may be due to bacterial allergy, such a conclusion should not be reached until every effort has been made to find a nonbacterial factor or, if not, to treat the patient as though it were nonbacterial. Wherever necessary, of course, vaccines, whether stock or autogenous (especially those obtained by bronchoscopic aspiration), may be useful adjuncts provided they are used with caution and in small doses. In the past three or four years, we have been employing the intracutaneous method of administration for va...