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Case 1. Thrombotic-thrombocytopenic purpura (TTP, Moschkowitz' disease) in a 57-year-old woman had for one year been treated conservatively. But when daily plasmapheresis was temporarily discontinued she developed behavioural changes and impaired speech, providing an indication for splenectomy. Case 2. A 53-year-old woman with TTP had been similarly treated for one month. Splenectomy was indicated when neurological symptoms rapidly developed.At admission, creatinine 110 mg/d, white cell count (WBC) 12.4 G/l haemoglobin 10.1 g/dl, haematocrit 0.29, platelets 91 G/l. Prothrombin time (PTT) and thromboplastin time were normal. Patient 2. At admission, platelet count was below 10 G/l and she had various neurological abnormalities. Haemoglobin was 9.0 f/dl, haematocrit 0.27. Platelet count, PTT, thromboplastin time and renal functions were normal.Case 1. After plasmapheresis and administration of cryoprecipitate-free fresh frozen plasma (FFP) excess, laparoscopic splenectomy was performed. On the third postoperative day WBC count was 11.5 G/l, haemoglobin level was unchanged, but platelet count was now normal, as were PTT and thromboplastin time and renal functions. 8 and 32 months after the operation WBC count, haemoglobin, haematocrit and platelets were all normal. There were no neurological abnormalities postoperatively. Case 2. Laparoscopic splenectomy was performed after intensive haematological preparation. The pre- and postoperative course was uneventful and she was discharged on the 8th postoperative day, at which time her haemoglobin was 8.4 g/dl, haematocrit 0.25, while platelets, PTT, thromboplastin time and renal functions were all normal and remained so at follow-up 11 months later. There have been no neurological symptoms after the splenectomy.Laparoscopic splenectomy is a haematologically and surgically safe treatment of TTP and should be considered for all cases of TTP that fail to respond to conservative management.

Among 345 patients with Hodgkin's disease (HD) in full remission and followed for a mean of 7.2 years (11 months-26 years) since the initial diagnosis, 33 were found to have a second malignancy. The cumulative incidence after 10 years was 13.5%, after 15 years 21%. Non-Hodgkin lymphoma was the most frequent (n = 7), followed by bronchial carcinoma (n = 5) and acute myeloid leukaemia (n = 3). There was a definitely increased risk in elder patients (P0.001) and in those who had had a splenectomy. There was no demonstrable effect of type of therapy, primary stage and frequency of recurrence. It is concluded that patients with Hodgkin's disease should have life-long oncological follow-up. This preliminary study is being extended into a multicentre investigation of a larger number of patients.

64 patients with extensive non-Hodgkin lymphomas were treated with a modified MOPP scheme. 41 patients had stage IV disease. 59 patients responded to treatment. In 22 cases complete remission was obtained and in 37 cases partial remission. The proportion of complete remissions was the same for reticulosarcoma (9 out of 28) and lymphosarcoma (7 out of 22). The remission rate for Brill-Symmers disease was higher (6 out of 14). For patients with lymphosarcoma the average duration of complete remission was 26.9 months and for patients with reticulosarcoma 25 months. 42 of the 59 patients who responded to treatment survived one year, 33 of them two or more years. After a two-year period there were no more deaths.

In two patients in the blast phase of chronic myeloid leukaemia there was a marked rise in serum potassium levels, while plasma potassium was at the lower range of normal and there were no signs of hyperkalaemia clinically. After reduction of the pathological cells under cytostatic treatment the serum potassium levels returned to normal. This in-vitro phenomenon seems to be more common in patients with marked thrombocytosis and leukaemia than has previously been thought. In such patients hypokalaemia may be undetected because serum potassium levels arenormal. Pseudo-hyperkalaemia exists when the potassium level is normal in plasma obtained by centrifugation immediately after the blood sample has been taken, without addition of plastic spheres and at once separated from the blood cells.

The course of disease in 61 consecutive patients with non-Hodgkin lymphoma of high grade malignancy, treated between 1979 and 1985 with either CHOP or COP-BLAM regimen, was analysed retrospectively. Both groups showed a highly similar distribution of prognostic variables. COP-BLAM treatment resulted in significantly more complete remissions (23 of 27) than CHOP (11 of 29, P = 0.001). Life expectancy was, therefore, considerably higher in the COP-BLAM treated group. The mean observation period, however, was longer for CHOP-treated patients (37 vs. 30 months. The higher remission rate of the COP-BLAM regimen was not compromised by a substantial increase in toxicity; no therapy-related death was observed. Thus, the COP-BLAM regimen appears to be superior in inducing complete remissions in aggressive non-Hodgkin lymphoma. Actual survival curves suggest that this corresponds to an increased proportion of cured patients, but longer follow-ups are needed.