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Upon admission to the hospital, 7,984 patients were tested for hepatitis B surface antigen (HBsAg) by radioimmunoassay. Seventy-one patients had sera positive for HBsAg. Twenty-four (34%) were possible asymptomatic carriers in whom liver function was not further evaluated and occult liver disease could not be excluded: 16 (23%) had either a previous history or admitting diagnosis of hepatic dysfunction; eight(11%) had occult liver disease, revealed after HBsAg antigenemia was discovered; and 25 (34%) were unsuspected asymptomatic carriers whose liver function was normal. We concluded that screening for HBsAg was an effective preventive tool in identifying HBsAg-positive patients. Screening solely for the detection of occult liver disease is not an effective method because of the high cost. Perhaps because of the unsolicited nature of this data collection, screening for HBsAg was not clinically effective for the majority of patients, as evidenced by the high incidence of inadequate clinical evaluations and lack of serologic follow-up. Proposals to alleviate ineffectiveness are discussed.

Prednisone was used in the treatment of 30 consecutive patients with ITP (idiopathic thrombocytopenic purpura) under conditions that permitted the establishment of a satisfactory base line for metabolic and hematological studies, especially as to platelet count and other coagulation studies. Eleven cases were of the "acute," and 19 cases of the chronic type. The initial dose of prednisone varied between 20 and 150 mg. per day, given by mouth. The results ranged from complete absence of response to sustained remission without apparent need of further treatment. In 22 of the 30 cases the platelet count rose from the initial low values to normal in 6 to 150 days. Much individual adjustment of dosage was necessary. Maintenance dosages ranged from 2.5 to 15 mg. per day, but in eight patients it was possible to withdraw the prednisone entirely after establishing a normal platelet count. Splenectomy was performed in five patients of this series but was followed by complete, sustained remission in only one case. These results lead to the conclusion that in the treatment of ITP chief reliance should be placed upon such measures as prednisone therapy and transfusions, splenectomy being reserved for the occasional severe cases that do not respond to medical measures.