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Fifty-four patients with deep venous thrombosis diagnosed on the basis of venographic studies were treated by four physicians using the same protocol but acting independently. In the early part of the study all patients were treated with streptokinase; in the latter part patients were randomized and treatment was either heparin or streptokinase. Of 40 patients who. received streptokinase, 22 were randomized and 18 were nonrandomized. Both drugs were administered by continuous IV infusion for 72 hours. Patients treated with streptokinase in the early stages of disease did very well; 90% of patients treated within five days of the onset of clinical symptoms and 75% treated within two weeks of onset showed marked improvement on post-treatment venograms. Only one patient who was treated with heparin showed a good result. Clinical results were similar in both groups. The incidence of important complications, such as significant bleeding and pulmonary emboli, was the same with both modalities. Fever of more than 101 F developed in about 50% of patients treated with streptokinase but in only one patient treated with heparin. We conclude that streptokinase is very effective in treating patients with acute deep venous thrombosis.

The authors report the first known example of hypoxic-ischemic white matter necrosis limited to one cerebral hemisphere. The patient was a 63-year-old man who developed signs of a stroke following a myocardial infarct after a left carotid endarterectomy and died seven days later. At autopsy, extensive necrosis of centrum semiovale was found only in the cerebral hemisphere supplied by the endoarterectomized carotid artery. A recent thrombus was found at the site of the endarterectomy, and the right common carotid artery was completely occluded by an old thrombus. This observation probably is explained by a well-established collateral blood supply to the right cerebral hemisphere, which protected it from the effects of the hypotension that accompanied the myocardial infarct.