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June 22, 1940


JAMA. 1940;114(25):2489. doi:10.1001/jama.1940.02810250063022

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To the Editor:—  Drs. Dean and Dulin have reported two fatal cases of pulmonary embolism following injection of varicose veins (The Journal, April 6, p. 1344). They do not state whether other nonfatal cases of embolism occurred in their total of 600 cases. The mortality of this accident is apparently high: Dean and Dulin quote Silverman's collection of twenty cases with fifteen deaths.In one of the cases reported by these writers an interval of six days elapsed between the first and the second (fatal) embolism. During this interval the patient is described as having bronchopneumonia. Despite this consequence of embolism, might it not have been possible to ligate the external iliac vein and thus forestall the subsequent fatality? I reported such an operation, done after the second embolism (Am. J. Surg.45:145 [July] 1939). It was possible with spinal anesthesia to ligate the vein above its proximal thrombosed

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