Pygopagus conjoined twins.

mild congestive phenomena. In such cases it appears justifiable to rely upon physiotherapeutic measures while in bed, and early ambulation, to prevent venous thromboembolism. In the case of older patients with severe congestive failure, however, oral anticoagulant drug therapy can be expected to prevent venous thromboembolism after the second week, and such prophylaxis is clearly indicated if its possible early thrombogenic tendency can be overcome. Concurrent high-dosage intravenous heparin therapy during the first week or 10 days may surmount this difficulty, but, with the methods at present in use, would seriously interfere with the prothrombin estimations necessary for accurate adjustment of the dose of oral anticoagulant. Rapid attainment of therapeutically desirable prothrombin levels by means of heavier initial loading doses of a quicker acting oral anticoagulant such as ethyl biscoumacetate (Weiner et ac., 1955), perhaps with heparin for the first day or two, may offer a preferable alternative.