To the Editor.–The March 1974 issue of the Archives presents a striking paradox between its lead editorial (a plea for selectivity and cost consciousness in using sophisticated laboratory services) and the major symposium on treatment of portal hypertension. I will grant that the symposium is informative and well organized, but it leaves the old country doctor wondering why esophageal balloon tamponade gets short shrift.
In their section on emergency shunts, Dr. Orloff et al (108:293, 1974) emphasize specifically that "no patient was treated with esophageal balloon tamponade," and one wonders why not—if only to stop bleeding and reduce the number of transfusions needed between admission and operation.
Dr. Nusbaum and his associates (108:342, 1974) control portal hypertension by selective mesenteric arterial infusion of vasopressin, which is a beautiful way to go, in those hospitals that are geared up for the technique.
Out here in the boondocks we do see