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This review will address the general approach to the management of the typical elderly patient requiring anticoagulation. Most of the data has been derived from studies of patients with nonvalvular atrial fibrillation. Data from postmyocardial infarction trials have also been included. A practical clinical approach to anticoagulation in the elderly is described. Emphasis has been placed on maximizing the benefit and reducing the risk of anticoagulation in the rapidly expanding group of elderly patients aged >/=75 who are at the greatest risk of stroke and are likely to benefit the most from antithrombotic therapy.

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An unusual and rare case of broad ligament leiomyoma with massive ascites and bilateral pleural effusion is described. The ascites and pleural effusion resolved dramatically following removal of the tumor. Patients with pseudo‐Meigs' syndrome may present a diagnostic problem as they masquerade as carcinoma with malignant effusions. Thus they should always be considered for exploratory laparotomy.

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Medical termination of a first trimester intrauterine pregnancy associated with large and multiple leiomyomas posed a unique problem because the sac was inaccessible per vaginum for surgical or vacuum evacuation. The use of prostaglandins was contraindicated due to a past history of bronchial asthma. But intraamniotic and intraplacental instillation of methotrexate, 25 mg at each site, under ultrasound guidance resulted in termination of pregnancy. No side effects or complications were observed after the procedure.

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