The past few years have seen an explosion of scientific advances, and many have been translated into new diagnostic or therapeutic approaches to patients with disease. We have been able to continue our research efforts. We instituted testing for approximately 50% of patients with occult clotting disorders. For patients with bleeding problems, we have been able to study several new synthetic and biologic substances which can be used either prophylactically to prevent a bleeding episode or to treat one. For patients with oral surgical procedures or vaginal bleeding who cannot appropriately stop hemorrhage because of inadequate clotting factors, a novel and highly concentrated nasal spray containing a synthetic adrenaline analog has been developed and is highly successful. Our work has just led to the licensing of this new product. Several biologicals are being developed to treat a common coagulation deficiency, von Willebrand's disease. These are derived from human blood and are virally-inactivated to prevent HIV or hepatitis transmission. Four new "recombinant" factors are being studied for hemophiliacs, and we serve as a major test site. A common genetic coagulation defect found more frequently in Jewish persons of Eastern European origin has not until recently been able to be treated with a safe blood product. Such a product has been developed in England, and we serve as a national study center for this material. Hemophiliacs and von Willebrand's disease patients with and without AIDS continue to be treated at our comprehensive multi-discipline center at Mount Sinai.