Adult hemolytic-uremic syndrome. Familial variant.

We describe here a family with hemolytic-uremic syndrome culminating in renal failure and severe hypertension in the involved male adults. Members of this family developed a microangiopathic hemolytic anemia, progressive renal failure, the onset of elevation of blood pressure, and an untimely death in young adulthood. One affected family member has survived the initial crisis. The family history presents further evidence for an autosomal dominant pattern of inheritance of hemolytic-uremic syndrome with presentation in adulthood.

Emergency transvenous (subclavian) cardiac pacing in elderly patients.

Emergency transvenous cardiac pacing can be performed in elderly patients rapidly, effectively, and with few complications. An experienced physician using the subclavian route usually can achieve effective pacing with equipment priced well within the budget of most community hospitals. Data on 36 patients (age range, 75-94 years) are presented.

Case report: Infectious mononucleosis in a 41-year-old man.

A 41-year-old man was found to have infectious mononucleosis, a disease frequently overlooked in patients of this age group. The symptoms and signs observed in this patient are seen in less than 10% of patients with this disease: arthralgia, epistaxis, jaundice, skin rash, and pneumonitis. Although mildly depressed platelet counts are common in patients with infectious mononucleosis, the count in this patient was markedly depressed.

Temporary cardiac pacing. Diagnostic and therapeutic indications.

Temporary cardiac pacing is a useful tool both diagnostically and therapeutically. A wide array of methods are available for delivering such pacing to the myocardium. Careful patient evaluation, which includes ruling out the use of certain drugs and the presence of certain diseases, will help determine the most desirable pacing therapy. In an emergency situation, transcutaneous pacing is the ideal modality for use by the primary care physician.

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Peritoneal dialysis: its potential for use in the community hospital.

Peritoneal dialysis is a treatment of proven efficiency for a variety of disorders. Experience with 53 peritoneal dialyses performed on 28 patients over a three-year period at two community hospitals without permanent house staffs is summarized. Proper adherence to a few basic principles can lead to a very low incidence of complications, especially those of an inflammatory nature. This form of dialysis has considerable potential for the small community hospital. Training programs should make the knowledge and skill of this technic available to those wishing to learn it, and especially to those considering practice in communities removed from the medical center.

Bedside emergency transvenous cardiac pacing: experience in two community hospitals.

Emergency bedside transvenous subclavian cardiac pacing in 51 patients over a three-year period in two community hospitals is described. Fifty-three procedures were performed at the bedside with semifloating bipolar pacemaker catheters under continuous electrocardiographic monitoring to assist in the placement of the catheter tip. Of the 53 procedures, initial success in pacing was observed in 41 patients (77%). The largest number of failures to either initiate or maintain pacing was observed in the group with cardiac arrest associated with extensive myocardial infarction and complete heart block. Complications of this procedure were minimal. Only one 10% pneumothorax was noted. This modified technique is easily mastered and may prove lifesaving in an emergency.

Acute abdominal pain precipitated by phenformin-associated lactic acidosis.

Phenformin-associated lactic acidosis is an important though unusual cause of acute abdominal pain. Its clinical picture suggests other catastrophic abdominal entities. A representative case is presented. Aids to arriving at this diagnosis are presented and the specific therapy is outlined. The pathophysiology of this condition is discussed.