Acute splenic sequestration in an adult with hemoglobin S-C disease.

Acute splenic sequestration crisis is a common, potentially life-threatening complication of sickle cell anemia in children that is uncommon in adults.We present the case of a 44-year-old gentleman with undiagnosed hemoglobin S-C disease who developed intense back pain, marked abdominal distension, systemic inflammatory response syndrome, and multisystem organ failure that first presented as acute splenic sequestration crisis. The hemoglobinopathy SC is a disease caused by heterozygous-globin chain mutations with over-lapping clinical features of sickle cell disease with changes in the frequency of these manifestations reflected by the combination of characteristics of hemoglobin C and hemoglobin S. In hemoglobin S-C disease, autosplenectomy is rare and splenomegaly usually persists until adulthood;vasoocclusive complications are seen less habitually and become evident at a later time compared with sickle cell disease. The diagnosis of hemoglobin S-C disease is essentially done by exclusion. Transfusion of red blood cells is the treatment of choice, but splenectomy is indicated if transfusion therapy fails. A review of the literature and keypoints for the emergency practitioner are included.

Einthoven's string galvanometer: the first electrocardiograph.

Willem Einthoven (1860--1927), known as the creator of the electrocardiograph, won a Nobel Prize in 1924 for his contributions to the field of electrocardiography. He was dedicated to research and learning. In developing the electrocardiograph, Einthoven built on the work of earlier physiologists who had studied the electrical mechanisms of the heart. Each earlier invention proved important by contributing concepts and knowledge that would shape Einthoven's device. Herein, we review the history of the electrocardiograph, with a focus on Willem Einthoven's quest to make the device a practical clinical instrument in the diagnosis of cardiac abnormalities.