["Near-drowning". First aid at the scene of the accident. The need for aftercare and intensive therapy facilities (author's transl)]

Accidental drowning caused asphyxia which without active intervention leads to hypoxemic lesions of the entire organic system, the brain being the weakest spot. Contrary to earlier ideas derived from animal experiments, differentiation into the various pathomechanisms of drowning is irrelevant for emergency treatment and intensive medical aftercare. In all cases, arterial hypoxemia with its consequences are the main problem. Whereas in serious cases the victim of drowning is of necessity given modern intensive treatment, there is a danger for the less severe cases of "near-drowning" that intensive treatment does not appear essential at first and consequently they are usually neglected.

Case report. An immediate hemolytic transfusion reaction apparently caused by anti-Dia

The Diego blood group system has had its primary applications in population genetics and anthropology, although it can also give rise to clinical problems. Anti-Dia has ofter been reported to cause hemolytic disease of the newborn. The patient presented in the report experienced an immediate hemolytic transfusion reaction apparently due to anti-Dia. We believe it to be the only such case reported since the Diego system was first discovered in 1956.

[Severe forms of imported malaria concerning three pernicious attacks and a black water fever (hemoglobinuria) (author's transl)]

Four severe cases of imported malaria are reported here. Three of them are pernicious and the fourth is a black water fever (hemoglobinuria). The difficulties of initial diagnosis are exposed. There was no mortality in these four cases which represent the annual recruiting of a multipurpose intensive care unit. But the complications are severe in contradiction with easy effective chemoprophylaxis. The principles of treatment and prophylaxis are resumed in the light of these four observations.

Serum glutamic oxalacetic transaminase, glutamic pyruvic transaminase, gamma-glutamyl transpeptidase and glutamic dehydrogenase levels in favism

Serum GOT, GPT, gamma-GT and GLDH were determined in 15 G-6-PD-deficient subjects during a hemolytic crisis and hemoglobinuria due to ingestion of fresh fava beans. The same G-6-PD-deficient subjects were studied again 2 months after the crisis, when they were asymptomatic. 15 normal healthy children served as controls. A statistically significant increase, above normal, in serum GOT, GLDH and gamma-GT was observed in the favic subjects during the crisis. All the values reverted to normal in the asymptomatic period.

Delayed haemolytic transfusion reactions due to anti-C

In 5 patients of phenotype ccDEe or ccDEE, the transfusion of 2--14 U of C-positive blood was folloued 5--9 days later by haemoglobinuria lasting 2--4 days. Anti-C was the only antibody present in all 5 cases but was always of low titre; with CC cells the maximum titre recorded with the indirect antiglobulin test was 8 and with the agglutination of enzyme-treated cells, 128. The discordance between the weakness of the antibody in vivo and the amount of haemoglobin released intravascularly is surprising but may be related to the type of IgG molecule of which anti-C is composed.

Acute renal failure following scorpion sting

Fifteen cases of acute renal failure follwoing scorpion sting were studied. The onset of disease was characterized by the occurrence of hemoglobinuria within 24 h of the sting. Most of the patients developed oliguria, edema, hemolytic anemia, and hemolytic jaundice. Renal failure developed within a few days after the sting, and in five patients was severe enough to need dialysis. The onset of diuresis in oliguric patients occurred between 6 and 21 days following the sting. Renal biopsies were possible in four cases and showed mesangial proliferation, variable degrees of tubular changes, and mild interstitial infiltration. The pathogenesis of acute renal failure in these patients is discussed

Paroxysmal cold hemoglobinuria

The clinical and hematological features of a rare autoimmune disorder, PCH, are reviewed. Based on the case reports of 24 patients suffering from this disease, the presence of cold hemolysins in the sera of these patients as the main cause for the red cell destruction following exposure to cold is further discussed. However, recent electron microscope and biochemical studies suggest, in addition, that alterations of the red cells, and especially of their membranes, may play a role in the hemolytic process. The role of other factors, such as thermal range, specificity, and the immunological properties of the Donath-Landsteiner antibodies, as well as the role of the complement in the cold and warm phase of the Donath-Landsteiner reaction, is discussed. The differential diagnosis between PCH and the closely related CHD is outlined. While most of the reports deal with the mechanism of red cell destruction, relatively little attention is given to the treatment of the disease. It appears that the oldest remedy, i.e., warming of the patient and prevention of his exposure to cold, remains the best.

Child abuse and hemoglobinuria

Hemoglobinuria occurred in two children following severe beating. The development of transient oliguria in one child and acute renal failure in the other emphasizes the importance of early recognition of these unusual complications in the syndrome of child abuse. Appropriate therapy should be given to prevent or lessen the severity of acute renal failure in this clinical situation.

Necrotic arachnidism

Ten bites by Loxosceles reclusa, the North American brown recluse spider, are reported from South Carolina. Envenomation by the brown recluse spider is becoming a public health problem in the United States. The spider reportedly now is found from coast to coast in the southern half of the country and its range is probably increasing. The spider bite varies in intensity, causing reactions ranging from an area of severe necrosis to a mild cutaneous reaction. Treatment is unsatisfactory, and no antivenom is currently available. Even though a specific test is available for loxoscelism, diagnosis remains difficult.

Benign hemoglobinuria following transfusion of accidentally frozen blood

A patient was transfused with a unit of red blood cells that had been frozen accidentally prior to transfusion. Although he had received approximately 60 gm of free hemoglobin intravenously, the patient's only clinical reaction was massive hemoglobinuria. The benign clinical response, in the presence of massive hemoglobinuria, is attributed to the absence of immunologic imcompatibility and, thus, failure to activate vasoactive mediators and disseminated intravascular coagulation. The case illustrates revised concepts of the pathophysiology of acute renal failure associated with hemolytic blood transfusion reactions.

Sudden hemolysis indicating prosthetic valve dysfunction

Ten months after aortic valve replacement (Björk-Shiley prosthesis) a 57-year-old man had thrombotic encapsulation of his prosthetic valve. The only clinical manifestation of this serious complication was gross hemoglobinuria. The management of the patient is described. The slightest change in the condition of a patient after prosthetic valve replacement should be viewed as a possible sign of thrombosis.

Exertional hemoglobinuria

A 16 years old boy had a typical exertional hemoglobinuria after walking with his new leather shoes on. The attacks of hemoglobinuria were associated with the appearance of an unstable hemoglobin in red cells. A slightly decreased fragility curve by 24 hr incubated red cells, the increase of autohemolysis and the appearance of heat labile hemoglobin were observed after exertion. These findings support that exertional hemoglobinuria may be regarded as a transitory erythropathia.