Sandbox:Prince

George Washington, the United States’ first president, 2 yr after leaving office on December 13, 1799, was reported to have “a cold” and mild hoarseness. The next morning, around 2:00 AM, he had difficulty breathing. By 6:00 AM, he was febrile, had throat pain, and experienced respiratory distress. Three physicians were called to his side and tried various remedies, all without success.1 Washington died at 10:20 PM, likely due to bacterial epiglottitis. If he had lived and received care 200 yr later, the outcome might have been different.

Variable	Empyema Thoracis	Lung abscess	parapneumonic effusion	Pneumonia	Lung cancer

Von Willebrand disease (vWD) is the most common genetic coagulation disorder described in humans. It affects up to 1% of the population, although most cases are mild. Symptomatic vWD is much rare, ~1 in 10000. Von Willebrand disease arises from a qualitative or quantitative deficiency of von Willebrand factor (vWF), a large glycoprotein protein that is required for platelets to bind to collagen. vWF is therefore important in primary hemostasis. When the disease comes to medical attention, it usually presents in the typical manner for platelet disorders: mucosal bleeding and easy bruising. The disease is usually inherited in an autosomal dominant manner, although there are recessive forms as well, and it can also be acquired secondary to another disease.

diagnosis hxThe disease is characterized mainly by mucosa-associated bleeding and bleeding after surgery and trauma. The diagnosis is based on a personal or family history of bleeding and laboratory evidence of abnormalities in von Willebrand factor, factor VIII, or both.