Arch Surg Chicago
-
Two patients with splenic abscess were successfully treated. In one patient, Streptococcus viridans, possibly arising in a dental abscess, led to inflammatory left upper quadrant signs. An exploratory laparotomy was performed, and the spleen, being found enlarged, was removed. ⋯ Laparotomy was done for pyrexia of unknown origin, and the removal of a normal-sized spleen was elected on the suspicion of lymphosarcoma. The spleen was abscessed, apparently because of old infarcts. A high index of suspicion is important in diagnosis, and selective angiography, not used in these two patients, is recommended.
-
Intermittent mandatory ventilation allows a gradual transition from mechanical ventilation to spontaneous breathing. This is accomplished by providing a continuous source of fresh gas from which the patient can breathe as ventilator rates are decreased from 1 to 2 per minute. Monitoring of arterial blood gas tension values documents the safety of further withdrawal of ventilatory support. Many patients are more easily and safely weaned by this method than by conventional techniques.
-
Profound hypercalcemia associated with immobilization is rare. Hypercalcemic crisis occurring as a result of immobilization in which there was not a coexisting, contributing medical condition has not, to our knowledge, been reported previously. ⋯ Review of previously reported cases emphasizes the difficulty in recognition and diagnosis of this unusual condition. Surgeons treating patients with fractures should be aware of this complication and familiar with its appropriate therapy.