Arch Surg Chicago
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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.
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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.
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Subtrochanteric fractures of the femur comprise only 5% to 7% of hip fractures, but are important because of the difficulty in management. They combine the problem of instability to varus deformation common to comminuted intertrochanteric fractures and the problem of delayed union common to diaphysial fractures of the femur. ⋯ Improved results have been obtained by utilizing a fixation device that can control the intertrochanteric instability and that has sufficient strength to withstand deforming forces that may be present for up to a year while the fracture is uniting. Bone grafting has been found very useful in shortening the overall period of healing.