Edson F. Fowler

Traumatic rupture of the spleen, with special reference to delayed splenic rupture

Abstract 1. 1. The incidence of both acute and delayed splenic rupture is increasing due to high speed travel and now represents 0.15 per cent of all hospital admissions due to trauma. 2. 2. The incidence of delayed splenic rupture is high, being present in eight of our twenty-four cases, an incidence of 33.3 per cent. 3. 3. Splenic rupture is frequently associated with rib fractures. It occurred in 3.9 per cent of a consecutive series of 153 fractures of one or more of the lower left eight ribs. 4. 4. Six of our twenty-four cases with splenic rupture had associated left lower rib fractures. 5. 5. The establishment of a clinical baseline with respect to blood count, hematocrit and blood volume is clearly indicated. Frequent repetition of these tests is fundamental to the diagnosis of delayed splenic rupture. 6. 6. The presence of a left basal pleuritic response as demonstrated by x-rays taken more than twenty-four hours after injury is highly suggestive of delayed splenic rupture. This response was present in 83.4 per cent of our cases. 7. 7. Of sixteen cases of acute splenic rupture, three patients died soon after admission to the hospital because of multiple injuries including skull fracture. Of the remaining thirteen patients who came to surgery, all survived except one with aleukemic leukemia who died from his disease. 8. 8. There was no mortality in eight cases of delayed splenic rupture.

The water tolerance of the hypertensive patient. Its relation to operability

Abstract Normal water tolerance is defined as the ability of the individual to reconcentrate the urine during a period of four hours and to eliminate the ingested water mostly in the first two hours. Six patterns have been described which show response of the kidney to the ingestion of 1,500 c.c. of water. The patterns have been correlated with the results obtained in hypertensive patients following dorsolumbar sympathectomies. It seems that a certain group of failures could be avoided by excluding from surgery patients with crippled renal function. These patterns presumably indicate irreversible renal damage or such extra renal factors which sympathectomy does not influence.