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We present three case-reports of splenic abscess in patients who were initially diagnosed with bacterial endocarditis. In all cases the diagnosis of splenic abscess was based on the findings of abdominal CT scan or MRI. All patients were treated by laparotomy and splenectomy. Two patients fully recovered and one patient, who suffered from splenic rupture and massive blood loss before surgery, died. Splenic abscess is a well-described but rare complication of infective endocarditis. Rapid diagnosis and treatment are essential as its course can prove fatal. Abdominal CT scan or MRI should be performed if there is clinical suspicion of splenic abscedation. Immediate splenectomy combined with appropriate antibiotics and valve replacement surgery is the treatment of choice. Splenic tissue is very fragile - especially if the abscess is located subcapsular - and a splenic rupture can result from minimal trauma. If the patient's general state allows it, it is best to perform splenectomy prior to valve replacement surgery to prevent re-infection of the valve prosthesis. A combined one-stage procedure is also an option.

Purpose: To analyse change in distance between the humeral head and the glenoid fossa during traction in the maximally loose-packed position (MLPP) and the maximally closed-packed position (MCPP) under standardized conditions.Subjects: Six healthy subjects (three male and three female) with a mean age of 40.5 years, volunteered to participate in this study.Materials and methods: Subjects were placed with the right shoulder in a modified shoulder brace (Otto Bock Armabduktions-Orthese in Modular Bauweise((R))) in 45degrees abduction in the plane of the scapula with neutral rotation (MLPP). A standard anterior-posterior radiograph of the glenohumeral joint was made. A 14 kg traction force was applied for 40 s, and a second radiograph was made. The same procedure was repeated with the shoulder placed in the MCPP, which was 90degrees abduction and 90degrees external rotation. A radiologist, blinded for the variable traction or no traction, performed all radiographic measurements. Measurements were made on the same radiographs on two separate occasions (O1 and O2) with a 2-month interval.Results: No significant differences were found in mean distance between the humeral head and the glenoid fossa during traction in the MLPP compared to traction in the MCPP (O1: P = 1.00) and (O2: P = 0.63).Conclusions: Application of a 14 kg force does not result in a significant increase of distance between the humeral head and the glenoid fossa. No significant difference was found between the change in distance of the humeral head and the glenoid fossa after traction in the MLPP compared to traction in the MCPP. (C) 2003 Elsevier Science Ltd. All rights reserved.