Splenic rupture in pregnancy.

It is difficult to understand what relevance biomagnetic methods for the study of heart conduction have to the study of atherosclerosis and this applies to a number of other chapters. Indeed many of them describe methods such as thallium scintigraphy which may be capable of detecting the consequences of atherosclerotic disease but generally do so only when the disease is already extremely advanced and has reached the stage of producing clinically detectable abnormalities. Some sections of the book are so weak as not to warrant inclusion. It seems particularly unfortunate for example that positron emission tomography which is perhaps one of the more exciting methods available should be dismissed in two pages while plethysmography occupies 20 pages. Those with a direct interest in atherosclerosis research or non-invasive methods in the detection of cardiovascular disease will find little to interest or educate them in this book. Those with a more basic knowledge seeking an introduction or grounding in the subject would be better advised to look elsewhere. In the opinion of the authors the leukaemia process is the result of a disturbed balance between the activity of antileukaemogens such as antioxidants and immunopotentiating factors on the one hand and leukaemogenic factors in the environment on the other. The authors consider in leukaemogenesis, cytogenetic factors, immunolo-gic factors, physical, chemical and biological factors. The text is dry and aged in flavour. The references are old and mostly from the 1960s and 1970s. The approach to cytogenetics and immunology is, for instance, rudimentary and the index is pathetically inadequate. On the other hand some of the detailed epidemiology of leukaemia in Poland is very well done and reflects a great deal of detailed cautious study. On the whole a book of very highly specialized interest. It would be generous to say it must have lost a great deal in translation. Splenic rupture in pregnancy Sir, I was interested to read the case report of a ruptured spleen occurring in early pregnancy (Lamberton, 1983) and would like to report a case of splenic rupture which occurred in the 16th week of a 40-year-old's seventh pregnancy. She presented with upper abdominal pain of sudden onset radiating to her back and left shoulder. Physical examination revealed a patient in hypovolaemic shock with tenderness in the left hypochondrium and a positive Kehrs sign. The absence of vaginal bleeding suggested a surgical rather than an obstetrical source of haemorrhage …