Appendicitis: the perforation rate when reviewed by decades in a general hospital.

Acute appendicitis at this medical center for 1984 was reviewed and compared with previous studies reporting 1944 and 1964. In 1984, the perforation rate was strikingly higher than the earlier years. It was zero in 1944, rose to 13.6 per cent in 1964, and to 31.4 per cent in 1984. One quarter of perforations in 1984 occurred during the first decade of life. In 1984, 14 per cent (10/70) of all patients with appendicitis were examined by a physician prior to eventual hospitalization; nine had perforated the appendix, representing 41 per cent of all perforations. Major factors responsible for the increase in perforations included (1) an increase in patients less than ten years old (a group at high risk for perforation), and (2) physician or patient delay in hospitalization. We suggest that physician and public education, which has proven effective in the past, should be reinstituted. Critical review of appendicitis should be carried out at individual institutions to identify, and thus, modify trends in this disease. Perforation increases morbidity and cost, yet is easily avoidable.

Round atelectasis in an elderly man: the role of thoracotomy.

In summary, a case of round atelectasis appearing subsequent to a pleural effusion in an elderly man 6 months after open heart surgery is reported. Although plain roentgenograms and linear and computerized tomography could help the physician make the diagnosis with confidence, a needle biopsy of the lesion at the very least or exploratory thoracotomy may sometimes still be justified for the properly selected patient.

Massive mitral regrgitation from chordal rupture and coronary artery disease.

The precise mechanism that causes spontaneous rupture of chordae tendineae remains unknown. That it may occur in patients with no disease other than underlying or associated coronary artery occlusion has not been previously reported. Six patients with chordal rupture were found among 600 patients who underwent operation for mitral regurgitation in a 6-year period. All 6 patients without exception underwent simultaneous mitral valve replacement and coronary revascularization. The salient clinical features of these patients are summarized, and 1 case is reported in detail.

Mediastinal thymic cyst after open heart surgery.

A benign thymic cyst seen six years after valvular heart surgery is described, and the question of the possible role of previous surgical trauma in the development of the cyst is raised.