The Ross operation--early echocardiographic comparison of different operative techniques.

Fifty-four consecutive patients underwent aortic valve replacement with a pulmonary autograft (Ross operation) over an 18-month period. It was inserted as an intra-aortic cylinder in 13 patients and as a total aortic root replacement in 41; unwrapped in 16, partially wrapped with autologous pericardium in 12 and completely wrapped with bovine pericardium in 13. There were two cardiac deaths, one death from mediastinitis, and two early reoperations to replace an incompetent autograft. Comparison of postoperative echocardiographic data showed a higher incidence of moderate and severe autograft incompetence in the intra-aortic cylinder group and also in the subset without previous operation which had a total root replacement without a complete wrap. Autograft function was best in the group which received a total root replacement with a complete wrap and in those with previous cardiac surgery who received an unwrapped autograft. This preliminary information with short follow up supports the use of complete wrapping of the autograft when it is used as a total root replacement particularly in older patients without previous cardiac surgery in whom future autograft growth is not desirable.

Right lower quadrant pain in young patients with leukemia. A surgical perspective.

A retrospective review of cecal and appendiceal complications occurring in young patients with acute leukemia since 1969 was performed. The objective of this study was to determine the relative incidence of appendicitis and typhlitis among patients with acute leukemia who had operation or autopsy in this institution as well as to determine the risks of operative intervention. Fifteen patients with these complications were identified among the 400 patients with acute leukemia seen during this time period. Signs and symptoms of an acute abdomen were present despite immunosuppression. The incidence of sepsis at the time of presentation was 53%. Preoperative risk factors identified most frequently were coagulopathy and organ failure resulting from sepsis. Postoperative morbidity (25%) and mortality rates (8%) were related to the development of infectious complications. Appendicitis occurred in eight of the 15 patients studied, whereas typhlitis or its complications was found in seven patients. No preoperative factors could be found to differentiate typhlitis from appendicitis on clinical examination. It is suggested that operation can be safely performed in neutropenic patients who have acute right lower quadrant pain and signs of peritoneal irritation and may be the only effective way of differentiating appendicitis from typhlitis.