The results of the Cornell Elective Surgery Second Opinion Program are presented. From February 1972 to January 1978, 7053 patients were evaluated for proposed elective surgery, and in 27.6% of these, the operations were not approved. The subspecialties of orthopedics and gynecology demonstrated the highest rates of non-confirmation, while that for general surgery was 18%. A group of 318 patients with general surgical diagnosis are reviewed. The percentage of nonconfirmed surgery for this group was 15 percent. The most common reasons for not approving the operations were absence of pathology and failure to utilize medical therapy when indicated.

The clinical course of 70 patients with tuberculous peritonitis seen over a 43 year period has been reviewed. Thirty-seven patients were diagnosed prior to the advent of anti-tuberculous chemotherapy and 33 after. Clinical manifestations remained unchanged over the period of study. Abdominal pain (93%), fever (63%), gastrointestinal upset (60%), weight loss (60%), and ascites (59%) continue to be the most common findings. Females outnumbered males 2:1. In 89% of patients the duration of symptoms prior to diagnosis was a week or longer, and in 47% it was longer than a month. Diagnosis was confirmed by histologic examination of intra-abdominal tissue in 44% of cases, by clinical suspicion with an extraperitoneal site of tuberculosis in 29%, by bacteriology of peritoneal fluid in 24%, and by autopsy alone in 3%. An extraperitoneal site of tuberculsis was present in 83% of patients. The importance of obtaining a definitive diagnosis, and of instituting immediate antimicrobial therapy is emphasized by the mortality of 49% in the pre-antibiotic era, and of 7% in patients receiving anti-microbial therapy. The conclusions from this review are that: 1) with suggestive clinical manifestations and bacteriologic proof of active tuberculosis anywhere in the patient, operation is not mandated; 2) in the presence of the above clinical manifestations, and in the absence of definitive bacteriologic proof, exploratory laparotomy is indicated for diagnostic purposes; 3) antituberculous chemotherapy is highly effective, and is the treatment of choice.

Thirty‐one eases of intestinal tuberculosis, diagnosed from 1932 through 1975 at The New York Hospital‐Cornell Medical Center, were reviewed with particular reference to the impact of antituberculous chemotherapy on the outcome of the disease and to the role of surgery in diagnosis and treatment. The chest X‐ray was 90% effective in demonstrating evidence of tuberculosis in this series. However, since even on gross examination differentiation of intestinal tuberculosis from Crohn's disease or neoplasia may be impossible, surgical exploration is indicated when diagnosis is in doubt and biopsy and culture of intra‐abdominal tissue should be performed for diagnostic purposes. The importance of instituting immediate therapy is emphasized by a 67% mortality rate in the prestreptomycin era and a 21% mortality rate in patients receiving appropriate drug therapy. Because of the success of chemotherapy, intestinal resection is seldom indicated, except in those cases in which scarring and stricture formation demand surgical relief of intestinal obstruction, or in which the complications of fistula, hemorrhage, or perforation may occur.