Nonbacterial vegetations on the heart valves.

Like most controversial topics in medicine, the truth probably lies between the two schools of thought. In the early acute Case-roughly within the first 48 hours-operation is indeed quite simple and there is no contraindication to its performance in an otherwise fit patient provided a skilled surgeon is available and that there are full facilities for operative cholangiography. Surgery is also indicated if the gall bladder has perforated before admission or if the disease does not settle with conservative treatment, when a cholecystotomy us usually necessary. However, in the patient whose acute attack has been in progress for some days, or who is grossly fat or a poor risk or who is in a hospital where adequate operative facilities are not available, a conservative regimen is the wiser course better a living problem than a dead certainty.