Aortic atresia and aortico-left ventricular tunnel: successful surgical management by Konno aortoventriculoplasty in a neonate.

A newborn infant with aortic atresia and aortico-left ventricular tunnel was successfully treated by Konno aortoventriculoplasty. A 15 mm Ionescu-Shiley pericardial xenograft was inserted when the patient was 5 days old and it was replaced with a 19 mm St. Jude Medical prosthesis at 2 years of age.

Complications and recovery from laparoscopy-assisted vaginal hysterectomy compared with abdominal and vaginal hysterectomy.

OBJECTIVE: To complete a systematic review of the published literature comparing complications, postoperative recovery time, and costs following laparoscopy-assisted vaginal hysterectomy, total abdominal hysterectomy (TAH), and vaginal hysterectomy. DATA SOURCES: We searched MEDLINE and several bibliographies, identifying all reports using the term "laparoscopy-assisted hysterectomy" published from 1989 to September 1995. METHODS OF STUDY SELECTION: We excluded case reports, letters, and reports of laparoscopy-assisted vaginal hysterectomy procedures used for radical cancer surgery, sex-change operations, total laparoscopic hysterectomy, or supracervical hysterectomy. TABULATION, INTEGRATION, AND RESULTS: Cases identified included 3112 laparoscopy-assisted vaginal hysterectomies, 1618 TAHs, and 690 vaginal hysterectomies. Laparoscopy-assisted vaginal hysterectomy cases compared with TAH cases demonstrated significantly greater incidence of bladder injury (1.8% for laparoscopy-assisted vaginal hysterectomy versus 0.4% for TAH; P = .01), significantly longer operating room time (115 minutes, standard deviation [SD] 37 minutes, for laparoscopy-assisted vaginal hysterectomy versus 87 minutes, SD 18 minutes, for TAH; P < .001), and significantly shorter hospitalization (49 hours, SD 16 hours, for laparoscopy-assisted vaginal hysterectomy versus 79 hours, SD 20 hours, for TAH; P < .001). Use of analgesia was consistently less for laparoscopy-assisted vaginal hysterectomy and return to full activity was always sooner when compared to TAH. Cost for the new procedure was higher in seven out of 11 studies, but when disposable instruments and hospital length of stay are considered, the remaining four studies reported a lower cost for laparoscopy-assisted vaginal hysterectomy. CONCLUSION: Although laparoscopy-assisted vaginal hysterectomy involves a shorter hospital stay, speedier postoperative recovery, and less analgesia use, there is also a higher rate of bladder injury and lengthier surgery. These outcomes must be weighed when choosing an intervention.

Spectrum of sinus node dysfunction in two siblings.

Two siblings, ages 14 and 23, with various features of sinus node dysfunction have been reported. Sinus bradycardia was the presenting feature in both patients. During the follow-up period both patients developed various types of ectopic rhythms which increased with exercise. One of them developed "silent atrium" at the age of 23 and had cerebral embolus as a complication. The other patient had frequent syncopal episodes and had to be treated with a combination of electronic pacemaker and antiarrhythmic drugs.

Aneurysm of the membraous septum in ventricular septal defect.

An aneurysm of the membranous septum was found frequently in patients with ventricular septal defect; although appearance at catheterization during infancy was not common, aneurysms were detected in about half of the patients older than 2 years of age. A significant decrease in the left-to-right shunt occurred with the development of an aneurysm, but progression to complete spontaneous closure was not seen in any patient. In three older patients, an aneurysm of the membranous septum "disappeared" with time, even though complete spontaneous closure had not occurred.