Reports on surgical repair of cases with L-malposition of the great arteries with situs solitus atrialis and concordant atrioventricular connection are uncommon. A review of the anatomical characteristics of these cases has shown several peculiarities that may have considerable important in planning operation. Among them we emphasize the morphology of the ventricular septal defects, possible outflow tract obstructions and coronary artery course, anomalies of the atrioventricular valves and the course of the conduction system. Each of these aspects is reviewed from a surgical viewpoint in the light of our combined previous surgical and anatomical experience and of a review of previous reports by other authors.

Aorta↗

PubMedDate not supplied

[Primary lymphoma of the spleen: echographic diagnosis].

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Female↗

PubMedDate not supplied

[Anomalous pulmonary venous drainage to inferior vena cava (author's transl)].

Four cases between one day of life and seven years are presented. Two of them were males and two females. All of them had cardiac pulsation palpable to the right of the sternum, one with some bulging of the left hemitorax. In two cases a systolic murmur was heard over the second intercostal space associated with fixed splitting of the second sound and the other case presented recurrent infections processes of the lung dying ultimately from bronchoneumonia. On the simple X-ray displacement of the mediastine towards the right side, dextroposition of the heart, right pulmonary hyoplasia, enlargement of the right atrium and image in "scimitar" (obvious in two cases and possibly existed in the other two) was observed. In three cases a lung scan was carried out which showed a marked decrease in perfusion of the right lung. Angiocardiography in all cases as able to demonstrate anomalous venous drainage of the right lung to inferior vena cava directly.

Abnormalities, Multiple↗

PubMedDate not supplied

Will patient satisfaction set the preventive services implementation agenda?

BACKGROUND: Patient satisfaction has become a measure of the quality of health care, and in highly competitive markets like the Twin Cities metropolitan area of Minnesota, it has become a health plan marketing tool. The purpose of this analysis is to examine whether the known association between preventive services and patient satisfaction might spontaneously lead clinicians to recommend preventive services at greater rates. DESIGN: We conducted a mail survey of a stratified random sample (n = 6,830) of adult patients who had recently visited a physician in one of 44 clinics in and around Minneapolis-St. Paul, Minnesota. The main outcome measures are patient-reported rates of being advised to have eight preventive services, patient satisfaction with preventive services, patient satisfaction with overall health care, and correlations among these variables. RESULTS: Self-reports of being advised to have a preventive service when due were correlated with higher levels of satisfaction with that specific service only at levels of r = 0.16 to r = 0.35. They were correlated at levels of r = 0.01 to r = 0.27 with the Group Health Association of America satisfaction index. CONCLUSIONS: Although there is a positive association between being advised to have a preventive service on the one hand and reporting satisfaction with care on the other, this association appears too weak to spontaneously stimulate physicians to recommend preventive services to their patients. This suggests that, if preventive services are to be delivered at higher rates, they must become an explicit component of quality evaluations.

Adult↗