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Biomedical subjects

G Pappas

Publications and source records attributed to G Pappas.

At least 55 records · Page 3Linked to original sources
PubMed1995

The effect of gaps in health insurance on continuity of a regular source of care among preschool-aged children in the United States.

OBJECTIVE: To estimate the prevalence and length of gaps in health insurance coverage and their effect on having a regular source of care in a national sample of preschool-aged children. DESIGN: Follow-up survey of a nationally representative sample of 3-year-old children in the US population by phone or personal interview. PARTICIPANTS: A total of 8129 children whose mothers were interviewed for the 1991 longitudinal Follow-up to the National Maternal and infant Health Survey. MAIN OUTCOME MEASURES: Report of any gap in health insurance for the children, the length of the gap, and the number of different sites where the children were taken for medical care as a measure of continuity of a regular source of care. RESULTS: About one quarter of Us children were without health insurance for at least 1 month during their first 3 years of life. Over half of these children had a health insurance gap of more than 6 months. Less than half of US children had only one site of care during their first 3 years. Children with health insurance gaps of longer than 6 months were at increased risk of having more than one care site (odds ratio = 1.52; 95% confidence interval, 1.19 to 1.96). This risk further increased when an emergency treatment was discounted as a multiple site of care. CONCLUSIONS: Having a gap in health insurance coverage is an important determinant for not having a regular source of care for preschool-aged children. This finding is of concern, given the sizable percentage of children in the United States who lacked continuous health care coverage during a critical period of development.

Child Health Services↗
PubMed1994

Over-the-counter medication use among US preschool-age children.

OBJECTIVE: To estimate the prevalence of recent over-the-counter (OTC) medication use in a national sample of preschool-age children. DESIGN: Follow-up survey of a nationally representative sample of 3-year-old children in the US population by telephone or personal interview. PARTICIPANTS: A total of 8145 children whose mothers were interviewed for the 1991 Longitudinal Follow-up to the National Maternal and Infant Health Survey. MAIN OUTCOME MEASURES: Report of any OTC medications given in the past 30 days and the type of medications that the child received. RESULTS: During the past 30 days, 53.7% of all 3-year-old children in the United States were given some OTC medications. Among OTC medication users, the most common medications reported were Tylenol (66.7%) and cough or cold medicine (66.7%). Most respondents reported that recent child illness episodes (70%) were treated with OTC medications. After adjustment for recent child illness, women who were white (odds ratio [OR], 1.32; 95% confidence interval [CI], 1.13 to 1.55), were more educated (OR, 1.58; 95% CI, 1.24 to 2.00), and had higher incomes (OR, 1.75; 95% CI, 1.33 to 2.30) were more likely to have given their child OTC medications. Women without health insurance were also more likely to have given OTC medications (OR, 1.27; 95% CI, 1.04 to 1.55). Provider visits, but not telephone calls, were associated with a reduction in OTC medication usage. CONCLUSIONS: Over-the-counter medications are an important component of health care for treating illness in US preschool-age children. The high prevalence of use has occurred despite the dearth of scientific proof for the effectiveness of certain classes of OTC medications and the risks associated with improper use.

Acute Disease↗
PubMed1993

The increasing disparity in mortality between socioeconomic groups in the United States, 1960 and 1986.

BACKGROUND: There is an inverse relation between socioeconomic status and mortality. Over the past several decades death rates in the United States have declined, but it is unclear whether all socioeconomic groups have benefited equally. METHODS: Using records from the 1986 National Mortality Followback Survey (n = 13,491) and the 1986 National Health Interview Survey (n = 30,725), we replicated the analysis by Kitagawa and Hauser of differential mortality in 1960. We calculated direct standardized mortality rates and indirect standardized mortality ratios for persons 25 to 64 years of age according to race, sex, income, and family status. RESULTS: The inverse relation between mortality and socioeconomic status persisted in 1986 and was stronger than in 1960. The disparity in mortality rates according to income and education increased for men and women, whites and blacks, and family members and unrelated persons. Over the 26-year period, the inequalities according to educational level increased for whites and blacks by over 20 percent in women and by over 100 percent in men. In whites, absolute death rates declined in persons of all educational levels, but the reduction was greater for men and women with more education than for those with less. CONCLUSIONS: Despite an overall decline in death rates in the United States since 1960, poor and poorly educated people still die at higher rates than those with higher incomes or better educations, and this disparity increased between 1960 and 1986.

Adult↗
PubMed1991

Subnanomole detection and quantitation of high specific activity 32P-nucleotides.

Microbore liquid chromatography utilizes conventional HPLC and ultraviolet detection principles to determine subnanomole mass quantities of biologically significant molecules. This system takes advantage of specifically designed microflow equipment to analyze ultraviolet absorbing species at the picomole range. 32P-labeled nucleotides are examples of compounds routinely used at picomole quantities that are extremely difficult to accurately quantify using standard mass measurement techniques. The procedure described in this paper has the capability of measuring nucleotides down to 10 pmol using commercially available microbore ultraviolet detection equipment. The technique can be used to accurately measure the specific activity of as little as 10 microCi of an aqueous 32P-nucleotide solution.

Chromatography, High Pressure Liquid↗
PubMed1990

Some implications for the study of the doctor-patient interaction: power, structure, and agency in the works of Howard Waitzkin and Arthur Kleinman.

This article critiques two major theoretical perspectives concerning the doctor-patient interaction in medical anthropology represented by the work of Howard Waitzkin and Arthur Kleinman. In his work on the doctor-patient interaction Waitzkin has tended to draw on structural explanations which subordinate the role of agency. Kleinman's work emphasizes agency without satisfactorily integrating structural or social causality in his work on the doctor-patient interaction. The work of Anthony Giddens and others has clarified the structure/agency dichotomy in social science to which the nature of power is central.

Dominance-Subordination↗
PubMed1990

Hypertension prevalence and the status of awareness, treatment, and control in the Hispanic Health and Nutrition Examination Survey (HHANES), 1982-84.

The prevalence rates of hypertension among adult (ages 18-74) Mexican Americans, Cuban Americans, and Puerto Ricans were estimated using data from the 1982-84 Hispanic Health and Nutrition Examination Survey (HHANES). Hypertension is defined as diastolic greater than or equal to 90 mm Hg, or systolic greater than or equal to 140 mm Hg, or currently taking antihypertensive medication. Among Mexican Americans in the Southwestern United States, 16.8 percent of the males and 14.1 percent of the females were found to be hypertensive. Among Cuban Americans in Dade County, Florida 22.8 percent of the males and 15.5 percent of the females were hypertensive. Among Puerto Ricans in the New York City area 15.6 percent of the males and 11.5 percent of the females were hypertensive. The age-adjusted rates are significantly lower than comparable rates for Whites and Blacks as measured in the second National Health and Nutrition Examination Survey (NHANES II), 1976-80. Control of hypertension in the HHANES populations fall short of the 1990 Objectives for the Nation established by the US Public Health Service 60 percent (34 percent controlled Mexican American hypertensives, 27.8 percent controlled Cuban American hypertensives, and 29 percent controlled Puerto Rican hypertensives.

Adult↗
PubMed1989

Evolution of the management of anomalous left coronary artery: a new surgical approach.

Twelve patients with anomalous left coronary artery (LCA) from the pulmonary artery were treated surgically. Mean age was 13 months and mean weight, 7.7 kg. One of the following techniques was used in 8 patients: suture obliteration of the coronary orifice, ligation of the anomalous LCA and grafting of the internal mammary artery to the distal LCA, aortic reimplantation of the anomalous LCA, creation of an aortopulmonary window, and direct anastomosis to the right subclavian artery. In 4 patients, a new technique to establish a two-coronary artery system involved tube extension of the anomalous LCA with pulmonary artery wall and then anastomosis to the right subclavian artery using cardiopulmonary by-pass without aortic cross-clamping. There were two hospital deaths (17%) and one late death. The condition of the 9 long-term survivors was improved at late follow-up. Postoperative assessment showed smaller Q wave on the electrocardiogram, reduced cardiac size, and good left ventricular function. All patients in whom the repair was done using the new technique were free from postoperative cardiac complications, had shortened hospital stays, and were alive with a patent two-coronary artery system at late follow-up. We believe this approach is a safer method for establishing a two-coronary artery system in infants and small children with an anomalous LCA arising from the pulmonary artery.

Cardiopulmonary Bypass↗
PubMed1989

Pulmonary allograft conduit repair of tetralogy of Fallot. An alternative to transannular patch repair.

Cryopreserved allograft valves and valved conduits have been used in 122 patients during the past 3 years for surgical repair of congenital heart disease. In 55 of these patients, the right ventricular outflow tract was reconstructed with a pulmonary allograft conduit. Although most children requiring a conduit had complex lesions, 12 patients with tetralogy of Fallot without pulmonary atresia or absent valve syndrome have been treated in this manner since April 1985. Patients were selected for conduit therapy because of congenital or iatrogenic pulmonary artery problems (nine patients had 12 prior shunts) or increased pulmonary vascular resistance. Ages ranged from 7 months to 6 years (mean 3.1 years) and weights from 7.4 to 18.5 kg (mean 12.2 kg). Pulmonary artery conduit size ranged from 16 to 24 mm internal diameter (mean 22 mm). Distal pulmonary artery reconstruction beyond the bifurcation was required in nine patients and the proximal connection was completed with a hood-shaped patch. One operative death (8.3%) occurred at 20 days as a result of severe right ventricular dysfunction. Left pulmonary artery thrombosis was discovered postmortem. Eleven survivors observed for 3 to 37 months (mean 17 months) are without cardiac symptoms. A chronologically overlapping group of tetralogy of Fallot repairs accomplished with a transannular patch was also reviewed. Twenty-five patients aged 2 months to 4 years (mean 1.7 years) and weighing 3.6 to 14.8 kg (mean 9.2 kg) underwent this procedure from April 1983 to January 1987 (seven patients had one prior shunt each). The mortality rate in this group was 28% (six operative deaths and one late death). Of 18 survivors observed from 20 to 60 months (mean 41.4 months), five (28%) have required pulmonary artery conduit reconstruction for chronic right ventricular failure. Postrepair right ventricular/left ventricular pressure ratios were available in 19 patients, including five of seven who died and three of five who required reoperation. The ratios averaged 0.54, which indicates adequate relief of obstruction. The operative mortality rate from a number of series for transannular patch repair of tetralogy of Fallot averages 16%, ranging from 3% to 63%. However, when distal pulmonary artery problems are added as a risk factor this rate rises to 21%, and valved conduit insertion increases the mortality rate (Kirklin and Barratt-Boyes, 1986). Although not clearly superior, pulmonary artery conduit repair of tetralogy of Fallot achieves results comparable with those of transannular patch repair and is recommended as an alternative, particularly when distal pulmonary artery anatomy is abnormal or vascular resistance is elevated.

Blood Vessel Prosthesis↗
PubMed1988

Extensive tumor resection under deep hypothermia and circulatory arrest.

The risk of fatal hemorrhage may limit the completeness of resection in hepatic malignancies and in vascular extensions of Wilms' tumors. We have used Ein's technique of deep hypothermia (average 17 degrees C) with cardiac arrest (average 39 minutes) and exsanguination in performing five hepatic and two intravenous Wilms' tumor resections. The initial hepatic resection takes less than 15 minutes to perform in a bloodless field and the specimen is immediately examined by frozen section for determination of adequacy of margin. Additional resection is easily performed. Of four trisegmentectomies and one left lobectomy, two required additional resections. Mattress sutures were used to control hemorrhage during recirculation. One patient died from bleeding and cardiac decompensation and another from recurrence of tumor. The Wilms' tumors extended from the iliac vein into the right atrium in one child and from the right renal vein to the right atrium with extensions into the hepatic and lumbar veins in another. After nephrectomy, the atria and inferior vena cava were opened and the tumor extracted under direct vision. Both patients are well.

Carcinoma, Hepatocellular↗
PubMed1986

Left pulmonary vein stenosis associated with transposition of the great arteries.

Two patients with unilateral left pulmonary vein stenosis associated with dextrotransposition of the great arteries and intact ventricular septum are described. Excessive preferential pulmonary artery blood flow to the unaffected side is diagnostic. Awareness and recognition of this rare association is important and the obstruction can be managed with excision of the diaphragm and venoatrioplasty when needed during a Senning or Mustard repair.

Humans↗
PubMed1986

Results of surgical treatment of coarctation of the aorta in the critically ill neonate. Including the influence of pulmonary artery banding.

During a 7 year period, 64 consecutive neonates (less than 30 days of age) underwent surgical repair of coarctation of the aorta. There were no intraoperative deaths, four (6%) postoperative deaths, and seven (12%) late deaths. Improvement in the survival rate in this study can be attributed to improved perioperative care, avoidance of hypothermia during the operation, use of prostaglandin E1 to stabilize the patient's condition before the operation, emergency cardiac catheterization and operations, adequate relief of the aortic obstruction, and appropriate use of pulmonary artery banding. The last of these factors may further reduce the mortality. Banding of the pulmonary artery in patients with complex cardiac lesions associated with a ventricular septal defect has significantly lowered the mortality compared with the mortality of those without pulmonary artery banding. In contrast, the absence of pulmonary artery banding in those with a large ventricular septal defect did not affect the mortality or postoperative ventilator requirements as compared to patients having banding and coarctation repair. One late death was related to complications of the pulmonary artery band.

Aortic Coarctation↗
PubMed1985

Taussig-Bing anomaly and coarctation of the aorta in infancy: surgical options.

The coexistence of the Taussig-Bing anomaly and coarctation of the aorta is a highly complex situation carrying a dismal prognosis. Through our experience and a review, we have observed that neonates requiring coarctation repair, pulmonary artery banding, and patent ductus ligation are at high risk of expiring before reaching an age at which a difficult total repair is feasible. It appears that patients presenting beyond the neonatal period have a better chance of surviving an initial surgical procedure and the definitive repair. A surgical management protocol has been suggested. Although associated with an uncertain late prognosis, arterial level repairs are the most physiologic, and their results to date are encouraging.

Aortic Coarctation↗
PubMed1985

Surgical treatment for rhabdomyoma of the right atrium causing arrhythmias.

Rhabdomyomas of the heart occur as multiple lesions in 90% of patients so affected, and 80% of the patients die in the first year of life. A 21-month-old child presented with a large isolated right atrial rhabdomyoma causing a supraventricular tachyarrhythmia. Surgical excision cured the arrhythmia.

Arrhythmias, Cardiac↗
PubMed1983

Surgical management of absent right pulmonary artery with associated pulmonary hypertension.

A critically ill 21-month-old girl with congenital absence of the right pulmonary artery and severe pulmonary hypertension and congestive heart failure underwent conduit restoration of flow to the right lung. This patient had marked clinical improvement and reduction in pulmonary hypertension and represents the second reported surgically-treated case for absent right pulmonary artery. Reestablishment of pulmonary artery continuity is therefore recommended when cardiac failure and pulmonary hypertension occurs.

Blood Vessel Prosthesis↗
PubMed1983

Surgical approach to critical pulmonary valve stenosis in infants less than six months of age.

During the past 7 1/2 years, 36 infants (less than or equal to 6 months of age) underwent surgical relief of critical pulmonary valve stenosis. The results of closed and open (cardiopulmonary bypass, CPB) procedures were compared. Closed procedures included Brock valvotomy (two patients) and normothermic inflow stasis with transpulmonary valvectomy (10 patients). Twenty-two patients had open procedures with valvectomy alone (five patients) and right ventricular outflow tract (RVOT) reconstruction (17 patients). Two additional patients had staged operations (shunt followed by open procedure at 3 and 5 months postoperatively). Patients who had the closed procedures, as compared with CPB, were significantly younger (10 versus 61 days, p less than 0.01) and more critically ill with congestive heart failure and acidosis. In addition, the mean peak systolic right ventricular-left ventricular pressure ratios (RVP/LVP) were higher (1.6 versus 1.4, p less than 0.02) in the closed group. There were no deaths in the closed group in contrast to six deaths among those having RVOT reconstruction (0/12 versus 6/17 or 35%, p less than 0.04). Critical obstruction of the pulmonary valve, tricuspid valve regurgitation, and hypoplastia of the right ventricle occurred more frequently in the closed group. All operative deaths resulted from right heart failure. There were no late deaths in the entire series. Three patients in the closed group (mean follow-up 2.8 years) required operations for recurrent pulmonary valve stenosis approximately 2 years postoperatively, and none in the open group (mean follow-up 2.0 years). In conclusion, despite current advances in infant CPB and care, the results from our experience suggests that closed procedures, especially inflow stasis and pulmonary valvectomy, are superior to the use of CPB and RVOT reconstruction, even in the presence of pulmonary valve dysplasia.

Blood Gas Analysis↗
PubMed1982

Surgical and medical experience with 734 premature infants with patient ductus arteriosus.

During the past 5 years, patent ductus arteriosus (PDA) presented in 734 preterm infants (less than 2.5 kg and 37 weeks gestation) of 2,532 admissions (29%). The ductus presented with murmur, bounding pulses, and often congestive heart failure. Medical treatment consisted of the following: fluid restriction, furosemide, respiratory support, and rarely digoxin. The patients who were unresponsive to medical treatment had surgical ligation (306 of 734 or 42%). The patients who had ductal ligation were smaller, i .e., 82% of the surgical patients weighed less than 1.5 kg as compared to 38% of the medical patients. Of those patients weighing less than 1.5 kg, the surgical and medical groups were compared and the following observations made: The incidence of respiratory distress syndrome was greater in the surgical group (86% or 216 of 252 patients versus 69% or 111 of 161 medical patients, p less than 0.001) and the long-term survival was better (89% or 224 of 252 surgical patients versus 77% or 124 of 161 medical patients, p less than 0.005). In addition, the average duration of intubation was shorter in this surgical subgroup (8.9 versus 13.6 days). Significant left atrial enlargement and echocardiographic left atrial/aortic (LA/Ao) ratios of greater than 1.5:1 occurred in 58% or 171 of 290 surgical patients versus 32% or 59 of 190 medical patients (p less than 0.001). During the first 3 years of this study (medical treatment averaged 5 days), the duration of intubation in the surgical patients averaged 15.2 days; by comparison, in the last 2 years of this study (medical treatment averaged 1 to 2 days), the duration of intubation was 6.5 days (p less than 0.001). Necrotizing enterocolitis (NEC) occurred in 11% or 46 of 428 medical patients versus 0.3% (one of 305 patients) in the ligated group postoperatively (p less than 0.001). Late deaths were related to lung disease, central nervous system problems, NEC, and so on. From this study, it was determined that ligation of a significant PDA is associated with (1) zero surgical risk, (2) a reduced incidence of NEC, (3) reduced duration of intubation, especially with early ligation, and (4) improvement in late survival. Thus the surgical approach is our treatment of choice for a refractory PDA.

Age Factors↗