Biomedical subjects
Publications and source records attributed to J F McCarthy.
Excessive bleeding post coronary artery bypass surgery (CABG) remains a major source of morbidity and mortality. Approaching this bleeding with a resternotomy, while necessary in the vast majority of cases, is associated with an increased incidence of infections and sternal wound complications. A thoracoscopic approach in select patients with a pleural based collection is described.
OBJECTIVE: Congenital tracheobronchial obstruction (TBO) presents a complex problem both in terms of diverse aetiology, presence of associated anomalies and the operative strategy to be adopted. We report a single centre experience in managing this difficult problem. METHODS: Twenty-four infants and children with TBO referred to our unit over a 12-year period are reviewed. Aetiology of TBO included vascular rings (n = 9), anomalous innominate artery (n = 6), congenital tracheal stenosis (n = 5), segmental bronchial stenosis (n = 2) and pulmonary artery compression of the main bronchi (n = 2). Seven patients had concurrent cardiac anomalies. Stridor was the commonest presenting symptom (67%). Mean delay from onset of symptoms to referral was 19 months. One patient died preoperatively due to acute airway obstruction. Mean age at operation was 33.1 +/- 42 months (range 4 days-156 months) and 11 children were under 1 year at the time of surgery. In cases of TBO secondary to vascular rings, division of the ring resulted in relief of symptoms in seven cases, with two requiring further surgery for resultant tracheomalacia. Four of the five patients having tracheal resection were operated on with the use of cardiopulmonary bypass; three of these patients had concurrent correction of cardiac lesions, with two survivors. Tracheobronchial anastomoses were carried out using continuous polydioxanone (PDS). Patients with anomalous innominate arteries required aortopexy in five and innominate artery suspension in one, while those with pulmonary artery compression of the main bronchi had correction of their intracardiac defects (n = 2). RESULTS: Hospital mortality was 8.7% and there has been one late death due to Eisenmenger syndrome secondary to pulmonary regurgitation, atrial septal defect (ASD) and patent ductus arteriosus (PDA). On follow-up (mean 40 +/- 31 months), 19 patients are alive and symptom free. There have been no anastomotic strictures following tracheobronchial resection. The single most important predictor of mortality was the presence of associated cardiac anomalies. CONCLUSIONS: TBO can be managed effectively by a single operation in both infants and children without a detrimental effect on tracheal growth. We advocate consideration of concurrent repair of the tracheal and cardiac lesions. Cardiopulmonary bypass (CPB) allows this concurrent correction of cardiac lesions and also facilitates tracheal resection.
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PURPOSE: To compare the demographic, behavioral, psychosocial, and academic characteristics of users versus nonusers of inner-city junior high school-based health clinics. METHODS: Students who used (n = 1344) and did not use (n = 2394) the health clinics based in four junior high schools in an economically disadvantaged, medically underserved New York City school district were compared on their responses to a health risk survey administered at the end of the 1991/92 academic year. RESULTS: Compared to students who did not use the clinics, students who used the clinics were more likely to have had unprotected sexual intercourse, to have had suicide intentions or attempts, to be suspended from school for fighting, to be exposed to violence and the illicit drug culture, to hold beliefs favoring involvement in sexual intercourse and suicidality, and to have failed subjects in school. CONCLUSIONS: Users of these junior high school-based health clinics are engaging in behaviors and hold beliefs that place them at risk for serious adverse health outcomes. School-based clinics have the potential to provide early intervention for these high risk adolescents.
Between January 1, 1990, and March 20, 1994, 56 patients had a homograft valve device placed in the aortic position. The mean age at operation was 53.3 years (range 5-77 years). Diagnosis included dominant aortic stenosis in 27 patients (48.2%) and aortic incompetence in 29 (51.8%). Thirteen patients (23.2%) had subacute bacterial endocarditis. Forty-three aortic homografts and 13 pulmonary homografts were placed. Concomitant procedures were performed in 12 patients (21.8%). The hospital mortality was 7.3% (four patients). On follow-up, three pulmonary valves have failed, two between 1 and 5 weeks post implantation. At reoperation a linear cusp fracture was found in all with no evidence of infection. All remaining patients have no, trivial, or mild, aortic regurgitation on echo and remain well. Pulmonary and aortic valves were compared for failure, P = 0.02 suggesting a significant difference between valve substitutes. In conclusion we advise caution in using pulmonary allografts in the aortic position.
OBJECTIVE: Mitral valve repair is now well established in adults. Congenital anomalies of the mitral valve, however, represent a more complex and diverse population with a high prevalence of associated cardiac anomalies. Less is known about the results of valve sparing surgery in this group of patients. We reviewed our experience to determine these results. METHODS: Twenty three children with mitral valve anomalies and concordant atrioventricular and ventriculoarterial connections but excluding partial and total atrioventricular canal defect (AVC) or isolated cleft were operated on between January 1 1983 and January 1994. Mean age at operation was 3.2 years (range 2 months-10.7 years) with 10 patients less than 1 year. Eighteen patients (78%) were in New York Heart Association Functional class (NYHA) 111/1V. Aetiology of mitral valve disease was congenital in 21 (91.3) and ischaemic of congenital origin in 2 (8.7%). mitral regurgitation was dominant in 13 (57%), mitral stenosis in 10 (43%)-5 parachute valves. Associated defects occurred in 15 patients (65.2%). All mitral incompetence patients (13) had some form of annuloplasty-modified de Vega 5, Wooler Kay 5, Paneth 2 and Puig Messana 1. RESULTS: Hospital mortality was 13% (3 patients). Mean follow up time was 51.3 months with a cumulative follow up of 102.6 patient years There were 2 late deaths. Repeat operations were required in 3 patients-2 reparative and 1 mitral valve replacement. One patient awaits reoperation and the remaining 17 have no, minimal or mild mitral stenosis or incompetence on echocardiography. Seventeen (94%) of the surviving patients are in NYHA 1/11. One and 7 year actuarial survival rates are 82.2% +/- 7.9% and 77.4% +/- 8.7% while actuarial freedom from reoperation was 95.5% +/- 4.3% at 1 year and 84.1% +/- 7.6% at 7 years. There has been no incidence of thromboembolism. CONCLUSIONS: Reparative techniques can be successfully applied to congenital mitral valve disease, especially in children less than 1 year of age, and can be accomplished with a low hospital mortality and acceptable long term survival rates.
PURPOSE: To develop and evaluate a risk factor screening survey as a mechanism to identify inner-city junior high school students who may benefit from medical or mental health services available in school-based clinics. METHODS: A 36-item health risk factor screening survey was developed and administered to 3,787 predominantly Hispanic students from four schools in an economically disadvantaged, medically underserved New York City school district. Students who indicated that they were experiencing one of five major risk factors (suicidality, sexual activity, parental or guardian substance use, personal substance use, or having run away) were scheduled to visit the clinic for services, and to have their survey responses validated by clinic interview. RESULTS: The development of the screening tool resulted in a short, easy to read and understand survey instrument that was feasible to administer within a classroom setting. The reliability of the instrument was excellent, and the results of the validity study indicated that it was successful in identifying students who did not need clinic services. The screening tool produced mixed results in identifying those truly in need through single item identification (e.g., produced a moderate number of "false positives"), although combining items on the screening tool produced much higher positive predictive values. CONCLUSIONS: This screening tool can be used to effectively focus limited clinical resources on those in need. Outreach surveys of this type should be considered as a valuable component of a school-based clinic service delivery strategy.
The clinical features and successful management of a patient with right main bronchus disruption after blunt chest trauma are described. The presentation was one of bilateral tension pneumothoraces. A high index of suspicion, coupled with appropriate airway management at presentation, was vital for the successful treatment of this patient. Surgical resection using a sleeve lobectomy, an operation rarely used in trauma patients, was highly effective in this patient, and the technique is described in this report.
To explore weapon carrying among young, inner-city adolescents, a survey was administered in fall 1993 to 2005 predominately Hispanic students (mean age = 12.8 years) in three New York City junior high schools. The survey revealed that 21% of students reported personally carrying a weapon; guns and knives were the weapons most commonly carried. Most of those who carried guns reported that they bought them. Forty-two percent indicated that they had a family member or close friend who had been shot. Boys and older students were more likely to report carrying weapons. Preventive efforts may need to begin before or on entry into junior high school rather than high school.
OBJECTIVE: To describe the use of school-based health clinics by urban minority junior high school students. DESIGN: Review of demographic and utilization data collected by service providers during clinic visits. SETTINGS AND PARTICIPANTS: Health clinics in four junior high schools that enrolled predominantly Hispanic students who were residing in an economically disadvantaged, medically underserved New York (NY) school district. RESULTS: Of 5757 students who were enrolled in the schools, 5296 (92%) obtained parental consent to use the clinics, and 3723 (65%) used the clinics during the 1991-1992 academic year. Clinic users were 11 to 15 years old, 50% male and 50% female, 81% Hispanic and 14% black, and 29% sixth graders, 33% seventh graders, and 38% eighth graders. Clinic users made 16,340 clinic visits during the 1991-1992 academic year. Presenting complaints were mental health problems (32%), illness (14%), injury (12%), physical examination (5%), immunization (3%), follow-up (21%), and other (13%). Referral sources were clinic outreach (48%), self (44%), and school personnel (8%). Disposition of visits was on-site treatment (92%), referral to an affiliated hospital (5%), and referral elsewhere (3%). Compared with a nationwide group of high school-based clinics that served predominantly black adolescents, these clinics provided more mental health care (31% vs 21%), similar illness/injury care (32% vs 30%), and less preventive (10% vs 24%) and reproductive/contraceptive (7% vs 12%) care. CONCLUSIONS: Junior high school-based clinics can provide a wide range of primary and preventive health care services for large numbers of medically underserved youths. The provision of mental health services may fill a critical need among inner-city adolescents. Clinic outreach may be necessary to maximize utilization, especially among high-risk students.
OBJECTIVE: A greater understanding of minority adolescents' involvement in sex and violence is an essential precursor to the development of effective prevention programs targeted at inner-city youths. METHOD: To estimate the prevalence of involvement in sexual, assaultive, and suicidal behaviors and to quantify the relative importance of demographic, psychosocial, and behavioral risk factors for those behaviors, a survey was administered in the spring of 1992 to a sample of 3,738 predominantly Hispanic and African-American students attending four junior high schools in an economically disadvantaged, medically underserved New York City school district. The mean age of participants was 13.5 years; 73.7% were Dominican, 6.9% were other Hispanic, and 10.4% were black. RESULTS: Thirty-one percent of males and 7% of females reported involvement in sexual intercourse, 27% of males and 8% of females reported involvement in assaultive behavior and 10% of males and 19% of females reported suicide intentions/attempts. The primary risk factor for sexual intercourse was a belief that involvement in intercourse was common and acceptable among peers. The primary risk factor for assaultive behavior was adverse social circumstances. The primary risk factor for suicide intentions/attempts was symptoms of depression. The risk for involvement in each of the three investigated risk behaviors was substantially increased by involvement in the other two behaviors. CONCLUSIONS: These findings underscore the urgent need for comprehensive sex and violence prevention programs targeted at urban minority junior high school students and suggest factors that may identify students at highest risk.
A forced-gradient tracer test was conducted at the Georgetown site to study the transport of natural organic matter (NOM) in groundwater. In particular, the goal of this experiment was to investigate the interactions between NOM and the aquifer matrix. A detailed three-dimensional characterization of the hydrologic conductivity heterogeneity of the site was obtained using slug tests. The transport of a conservative tracer (chloride) was successfully reproduced using these conductivity data. Despite the good simulation of the flow field, NOM breakthrough curves could not be reproduced using a two-site sorption model with spatially constant parameters. Preliminary results suggest that different mechanisms for the adsorption/desorption processes, as well as their spatial variability, may significantly affect the transport and fate of NOM.
Video-assisted thoracic surgery (VATS) combines excellent visualization of the intrathoracic structures with a minimally invasive technique. A patient is presented who underwent successful ligation of a patent ductus arteriosus with a video-assisted thoracoscopic technique.
Radiation therapy may be beneficial after radical prostatectomy in some patients with pathological stage C prostate cancer and in those with detectable postoperative prostate specific antigen (PSA) levels. A total of 64 men underwent postoperative radiation therapy following radical prostatectomy for pathological stage C disease (27), a detectable serum PSA level (11) or both conditions (26). Of the 27 men treated prophylactically for pathological stage C disease 18 (67%) had no evidence of recurrence after radiation within the first 6 months postoperatively (median followup 40 months, range 17 to 97). Of 22 men treated for delayed PSA elevation 15 (68%) currently are disease-free (median followup 27.5 months, range 15 to 47). Of 15 men treated within the first 6 months after radical prostatectomy for persistently detectable PSA levels 8 (53%) had an initial decrease in PSA to undetectable levels but only 5 (33%) had a durable complete response (median followup 36 months, range 8 to 56). We conclude that patients with pathological stage C disease who are most likely to benefit from postoperative radiation therapy are those with initially undetectable postoperative PSA levels. We observed no striking difference in treatment outcome between early and delayed adjuvant radiation therapy.
A video assisted thoracic surgical repair of a paraoesophageal hernia is described. The advantage of the procedure was the combination of the diagnostic and therapeutic facility characteristic of a transthoracic approach without exposing the patient to the morbidity of formal thoracotomy.
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Using parish records from 10 different countries with small Armenian communities, this study compared patterns of infant mortality in these countries over a period of 245 years. Deaths registered as aged < or = 1 year were used to estimate the numerator for the infant mortality rates (IMR) while the denominator was estimated from births in the same year based on baptisms in the appropriate registers. To check on the validity of using the baptisms as the denominator for the IMR, records of infant deaths were linked with the baptismal records. Thus, from a sample of 273 infant deaths 78.4% had a baptismal record in the registers of the same church in which the death was recorded. Of the deaths 60% had a recorded cause of death. Over the past 245 years, IMR have fallen substantially in all parishes. However, there were notable exceptions to this general pattern of declining IMR over time. For example, the IMR was tripled in Palestine during the decade of the First World War, possibly as a result of the influx of refugees deported from Turkey. A study of the seasonal occurrence of the deaths revealed peaking of deaths between May and August, a pattern influenced by the relative importance of gastroenteritis as a cause of death during the summer months in Egypt where the majority of these infant deaths were recorded. A review of the most important causes of death helped identify an outbreak of undetermined cause in Belgrade in 1737 and an outbreak of dysentery deaths in Alexandria, Egypt, in 1909.(ABSTRACT TRUNCATED AT 250 WORDS)
An approach, using biomarkers (biological responses) for assessing the biological and ecological significance of contaminants present in the environment is described. Living organisms integrate exposure to contaminants in their environment and respond in some measurable and predictable way. Responses are observed at several levels of biological organization from the biomolecular level, where pollutants can cause damage to critical cellular macromolecules and elicit defensive strategies such as detoxication and repair mechanisms, to the organismal level, where severe disturbances are manifested as impairment in growth, reproduction, developmental abnormalities, or decreased survival. Biomarkers can provide not only evidence of exposure to a broad spectrum of anthropogenic chemicals, but also a temporally integrated measure of bioavailable contaminant levels. A suite of biomarkers are evaluated over time to determine the magnitude of the problem and possible consequences. Relationships between biomarker response and adverse ecological effects are determined from estimates of animal health and population structure.