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Biomedical subjects

L George

Publications and source records attributed to L George.

At least 73 records · Page 4Linked to original sources
PubMed1988

Experience with Damus procedure.

Sixteen patients with complex cyanotic congenital heart disease underwent an operation involving the use of the aorta and the main pulmonary artery as the egress for systemic arterial blood flow (the Damus-Kaye-Stansell operation, modified as discussed). The indication for this approach was either preoperative aortic outlet obstruction or likelihood that the repair would produce such obstruction. A modification of the original technique is introduced that involves transection of both great arteries, anastomosis of the contiguous aortic and pulmonic walls, and connection of the distal aorta to the perimeter of the new (bivalved) great artery. Eleven of the 16 patients survived operation: six of six who underwent a concurrent Fontan operation, four of six who underwent a concurrent right-ventricle-to-pulmonary-artery-conduit procedure, and one of four who underwent a concurrent systemic-pulmonary shunt procedure. Postoperative status in the 11 survivors is good: one patient has a gradient from the left ventricle to the aorta, 10 of 11 have little or no aortic regurgitation, and the remaining patients have a normal physiological status. We conclude that the Damus procedure is a useful addition to the surgical armamentarium for treatment of certain types of cyanotic congenital heart disease.

Angiography↗
PubMed1987

Somatization disorder in the community. A study of diagnostic concordance among three diagnostic systems.

Somatization disorder, the presentation of multiple somatic complaints in multiple organ systems, can be diagnosed by three roughly comparable diagnostic systems: the Washington University Feighner criteria, the Research Diagnostic Criteria, and DSM-III criteria. This study evaluates diagnostic concordance for somatization disorder in these three diagnostic systems using data gathered in the National Institute of Mental Health-sponsored Epidemiologic Catchment Area Program at four sites. Data gathered through use of the Diagnostic Interview Schedule at the Duke, Johns Hopkins, Washington, and Yale University sites indicate that each criterion set identifies a somewhat different group of respondents. Feighner criteria identify the fewest number of respondents, followed by DSM-III criteria and the Research Diagnostic Criteria. Demographic, symptomatic, health utilization, and other severity indices indicate that the respondents identified by each group are very similar and that all diagnostic groups are clearly distinguishable from the normal population.

Adolescent↗
PubMed1987

Attentional resources and hemispheric functional asymmetry in schizophrenia.

Inconsistent findings within certain areas of schizophrenia research--processing of verbal and pictorial stimuli, and hemispheric functional asymmetry--suggest the importance of examining the attentional resources associated with the cerebral hemispheres among schizophrenics. A cognitive task battery was developed which assessed the functioning of the left and right hemispheres under varying attentional loads. This battery was administered to paranoid and non-paranoid schizophrenics, and three control groups. Error rate and response latencies were monitored. It was found that the schizophrenics, particularly the non-paranoids, displayed evidence of a generalized decrease in available resources across attentional pools. In addition, response latencies were indicative of a complex interaction involving loads and visual field of stimulus presentation, which differed across schizophrenic subtypes. These lateralized effects among the schizophrenics did not interact with the differential sensitivity of the hemispheres to stimulus characteristics.

Adolescent↗
PubMed1987

Balloon dilatation of porcine bioprosthetic valves in the pulmonary position.

Balloon dilatation (BD) of bioprosthetic valves was investigated in vivo and in vitro. Four children with stenotic bioprosthetic porcine valves in the pulmonary position underwent BD of the valve 10 to 24 months after its insertion. Average valve gradient was reduced from 47.5 to 27 mm Hg. Obstruction at the conduit-branch pulmonary artery connection became apparent after dilatation of the valve. These distal stenoses were also dilated. BD technique was tested in vitro with the use of nonstenotic valves in fresh conduits. No damage to the valve or to the conduit was found when oversized balloons were used in a standard fashion or intentionally inflated until rupture. It is concluded that conduit replacement may be deferred by balloon dilatation of obstructed biological valves and/or a stenotic conduit-pulmonary artery anastomosis.

Angioplasty, Balloon↗
PubMed1986

Developing a screening index for community studies of somatization disorder.

Despite the low prevalence of somatization disorder in the community, the section of the Diagnostic Interview Schedule used to make the diagnosis--as well as previous diagnostic interviews for the related diagnoses of hysteria, and Briquet's syndrome--is quite lengthy. This study evaluates a somatization disorder screening index derived from completed interviews from the NIMH sponsored Epidemiologic Catchment Area program. A screening index comprised of 11 symptoms of somatization was derived at the Duke ECA site and replicated across the Johns Hopkins, Yale, and Washington University sites. Across ECA sites a screening threshold of five of 11 symptoms correctly identified 41 of 42 respondents with DIS/DSM-III somatization disorder (97.6%) while correctly classifying 14,600 of 14,750 (99.0%) without the disorder. The screening index offers promise as a screening device for clinical and community studies of somatization disorder.

Humans↗
PubMed1986

Somatization disorder in a US southern community: use of a new procedure for analysis of medical classification.

The authors examine somatization disorder in a community population, using grade of membership analysis, a new multivariate analytical technique for the analysis of medical classification. The technique is used to examine whether somatic symptoms will cluster into a clinical syndrome resembling somatization disorder, as defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM-III), if no a priori assumptions are made about the interrelationship of somatic symptoms or their clustering into clinical syndromes. Grade of membership analysis is applied to all respondents in the US National Institute of Mental Health Epidemiological Catchment Area Project of the Piedmont region of North Carolina reporting three or more somatic symptoms from the somatization disorder section of the Diagnostic Interview Schedule. The analysis indicates that seven 'pure' types, roughly analogous to clusters in cluster analysis, best describe the interrelationship of the symptoms included in the analysis. One 'pure' type in the analysis is nearly identical to DSM-III somatization disorder and is associated with demographic characteristics consistently found among patients with DSM-III somatization disorder. The present results demonstrate that symptoms associated with this disorder do cluster in a highly predictable fashion and represent a strong validation of the natural occurrence of an entity resembling somatization disorder.

Adolescent↗
PubMed1986

Somatization disorder in a community population.

The data recently collected in the Piedmont region of North Carolina as part of the National Institute of Mental Health Epidemiologic Catchment Area Program were used to examine somatization disorder in a community population. The authors found an adjusted prevalence of 0.38% for somatization disorder diagnosed according to the Diagnostic Interview Schedule and DSM-III. Respondents with somatization disorder demonstrated demographic characteristics (female, unmarried, nonwhite, from a rural area, less educated) that are consistent with findings from past clinical and epidemiologic studies of somatization disorder. The adjusted prevalence is higher than that of other Epidemiologic Catchment Area sites, and possible explanations for this findings are discussed.

Adolescent↗
PubMed1985

Cognition and symptomatology in schizophrenia.

The experimental work on cognitive processes in schizophrenia is critically reviewed with respect to its relevance in understanding schizophrenic symptomatology. Several logical and empirical issues that complicate any comprehensive attempt to relate schizophrenic symptoms and information processing are discussed. Studies germane to schizophrenic sensory/perceptual, cognitive, affective, and motor anomalies are examined, and it is concluded that the cognitive approach to these areas is promising, but further research and theory elaboration will be required in order to provide a firm basis for cognitively oriented intervention attempts.

Affect↗
PubMed1984

The design of the Epidemiologic Catchment Area surveys. The control and measurement of error.

Several methods are used to minimize and measure error in the NIMH Epidemiologic Catchment Area program. Sampling methods involve the inclusion of group quarters such as prisons, nursing homes, and mental hospitals in the sample frame and the use of probability sampling throughout. Interviewing, methods include use of identical diagnostic interview protocols, centralized training of interview supervisors, standard instructions to interviewers, and reinterview of a subsample by clinicians. In the area of completion, the methods include a 75% to 80% respondent completion rate, a 95% or greater completion rate for individual questions, use of informant interviews where necessary, and statistical adjustments to correct for low completion rates in some subgroups. Analytic methods include use of a computerized diagnostic algorithm, common estimation formulas on identically formatted data files, and estimation of exact variances that take account of the multistage sample design.

Catchment Area, Health↗
PubMed1984

Shared coronary arteries and coronary venous drainage in thoracopagus twins.

A pair of type B thoracopagus twins with complex cyanotic heart disease had shared coronary arteries and coronary venous drainage. Surgical separation was not attempted and the twins died at 10.5 months of age. Antemortem angiography demonstrated that Twin A's right coronary artery supplied Twin B's diaphragmatic and anterior ventricular myocardial free wall. A midline communication existed between each twin's right atrium at a common coronary sinus. The crossing coronary artery coursed alongside this connection and was visualized echocardiographically. At postmortem examination, the great cardiac vein of Twin A drained into the orifice of the common coronary sinus on Twin B's side of the midline. In five of six previously reported cases, the children died at attempted separation shortly after ligation of the interatrial communication. This may have been because of occlusion of a coronary artery or acute obstruction of a coronary vein. Consideration of separation of type B thoracopagus twins requires anatomic delineation of the coronary arteries and veins.

Arteries↗
PubMed1984

Imagery and verbal aspects of schizophrenic informational performance.

Imagery and verbal aspects of schizophrenic informational performance were examined. Pictorially and verbally presented pairs of items were compared with respect to both pronounceability of their names and their real-life sizes. Results indicated slower stimulus encoding of pictorial than verbal stimulation among the schizophrenics, especially paranoids. On the other hand, comparison of item properties appeared intact regardless of stimulus-presentation format. Non-paranoids made fewer errors as size judgements became more difficult, suggesting protection against erroneously stating the presence of stimulus properties. Scores from a questionnaire directed toward habitual use of imagery and verbal processes indicated significantly greater preference for the latter among paranoids.

Adult↗
PubMed1984

Effect of organic contamination upon microbial distributions and heterotrophic uptake in a Cape Cod, Mass., aquifer.

Bacterial abundance, distribution, and heterotrophic uptake in a freshwater aquifer contaminated by treated sewage were determined from analyses of groundwater and sediment-core samples. The number of free-living (unattached) bacteria in contaminated groundwater declined steadily with increasing distance from the source of sewage infiltration, from 1.94 (+/- 0.20) X 10(6) ml-1 at 0.21 km to 0.25 (+/- 0.02) X 10(6) ml-1 at 0.97 km. Bacterial abundance in groundwater sampled at 0.31 km correlated strongly with specific conductance and increased sharply from 4.0 (+/- 0.3) X 10(4) ml-1 at a depth of 6 m to 1.58 (+/- 0.12) X 10(6) ml-1 at 14 m, then declined at 20 and 31 m to 1.29 (+/- 0.12) X 10(6) and 0.96 (+/- 0.12) X 10(6) ml-1, respectively. A majority of the bacteria in contaminated and uncontaminated zones of the aquifer were bound to the surfaces of particulates, less than 60 micron in diameter. The glucose uptake rate, assayed at in situ and 5 microM concentrations, declined steadily in contaminated groundwater sampled along a transect. A preparative wet-sieving technique for use in processing core samples for bacterial enumeration is described and evaluated.

Bacteria↗
PubMed1984

Systemic-pulmonary shunts in infants and children. Early and late results.

From September, 1978, to January, 1983, 44 cyanotic infants and children underwent a systemic-pulmonary artery shunt for the treatment of reduced pulmonary blood flow. Age ranged from 18 hours to 4 years (mean age = 0.49 years). Weight ranged from 1.7 kg to 13.2 kg (mean weight = 4.9 kg). There were 12 classic Blalock-Taussig shunts, five central polytetrafluoroethylene shunts, six interposition modified Blalock-Taussig shunts, and 21 Great Ormond Street type of modified Blalock-Taussig shunts. No direct aorta-pulmonary artery anastomoses were performed. There was one postoperative death (1/44 = 2.3%) in a 1,700 gm neonate born with pulmonary atresia and intact ventricular septum (shunt patent). Four shunts required early revision: one thrombosed central shunt, a kinked patent interposition Blalock-Taussig shunt, a small but patent Blalock-Taussig shunt, and one excessive Great Ormond Street type of Blalock-Taussig shunt. Two late deaths were probably shunt-related: one Blalock-Taussig and one central. All four types of shunts provided good palliation, but the Great Ormond Street type of Blalock-Taussig shunt is our preferred shunt because of (1) low operative risk, (2) predictable patency (100% in our series), (3) lack of distortion of pulmonary arterial anatomy, and (4) technical ease of insertion as well as takedown.

Birth Weight↗
PubMed1984

Antisperm responses in male dogs with chronic Brucella canis infections.

Male Beagles infected with Brucella canis for greater than or equal to 3 months developed serum antibodies that agglutinated normal canine spermatozoa. Titers were highest in dogs that had been infected for 4 to 6 months. Lower spermagglutinin titers were detected in sera collected 10 months after inoculation. Antibodies were also observed in seminal plasma of chronically infected dogs. Seminal plasma from infected, but not from clinically normal dogs, caused head-to-head agglutination of normal sperm. In contrast to macroagglutination of sperm by serum antibodies, agglutination by seminal plasma antibodies was detected only by microscopic examination. Seminal plasma agglutinins were not inactivated by heat (56 C, 1 hour) or by reduction with 2-mercaptoethanol. When seminal plasma and sperm were mixed with 2 hemolytic units of guinea pig complement, spermatozoa were not inactivated. Spermagglutinin activity was present in the first 2 spectral absorption peaks of Sephadex G-200 fractionated seminal plasma. Fractions that had the highest spermagglutinin titers contained mostly immunoglobulin A. Seminal plasma from infected dogs also contained cytophilic factors for normal splenic macrophages that caused sperm adherence to macrophages. Dogs with a bacteremia lasting greater than 4 months had cutaneous delayed-type hypersensitivity reactions when tested with soluble canine testicular extracts. Reactions did not occur in normal dogs. Dogs with testicular atrophy had the most severe skin test responses. Seemingly, isoimmune responses to sperm antigens are involved in infertility caused by B canis infection of male dogs.

Agglutinins↗
PubMed1984

Containing costs in the treatment of congenital heart disease.

In the Congenital Heart Program at San Diego Children's Hospital, alterations in medical practice have reduced costs without impairing quality or access. Pediatric cardiac catheterization was done in 483 consecutive elective patients without overnight hospital stay. Hospital readmission was required in one patient for psoas tendinitis. Avoiding overnight hospital stay minimized attendant risks of hospital care, lessened psychosocial trauma and reduced the average hospital bill by $493 (29%). Hospital stay was also reduced for elective surgical correction of congenital heart disease on a case-by-case basis. Review of 151 consecutive cases (1978 through 1982) showed a decrease in both preoperative days in hospital and postoperative days in an intensive care unit. The duration of the postoperative stay was shortened from 6.8 days in 1978-1979 to 4.4 days in 1982 (P <.05). No increase in morbidity and no mortality resulted from the shortened perioperative hospital stay. Financial savings from this process averaged $991 per procedure.Diagnostic tests were reassessed and many precatheterization laboratory tests were eliminated. Without change in new patients seen or surgical volume, the use of cardiac catheterization decreased from 241 procedures in 1981 to 161 in 1982 and the number of operations without catheterization increased (11 to 22, 1981 to 1982). No increase in surgical morbidity or mortality was found comparing those diagnosed only by echocardiography with those who had preoperative cardiac catheterization. The decrease of 80 catheterizations in one year resulted in a savings of $188,800.True cost containment (reducing cost without reducing quality) can be accomplished in congenital heart programs. Similar cost containments in other disciplines may also be achieved.

California↗
PubMed1983

Two-dimensional echocardiographic discrimination of normal from abnormal great artery relationships.

A prospective study was performed to determine the diagnostic accuracy of precordial two-dimensional echocardiographic techniques in discriminating normal from abnormal great artery relationships. We studied 503 children using standard parasternal short-axis view and a modified technique called rotating high long-axis view (RHLAV). In RHLAV, there is rapid superimposition of the proximal courses of the two great arteries seen by rotation of the ultrasonic beam. Discrimination was based on the crossing great artery relationship seen with normally related great arteries (NRGA) and the parallel courses found in both transposition and malposition of the great arteries (TGA/MGA). Using the RHLAV, the great artery interrelationship was accurately determined in all 503 patients. Precordial two-dimensional echocardiography can accurately discriminate great artery relationships and is a useful addition to other two-dimensional echocardiographic techniques.

Adolescent↗