George Lister
Yale University, Pediatrics, Faculty Member
SUMMARY The preceding discussion focused on some of the unique aspects of cardiopulmonary interaction in the infant and child with congenital cardiac anomalies. We have extracted liberally from our previous reviews and have tried to... more
SUMMARY The preceding discussion focused on some of the unique aspects of cardiopulmonary interaction in the infant and child with congenital cardiac anomalies. We have extracted liberally from our previous reviews and have tried to select information from the literature that helps to elucidate mechanisms for many of the observed phenomena. Where data were not available, we attempted to draw inference from analogous conditions or speculated about the pathophysiology. We have grouped the cardiac lesions by virtue of their predominant pathophysiology. Our rationale was to provide the reader with a framework for understanding the genesis of respiratory problems caused by congenital heart disease and for anticipating untoward problems that could arise with a particular “therapeutic” maneuver. Finally, we hope to have stimulated interest in an area ripe for probing—the fascinating interdependence between the heart and the lung in the young child.
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... 5 May 1974 Oxygen Uptake in Infants and Children: A Simple Method for Measurement G. Lister, MD, JIE Hoffman, MD, FRCP, and AM Rudolph, MD, FRCP, FACC From the Department of Pediatrics and Cardiovascular Research Institute, University... more
... 5 May 1974 Oxygen Uptake in Infants and Children: A Simple Method for Measurement G. Lister, MD, JIE Hoffman, MD, FRCP, and AM Rudolph, MD, FRCP, FACC From the Department of Pediatrics and Cardiovascular Research Institute, University of California-San Francisco ...
Research Interests: Mathematics, Pediatrics, Carbon Dioxide, Medicine, Methods, and 15 moreHumans, Air, Pubmed, Ethanol, Infant, Atmospheric Pressure, Newborn Infant, Cardiac Catheterization, Oxygen, Humidity, Age Factors, Oxygen Consumption, Child preschool, Psychology and Cognitive Sciences, and Medical and Health Sciences
• the precise origin of Reye's syndrome is unknown, therapeutic approaches to the disease have three major goals: intensive supportive care, correction of identifiable metabolic abnormalities, and control of intracranial pressure... more
• the precise origin of Reye's syndrome is unknown, therapeutic approaches to the disease have three major goals: intensive supportive care, correction of identifiable metabolic abnormalities, and control of intracranial pressure (ICP). 1 For mild cases (stages I and II), the patient should be observed closely in a pediatric intensive care unit (such patients are subject to rapid and sudden deterioration in neurologic status) and treated with intravenous hypertonic (10% to 15%) glucose solutions at normal maintenance volumes. There is evidence that administration of hypertonic glucose solution to patients in the early stages may prevent disease progression. 2 If the disease progresses to stage III or worse, more aggressive therapy is necessary. The following recommendations are for treatment of patients with severe Reye's syndrome (stages III through V). INTENSIVE SUPPORTIVE CARE Children with Reye's syndrome are subject to hyperthermia, even in the absence of detectable infection, and to sudden respiratory
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Society for Pediatric Research Presidential Address 1993: Development of the Academic Pediatrician
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Tienda online donde Comprar Rudolph's Pediatrics + Cd-Rom al precio 156,99 € de Colin. D Rudolph | Abraham. M Rudolph | George Lister | Lewis R. First | Anne A. Gershon, tienda de Libros de Medicina, Libros de Pediatria - Pediatria... more
Tienda online donde Comprar Rudolph's Pediatrics + Cd-Rom al precio 156,99 € de Colin. D Rudolph | Abraham. M Rudolph | George Lister | Lewis R. First | Anne A. Gershon, tienda de Libros de Medicina, Libros de Pediatria - Pediatria general
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Research Interests: Risk, Social Support, Medicine, Catheterization, Accidents, and 14 moreINTENSIVE CARE, Resuscitation, Intensive Care Unit, Oxygen, Intensive Care Medicine, Neonatal Intensive Care Unit, Pressure Ulcer, Intensive Care Units, Critically Ill Patients, Adverse effect, Equipment safety, Paediatrics and reproductive medicine, Cross Infection, and Respiration Artificial
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Over the past 20 years, hospitalists have emerged as a distinct group of pediatric practitioners. In August of 2014, the American Board of Pediatrics (ABP) received a petition to consider recommending that pediatric hospital medicine... more
Over the past 20 years, hospitalists have emerged as a distinct group of pediatric practitioners. In August of 2014, the American Board of Pediatrics (ABP) received a petition to consider recommending that pediatric hospital medicine (PHM) be recognized as a distinct new subspecialty. PHM as a formal subspecialty raises important considerations related to: (1) quality, cost, and access to pediatric health care; (2) current pediatric residency training; (3) the evolving body of knowledge in pediatrics; and (4) the impact on both primary care generalists and existing subspecialists. After a comprehensive and iterative review process, the ABP recommended that the American Board of Medical Specialties approve PHM as a new subspecialty. This article describes the broad array of challenges and certain unique opportunities that were considered by the ABP in supporting PHM as a new pediatric subspecialty.
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Oxygen consumption of tissue, an organ, or the whole body is usually a function of metabolic demands, and it is not dependent on oxygen supply. With moderate reductions in systemic oxygen transport (SOT: the product of cardiac output in... more
Oxygen consumption of tissue, an organ, or the whole body is usually a function of metabolic demands, and it is not dependent on oxygen supply. With moderate reductions in systemic oxygen transport (SOT: the product of cardiac output in arterial oxygen content), there is usually sufficient reserve to maintain oxygen consumption (\( {\dot V_{{O_2}}} \): the product of cardiac output and arteriovenous oxygen content difference). Alternatively, if metabolic demands are increased, as with exercise or fever, there is sufficient transport to meet these needs [1].
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A wide variety of artifacts may be found when monitoring the ECG in a neonatal intensive care unit. Many of the artifacts resemble arrhythmias, and unless they are recognized as artifacts they may lead to serious errors of diagnosis and... more
A wide variety of artifacts may be found when monitoring the ECG in a neonatal intensive care unit. Many of the artifacts resemble arrhythmias, and unless they are recognized as artifacts they may lead to serious errors of diagnosis and therapy. Many of the artifacts are caused by patient movement such as seizures, tremulousness, or hiccups. Others may be introduced by the monitor itself or be caused by electrical equipment in the vicinity. A group of ECC tracings is presented to illustrate the various artifacts encountered. Features that distinguish the artifacts from the arrhythmias they mimic are described, as are suggestions for elimination of the artifacts.
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The effect of physical training on the exercise performance of 26 patients following surgical repair of tetralogy of Fallot (16 patients) and ventricular septal defect (ten patients) was evaluated. Base line exercise testing was performed... more
The effect of physical training on the exercise performance of 26 patients following surgical repair of tetralogy of Fallot (16 patients) and ventricular septal defect (ten patients) was evaluated. Base line exercise testing was performed on a bicycle ergometer using the technique of Godfrey. Patients were placed on a six-week alternate day submaximal interval home exercise program of varying duration and intensity. Work loads at 50%, 60%, and 70% maximum oxygen consumption were selected to maintain heart rates between 130 and 160 beats per minute. Subjects completed an average of 18 of the possible 21 training sessions (range 11 to 21). A 25% improvement (P < .001) was noted in maximum work capacity (747 to 935 km). Sixty-five percent of the patients performed at less than expected maximum work capacity prior to training, but only 31% performed at less than expected maximum work capacity after training. Repeat testing at work loads of one-third, one-half, and two-thirds the orig...
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There is significant controversy about the role of bronchodilator therapy for wheezing in infants. A double-blind, randomized trial of subcutaneous epinephrine v normal saline was conducted in children <24 months of age evaluated at... more
There is significant controversy about the role of bronchodilator therapy for wheezing in infants. A double-blind, randomized trial of subcutaneous epinephrine v normal saline was conducted in children <24 months of age evaluated at Yale-New Haven Hospital. Respiratory assessments using a newly developed Respiratory Distress Assessment Instrument were made at baseline and 15 minutes after each of two injections. Relief of respiratory distress was assessed using strict a priori criteria based on changes in respiratory rate, wheezing, and retractions as scored in the Respiratory Distress Assessment Instrument. Significantly more children improved their respiratory status with epinephrine (nine of 16) than placebo (one of 14) (Fisher exact test, P = .0067). Paired data in individuals receiving placebo and then epinephrine confirmed this (Wilcoxon signed ranks test, P < .01). Sixty-three percent of patients <12 months and 92% of those 12 to 24 months improved with epinephrine, ...
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The examination of multiple bones from a child who died of complications of septicemia and osteomyelitis elucidated the pathologic processes of infantile osteomyelitis. From a metaphyseal focus, there is spread in several directions. Most... more
The examination of multiple bones from a child who died of complications of septicemia and osteomyelitis elucidated the pathologic processes of infantile osteomyelitis. From a metaphyseal focus, there is spread in several directions. Most important, the infection can spread across the growth plate, along transphyseal vessels, to penetrate the epiphysis. Areas of direct destruction of growth plate were frequent findings, and allowed another route into the epiphysis.
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Preliminary data from a study of the effects of anemia on organ blood flow showed large discrepancies between cardiac output measured with the microsphere technique and simultaneous values calculated by the Fick principle. The most likely... more
Preliminary data from a study of the effects of anemia on organ blood flow showed large discrepancies between cardiac output measured with the microsphere technique and simultaneous values calculated by the Fick principle. The most likely explanation was that the reference sample drawn according to our standard procedure underestimated the microsphere concentration in arterial blood, resulting in erroneously high blood flow values. In the present experiments we compared our usual reference sample, from a small catheter advanced from a peripheral artery into the brachiocephalic artery (withdrawal rate 1.3 ml/min), with a simultaneous sample from a larger catheter withdrawn at the much higher rate (7.89 ml/min). At hematocrits above 32%, microsphere concentrations from the two catheters were similar, but below 32% the concentration of microspheres in blood from the larger catheter was 30-50% more than from the smaller. The discrepancy was not altered by changing the injection site fro...
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Angiotensin-converting enzyme (ACE) activity of the cerebral microcirculation of anesthetized dogs was measured from cerebral venous outflow curves after bolus injection of a synthetic ACE substrate, [3H]benzoyl-phenylalanyl-alanylproline... more
Angiotensin-converting enzyme (ACE) activity of the cerebral microcirculation of anesthetized dogs was measured from cerebral venous outflow curves after bolus injection of a synthetic ACE substrate, [3H]benzoyl-phenylalanyl-alanylproline ([3H]BPAP), into a common carotid artery. Cerebral BPAP metabolism was quantified by measuring the concentration of [3H]benzoyl-phenylalanine (the product of BPAP hydrolysis by ACE) in blood samples from the sagittal sinus after occlusion of the lateral sinuses with bone wax. Instantaneous BPAP metabolism in each sample increased as a function of time after injection, suggestive of perfusion heterogeneity, and averaged 59 +/- 4% (n = 8) over a single pass during normoxia and normocapnia. The ratio of Vmax (the maximal rate of cerebral BPAP metabolism) to Km (the concentration at Vmax/2), was calculated from instantaneous outflow curves using a model based on first-order kinetics. Increases in cerebral blood flow during either hypoxia or hypercapnia...
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The major attempt in this monograph has been to provide a systematic approach to OT in the infant under normal and abnormal conditions based on an appreciation of pathophysiologic mechanisms. This has included a consideration of oxygen... more
The major attempt in this monograph has been to provide a systematic approach to OT in the infant under normal and abnormal conditions based on an appreciation of pathophysiologic mechanisms. This has included a consideration of oxygen uptake, gas transfer from the lungs to the circulation, oxygen delivery to the tissues, and various adaptive responses. We have discussed disorders involving the control of respiration, the upper and lower airways, lung parenchyma, pulmonary circulation, heart, and the oxygen carrier, hemoglobin, that may impair OT to tissues, and how compensation for these conditions can be achieved. The clinical presentation in each of these pathologic processes represents the net effect of the lesion on the multiple steps involved in the transport of oxygen to the tissues and the adaptation provided by the lungs, heart, circulation, and hematologic system. These must be taken into account in developing a plan for medical and/or surgical treatment that is focused on improving the supply of oxygen to the various organ systems of the body.
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Perinatology deals with the birth and death, the illness and health, of the about-to-be and the just born. Growing numbers of healthy children bear witness to its promise; if they had been born a few years earlier, they would have died or... more
Perinatology deals with the birth and death, the illness and health, of the about-to-be and the just born. Growing numbers of healthy children bear witness to its promise; if they had been born a few years earlier, they would have died or survived damaged. But, like many of the babies whom it serves, perinatal medicine has its own developmental quandaries as a result of its rapid growth. Its most profound ethical problems are ancient. The pessimist of the Hebraic scriptures, Koheleth, wrote in the Book of Ecclesiastes: "An untimely birth is better off than a living person, for the miscarriage goes into darkness, where its name disappears: it has not seen the light nor known anything, yet it finds a rest denied to the living" (Eccles. 6. 3-5). Two thousand years later, we worry whether the "untimely births" which we struggle to save would not sometimes be better off going into darkness. We wonder whether our prenatal diagnosis sends into darkness some who could and should live. The Greek philosopher (and bioscientist) Aristotle serenely decreed for his ideal state: "As to the exposure of children, let there be a law that no deformed child shall live. However, let no child be exposed because of excess population, but when couples have too many children, let abortions be procured before sense and life have begun." (Politics, VII, 16, 335b20). Today we still agonize over the preservation of the deformed, over the size and quality of populations, and the termination of unborn life.
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Two years ago, Steve Kohl, MD, then president of the Society for Pediatric Research (Elk Grove Village, Ill), wrote a thoughtful article discussing the relationship between the research agenda of pediatric scientists and the vast health... more
Two years ago, Steve Kohl, MD, then president of the Society for Pediatric Research (Elk Grove Village, Ill), wrote a thoughtful article discussing the relationship between the research agenda of pediatric scientists and the vast health care needs of this nation's poor children. 1 In Kohl's discussion he suggested that the same investigative rigor and resources that we devote to laboratory research can and should be directed to problems and questions that affect the health and welfare of our most vulnerable and underserved population, children. Furthermore, Kohl proposed that our national priorities be shifted from concern with external security to our internal societal problems, and he listed 10 other proposals to accomplish his primary goals. The purpose of this commentary is to review the progress since Kohl's article was published. We fully recognize that the time has been relatively short, so our expectations for forward progress must be tempered slightly.
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Dr. George Lister delivered the following presentation as the Lee E. Farr Lecturer on May 8, 2011, which served as the culmination of the annual Student Research Day at Yale School of Medicine. He is the Chair of Pediatrics at the... more
Dr. George Lister delivered the following presentation as the Lee E. Farr Lecturer on May 8, 2011, which served as the culmination of the annual Student Research Day at Yale School of Medicine. He is the Chair of Pediatrics at the University of Texas Southwestern Medical School and Pediatrician-in-Chief at Children's Medical Center of Dallas. In his lecture to the medical students, who had just completed their research theses, Dr. Lister discusses his own work on sudden infant death syndrome (SIDS), demonstrating the complexity of clinical research and proving insight into the traits required of physician scientists. Committed to medical education and recognized by several awards for his mentorship, he ends the talk by imparting valuable advice on future physicians.
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A 15-year-old boy with diarrhea, dizziness, dysesthesias, and depression is described. On admission, his blood pressure was 110/84 reclining but less than 40 systolic while standing. Vibratory sensation and nerve conduction velocities... more
A 15-year-old boy with diarrhea, dizziness, dysesthesias, and depression is described. On admission, his blood pressure was 110/84 reclining but less than 40 systolic while standing. Vibratory sensation and nerve conduction velocities were decreased in his lower extremities. CSF protein concentration was normal but sural nerve biopsy demonstrated generalized demyelination. Extensive toxicologic and metabolic screening proved unremarkable. Norepinephrine concentrations in plasma and urine, and CSF concentration of 3-methoxy-4-hydroxy phenylglycol (MHPG) were markedly reduced. The patient demonstrates a combination of autonomic dysfunction, peripheral neuropathy, and affective disorder. This collection of clinical and neurochemical findings represents a previously unreported entity involving a defect of both central and peripheral noradrenergic systems.
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A strong association between infant bed sharing and sudden infant death syndrome or unintentional sleep-related death in infants has been established. Occurrences of unintentional sleep-related deaths among infants appear to be... more
A strong association between infant bed sharing and sudden infant death syndrome or unintentional sleep-related death in infants has been established. Occurrences of unintentional sleep-related deaths among infants appear to be increasing. To determine the trends and factors associated with infant bed sharing from 1993 through 2010, including the association of physician advice on bed sharing. National Infant Sleep Position study conducted with annual telephone surveys. The 48 contiguous states. Nighttime caregivers of infants born within 7 months of each survey administration. Approximately 1000 interviews were completed annually. Infant bed sharing as a usual practice. Of 18 986 participants, 11.2% reported an infant sharing a bed as a usual practice. Bed sharing increased from 1993 (6.5%) to 2010 (13.5%). Although bed sharing increased significantly among white respondents from 1993 to 2000 (P < .001), the increase from 2001 to 2010 was not significant (P = .48). Black and His...
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The recent study by Shipman et al1 is noteworthy, particularly given their focused examination of pediatric workforce data at the level of primary care service areas (PCSAs). As Shipman noted, although concerns regarding the number of... more
The recent study by Shipman et al1 is noteworthy, particularly given their focused examination of pediatric workforce data at the level of primary care service areas (PCSAs). As Shipman noted, although concerns regarding the number of primary care physicians have led to efforts to increase the number of trainees who elect careers in primary care, little has been done regarding the inequitable geographic distribution of the pediatric workforce. Although we agree that primary care for children across the United States may not be distributed equitably and support the need for further research in this area, some limitations can potentially threaten the interpretability of the results. The workforce numbers that are reported annually by the American Board of Pediatrics (ABP) differ from those presented in the article. The main reason for the difference is the database used …
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... Julien IE Hoffman, MD. George Lister, MD. 1 Department of Pediatrics; 2 Cardiovascular Research Institute; 3 University of California, San ... To divert resources for unproductive monitoring, with the costs of equipment and personnel,... more
... Julien IE Hoffman, MD. George Lister, MD. 1 Department of Pediatrics; 2 Cardiovascular Research Institute; 3 University of California, San ... To divert resources for unproductive monitoring, with the costs of equipment and personnel, the toll on parents, and the risk ... Ann NY Acad Sci. ...
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Research Interests: Pediatrics, Forecasting, Accreditation, Public Health, Medicine, and 15 moreHumans, Child, Needs Assessment, Organizational, Care, Ideal, Health Care Delivery, Certification, Child Health Services, Innovation, Nino, Medical, Psychology and Cognitive Sciences, internship and residency, and Medical and Health Sciences
OBJECTIVES. The risk for sudden infant death syndrome in black infants is twice that of white infants, and their parents are less likely to place them in the supine position for sleep. We previously identified barriers for parents to... more
OBJECTIVES. The risk for sudden infant death syndrome in black infants is twice that of white infants, and their parents are less likely to place them in the supine position for sleep. We previously identified barriers for parents to follow recommendations for sleep position. Our objective with this study was to quantify these barriers, particularly among low-income, primarily black mothers. DESIGN/METHODS. We conducted face-to-face interviews with 671 mothers, 64% of whom were black, who attended Women, Infants, and Children Program centers in Boston, Massachusetts, Dallas, Texas, Los Angeles, California, and New Haven, Connecticut. We used univariate analyses to quantify factors that were associated with choice of sleeping position and multivariate logistic regression to calculate adjusted odds ratios for the 2 outcome variables: “ever” (meaning usually, sometimes, or last night) put infant in the prone position for sleep and “usually” put infant in the supine position to sleep. R...
Research Interests: Pediatrics, Poverty, Health Education, Infant Toddler Care, Medicine, and 15 moreHumans, Female, Male, Infant, Mothers, African Americans, Newborn Infant, Questionnaires, Adult, European Continental Ancestry Group, Airway Obstruction, Cooperative Behavior, Psychology and Cognitive Sciences, Infant Care, and Medical and Health Sciences
OBJECTIVE: In response to limitations in access to subspecialty care, I present personal observations and suggestions related to education of future pediatricians regarding development of critical thinking skills, care of complex and... more
OBJECTIVE: In response to limitations in access to subspecialty care, I present personal observations and suggestions related to education of future pediatricians regarding development of critical thinking skills, care of complex and chronically ill patients, development of empathy, and restoration of responsibility that may help ameliorate this serious problem. Toward this end, I also offer 1 approach, a 24/7 telephone consultation network, for enriching interaction of primary care providers (PCPs) and subspecialists who can potentially provide rapid access to needed advice, reduce demand for subspecialty appointments, bolster decision-making and expertise, and realign resources with need. METHODS: Data were obtained from 579 requests by PCPs for telephone consultation by subspecialists in 8 areas (including child psychiatry). RESULTS: Of calls, 27% took <5 minutes and 79% took 5 to 15 minutes. Of calls, 28% resulted in a clinic visit; 8% prompted hospital transfer, hospital adm...
Research Interests: Pediatrics, Primary Health Care, Medicine, Curriculum, Problem Solving, and 15 moreHumans, Child, Chronic Disease, United States, Graduate medical education, Specialization, Interdisciplinary Communication, Clinical Competence, Remote Consultation, Cooperative Behavior, Health Services Accessibility, Decision Support Techniques, Psychology and Cognitive Sciences, internship and residency, and Medical and Health Sciences
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We previously observed young lambs to be more tolerant of hypoxia; compared with older lambs, they accumulate lactate at a slower rate during comparable reduction in cardiac output, and have a greater percent decrease in cardiac output... more
We previously observed young lambs to be more tolerant of hypoxia; compared with older lambs, they accumulate lactate at a slower rate during comparable reduction in cardiac output, and have a greater percent decrease in cardiac output before onset of systemic lactate accumulation. To determine the mechanism of lactic acidosis and the cause for this &quot;tolerance,&quot; we reduced cardiac output progressively in seven chronically catheterized conscious lambs (16.4 + 5.1 d) and measured hepatic and gastrointestinal (GI) blood flow (radioactive microspheres) and delivery, uptake, and extraction of lactate and O2. Hepatic O2 consumption declined proportionately below a critical hepatic O2 delivery (approximately 2 mL O2/min/kg), corresponding to the systemic O2 delivery associated with the onset of systemic lactate accumulation. As hepatic O2 delivery decreased below the critical value, there was initially net hepatic lactate uptake and then a change to net production when the O2 delivery decreased below approximately 1 mL O2/min kg. The GI tract had net lactate production at rest, but surprisingly switched to lactate uptake as cardiac output decreased. The mechanism of lactic acidosis was failure of hepatic lactate uptake to increase despite increased hepatic lactate delivery, as reported in adults subjects. However, in contrast, there was &quot;true&quot; hepatic dysfunction and lactate production only at the lowest levels of cardiac output, after onset of systemic lactate accumulation. Moreover, we speculate that tolerance of young lambs to hypoxia is at least due to two factors: 1) hepatic lactate uptake is maintained beyond the &quot;critical&quot; O2 delivery and fall in hepatic O2 consumption, and 2) there is a switch to lactate uptake by the GI tract serving to buffer the lactate.
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We studied the acute effects of increasing hemoglobin concentration and hematocrit on the pulmonary and systemic circulations of nine infants with large left-to-right shunts. After isovolemic exchange transfusion, which was designed to... more
We studied the acute effects of increasing hemoglobin concentration and hematocrit on the pulmonary and systemic circulations of nine infants with large left-to-right shunts. After isovolemic exchange transfusion, which was designed to raise hemoglobin but keep blood volume constant, a consistent rise in systemic and pulmonary vascular resistances occurred. This rise was comparable to those previously found in isolated circulations showing a linear relation between hematocrit and loge of the vascular resistance. These changes in resistance were accompanied by decreases in systemic and pulmonary blood flow and a marked decline in left-to-right shunt. Despite the decrease in systemic blood flow, there was no decline in systemic oxygen transport, and there may have been a marginal decrease in left ventricular stroke work. These observations help explain why the newborn with a large ventricular septal defect and a high hemoglobin concentration does not have clinical signs of a large left-to-right shunt, and also suggest that the postnatal decline in hematocrit has a substantial role in the normal fall in pulmonary vascular resistance after birth.