Search PubMed⌕ Search

Biomedical subjects

F Kennedy

Publications and source records attributed to F Kennedy.

At least 19 recordsLinked to original sources
PubMed2000

Orientation of Phalerisida maculata Kulzer (Coleoptera, Tenebrionidae) in sandy beaches of the Chilean coast. Orientation of Phalerisida maculata in sandy beaches.

The orientation stimuli of adult individuals of the beetle Phalerisida maculata Kulzer (Coleoptera, Tenebrionidae) over the beach surface, were studied at two sandy beaches of the chilean coast approximately 1300 km apart, Apolillado (ca. 29 degrees S) and Playa Universitaria de Mehuín (ca. 39 degrees S). Phalerisida maculata did not orient by astronomic cues such as the sun and moon, nor by the terrestrial magnetic field. Both populations showed positive scototaxis, and oriented downward on slopes with dry sediments, and upwards on slopes with wet sediments.

Journal Article↗
PubMed2000

Emergency room thoracotomy: a single surgeon's thirteen-year experience.

Our objectives were to elucidate the postoperative complications in patients who have had emergency room thoracotomy (ERT), to define anatomic and physiologic parameters that are compatible with survival and to document the evolution of management of these patients. A single surgeon's experience over a 13-year period was reviewed. All patients where he was the primary or supervising surgeon for the ERT were included. Data were analyzed for mechanism (penetrating/blunt), hospital where performed, survival to intensive care unit, survival to discharge, and postoperative complications. Among survivors, data were analyzed for the anatomic injuries and the patients' physiologic condition in the field and on arrival. There were a total of 102 patients; penetrating injury 94 (92 percent); blunt, 8 (8 percent). Ten patients (10 percent) reached the intensive care unit alive. Three of the ten (30 percent) died at 2 hours, 12 hours, and 7 days postoperatively. Seven patients survived to hospital discharge. All seven had penetrating chest injuries and were not in cardiac arrest when first examined by paramedics. Four of the seven survivors (57 percent) had major complications. Survival for the early period was 1.6 percent (1/62) and for the later period 15 percent (6/40); P < 0.05. During the study period, changes in patient management included 1) for penetrating torso injury, withholding ERT when survival was extremely unlikely; 2) increased use of blood- and fluid-warming measures; 3) elimination of aortic cross-clamping, instead judiciously using manual compression; 4) making the main purpose of ERT the relief of cardiac tamponade; and 5) immediately controlling any cardiac injury with a simple running suture on a large needle. We conclude the following: 1) The postoperative course after ERT carried significant mortality and morbidity. 2) Compatibility with survival required both the absence of cardiac arrest when initially evaluated in the field and the presence of penetrating chest injury. 3) Significant changes occurred in patient management during this 13-year period. Survival was higher in the latter part of this period.

Emergencies↗
PubMed2000

Evaluating the role of physical and radiographic examinations in assessing bullet tract termination for gunshot victims.

Knowledge of the path of a bullet and how it terminates is critical for expeditious assessment and optimal management of patients with gunshot wounds. To assess the accuracy of physical examination and X-rays in these patients, a prospective study was undertaken for all gunshot victims seen for a 1-year period on a single trauma service. The paramedics and trauma surgeons' physical examinations were evaluated for whether a bullet tract could be accurately categorized as 1) through and through, 2) graze, 3) palpable under dermis, or 4) retained (ie, not palpable). The impact of X-rays was assessed with regard to how it affected the trauma surgeons' categorization. A total of 78 patients were seen with a total of 120 bullet tracts. Seventy-seven per cent were injured by assault, and 64 per cent were shot with a 9-mm or .38-caliber handgun. Twenty of 60 (33%) bullet tracts on the torso terminated with a missile that was palpable under dermis, but only 2 of 10 neck (20%), 1 of 28 extremity (4%), and 1 of 22 head/face (5%) did so. Paramedics evaluated 15 torso bullet tracts that ended palpable under dermis, of which they detected 5 (33%). Upon initial examination, the trauma surgeon detected 11 of 20 torso bullet tracts that ended palpable under dermis (55%), and detected 14 of the 20 after X-rays were done (70%). Overall, obtaining X-rays changed the categorization for 15 of 111 bullet tracts (13%). We conclude that bullet tracts on the torso result in a subcutaneously palpable bullet one-third of the time, much more frequently than in other body regions. Paramedics only detect one-third of subcutaneously palpable missiles on the torso. X-rays change the categorization of bullet tracts infrequently. We recommend that a careful examination of the skin of the torso to detect palpable missiles be incorporated into the secondary survey of patients with wounds to that body region.

Allied Health Personnel↗
PubMed1998

A risk profile of emergency room adult trauma victims: intentional versus unintentional trauma injuries.

This article presents a prospective study of 285 adult trauma victims admitted to a Los Angeles inner-city level 1 trauma center, from November 1991 to February 1992. The purpose of this study was to determine the magnitude of intentional and unintentional trauma injuries in this adult patient population, and to identify sociodemographic, lifestyle and medical risk factors predisposing patients to intentional vs. unintentional trauma injury. Chi-square analysis revealed that intentional trauma victims and unintentional trauma victims significantly differ in 8 of 13 risk factors. The resulting risk profile indicated that intentional trauma victims were more likely to be between the ages of 16-29 years old; African American males and more likely to present to the emergency room with injury severity scores higher than 15 (indicating severe injuries) than unintentional trauma victims. Strategies for prevention and medical social work intervention are discussed.

Adolescent↗
PubMed1996

Lamivudine prophylaxis against reinfection in liver transplantation for hepatitis B cirrhosis.

BACKGROUND: Orthotopic liver transplantation in patients positive for hepatitis B virus (HBV) DNA is associated with a high reinfection rate, even with hepatitis B immunoglobulin (HBIG) prophylaxis. Nucleoside analogues that inhibit hepatitis B replication in patients with chronic hepatitis B could prevent reinfection after transplantation. The aim of this study was to analyse the efficacy and safety of prophylaxis both before and after transplantation with the nucleoside analogue lamivudine, without HBIG, in patients undergoing liver transplantation. METHODS: 17 HBsAg-positive patients with decompensated cirrhosis and previous evidence of viral replication were enrolled. 12 were HBV-DNA-positive by a signal amplification assay. Patients were treated with oral lamivudine (100 mg daily) for at least 4 weeks before transplantation and followed up for 18-90 weeks after transplantation. FINDINGS: HBV DNA became undetectable in serum before transplantation in all HBV-DNA-positive patients. Four died before transplantation from complications of cirrhosis; one patient was withdrawn from the study because of a cerebrovascular accident. The remaining 12 patients underwent transplantation. Two patients died after transplantation (one at 3 days and one [suicide] at 20 weeks). HBV DNA reappeared in one patient with histological evidence of recurrent hepatitis (72 weeks). By week 24 the nine remaining patients had lost HBsAg and remained negative for HBV DNA. INTERPRETATION: Lamivudine treatment may prove useful in preventing recurrence of hepatitis B after liver transplantation. The effect on survival of patients after transplantation remains to be assessed.

DNA, Viral↗
PubMed1996

Transmediastinal gunshot wounds. A reconsideration of the role of aortography.

OBJECTIVE: To evaluate the contribution of aortography in the management of stable patients with transmediastinal gunshot wounds. DESIGN: Retrospective review of clinical records. SETTING: Level I urban trauma center. PATIENTS: Forty-three patients with aortic or esophageal gunshot injuries. INTERVENTIONS: Patients who were stable after initial resuscitation underwent aortography followed by esophagography. MAIN OUTCOME MEASURES: Hemodynamic status on admission, time devoted to diagnostic workup, surgical (or autopsy) findings, morbidity, and mortality. RESULTS: There were 24 esophageal injuries and 20 aortic injuries. Patients with aortic injuries were less often stable for aortography (10% vs 42%; P = .02), and fewer of them survived (15% vs 58%; P = .01). In no patient was the aortic injury initially detected by aortography. Stable patients with esophageal injuries experienced an average 11-hour interval between injury and surgery (nearly 3 hours attributable to aortography). CONCLUSION: Esophageal evaluation should precede aortography in the workup of stable patients with transmediastinal gunshot wounds.

Adolescent↗
PubMed1996

The critical care of the severely injured patient--I. Assessing and improving oxygen delivery.

The hallmark of critical care of the major trauma victim is the assurance of adequate cellular perfusion of oxygen and nutrients. Although controversy exists as to the exact endpoint of therapeutic maneuvers aimed at this assurance, there should be general agreement that benefit is to be gained from careful observation of clinical signs of perfusion status and bedside determinations of oxygen transport parameters.

Critical Care↗
PubMed1996

Geographic and temporal patterns of recurrent intentional injury in south-central Los Angeles.

To better understand geographic and temporal patterns of recurrent intentional injury, 285 consecutive trauma patients were evaluated prospectively. Fifteen were excluded because of immediate death or severe brain injury. The remaining 270 patients were interviewed. Of these, 59 (22%) had been treated in a hospital for a total of 75 previous episodes of intentional trauma (mean: 1.3 episodes/patient). In 66 of the 75 episodes, the patient recalled where treatment had been received (88%). Twenty-eight (42%) of the 66 episodes had been treated at King/Drew Medical Center (KDMC), 36 (55%) had been treated at a hospital within a 3-mile radius of KDMC, 48 (73%) within an 8-mile radius, and 63 (95%) within a 10-mile radius. Sixty-five percent of the episodes occurred 5 years or less prior to the current injury (range: 11 days to 30 years; mean: 4.9 years). Patients currently admitted for intentional injury were more likely to have had intentional injury previously than those with unintentional injury (27% versus 12%). Based on these findings, we conclude that intentional trauma patients in our community remain in a defined geographic region and that there is a definable high-risk period for recurrent intentional injury. These conclusions should enhance the development of a framework on which future violence prevention programs can be designed.

Adolescent↗
PubMed1995

Gunshot wounds to the thoracic aorta in the '90s: only prevention will make a difference.

The clinical experience with gunshot injuries to the thoracic aorta at a large urban trauma center was reviewed. Of 1961 patients admitted with gunshot wounds to the chest, 20 sustained injuries to the thoracic aorta. Mortality occurred in 17 patients (85%), all of whom were hypotensive or moribund upon admission. The three patients (15%) presenting with a systolic blood pressure above 100 mm Hg survived; only one of these underwent surgery during the acute period. Only two patients were stable enough for aortography. Advances in the management of critically injured patients have not improved the outcome with this lethal injury.

Adolescent↗
PubMed1995

Blunt injury to the left common iliac artery.

Injury to the common iliac artery is very uncommon in blunt trauma. We report two cases of intimal tear that led to thrombotic occlusion of the left common iliac artery in victims of motor vehicle collisions.

Adult↗
PubMed1993

General practitioner referral patterns.

A survey of general practitioners (GPs) in the Western Health and Social Services Board was carried out in November 1990. The main objectives were to determine the factors which influence GPs' decisions to refer to particular hospitals and to ascertain current out-patient referral patterns. A self-administered questionnaire was sent to 157 GPs. The response rate was 94 per cent. It was found that waiting lists and personal knowledge of consultants' expertise were considered to be of particular importance in making referral decisions for elective/non-urgent procedures. Referrals were usually made to the nearest hospital with a relevant out-patient clinic. The majority (96 per cent) of respondents indicated that they would be willing to change their referral patterns for elective/non-urgent procedures in response to shorter waiting times. It is concluded that GPs may be more willing to change their referral patterns than might have been expected.

Decision Making↗
PubMed1993

Relationship between supranormal circulatory values, time delays, and outcome in severely traumatized patients.

OBJECTIVE: To describe the temporal patterns of hemodynamics and oxygen transport in survivors and nonsurvivors of severe trauma in relation to time delays, mortality, and morbidity. DESIGN: Prospective, empiric analysis. SETTING: University-run, inner city county hospital with a Level I trauma center. PATIENTS: A series of 90 consecutively monitored, severely ill trauma patients. METHODS: We followed 90 patients from admission through their hospital course, and divided the study group into patients with estimated blood loss of < or = 3000 mL and those patients with an estimated blood loss of < 3000 mL. For each patient, vital signs were recorded in the Emergency Department, operating room, recovery room, and surgical ICU. Hemodynamic and oxygen transport variables were measured at least every 12 hrs for 96 hrs postadmission. Final outcome and complications were recorded. RESULTS: In the first 24 hrs, the values of 60 survivors were significantly higher than the values of 30 nonsurvivors for mean cardiac index (4.52 +/- 1.45 vs. 3.80 +/- 1.20 L/min/m2; p < .05), oxygen delivery (670 +/- 230 vs. 540 +/- 200 mL/min/m2; p < .01), and oxygen consumption (166 +/- 48 vs. 134 +/- 47 mL/min/m2; p < .01). Thirteen (50%) of 26 patients who never attained mean survivors' values (defined as the mean survivors' values listed above) died. Also, 12 (57%) of 21 patients who took > 24 hrs to attain these values died. In contrast, only five (12%) of 43 patients who reached mean survivors' values in < or = 24 hrs died. Thirty-five of 90 patients lost < 3000 mL of blood; 17 of these 35 patients failed to reach survivors' values within 24 hrs, and 12 (71%) patients died. However, of 18 patients with an estimated blood loss of > 3000 mL, who reached survivors' values in < or = 24 hrs, only two (12%) died. The patients reaching survivors' values in < or = 24 hrs, > 24 hrs, or not at all had similar Injury Severity Scores (28 +/- 13, 26 +/- 13, and 26 +/- 12, respectively) and Trauma Scores (12 +/- 3, 13 +/- 3, and 12 +/- 3, respectively). Only six (12%) of 43 patients reaching survivors' values in < or = 24 hrs developed adult respiratory distress syndrome (ARDS), while 27 (57%) of 47 patients showed these values in > 24 hrs or never developed ARDS. CONCLUSIONS: Reaching supranormal circulatory values, especially within 24 hrs of injury, may improve survival and reduce the frequency of shock-related organ failure in severely traumatized patients.

Hemodynamics↗
PubMed1993

The Glasgow Coma Scale and prognosis in gunshot wounds to the brain.

To determine which factors predict survival in patients with gunshot wounds to the brain, 192 patients who had intracranial injury demonstrated on computed tomographic (CT) scanning were retrospectively reviewed. Glasgow Coma Scale (GCS) scores on admission seemed to be the most important factor in predicting survival. Age, the presence of extruded brain, and use of a shotgun could not be shown to be factors independent of admission GCS score. Findings on CT scans (single lobe vs. multilobe involvement) helped to predict survival only in patients with GCS scores 5-13. The mortality rate was 35%. Among survivors 18% had brain-related long-term disability, and an additional 27% had long-term disability related to associated eye injury.

Adolescent↗