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Kennedy EM, Wood RP, Shaw BW. Primary nonfunction. Is there a contribution from the back table bath? Transplantation 1990; 49:739-43. [PMID: 2326869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
A persistent problem in orthotopic liver transplantation (OLT) is primary nonfunction (PNF) of the hepatic allograft. In most instances the cause of the failure is unknown. In an attempt to minimize these graft failure, modifications in the procurement and operative procedure have been investigated. One change in the procedure at the University of Nebraska Medical Center has been the monitoring of the temperature of the fluid in the back table bath during preparation of the donor liver. Our initial procedure involved creating an ice slurry of lactated Ringer's solution and ice slush in which the donor liver was then prepared. The temperature of this ice slurry was retrospectively found to be from -3 degrees C to -1 degrees C (group I). In this group there was a higher-than-expected incidence of PNF. To investigate whether the temperature of the back table bath influenced the incidence of PNF, beginning with transplant No. 42 the preparation of the back table bath was modified. The bath was created by adding a small amount of PlasmaLyte slush to 2 L of PlasmaLyte (group II). The temperature of the bath was maintained at 2-4 degrees C. Data were collected on 100 consecutive liver transplants. All transplants were performed using standard techniques, the operation for the two groups differing only as described above. Transaminase levels were followed as an index of the allograft function and were expected to begin to normalize within 2-3 days after transplantation. While both groups display this trend, transaminase levels in group II were significantly lower postoperatively than group I levels (P less than 0.05). Preoperative values were similar. There were 7 PNFs in group I; 0 in group II (P less than 0.005). We feel that the change in the back table procedure has positively influenced the function of the hepatic allografts, and we conclude that transplant centers need to monitor the temperature at which all allografts are stored and prepared, and the cognizant that this may influence the postoperative function of the transplanted liver.
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Kennedy EM. Kennedy proposes health care for all. THE AMERICAN NURSE 1990; 22:2. [PMID: 2181897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Stratta RJ, Shaefer MS, Markin RS, Wood RP, Kennedy EM, Langnas AN, Reed EC, Woods GL, Donovan JP, Pillen TJ. Clinical patterns of cytomegalovirus disease after liver transplantation. ARCHIVES OF SURGERY (CHICAGO, ILL. : 1960) 1989; 124:1443-9; discussion 1449-50. [PMID: 2556090 DOI: 10.1001/archsurg.1989.01410120093018] [Citation(s) in RCA: 86] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
During a 43-month period, we performed 248 liver transplantations in 211 patients (127 adults and 84 children). Cytomegalovirus (CMV) disease was documented in 73 recipients (34.6%). Risk factors for CMV disease included donor CMV seropositivity, antilymphocyte therapy, and retransplantation. The mean time of occurrence of CMV disease was 38.3 days after transplantation, and the most frequent site of disease was the hepatic allograft. A total of 69 patients were treated with intravenous ganciclovir, with a prompt and lasting response documented in 51 (73.9%). The remaining 18 (26.1%) developed recurrent CMV disease, which was more common after primary CMV exposure. Cytomegalovirus disease was ultimately controlled by ganciclovir in 94.2% of cases. This disease occurs early after transplantation and can be related to well-defined risk factors. Although ganciclovir therapy is effective, preliminary experience with prophylaxis shows promise in reducing the incidence of CMV disease.
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Newland MC, Leuschen P, Sarafian LB, Hurlbert BJ, Fleming WF, Chapin JW, Becker GL, Kennedy EM, Bolam DD, Newland JR. Fentanyl intermittent bolus technique for anesthesia in infants and children undergoing cardiac surgery. JOURNAL OF CARDIOTHORACIC ANESTHESIA 1989; 3:407-10. [PMID: 2520913 DOI: 10.1016/s0888-6296(89)97315-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The use of fentanyl by an incremental intravenous (IV) bolus technique was evaluated in eight pediatric patients (ages 4 months to 5 years, ASA III-IV) undergoing corrective surgery for congenital heart defects. Anesthesia was induced with 5 to 10 micrograms/kg of fentanyl. Additional boluses of comparable size were given intermittently thereafter, in order that a total dose of 100 micrograms/kg was achieved just before instituting cardiopulmonary bypass (CPB). Heart rate, systolic blood pressure, various measures of anesthetic depth, and plasma fentanyl levels measured by radioimmunoassay were compared at various points during anesthesia, surgery, and recovery. Decreases in heart rate were observed at the time of sternal incision and at 30 minutes thereafter, when doses of fentanyl were near-maximal. No changes from baseline in systolic blood pressure or in anesthetic depth occurred at any of the intervals studied. The plasma concentration of fentanyl was 30 +/- 8 ng/mL just after completion of the fentanyl administration, immediately before CPB. With onset of CPB, the fentanyl level fell to 13 +/- 9 ng/mL, a statistically significant difference from the baseline value. No further change occurred over the additional 231 +/- 74 minutes in the operating room. The fentanyl concentration was 10 +/- 4 ng/mL upon entry into the recovery room. It is concluded that administration of fentanyl in small, intermittent IV boluses, with dosing completed before the onset of CPB, produces satisfactory plasma levels, anesthesia, and hemodynamic stability in children undergoing corrective surgery for congenital cardiac defects.
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Kennedy EM. Bill mandates health insurance for employees. HEALTH PROGRESS (SAINT LOUIS, MO.) 1988; 69:24-6. [PMID: 10287454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/13/2023]
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Kennedy EM. An interview with Senator Edward M. Kennedy. Interview by Janet I. Pisaneschi, Leopold G. Selker, Susan E. Siska, Arthur A. Savage and David C. Broski. JOURNAL OF ALLIED HEALTH 1988; 17:3-13. [PMID: 3350762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Kennedy EM. On Capitol Hill with Edward H. Kennedy. Interview by Hurdis Griffith. NURSING ECONOMIC$ 1987; 5:207-12. [PMID: 3657992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Chapin JW, Wood RP, Hurlbert BJ, Shaw BW, Kennedy EM, Cuka DJ, Markin RS, Peters KR, Newland MC. Sources of increased serum potassium following reperfusion of liver allografts. Transplant Proc 1987; 19:51-3. [PMID: 3303533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Kennedy EM. Balanced health care spending policy needed so hospitals won't be victimized for deficit. REVIEW (FEDERATION OF AMERICAN HEALTH SYSTEMS) 1987; 20:34-6. [PMID: 10301422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Kennedy EM. Ensuring access to essential health care. HOSPITALS 1987; 61:120. [PMID: 3793057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Fleming WH, Sarafian LB, Leuschen MP, Newland MC, Kennedy EM, Kugler JD, Chapin JW, Hurlbert BJ, Bolam DL, Nelson RM. Serum concentrations of prostacyclin and thromboxane in children before, during, and after cardiopulmonary bypass. J Thorac Cardiovasc Surg 1986; 92:73-8. [PMID: 3755198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Twenty-six consecutive pediatric patients undergoing reparative procedures necessitating cardiopulmonary bypass were prospectively studied to determine changes in serum levels of 6-keto-prostaglandin F1 alpha and thromboxane B2. Cardiac lesions included acyanotic lesions (five patients), obstructive lesions (10 patients), and right-to-left shunts (11 patients). There was a significant (p less than 0.05) increase in 6-keto-prostaglandin F1 alpha from preoperative levels measured at the time of arterial and venous cannula insertion. This concentration was maintained throughout cardiopulmonary bypass and remained significantly elevated (p less than 0.001) in the recovery room, but returned to preoperative levels by the morning after the operation. Preoperative levels of thromboxane B2 varied widely and were not significantly different from intraoperative levels. The postoperative levels of thromboxane B2, however, were significantly different (p less than 0.05) from the intraoperative levels. In the pediatric age group undergoing cardiopulmonary bypass, 6-keto-prostaglandin F1 alpha and thromboxane B2 change during bypass but do not significantly differ when preoperative levels are compared to postoperative values.
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Kennedy EM. Views on doctors' income and legislation. An interview with Senator Kennedy. Interview by Penny Tselikis. PHYSICIAN'S MANAGEMENT 1984; 24:90-2, 95. [PMID: 10268114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Kennedy EM. Health cost inflation affects profitability of American business as a whole. BUSINESS AND HEALTH 1984; 1:56. [PMID: 10310516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Kennedy EM, Snowden N, Westenfelder G, Phair JP. The effects of subinhibitory concentrations of various antibiotics on phagocytosis of Streptococcus faecalis. J Antimicrob Chemother 1983; 12 Suppl C:69-74. [PMID: 6417102 DOI: 10.1093/jac/12.suppl_c.69] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
This study reports the effects of subinhibitory concentrations of the antibiotics, clindamycin, gentamicin, moxalactam, and penicillin G, against 6 blood isolates of Streptococcus faecalis to determine possible enhancement of phagocytosis. In addition, combinations of penicillin G plus streptomycin, penicillin G and gentamicin, and clindamycin plus gentamicin were studied to determine synergistic growth inhibition. Results suggest no observable effect in phagocytosis from subinhibitory concentrations of the studied antibiotics singly or in combination. The number of viable intracellular Str. faecalis were also not affected by pre-treatment with antibiotics.
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Kennedy EM. Federal EMS legislation. EMERGENCY MEDICAL SERVICES 1982; 11:11-2. [PMID: 10253753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Kennedy EM. Current prospects for biomedical research. CLINICAL RESEARCH 1979; 27:245-7. [PMID: 10243444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Kennedy EM. Legislating health care. JOURNAL OF THE ASSOCIATION FOR THE CARE OF CHILDREN IN HOSPITALS 1979; 7:3-7. [PMID: 10237005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Kennedy EM. Ted Kennedy: an old enemy takes a new look at doctors. MEDICAL ECONOMICS 1978; 55:35-6, 40, 42-4. [PMID: 10239445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Kennedy EM. A positive health strategy: the time is now. AMERICAN LUNG ASSOCIATION BULLETIN 1978; 64:2-4. [PMID: 10238959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Kennedy EM. Califano and Kennedy take sides on national health plan. HEALTH CARE WEEK 1978; 2:8. [PMID: 10323948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Kennedy EM. The congress and national health policy. Fifth Annual Matthew B. Rosenhaus Lecture. Am J Public Health 1978; 68:241-4. [PMID: 637170 PMCID: PMC1653906 DOI: 10.2105/ajph.68.3.241] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Kennedy EM. Health manpower, DNA and National Health Insurance. MARYLAND STATE MEDICAL JOURNAL 1978; 27:35-7. [PMID: 633954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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