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W Padberg

Publications and source records attributed to W Padberg.

At least 19 recordsLinked to original sources
PubMed2000

[Actinomycosis of the colon as a rare differential diagnosis of colonic carcinoma].

INTRODUCTION: Abdominal actinomycosis is an uncommon disease. Nevertheless it should be considered in case of unclear tumor-like abdominal masses. METHODS: We report a case of a 49-year-old patient with an intrauterine device. The patient was submitted with a solid and painful tumor in the upper abdomen. After sonography, computerized tomography, gastroduodenoscopy and colonoscopy the preoperative presumptive diagnosis was a carcinoma of the transvers colon invading the abdominal wall. Pathological examination after a right hemicolectomy surprisingly revealed an actinomycosis. RESULTS: Based on this case diagnostic tools and therapeutic options of actinomycosis of the colon are discussed. CONCLUSIONS: This case illustrates the importance to consider the possibility of actinomycosis when finding an unclear abdominal mass. After a surgical excision an abdominal actinomycosis requires antibiotic therapy.

Actinomycosis↗
PubMed1998

Simultaneous analysis of 4- and 5-series lipoxygenase and cytochrome P450 products from different biological sources by reversed-phase high-performance liquid chromatographic technique.

Quantification of lipoxygenase and cytochrome P450 products of both arachidonic acid (AA) and eicosapentaenoic acid (EPA) is of broad interest due to the multiple biological activities of these compounds. We developed a method combining (i) solid-phase extraction, (ii) isocratic reversed-phase high-performance liquid chromatographic separation, and (iii) online photodiode array detection with spectrum analysis for identification and measurement of all main 4- and 5-series eicosanoids (leukotrienes, hydroxyeicosatetraenoic acids/hydroxyeicosapentaenoic acids, epoxyeicosatrienoic acids) within one run. With these procedures, standard mixtures of AA- and EPA-derived lipid mediators were recovered from different biological liquids, like lung perfusate, human bronchoalveolar lavage fluid, and cell supernatant with linear characteristics for each compound. Recoveries of the different lipid mediators exceeded 80% showing excellent reproducibility. Application of the method to isolated, perfused, and ventilated human lungs challenged with the calcium ionophore A23187 and to human neutrophils stimulated in the presence of arachidonic acid and eicosapentaenoic acid with N-formyl-methionyl-leucyl-phenylalanine demonstrated the generation of a large array of lipoxygenase and cytochrome P450 products. Thus, convenient quantification of 4- and 5-series eicosanoids in fluids of biological interest is achieved by a technique comprising solid-phase extraction, isocratic reversed-phase high-performance liquid chromatography, and photodiode array-based online spectrum analysis of eluting compounds.

Arachidonate 5-Lipoxygenase↗
PubMed1998

Retracted: Influence of dopexamine hydrochloride on haemodynamics and regulators of circulation in patients undergoing major abdominal surgery.

BACKGROUND: Catecholaminergic support is often used to improve haemodynamics in patients undergoing major abdominal surgery. Dopexamine is a synthetic vasoactive catecholamine with beneficial microcirculatory properties. METHODS: The influence of perioperative administration of dopexamine on cardiorespiratory data and important regulators of macro- and microcirculation were studied in 30 patients undergoing Whipple pancreaticduodenectomy. The patients received randomized and blinded either 2 micrograms.kg-1.min-1 of dopexamine (n = 15) or placebo (n = 15, control group). The infusion was started after induction of anaesthesia and continued until the morning of the first postoperative day. Endothelin-1 (ET-1), vasopressin, atrial natriuretic peptide (ANP), and catecholamine plasma levels were measured from arterial blood samples. Measurements were carried out after induction of anaesthesia, 2 h after onset of surgery, at the end of surgery, 2 h after surgery, and on the morning of the first postoperative day. RESULTS: Cardiac index (CI) increased significantly in the dopexamine group (from 2.61 +/- 0.41 to 4.57 +/- 0.78 l.min-1.m-2) and remained elevated until the morning of the first postoperative day. Oxygen delivery index (DO2I) and oxygen consumption index (VO2I) were also significantly increased in the dopexamine group (DO2I: from 416 +/- 91 to 717 +/- 110 ml/m2.m2; VO2I: from 98 +/- 25 to 157 +/- 22 ml/m2.m2), being significantly higher than in the control group. pHi remained stable only in the dopexamine patients, indicating adequate splanchnic perfusion. Vasopressive regulators of circulation increased significantly only in the untreated control patients (vasopressin: from 4.37 +/- 1.1 to 35.9 +/- 12.1 pg/ml; ET-1: from 2.88 +/- 0.91 to 6.91 +/- 1.20 pg/ml). CONCLUSION: Patients undergoing major abdominal surgery may profit from prophylactic perioperative administration of dopexamine hydrochloride in the form of improved haemodynamics and oxygenation as well as beneficial influence on important regulators of organ blood flow.

Adrenergic beta-Agonists↗
PubMed1998

[Value of locoregional chemotherapy in liver metastases of breast carcinoma].

Between 1985 and 1997, we performed a locoregional chemotherapy in 59 patients suffering from non-resectable liver metastases of breast cancer. 36 of them only had liver metastases, in 23 patients liver metastases were combined with extrahepatic tumor spread. Furthermore, in 7 patients locoregional chemotherapy was used as a adjuvant regimen after metastasectomy. The average age of our patients was 52 (32-81) years. In most of our patients, a cytostatic scheme of mitoxantron, 5-fluorouracil and doxorubicin or a scheme of vincristin, mitomycin and mitoxantron was administered. The median survival of all patients was 11 months, in the patients with no additional extrahepatic tumor spread it was 16, in the patients with extrahepatic metastases 3 months, respectively.

Adult↗
PubMed1997

[The effects of dopexamine. Transpulmonary shunt volume in thoracic surgical procedures with one-lung respiration].

OBJECTIVE: To study the influence of dopexamine on pulmonary shunt and hypoxic pulmonary vasoconstriction during major thoracic surgery with one-lung ventilation (OLV). DESIGN: Prospective, randomised, placebo-controlled study. SETTING: University hospital. PATIENTS: Twenty adult patients undergoing elective pulmonary resection. ANAESTHESIA: General anaesthesia was performed using propofol, fentanyl, N2O and vecuronium. Volume-controlled ventilation was performed to maintain normocapnia over the whole investigation period. During OLV, the tidal volume was reduced and the respiratory rate was increased to avoid a peak airway pressure exceeding 40 cm H2O. Furthermore the FiO2 was increased to 1.0 and the external PEEP was removed during OLV. INTERVENTIONS: The patients received either dopexamine at 2 micrograms/kg/min (group A, n = 10) or 0.9% saline as control (group B, n = 10) after assessing the baseline values. MEASUREMENT AND RESULTS: The following cardiorespiratory variables were recorded: Heart rate, mean arterial pressure and mean pulmonary arterial pressure. Cardiac output was measured by thermodilution using a continuous cardiac output thermodilution catheter. Arterial and mixed venous blood gas analysis were measured from simultaneously drawn samples. Cardiac index (CI), systemic vascular resistance index, pulmonary vascular resistance index, oxygen delivery index (DO2I), oxygen consumption index and the venous admixture were calculated using standard formula. Furthermore, pressure-flow-curves were constructed to analyse flow independent changes in the pulmonary vascular resistance. Data were recorded at the following times: After induction of anaesthesia in stable haemodynamics during two-lung ventilation (baseline values, T0), intraoperatively during one-lung ventilation (T1) and postoperatively after re-establishing two-lung ventilation (T2). Patients characteristics, data from the preoperative lung function testing and surgical procedures did not differ significantly between the groups. CI increased in the dopexamine group from 2.5 +/- 1.2 1.min-1.m-2 (T0) to 3.6 +/- 0.9 l.min-1.m-2 (T1) and 4.0 +/- 1.3 l.min-1.m-2 (T2). The course of the intrapulmonary right-to-left shunting did not differ between the groups. In the dopexamine-treated group the DO2I increased from 430 +/- 143 ml.min.m-2 (T0) to 652 +/- 255 ml.min.m-2 (T1) and 653 +/- 207 ml.min.m-2 (T2). Regarding the pressure-flow-curves there was no difference during OLV between the two groups indicating no major blocking effect of dopexamine on hypoxic pulmonary vasoconstriction. CONCLUSION: It is concluded that dopexamine can be used to improve haemodynamics and oxygen delivery during thoracic surgery without increasing venous admixture during one-lung ventilation.

Aged↗
PubMed1997

[Primitive neuroectodermal tumor].

The primitive neuroectodermal tumor is a rare soft tissue neoplasm occurring in children and young adults. It derives from a carcinogeneic alteration of pluripotent neural crest cells, caused by a balanced reciprocal translocation t(11;22) (q24;q12). Treatment of this undifferentiated, extremely malignant small cell tumor is carried out in compliance with the soft tissue trail (CWS) from the German Society of Pediatric Oncology. Biopsy-proven diagnosis is followed by primary chemotherapy, which in 95% of cases leads to remission, allowing excision of the remainder of the tumor without mutilation and avoidance of intraoperative tumor cell dissemination. After excision, irradiation of the tumor site and two further sequences of chemotherapy are performed. If PNETs of the paravertebral region cause symptoms of paralysis and immediate surgery is required, postoperative chemotherapy, a second-look operation and irradiation are mandatory. Between 1986 and 1994, in cooperation with our pediatric and radiotherapy colleagues, we treated ten patients. In four patients (median age, 14 years) the PNET originated from the chest wall, in six patients from the paravertebral and retroperitoneal region. Five patients died after 20 months on average, while the remaining five patients are in full remission after 31, 46, 50, 51 and 91 months, respectively.

Adolescent↗
PubMed1997

[Use of preoperative infusion cholangiography before laparoscopic cholecystectomy].

In the present study, we intend to evaluate whether intravenous cholangiography, performed on a routine basis in the preoperative period, in addition ultrasonography, history or elevations of serum bilirubin and alkaline phosphatase, provides any supplementary information in detecting patients with asymptomatic calculi in the common bile duct before laparoscopic cholecystectomy is carried out. Therefore, 513 patients were included in a retrospective analysis. From our data, we conclude that preoperative intravenous cholangiography cannot be recommended, when costs and risks and a potential benefit for the patient are considered.

Cholangiography↗
PubMed1996

RETRACTED: Cardiorespiratory changes in patients undergoing pulmonary resection using different anesthetic management techniques.

OBJECTIVE: Pulmonary resection may be associated with considerable alterations of the cardiorespiratory system. The ideal anesthetic regimen for these patients is not yet definitely determined. DESIGN: Prospective, randomized study. SETTING: Single-institutional, clinical investigation in a thoracic anesthesia department of a university hospital. PARTICIPANTS: Fifty consecutive patients scheduled for elective thoracic surgery for lung cancer. INTERVENTIONS: In 20 patients undergoing lobectomy, fentanyl/propofol/nitrous oxide/vecuronium anesthesia was used, and extubation was planned immediately after surgery (group 1A, early extubation). Another 20 patients with lobectomy were anesthetized during fentanyl/midazolam/vecuronium, and they were extubated in the intensive care unit (ICU) (group 1B, late extubation). Ten patients underwent pneumonectomy (extubation planned in the ICU) (group 2, pneumonectomy). Patients of groups 1A and 1B were selected according to a randomized sequence. MEASUREMENTS AND MAIN RESULTS: Extensive hemodynamic monitoring was performed using a pulmonary artery catheter by which right ventricular hemodynamics (right ventricular ejection fraction [RVEF], right ventricular end-systolic, and end-diastolic volumes) were additionally measured. Measurements were performed after induction of anesthesia (supine position, baseline values), before surgery (lateral position), 30 minutes after one-lung ventilation (OLV) was induced, at the end of surgery (supine position), 2 hours after surgery (in ICU), and on the morning of the first postoperative day. Pneumonectomy resulted in an increase in the pulmonary wedge pressure (from 12.2 +/- 2.9 to 18.3 +/- 3.8 mmHg) and a deterioration in right ventricular hemodynamics with a decrease in RVEF from 40.6 +/- 3.4% to 28.8 +/- 4.3% at the end of surgery. These changes were also seen on the morning of the first postoperative day. PaO2/FI02, Qs/Qt, VO2I, and DO2I were also significantly different between pneumonectomy and lobectomy patients. Intraoperatively, patients of group 1A and 1B showed almost similar cardiorespiratory data. During OLV, PaO2/FIO2 was significantly less reduced in group 1A (to 292 +/- 98 mmHg) than in group 1B (to 200 +/- 120 mmHg). Postoperatively, patients of group 1A were orientated, and physiotherapy could be started early. No relevant differences with regard to cardiorespiratory parameters were observed between group 1A and group 1B in the postoperative period until the first postoperative day. CONCLUSIONS: In comparison with lobectomy patients, pneumonectomy resulted in more pronounced and sustained deterioration in right ventricular hemodynamics. The kind of anesthesia regimen did not influence most of the cardiorespiratory parameters intraoperatively, except for Qs/Qt, which was least compromised in the propofol patients during OLV. Early extubation could safely be performed in the lobectomy patients anesthetized with propofol without showing any negative cardiorespiratory effects.

Adult↗
PubMed1996

The influence of volume therapy and pentoxifylline infusion on circulating adhesion molecules in trauma patients.

Adhesion molecules appear to play a pivotal role in tissue damage secondary to the inflammatory process. Besides neutrophil- and endothelial-bound adhesion molecules, soluble forms have been detected in the circulating blood. They seem to be good markers of endothelial damage, but they may also have other biological functions. Plasma concentrations of soluble adhesion molecules (endothelial leucocyte adhesion molecules (sELAM-1), intercellular adhesion molecule-1 (sICAM-1), vascular cell adhesion molecule-1 (sVCAM-1), and granule membrane protein 140 (sGMP-140) were serially measured over 5 days by enzyme-linked immunosorbent assays (ELISA) in 45 consecutive trauma patients. These received, by random allocation, only either hydroxyethylstarch solution 10% (mean molecular weight 200,000 daltons) (n = 15) or human albumin 20% (n = 15) for volume therapy. Another 15 patients without defined volume therapy received pentoxifylline continuously (1.2 mg.kg-1.h-1). Measurements were carried out on the day of admission to the intensive care unit (baseline) and during the next 5 days. At baseline, plasma concentrations of all adhesion molecules were similar in all groups. In the hydroxyethyl starch group, sELAM-1 and sICAM-1 concentrations decreased significantly (p < 0.05) reaching normal values during the study period whereas the mean (SD) values increased in the pentoxifylline group (sELAM-1: 71.1 (16.7) to 91.6 (17.8) ng.ml-1) and the albumin group (sICAM-1: 400 (81) to 749 (101) ng.ml-1) (p < 0.05). sVCAM-1 increased outside the normal range only in the human albumin group (to 760 +/- 69 ng.ml-1) (p < 0.05). sGMP-140 plasma concentration increased only in those receiving albumin (432 (85) to 550 (93) ng.ml-1) and this was significantly different to the other groups (p < 0.05). None of the other haemodynamic or laboratory factors could be correlated with plasma concentrations of the adhesion molecules. We conclude that volume therapy with hydroxyethyl starch resulted in a decrease in circulating adhesion molecules in our trauma patients. In contrast, volume therapy with albumin did not exert this effect. Continuous infusion of pentoxifylline did not have a beneficial modulating action on circulating adhesion molecules.

Adult↗
PubMed1996

[Results of elective lymph node excision in melanoma of the trunk].

In our department, between 1979 and 1994, 254 patients, thereof 171 male, 83 female with the average age of 48.2 years underwent surgery because of stage 1 (T2) to stage 3 melanoma that was located on the trunk. Our retrospective analysis was based on those 211 patients who had been followed up by the department of dermatology in our medical center. It was the aim of our study-apart from determining the long-term-prognosis-to find out the number of patients in whom a curative resection could be only achieved by elective lymph node dissection. The 5-year survival rate amounted to 79% for all patients. For patients suffering from stage 1-disease (T2) it was 93%, for those with stage 2-disease 89%, and in case of stage 3-disease 49% respectively. After ELND had been performed, no lymph node metastases were found in patients (0/22) suffering from a T2-tumor. In case of T3-tumors, in 13% (11/82) and in case of T4-tumors in 30% (13/43) lymph node metastases were found. However, only 5 out of 11 patients, with the established diagnosis of a T3-tumor in whom positive lymph-nodes had been found by ELND, and merely 6 out of the 13 patients with a T4-tumor, are still alive after a mean follow-up period of 74 months. We conclude that ELND is not indicated in patients with T2-melanoma. In case of T3- and T4-melanoma, some doubts exist whether patients really benefit from this surgical procedure. Randomized prospective studies are necessary to clarify the importance of elective lymph node dissection.

Adolescent↗
PubMed1996

[The importance of mediastinoscopy for accurate lymph node staging].

The mediastinoscopy (MS) was developed 1959 by Carlens. Since the introduction of computertomography (CT) in the diagnostic of the thorax the MS was no longer used routinely. Because of the introduction of the CT in our clinic we performed only 111 MS between 1981 and 1992, in contrast to 185 MS between 1976 and 1981. No patient died perioperatively. Two patients had to be operated on for bleeding. The sensitivity of the modern CT-scan for a correct preoperative staging of a bronchial carcinoma runs up to 90% and the specifity up to 85%. Therefore a correct preoperative staging can only be reached histologically with the help of a MS. An exception are T1 and T2 tumors because of only 28% mediastinal lymph node metastases. We think that the MS should be performed more often in order to reach a correct, histologically ascertained staging preoperatively.

Carcinoma, Bronchogenic↗
PubMed1996

[Primary neuroectodermal tumor (PNET): a rare highly malignant soft tissue tumor in children and young adults].

The PNET is an extremely malignant soft tissue neoplasm resulting from a balanced reciprocal translocation t (11; 22) (q24; q12). Treatment of the undifferentiated small cell tumor is carried out in compliance with the protocol of the soft tissue trail (CWS) from the German Society of Pediatric Oncology. Biopsy-proven diagnosis is followed by primary chemotherapy which leads in 95% of cases to remission. After excision of the remainder of the malignancy, an irradiation of the tumor site and two further sequences of chemotherapy are performed. Between 1986 and 1994, in cooperation with our pediatric and radiotherapeutical colleagues, we treated ten patients. In four patients (median age, 14 years) the PNET originated from the chest wall, in six patients from the paravertebral and retroperitoneal region. Five patients died after 20 months on average, while the remaining five patients are in full remission after 22, 37, 41, 42 and 82 months, respectively.

Adolescent↗
PubMed1996

[Is surgical therapy of bronchial carcinoma in advanced age justified?].

It was the aim of this study to evaluate the results of surgical therapy in patients with bronchial carcinoma aged younger and older than 70 years. From 1985 to 1995, 130 patients older than 70 years (group 1) and 572 patients younger than 70 years (group 2) underwent thoracotomy for bronchial carcinoma. The 5-year survival rate was significantly worse in the older group (25%) as compared to group 2 (39%). Postoperative complications such as atelectases, pulmonary insufficiency and cardiac problems were more frequent in group 1. Thirty-day mortality was almost double (9.2%) in the older group.

Aged↗