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Bender F, Tarasconi A, Catena F, Sartelli M, Coccolini F, Liese J, Padberg W, Reichert M, Hecker A. [Current WSES-AAST guidelines on anorectal emergencies-Summary and comments]. Chirurgie (Heidelb) 2023; 94:333-341. [PMID: 36808498 DOI: 10.1007/s00104-023-01826-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/23/2023] [Indexed: 06/18/2023]
Abstract
In 2019, the World Society of Emergency Surgery (WSES) and the American Association for the Surgery of Trauma (AAST) generated consensus recommendations for the treatment of anorectal emergencies in Parma, Italy, and published a guideline in 2021. This is the first global guideline dealing with this important topic for surgeons' everyday work. Seven anorectal emergencies were discussed and the guideline recommendations were given according to the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system.
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Affiliation(s)
- F Bender
- Allgemein‑, Viszeral‑, Thorax‑, Transplantations- und Kinderchirurgie, Universitätsklinikum Gießen, Rudolf-Buchheim-Str. 7, 35392, Gießen, Deutschland
| | - A Tarasconi
- Emergency Surgery Department, Parma University Hospital, Parma, Italien
| | - F Catena
- General, Emergency and Trauma Surgery Dept., Bufalini Hospital, Cesena, Italien
| | - M Sartelli
- Department of Surgery, Macerata Hospital, Macerata, Italien
| | - F Coccolini
- General, Emergency and Trauma Surgery Department, Pisa University Hospital, Pisa, Italien
| | - J Liese
- Allgemein‑, Viszeral‑, Thorax‑, Transplantations- und Kinderchirurgie, Universitätsklinikum Gießen, Rudolf-Buchheim-Str. 7, 35392, Gießen, Deutschland
| | - W Padberg
- Allgemein‑, Viszeral‑, Thorax‑, Transplantations- und Kinderchirurgie, Universitätsklinikum Gießen, Rudolf-Buchheim-Str. 7, 35392, Gießen, Deutschland
| | - M Reichert
- Allgemein‑, Viszeral‑, Thorax‑, Transplantations- und Kinderchirurgie, Universitätsklinikum Gießen, Rudolf-Buchheim-Str. 7, 35392, Gießen, Deutschland
| | - A Hecker
- Allgemein‑, Viszeral‑, Thorax‑, Transplantations- und Kinderchirurgie, Universitätsklinikum Gießen, Rudolf-Buchheim-Str. 7, 35392, Gießen, Deutschland.
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Karakizlis H, Trudel N, Brose A, Reinisch A, Reichert M, Hecker A, Bender F, Askevold I, Rainer L, Weimer R, Krombach GA, Padberg W, Liese J. Sarcopenia of kidney transplant recipients as a predictive marker for reduced graft function and graft survival after kidney transplantation. Langenbecks Arch Surg 2023; 408:103. [PMID: 36826595 PMCID: PMC9958183 DOI: 10.1007/s00423-023-02836-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 02/13/2023] [Indexed: 02/25/2023]
Abstract
PURPOSE The association between sarcopenia of kidney transplant recipients and outcome after kidney transplantation (KT) has not yet been fully understood and is still considered controversial. The aim of our study was to analyze the impact of pre-transplant sarcopenia on graft function, postoperative complication rates, and survival of the patients after renal transplantation. METHODS In this retrospective single-center study, all patients who underwent KT (01/2013-12/2017) were included. Demographic data, rejection rates, delayed graft function, and graft and patient survival rates were analyzed. Sarcopenia was measured in computed tomography images by the sex-adjusted Hounsfield unit average calculation (HUAC). RESULTS During the study period, 111 single KTs (38 women and 73 men) were performed. Living donor kidney transplants were performed in 48.6%. In total, 32.4% patients had sarcopenia. Sarcopenic patients were significantly older (59.6 years vs. 49.8 years; p < 0.001), had a higher body mass index (BMI = 27.6 kg/m2 vs. 25.0 kg/m2; p = 0.002), and were more likely to receive deceased donor kidneys (72.2% vs. 41.3%; p = 0.002). Interestingly, 3 years after KT, the creatinine serum levels were significantly higher (2.0 mg/dl vs. 1.5 mg/dl; p = 0.001), whereas eGFR (39.9 ml/min vs. 53.4 ml/min; p = 0.001) and graft survival were significantly lower (p = 0.004) in sarcopenic transplant recipients. Sarcopenic patients stayed in hospital significantly longer postoperatively than those who were non-sarcopenic. CONCLUSIONS At the time of kidney transplantation, sarcopenia was found to predict reduced long-term graft function and diminished graft survival after KT. The early identification of sarcopenic patients can not only enable an optimized selection of recipients, but also the initiation of pre-habilitation programs during the waiting period.
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Affiliation(s)
- H Karakizlis
- Department of Internal Medicine II, Division of Nephrology and Renal Transplantation, Justus-Liebig-University of Giessen, Giessen, Germany
| | - N Trudel
- Department of General, Visceral and Thoracic Surgery, Justus-Liebig-University of Giessen, Rudolf-Buchheim-Str. 7, Giessen, Germany
- Department of Diagnostic and Interventional Radiology, Marienhospital Stuttgart, Stuttgart, Germany
| | - A Brose
- Department of Radiology, Justus-Liebig-University of Giessen, Giessen, Germany
| | - A Reinisch
- Department of General, Visceral and Oncologic Surgery, Hospital and Clinics Wetzlar, Teaching Hospital of the Justus-Liebig-University Giessen, Wetzlar, Germany
| | - M Reichert
- Department of General, Visceral and Thoracic Surgery, Justus-Liebig-University of Giessen, Rudolf-Buchheim-Str. 7, Giessen, Germany
| | - A Hecker
- Department of General, Visceral and Thoracic Surgery, Justus-Liebig-University of Giessen, Rudolf-Buchheim-Str. 7, Giessen, Germany
| | - F Bender
- Department of General, Visceral and Thoracic Surgery, Justus-Liebig-University of Giessen, Rudolf-Buchheim-Str. 7, Giessen, Germany
| | - I Askevold
- Department of General, Visceral and Thoracic Surgery, Justus-Liebig-University of Giessen, Rudolf-Buchheim-Str. 7, Giessen, Germany
| | - L Rainer
- Department of Internal Medicine II, Division of Nephrology and Renal Transplantation, Justus-Liebig-University of Giessen, Giessen, Germany
| | - R Weimer
- Department of Internal Medicine II, Division of Nephrology and Renal Transplantation, Justus-Liebig-University of Giessen, Giessen, Germany
| | - G A Krombach
- Department of Radiology, Justus-Liebig-University of Giessen, Giessen, Germany
| | - W Padberg
- Department of General, Visceral and Thoracic Surgery, Justus-Liebig-University of Giessen, Rudolf-Buchheim-Str. 7, Giessen, Germany
| | - J Liese
- Department of General, Visceral and Thoracic Surgery, Justus-Liebig-University of Giessen, Rudolf-Buchheim-Str. 7, Giessen, Germany.
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Agné A, Richter K, Padberg W, Janciauskiene S, Grau V. Commercial α1-antitrypsin preparations markedly differ in their potential to inhibit the ATP-induced release of monocytic interleukin-1β. Pulm Pharmacol Ther 2021; 68:102020. [PMID: 33774155 DOI: 10.1016/j.pupt.2021.102020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 03/16/2021] [Accepted: 03/18/2021] [Indexed: 01/07/2023]
Abstract
The acute phase protein α1-antitrypsin (AAT) inhibits numerous proteases, specifically neutrophil elastase. Patients with an AAT deficiency due to mutations frequently develop early onset emphysema. The commercial preparations of human plasma AAT are clinically used as biopharmaceuticals to protect the lung tissue of AAT-deficient patients from damage caused by neutrophil elastase. Accordingly, preparations of AAT are validated for their anti-elastase activity. However, several anti-inflammatory effects of AAT were described, some of them being independent from its anti-protease function. We recently demonstrated that AAT isolated from the blood of healthy persons efficiently inhibits the ATP-induced release of interleukin-1β by human monocytes. This finding is of therapeutic relevance, because IL-1β plays an important role in numerous debilitating and life-threatening inflammatory diseases. As anti-inflammatory functions of AAT are of increasing clinical interest, we compared the potential of two widely used AAT preparations, Prolastin® and Respreeza®, to inhibit the ATP-induced release of IL-1β using human monocytic U937 cells. We detected marked functional differences between both medicaments. The AAT preparation Respreeza® is less active compared to Prolastin® regarding the inhibition of the ATP-induced release of monocytic IL-1β. Chemical oxidation of Respreeza® restored this anti-inflammatory activity, while destroying its anti-protease function. Our data suggest that the anti-inflammatory potential and the anti-protease function of AAT can be fully uncoupled. In the light of the increasing clinical interest in anti-inflammatory functions of AAT, commercial AAT preparations should be carefully reinvestigated and optimized to preserve the dual anti-protease and anti-inflammatory activity of native AAT.
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Affiliation(s)
- A Agné
- Laboratory of Experimental Surgery, Department of General and Thoracic Surgery, Justus-Liebig-University, Giessen, Germany
| | - K Richter
- Laboratory of Experimental Surgery, Department of General and Thoracic Surgery, Justus-Liebig-University, Giessen, Germany
| | - W Padberg
- Laboratory of Experimental Surgery, Department of General and Thoracic Surgery, Justus-Liebig-University, Giessen, Germany
| | - S Janciauskiene
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany; Member of the German Centre for Lung Research (DZL), Germany
| | - V Grau
- Laboratory of Experimental Surgery, Department of General and Thoracic Surgery, Justus-Liebig-University, Giessen, Germany; Member of the German Centre for Lung Research (DZL), Germany.
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Hecker A, Hecker M, Liese J, Kauffels-Sprenger A, Weigand MA, Coccolini F, Catena F, Sartelli M, Padberg W, Reichert M, Askevold I. [Summary and comments on the WSES guidelines on open abdomen in trauma and non-trauma patients]. Chirurg 2021; 92:344-349. [PMID: 33666667 DOI: 10.1007/s00104-021-01373-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2021] [Indexed: 10/22/2022]
Abstract
The first edition of the World Society of Emergency Surgeons (WSES) guidelines on the indications and treatment of open abdomen in trauma as well as in non-trauma patients was published at the end of 2018. Publications from 1980 to 2017 were included in the evaluation. Based on the GRADE system each publication was checked for its evidence and evaluated in a Delphi process. In this article the aspects of the guidelines are presented and commented on.
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Affiliation(s)
- A Hecker
- Klinik für Allgemein‑, Viszeral‑, Thorax‑, Transplantations- und Kinderchirurgie, Universitätsklinikum Gießen und Marburg GmbH, Standort Gießen, Rudolf-Buchheim-Str. 7, 35392, Gießen, Deutschland.
| | - M Hecker
- Medizinische Klinik II, Universitätsklinikum Gießen und Marburg GmbH, Standort Gießen, Gießen, Deutschland
| | - J Liese
- Klinik für Allgemein‑, Viszeral‑, Thorax‑, Transplantations- und Kinderchirurgie, Universitätsklinikum Gießen und Marburg GmbH, Standort Gießen, Rudolf-Buchheim-Str. 7, 35392, Gießen, Deutschland
| | - A Kauffels-Sprenger
- Klinik für Allgemein‑, Viszeral‑, Thorax‑, Transplantations- und Kinderchirurgie, Universitätsklinikum Gießen und Marburg GmbH, Standort Gießen, Rudolf-Buchheim-Str. 7, 35392, Gießen, Deutschland
| | - M A Weigand
- Klinik für Anästhesiologie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - F Coccolini
- Klinik für Notfall- und Traumachirurgie, Bufalini Hospital, Cesena, Italien
| | - F Catena
- Klinik für Notfall- und Traumachirurgie, Parma Maggiore Hospital, Parma, Italien
| | | | - W Padberg
- Klinik für Allgemein‑, Viszeral‑, Thorax‑, Transplantations- und Kinderchirurgie, Universitätsklinikum Gießen und Marburg GmbH, Standort Gießen, Rudolf-Buchheim-Str. 7, 35392, Gießen, Deutschland
| | - M Reichert
- Klinik für Allgemein‑, Viszeral‑, Thorax‑, Transplantations- und Kinderchirurgie, Universitätsklinikum Gießen und Marburg GmbH, Standort Gießen, Rudolf-Buchheim-Str. 7, 35392, Gießen, Deutschland
| | - I Askevold
- Klinik für Allgemein‑, Viszeral‑, Thorax‑, Transplantations- und Kinderchirurgie, Universitätsklinikum Gießen und Marburg GmbH, Standort Gießen, Rudolf-Buchheim-Str. 7, 35392, Gießen, Deutschland
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Boldt J, Heesen M, Welters I, Padberg W, Martin K, Hempelmann G. Retraction notice to "Does the type of volume therapy influence endothelial-related coagulation in the critically ill?" [Br J Anaesth 75 (1995) 740-6]. Br J Anaesth 2020; 125:415. [PMID: 32861409 DOI: 10.1016/j.bja.2020.07.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
This article has been retracted: please see Elsevier Policy on Article Withdrawal (https://www.elsevier.com/about/our-business/policies/article-withdrawal). This article has been retracted at the request of the Editor-in-Chief, Professor Hugh Hemmings, based on the recommendations of Justus-Liebig-University Giessen following an internal review of research conducted by Joachim Boldt at the University. This is further described in 'Further Retractions of Articles by Joachim Boldt', https://doi.org/10.1016/j.bja.2020.02.024.
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Affiliation(s)
- J Boldt
- Department of Anaesthesiology and Intensive Care Medicine, Justus-Liebig-University Giessen, Germany
| | - M Heesen
- Department of Anaesthesiology and Intensive Care Medicine, Justus-Liebig-University Giessen, Germany
| | - I Welters
- Department of Anaesthesiology and Intensive Care Medicine, Justus-Liebig-University Giessen, Germany
| | - W Padberg
- Department of Anaesthesiology and Intensive Care Medicine, Justus-Liebig-University Giessen, Germany
| | - K Martin
- Department of Anaesthesiology and Intensive Care Medicine, Justus-Liebig-University Giessen, Germany
| | - G Hempelmann
- Department of Anaesthesiology and Intensive Care Medicine, Justus-Liebig-University Giessen, Germany
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Oppelt PU, Askevold I, Bender F, Liese J, Padberg W, Hecker A, Reichert M. Morgagni-Larrey diaphragmatic hernia repair in adult patients: a retrospective single-center experience. Hernia 2020; 25:479-489. [PMID: 32112200 PMCID: PMC8055631 DOI: 10.1007/s10029-020-02147-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Accepted: 02/06/2020] [Indexed: 01/13/2023]
Abstract
Purpose Morgagni−Larrey congenital diaphragmatic hernia (MLH) is rare in adult patients and surgery is performed infrequently. The evidence regarding the most beneficial treatment modality is low. Nevertheless, with increasing experience in minimally-invasive surgery, the literature proves the laparoscopic approach as being safely feasible. However, knowledge on the disease as well as treatment options are based on single surgeon’s experiences and small case series in the literature. Methods Retrospective single-center analysis on adult patients (≥ 18 years) with MLH from 01/2003 to 06/2019 regarding symptoms, hernia sac contents, surgical technique and perioperative outcome. Results 4.0% of diaphragmatic hernia repair procedures were performed for MLH (n = 11 patients). 27.3% of these patients were asymptomatic. Dyspnea or gastrointestinal symptoms were frequently observed (both in 45.5% of the patients). Colon transversum (63.6%), omentum majus (45.5%) and/or stomach (27.3%) were the most common hernia sac contents. Correct diagnosis was achieved preoperatively in 10/11 patients by cross-sectional imaging. All procedures were performed by trans-abdominal surgery (laparotomy in four and laparoscopy in seven patients). All hernias were reinforced by mesh after primary closure. No differences were observed in the perioperative outcome between patients who underwent hernia repair by laparotomy versus laparoscopy. Pleural complications requiring drainage were the most common postoperative complications. Conclusion MLH repair seems to be safely feasible by laparoscopic surgery. The benefit of mesh augmentation in MLH repair is not clear yet. In contrast to the current literature, all patients in this study received mesh augmentation after primary closure of the hernia. This should be evaluated in larger patient cohorts with long-term follow-up.
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Affiliation(s)
- P U Oppelt
- Department of General, Visceral, Thoracic, Transplant and Pediatric Surgery, University Hospital of Giessen, Giessen, Germany
| | - I Askevold
- Department of General, Visceral, Thoracic, Transplant and Pediatric Surgery, University Hospital of Giessen, Giessen, Germany
| | - F Bender
- Department of General, Visceral, Thoracic, Transplant and Pediatric Surgery, University Hospital of Giessen, Giessen, Germany
| | - J Liese
- Department of General, Visceral, Thoracic, Transplant and Pediatric Surgery, University Hospital of Giessen, Giessen, Germany
| | - W Padberg
- Department of General, Visceral, Thoracic, Transplant and Pediatric Surgery, University Hospital of Giessen, Giessen, Germany
| | - A Hecker
- Department of General, Visceral, Thoracic, Transplant and Pediatric Surgery, University Hospital of Giessen, Giessen, Germany
| | - M Reichert
- Department of General, Visceral, Thoracic, Transplant and Pediatric Surgery, University Hospital of Giessen, Giessen, Germany.
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Agné A, Richter K, Tumpara S, Sauer AL, Beckert F, Wrenger S, Zakrzewicz A, Hecker A, Markmann M, Koch C, Zajonz T, Sander M, Böning A, Padberg W, Janciauskiene S, Grau V. Does heart surgery change the capacity of α1-antitrypsin to inhibit the ATP-induced release of monocytic interleukin-1β? A preliminary study. Int Immunopharmacol 2020; 81:106297. [PMID: 32062078 DOI: 10.1016/j.intimp.2020.106297] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 01/31/2020] [Accepted: 02/05/2020] [Indexed: 12/20/2022]
Abstract
Heart surgery involving cardiopulmonary bypass induces systemic inflammation that is, at least in part, caused by extracellular ATP originating from damaged cells and by proteases secreted by activated neutrophils. The anti-protease α1-antitrypsin (AAT) forms complexes with several proteases including neutrophil elastase, resulting in a mutual loss of activity. We demonstrated recently that AAT inhibits the ATP-induced release of the pro-inflammatory cytokine interleukin-1β by human monocytes by a mechanism involving activation of metabotropic functions at nicotinic acetylcholine receptors. Interleukin-1β importantly contributes to the pathogenesis of sterile inflammatory response syndrome. Thus, AAT might function as an endogenous safeguard against life-threatening systemic inflammation. In this preliminary study, we test the hypothesis that during cardiopulmonary bypass, AAT is inactivated as an anti- protease and as an inhibitor of ATP-induced interleukin-1β release. AAT was affinity-purified from the blood plasma of patients before, during and after surgery. Lipopolysaccharide-primed human monocytic U937 cells were stimulated with ATP in the presence or absence of patient AAT to test for its inhibitory effect on interleukin-1β release. Anti-protease activity was investigated via complex formation with neutrophil elastase. The capacity of patient AAT to inhibit the ATP-induced release of interleukin-1β might be slightly reduced in response to heart surgery and complex formation of patient AAT with neutrophil elastase was unimpaired. We conclude that surgery involving cardiopulmonary bypass does not markedly reduce the anti-inflammatory and the anti-protease activity of AAT. The question if AAT augmentation therapy during heart surgery is suited to attenuate postoperative inflammation warrants further studies in vivo.
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Affiliation(s)
- A Agné
- Laboratory of Experimental Surgery, Department of General and Thoracic Surgery, Justus-Liebig-University of Giessen, Giessen, Germany.
| | - K Richter
- Laboratory of Experimental Surgery, Department of General and Thoracic Surgery, Justus-Liebig-University of Giessen, Giessen, Germany
| | - S Tumpara
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
| | - A-L Sauer
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, Justus-Liebig University of Giessen, Giessen, Germany
| | - F Beckert
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, Justus-Liebig University of Giessen, Giessen, Germany
| | - S Wrenger
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
| | - A Zakrzewicz
- Laboratory of Experimental Surgery, Department of General and Thoracic Surgery, Justus-Liebig-University of Giessen, Giessen, Germany
| | - A Hecker
- Laboratory of Experimental Surgery, Department of General and Thoracic Surgery, Justus-Liebig-University of Giessen, Giessen, Germany
| | - M Markmann
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, Justus-Liebig University of Giessen, Giessen, Germany
| | - C Koch
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, Justus-Liebig University of Giessen, Giessen, Germany
| | - T Zajonz
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, Justus-Liebig University of Giessen, Giessen, Germany
| | - M Sander
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, Justus-Liebig University of Giessen, Giessen, Germany
| | - A Böning
- Department of Heart and Vascular Surgery, Justus-Liebig University of Giessen, Giessen, Germany
| | - W Padberg
- Laboratory of Experimental Surgery, Department of General and Thoracic Surgery, Justus-Liebig-University of Giessen, Giessen, Germany
| | - S Janciauskiene
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany; Member of the German Centre for Lung Research (DZL), Germany
| | - V Grau
- Laboratory of Experimental Surgery, Department of General and Thoracic Surgery, Justus-Liebig-University of Giessen, Giessen, Germany; Member of the German Centre for Lung Research (DZL), Germany
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Hecker A, Reichert M, Reuß CJ, Schmoch T, Riedel JG, Schneck E, Padberg W, Weigand MA, Hecker M. Intra-abdominal sepsis: new definitions and current clinical standards. Langenbecks Arch Surg 2019; 404:257-271. [DOI: 10.1007/s00423-019-01752-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 01/08/2019] [Indexed: 12/22/2022]
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Karrasch T, Walmrath HD, Kampschulte M, Steiner D, Seeger W, Padberg W, Sibelius U, Gattenlöhner S, Schäffler A. [Disseminated osteolytic lesions in a 28-year-old refugee]. Internist (Berl) 2017; 59:486-493. [PMID: 28748250 DOI: 10.1007/s00108-017-0300-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
A 28-year-old Syrian refugee presented with right-sided knee pain and progressive deterioration of the general condition over the past months. Laboratory diagnostics revealed severe hypercalcemia due to primary hyperparathyroidism, and computed tomography (CT) scanning demonstrated disseminated osteolytic lesions throughout the skeleton. Histologically, these lesions were characterized by multinuclear giant cells (defining these lesions as so-called brown tumors). Finally, surgical removal of a jugular mass allowed the histopathologic diagnosis of a sporadic parathyroid carcinoma. In the patient, this condition was associated with a mutation in the HPRT2 gene locus.
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Affiliation(s)
- T Karrasch
- Klinik und Poliklinik für Innere Medizin III, Universitätsklinikum Gießen und Marburg, Standort Gießen, 35392, Gießen, Deutschland.
| | - H D Walmrath
- Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Gießen und Marburg, Standort Gießen, Gießen, Deutschland
| | - M Kampschulte
- Institut für Radiologie, Universitätsklinikum Gießen und Marburg, Standort Gießen, Gießen, Deutschland
| | - D Steiner
- Klinik für Nuklearmedizin, Universitätsklinikum Gießen und Marburg, Standort Gießen, Gießen, Deutschland
| | - W Seeger
- Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Gießen und Marburg, Standort Gießen, Gießen, Deutschland
| | - W Padberg
- Klinik und Poliklinik für Allgemein‑, Viszeral- und Thoraxchirurgie, Universitätsklinikum Gießen und Marburg, Standort Gießen, Gießen, Deutschland
| | - U Sibelius
- Klinik und Poliklinik für Innere Medizin IV/V, Universitätsklinikum Gießen und Marburg, Standort Gießen, Gießen, Deutschland
| | - S Gattenlöhner
- Institut für Pathologie, Universitätsklinikum Gießen und Marburg, Standort Gießen, Gießen, Deutschland
| | - A Schäffler
- Klinik und Poliklinik für Innere Medizin III, Universitätsklinikum Gießen und Marburg, Standort Gießen, 35392, Gießen, Deutschland
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Reichert M, Gohlke AB, Padberg W, Bodner J. Aktueller Stand video-assistierter-thorakoskopischer anatomischer Lungenresektionen in Deutschland – Ergebnisse einer deutschlandweiten Umfrage. Zentralbl Chir 2016. [DOI: 10.1055/s-0036-1587461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Reichert M, Pösentrup B, Hiebinger A, Pons-Kühnemann J, Padberg W, Bodner J. P-220THORACOTOMY VERSUS VIDEO-ASSISTED THORACOSCOPIC SURGERY FOR PLEURAL DECORTICATION IN STAGE III PLEURAL EMPYEMA: AN ANALYSIS OF 217 CONSECUTIVE PATIENTS. Interact Cardiovasc Thorac Surg 2016. [DOI: 10.1093/icvts/ivw260.218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Zakrzewicz A, Wilker S, Stumpf S, Petrie K, Padberg W, Janciauskiene S, Grau V. Potential protective role of secretory leukocyte protease inhibitor (SLPI) in transplanted organs. Pneumologie 2016. [DOI: 10.1055/s-0036-1584625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Siebers R, Fink B, Richter K, Wilker S, Küllmar M, Zukunft S, Aggarwal N, Zakrzewicz A, Padberg W, Janciauskiene S, Grau V. A soluble factor mediates alpha-1 antitrypsin-induced inhibition of ATP-induced IL-1β release by monocytic cells. Pneumologie 2016. [DOI: 10.1055/s-0036-1584659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Richter K, Mathes V, Fronius M, Althaus M, Hecker A, Krasteva-Christ G, Padberg W, Hone AJ, McIntosh JM, Zakrzewicz A, Grau V. Phosphocholine - an agonist of metabotropic but not of ionotropic functions of α9-containing nicotinic acetylcholine receptors. Sci Rep 2016; 6:28660. [PMID: 27349288 PMCID: PMC4923896 DOI: 10.1038/srep28660] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Accepted: 06/06/2016] [Indexed: 11/09/2022] Open
Abstract
We demonstrated previously that phosphocholine and phosphocholine-modified macromolecules efficiently inhibit ATP-dependent release of interleukin-1β from human and murine monocytes by a mechanism involving nicotinic acetylcholine receptors (nAChR). Interleukin-1β is a potent pro-inflammatory cytokine of innate immunity that plays pivotal roles in host defence. Control of interleukin-1β release is vital as excessively high systemic levels cause life threatening inflammatory diseases. In spite of its structural similarity to acetylcholine, there are no other reports on interactions of phosphocholine with nAChR. In this study, we demonstrate that phosphocholine inhibits ion-channel function of ATP receptor P2X7 in monocytic cells via nAChR containing α9 and α10 subunits. In stark contrast to choline, phosphocholine does not evoke ion current responses in Xenopus laevis oocytes, which heterologously express functional homomeric nAChR composed of α9 subunits or heteromeric receptors containing α9 and α10 subunits. Preincubation of these oocytes with phosphocholine, however, attenuated choline-induced ion current changes, suggesting that phosphocholine may act as a silent agonist. We conclude that phophocholine activates immuno-modulatory nAChR expressed by monocytes but does not stimulate canonical ionotropic receptor functions.
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Affiliation(s)
- K. Richter
- Laboratory of Experimental Surgery, Department of General and Thoracic Surgery, German Centre for Lung Research, Justus-Liebig-University Giessen, Giessen, Germany
| | - V. Mathes
- Laboratory of Experimental Surgery, Department of General and Thoracic Surgery, German Centre for Lung Research, Justus-Liebig-University Giessen, Giessen, Germany
| | - M. Fronius
- Department of Physiology, University of Otago, Dunedin, New Zealand
| | - M. Althaus
- Institute for Animal Physiology, Justus-Liebig-University of Giessen, Giessen, Germany
| | - A. Hecker
- Laboratory of Experimental Surgery, Department of General and Thoracic Surgery, German Centre for Lung Research, Justus-Liebig-University Giessen, Giessen, Germany
| | - G. Krasteva-Christ
- Intitute for Anatomy and Cell Biology, Julius-Maximilians-University of Wuerzburg, Wuerzburg, Germany
| | - W. Padberg
- Laboratory of Experimental Surgery, Department of General and Thoracic Surgery, German Centre for Lung Research, Justus-Liebig-University Giessen, Giessen, Germany
| | - A. J. Hone
- Department of Biology, University of Utah, Salt Lake City, Utah, USA
| | - J. M. McIntosh
- Department of Biology, University of Utah, Salt Lake City, Utah, USA
- George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, Utah, USA
- Department of Psychiatry, University of Utah, Salt Lake City, Utah, USA
| | - A. Zakrzewicz
- Laboratory of Experimental Surgery, Department of General and Thoracic Surgery, German Centre for Lung Research, Justus-Liebig-University Giessen, Giessen, Germany
| | - V. Grau
- Laboratory of Experimental Surgery, Department of General and Thoracic Surgery, German Centre for Lung Research, Justus-Liebig-University Giessen, Giessen, Germany
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Holler JPN, Ahlbrandt J, Gruß M, Hecker A, Weigand MA, Padberg W, Röhrig R. [The effect of peridural analgesia on long-term survival after surgery in patients with colorectal cancer : A systematic meta-analysis]. Chirurg 2016; 86:655-61. [PMID: 25298186 DOI: 10.1007/s00104-014-2891-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND The results of recent clinical studies suggest a potential benefit of peridural analgesia (PDA) during general anesthesia on long-term survival in patients after surgery for colorectal cancer. In order to test the hypothesis a meta-analysis was performed. OBJECTIVES To determine the prognostic impact of perioperative PDA on long-term survival in patients with colorectal cancer who underwent surgical resection. MATERIAL AND METHODS By searching the relevant literature (up to May 2014) a total of 5 studies were identified from a total of 608 publications and a meta-analysis was carried out. Adjusted hazard ratios (HR) with 95 % confidence intervals (CI) were used to assess the strength of associations. The random effects model was used to analyze the data and a modified forest plot was applied. Additionally, a potential publication bias was visually examined in a funnel plot. RESULTS A positive association between PDA and improved long-term survival was observed in patients who underwent surgery for colorectal cancer without metastases (HR = 0.81, 95 % CI 0.68-0.96, p = 0.055). CONCLUSION Despite a publication bias the use of PDA in patients who underwent surgery for colorectal cancer without metastases seemed to be advantageous. Randomized controlled trials are warranted to confirm the positive effects of additional PDA. The exact mechanisms of tumor suppressive effects of PDA have not yet been elucidated.
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Affiliation(s)
- J P N Holler
- Klinik für Allgemein-, Viszeral-, Thorax-, Transplantations- und Kinderchirurgie, Justus-Liebig-Universität, Universitätskliniken Gießen und Marburg, Standort Gießen , Gießen, Deutschland
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Reichert M, Hecker M, Hörbelt R, Lerner S, Holler J, Hecker CM, Padberg W, Weigand MA, Hecker A. [Erratum to: The role of biomarkers in the diagnostics of acute mesenteric ischemia]. Chirurg 2015; 86:55. [PMID: 25591415 DOI: 10.1007/s00104-014-2906-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- M Reichert
- Klinik für Allgemein-, Viszeral-, Thorax-, Transplantations- und Kinderchirurgie, Universitätsklinik Gießen und Marburg GmbH, Standort Gießen, Rudolf Buchheim Str. 7, 35392, Gießen, Deutschland
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Reichert M, Hecker M, Hörbelt R, Lerner S, Höller J, Hecker CM, Padberg W, Weigand MA, Hecker A. [The role of biomarkers in the diagnostics of acute mesenteric ischemia]. Chirurg 2015; 86:47-55. [PMID: 25298185 DOI: 10.1007/s00104-014-2887-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Acute mesenteric ischemia is a severe and challenging disease. Unspecific symptoms in the initial phase make a fast diagnosis difficult although it is of major importance to protect patients from irreversible ischemia, extended bowel resection, sepsis and death in the late phase. In contrast to troponin as an early biomarker for cardiac ischemia, a reliable biomarker for acute intestinal ischemia has not yet been identified in the current literature and clinical practice. This would allow the early identification of these critically ill patients in the initial reversible phase of acute intestinal ischemia.This review highlights the pathophysiology, epidemiology and clinical findings of acute mesenteric ischemia and gives an overview of biomarkers which have been investigated in mesenteric ischemia with a special focus on lactate, which is the only parameter routinely used in the diagnostic setting of acute mesenteric ischemia.
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Affiliation(s)
- M Reichert
- Klinik für Allgemein-, Viszeral-, Thorax-, Transplantations- und Kinderchirurgie, Universitätsklinik Gießen und Marburg GmbH, Standort Gießen, Rudolf Buchheim Str. 7, 35392, Gießen, Deutschland
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Hecker A, Schneck E, Röhrig R, Roller F, Hecker B, Holler J, Koch C, Hecker M, Reichert M, Lichtenstern C, Krombach GA, Padberg W, Weigand MA. The impact of early surgical intervention in free intestinal perforation: a time-to-intervention pilot study. World J Emerg Surg 2015; 10:54. [PMID: 26550026 PMCID: PMC4636838 DOI: 10.1186/s13017-015-0047-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2015] [Accepted: 10/23/2015] [Indexed: 12/29/2022] Open
Abstract
PURPOSES An abdominal inflammatory focus is the second most often source of sepsis with a high risk of death in surgical intensive care units. By establishing evidence-based bundled strategies the surviving sepsis campaign provided an optimized rapid and continuous treatment of these emergency patients. Hereby the hospital mortality decreased from 35 to 30 %. Sepsis treatment is based on three major therapeutic elements: surgical treatment (source control), antiinfective treatment, and supportive care. The international guidelines of the surviving sepsis campaign were updated recently and recommend rapid diagnosis of the infection and source control within the first 12 h after the diagnosis (grade 1c). Interestingly this recommendation is mainly based on studies on soft tissue infections. METHODS In this retrospective analysis 76 septic patients with an intraabdominal inflammatory focus were included. All patients underwent surgery at different time-points after diagnosis. RESULTS With 80 % patients of the early intervention group had an improved overall survival (vs. 73 % in the late intervention group). CONCLUSIONS Literature on the time dependency of early source control is rare and in part contradicting. Results of this pilot study reveal that immediate surgical intervention might be of advantage for septic emergency patients. Further multi-center approaches will be necessary to evaluate, whether the TTI has any impact on the outcome of septic patients with intestinal perforation.
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Affiliation(s)
- Andreas Hecker
- Department of General and Thoracic Surgery, University Hospital Giessen, Rudolf-Buchheim-Street 7, 35392 Giessen, Germany
| | - E Schneck
- Department of Anesthesiology, Surgical Intensive Care Medicine and Pain Therapy, University Hospital Giessen, Rudolf-Buchheim-Street 7, 35392 Giessen, Germany
| | - R Röhrig
- Department of Anesthesiology, Surgical Intensive Care Medicine and Pain Therapy, University Hospital Giessen, Rudolf-Buchheim-Street 7, 35392 Giessen, Germany
| | - F Roller
- Department of Radiology, University Hospital Giessen, Rudolf-Buchheim-Street 7, 35392 Giessen, Germany
| | - B Hecker
- Department of Anesthesiology, Surgical Intensive Care Medicine and Pain Therapy, University Hospital Giessen, Rudolf-Buchheim-Street 7, 35392 Giessen, Germany
| | - J Holler
- Department of General and Thoracic Surgery, University Hospital Giessen, Rudolf-Buchheim-Street 7, 35392 Giessen, Germany
| | - C Koch
- Department of Anesthesiology, Surgical Intensive Care Medicine and Pain Therapy, University Hospital Giessen, Rudolf-Buchheim-Street 7, 35392 Giessen, Germany
| | - M Hecker
- Department of Internal Medicine, University Hospital Giessen, Rudolf-Buchheim-Street 7, 35392 Giessen, Germany
| | - M Reichert
- Department of General and Thoracic Surgery, University Hospital Giessen, Rudolf-Buchheim-Street 7, 35392 Giessen, Germany
| | - C Lichtenstern
- Department of Anesthesiology, Surgical Intensive Care Medicine and Pain Therapy, University Hospital Giessen, Rudolf-Buchheim-Street 7, 35392 Giessen, Germany
| | - G A Krombach
- Department of Radiology, University Hospital Giessen, Rudolf-Buchheim-Street 7, 35392 Giessen, Germany
| | - W Padberg
- Department of General and Thoracic Surgery, University Hospital Giessen, Rudolf-Buchheim-Street 7, 35392 Giessen, Germany
| | - M A Weigand
- Department of Anesthesiology, Surgical Intensive Care Medicine and Pain Therapy, University Hospital Giessen, Rudolf-Buchheim-Street 7, 35392 Giessen, Germany
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Hecker A, Hecker B, Hecker M, Riedel JG, Weigand MA, Padberg W. Acute abdominal compartment syndrome: current diagnostic and therapeutic options. Langenbecks Arch Surg 2015; 401:15-24. [PMID: 26518567 DOI: 10.1007/s00423-015-1353-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Accepted: 10/22/2015] [Indexed: 12/22/2022]
Abstract
BACKGROUND If untreated, the abdominal compartment syndrome (ACS) has a mortality of nearly 100 %. Thus, its early recognition is of major importance for daily rounds on surgical intensive care units. Intraabdominal hypertension (IAH) is a poorly recognized entity, which occurs if intraabdominal pressure arises >12 mmHg. Measurement of the intravesical pressure is the gold standard to diagnose IAH, which can be detected in about one fourth of surgical intensive care patients. PURPOSE The aim of this manuscript is to outline the current diagnostic and therapeutic options for IAH and ACS. While diagnosis of IAH and ACS strongly depends on clinical experience, new diagnostic markers could play an important role in the future. Therapy of IAH/ACS consists of five treatment "columns": intraluminal evacuation, intraabdominal evacuation, improvement of abdominal wall compliance, fluid management, and improved organ perfusion. If conservative therapy fails, emergency laparotomy is the most effective therapeutic approach to achieve abdominal decompression. Thereafter, patients with an open abdomen require intensive care and are permanently threatened by the quadrangle of fluid loss, muscle proteolysis, heat loss, and an impaired immune function. As a consequence, complication rate dramatically increases after 8 days of open abdomen therapy. CONCLUSION Despite many efforts, the mortality of patients with ACS remains unacceptably high. Permanent clinical education and surgical trials will be necessary to improve the outcome of our critically ill surgical patients.
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Affiliation(s)
- A Hecker
- Department of General and Thoracic Surgery, University Hospital of Giessen, Rudolf-Buchheim-Street 7, 35392, Giessen, Germany.
| | - B Hecker
- Department of Anesthesiology, Heidelberg University Hospital, Heidelberg, Germany
| | - M Hecker
- Medical Clinic II, Pulmonary and Critical Care Medicine, University Hospital of Giessen, Giessen, Germany
| | - J G Riedel
- Department of General and Thoracic Surgery, University Hospital of Giessen, Rudolf-Buchheim-Street 7, 35392, Giessen, Germany
| | - M A Weigand
- Department of Anesthesiology, Heidelberg University Hospital, Heidelberg, Germany
| | - W Padberg
- Department of General and Thoracic Surgery, University Hospital of Giessen, Rudolf-Buchheim-Street 7, 35392, Giessen, Germany
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Reichert M, Busse A, Hecker A, Askevold I, Kampschulte M, Wüsten O, Krombach GA, Schwandner T, Padberg W. Changes in Dynamic Pelvic Floor Magnet Resonance Imaging and Patient Satisfaction after Resection Rectopexy for Obstructed Defecation Syndrome. ROFO-FORTSCHR RONTG 2015; 188:38-44. [PMID: 26327668 DOI: 10.1055/s-0041-105406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE Resection rectopexy (RR) provides good functional results and low recurrence rates for the treatment of obstructed defecation syndrome based on rectal prolapse and cul-de-sac syndrome, whereas little is known about changes in pelvic floor dynamics and patient satisfaction after surgery. MATERIALS AND METHODS Within three years 26 consecutive female patients were prospectively included. Indications for RR (22 laparoscopic, 3 primary open and 1 converted-to-open) were rectal prolapse III° in 11 patients and cul-de-sac syndrome in 15 patients. Patients' quality of life (QOL), fecal behavior and defecation-associated pain were investigated before and after surgical treatment using anamnesis and clinical examination, Rand 36-idem health survey (SF-36), Cleveland-Clinic Incontinence Score (CCIS) and the visual analog scale for defecation-associated pain (VAS). Dynamic pelvic floor magnet resonance imaging (dPF-MRI) was used for the investigation of changes in pelvic floor anatomy and function before and after surgery. RESULTS RR improved the rate of fecal incontinence (p < 0.01) and CCIS (p = 0.01). The use of laxatives (p = 0.01), the need for self-digitation (p = 0.02) and VAS (p < 0.01) were decreased, leading to improvements in QOL (overall p < 0.01). RR led to shortening of the H-line but not of the M-line under rest (p < 0.01) and during defecation (p = 0.04). A rectocele was co-incident in all patients in dPF-MRI before surgery. RR led to a reduction (p < 0.01) and declined protrusion (p = 0.03) of the rectocele. This results in a decreased rate of cul-de-sac (p < 0.01) and increased rate of complete defecation (p < 0.01) after surgery. At the 36-month follow-up no recurrence was observed. CONCLUSION RR promises high rates of patient satisfaction and improvement in pelvic floor anatomy in select patients. KEY POINTS • RR improves the pelvic floor anatomy of patients suffering from ODS. • RR improves the QOL of patients suffering from ODS. • An improvement in pelvic floor anatomy led to an improved QOL. • RR is an adequate treatment for select patients suffering from ODS.
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Affiliation(s)
- M Reichert
- Department of General and Thoracic Surgery, University Hospital of Giessen, Germany
| | - A Busse
- Department of General and Thoracic Surgery, University Hospital of Giessen, Germany
| | - A Hecker
- Department of General and Thoracic Surgery, University Hospital of Giessen, Germany
| | - I Askevold
- Department of General and Thoracic Surgery, University Hospital of Giessen, Germany
| | - M Kampschulte
- Department of Diagnostic and Interventional Radiology, University Hospital of Giessen, Germany
| | - O Wüsten
- Department of Diagnostic and Interventional Radiology, University Hospital of Giessen, Germany
| | - G A Krombach
- Department of Diagnostic and Interventional Radiology, University Hospital of Giessen, Germany
| | - T Schwandner
- Department of General and Thoracic Surgery, University Hospital of Giessen, Germany
| | - W Padberg
- Department of General and Thoracic Surgery, University Hospital of Giessen, Germany
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Koch C, Hecker A, Grau V, Padberg W, Wolff M, Henrich M. Intravenous immunoglobulin in necrotizing fasciitis - A case report and review of recent literature. Ann Med Surg (Lond) 2015; 4:260-3. [PMID: 26288730 PMCID: PMC4539184 DOI: 10.1016/j.amsu.2015.07.017] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Revised: 07/30/2015] [Accepted: 07/30/2015] [Indexed: 11/24/2022] Open
Abstract
Introduction Necrotizing fasciitis (NF) is an inflammatory disease of the soft tissue, which causes local tissue destruction and can lead to lethal septic shock. The therapy consists of early surgical treatment of the septic focus and an accompanying broad spectrum antibiotic therapy. Recent literature considers the additional use of immunoglobulin therapy in severe soft skin and tissue infections. Presentation of case In this report, we describe the case of a 33-year-old male patient treated at a university hospital intensive care unit because of an NF of his left leg. The patient rapidly developed a complicated septic disease after a minor superficial trauma. Despite intense microbiological diagnosis, no causative pathogens were identified. After non-responding to established broad anti-infective treatment, the patient received intravenous immunoglobulin, that rapidly improved his clinical condition. Discussion NF represents a disease processes, which is characterized by fulminant, widespread necrosis of soft tissue, systemic toxicity, and high mortality (>30%). Beside the surgical debridement and broad spectrum antibiotic therapy IVIg therapy might be an additional option in the treatment of NF. But the current literature supporting the use of IVIG in NF is largely based on retrospective or case-controlled studies, and only small randomized trials. Conclusion The demonstrated case suggests that IVIg treatment of patients with NF can be considered in case of hemodynamic unstable, critically ill patients. Although randomized controlled trials are missing, some patients might benefit from diminishing hyperinflammation by immunoglobins. Necrotizing fasciitis (NF) is an inflammatory disease, which causes local tissue destruction up to lethal septic shock. We describe the case of a 33-year-old male patient representing an NF of his left leg. After non-responding to established broad anti-infective treatment, the patient received immunoglobulin (IVIg). The presented case suggests that IVIg treatment of patients with NF might be considered in case of critically ill patients.
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Affiliation(s)
- C Koch
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Giessen and Marburg, 35392 Giessen, Germany
| | - A Hecker
- Department General and Thoracic Surgery, University Hospital of Giessen and Marburg, 35392 Giessen, Germany
| | - V Grau
- Department General and Thoracic Surgery, University Hospital of Giessen and Marburg, 35392 Giessen, Germany
| | - W Padberg
- Department General and Thoracic Surgery, University Hospital of Giessen and Marburg, 35392 Giessen, Germany
| | - M Wolff
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Giessen and Marburg, 35392 Giessen, Germany
| | - M Henrich
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Giessen and Marburg, 35392 Giessen, Germany
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Siebers R, Wilker S, Küllmar M, Aggarwal N, Zakrzewicz A, Padberg W, Janciauskiene S, Grau V. Alpha-1 antitrypsin inhibits ATP-induced release of IL-1β in human monocytes via a cholinergic pathway. Pneumologie 2015. [DOI: 10.1055/s-0035-1556630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Hiller S, Zakrzewicz A, Wilker S, Jurastow I, Hecker A, Kummer W, Padberg W, Grau V. β-NAD inhibits ATP-mediated interleukin-1β release. Pneumologie 2015. [DOI: 10.1055/s-0035-1556629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Zakrzewicz A, Wilker S, Janciauskiene S, Tikkanen R, Padberg W, Grau V. SLPI suppresses ATP-mediated release of IL-1β from human monocytes – evidence for a novel anti-inflammatory mechanism. Pneumologie 2015. [DOI: 10.1055/s-0035-1556628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Backhaus S, Wilker S, Zakrzewicz A, Küllmar M, Padberg W, Ruppert C, Grau V. Surfactant inhibits ATP-induced release of interleukin-1β in human monocytes. Pneumologie 2015. [DOI: 10.1055/s-0035-1556631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Abstract
Bei der akuten Pankreatitis handelt es sich um eine potenziell tödlich verlaufende Erkrankung mit individuell unterschiedlich ausgeprägter systemischer Beteiligung. Aus diesem Grund kommen der frühzeitigen Diagnose und nachfolgenden Risikostratifikation im klinischen Management dieser häufigen gastroenterologischen Erkrankung entscheidende Rollen zu. Schwere Verlaufsformen treten in etwa 20 % der Fälle auf und bedürfen zumeist intensivmedizinischer Überwachung und interdisziplinärer Behandlung. Therapeutisch stehen in der Akutphase die adäquate Flüssigkeitssubstitution und suffiziente Schmerztherapie im Vordergrund. Im Hinblick auf den Einsatz von Antibiotika und die Anpassung der Ernährung hat sich in den letzten Jahren ein Paradigmenwechsel vollzogen. Je nach Schwere der Erkrankung und möglichen Komplikationen können auch endoskopisch-/radiologisch-interventionelle Maßnahmen oder eine operative Versorgung notwendig werden.
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Affiliation(s)
- M Hecker
- Medizinische Klinik II, Universitätsklinikum Gießen und Marburg, Standort Gießen, Klinikstr. 33, 35392, Gießen, Deutschland,
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Reichert M, Schwandner T, Hecker A, Behnk A, Baumgart-Vogt E, Wagenlehner F, Padberg W. Surgical Approach for Repair of Rectovaginal Fistula by Modified Martius Flap. Geburtshilfe Frauenheilkd 2014; 74:923-927. [PMID: 25364031 DOI: 10.1055/s-0034-1383149] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Revised: 09/08/2014] [Accepted: 09/15/2014] [Indexed: 12/19/2022] Open
Abstract
Rectovaginal fistulas (RVF) are rare but represent a challenge for both patients and surgeons. The most common cause of RVF is obstetric trauma, and treatment is based on fistula classification and localization of the fistula in relation to the vagina and rectum. Conventional therapy frequently fails, making surgery the most viable approach for fistula repair. One surgical procedure which offers adequate repair of lower and middle rectovaginal fistulas consists of interposition of a bulbocavernosus fat flap also called modified Martius flap. First described by Heinrich Martius in 1928, this approach has been continuously modified and adjusted over time and is used in the repair of various pelvic floor disorders. Overall success rates reported in the literature of the interposition of a Martius flap as an adjunct procedure in the surgical management of RVF are 65-100 %. We present a detailed description of the operation technique together with a discussion of the use of a dorsal-flapped modified Martius flap in the treatment of RVF.
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Affiliation(s)
- M Reichert
- Department of General and Thoracic Surgery, University Hospital of Giessen, Giessen
| | - T Schwandner
- Department of General and Thoracic Surgery, University Hospital of Giessen, Giessen
| | - A Hecker
- Department of General and Thoracic Surgery, University Hospital of Giessen, Giessen
| | - A Behnk
- Department of Gynaecology and Obstetrics, University Hospital of Giessen, Giessen
| | | | - F Wagenlehner
- Department of Urology, University Hospital of Giessen, Giessen
| | - W Padberg
- Department of General and Thoracic Surgery, University Hospital of Giessen, Giessen
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Reichert M, Atanasova S, Fuchs-Moll G, Petri K, Padberg W, Grau V. Do B-cells contribute to experimental Bronchiolitis obliterans syndrome? Pneumologie 2014. [DOI: 10.1055/s-0034-1376819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Siebers K, Atanasova S, Reichert M, Padberg W, Grau V. Changes in local alpha-1-antitrypsin expression during the pathogenesis of experimental bronchiolitis obliterans syndrome. Pneumologie 2014. [DOI: 10.1055/s-0034-1376823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Zakrzewicz A, Rabin L, Fischer A, Padberg W, Grau V. Interleukin 18 in the pathogenesis of experimental bronchiolitis obliterans syndrome (BOS). Pneumologie 2014. [DOI: 10.1055/s-0034-1376820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Hecker A, Uhle F, Schwandner T, Padberg W, Weigand MA. Diagnostics, therapy and outcome prediction in abdominal sepsis: current standards and future perspectives. Langenbecks Arch Surg 2013; 399:11-22. [PMID: 24186147 DOI: 10.1007/s00423-013-1132-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Accepted: 10/07/2013] [Indexed: 02/07/2023]
Abstract
PURPOSE In the perioperative phase, sepsis and sepsis-associated death are the most important problems for both the surgeon and the intensivist. Critically ill patients profit from an early identification and implementation of an interdisciplinary therapy. The purpose of this review on septic peritonitis is to give an update on the diagnosis and its evidence-based treatment. RESULTS Rapid diagnosis of sepsis is essential for patient´s survival. A bundle of studies was performed on early recognition and on new diagnostic tools for abdominal sepsis. Although surgical intervention is considered as an essential therapeutic step in sepsis therapy the time-point of source control is still controversially discussed in the literature. Furthermore, the Surviving Sepsis Campaign (SSC) guidelines were updated in 2012 to facilitate evidence-based medicine for septic patients. CONCLUSION Despite many efforts, the mortality of surgical septic patients remains unacceptably high. Permanent clinical education and further surgical trials are necessary to improve the outcome of critically ill patients.
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Affiliation(s)
- A Hecker
- Department of General and Thoracic Surgery, University Hospital Giessen, Giessen, Germany,
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Gehron J, Mann V, Hirschburger M, Schierl R, Reiter A, Padberg W. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) for rare sarcomatosis in pediatric patients – perfusion, anaesthetic and toxicity management. Thorac Cardiovasc Surg 2013. [DOI: 10.1055/s-0032-1332687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Renner FC, Dietrich H, Bulut N, Celik D, Freitag E, Gaertner N, Karoui S, Mark J, Raatz C, Padberg W, Opelz G, Weimer R. Intracellular Cytokine Responses Allow Early Detection of Patients at Risk of Polyomavirus-Associated Graft Nephropathy. Transplantation 2012. [DOI: 10.1097/00007890-201211271-00224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Schmitz J, Zakrzewicz A, Wilker S, Kuncová J, Padberg W, Grau V, Holler J. Differential expression of Neuropeptide Y (NPY) and NPY receptors 1/2 between rat lung and kidney allografts. Pneumologie 2012. [DOI: 10.1055/s-0032-1315548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Atanasova S, Evers A, Fuchs G, Petri K, Obert M, Fischer-Heuschkel A, Rabin L, Hirschburger M, Padberg W, Grau V. A new experimental model for chronic lung allograft damage. Pneumologie 2012. [DOI: 10.1055/s-0032-1315547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Schwandner T, Heimerl T, König IR, Kierer W, Roblick M, Bouchard R, Unglaube T, Holch P, Kolbert G, Padberg W, Ziegler A. [3T-AI: a new treatment algorithm for anal incontinence with a higher evidence level]. Zentralbl Chir 2011; 137:345-51. [PMID: 21968596 DOI: 10.1055/s-0031-1271468] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND The evidence for conservative treatment of anal incontinence is poor. In our first publication [Schwandner et al. Dis Colon Rectum 2010; 53: 1007-1016] we demonstrated that a novel therapeutic concept, termed triple target treatment (3T), combining amplitude-modulated medium frequency stimulation and electromyography biofeedback (EMG-BF) was superior to EMG-BF alone. Questions about the required treatment duration and the relevant subgroups of patients with sphincter damage and damaged anal sensibility were not addressed. METHODS We enrolled 158 patients with anal incontinence in this randomized study. Here, we -report on the important subgroup analyses of patients with and without sphincter damage and damaged anal sensibility for the endpoints Cleveland Clinic Score (CCS) and success record. Using the results of this study we propose a novel treatment algorithm which is open for discussion. RESULTS In patients with sphincter damage, the median difference on the CCS from baseline to 9 months was 5 points higher for 3T than for EMG-BF (95 % confidence interval 0-8; p = 0.0168). While 47 % of the patients with sphincter damage became continent with 3T, only 18 % did with EMG-BF (p = 0.0036). Ten of 17 patients in the 3T group regained anal sensibility after 3 months stimulation. There was tendency towards improved continence in patients with neuropathy upon 3T treatment (p = 0.1219). CONCLUSIONS 3T is superior to EMG-BF alone for patients with sphincter damage and neuropathic anal incontinence. It is a successful key element within our treatment algorithm, even in patients with sphincter damage and neuropathic anal incontinence.
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Affiliation(s)
- T Schwandner
- Justus-Liebig-Universität Gießen, Klinik für Allgemein-, Viszeral-, Thorax- und Transplantationschirurgie, Gießen, Deutschland
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Abstract
It is still disputed in which anatomical compartments of allograft recipients T-cells proliferate. After experimental renal transplantation, host monocytes and lymphocytes accumulate in the lumina of graft blood vessels. In this study, we test the hypothesis that T lymphocytes proliferate in the vascular bed of the graft. Kidneys were transplanted in the Dark Agouti to Lewis rat strain combination, an established experimental model for acute rejection. Isogeneic transplantation was performed as a control. Cells in the S-phase of mitosis were detected in situ three days posttransplantation by pulse-labeling with BrdU and by immunohistochemical detection of the proliferating cell nuclear antigen (PCNA). More than 20% of all T-cells in the lumina of allograft blood vessels incorporated BrdU and approximately 30% of them expressed PCNA. In the blood vessels of isografts as well as in other organs of allograft recipients, only few BrdU(+) cells were detected. A majority of the BrdU(+) cells in graft blood vessels expressed CD8. In conclusion, we demonstrate that CD8(+) T lymphocytes proliferate in the lumina of the blood vessels of renal allografts during the onset of acute rejection.
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Affiliation(s)
- V Grau
- Laboratory of Experimental Surgery, Department of General and Thoracic Surgery, Justus-Liebig-University Giessen, Germany.
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Abstract
Primary tumors of the trachea account for less than 0.1% of all tumors. They are malignant in more than 90% of cases with squamous cell carcinoma and adenoidcystic carcinoma accounting for 2/3 of all tracheal tumors. Since they are often misdiagnosed as asthma or chronic lung disease, diagnosis can be delayed for years. Once the diagnosis has been established, surgical resection being the only curative treatment should be considered first. Modern techniques for tracheal surgery such as laryngotracheal, tracheal or carinal resection and different tracheal mobilisation maneuvers such as laryngeal and hilar release allow for resection of more than 50% of the trachea and anastomosis without excessive tension. Results in patients with complete tumor resection are good with 5-year and 10-year survival between 39% and 79% and between 18% and 51%, respectively. However, careful patient evaluation, preservation of tracheal blood supply and accepting the limits of resectability are mandatory to avoid major complications that accompany tracheal resections in more than 20% of cases depending on the type of resection.
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MESH Headings
- Airway Obstruction/diagnosis
- Airway Obstruction/mortality
- Airway Obstruction/pathology
- Airway Obstruction/surgery
- Anastomosis, Surgical/methods
- Carcinoma, Adenoid Cystic/diagnosis
- Carcinoma, Adenoid Cystic/mortality
- Carcinoma, Adenoid Cystic/pathology
- Carcinoma, Adenoid Cystic/surgery
- Carcinoma, Squamous Cell/diagnosis
- Carcinoma, Squamous Cell/mortality
- Carcinoma, Squamous Cell/pathology
- Carcinoma, Squamous Cell/surgery
- Cervicoplasty/methods
- Follow-Up Studies
- Humans
- Lymph Node Excision/methods
- Lymphatic Metastasis/pathology
- Mediastinal Neoplasms/diagnosis
- Mediastinal Neoplasms/mortality
- Mediastinal Neoplasms/pathology
- Mediastinal Neoplasms/surgery
- Microsurgery/methods
- Neoplasm Invasiveness
- Neoplasm Staging
- Postoperative Complications/etiology
- Postoperative Complications/mortality
- Postoperative Complications/surgery
- Risk Factors
- Survival Rate
- Tomography, X-Ray Computed
- Trachea/blood supply
- Trachea/innervation
- Trachea/pathology
- Trachea/surgery
- Tracheal Neoplasms/diagnosis
- Tracheal Neoplasms/mortality
- Tracheal Neoplasms/pathology
- Tracheal Neoplasms/surgery
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Affiliation(s)
- R Hoerbelt
- Klinik für Allgemein-, Viszeral-, Thorax-, Transplantations- und Kinderchirurgie, Universitätsklinikum Giessen und Marburg, Standort Giessen, Deutschland.
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Albertsmeyer S, Renner FC, Yildiz S, Rainer L, Feuring EK, Kamali-Ernst S, Ernst W, Zinn S, Rieke J, Padberg W, Weimer R. One hundred six live kidney donors in a single German transplantation center: renal, physical, and psychological follow-up. Transplant Proc 2011; 42:3992-3. [PMID: 21168608 DOI: 10.1016/j.transproceed.2010.09.039] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2010] [Accepted: 09/09/2010] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The objective of this study was to analyze the psychological and physical status as well as renal outcomes of 106 live kidney donors between 1993 and 2003. METHODS We performed general and nephrological examinations, including measurements of creatinine clearance (ClCr), proteinuria, and 24-hour blood pressure monitoring. We evaluated the psychological and general health situation using the standardized SF-36 questionnaire. RESULTS We evaluated 69/106 (65%) live kidney donors at 5.3 ± 0.4 years after donation. The reason for the 37 drop-outs were unknown current address (n = 21), refusal of study participation (n = 14), and death due to accident and suicide (n = 2). In the 69 donors renal function was well preserved: serum creatinine 1.3 ± 0.0 mg/dL; ClCr 81 ± 2 mL/min; postdonation to predonation ClCr ratio 0.73 ± 0.02; and proteinuria 104 ± 11 mg/d. None of the donors experienced renal failure, although 36/69 (52%) patients have developed de novo hypertension. Compared with normotensive donors, the hypertensive subgroup was significantly older at the time of donation (50.7 ± 1.4 vs 46.4 ± 1.6 years; P = .010) and had a longer interval since donation (6.4 ± 0.2 vs 3.9 ± 0.1 years; P = .001). SF-36 questionnaire results in live kidney donors showed higher scores regarding physical (54.3 ± 0.8 vs 49.3 ± 0.1; P = .048) and psychological health (53.8 ± 0.6 vs 50.7 ± 0.1; P = .043) compared with the average German population. CONCLUSION Our cohort of live kidney donors showed good renal outcomes and superior SF-36 scores in both physical and psychological health compared with the German population. The risk of de novo hypertension increased with age and time after donation. Blood pressure screening should be regularly performed especially in the long term after donation.
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Affiliation(s)
- S Albertsmeyer
- Department of Internal Medicine, University Clinic of Giessen and Marburg, Giessen, Germany.
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Körner C, Kuchenbuch T, Pfeil U, Jung K, Padberg W, Kummer W, Mühlfeld C, Grau V. Intermedin-treatment of pulmonary ischaemia/reperfusion injury in the living mouse. Pneumologie 2011. [DOI: 10.1055/s-0030-1270376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Renner F, Czekalinska B, Kemkes-Matthes B, Feustel A, Stertmann W, Padberg W, Weimer R. Postoperative Bleeding after AB0-incompatible Living Donor Kidney Transplantation. Transplant Proc 2010; 42:4164-6. [DOI: 10.1016/j.transproceed.2010.09.056] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2010] [Accepted: 09/16/2010] [Indexed: 11/29/2022]
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Hackethal A, Sucke J, Oehmke F, Münstedt K, Padberg W, Tinneberg HR. Establishing transvaginal NOTES for gynecological and surgical indications: benefits, limits, and patient experience. Endoscopy 2010; 42:875-8. [PMID: 20886410 DOI: 10.1055/s-0030-1255756] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
Gynecologists have been performing transvaginal surgery for over a century and consequently the transvaginal approach was advocated for establishing natural orifice transluminal endoscopic surgery (NOTES) in gynecological and surgical practice. From 2008 the NOTES alternative has been offered to selected patients. Transvaginal cholecystectomies were intended in 13 patients and completed in 12. Various additional procedures were performed. All surgical procedures and postoperative courses were uneventful. The mean operating time for transvaginal cholecystectomy only was 88.4 minutes (standard deviation [SD] 17.3). A questionnaire was posted to the patients after a mean follow-up of 8.5 months. Patients primarily chose transvaginal NOTES because of the lack of scarring. Vaginal sensation was not affected. Patients perceived transgastric, transvesical, and transrectal surgery to be less acceptable approaches. The feasibility of transvaginal NOTES was proven for different indications. Patients' experiences and perceptions concerning transvaginal NOTES were excellent.
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Affiliation(s)
- A Hackethal
- Department of Gynaecology and Obstetrics, Justus-Liebig-University Giessen, Klinikstrasse 32, Germany.
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Hirschburger M, Enders J, Alzen G, Padberg W, Wagner HJ. An inflammatory myofibroblastic tumor of the stomach as a rare cause of gastric outlet obstruction in an 8-month-old infant. Klin Padiatr 2010; 222:192-3. [PMID: 20514627 DOI: 10.1055/s-0029-1238320] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Inflammatory myofibroblastic tumors (IMT) are a rare entity. Localization in the stomach is extremely seldom and almost exclusively seen in children. Invasive growth of IMT may lead to irresectability or recurrence. In an 8-month-old girl presented with repetitive vomiting for several days. Complete surgical resection of a gastric IMT was possible.
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Affiliation(s)
- M Hirschburger
- University Hospital, Department of General, Thoracic- and Pediatric Surgery, Giessen, Germany
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44
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Kiss L, Schutte H, Padberg W, Weissmann N, Mayer K, Gessler T, Voswinckel R, Seeger W, Grimminger F. Epoxyeicosatrienoates are the dominant eicosanoids in human lungs upon microbial challenge. Eur Respir J 2010; 18:125-8. [DOI: 10.1183/09031936.00000309] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Grau V, Padberg W, Kummer W, Pfeil U. Verminderte Expression von Keratinozytenwachstumsfaktor und seines Rezeptors während der akuten Abstoßung von Lungentransplantaten in der Ratte. Pneumologie 2010. [DOI: 10.1055/s-0029-1247916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Abstract
The objective of this study was to evaluate the efficacy of 2 different homeopathic prophylactic strategies for the prevention of endometritis. The drugs used were Lachesis compositum (Lachesis), Carduus compositum (Carduus), and Traumeel LT (Traumeel). Each drug contained a mixed formula of homeopathic remedies. All 929 cows received the first treatment within 24 h postpartum. The second to fourth treatments were conducted at 7 to 13, 14 to 20, and 21 to 27 d in milk, respectively. In the first group, the 4 treatments were Traumeel, Lachesis, Carduus, and Carduus, respectively (n = 206). In the second group, Lachesis was administered 3 times, followed by 1 treatment with Carduus (n = 198). The control group received 4 injections of saline (n = 189). In the fourth week after calving, the prevalence of clinical endometritis, uterine involution, and ovarian activity was monitored by rectal palpation and by ultrasonography. To assess the resumption of ovarian activity, blood samples were taken to determine the concentration of serum progesterone. The concentrations of beta-hydroxybutyrate and nonesterified fatty acids in blood serum were examined to evaluate energy metabolism. The incidence of clinical endometritis at 21 to 27 d in milk did not differ between the groups (44.4, 44.8, and 36.9% in the Traumeel, Lachesis, Carduus, and Carduus group; the 3x Lachesis, followed by Carduus group; and the control group, respectively). The proportion of cows with cyclic activity at 21 to 27 d in milk and the proportion of cows above threshold values of progesterone, beta-hydroxybutyrate, and nonesterified fatty acids did not differ significantly between groups. When reproductive performance data were analyzed, no significant differences were found between groups. Hence, the treatment protocols tested were not effective in preventing bovine endometritis or in enhancing reproductive performance in this study.
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Affiliation(s)
- S Arlt
- Clinic for Animal Reproduction, Faculty of Veterinarian Medicine, Freie Universität Berlin, Königsweg 65, 14163 Berlin, Germany
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Eckhard M, Schindler R, Renner F, Schief W, Padberg W, Weimer R, Bretzel R, Brendel M. New-Onset Diabetes Mellitus After Renal Transplantation. Transplant Proc 2009; 41:2544-5. [DOI: 10.1016/j.transproceed.2009.06.100] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Hirschburger M, Hecker A, Padberg W, Neubauer BA, Motz R, Haase C, Marquardt T, Hahn A. Treatment of gastroesophageal reflux with nissen fundoplication and gastrostomy tube insertion in infantile pompe's disease. Neuropediatrics 2009; 40:28-31. [PMID: 19639525 DOI: 10.1055/s-0029-1231066] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
In infantile Pompe's disease, enzyme replacement therapy (ERT) has been shown to reverse cardiomyopathy, improve skeletal muscle strength, and prolong survival. We report on five patients in whom complications related to gastroesophageal reflux (GER) resulted in deterioration of their clinical status despite initial improvement under ERT. Surgical antireflux therapy, performed in four, yielded positive results in two. Three patients experienced severe aspirations related to GER and underwent fundoplication and gastrostomy subsequently. Two did not regain former motor functions and deceased shortly thereafter, while one slowly recuperated and is in a stable state at age 53 months. In a further patient, severe GER prompted fundoplication at age 17 months. No aspirations occurred until the girl deceased probably due to cardiac arrest 20 months later. These cases suggest that infants with Pompe's disease under ERT may benefit from timely performed fundoplication and gastric tube placement.
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Affiliation(s)
- M Hirschburger
- Department of General and Thoracic Surgery, University of Giessen, Giessen, Germany
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Hirschburger M, Sauer S, Schwandner T, Schief W, Kuchenbuch T, Zoerb C, Janssen H, Grau V, Stertmann W, Rau WS, Padberg W. Extratumoral spiral fixed wire marking of small pulmonary nodules for thoracoscopic resection. Thorac Cardiovasc Surg 2008; 56:106-9. [PMID: 18278687 DOI: 10.1055/s-2007-989398] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Video-assisted thoracoscopic surgery (VATS) for pulmonary nodules close to the visceral pleura is an established procedure. Different methods have been developed to mark these nodules when resecting small nodules distant to the pleural surface. The possibility of tumor cell spread due to nodule penetration is a major drawback. Furthermore, guide wire-based marking systems have revealed the problem of accidental wire dislocation prior to resection. METHODS In this study, a new marker system for computed tomography-guided extranodular spiral fixed wire marking (ESFWM) was evaluated in an attempt to maintain tumor integrity while reducing the risk of wire dislocation. RESULTS Our study included 42 patients with 44 marked nodules. 40 nodules were resected by VATS in 38 of these patients. The remaining 4 patients required conversion to thoracotomy due to adhesions and a non-deflated lung. Wire dislocation and nodule penetration occurred only once. CONCLUSION The new lung marker system revealed a very low risk of wire dislocation. Peritumoral marking allows the safe resection of subpleural nodules without a risk of tumor cell spread.
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Affiliation(s)
- M Hirschburger
- Department of General and Thoracic Surgery, University Giessen, Giessen, Germany.
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50
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Schneider U, Kohr S, Moor H, Padberg W. Nicht alles, was pfeift, ist Asthma. Pneumologie 2008. [DOI: 10.1055/s-2008-1074180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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