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Biomedical subjects

P Wolf

Publications and source records attributed to P Wolf.

At least 19 recordsLinked to original sources
PubMed1992

[Enhancement of the quality of hepatic graft by restoration of hepatic glycogen reserves in the donor].

It has been suggested that depletion of donor hepatic glycogen reserves deleteriously affects the resistance of the hepatic graft to ischemic episodes. In this study, performed in the pig model, we showed that it is possible to enhance the quality of the graft at the time of reperfusion by using a method which rapidly restores the donor hepatic glycogen reserves. With the aid of an isolated liver perfusion model, we compared grafts (n = 24) harvested from pigs fed (group N), fasted for 24h (group J), or fasted with a restoration of glycogen reserves (group P). After the grafts were subjected to 8 hours of cold ischemia, the release of alanine aminotransferase, aspartate aminotransferase and lactic dehydrogenase in the perfusate increased in group J (P < 0.05 vs group N); the increase was corrected in group P (P < 0.05 vs group J). When the grafts were subjected to 15 minutes warm ischemia prior to the liver harvest, the production of bile was reduced in group J (P < 0.05 vs group N); bile production was reestablished in group P (P < 0.05 vs group J). The clinical application of such a method of donor nutritional conditioning, in the hours which precede organ harvesting, may enhance the quality of the hepatic graft at the time of transplantation.

Animals↗
PubMed1992

Adenoid cystic carcinoma of the palate.

We reviewed the clinical records of 41 patients who received definitive treatment for adenoid cystic carcinoma arising from the palate. Tumors were divided into three categories depending on local extension and pattern of growth. Surgery, either alone or in combination with post-operative radiation therapy, yielded satisfactory local regional control of the cancer. Patients who had adenoid cystic carcinoma with diffuse microscopic spread into adjacent tissues had the highest propensity for the development of distant metastases.

Adult↗
PubMed1992

Ampicillin-sulbactam vs clindamycin in head and neck oncologic surgery. The need for gram-negative coverage.

This study was undertaken to assess whether gram-negative antimicrobial coverage is required in patients undergoing head and neck oncologic surgery. Ampicillin sodium-sulbactam sodium and clindamycin phosphate were compared in a prospective, randomized, parallel, double-blind trial of 212 patients undergoing head and neck procedures involving clean-contaminated wounds. Both antibiotics were given up to 1 hour before surgery and continued at 6-hour intervals after surgery for an additional eight doses. Fourteen infections occurred in the ampicillin-sulbactam-treated group (13.3%) and 29 infections in the clindamycin-treated group (27.1%). From patients receiving clindamycin, 29 gram-negative organisms were isolated, compared with six from those patients receiving ampicillin-sulbactam. This finding supports the need for gram-negative coverage in patients undergoing clean-contaminated head and neck oncologic surgery.

Adult↗
PubMed1992

Mycosis fungoides mimicking perioral dermatitis.

A 71-year-old woman under PUVA-treatment for mycosis fungoides developed erythematous patches around the nasolabial folds and papules on the chin with clinical features of perioral dermatitis. Histology showed a specific infiltrate of mycosis fungoides with predominance of medium to large-sized pleomorphic lymphocytes and immunoblasts. Immunohistochemical analysis revealed the T-phenotype of the neoplastic cells. Small clusters of B-lymphocytes could also be observed within the infiltrate. Perioral dermatitis-like lesions can be added to the spectrum of rare and unusual clinical manifestations of mycosis fungoides.

Aged↗
PubMed1992

Steady state concentrations and diurnal fluctuations of carbamazepine in patients after different slow release formulations.

The bioavailability and serum level fluctuations of three carbamazepine (CBZ, CAS 298-46-4) slow release preparations marketed in Germany were compared in patients with epilepsy. Ten patients who were on CBZ monotherapy and had reached a steady state with morning trough levels above 10 micrograms/ml received all 3 preparations in sequential 3-day periods. On the 3rd day of each period, a 24-h serum drug level profile was determined. Only minimal differences could be found. One preparation had a significantly higher AUC than one of the others (p less than 0.05), and this difference seemed to be correlated with higher fluctuations of serum levels and, especially, an increased Cmax. Although the group differences are minimal, more important differences could be observed individually. One patient had, with one of the three preparations, a reduction in seizure frequency but simultaneously developed important signs and symptoms of toxicity. It is concluded that all 3 preparations are equally suitable for chronic antiepileptic drug treatment. In a well-controlled patient, however, interchange between preparations is not advisable as their kinetics in individual patients can be sufficiently different to cause toxicity or seizure relapse.

Adolescent↗
PubMed1992

[Effect of nutritional status of the donor on the quality of hepatic graft. Value of restoration of glycogenic reserves of the donor].

Initial function of the graft is an essential factor for successful liver transplantation. The aim of this study was to evaluate the influence of the nutritional status of the donor on hepatic graft quality at reperfusion. Livers (n = 41) were taken from pigs normally fed or fasted for 24 h or fasted for 24 h and conditioned for 2 hours with a solution containing glucose, fructose and glutamine. The quality of liver grafts was evaluated using an original, blood-free isolated perfusion model, after 8 h cold storage, or after 15 min warm ischemia performed prior to harvesting. The hepatic concentration of glycogen and ATP, measured from in vivo biopsies, was decreased in fasted animals (P less than 0.05 vs fed) and restored by nutritional conditioning (P less than 0.05 vs fasted). At the time of reperfusion following 8 h cold ischemia, the liberation of aminotransferases and lactate dehydrogenase was elevated in livers coming from fasted animals (P less than 0.05 vs fed) and restored to fed levels after nutritional conditioning (P less than 0.01 vs fasted). After 15 min of warm ischemia, the bile secretion during the reperfusion period was decreased in the 24 h fasted livers (P less than 0.01 vs fed) and reestablished after nutritional conditioning (P less than 0.01 vs fasted). Perfusion of the donor liver, in the 2 h preceding harvest, with a solution of glucose plus neoglucogenic precursors enhances the quality of the liver graft at the time of reperfusion.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1992

[Problems posed by the inferior vena cava in liver transplantation].

On the basis of a 200-case series, we report about the problems posed by the inferior vena cava for liver transplantation, and about the means implemented to solve these problems. Before hepatic transplantation, agenesia of the vena cava, which was encountered once, did not prevent grafting. During transplantation, the inferior vena cava posed problems due to its size or to the approach. These were solved using an extracorporeal venovenous shunt, which we advocate to systematically use for liver transplantation. Following transplantation, in addition to hemorrhages, the problems posed by the IVC included supra- or infrahepatic anastomotic stenoses (2 cases) and infrarenal, retrohepatic or suprahepatic thromboses (2 cases). Their repair again resorted to a venovenous shunt, for which we specify the strategy of use.

Adult↗
PubMed1991

[Apparent drug resistance in epilepsy].

To elucidate possible sources of error in the assessment of drug-resistant epilepsy questionnaires were sent, at least one year after hospital discharge, to 259 patients hospitalized between 1. 1. and 31. 12. 1986 because of epilepsy. Information thus obtained included whether and what seizures had occurred after discharge and what drugs had been taken. Answers were received from 173 patients (67%). They revealed that 18 patients (12 men and 6 women; mean age 29.6 [16-58] years) had, before hospitalization, been wrongly thought to have epilepsy resistant to antiepileptic drugs, significantly more often (P less than 0.05) those with generalized epilepsy (21.2%) than with focal seizures (7.4%) or those with both generalized and focal attacks (9.4%). In five patients increasing the dosage of a drug currently taken stopped the seizures. In 12 patients at least one new drug was introduced, in seven of them as a differentiated choice guided by type of seizure and kind of epilepsy. In 11 of these patients the dosage of other drugs could be reduced or the drug discontinued altogether. In one woman seizures stopped after clonazepam had been discontinued. With two exceptions (mesuximide) success was achieved with just one of five standard antiepileptic drugs or by individually determined combinations of them. These results indicate that even in apparent drug resistance absence from seizures can be achieved in many cases of epilepsy if treatment strictly follows accepted principles.

Adolescent↗
PubMed1991

Prognostic variables in parotid gland cancer.

We performed a retrospective review of 178 previously untreated patients with primary malignant neoplasms of the parotid gland treated at our institution between 1960 and 1985. Patients were followed up for a median of 7.5 years. Fifty-nine percent underwent surgery alone, and 40% underwent surgery and radiation therapy. Univariate and multivariate analyses established the prognostic influence of cancer stage, cancer grade, histologic type, presence of lymphatic invasion, perineural invasion, tumor size, extension beyond the parotid gland fascia, cervical adenopathy, quality of margins, and patient age and gender. Survival was influenced most by tumor grade, tumor size, presence of positive cervical lymph nodes, and facial nerve invasion. The risk of local-regional recurrence was most affected by cervical adenopathy and tumor size. Distant metastases were predicted by tumor grade and size. At last contact, 39% of patients were alive and free of disease, while 26% had died of the disease. We analyzed the optimal surgical procedure and the rationale for the selection of combined treatment.

Adolescent↗
PubMed1991

Metastatic adenocarcinoma to the neck from an unknown primary source.

We report a retrospective review of 223 patients who presented to the Department of Head and Neck Surgery from 1970 through 1987 with a diagnosis of metastatic adenocarcinoma of unknown primary origin. Multivariate analysis was performed using the following parameters: age, sex, initial side and site of nodal involvement, involvement of other body sites, degree of differentiation, treatment modality, outcome, and survival. Follow-up was obtained in all patients, with a minimum of 2 years for survivors. Average age was 55 years, with an approximately equal male:female ratio. The most common site of presentation was the supraclavicular fossa (76%). The initial side of presentation was the left neck in 53% of patients, right neck in 33%, and bilateral in 14%. Metastatic disease to other body sites was present in 86% of patients, with the most common sites being mediastinum (35%), lung (21%), and bones (19%). Increased survival was associated with unilateral neck involvement (p = 0.001) and disease limited to nodes above the cricoid cartilage (p = 0.007). Mean survival was 17 months, with a median of 8 months. Death was due to the index cancer in all but four patients; three of these four patients died of treatment-related causes. Survival was 20% at 2 years and 9% at 5 years. Length of survival was not affected by age, sex, initial side of neck disease, location of other metastatic sites, histologic appearance, or treatment modality. Our current algorithm for the work-up and treatment of this lethal disease is explained.

Adenocarcinoma↗
PubMed1991

PUVA-induced lymphomatoid papulosis in a patient with mycosis fungoides.

The occurrence of lymphomatoid papulosis in patients with cutaneous lymphoma, particularly mycosis fungoides, has been described in medical literature. A 68-year-old woman affected by mycosis fungoides in the plaque stage noticed that multiple papulonodular lesions of lymphomatoid papulosis developed suddenly after a few sessions of PUVA therapy. The PUVA induction of lymphomatoid papulosis was confirmed by the appearance of new lesions after a second cycle of PUVA exposure on a limited area of the body. Complete regression of all PUVA-induced lymphomatoid papulosis lesions was achieved within a few weeks with oral prednisone and topical steroids. During the entire treatment the patches and plaques of mycosis fungoides persisted unchanged.

Aged↗
PubMed1991

[Peroperative massive pulmonary embolism of tumoral origin. Value of extensive monitoring].

A case is reported of a 47-year-old female patient who suffered from massive tumour embolism during a nephrectomy for a renal carcinoma invading the inferior vena cava. Intraoperative monitoring consisted in direct blood pressure measurement (radial artery cannula), central haemodynamic monitoring (Swan-Ganz catheter), pulse oximetry and capnography. During the surgical manipulation of the suprahepatic vena cava, Petco2 suddenly decreased (from 25 mmHg to 14 mmHg), together with Spo2 (from 99% to 89%), and the mean pulmonary arterial pressure increased from 18 mmHg to 40 mmHg. The drop in arterial blood pressure to 50/30 mmHg, initiated an immediate sternotomy. After clamping the superior and inferior venae cavae, numerous tumour fragments were removed from the pulmonary artery. Cardiac activity restarted after internal cardiac massage, 1 mg adrenaline, 1 g calcium chloride and 150 mmol of molar sodium bicarbonate. The whole procedure lasted 30 min. Arterial blood pressure became stable at 110/50 mmHg, pulmonary arterial and wedge pressures at 20 and 5 mmHg. The Spo2 increased to 98%, and Petco2 to 25 mmHg. The nephrectomy was then carried out, the patient being given 5 micrograms.kg-1.min-1 dobutamine and 3 micrograms.kg-1.min-1 dopamine. At the end of surgery, systolic blood pressure was 120 mmHg, mean pulmonary arterial pressure 25 mmHg, and PaCO2 34 mmHg. The patient left the intensive care unit after twelve days. After one year of follow-up, no complication had occurred. The value of cardiopulmonary bypass in nephrectomy for renal carcinoma invading the vena cava, or the renal vein, is discussed.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenocarcinoma↗
PubMed1991

The "military family syndrome" revisited: "by the numbers".

Because concerns have been raised about high levels of psychopathology in military children, the authors used standardized psychopathology rating scales to survey 213 six-to twelve-year-old children of military parents and their parents. Results from children's symptom self-reports, as well as from teachers' ratings of children, indicated that children's symptom levels were at levels consistent with national norms. In contrast, parents' (especially mothers') ratings of children were significantly higher than national norms, as were parents' ratings of their own symptoms. Also, parents' own symptom reports showed somewhat stronger relationships with life stressors presumably affecting the child than did the children's and teachers' reports. Results suggest that parents' reports of children's symptoms may be mediated by the effects of military life stressors on the parents, but these stressors do not necessarily result in higher symptoms in the children. Overall results do not support the notion that levels of psychopathology are greatly increased in children of military parents. Further studies of military families should address the effects of rank and socioeconomic status, housing, and the current impact of life stressors on the parents as well as the children in order to avoid drawing erroneous conclusions about parts or all of the military community.

Adult↗
PubMed1991

Artificial penile nodules and secondary syphilis.

A patient with artificial penile nodules and ulcerative plaques on the penis is described. Clinical course, histology and serological examination revealed a diagnosis of secondary syphilis. The differential diagnosis of the ulcerative genital lesions in the presence of artificial penile nodules is discussed.

Adult↗