Stephan A Padosch's research while affiliated with University of Cologne and other places

Publications (114)

Article
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Background Sepsis and other infectious complications are major causes of mortality and morbidity in patients after cardiac surgery. Whereas conventional blood culture (BC) suffers from low sensitivity as well as a reporting delay of approximately 48–72 h, real-time multiplex polymerase chain reaction (PCR) based technologies like “SeptiFast” (SF) m...
Preprint
Background: Sepsis and other infectious complications are major causes of mortality and mor-bidity in patients after cardiac surgery. Whereas conventional blood culture (BC) suffers from low sensitivity as well as a reporting delay of approximately 48–72 h, real-time multiplex poly-merase chain reaction (PCR) based technologies like “SeptiFast” (SF...
Article
Full-text available
To date, the optimal cooling device for targeted temperature management (TTM) remains unclear. Water-circulating cooling blankets are broadly available and quickly applied but reveal inaccuracy during maintenance and rewarming period. Recently, esophageal heat exchangers (EHEs) have been shown to be easily inserted, revealed effective cooling rates...
Preprint
Background: Sepsis and other infectious complications are major causes of mortality and morbidity in patients after cardiac surgery. Whereas blood culture (BC) as the current diagnostic gold standard suffers from low sensitivity as well as a reporting delay of approximately 48–72 h, polymerase chain reaction (PCR) based technologies might offer a f...
Article
Full-text available
Background: Targeted temperature management is a standard therapy for unconscious survivors of cardiac arrest. To date, multiple cooling methods are available including invasive intravascular cooling devices (IVDs), which are widely used in the clinical setting. Recently, esophageal heat exchangers (EHEs) have been developed providing cooling via...
Article
Background: Peri-operative critical events are still a major problem in paediatric anaesthesia care. Access to more experienced healthcare teams might reduce the adverse event rate and improve outcomes. Objective: The current study analysed incidences of peri-operative paediatric cardiac arrest before and after implementation of a specialised pa...
Article
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Background Contribution of the small intestine to systemic inflammation after cardiac arrest (CA) is poorly understood. The objective was to evaluate whether an in vivo rat model of 6 min CA is suitable to initiate intestinal ischaemia-reperfusion-injury and to evaluate histomorphological changes and inflammatory processes in the small intestinal m...
Article
Background: In recent decades, the incidences of anaesthesia-related perioperative mortality and adverse outcomes have decreased drastically. However, to date, data on perioperative cardiac arrest and risk factors of perioperative cardiac arrest from European countries are scarce. Objectives: To determine the incidences of perioperative cardiac...
Article
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Background Targeted temperature management (TTM) is widely used in critical care settings for conditions including hepatic encephalopathy, hypoxic ischemic encephalopathy, meningitis, myocardial infarction, paediatric cardiac arrest, spinal cord injury, traumatic brain injury, ischemic stroke and sepsis. Furthermore, TTM is a key treatment for pati...
Data
Specific oesophageal tissue pathologies examined after treatment with OHE11, OHE14.7 or control animals. The sum was calculated for each slide. (TIF)
Article
Purpose: Toxic reactions to local anesthetics are rare but potentially lethal. In fact, animal studies and case reports demonstrate that the administration of lipid emulsions after initializing cardiopulmonary resuscitation is a promising treatment option. The aim of this study was to determine how many hospitals in Germany are prepared to treat t...
Article
The authors hypothesized that, compared with conventional ultrasound (CUS), the use of a novel navigated ultrasound (NUS) technology would increase success rates and decrease performance times of vascular access procedures in a gel phantom model. A prospective, randomized, crossover study. A university Hospital. Participants were 44 anesthesiologis...
Article
Severe traumatic brain injury is among the most common causes of death in young adults in the industrialized nations. Secondary injury due to an activation of pathophysiological signaling pathways significantly enlarges primary injury directly caused by trauma and is responsible for one third of all fatalities due to traumatic brain injury. Critica...
Article
Transoral laser surgery has become a standard procedure in the treatment of benign and malignant neoplasms of the upper aerodigestive tract. As the laser cuts and coagulates simultaneously, intraoperative bleeding is reduced, thus improving visualization of the operative field. However, the specific risks for patients and personnel that are associa...
Article
Transoral laser surgery has become a standard procedure in the treatment of benign and malignant neoplasms of the upper aerodigestive tract. As the laser cuts and coagulates simultaneously, intraoperative bleeding is reduced, thus improving visualization of the operative field. However, the specific risks for patients and personnel that are associa...
Article
Critical incidents in clinical medicine can have far-reaching consequences on patient health. In cases of severe medical errors they can seriously harm the patient or even lead to death. The involvement in such an event can result in a stress reaction, a so-called acute posttraumatic stress disorder in the healthcare provider, the so-called second...
Article
Die akute Lungenthrombembolie (LE) ist eine lebensbedrohliche Erkrankung, deren unverzügliche korrekte Diagnose und Therapieeinleitung die Prognose der betroffenen Patienten entscheidend verbessert. Vorwürfe ärztlicher Behandlungsfehler betreffen hierbei nicht nur ein mögliches Nichterkennen der LE, sondern überdies auch nachfolgende Diagnoseschrit...
Article
Die Pneumonie ist eine Erkrankung mit allgemein zunehmender Inzidenz und zählt zu den häufigsten Komplikationen von Krankenhaus- sowie Pflegeheimaufenthalten mit erheblicher klinischer, forensischer, gesundheitspolitischer und volkswirtschaftlicher Relevanz. Bei der forensischen Begutachtung von Behandlungsfehlervorwürfen im Zusammenhang mit Pneumo...
Article
Mass panic situations usually occur at large public events - although only rarely. Nevertheless, (senior) emergency physicians need to be aware of, and prepare for, such an eventuality with an eye to (emergency) crowd management, the local situation, emergency escape routes and evacuation strategies. During such a large-scale public event, an outbr...
Article
Severe traumatic brain injury ranks among the most common causes of death in young adults in western countries. Severe traumatic brain injury is typically followed by a pronounced pathophysiological cascade that accounts for many deaths. The aim of intensive care medicine after traumatic brain injury is to minimize and to control the consequences o...
Article
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Demographic changes in Germany are leading towards a decrease of the population from the current 82 million to 74 million in the year 2050. As a consequence the shortage of qualified staff will be aggravated and intensifying recruiting efforts will increase competition among employers. An alternative is to utilize the potential of jobholders older...
Article
Since first described in 1946 by Mendelson, aspiration of gastric content resulting in severe pulmonary complications is a known hazard of general anaesthesia. We report on a case of massive aspiration of gastric content during induction of general anaesthesia, resulting in severe prolonged hypoxaemia with cardiac arrest, followed by rapid onset of...
Article
The aim of the present study was to evaluate whether different video laryngoscopes (VLs) facilitate endotracheal intubation (ETI) faster or more secure than conventional laryngoscopy in a manikin with immobilized cervical spine. After local ethics board approval, a standard airway manikin with cervical spine immobilization by means of a standard st...
Article
Die therapeutische Hypothermie ist bislang das einzige erwiesenermaßen effektive Therapieprinzip zur neuronalen Protektion nach Herz-Kreislauf-Stillstand mit Wiederherstellung eines spontanen Kreislaufs. Durch den frühen Einsatz der therapeutischen Hypothermie kann eine Verbesserung von Überleben und neuronaler Funktion dieser Patientengruppe errei...
Article
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Acute right heart failure (RHF) is a frequent and severe complication during perioperative and intensive care treatment in intensive care units (ICUs). The most common causes are pulmonary hypertension, left heart failure, pulmonary embolism, sepsis, acute lung injury (ALI) and thoracosurgical procedures. Acute RHF is not only a major contributor t...
Article
Introduction Even today aerial bombs and unexploded ordnance from World War II are still common. For deactivation many relevant factors must be noted by emergency medical service personnel. The aim of the present review is to summarize resulting problems and to assess organizational challenges for deactivation procedures of aerial bombs. Materials...
Article
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At present, besides well-known financial problems, German hospitals are facing a serious lack of qualified medical staff. Given these facts, it is of great importance, especially in work load burdened disciplines, such as cardiovascular anaesthesiology, to retain highly qualified medical staff. Here, human resource development measures offer valuab...
Article
Poor neurological outcome remains a major problem in patients suffering cardiac arrest. Recent data have demonstrated potent neuroprotective effects of the administration of sulfide donor compounds after ischaemia/reperfusion injury following cardiac arrest and resuscitation. Therefore, we sought to evaluate the impact of sodium sulfide (Na(2)S), a...
Article
Der plötzliche Herz-Kreislauf-Stillstand aufgrund eines akuten Myokardinfarktes oder einer fulminanten Lungenembolie ist aktuell eine der häufigsten Todesursachen in Mitteleuropa. Die Letalität ist dabei ausgesprochen hoch, insbesondere bei außerklinischem Ereignis. Für diese beiden akuten Erkrankungen ist die Thrombolyse seit langem eine etabliert...
Article
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There is a significant shortage of highly qualified personnel in medicine, especially skilled doctors and nurses. This shortage of qualified labor has led to competition between hospitals. Analyzing the circumstances of the competition, nurses and doctors of the so-called generation Y are of importance. Recruitment and retention of these staff memb...
Article
Recently, human resource development concepts have become more important in intensive care medicine. Motivationally oriented leadership is an essential part of this strategy. Of particular significance, leadership first of all means not to demotivate the personnel. Furthermore, a motivationally oriented leadership concept creates a framework in whi...
Article
Sudden cardiac death is a leading cause of death in Europe. In the vast majority, myocardial infarction or pulmonary embolism is the underlying cause. Lethality is still high, especially if the arrest occurs out of hospital. For these two severe conditions, thrombolysis has proven to be an established therapy. Coronary perfusion is restored or the...
Article
In den westlichen Industrienationen werden jährlich zwischen 40 und 90 kardiopulmonale Wiederbelebungen auf 100.000 Einwohner bei Patienten mit Herz-Kreislauf-Stillstand durchgeführt. In 50–70% dieser Fälle liegt dem Herz-Kreislauf-Stillstand ein akuter Myokardinfarkt oder – deutlich seltener – auch eine fulminante Lungenembolie zugrunde. Allein au...
Article
The term "postresuscitation syndrome" includes among other pathophysiology impaired microcirculation and endothelial leakage. GPIIb/IIIa receptor antagonists like abciximab have been shown to reduce endothelial leakage and to improve microcirculatory disturbances during experimental endotoxaemia where comparably similar endothelial dysfunction has...
Article
The clinical symptoms and pathophysiologic mechanisms during and after ischaemia-reperfusion following cardiac arrest (CA) and successful cardiopulmonary resuscitation (CPR) closely resemble those observed in patients with severe sepsis. Impairment of microcirculation and endothelial leakage seem to play key roles in the underlying pathophysiology....
Article
This study evaluated the time course of caspase activation in selectively vulnerable brain areas (hippocampus, nucleus reticularis thalami (NRT), cortex and striatum) following cardiopulmonary resuscitation (CPR) after global cerebral ischemia due to cardiac arrest (CA) in rats. Caspases are well known to play a crucial role in the apoptotic cascad...
Article
The present study provides a current survey of driving while intoxicated (DWI) and the effects of the introduction of the breath alcohol concentration (BrAC) (as assessed by Alcotest 7110 Evidential) as a means of evidence in court in the catchment area of the Bonn Institute of Forensic Medicine. For this purpose, the records of the laboratory for...
Article
The response of the human body to cardiac arrest (CA) and cardiopulmonary resuscitation is characterised by excessive coagulation, inadequate endogenous anti-coagulation and fibrinolysis as well as an inflammatory syndrome that closely resembles the immunological profile observed in patients with sepsis. Recombinant human activated protein C (rhAPC...
Article
Neurofibromatosis type 1 (NF−1), a phacomatosis with an incidence of 1:3,000–4,000, is characterized by multiple benign nerve tumors, skin caf�-au-lait spots and a variety of other dysplastic abnormalities, e.g., of blood vessels. On rare occasions NF−1 is associated with arterial dysplasia (vascular neurofibrosis), which is poorly defined and can...
Article
Given a current total incidence of erroneously administered blood transfusions of 1:12,000–1:36,000 (AB0 incompatible 1:38,000), the percentage of lethal outcomes ranges between 2 and 5%; i.e. the sole fact of an erroneous transfusion does not mandatorily result in a causal connection with lethal outcome, which can give rise to problems in the medi...
Article
Assessing injuries in forensic medicine casework, examiners are often confronted with the question of self-infliction versus third parties' influence, respectively, deliberate self-harm versus maltreatment. We report the case of a 40-year-old male who presented with numerous partially healed thermal injuries of different age. These burns were shape...
Article
Objectives. The aim of this prospective study was to assess the relation between hemodynamic changes and β-endorphin and catecholamine levels in cardiac arrest survivors in the early postresucitation period. Material and Methods. Thirty-two patients in whom spontaneous circulation (ROSC) was restored successfully after cardiac arrest due to non-tra...
Article
In contrast to typical autoerotic fatalities, when death is due to asphyxia mostly by mechanical compression of the neck, atypical autoerotic accidental deaths (AADs) involve sexual self-stimulation by other means such as electrocution or inhalation of chemical agents. Especially in lethal cases of volatile substance abuse (VSA), a differentiation...
Article
Spinal epidural haematomas (sEDH) can be regarded as rare events, in principle a spontaneous and a traumatic aetiology can be distinguished. Spontaneous spinal epidural haematomas can arise, e.g. from vascular malformations, coagulopathies, etc. On the other hand, traumatic sEDH are related to, e.g. spinal trauma or intraoperative vascular injuries...
Article
The suicidal infliction of two gunshot wounds to the head represents a critical issue for medicolegal investigation. In principle, simultaneous infliction with two firearms or third parties' involvement, i.e. two consecutive gunshots, have to be considered. We report for the first time on a case of suicidal infliction of two simultaneous gunshots t...
Article
After inconspicuous pregnancy and birth, a 16-year-old mother presented her male baby 5 days later with severe diarrhoea and vomiting. During the following weeks, the child temporarily showed hypotension, hypothermia and increased body temperature, bradyarrythmia with apnoea, continuing diarrhoea, sometimes vomiting and developed signs of pancreati...
Article
Full-text available
Absinthe, a bitter spirit containing wormwood (Artemisia absinthium L.), was banned at the beginning of the 20th century as consequence of its supposed unique adverse effects. After nearly century-long prohibition, absinthe has seen a resurgence after recent de-restriction in many European countries. This review provides information on the history...
Article
Haemorrhagic fractures of the thyroid cartilage and hyoid bone are frequently observed in cases of strangulation and often regarded as evidence for an assault against the neck. In contrast, two cases of laryngohyoid fractures after agonal falls in prone position are presented to draw attention to alternative causes of these injuries with special re...
Article
The alcoholic beverage absinthe is recently experiencing a revival after a yearlong prohibition. This review article provides information on all aspects of this bitter spirit and its major components, especially wormwood (Artemisia absinthium L.), which contains the toxic monoterpene thujone. Over 100 references on historic and current literature a...
Article
We report about a fatality during patient-controlled analgesia (PCA). Piritramide peripheral blood concentration was measured with 0.1 mg/l and exceeded the normal therapeutic range. Therefore, a fatal overdose was considered as the cause of death with respiratory depression as the underlying pathophysiological mechanism. The tissue distribution wa...
Article
The medicolegal and subsequent criminologic interpretation of forensic and pathological findings in cases of homicide makes up an important tool of case profiling. In a retrospective study of 26 cases of "multiple homicides" involving 31 perpetrators (30 males, 1 female, mean age 33.5 years) and 73 victims (33 males, 40 females, mean age 36 years,...
Article
Full-text available
In 1991, the European Commission permitted the addition of thujone-containing plant extracts (wormwood, mugwort) as well as aroma extracts to alcoholic beverages and spirits. For bitter spirits, such as absinthe, which has enjoyed more and more popularity in recent years, a limit of 35 mg/l alpha-/beta-thujone was established by the European Commis...
Article
In contrary to "physical restraint", describing a fixed body position due to external devices, "positional restraint" is defined as an abnormal body position, resulting from accidental fixation under unfortunate circumstances. We report on a remarkable case of positional asphyxia of an alcoholised young man after a fall down a staircase. On externa...
Article
Occupational accidents, often presenting with lethal outcomes, are a rarely reported issue in forensic literature. However, these incidents are part of medicolegal casework with special regard to reconstruction, liabilities and insurance law-related issues, respectively. We report on a lethal occupational accident in a metropolitan sewage plant. Wh...
Article
Amisulpride is a substituted benzamide used as an atypical antipsychotic drug. It antagonizes dopamine D2 and D3 receptor-mediated effects with greater affinity for the limbic system suggesting better neurological tolerance than classical neuroleptics. However, occasionally amisulpride intoxications associated with seizures, comatose conditions and...
Article
In cases of suicidal gunshots, the capacity to act may be preserved for a certain period of time, so that the suicide may be completed with another method. In the presented case a 74-year-old man was found hanged on the first floor of his house with two gunshot wounds in the chest. Both on the ground and the upper floor traces of suicidal acts were...
Article
Zusammenfassung Durch vergleichende immunhistochemisch-morphometrische Untersuchungen am Hippocampus Drogentoter mit anamnestisch gesichertem chronischen Opiatabusus und eines altersentsprechenden Kontrollkollektivs wurde in der vorliegenden Studie überprüft, ob der neuronalen Adaptation im menschlichen Hippocampus unter chronischer Opiatexposition...
Chapter
The medicolegal literature provides many reports on the morphological appearance of stab injuries caused by pieces of broken glass (e.g., glass splinters). The review presented here focuses on the particular aspect of blow injuries to the head and skull inflicted by glass bottles. Findings from an experimental biomechanical study conducted by the a...
Chapter
This chapter focuses on occupation-related peculiarities of suicides. It is intended to elucidate problems that may arise in occupation-related suicides and to provide approaches and solutions for practical forensic casework. A number of suicides with outstanding occupation-related features observed by the authors are presented and compared with an...
Article
We report the case of a 15 day old male newborn who died suddenly without having presented any clinical symptoms before death. At autopsy, he was found to have global cardiomegaly, with biventricular hypertrophy, interventricular defect and aortic stenosis. He also presented a bilateral lung congestion and pleural effusion. This case reminds us how...
Article
The second part of the paper on suicides by gunshots to the head in the presence of witnesses focuses on relevant morphological autopsy findings such as entrance site, signs of close range or contact shots, bullet path etc. and also discusses selected aspects of ascertaining gunshot residues. For the identification of the shooter an integral medico...
Article
After transient global cerebral ischemia, selective vulnerable brain areas show delayed neurodegeneration with characteristics of apoptosis. Recent data demonstrate potent neuroprotective effects of the application of endogenous growth hormones such as brain-derived neurotrophic factor (BDNF) after focal cerebral ischemia. To assess possible effect...
Article
Unter den klinisch bekannten Strungen des Wasser-Elektrolyt-Haushalts stellt eine im Anschluss an Operationen an der Hirnbasis auftretende Hypernatrimie und Hyperosmolalitt eine vergleichsweise seltene Komplikation dar, die als postoperative neurogene Strung der Osmoregulation (Strung im hypothalamohypophysren Regelkreis) aufgefasst wird. Im Folgen...
Article
In the USA the frequency of witnessed suicide, i.e. suicide committed in the presence of at least one further individual, is reported to range between 5 and 15%. As up to now no detailed analysis of this special issue has been given in the medicolegal literature, this article presents and discusses a number of cases including 8 males and 1 female (...
Article
The cause of sudden infant death syndrome (SIDS) is an unresolved problem of high relevance. Previous studies indicate a role of infections. In our prospective study, we investigated the frequency of virus-induced myocardial affections in SIDS. Postmortem samples from SIDS victims and control subjects were investigated prospectively. Pediatric case...
Article
Fatal drug concentrations in body fluids and tissue samples are presented for more than 200 drugs and chemicals of toxicologic interest. Additionally, a reference list is added with more than 600 original papers concerning intoxications with a lethal outcome. The data can be helpful for the interpretation and plausibility control in own cases of in...
Article
Downstairs falls frequently occur within domestic environments and are mainly associated with elderly and intoxicated individuals, often feature multiple injuries on various parts of the body. In most cases it is not possible to determine the cause of the fall and/or death solely by means of external examination. In this retrospective study, which...