Biomedical subjects
Publications and source records attributed to J M Engel.
Three female patients with ultrasound criteria of pelvic cysts but with wads of omentum mimicking cystic structures are reported. In 2 patients the omentum was involved in an inflammatory process; in the third, normal omentum was found filling old surgical defects. All were confirmed surgically.
The background, technique and ultrasonic criteria used in the diagnosis of biliary tract disease are reviewed and illustrative case histories and sonograms presented. The results in 100 prospective patients undergoing both biliary tract ultrasound and orall cholecystography are presented with surgical follow-up in 53 patients. Ultrasound was technically adequate in 96% of the patients examined and was accurate in 51 of the 53 patients who came to surgery. The gray scale ultrasound examination was more accurate than oral cholecystography, especially in the subgroup of patients with nonvisualizing oral cholecystograms. The current role of elective biliary tract sonography is discussed and gray scale ultrasound is recommended as the initial screening test in all patients with suspected biliary tract disease.
A prospective study was performed in two parts after sonographic determination of gallbladder wall thickness in 110 consecutive patients. The first part was designed to evaluate accuracy of sonographic measurements in 40 patients on whom intraoperative measurements of wall thickness were obtained. Second, the significance of wall thickness as an indicator of disease was explored by comparing the 40 surgical patients and 44 controls. Sonography was found to be accurate in determining wall thickness to within 1 mm in 93% of patients and 1.5 mm in 100%. Wall thickness greater than 3.5 mm is highly accurate in predicting disease; however, a wall thickness 3 mm or less does not rule out cholecystitis.
The use of ultrasound in surgical diseases of the abdominal wall has received scant attention. The criteria for the ulrasonic diagnosis of abdominal wall disease and the usefulness of ultrasound in patients with incisional pain, occult hernias and abdominal wall masses are illustrated by the records of these patients. Ultrasound of the abdominal wall is a safe, rapid and noninvasive test that can be performed in any patient population, including the postoperative patient, without risk of contrast reaction of radiation exposure.
Malrotation in the adult can mimic acute appendicitis. A complete abdominal exploration is needed to find any obstructing bands or midgut volvulus. The difference between mixed rotation, which usually presents with midgut voluvlus and or duodenal obstruction, and nonrotation, which is usually asymptomatic or presents with intermittent attacks of abdominal pain, is stressed. Therapy is recommended according to the type of defect present.
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Although headache is one of the most common somatic complaints of children and adolescents, little is known about its phenomenology. Pediatric headache diagnosis and implications for treatment are often based on parental reports of consequent pain behaviors. Information on how parents assess and respond to children's headache activity is needed. This study identified how children with chronic, recurrent nonmalignant headaches communicated their headache occurrences to their mothers and how mothers responded to suspected headache occurrences. Specific guidelines are offered to assist nurses in the behavioral assessment and management of chronic pediatric headaches.
OBJECTIVE: This study was designed to compare measures of pain when children with burn injuries were engaged in a purposeful activity, specifically a play activity, versus rote exercise. METHOD: Two 6-year-old children participated in a study using a single-subject, randomized multiple treatment design to compare two conditions: purposeful activity and rote exercise. Data were gathered for each session on four dependent measures: number of repetitions of therapeutic exercise completed, number and type of overt distress behaviors displayed, scores on self-report scales of pain intensity, and overall enjoyment of the activity. RESULTS: Visual inspection of the graphed data suggested that, early in the rehabilitation process, the use of a play activity in comparison to rote exercise yielded better outcomes in terms of all four dependent measures. Additionally, the data implied that there may be a point later in the rehabilitation of a child with a burn injury when rote exercise may be as effective as play activities in meeting therapeutic goals. CONCLUSION: This study supports the belief that purposeful activity can yield results equal to or better than those achieved using rote exercise. Replication of this study is warranted, and the development is indicated of a measure of overt behavioral distress that is more appropriate than those currently available for children with burn injuries.
Physiotherapy is well regarded by all patients with diseases of the locomotor system. In a questionnaire aimed at the self-evaluation of "non-proven remedies", we offered hospitalized patients of the Rheumaklinik Bad Bramstedt questions regarding classical forms of physiotherapy. Of 1600 questionnaires distributed, 447 (27.9%) could be counted and analysed. Categorized into four major groups of rheumatic diseases (rheumatoid arthritis/inflammatory diseases of joints, ankylosing spondylitis, osteoarthritis and degenerative spine disease, including minor rheumatic complaints) we collected patients' opinions of different therapies. In addition, we set up a list of preferred therapies and a list of negative therapies, estimated as less helpful or even harmful, as well as a list of therapies which patients would like to try. The results confirm the value of classical methods of physiotherapy (exercises, pelotherapy, massage), which had a high degree of acceptance and effectiveness.
The measurement of absolute temperatures on the surface of the human body using quantitative thermography allows this technique to be used in rheumatology, for the diagnosis and monitoring the course of inflammatory diseases of the locomotor system. The patient is exposed to a room temperature of 18 degrees C and the skin temperature measured over the joint for a defined area (region of interest). Inflamed joints show distinctly higher absolute temperatures than normal ones within the observation time of 40 minutes. Moreover, the skin over healthy joints cools faster and to a greater extent than skin over inflamed joints, whose temperatures remain the same or even rise minimally in more acute cases. Using two measurements, the determination of the absolute temperatures (static thermography), and the changes in these temperatures within a definite time interval (dynamic thermography) it is thus possible to establish a diagnosis of arthritis in the regions of the peripheral joints with the help of standardised nomograms with an accuracy of more than 90%, and to follow the course of the disease more exactly.
Being progressive and also involving variations in the severity of symptoms, chronic rheumatic diseases present difficulties with respect to documentation. Since dramatic changes in the course of disease are rare, early detection of very slight changes is essential to successful antirheumatic therapy. Practical means of documentation are necessary if an overview of the various clinical findings and subjectively reported symptoms is to be maintained over a period of many years. This is especially true in the case of therapeutic studies. The documentation form should enable the recording of suitably grouped data on the various rheumatic diseases and modes of therapy. With governmental support (BMFT project MT 0289), a uniform documentation form, "Dokumentation Rheuma", was set up and tested at 14 hospitals for rheumatic diseases. The modular form chosen and the definition of items were well received by the clinicians. After several modifications, a modularly structured documentation system is now available, elements of which can be expanded according to the needs of the individual therapeutic study. The form can both constitute a part of the patient history and act as a link between different but parallel-running studies, thus making it unnecessary to record the same information twice for different purposes. At the same time, the data base can be used to answer scientific and epidemiological questions independent of the study in progress.
Computer-assisted evaluation of thermography of the knee joints allows diagnosis and quantitation of inflammatory processes. This needs an adequate thermography camera, registration standards and a thermographic index. With the aid of this index normal knee joints and those with inflammatory changes can clearly be differentiated: an index of less than 3.5 is normal, values above 5.0 indicate an inflammation. The author proposes to correct the thermographic index with reference to actual rectal temperature in order to improve inter- and intra-individual comparability of thermograms. Apart from the thermographic index, the formal analysis of the line-scan over the joint space and the maximal temperature of the joint can be used as further diagnostic criteria.