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Biomedical subjects

K Engel

Publications and source records attributed to K Engel.

At least 55 records · Page 3Linked to original sources
PubMed1991

[Prognostic factors for long-term survival in anorexia nervosa].

This work describes the results of a long-term follow-up (mean duration = 13.5 years) of 105 female anorexia nervosa patients, for 93.3% of whom (n = 98) we were able to obtain information. Our objective was to identify factors affecting the long-term prognosis in these cases. Weight gain and a stable partnership after treatment as well as high body weight on termination of treatment were shown to be especially important for long-term recovery. This suggests the following for treatment of anorexia nervosa: besides restoration of normal body functions, the patient should attempt to leave her parents' home and enter a partner relationship. Further weight gain should not be neglected during this process.

Anorexia Nervosa↗
PubMed1991

[Therapy of patients with severe anorexia (summary of a report on a research project)].

From 1981 to 1983 a special project on anorexia nervosa was granted within "Sonderforschungsbereich 115" (Hamburg--West Germany). We want to give a review of those aspects of our studies which led us to a therapeutic concept for severely affected inpatients. Starting in the diagnostic field with problems of motivation and alexithymia we turn to psychodynamic subgroups, mention the studies of endocrinology, the Self-structure and the father-types, continue with epidemiologic studies as a device of interpreting pathologic phenomena. Concerning our therapeutic investigations--basing on a long-term follow-up--we report on therapeutic elements, results, follow-up and a hierarchy in prognostic factors of our in-patient treatment. In a critical survey of the results we finally discuss therapeutic recommendations.

Affective Symptoms↗
PubMed1990

[Testing of a liquid, ready-to-use, breast milk substitute in the county of Funen].

A newly developed liquid ready-to-use cow's milk based formula (BD) was used as the sole nutrient in 314 healthy term infants below the age of 28 weeks--except for supplementary feeding introduced at an average age of 142 days. The incidence of dyspeptic problems (constipation, diarrhea, vomiting), the parents' and visiting nurses' comments on the product, and the causes of "BD failure" (termination of BD feeding because of suspected cow's milk allergy, dyspepsia, etc.) were recorded as were rates of weight gain and linear growth. It is concluded that BD is a valuable alternative to existing powdered milk formulas and that the growth of the infants compared satisfactorily with published reference values.

Animals↗
PubMed1990

[The pH and acidity of feces in colorectal neoplasms].

The pH and faecal titratable acidity in fresh faeces were measured in patients with colo-rectal carcinoma or adenoma and in normal individuals. Significantly higher pH values and lower acidity were found in patients with cancer than in normal individuals. Patients with cancer had pH greater than 6.90 more frequently than normal. Patients with adenomata did not differ significantly from normal individuals. These results support performance of intervention trials with lowering of the pH in the colon with the object of cancer prophylaxis even although the causal connection is obscure.

Adenoma↗
PubMed1990

[The extent of radical axillary lymph node excision].

A study on histological findings in 1047 patients who underwent total axillary lymph node dissection (topographical levels I-III), was conducted. A mean of 20.3 lymph nodes (LN) was assessed; LN metastases were detected in 492 cases. Retrospective analysis showed that, by mere dissection of LNs level I, 10 of the 492 nodal positive cases (2.0%) would have been classified false negative. Additionally, according to the number of positive LNs detected in stage I, 85 of the 492 patients (17%) would have been assigned to a group with a better prognosis (prognostic groups 1-3, 4-9, greater than or equal to 10 pos. LNs). By mere dissection of LNs levels I and II, only 1 of 492 (0.2%) patients would have been categorized false negative and only 24 patients (5%) would have been included in a group with a better prognosis, on the basis of the number of positive LNs dissected. Thus dissection of LNs stages I and II provides sufficient prognostic information. Since, however, in 145 nodal positive cases (14% of the entire collective e.g. 29.5% of all patients with positive lymph nodes), metastases were detected in level III, these LNs should be removed as well, in order to prevent axillary recurrences. One could only dispense with dissection of level III, if LN metastases levels I and II could be excluded during the operation.

Axilla↗
PubMed1990

[Guideline for the assessment of therapeutic success in the treatment of anorexia].

Several different empirical studies dealing with the field of intrafamily relations, long term prognostic factors and the differentiation of living and deceased allowed us to postulate a guiding criterion for the evaluation of anorexia-treatment: The success of treatment depends on the quality and development of social relations (object relationships). In this case the development of new relationships, that do not belong to the old pathogenous field, are extremely important.

Adult↗
PubMed1989

Perioperative systemic antibiotics for prophylaxis of infections in breast surgery: sulbactam/ampicillin versus mezlocillin/oxacillin.

In a prospective, randomized, open trial, efficacy of one dose of sulbactam/ampicillin (1 g:2 g) was compared to three doses of mezlocillin/oxacillin (2 g:1 g), starting with induction of anesthesia in 80 breast surgery patients with an increased risk of postoperative infection. No infections at the site of operation were seen in either group. Fever due to postoperative pulmonary complications occurred in one patient in the sulbactam/ampicillin group. The only side effect was a moderate exanthema observed in one patient in the mezlocillin/oxacillin group. In this study of the prophylaxis of patients with an increased risk of postoperative infections having the potential to jeopardize the results of surgery, a single dose of sulbactam/ampicillin was as effective as a short term course of three doses of mezlocillin/oxacillin.

Adult↗
PubMed1989

[Side effects and complications in breast-saving therapy of breast cancer].

From 1975 to June 1987, a total of 664 women underwent breast-conserving therapy for invasive carcinoma at the University Hospital for Women, Heidelberg, FRG (562 patients: surgical procedure/radiotherapy, 102 patients: only radiotherapy). A subgroup of 203 nonselected patients was prospectively followed up for complications and side effects. The population examined was representative of the entire series with reference to age distribution, tumor stage and localisation. The mean follow-up period was 28.9 months after primary therapy. Complications of breast-conserving therapy (surgery, post-operative radiotherapy, adjuvant chemotherapy for node-positive patients) were assessed by one investigator including evaluation of a standardized patients' questionnaire. The most frequent and serious single complication was lymphedema (LE) of the arm. The incidence of severe LE (greater than or equal to 3 cm difference in circumference) was 6.4%. A total of 25.1% of all patients reported some degree of swelling of the arm. The overall LE-rate was 23.1% according to the newly introduced LE-score combining the degree of difference in circumference, individual handicap and need for physiotherapy. The LE-rate was significantly increased in patients with adjuvant chemotherapy (40.1%, p less than 0.01). General impairment of arm function was reported frequently (65.6%). Shoulder mobility was severely restricted (abduction of arm less than or equal to 90 degrees) in 3.6%. Further complaints were related to impairment of fine motor function (4.5%), shielding of the arm (15.4%), reduction in absolute force (22.1%) and/or rapid tiring of the arm (37.4%). Radiotherapy related toxicity accounted for cutaneous edema (50.3%) and fibrosis of the breast (slight: 33.8%, pronounced: 9.7%).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

Empirical coverage of psychodynamic configurations of anorexia nervosa.

For the last several years, the clinical picture of anorexia nervosa has been covered at the following three levels: (1) symptomatology (including partner and family relations); (2) psychodynamics; (3) narcissistic level. As far as the psychodynamic level is concerned, this paper presents the pertinent theory in its operationalized form for a clinical rating. The convergent validity of the five psychodynamic configurations is tested by a comparison of clinical rating, a questionnaire (IATAN) and a standardized interview (SIAN); divergent validity is tested by verifying the mutual differences of the five configurations.

Adolescent↗
PubMed1989

An interaction model of anorexia nervosa.

Noticeable similarities were found in the psychosocial field by a comparison of a group of anorexia nervosa patients with a representative sample of normal controls. In particular, no confirmation could be found of the mother dominance coupled with the weak and frequently absent father, as postulated under the interactional model of anorexia nervosa. Empirical discriminate analyses of the role of individual family members are necessary.

Adolescent↗
PubMed1989

Termination of inpatient treatment of anorexia nervosa.

Following some general theoretical considerations, the paper empirically addresses the question of termination of inpatient treatment of anorexia nervosa. It identifies those factors which have been the causes of unsuccessful treatment (including fatal outcome) and which must therefore be taken into account, especially when terminating therapy. It is not the improvement of weight and somatic symptoms which turns out to be an adequate criterion for discharge, but rather the capability for generating new social relationships. The wish to go back to live with one's parents (when they did not participate in the therapy) or to live alone must not be accepted, following inpatient treatment.

Adult↗
PubMed1989

Long-term stability of anorexia nervosa treatments: follow-up study of 218 patients.

We are reporting about the stability of n = 218 female in-patient treatments of Anorexia nervosa carried out at the University Clinic at Hamburg-Eppendorf from 1965 to 1979 mainly by a special program: introductory interview (with the family present), in-patient medical treatment (bed-rest, phenothiazines, tube-feeding), strict regimen and addressing the patients' conflict situation. The average interval between the end of therapy and the follow-up examination was 9.8 years. We were able to collect data about 93 per cent (n = 202) of the former patients concerning their somatic, psychological and psychosocial status. Based on these data we could assess 30 patients (14 per cent of our basic sample) as free of symptoms while 84 patients (39 per cent) presented slight symptoms so that 53 per cent of the former patients could exercise their profession without being considerably handicapped and able to keep up a relationship with a partner. On the other hand, 39 patients (18 per cent) still showed marked symptoms at follow-up and with 19 patients (9 per cent) there were manifestations of severe or extreme symptoms. Thirty former patients (14 per cent) had died with the mortality rate distinctly increasing over the years. Possible interpretations of our results and consequences for therapy are presented.

Anorexia Nervosa↗
PubMed1989

[Criteria for terminating inpatient psychotherapy of anorexia nervosa patients].

Following some general theoretical considerations, the paper empirically addresses the question of termination of in-patient treatment of anorexia nervosa. It identifies those factors which have been the cause of unsuccessful treatment (including fatal outcome) and which must therefore be taken into account, especially when terminating therapy. It is not the improvement of weight and somatic symptoms which turns out to be an adequate criterion for discharge, but rather the capability for generating new social relationship. The wish to go back to living with parents (when they did not participate in therapy) or to live alone must not be accepted, following in-patient treatment.

Adult↗
PubMed1989

[Prevalence of anorectic behavior in a normal population. An epidemiologic study and its conclusions in the etiology and treatment of anorexia nervosa].

Data of a representative sample of female citizens of Hamburg (aged 15-25) are presented. The results of the representative sample generally support the findings of specific target groups with prevalence rate of 1-2% risk factors for Anorexia nervosa. The comparison of the representative sample with inpatient Anorexia nervosa patients found the expected significant differences with regard to symptomatology but noticeable similarities in the psycho-social field. So the theory of mother dominance coupled with the weak and frequently absent father, as postulated pathognomic for Anorexia nervosa, has to be new discussed.

Adolescent↗
PubMed1989

[Follow-up study of affect, anxiety and aggression in inpatient treatment of anorexia nervosa].

Under the assumption of affect-defense (alexithymia) n = 20 anorexia nervosa patients being treated in the University Hospital of Hamburg-Eppendorf from 1980 to 1982 were examined with respect to their affects of anxiety and aggressivity by employing speach samples (three times a week)--according to Gottschalk-Gleser--and questionnaires (ANIS) during hospitalization and compared to n = 10 control patients from somatic clinics (orthopedics, surgery, gynecology). Particularly examined were emotional responses toward events during the in-patient period. As the most important result we found distinct affectivity in the anorexia patients that was partly stronger than that of the somatic control patients, so that (judged from our sample of anorexia nervosa) the hypothesis of alexithymia has to be rejected.

Adult↗
PubMed1988

[Breast reconstruction using a skin expander prostheses following modified radical mastectomy].

In the period from September 1983 to May 1986, 116 breast reconstructions were performed at Heidelberg University Gynecological Clinic with the aid of skin expander prostheses, following modified radical mastectomy (89 primary and 27 secondary reconstructions). In 18% of all cases, complications occurred due to the expanders, the most common being loss of prosthesis material. A total of 82 women have meanwhile had the expander prosthesis replaced by a definitive gel prosthesis in a "second reconstruction phase". Reconstruction of the nipple and areola has been performed in six cases in a third phase. Today, breast reconstruction in one or two stages following modified radical mastectomy represents an integral part of surgical rehabilitation of primarily operable breast cancer in cases, where a primary conservative procedure is out of the question.

Adult↗
PubMed1988

[CA 15-3 and CEA as tumor markers in the diagnosis of the recurrence of breast cancer].

The significance of the tumor markers CA 15-3 and CEA for the oncological follow-up of breast cancer was examined in a retrospective analysis of 108 patients in whom, before and after hospitalization, it was possible to locate a local recurrence, a contralateral breast carcinoma, or a distant metastasis. Overall, examination of the group of patients showed that CA 15-3 was significantly more sensitive than CEA (57%/38%), with an increase of only 3% in sensitivity when investigating both markers simultaneously. Neither marker is suitable for the diagnosis of a relapse in the same region or a contralateral breast carcinoma, as pathologic values are only to be observed in one-third or, respectively, one-quarter of all cases. In cases of distant metastasis, CA 15-3 is significantly superior to CEA (osseous: 62%/41%; visceral: 73%/34%). Only where there is combined osseous/visceral metastatic spread is no significant difference manifested (87%/74%). In 15 out of 17 patients with an apparently relapse-free course both during and after hospitalization, the CA 15-3 value was normal where the CEA value was pathologic. Tumor progression would thus seem improbable where there is a pathologic CEA value in conjunction with a normal CA 15-3 value. In follow-up of breast cancer, simultaneously assay of both "nonredundant" tumor markers, which represent a useful spectrum for tumor control, is to be recommended.

Antigens, Neoplasm↗