Biomedical subjects

K Engel

Publications and source records attributed to K Engel.

At least 73 records · Page 4Linked to original sources

PubMed1988

[Rate of local recurrence and survival in patients with breast reconstruction following mastectomy].

A retrospective study was conducted covering 100 patients who underwent breast reconstruction with plastic prostheses following mastectomy during the period from 1975 to May 1986. They were compared with 100 patients (matched pairs) who had not undergone breast reconstruction. No significant difference between the two groups could be found as regards locoregional recurrences or the overall survival rate. The mean observation period was 86.5 months. Surgical removal of local recurrences did not necessarily involve removal of the prosthesis. Therefore, given adequate operability, and experience on the part of the surgeon, a breast reconstruction following mastectomy can now be performed on any patient desiring it to alleviate mental suffering.

Adult↗

PubMed1988

[Transposition and myocutaneous island flaps in primary or secondary locoregional surgical therapy of breast cancer].

New plastic surgical reconstruction techniques can today make a major contribution to locoregional therapy in breast cancer cases. The present paper reports on indications for and experience gathered in primary and secondary therapy with transposition (medial-pedicled thoracoepigastric) and myocutaneous island flaps (lower transversal rectus and latissimus dorsi) at the University Gynecological Clinic of Heidelberg between October 1981 and June 1987. Thirty-nine patients were treated using these techniques. Altogether nine rectus, 13 latissimus dorsi, and 21 thoracoepigastric flaps were used; in 16 cases for primary treatment with T4 tumors and in 27 cases for secondary treatment. In view of the rate of complications and recurrences seen, the indication must be established strictly and individually according to the location of the defect, the anatomic situation, and the prognosis for the patient. Today, the use of these plastic surgery techniques should lie in the hands of experienced surgeons and be an integral part of the treatment of primary advanced breast carcinomas or large locoregional recurrences.

Adult↗

PubMed1988

Adrenocorticotropic hormone in the control of renal tubular hydrogen ion secretion. Balance of non-metabolizable base in ACTH-stimulated weanling rats subject to acid or base loading.

Groups of weanling rats subject to ACTH-stimulation (tetracosactrin, 1 mg kg-1 day-1) were exposed to heavy oral loads of ammonium chloride (approx. 21 mmol kg-1 day-1) or sodium bicarbonate (approx. 40 mmol kg-1 day-1) for 8 days. During loading with sodium bicarbonate, the animals maintained a normal positive external (whole body) balance of non-metabolizable base (NB), excess NB being excreted quantitatively in the urine, whereas loading with ammonium chloride caused a fall in the mean balance of NB from a reference value of 12.1 mmol per 8 days to about zero. However, in the two groups the concentration in plasma of NB rose from the reference value (41 mmol l-1) to the same level (57 and 59 mmol l-1, respectively; P greater than 0.5) despite extreme differences in rates of gastrointestinal NB absorption, despite a significant rise in the rate of endogenous sulphuric acid production and despite the presence of ample chloride in diet and urine. These results indicate that ACTH determines the extracellular concentration of NB at which exchange of NB takes place by influencing, directly or indirectly, the relative rates of renal tubular H- secretion and Cl- reabsorption at any given rate of tubular reabsorption of Na-. Some cybernetic considerations of the disturbance are presented.

Acid-Base Equilibrium↗

PubMed1988

Prognostic factors in anorexia nervosa.

Preclinical inpatient therapy and postclinical prognostic factors concerning 113 cases were empirically scrutinized and hierarchically classified in accordance with their importance, especially in light of the relative weight of somatic, psychologic, or social variables. The criterion is the state of health at the time of follow-up, after 6.4 years. The results thus obtained are the basis of therapy recommendations.

Adaptation, Psychological↗

PubMed1988

Father types of anorexia nervosa patients: the 'bonding', the 'brutal', the 'weak' and the 'absent' father. An empirical study based on a comparison with fathers of a representative normal group.

Increased attention has been drawn in recent years to the importance of the father in the genesis of anorexia nervosa. Four types of fathers were identified and investigated by comparing, under this aspect, fathers of 96 most severely affected patients with those of 111 families of a representative normal group. The investigation showed significant differences with regard to the 'bonding' and the 'brutal' father, whereas the 'weak' and the 'absent' father showed no significantly different values; the latter was even more frequent in the Unormal population. The results shall be discussed with regard to anorexia nervosa therapy.

Adolescent↗

PubMed1988

Therapy results and follow-up of an integrated inpatient treatment for severe cases of anorexia nervosa.

The therapeutic elements of an inpatient treatment for anorexia nervosa are presented with the therapy results as well as a 2-year follow-up of 39 patients who were treated at Hamburg University Hospital from 1980 to 1983. The favorable results (high weight gain, short duration of therapy, distinct psychological improvement with a total of 53% of virtually cured patients at the end of therapy) declined partially during the 2-year follow-up period (51% virtually cured). The results are compared with those of an earlier concept which was focussed rather on strict regimen and medical treatment, which also resulted in 53% virtually cured patients (n = 218; follow-up period 9.6 years). We will discuss the question whether the methodology presented here can be an alternative to family therapy for somatically severe cases with structural (psychic) lability, lack of patient motivation and uncooperative families.

Adolescent↗

PubMed1988

Dimensions of the 'endangered self' in anorexia nervosa. Empirical study based on comparison with normal controls.

In addition to the diagnosis of symptoms we recently proposed the empirical analysis of psychodynamic levels; this paper aims at an empirical study of a third, and most essential, problem area: disturbances and/or regulatory processes of the self-system. Based on Deneke's newly developed questionnaire, 30 anorexia nervosa patients were examined, and then compared with 64 normal controls (female university students). A self-profile comprising 18 scales is used to graphically illustrate the disturbances. The primary deficits were found in the subscales of the 'endangered self' and the 'hypochondriac self', while the subscales of the 'classic narcissistic self' and the 'idealistic self' were found to be irrelevant. The significant self-system scales were then related to the symptomatology. The conclusion of the paper contains some therapy considerations.

Adolescent↗

PubMed1988

Clinical process studies on anxiety and aggressiveness affects in the inpatient therapy of anorexia nervosa.

Under the assumption of affect defense (alexithymia), 20 anorexia nervosa patients being treated in the University Hospital of Hamburg-Eppendorf were examined with respect to their affects of anxiety and aggressivity by employing speech samples (three times a week)--according to Gottschalk-Gleser--and questionnaires (ANIS) during hospitalization and compared to 10 control patients from somatic clinics (orthopedics, surgery, gynecology). Particular attention was given to emotional responses toward events during the inpatient period. The most important result found was the distinct affectivity in the anorexia patients, which was partly stronger than that of the somatic control patients, so that judging from our anorexia nervosa sample the hypothesis of alexithymia will have to be renewed and requires a more differentiated discussion.

Adult↗

PubMed1988

Comparative clinical and pharmacokinetic aspects of cefotetan versus cefoxitin plus metronidazole in vaginal hysterectomy.

In a randomised clinical trial, 102 women who underwent vaginal hysterectomy were given a single preoperative 2g dose of cefotetan (CTT) (52 pts) or three perioperative 2g doses of cefoxitin (CFX) plus 0.5g metronidazole (50 pts) as antibiotic prophylaxis. No statistically significant differences between the groups were detected in the clinical response (100% for both groups). The incidence of major wound infection (2% CTT and 0% CFX) were also comparable between the two treatment groups; post-operative changes in body temperature, duration of hospitalisation and post-operative urinary tract infections (16% CTT and 20% CFX) were similar. Both drugs were well tolerated. Twenty nine of the 102 patients were further investigated to determine the pharmacokinetics following a single 2g dose of CTT or CFX, in both serum and tissue. Although both antibiotics provided good concentrations during the early phase of surgery, CTT levels persisted for a longer time period. These results confirm that single dose cefotetan is equally as effective and safe as multiple dose cefoxitin plus metronidazole for prophylaxis in patients undergoing vaginal hysterectomy.

Adult↗

PubMed1988

Pharmacokinetics of sulbactam and ampicillin intravenously applied in combination to healthy volunteers and patients. Determination of the ratio of the two drugs in serum and in various tissues.

The pharmacokinetics of sulbactam, a new beta-lactamase inhibitor, and ampicillin were investigated in 9 healthy volunteers and 125 patients. The two drugs were administered intravenously in combination (Unacid). Each subject received 1 g sulbactam and 2 g ampicillin. The two drugs showed a similar pharmacokinetic profile in humans. Relevant pharmacokinetic parameters were calculated using a 2-compartment model on the basis of the serum and urine concentrations determined in healthy volunteers. The ratio of sulbactam to ampicillin was found to be nearly constant (approx. 1:2), both in the blood, in several tissues and at various time points. The two compounds apparently penetrated well into the myometrium, renal cortex and medulla, the gall bladder wall, the tonsils and the cutis of the skin. The sulbactam/ampicillin ratios in the bile ranged from 1:3 to 1:13 over 2 h after the infusion. The concentrations of the two compounds measured in the various fluids and tissues of the body reached levels which are effective against beta-lactamase producing bacteria. The similar pharmacokinetics of sulbactam and ampicillin in humans are considered an essential prerequisite for the therapeutic efficacy of such a combination product.

Adult↗

PubMed1987

Methionine-induced acidosis in the weanling rat.

Whole body balances of non-metabolizable base (NB) were studied in weanling rats fed a cereal-based diet with or without added L-methionine. In response to L-methionine loading (2.5 mmol day-1) the rats exhibited a significant reduction in rates of food intake (109 vs. 160 g per 8 days) and body growth (3 vs. 52 g per 8 days); fractional oxidation of absorbed dietary amino acid sulphur increased from 0.28 to 0.64; and mean urinary sulphate excretion increased from 2.3 to 14.8 mmol per 8 days. Mean rates of renal excretion of NB and filtered titratable organic acid decreased from 20 to -11 mmol per 8 days and from 22 to 8 mmol per 8 days. Balances of calcium and NB remained at reference values despite a decrease in whole blood 'base excess' from -1.0 to -6.4 mmol l-1. The concentration of NB in plasma rose but slightly. It is concluded that L-methionine loading in the weanling rat leads to extracellular non-carbonic acidosis subject to renal compensation. This acidosis is due not to retention of H+ released by ionization of endogenous sulphuric acid but possibly to accumulation of (acid) organic metabolites of methionine which are efficiently conserved by the kidneys. The rise in sulphuric acid production leads to an adaptive decrease in fractional reabsorption of filtered sulphate. Even during inhibited growth, absorbed dietary NB is retained and deposited in the skeleton, probably as calcium carbonate.

Acid-Base Equilibrium↗

PubMed1987

[Prognostic factors of anorexia nervosa--an empirical study for constructing a hierarchical order of important factors].

Reports on prognostic factors of anorexia nervosa differentiate positive, negative and irrelevant data. However, these fields stand in parallel without quantification and thus without aspiring a hierarchical order. Establishing such an order by relative importance is the aim of this study in which we report on n = 113 patients. Among these prognostic factors from the time before, during and after hospitalization are investigated empirically. The patients' present state acts as a criterion (follow-up after 6.4 years). The relevant factors are set up hierarchically and investigated by multivariate analysis with special respect to relative importance of somatic, psychological or social variables. Finally we give therapeutic recommendations.

Adult↗

PubMed1986

Interests and specialty choice in medicine.

The study deals with the origin of occupational satisfaction in the medical profession. It examines the relationship between the specialty choice within the medical profession on the one hand, and satisfaction with the occupational choice on the other. Following an intensive analysis of the medical profession and interviews with senior physicians, three dimensions along which the medical specialties differ were defined: contact with people (contact), usage of instruments and equipment (instruments), and occurrence of dramatic events in the physician's daily work (sensation). Eighty-one medical practitioners answered the IIP (interest inventory for physicians) which was constructed to measure their vocational interests. Results show: reliability coefficients of 0.85, 0.92 and 0.83 for the contact, instruments and sensation components of the IIP, respectively; and correlations of 0.31, 0.27 and 0.53 between interest-specialty congruence in contact, instruments and sensation, respectively, on the one hand, and satisfaction with the medical specialty choice on the other. Several implications and applications are discussed.

Career Choice↗

PubMed1986

Amenorrhea and predictors for remenorrhea in anorexia nervosa: a psychoendocrinological study in inpatients.

34 consecutively admitted anorexia nervosa inpatients were studied for variables relevant for 'early' vs. 'late' amenorrhea and for probable remenorrhea after therapy. The subsample reporting 'early' amenorrhea, i.e. preceding weight loss (n = 11), was characterized by less 'anorexia-specific' psychological traits and more weight loss before admission and a more marked (= pathological) FSH responsiveness to GnRH stimulation. Hence--contrary to our expectation--'early' amenorrhea seems to be a 'nonpsychogenic' phenomenon. Analysis according to FSH hyperresponsiveness yielded no additional information. Studying LH changes during therapy we found that a nonrise in basal LH secretion is associated with a type of anorexia characterized by early onset and a less severe but protracted course before admission, which then proves also more recalcitrant to therapy. The subsample which attained LH fluctuation before discharge showed a clear reduction of 'weight phobia' and a higher weight both on admission and before discharge.

Adult↗

PubMed1986

Psychoendocrinology of remenorrhea in the late outcome of anorexia nervosa.

Within a late follow-up of our former anorectic patients 38 consented to an endocrine checkup in addition to clinical and sociopsychologic assessments. Univariate comparisons of still or again amenorrheic patients (n = 22) versus remenorrheic patients (n = 16) showed many significances. However, some of these variables intercorrelated substantially. Therefore, we performed a stepwise discriminant analysis which yielded as the most differentiating variables 'subjective well-being' (24%), follow-up interval (16%), Frisch's 'fat percentage within body weight' (12%) and 'sexual behavior' (5%). As the mean follow-up intervals were 10 versus 6 years, anorectic patients seem to need considerable time for remenorrhea, or rather for the psychosocial-sexual adaptation necessary for it. The equally necessary weight gain does not correlate with the follow-up interval. Then there is a factor which seems to be 'constitutional': Early onset of amenorrhea predicts late nonremenorrhea (3%).

Adolescent↗

PubMed1986

Therapy motivation in anorexia nervosa: theory and first empirical results.

Anorexia nervosa patients are considered to be unmotivated for psychotherapy of eating disorders, because they present a lack of understanding and feeling for their disease. In order to objectify this lack of therapy motivation we formulated two questionnaires for patients and therapists. The items were obtained from 15 theoretically determined fields of both intra- and interpersonal subsets of motivation, and a 'motivation profile' was gained. In a first clinical application these profiles are obtained from an anorexia sample at the beginning and at the end of an inpatient treatment and combined with the corresponding therapist ratings. The results are compared with two control groups (preattended psychosomatics and somatic patients). Results collected hereby are used for the improvement of our questionnaires and for suggestions concerning further studies.

Adult↗

PubMed1985

Acid-base balance in ruminating calves given sodium hydroxide-treated straw.

1. Studies of whole-body balances of non-metabolizable base (NB) and several minerals, and of relevant acid-base quantities in blood and urine, were carried out in two 6-month-old ruminating Holstein X Friesian bull calves fed on fixed rations containing 500 g barley straw/kg diet (group A) to examine the quantitatively important components of the balance of NB and determine the rates of mineral and NB retention associated with normal body growth. 2. Parallel balance studies were conducted in six other bull calves given fixed rations containing 500 g alkali-treated barley straw/kg diet to evaluate the effects of long-term alkali-straw feeding on the rates of body growth and skeletal mineral and NB deposition and the renal control of extracellular electrolyte and acid-base status. The straw component was treated either with 50 g sodium hydroxide/kg dry matter (DM) (group B; two calves), or with 50 g or 100 g NaOH/kg DM and subsequently neutralized with hydrochloric acid (groups C and D, two calves per group). In all groups the animals were given free access to tap water. 3. Throughout the total 105 d experiment, all animals remained healthy and gained weight. Normal body growth group A) was associated with a positive balance of NB (1-2 mmol/kg live weight (LW) per d) due to continuing deposition of dietary NB in 'new tissue', largely in the developing skeleton. 4. During 105 d alkali-straw feeding, the animals showed a remarkable ability to cope with dietary loads of NAOH or sodium chloride, up to about 30 mmol/kg LW per d, without any significant disturbance of extracellular acid-base and electrolyte status or body growth rate. The surplus mineral and NB loads were absorbed and subsequently excreted in an increased volume of urine. Rates of mineral and NB retention were not significantly different from the reference values of group A and remained within the range of values reported from similar studies. In all groups, maintenance of normal whole blood and plasma acid-base and electrolyte status was accounted for by efficient renal control of the composition of the extracellular fluid compartment.

Acid-Base Equilibrium↗

PubMed1984

[Advantages and hazards of preventing infection following cesarean section--clinical and bacteriologic results of a high-dosage treatment with mezlocillin and oxacillin short-term preventive following clamping of the umbilical cord].

Between August 1980 and August 1981 a prospective randomised study was conducted at the Krankenhaus Nordwest , Dept. of OBGYN , Frankfurt, to investigate the efficacy of a short term prophylaxis using mezlocillin and oxacillin ( Optocillin ) in reducing infections after Caesarean section (6 gs Optocillin after clamping the umbilical cord and after 8 and 16 hours, respectively). Both the study group (sg) and the control group (cg) consisted of 50 patients each. Both groups were statistically homogeneous . Infections were significantly reduced by the prophylaxis: sg 26%/cg 64% - p less than 0,001, febrile morbidity: sg 10%/cg 38% - p less than 0,001, endometritis: sg 6%/cg 20% - p less than 0,08, UTI: sg 18%/cg 36% - p less than 0,05, wound infections: sg 2%/cg 18% - p less than 0,02. Severe infections, however, were seen in neither group. The duration of infections was shorter in the sg. The various postoperative infections were associated with different risk factors (rf) - endometritis: green amniotic fluid, operating time greater than 75 min; cervical dilatation less than 2 cm, UTI: PROM (greater than 6 hs), operating time less than 75 min, internal monitoring, cervical dilatation greater than 2 cm, wound infections: green amniotic fluid, internal monitoring, frequent vaginal examinations (greater than 6), cervical dilatation greater than 2 cm and operating time greater than 75 min. The prophylaxis was especially effective in the presence of the following rfs: green amniotic fluid, internal monitoring, frequent vaginal examinations (6), operating time greater than 75 min and when associated with combined rfs. The reduction of wound infections following the prophylaxis can be ascribed to the elimination of organisms (Staph. spec., enterococci,) at the site of operation.(ABSTRACT TRUNCATED AT 250 WORDS)

Cesarean Section↗