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Biomedical subjects

G L Engel

Publications and source records attributed to G L Engel.

At least 19 recordsLinked to original sources
PubMed1995

Anal dynamic graciloplasty in the treatment of intractable fecal incontinence.

BACKGROUND: In patients with intractable fecal incontinence, conventional treatment is not always successful. Dynamic graciloplasty (transposition of the gracilis muscle to the anus with the implantation of stimulating electrodes) was developed to provide such patients with functional neosphincters. We evaluated the clinical results of this new surgical approach and the effects on quality of life. METHODS: We treated 52 patients with dynamic graciloplasty. The clinical results of treatment were evaluated in an interview, by anal manometry, and by enema testing. The degree of continence was scored. To assess quality of life, four questionnaires were administered (parts 1 and 2 of the Nottingham Health Profile, the State-Trait Anxiety Inventory, and the Self-rating Depression scale). RESULTS: Among the 52 patients, 38 (73 percent) were continent after a median follow-up of 2.1 years. At 52 weeks the patients' condition had improved with respect to the median frequency of defecation (from five to two times per 24 hours, P < 0.001), the median time defecation could be postponed (from 9 seconds to 19 minutes, P = 0.012), and the median time an enema could be retained (from 0 to 180 seconds, P = 0.005). Patients in whom the technique was successful became less anxious than those in whom it failed (P = 0.002) and improved with regard to effectiveness in their occupations, ability to perform tasks around the home, personal relationships, sexual function, and social life (P = 0.01). They also became less isolated socially (P = 0.05). CONCLUSIONS: Dynamic graciloplasty is a safe and reliable technique in patients with severe incontinence and may result in a better quality of life.

Adolescent↗
PubMed1995

[Ambulatory surgery in the Netherlands].

Day care treatment is encouraged in the Netherlands on the one hand by the government and on the other hand by the request of the patients. There is a continuous shift from clinical to day care cases and through diversification, f.i. 24-hour admittance and short stay, one will be able to further reduce the number of expensive long stay hospital beds.

Adolescent↗
PubMed1992

Effect of impurities on estradiol crystallization in a sustained-release implant.

During the development of a silicone rubber implant for the delivery of estradiol 17-beta some batches of implants made from a certain lot of commercial estradiol inexplicably developed surface crystals of estradiol after several days of storage. An impurity profile was obtained for 28 lots of estradiol by a newly developed HPLC method. One or more impurities may have had a role in the spontaneous crystal growth on the surface of the implants, because the one lot of estradiol that initially had surface crystals on aging produced acceptable implants after multiple recrystallizations. Attempts to isolate suspected impurities for characterization were unsuccessful. During the manufacture of the implants, temperatures sufficient to melt the estradiol (mp, 173-179 degrees C) were used. It was expected that, upon implant cooling, melted impure estradiol would form a thermodynamically more active (i.e., noncrystalline) physical form. This metastable form could have migrated to the implant surface, where ambient conditions favored crystallization. Because melted estradiol of a higher purity tended to crystallize more readily, it was less likely to form a glass upon cooling. The phenomenon of surface crystallization was limited to one lot of estradiol with the highest level of impurities. Data from differential scanning calorimetry studies supported this conclusion.

Calorimetry, Differential Scanning↗
PubMed1992

Volume and outcome of organ transplantation.

In general, technically demanding medical procedures are associated with better outcomes when they are carried out in institutions and by physicians with higher volumes of practice. This paper examines the evidence for a volume-outcome relationship in the case of organ transplantation. Although few studies have been done on this subject, existing evidence is consistent with improved outcomes at higher volumes. Therefore, evidence supports policies that regionalize transplantation services.

Health Policy↗
PubMed1992

How much longer must medicine's science be bound by a seventeenth century world view?

The exclusion of nonmaterial human phenomena mandated by medical science's continuing allegiance to a 17th century scientific world view has constituted a major obstacle to medicine's scientific maturation as a human discipline. But 20th century conceptual changes even in physics (not to mention the influence of the theory of evolution) now renders that exclusion untenable and in effect legitimizes efforts to devise scientific means appropriate for the human domain. Practical as well as theoretical issues involved in such an undertaking are discussed within the framework of a 20th century scientific world view as represented by the biopsychosocial model, a counterpart to the traditional biomedical model.

Clinical Competence↗
PubMed1990

On looking inward and being scientific. A tribute to Arthur H. Schmale, MD.

Paradoxically, Schmale's greatest contribution remains hardly known even to his admirers. That has been his challenge to the tradition disallowing introspection and dialogue as scientific instrumentalities. There can be no more appropriate tribute to Schmale at 65 than to call attention to how he has gone about refining everyday observation, introspection, and dialogue for scientific use. In so doing he reestablishes the ancient triad introspection-observation-dialogue as the basic scientific method of clinical study.

History, 20th Century↗
PubMed1985

Cephalothin: hydrolysis of the C-3'-acetoxy moiety of a 7-aminocephalosporanic acid; observation of both acyl-oxygen bond cleavage and reversible alkyl-oxygen bond cleavage.

The aqueous solution chemistry of the C-3'-acetoxy moiety of cephalothin sodium (1b) was examined with the use of isotopically labeled H2(18)O and [2-13C]acetate anion. The 18O incorporation studies indicate that the hydrolysis (at pH 4.7 +/- 0.1) of 1b to the deacetyl derivative of cephalothin (2b) proceeds via two pathways: alkyl-oxygen bond cleavage (55-63%) and acyl-oxygen bond cleavage accounting for the remainder. The incorporation of [2-13C]acetate into 1b suggests that the alkyl-oxygen cleavage pathway is a reversible reaction.

Cephalosporins↗
PubMed1984

Sadness evoked by a film on grief: an experimental study.

"What Happened to Pity?," a BBC documentary on the grief responses to the Aberfan disaster in 1966, powerfully affects viewers and is an effective tool for the study of sadness. Observations in the classroom and in the laboratory demonstrate that the great majority of viewers experienced some degree of sadness along with anger and sympathy. Subjects classified as high loss/grief experienced more intense and extended sadness than did those who had not had significant losses. They also displayed more apprehension, anger, shame-guilt, giving-up, anxiety, and irritation. Subjects experiencing the most sadness, compared with those less affected, were more initiating and talkative and their relationships in the laboratory were closer, more gratifying, task-oriented, therapeutic, and trusting. With the film they displayed more sympathy, role-identification, personalization, and like, but felt more drained. With respect to stable personality features they were warm, sharing, introspective, dependent, and more personally (than monetarily) motivated to volunteer for the study.

Adult↗