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Biomedical subjects

K Engel

Publications and source records attributed to K Engel.

At least 37 records · Page 2Linked to original sources
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↗
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↗