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Biomedical subjects

R Neugebauer

Publications and source records attributed to R Neugebauer.

At least 55 records · Page 3Linked to original sources
PubMed1989

Reliability of seizure diaries in adult epileptic patients.

Daily diaries are used widely in neurologic research and clinical practice to assess alterations in seizure frequency among patients with epilepsy. However, no formal tests of the reliability of this data collection method have been performed. We investigated the reliability of seizure recall in adult patients participating in a longitudinal study of stress, mood and seizure frequency. Patients maintained daily diaries for 10-36 weeks. The reliability study entailed completion of a single additional diary on the evening of a randomly selected day with reference to the preceding day. This design produced two diaries, completed 1 day apart, for the same 24-hour period. Measuring reliability with the Pearson correlation coefficient, overall reliability of seizure recall was 0.95 and was not markedly influenced by the subjects' sociodemographic characteristics, neurological or psychological status. In sum, the assumption in the literature that the daily diary is a reliable method for securing data on seizure counts appears warranted.

Adolescent↗
PubMed1989

Diagnosis, guardianship, and residential care of the mentally ill in medieval and early modern England.

Histories of psychiatry concerning preindustrial Europe emphasize demonologic beliefs and physical mistreatment of the insane. Records of an English legal incompetency jurisdiction demonstrate that both government officials and laymen accepted that psychiatric disorders had biological and psychosocial origins. This jurisdiction, which developed a social welfare dimension by the seventeenth century, offered benevolent protection for the insane. Private guardians arranged for the lodging and care of their wards in private homes. While physicians played little role in the certification process, the guardians made frequent use of their skills. Furthermore, some physicians with established reputations in psychiatry accepted patients into their homes for prolonged cures.

England↗
PubMed1987

Exploitation of the insane in the New World. Benoni Buck, the first reported case of mental retardation in the American colonies.

Documenting the early history of mental illness in North America is complicated by the absence of colonial institutions specializing in the care or management of the insane. However, during the first half of the 17th century, a single authority existed in England, the Court of Wards and Liveries (1540-1660), with responsibility for appointing guardians for the mentally disabled. In 1637, Benoni Buck, a man with severe mental retardation, was referred to this court from Jamestown, Va. The ensuing conflict over Benoni's custody exposed a contradiction between the economic and political exigencies of a new order and the social obligation to protect the mentally ill. Benoni Buck is almost certainly the first case of mental disability reported from the English colonies. The case thereby represents a minor landmark in the history of mental illness in America; May 1987 marks the 350th anniversary of the first petition for guardianship.

England↗
PubMed1987

[Stable soft tissue reconstruction using an autochthonous muscle flap transposition and simultaneous bone reconstruction in post-traumatic and osteitis defects of the lower extremity].

Posttraumatic soft tissue and bone defects can pose problems for the surgeon. Autogenous bone from the iliac crest may be used to fill bone defects. To achieve bone healing, a well vascularized recipient site for the graft is important. Local muscle flaps or distant microvascular flaps improve vascularity by introducing a fresh blood supply. Cellular and humoral antibodies are more effective and allow quicker revascularisation of the transplanted graft. 49 soft tissue defects were treated by local muscle flaps. In 14 cases the soleus, in 28 the gastrocnemius, in three the tibialis anterior, in two the abductor hallucis, and in two the gracilis muscle was transposed. 38 cases had posttraumatic osteitis, in eight the defect was merely a soft tissue defect and in three due to tumour excision. In 24 patients a combination of soft tissue repair and cancellous bone grafting was performed. Four flaps failed because of total or partial necrosis. In all cases full weight bearing on the leg with good soft tissue cover was achieved.

Bone Transplantation↗
PubMed1986

[Simultaneous autologous spongioplasty and muscle flap transposition to restore the continuity of the leg with an osteitis defect].

About 12% of compound fractures of the lower leg give rise to posttraumatic osteitis. Loss of bone by sequestration causes many problems particularly if soft tissue quality is poor. Cancellous and corticocancellous bone from the iliac crest is used for bony reconstruction. To obtain bony union, a well vascularised recipient for the graft is essential. Local muscle flaps and distant microvascular flaps and distant microvascular flaps improve vascularity by their separate connection to the vascular system. We treated 54 soft tissue defects by local muscle flaps in 41 and by microvascular flaps in 13 cases. In 21 cases a cancellous or a corticocancellous bone graft was used. Necrosis or partial necrosis of the flap occurred in 12 cases. Skin closure and healing was obtained by secondary procedures. Combined muscle flap and bone grafting was found to allow full weight bearing within reasonable period of time.

Bone Transplantation↗
PubMed1986

Seizures in public places in New York City.

The frequency of police aid to persons experiencing seizures in public in New York City in 1977 was examined as an index of uncontrolled seizure disorders, and as a pointer to variations in seizure frequencies by age, sex, and ethnicity. The overall rate of assistance to persons with public seizures was 5.4 per 10,000 person years. For Blacks the rate was more than double that for Whites and "Hispanics" (10, 4.7, and 4 per 10,000 person years, respectively). Males were assisted about 2.5 times more often than females (8.2 vs 3.3 per 10,000 person years). Among Black males, young adults and those of late middle age had the most pronounced excess over White males of the same ages (26.1 and 23.1 vs 7.8 and 4.0, respectively, per 10,000 person years). These variations underscore an unmet need for medical care for seizures that is especially marked in particular ethnic, sex, and age groups.

Adolescent↗
PubMed1986

[Early measurement of intracranial pressure in polytrauma with associated craniocerebral trauma. II: Clinical and therapeutic aspects].

During the time from 1982/83 the intracranial pressure was continuously measured from patients who were polytraumatized and also had severe head injuries. In 53% of these cases the first readings could be obtained within 6 hours after the injury and in 33% first after 12 hours. During the time of evaluation this relationship shifted to earlier implantation. From 27% of these patients the intracranial pressure values fell into a range that instigated immediate therapeutical measures. This proves how important it is to have a direct reading from the intracranial pressure as soon as possible after injury. The aspects of therapy by increased intracranial pressure were discussed.

Accidents, Traffic↗
PubMed1985

[Cruciate ligament replacement--current status. Carbon fiber implants].

The substitution of cruciate ligaments with carbon fibre implants is a treatment method for chronic ligament instabilities which is sufficiently reliable and can be easily standardized. The good bio-compatibility of the material is sufficiently demonstrated, its biomechanical properties - above all the tensile strength - are excellent. The poor resistance to shearing forces of the carbon fibre implants has to be considered as a limiting factor. The risk of a rupture of the implant can be considerably reduced by coating the prospective intra-articular ligament section and by smoothing off the borehole edges. A check-up investigation of 96 out of 112 operated patients showed good or satisfactory results in 3/4 of the examined patients.

Adolescent↗
PubMed1985

[Early measurement of intracranial pressure in polytrauma with associated craniocerebral trauma. I: Principles].

In West Germany, head injury is the major cause both of death following trauma and of irreversible cerebral damage. The successful management of these cases largely depends on the prevention and treatment of secondary rises in intracranial pressure. The only certain way of detecting such increases is with the invasive technique of intracranial pressure monitoring. The pressure module should be implanted as soon as possible, ideally, before extensive definitive surgical treatment is carried out. Ease of usage has led us to prefer epidural pressure monitoring systems. Being relatively easy to learn and apply, this form of monitoring should be used in all hospitals involved in the treatment of severe head injury.

Brain Edema↗
PubMed1985

Carbon fiber replacement of the ligaments of the shoulder girdle and the treatment of lateral instability of the ankle joint.

A normal active human being will not accept chronic instability or persistent luxation of any joint. Many attempts have been made to stabilize a damaged joint with autogeneic and allogeneic materials and by various surgical techniques. In animal and clinical trials, carbon fibers are reported to be a promising material for ligament replacement in chronic joint instability. The authors are investigating carbon fibers not only for repair of chronic instability of knee joints but also for chronic luxations and subluxations of the sternoclavicular, acromioclavicular, and ankle joints. For long-term stability of the new ligament, carbon fibers must be implanted in cancellous bone channels. Ingrowth of connective tissue and newly formed bone produces a secure ligament anchorage. A temporary tension band wire loop immobilizes the sternoclavicular or acromioclavicular joint. The ankle ligament replacements are immobilized with a weight-bearing plaster boot for six weeks postoperation. The use of carbon fibers as a ligament replacement in the sternoclavicular, acromioclavicular, and ankle joints produces favorable functions and stability. Reconstruction of the normal ligament insertions of a joint is essential, particularly with respect to supination and free range of movement. Of 56 cases with lateral chronic instability of the ankle, 51 with a mean average postoperative follow-up period of two years, 49 had subjectively good results. Stable joints were demonstrable in 48 cases; supination was limited in four cases.

Acromioclavicular Joint↗
PubMed1985

Carbon fiber ligament replacement in chronic knee instability.

Procedures currently acknowledged or still accepted and performed in the operative treatment of chronic instability of the knee include autogeneic, allogeneic, and xenogeneic grafts or alloplastic materials such as carbon fibers. After years of experimental studies of the carbon material itself and its behavior in animals, the following facts have been established. Carbon fibers possess a good biocompatibility, have favorable elasticity (by use of a band with a braid angle of 43 degrees), and permit the ingrowth of collagenous fibers between the carbon fibers of the prosthesis. With carbon fibers, an anatomic reconstruction of the injured ligament is possible. These fibers must be incorporated in bone to provide a long-lasting anchorage. For fixation, the band is pulled through bone channels or put under a trap door at the site of the original ligament insertion. Since ruptures have occurred when pure carbon strands were used intra-articularly, a coat of resorbable collagen has been applied. In addition, the intra-articular segment of the band is enveloped in a sheet of dura or fascia lata, thus providing stability against shear stresses. Of 64 patients followed up over 13.6 months on average, 60 were satisfied: 28 had stable knees; 30 had minor instability; and six were unstable. The range of movement was equal to the unaffected side in 37, slightly decreased in 23, and much reduced in four cases.

Carbon↗
PubMed1985

In vivo and in vitro investigation of the long-term behavior and fatigue strength of carbon fiber ligament replacement.

The long-term behavior of carbon fiber ligament replacements was evaluated in sheep. In vitro assessments of both isolated carbon fiber prostheses and resected animal ligaments were performed. The right knee in 45 sheep was reconstructed. In 30 animals, only the medical collateral ligaments were replaced, but with different systems of anchorage to bone. In 15 animals, a combined replacement of medial collateral ligament and anterior cruciate ligament was performed. In the first group the animals were sacrificed three months postoperation, while in the latter group evaluation was performed one year after surgery. After one year the strength of the medial collateral ligament complex was higher than that of the normal sheep ligaments. The elasticity and extensibility were similar to those of the normal ligaments. No case of partial rupture or rupture of the medial collateral ligament replacements was seen, but four of 12 anterior cruciate replacements showed signs of partial rupture. In vitro testing showed that rupture is more likely to occur where movement occurs around a small radius of bending, and this may be a factor in these cases where the anterior cruciate ligament enters a bony tunnel at an acute angle. Histologic assessment showed good biocompatibility, similar to that reported by other authors. With an operative technique designed to increase the radius of bending where the carbon fiber enters bone, these ligament replacements have a fatigue strength and elasticity adequate for long-term survival.

Animals↗
PubMed1984

Application of a capture-recapture method (the Bernoulli census) to historical epidemiology.

Obstacles to historical epidemiologic research are formidable, especially for periods prior to the 19th century. Linguistic and paleographic difficulties are compounded by haphazard contemporary documentation and subsequent archival wastage, making real variations in disease frequency difficult to distinguish from record loss. This report investigates the application of a capture-recapture model, adapted from work on mobile animal populations, to this problem or archival loss. With the use of this technique, the original size of a psychiatric case population is estimated from incomplete extant enumerations. The cases are derived fron the Court of Wards and Liveries (1540-1660), the first statutory institution in England responsible for protecting persons legally incompetent due to mental disability. Documentation on this population survives in at least 10 record collections, the most extensive containing at best 82% of all original cases, the least extensive, 1%. Calculations based on extant files indicate a fourfold increase in the incidence of mental disability certifications between 1540-1549 and 1630-1639. The results of applying the Bernoulli census method to these materials eliminate biased archival loss as a plausible explanation for this rise. The origin of these changes in altered court policy or procedure, population growth, or increasing rates of mental disability awaits further investigation. While the Bernoulli census computations with historical data are mathematically equivalent ot those employed in recent epidemiologic applications, this specific data set prompts a conceptual revision of the Bernoulli model from capture to loss of random samples.

Animals↗
PubMed1983

Reliability of life-event interviews with outpatient schizophrenics.

Reliability of life-event reports was examined in 18 outpatient schizophrenics, using a 102-item structured checklist. Patients and one close relative were interviewed regarding events during the 12 preceding months. Interviewers were randomly assigned to patients, pair members were seen by different individuals. Mean intrapair agreement for all events combined was .22. Objective items exhibited greater reliability than subjective ones, but item ambiguity, event recency, and stressfulness did not appear to influence agreement. Pairs evidenced low concordance on event dates. A greater number of events were recalled for the more recent six months than for the earlier period, and a pronounced interviewer effect on the number of reported events emerged. These findings, together with those from other reliability investigations, cast doubt on the validity of some retrospective studies of the relationship of life events to illness onset.

Adolescent↗
PubMed1983

The influence of various carbon fibre braiding techniques and methods of fixation on the extensibility of ligament prostheses.

An alloplastic ligament prosthesis with carbon fibres should not only be biocompatible but should also restore the biomechanical function of a natural system, which includes restoring its elasticity. Tests with new types of braided carbon fibre strands showed their elastic extensibility to increase with increasing number of filament tows and increasing braid angle. The best results were obtained with 32 tows and a 43 degrees braid angle. This strand type was tested in vitro as a medial collateral ligament prosthesis with two methods of fixation in human knees and, in like manner, in vivo in sheep knees. Biomechanical tests in vitro using human cadaver knees and sheep knees after 12 weeks' implantation showed an elasticity similar to that of normal natural ligaments.

Animals↗