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He retired from died suddenly of eclampsia during her second the health service in October 1974 order super levitra 80 mg on-line erectile dysfunction drugs medicare, because pregnancy generic 80 mg super levitra otc yellow 5 impotence, leaving him alone with an infant son. His work there caught the eye of James Douglas, a philanthropist, and led to the establishment, in 1913, of the Memorial Hospital for the Study of Cancer and Allied Diseases. Douglas was espe- cially interested in radium and the benefits of radium therapy, and Ewing quickly became an enthusiast for radiation treatment of malignant diseases. As the pathologist of the hospital, he accumulated the great experience that formed the foundation of his book, Neoplastic Diseases,3 published in 1919. It was in 1920 that he first described the bone tumor with which he is iden- tified. As the director of Memorial Hospital, Ewing had great influence, and his strong support for the James EWING use of radiation therapy, rather than operations, 1866–1943 for the control of cancer affected the development of the surgical treatment of these lesions. He 2 James Ewing was born in Pittsburgh on Christ- maintained his position until a few years before mas Day in 1866. When he was 14 years old, his his death in 1943 and is remembered as one of education was interrupted by osteomyelitis of the the leaders in the fight against cancer during the femur, for which he was confined to bed for 2 first half of this century. At home he had a tutor and in addition he entertained himself by entering contests. In one, for which he provided the longest list of References words composed with the letters of the word Constantinople, he was successful. Codman EA (1925) Bone Sarcoma: An Interpreta- a microscope, the tool on which his later career tion of the Nomenclature Used by the Committee on was to be based. In 1884, Ewing entered Amherst the Registry of Bone Sarcomas of the American College of Surgeons. Int J Radiat draining sinus, he participated fully in all of the Oncol Biol Phys 2:185 student activities. Proc After his graduation from medical school in NY Pathol Soc 21:17 1891, Ewing interned in Pittsburgh and New York, showing particular interest in clinical and microscopic pathology. In 1899, at the age of 33, he was appointed the first professor of pathology at Cornell University. He was Robert Jones Lec- turer in the Royal College of Surgeons of England in 1938, but even more was he inspired by the Lady Jones Lectureship in Liverpool in 1929. It is through the allegiance of Fairbank to Liverpool and to Robert Jones that I first met him. Then I did not know that he was one of a family of five whose father, a medical practitioner in Windsor, had died when he was young; that he was an Epsom boy who had qualified in the Charing Cross Hospital Medical School; had foregone his earlier destiny to dental surgery; had been a civil surgeon in the Boer War, meeting Lord Roberts, Lord Kitchener, Rudyard Kipling and Conan Doyle; in the First World War had Harold Arthur Thomas driven mules and ambulances in Salonika—or was it Greece or Macedonia—I did not know. I FAIRBANK knew only that he was the great leader of ortho- 1876–1961 pedic surgery in London, consultant to King’s College Hospital where he had established the Sir Thomas Fairbank will be remembered as a first fracture clinic in London, and to the Great leader of surgery in Great Britain who shared with Ormond Street Hospital for Children and the Lord Sir Robert Jones, his senior colleague and friend, Mayor Treloar Orthopaedic Hospital at Alton. He will be remembered also as examining me as one of the first three candidates. Tom, or more affectionately as Uncle Tom, who Could I ever forget his grumpy kindness when, again shared with Robert Jones the sterling qual- having asked me to do a Stöffels bilateral obtura- ities of integrity, sincerity and modesty, with tor neurectomy by the abdominal approach, he courteous thoughtfulness for juniors such that assisted me with a retractor in one hand and a they became inspired as disciples. Thus each of lighted match within the stiff cadaveric abdomi- these leaders achieved the immortality of which nal walls with the other? In later years, when he had the heavy surviving influence of our founders with only two responsibility of directing the orthopedic organi- others, Rocyn Jones and Harry Platt. He was vice zation of the Emergency Medical Services of president to Robert Jones throughout the 5 years Great Britain in the Second World War, and I had of that memorable leadership; then president him- to compete gently for another orthopedic service self in 1926–1927; and thereafter Emeritus Fel- in the Royal Air Force, could there ever have been low, the first so to be honored. In founder member of the International Society of days of peace did he not hold the greatest second- Orthopedic and Traumatic Surgery, and later vice opinion private practice ever known by reason not president in Bologna and Rome. And, as ident of the orthopedic section of the British if we were not already bound as disciples, could Medical Association at its centenary meeting in he have given more stimulus to those of us who 102 Who’s Who in Orthopedics were young in creating the British volume of The from the French Government. Six months of this Journal of Bone and Joint Surgery than his series time was spent in Baltimore on the service of Pro- of contributions on disorders of bone growth? This had been a life study and a life collection, After his return to Toulouse in 1948, Ficat over which he chuckled happily for so many years turned his attention to orthopedics, becoming the after his deafness commanded retirement from equivalent of associate professor in 1958, profes- active practice, which was then published as a sor in 1962, and professor and chairman in 1970. Paul Ficat made again and, just as he learned it from Arbuthnot this his life’s work, resolving clinical problems Lane, we will again learn it from him because, through critical intraoperative observations, never sooner or later, we will know that the basic pro- missing an opportunity to make a measurement or tection of surgical cutting can never be antibiosis take a biopsy specimen for later evaluation. His operative tech- siologists, anatomists, and histologists were fre- nique was superb, and only the angry young men quent “accessories” to the operating room team. The quality of his work has been recognized by his peers and by the awards that he received, including the Chevalier de l’Ordre Nationale du Merite in 1972 and the Prix Bouchard of the National Academy of Science in 1978.

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Ryerson in his later life through his attendance at local meetings order 80 mg super levitra fast delivery weak erectile dysfunction treatment, including those of the Chicago Committee on Trauma generic 80mg super levitra with amex erectile dysfunction due diabetes, where his discussions of papers were always to the point. He was meticulous in his choice of words and insisted that others be equally meticulous. Luke’s Hospital, his operating room was always open to the younger men, and he would take time to explain the operative procedure. Although his Amulya Kumar SAHA primary interest was orthopedics, he would often observe other types of surgery being done. Fre- 1913– quently he came into my operating room to observe the procedure and give helpful sugges- Amulya Kumar Saha was born in 1913 in Pabna tions. Unbeknown to him, he was frequently in undivided India (now in Bangladesh). After referred to by the younger men as Uncle Ned, graduating with degrees in both science and medi- which indeed was a term of endearment. Ryerson belonged to several clubs in a surgical specialist and quickly rose to the rank Chicago and was an ardent and enthusiastic of major. In his later years his interest changed United Kingdom for additional training and study from golf to daily visits to the docks, seeing the in surgery. He received the titles of FRCS (Eng), many ships in port and conversing with their FRCS (Edin), and MChOrth (L’Pool) in 1948. Basu at the Indian Academy of Orthopedic Surgeons in January Museum in 1940. He delivered his first disserta- 1961, a lapel pin was given to each of the past tion to the Liverpool orthopedic group in 1948. It was my privilege Thereafter, the shoulder was one of his abiding and pleasure after this meeting to present this pin interests. On his return to India, Saha was first appointed Although he had some difficulty walking at that to the post of reader in surgery in Gwalior time, the spark in his eyes and kindly smile were Medical College. Subsequently, he joined the 294 Who’s Who in Orthopedics Nilratan Sircar Medical College and the Univer- ble. He was of the opinion that the Bankart lesion sity of Calcutta as associate professor of surgery, possibly was not the cause of recurrent anterior where he served from 1949 to 1955. From 1955 dislocation and occurred from lack of the stabi- to 1963, he served as professor director in the lizing factors and superimposed trauma. In other Department of Surgery at the same institution words, some shoulder joints are more prone than and eventually became an honorary consultant others to undergo spontaneous dislocation, with orthopedic surgeon, a position he held from 1964 or without minimal stress. In 1972, he was made emeritus profes- siderations, he evolved his operations: (1) glenoid sor of orthopedic surgery. During Professor neck osteotomy to increase the retrotilt of the Saha’s time, orthopedic surgery was just becom- glenoid (modified Meyer Burgdorff), when it was ing recognized as a specialty in India. Through demonstrated radiologically that the glenoid the force of circumstances, he was appointed to a retrotilt was diminished or there was actual post in general surgery, although he was pri- antetilt; (2) decreasing the retrotorsion of the marily interested in orthopedics. In fact, he was humeral head by rotation osteotomy of the upper largely instrumental in popularizing orthopedics shaft of the humerus, when there was excessive in Calcutta and training a number of younger retrotorsion demonstrable by special radiograms; surgeons in this field. They have maintained his (3) augmenting the power of the horizontal steer- high standards at Nilratan Sircar Medical College ers by transferring the tendon of the latissimus Hospital in Calcutta. Professor Saha’s major contribution to ortho- He published several monographs, one of which pedic research and clinical orthopedic practice is was translated into German in 1978. While at Nilratan For the post-poliomyelitis paralyzed and flail Sircar Medical College, he conducted extensive shoulder, Professor Saha developed his tech- studies on the functional anatomy of the shoulder niques of multiple muscle transfers based on his joint from anatomic, anthropologic, morphologic, concept of dynamic stability of the shoulder; this radiologic, and electromyographic, as well as work was described in a supplement to Acta mathematic, points of views. This concept studies, he published his work on the zero posi- and its application have been included in many tion of the glenohumeral joint in 1950. In 1957, books on the shoulder, including Campbell’s he was invited by the Royal College of Surgeons Operative Orthopedics. He was convinced that dynamic stability was Professor Saha was also interested in partial essential during various stages of elevation of the and total shoulder arthroplasty and was working shoulder joint with versatile ranges of move- in this field at the time of his retirement. He postulated that there are three main designed a removable metal prosthesis based on factors that maintain the dynamic stability of the his concept of dynamic stability of the shoulder, fully developed shoulder joint: (1) normal retrotilt which uses available muscles to provide motor of glenoid articular surface in relation to the axis power to the shoulder. Lately, this prosthesis has of the scapula; (2) the optimum retrotorsion of the been modified by one of his colleagues to include humeral head in relation to the shaft; (3) balanced a high-density polyethylene cover. Based on these In addition to the subjects already mentioned, principles, he evolved his operations for treatment Professor Saha was interested in various other of recurrent dislocation of the shoulder joint, aspects of orthopedics and was first and foremost which he considered to be primarily due to lack an excellent clinician and versatile surgeon.

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This started when I moved to Manhattan buy super levitra 80mg without prescription erectile dysfunction blogs forums, but I don’t think this is related discount 80 mg super levitra impotence causes. This doesn’t seem relevant, but I am recording everything without judgment. I am better when I am immobile, but I am losing my endurance and gaining weight so Are Your Ways of Staying Healthy Making You Sick? Exercising makes me worse, especially doing my weights after the treadmill. Physical therapy and my anti-inflammatory medications help, but the problem never really goes away. Step Four: Do a Family Medical History and Determine If You Have or Had Any Blood Relatives with a Similar Problem. Step Five: Search for Other Past or Present Mental or Physical Problems. I was treated for depression and anxiety after my father died of a heart attack when I was nineteen, but I was okay after about six months. I had a knee operation from a college football injury, but I recovered fully. Step Six: Categorize Your Current and Prior Significant Medical Problems by Etiology. Step Eight: Take Your Notebook to Your Physician and Get a Complete Physical Exam. Leonard returned to his physician with his Eight Step note- 160 Diagnosing Your Mystery Malady book in hand. And a single factor he kept repeating became the main clue and basis, not for his diagnosis, which was fairly clear, but for the cause of his condition. Making the Diagnosis Leonard’s notebook accurately described a fairly typical case of “frozen shoulder,” sometimes known as adhesive capsulitis, which is characterized by stiffness, limited range of motion and pain. The ligaments and tissue around the shoulder capsule or joint become inflamed and stiff. Usually this occurs after surgery or a fracture of the arm when the limb is immobilized. Leonard’s history didn’t seem to have any of the things that normally cause frozen shoulder. But his notebook repeatedly made mention of this problem occurring after he moved from the suburbs to Manhattan. He even joked about possibly being “allergic” to the city as a cause of his problem. Rosenbaum asked him to return to his journal, act like a medical detec- tive, and specifically list what in his life had changed since he moved to the city, using what he now knew about the causes of frozen shoulder—surgery, immobilization, or a physical trauma or injury. Leonard realized that the change from suburb to city was mainly in the form of exercise. Rosenbaum that both shoulders were being affected so Leonard had to be doing something with both arms. He asked Leonard to do an experiment using the treadmill: to run and describe exactly what he did with both arms while he ran. He reminded Leonard not to make any assumptions and to keep an open mind. Leonard did what he was told and immediately realized he was lean- ing both his arms on the support bars of the treadmill while running. By using his shoulders to support his weight, Leonard was probably causing progressive microtrauma to both shoulder joints. As the pain from the trauma intensified, Leonard began guarding against the pain by not using them. First he was immobilizing them as he Are Your Ways of Staying Healthy Making You Sick? Then he was immobilizing them further by refusing to use them because of the pain, giving himself a double whammy. Conclusion Attempting to stay healthy through diet and exercise is certainly recom- mended.

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Some of these responses are present during infancy but disappear during child- hood generic super levitra 80 mg with visa erectile dysfunction caused by vicodin, hence the terms “primitive reflexes” or “developmental signs” are also used (Babinski’s sign may therefore fall into this category) cheap super levitra 80mg amex facts on erectile dysfunction. The term “psychomotor signs” has also been used since there is often accompanying change in mental status. The frontal release signs may be categorized as: ● Prehensile: Sucking reflex (tactile, visual) Grasp reflex: hand, foot Rooting reflex (turning of the head toward a tactile stimulus on the face) ● Nociceptive: Snout reflex Pout reflex Glabellar (blink) reflex Palmomental reflex The corneomandibular and nuchocephalic reflexes may also be cate- gorized as “frontal release” signs. Some are of little clinical value - 130 - Functional Weakness and Sensory Disturbance F (e. Concurrent clinical findings may include dementia, gait disorder (frontal gait, marche à petit pas), urinary incontinence, akinetic mutism and gegenhalten. Common causes of these findings are diffuse cerebrovascular dis- ease and motor neurone disease. London: Edward Arnold, 1993: 144-174 Cross References Age-related signs; Babinski’s sign (1); Corneomandibular reflex; Gegenhalten; Grasp reflex; Marche à petit pas; Palmomental reflex; Pout reflex; Rooting reflex; Sucking reflex Fugue Fugue, and fugue-like state, are used to refer to a syndrome characterized by loss of personal memory (hence the alternative name of “twilight state”), automatic and sometimes repetitive behaviors, and wandering or driving away from normal surroundings. Fugue may be: Psychogenic: associated with depression (sometimes with suicide); alcoholism, amnesia; “hysteria”; Epileptic: complex partial seizures Narcoleptic Some patients with frontotemporal dementia may spend the day walking long distances, and may be found a long way from home, unable to give an account of themselves, and aggressive if challenged; generally they are able to find their way home (spared topographical memory) despite their other cognitive deficits. Cross References Amnesia; Automatism; Dementia; Poriomania; Seizures Functional Weakness and Sensory Disturbance Various signs have been deemed useful indicators of functional or “nonorganic” neurological illness, including: Collapsing or “give way” weakness Hoover’s sign Babinski’s trunk-thigh test “Arm drop” Belle indifférence Sternocleidomastoid sign Midline splitting sensory loss Functional postures, gaits: Monoplegic “dragging” Fluctuation of impairment Excessive slowness, hesitation “Psychogenic Romberg” sign “Walking on ice” - 131 - F Funnel Vision Uneconomic posture, waste of muscle energy Sudden knee buckling Although such signs may be suggestive, their diagnostic utility has never been formally investigated in prospective studies, and many, if not all, have been reported with “organic” illness. How to identify psychogenic disorders of stance and gait: a video study in 37 patients. Journal of Neurology, Neurosurgery and Psychiatry 2002; 73: 241-245 Cross References “Arm drop”; Babinski’s trunk-thigh test; Belle indifférence; Collapsing weakness; Hoover’s sign; Sternocleidomastoid test Funnel Vision - see “TUNNEL VISION” - 132 - G Gag Reflex The gag reflex is elicited by touching the posterior pharyngeal wall, ton- sillar area, or the base of the tongue, with the tip of a thin wooden (“orange”) stick. Depressing the tongue with a wooden spatula, and the use of a torch for illumination of the posterior pharynx, may be required to get a good view. There is a palatal response (palatal reflex), consisting of upward movement of the soft palate with ipsilateral devi- ation of the uvula; and a pharyngeal response (pharyngeal reflex or gag reflex) consisting of visible contraction of the pharyngeal wall. Lesser responses include medial movement, tensing, or corrugation of the pharyngeal wall. In addition there may be head withdrawal, eye water- ing, coughing, and retching. Some studies claim the reflex is absent in many normal individuals, especially with increasing age, without evident functional impairment; whereas others find it in all healthy individuals, although variable stimulus intensity is required to elicit it. The afferent limb of the reflex arc is the glossopharyngeal (IX) nerve, the efferent limb in the glossopharyngeal and vagus (X) nerves. Hence individual or combined lesions of the glossopharyngeal and vagus nerves depress the gag reflex, as in neurogenic bulbar palsy. Dysphagia is common after a stroke, and the gag reflex is often performed to assess the integrity of swallowing. Some argue that absence of the reflex does not predict aspiration and is of little diagnos- tic value, since this may be a normal finding in elderly individuals, whereas pharyngeal sensation (feeling the stimulus at the back of the pharynx) is rarely absent in normals and is a better predictor of the absence of aspiration. Others find that even a brisk pharyngeal response in motor neurone disease may be associated with impaired swallowing. A video swallow may be a better technique to assess the integrity of swallowing. Journal of Neurology, Neurosurgery and Psychiatry 1996; 61: 96-98 Cross References Bulbar palsy; Dysphagia Gait Apraxia Gait apraxia is a name given to an inability to walk despite intact motor systems and sensorium. Patients with gait apraxia are often - 133 - G Ganglionopathy hesitant, seemingly unable to lift their feet from the floor (“magnetic gait”) or put one foot in front of the other. Arms may be held out at the sides to balance for fear of falling; fear may be so great that the patient sits in a chair gripping its sides. These phenomena may be observed with lesions of the frontal lobe and white matter connections, with or without basal ganglia involvement, for example in diffuse cere- brovascular disease and normal pressure hydrocephalus. A syndrome of isolated gait apraxia has been described with focal degeneration of the medial frontal lobes. In modern classifications of gait disorders, gait apraxia is subsumed into the categories of frontal gait disorder, frontal disequilibrium, and isolated gait ignition failure. Gait apraxia is an important diagnosis to establish since those afflicted generally respond poorly, if at all, to physiotherapy; moreover, because both patient and therapist often become frustrated because of lack of progress, this form of treatment is often best avoided.

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