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They provided a greater surface Royal Infirmary and saw the effect of the appli- than the massive graft generic liv 52 100 ml visa treatment kidney stones, each forming a center of cation of antiseptic principles in the treatment of ossification that threw out osteoblasts from its compound fractures purchase liv 52 120 ml line medicine 2016, the impressive lowered mor- whole periphery cheap liv 52 100 ml overnight delivery conventional medicine. Herein he displays a remarkable tality and the hastened healing of wounds. From insight, for this seems to provide an explanation that time onwards he became an ardent supporter of the quickened osteogenetic power of small of Lister, employing in his practice antiseptic medullary bone grafts, which have found such lotions and the carbolic spray for several years. But by the middle 1880s he was already using 211 Who’s Who in Orthopedics instruments forged from a single piece of steel Surgeon-General in Scotland, serving in the Navy and was boiling his gauze. In addi- installed in the hospital a steam sterilizer for tion to the onerous duties of this post, he threw dressings after the Schimmelbusch pattern; was himself with great energy into organizing the boiling his instruments in a fish kettle, wearing a Princess Louise Hospital for Limbless Soldiers gown and had discarded the spray. He adopted an and Sailors at Erskine, the counterpart in Scotland aseptic technique. In 1922 he was elected President great deal with catgut and at last succeeded in of the British Medical Association on its visit to making a completely reliable and absorbable Glasgow in that year. In 1923 he was elected Pres- suture material, which he continued to make to ident of the International Society of Surgeons and the end of his life. In 1879 he when he went out to the Australasian Medical operated upon a patient for the relief of subdural Congress at Melbourne. He received the honor of hemorrhage with hemiplegia and the same year Knighthood in 1902, was made a Companion of removed a brain tumor in a girl 14 years of age. He died of pneu- advance was his recognition that middle-ear monia on March 22, 1924. Mary Watson, daughter of Hugh Allan of This induced him to design and perfect an opera- Crosshill, Glasgow, and had three sons and three tion for mastoid disease. This work was personality was forceful; he was possessed of acclaimed all over the world and became a immense energy and driving power, prosecuting classic. The same year he published another work, his work as a scientific surgeon with consuming Atlas on Head Sections, in the fine production of zeal. His individualism and temperament pre- which he spared neither labor nor expense. He was tall, had experience in dealing with penetrating wounds of a commanding figure and was gifted with a clear, the thorax before he attempted a direct attack on resonant voice, all of which enabled him to hold the lungs. In 1895 he was asked to see a patient and often sway any audience he addressed. He who was desperately ill, emaciated and toxic from was born at a fortunate hour and took full advan- extensive active tuberculous disease of the left tage of the opportunities that were presented, lung with secondary pyogenic infection and turning all his talents to such development of abscess formation. The man recov- Macewen’s contributions were so varied and of ered his health completely and afterwards was such a quality that he must be regarded as one of actively engaged in earning his livelihood for the greatest surgeons of all time. In 1892 Macewen became Regius Professor of Surgery at Glasgow University, a post that entailed a good deal of teaching and transference of his surgical work to the Western Infirmary. He was also elected an Honorary Fellow of the Royal Colleges of Surgeons of England and of Ireland; several universities conferred honorary degrees upon him, and he received recognition from leading surgical societies abroad. Soon after the outbreak of war in 1914, he was commissioned as 212 Who’s Who in Orthopedics famous contributions are probably his studies on the pathogenesis of low-back pain, which led to a greater understanding of what many had pre- viously diagnosed as lumbago. He also had expertise in the areas of hallux rigidus, patellar dislocation, opponens transfer, whiplash injuries, pathological changes in the neurocentral joints of the cervical spine, lesions of the menisci, anterior tibial compartment syndrome, the effect on osteo- genesis of alternating currents in bone, blood supply of the vertebral bodies and the femoral head, the reaction of body tissues to ceramics, the microcirculation of the rotator cuff, and shoulder arthroplasty. He was awarded the Hunterian Lectureship of the Royal College of Surgeons of England for his studies on the rotator cuff. To North Ian MACNAB Americans, his knowledge and expertise, com- bined with his command of the English language 1921–1992 and his Churchillian oratory, made him one of the most sought-after orthopedic lecturers and visit- Ian Macnab was the son of a Scottish shipbuilder ing professors. When Ian was 5 years was exemplified in his classic Presidential old, his parents sent him home to Britain to Address, entitled “Seek and Ye Shall Find,” to the receive an education in an English boarding Canadian Orthopedic Association in 1977, in school. He attended medical school at the Uni- which he stated: “You do not have to be a trained versity of Birmingham, graduating with first-class investigator to discover. After a residency in general and orthope- serve your sense of wonder, your ability to be dic surgery, he served in the Royal Army Medical astonished and you must be sure that your brain Corps, from 1945 to 1947.

Close observation for complications discount liv 52 100 ml without a prescription symptoms juvenile rheumatoid arthritis, like cataracts order 120 ml liv 52 with visa treatment 31st october, chole- cystitis buy discount liv 52 on line symptoms kennel cough, cardiac conduction abnormalities, and endocrine dysfunction is integral to providing good care. These complications can be mitigated with appropriate surgical procedures, hormone replacement, and occasionally pacemaker placement. Encoura- ging responses to certain medical treatments in DM1 have occurred. For example, mexiletine and tocainide show promise in lessening myotonia. Modafinil has reduced hypersomnolence, Coenzyme Q10 may ameliorate cardiac dysfunction. Troglitazone and possibly the currently available thiozolidine diones can reduce the insulin resis- tance, and dehydroepiandosterone (DHEA) may be useful for cognitive problems and for myotonia relief. Controlled, randomized studies are necessary to evaluate these new potential treatments. LIMB–GIRDLE MUSCULAR DYSTROPHIES At the moment there are 10 autosomal recessive forms and 5 autosomal dominant forms of LGMD. Because of their pattern of weakness, the LGMDs are often con- fused with Duchenne dystrophy. However, most forms of LGMD are more slowly progressive than Duchenne dystrophy and have fewer complications. It is important to avoid making a prognosis for survi- val, the development of complications, or for the rate of progression for different types of LGMD based upon the natural history of Duchenne dystrophy. It is also important not to assume that corticosteroid therapy will be effective in the different forms of LGMD. For all of the LGMDs care relies on early orthopedic, respiratory, and physical conditioning measures. Cardiomyopathies and conduction defects are particularly prevalent in some forms of LGMD, for example, two autosomal recessive forms of LGMD, alpha and gamma sarcoglycanopathies, and two dominant forms, LGMD1B and LGMD1D. Specific therapy to reverse muscle wasting and weakness is not currently available. DNA diagnosis is possible by detec- tion of a reduced number of repeats of a large repetitive sequence at the end of chro- mosome 4, yet curiously the causal gene has not yet been identified. The infant-onset congenital muscular dystrophies are rare disorders and are not usually confused with Duchenne dystrophy, LGMD, Becker dystrophy, or FSHD. For more detailed discussion, the reader should refer to the recent reviews. Emery–Dreifuss muscular dystrophy (EDMD) is a rare x-linked and more rarely an autosomal recessive or dominantly inherited disorder. The EDMD is clini- cally and genetically distinct from x-lined Duchenne and Becker muscular dystro- phies. The EDMD can result from mutations either in emerin (x-linked form) or in A-type lamin (autosomal dominant form). It can have severe cardiac complications that require urgent treatment, typically pacemaker implantation. Cardiac symptoms may prompt medical evaluation in EDMD before complaints about muscle weak- ness or contractures. Neuromuscular Disorders of Infancy, Childhood, and Adolescence— A Clinicians Approach. Pulmonary manifestations of neuromuscular disease with special reference to Duchenne muscular dystrophy and spinal muscular atrophy. Spinal stabilization in Duchenne muscular dystrophy: principles of treatment and record of 31 operative treated cases. Corticosteroid and anabolic hormone treatment of Duchenne muscular dystro- phy. The Molecular and Genetic Basis of Neurologic and Psychia- tric Disease. Lefton-Greif Johns Hopkins University School of Medicine, Baltimore, Maryland, U. INTRODUCTION Dysphagia (swallowing difficulty) in the pediatric population is generally one component of a broad continuum of complex medical, health, and developmental problems and is common in infants and children with histories of prematurity, genetic syndromes, and neurologic disorders.

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The fire service in Seattle is highly coordinated and a standard fire appliance can reach any part of the city within four minutes buy liv 52 120 ml low cost treatment 4 ringworm. CPR was generic 60 ml liv 52 with amex symptoms 14 days after iui, therefore buy generic liv 52 on line symptoms 2 days before period, already in progress when more highly trained ambulance paramedics arrived some minutes later. Two factors were found to be crucial determinants of survival from cardiac arrest. The first was the presence of bystanders able to perform basic life support. To reduce this time interval further, the firefighters in Seattle were equipped with defibrillators, a process facilitated by the development of the semi-automatic advisory models that require less training to use. Vickery, the chief of the fire service in Seattle, made the important suggestion that CPR by members of the public should be the first stage in the provision of coronary care outside hospital. Together with Cobb, he inaugurated training in resuscitation techniques for the public to further increase the practice of CPR. The widespread provision of bystander CPR in the community, coupled with the provision of prompt defibrillation, has resulted in survival rates of up to 40% being reported from that area of the United States. In the United Kingdom, progress in community resuscitation was slower to gain momentum, but progress has been rapid in recent years. Scotland became the first country in the world to equip every emergency ambulance with a defibrillator. These are now standard equipment throughout the United Kingdom, with survival rates of up to 50% reported when cardiac arrest is witnessed by an ambulance crew. Initiatives to train the public in CPR techniques have proved popular and have made an important contribution to improved survival rates. More recently, resuscitation in the community has made a crucial advance with the introduction of “public access defibrillation”—a concept intended to further reduce the delay in defibrillation by placing defibrillators in busy public places for use by trained lay people before the arrival of the ambulance service. The rhythm recognition algorithms in modern automated defibrillators have proved sufficiently accurate and the machines are simple to operate by suitably trained lay people. Some public access defibrillation programmes have reported impressive results and England now has the first national public access defibrillation programme in the world. The British Heart Foundation has been instrumental in supplying defibrillators for use by the public, and although public access defibrillation is in its early stages in the United Kingdom, several people who have collapsed at railway stations or airports have been resuscitated by lay people before the arrival of the emergency medical services. Major efforts have been made to improve hospital resuscitation in the United Kingdom. Increasingly, proficiency in resuscitation skills is expected at postgraduate examinations and has been become a pre-requisite for appointment to many specialist posts. The automated defibrillator has enabled a wider range of staff to administer the first crucial shocks with the minimum of delay. In the ideal situation, a patient is promptly defibrillated by those present at the time of the arrest well before the arrival of the hospital cardiac arrest team. These may be junior medical or nursing staff with relatively limited experience. The recognition that many hospital patients who suffer cardiopulmonary arrest display warning signs indicating an underlying deterioration in their clinical condition has led to a redefinition of the roles of hospital cardiac arrest team. Increasingly, medical emergency teams are called at the first appearance of such premonitory signs to prevent cardiac arrest by the intensive management of the factors complicating the patient’s underlying condition. Should cardiac arrest occur the chances of resuscitation are increased by concentrating the experienced staff and equipment at the patient’s bedside. Separate courses administered by the Resuscitation Council (UK) teach adult, paediatric, or neonatal resuscitation. The Resuscitation Council (UK) comprises doctors from many disciplines and others who share the desire to improve standards of resuscitation both in hospital and in the community. Members of the Resuscitation Council (UK), with invited experts, produced the first edition of the ABC of Resuscitation in 1986 with the intention that it should serve as a practical guide to resuscitation for the 1980s. The second, third, and fourth editions moved into the 1990s and it is our intention that the fifth edition will perform the same function in the new millennium.

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His last conscious words were: “My lamp is almost extinguished; I hope it has burnt for the benefit of others purchase liv 52 200 ml with amex medicine rheumatoid arthritis. Percivall Pott was a great leader in surgery who shone as a clinical surgeon purchase cheap liv 52 treatment urinary tract infection. He flourished before the emergence of surgical pathology under John Hunter purchase liv 52 in india medicine 7 day box, and the deductions from his clinical observation suffered from this lack of scientific interpretation. He was, however, particularly free Kenneth Hampden PRIDIE from the shackles of tradition and was bold enough to cut a path of his own. In a sense he 1906–1963 was more acquainted with the practice of surgery than Hunter but he lacked, as they all lacked Born in Bristol, educated at Clifton College and before the coming of Pasteur and Lister, the the University of Bristol, Ken was a true son of one key that saved surgery from being a tragic that ancient city, in which he spent his whole life adventure. He took part in the an impressive personality, a character in the best formation of the Corporation of Surgeons and sense of the term, and his life and work depict the became its Master, started organized teaching of originality of his mind. Once equipped with his medical students, and by his humane attitude, Fellowship of the Royal College of Surgeons of good sense and personal integrity helped greatly England, he made comparatively brief visits to to raise the status of surgery in this country. His Böhler’s clinic in Vienna, to Watson-Jones’ frac- writings were clear and composed with scholarly ture clinic in Liverpool and to Girdlestone at grace, and his observations recorded faithfully Oxford, and by the age of 28 was appointed assis- without being tedious. Their translation into tant fracture surgeon at the Bristol Royal Infir- European languages did much to promote the mary, to become the first surgeon in Bristol to prestige of British surgery abroad. His 278 Who’s Who in Orthopedics ability, enthusiasm and boundless energy led to pulley fixtures—usually ineffectively held by the his early recognition in Bristol and in many overworked thumb screw; the grapple attach- centers throughout the country as one with an ments to enable it to be fixed readily to any type important contribution. In these early days he of bed; the wooden frame for holding the leg with worked closely with the late E. Hey Groves, knee bent, so controlling rotation and simplifying who had recently retired from the Bristol General radiography in fractures of the neck of the femur; Hospital. Hey Groves frequently visited the frac- the frequent use of the Forstner augur bit, as in ture clinic and these two personalities, with much his operation to fuse the ankle; the widespread use in common, would have long and entertaining of staples; the excellent ball-cutter for the acetab- arguments, Ken being typically uninhibited even ulum in hip arthroplasty, comprising a tool far in the presence of this doyen of orthopedic superior to any other designed for this purpose; surgery. Throughout his life he retained a great and many ingenious modifications to instruments admiration for Hey Groves, to whose inspiration that have enhanced their effectiveness. He was a he always felt he owed so much, and who had, true disciple of Hey Groves. He was a beautiful The fracture clinic grew in numbers and repu- operator and always a courageous one. Although tation, and in spite of poor premises, became one full of vision and enterprise, his practice always of the best known in the country. Ken Pridie also remained sound, held in check above all by the took a leading part in extending the activities of kindness of heart that preserved his patients from Winford Orthopaedic Hospital to include adult too much surgery and from that painful elabora- patients, and this expansion was accelerated by tion of after-treatment that one sometimes meets. He spread his influence by Although his interests in orthopedic surgery were setting up clinics in Bridgwater, Burnham-on-Sea widespread, his best known work was in the treat- and Tetbury hospitals. To see his was the university heavyweight boxing champion massive form advance toward the rostrum would in 1925–1926 and played regularly in the pack for stimulate flagging interest, and a smattering of the Bristol Rugby Club between 1929 and 1934. He It was in shot putting, the discus and in hammer was a forthright and colorful speaker, with a great throwing that he was best known. He was record as Midland shot-putting champion from never ashamed to ask questions or confess igno- 1931 to 1951, and broke the British native record rance and, in spite of a formidable exterior, for discus in 1931. His contri- Empire Games in 1930 and 1934 and was selected butions to the literature were not numerous, and for the Olympic Games in 1932, although he was those who worked with him know that his ideas unfortunately prevented from participating. His witty always averse to the slavish following of estab- sayings, kindly humor and simple tastes endeared lished methods. He welcomed innovation and him to the children of his colleagues and most cer- never became set in his ideas, even in fields to tainly to all of his delightful family of seven which he had contributed a great deal. He was try to orthopedic surgery: the traction beam with content to devote his undoubted talents to fur- square rods throughout, to obviate the rotation of thering orthopedic surgery in Bristol and was not 279 Who’s Who in Orthopedics a seeker after high places. He was not a “com- mittee man” but could be irritating and irrepress- ible in committee, usually presenting some aspect of the subject normally ignored yet worthy of further consideration. His originality and personality brought numer- ous overseas visitors to Bristol and many were privileged to be entertained by K. Others might meet the Pridies in the Isles of Scilly, where swimming and boating were the regular holiday activities based on their diminu- tive holiday abode on St. Kenneth Pridie, Lecturer in Orthopedic Surgery at the University of Bristol and Senior William Thomas Gordon PUGH Orthopedic Surgeon at Bristol Royal Hospital and Winford Orthopedic Hospital, died suddenly on 1872–1945 May 4, 1963, at the age of 57 years while reading a paper to the South-West Orthopedic Club William Thomas Gordon Pugh was the Medical meeting at Exeter. He had had to reduce his activ- Superintendent of Queen Mary’s Hospital for ities since the first evidence of cardiac insuffi- Children, Carshalton, from 1909 until his retire- ciency in 1962 and appeared to be doing well until ment in 1937.

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