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He became director of a combined ortho- 104 Who’s Who in Orthopedics pedic program with Roosevelt Hospital discount 150 mg viagra extra dosage visa, which was integrated in 1987 after the two institutions merged 120 mg viagra extra dosage amex. Bill was an energetic purchase viagra extra dosage 200mg amex, highly motivated surgeon and educator with excellent clinical and operative skills discount viagra extra dosage 150mg fast delivery. His enthusiasm for orthopedic surgery was passed on to many of the residents whom he trained buy viagra extra dosage 130 mg otc, who were often in awe of his accom- plishments and his unique personality. He pro- duced 14 sound-slide programs and 15 medical motion pictures and videotapes and was credited with 162 scientific publications, 60 of which appeared in The Journal of Bone and Joint Surgery. Well known as an international lecturer and teacher, he was invited to serve as a visiting professor at many academic institutions and societies in America and throughout the world. Although his interests encompassed many areas Jean Timothee Emile FOUCHER of the musculoskeletal system, his major contri- butions were related to his work on the cervical 1823–1867 and lumbar spine. Despite his remarkably busy career, Bill found Jean Timothee Emile Foucher was born in Saint- time to study the origins of ancient civilizations. Mars, where his father conducted a small private He visited many sites around the Mediterranean school. It was his father’s wish that his son would and in Central and South America and assembled follow his example and become a teacher also, an outstanding collection of photographic slides and it was over considerable opposition that that were of archaeological and anthropological Foucher broke away to attend medical school in interest. He gradually rose through the ranks pedic meetings and was always ready to given an of the medical system in Paris as a protégé of interesting dissertation on the structural remains Velpeau, becoming chief of the surgical service of ancient cities, tombs, and meeting sites, during at Bicetre in 1863. He which he would point out evidence of muscu- conducted animal experiments using various loskeletal diseases and how they were treated in anesthetic agents, tested a number of antiseptics, early times. His work on epiphyseal injuries falls during a Fielding slide show, and those who were into this last category. In order to appreciate his present at his Presidential Address in Anaheim, accomplishment, his short career must be viewed California, will not forget the multiple slide pro- against the background of the turbulent times in jectors that were positioned and synchronized which he worked. The pres- the result of a ruptured aneurysm of the thoracic entation received a standing ovation. He was survived by his wife, Doris; four children, Pamela, Bruce, Debra, and Victoria. At the time of his retirement from the Chair of Orthopedic Surgery at the Medical College of the University in 1938, he was made Professor Emeritus. During the World War he served as Major in the Medical Corps, United States Army, and was Chief of the Department of Orthopedic Surgery at Walter Reed Hospital at that time. Freiberg always took a special interest in the affairs of the American Orthopedic Associa- tion, particularly in its development, to the end that it might be an important and influential factor in establishing and maintaining a high and digni- fied standard. He was President of the Association for the year 1910–1911 and always took an active part in the scientific and administrative proceed- ings of all its meetings, and served on many important committees. Freiberg was frequently consulted on matters 1868–1940 of parliamentary law. His mind was keen and ana- lytical, his judgment fair and tinged with kindli- Dr. He was a splendid speaker and his tongue August 17, 1868, the son of Joseph and Amalia had no barb. He was a graduate of the University of quently turned the discussion toward correct and Cincinnati and of the Medical College of Ohio, wise decision. His honesty and good sense added which later became the Medical College of the weight to his opinions. After his internship at the General in its scientific sessions and the Association Hospital, he spent considerable time abroad, always looked forward to his communications as studying at the universities of Würzburg, being of value, for they indicated the result of his Strasbourg, Berlin, and Vienna. His position this country in 1893, he began practice in Cincin- was always foremost in the advance line of nati, and, as was the custom in those days, he progress. Freiberg always took an active part in the was always foremost in aiding advancements that affairs of his profession and was a member of came to orthopedic surgery through the enlarge- the American Medical Association, the American ment of the field of surgery resulting from the Orthopedic Association, the Clinical Orthopedic advent of antiseptic surgery. He kept in close Society, and a Fellow of the American College touch with the departments of medicine other than of Surgeons and of the American Academy of that to which he devoted his life, and he did this Orthopedic Surgeons. He was also active in on principle as part of his eager quest for knowl- local medical affairs. He was President of the edge, which was evident in his clear sense of Ohio Medical Society, 1929–1930; the Cincinnati values and breadth of grasp. His consideration of Academy of Medicine, 1923–1924; and Chair- all sides of any problem gave weight and confi- man of the Orthopedic Section of the American dence to his decision. Freiberg died in Cincinnati, July played an important part in the establishment of 14, 1940, after an illness of 2 weeks.

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His reputation out calmly and patiently order viagra extra dosage 120mg with visa, and much appreciated as a scientific surgeon is likely to increase rather by patients of all ages purchase 130mg viagra extra dosage with amex. Clinical notes 120mg viagra extra dosage sale, whether than diminish as the years pass viagra extra dosage 200 mg low price, for his many dictated or in his own handwriting order viagra extra dosage 150mg without a prescription, were written original contributions are so tried and tested with the greatest care and clarity, and the house that his work will survive. When Sir Herbert resigned from the Nuffield Operations were usually carried out personally. Chair of Orthopedic Surgery in Oxford to return He was a gentle expert surgeon, especially in to the Royal National Orthopedic Hospital in his own particular fields, but once an assistant 1948, he had already been resident surgeon at had shown himself to be completely competent, Stanmore between 1931 and 1940 and had he was fully trusted and Sir Herbert had no worked with many of the consultant staff, the qualms about delegation. He believed that the majority of whom had been appointed 2 years operator should write the operation note, in his before. The Postgraduate Federation had been own case often with a diagram to eliminate any formed and the Institute of Orthopedics was doubt. These notes and drawings were of great already in being under its dean, Mr. The apparent ease in enthusiasm for this new concept of a group of and simplicity with which the final conclusions orthopedic surgeons working together in different were presented must be emphasized, and were fields, and combining together to teach and train seldom, if ever, the result of a sudden brainwave the increasing number of keen young men. The rapid change from the an orderly, logical manner, easily understood and rather personal apprenticeship system to a guided remembered. He could project with equal ease to specialist education with a number of teachers the level required, to nurses, to men or women at was not always immediately appreciated, and Sir an early stage of orthopedic training or to other Herbert spent many hours with individual regis- experts in one of his particular specialties—and trars discussing their progress and plans. After dinner, informal dis- Seddon as pupil or colleague has learned his cussion might take place, and the rose garden at subject in a way he will never forget and will be one time acquired, wrongly, a somewhat sinister forever grateful. Registrars were helped to plan research inves- tigations and meetings were organized at which With the death of Sir Herbert Seddon at the close they could try out their ideas before their peers— of 1977, British orthopedic surgery lost one of now almost a universal practice. Genius has been defined as an infinite Regular bedside consultant teaching ward capacity for taking pains. This describes Jim rounds continued for most of the junior staff, and Seddon in a nutshell. Men from other London operating theater tackling a difficult nerve repair, hospitals as well as postgraduates were included, or preparing a lecture, or even learning the steps so that the attendance became too large to be of a new dance in his office at Oxford, the same accommodated in the wards, and the demonstra- concentration and meticulous care was always tions were transferred to the lecture theater. There his remark- patients and staff alike as little less than the Deity. Furthermore, the physiothera- former director was still very much active did pists, often working in difficult circumstances, little to ease the difficulties of the new encumbent. He also developed doubt that, despite the inevitable clashes of per- simple splints that could be made locally by ordi- sonality, there was a deep mutual respect. The first and overwhelming impression times frightened, and often in pain. His strict regard for accuracy During the war years, while his family were in and intellectual honesty made him a welcome col- the United States, Seddon lived with his parents laborator with scientists in other departments of and latterly his mother, who acted as hostess. Young and Peter account of the Oxford days would be complete Medawar in the Department of Zoology. It was without reference to this remarkable Yorkshire these links, and others, that enabled him to estab- lady, who took such a mischievous delight in lish a scientific basis for the clinical research that teasing “the Professor,” of whom she was so he was undertaking on peripheral nerve injuries. There is no doubt that this background, together As a Fellow of Worcester College, he enjoyed with his capacity for ensuring a high quality of to the full dining in a traditional atmosphere, with note taking and recording, established the inter- stimulating conversation far removed from clini- national reputation of the Oxford Peripheral cal orthopedics. Nerve Injury Unit—one of five set up by the In these days, with an orthopedic training Medical Research Council in Britain. It is hardly surprising that he gath- ered round him a team of men and women who gladly and unsparingly gave of their best to him. The results of this teamwork found expression in the report of the Medical Research Council on peripheral nerve injuries and later in his own book, Surgical Disorders of the Peripheral Nerves. Both indeed are fitting tributes to the work of the man himself and the team he directed. It seems unlikely that, 302 Who’s Who in Orthopedics Senn was the first surgeon to advocate the reduction and nailing of hip fractures on the basis of animal experiments. When his paper, “The treatment of fractures of the neck of the femur by immedi- ate reduction and permanent fixation,” was first presented at the meeting of the American Surgi- cal Association on June 1, 1883, its concepts were vigorously opposed by all of his listeners, pro- voking Senn to say: “Any person who can hit the head of a femur in a cat will certainly not miss it in operating on a human subject. His emphasis on the importance of the impaction of the fractures after reduction was echoed years later by Cotton. After graduating from the PhD, LLD, (1844–1908) Master surgeon, patholo- local high school, he taught school for a short gist, and teacher.

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If an established sore is present order viagra extra dosage 150 mg overnight delivery, any slough is excised and the wound is dressed with a desloughing agent if necessary buy viagra extra dosage 150 mg lowest price. Once the wound is clean and has healthy granulation tissue 200 mg viagra extra dosage with amex, occlusive dressings may be used buy generic viagra extra dosage 130mg online. Complete relief of pressure on the affected area is essential until healing has occurred generic 120mg viagra extra dosage visa. Indications for surgery are: (1) a large sore which would take Figure 6. In this patient this was achieved after only three days of bed rest underlying bursa. If possible, surgical treatment is by excision with appropriate positioning. Recurrence is uncommon and if it occurs can be more easily treated after this type of surgery than if large areas of tissues have been disturbed by previous use of a flap. Baltimore: Williams and Wilkins, 1998 • Ayers DC, McCollister Evarts C, Parkinson JR. Spinal Cord —if slough, treat with desloughing agent or excise 1999;37:383–91 —treat general condition, e. The use of bony prominence indomethacin to prevent the formation of heterotopic bone after total hip replacement. J Bone Joint Surg 1988;70A:834–8 • Tator CH, Duncan EG, Edmonds VE, Lapczak LI, Andrews DF. Neurological recovery, mortality and length of stay after acute spinal cord injury associated with changes in management. Paraplegia 1995;33:254–62 32 7 Urological management Peter Guy, David Grundy After spinal cord injury (SCI), dysfunctional voiding patterns soon emerge. These are usually characterised by hyperreflexic bladder contractions in suprasacral cord lesions and acontractile Box 7. Quite • Preservation of renal function apart from socially incapacitating incontinence, the resulting • Continence urodynamic abnormalities can lead to recurrent urinary tract infection (UTI), vesico-ureteric reflux, and upper tract dilatation and hydronephrosis. Constant urological vigilance is therefore an essential part of management. Commercially available coated self-lubricating Paraurethral gland abscess catheters are now widely available. Catheterisation is Urethral diverticulum/fistula undertaken 4–6 hourly; by restricting fluid intake to maintain • Calculous/biofilm encrustation a urine output of around 1500ml per day, bladder volumes • Recurrent blockage / dysreflexic attacks should not exceed 400–500ml per catheterisation. In practice, many will retain an indwelling catheter until about 12 weeks after injury, when formal urodynamic appraisal can be undertaken. Tapping and expression After a period of “spinal shock”, involuntary detrusor activity is observed in most patients with suprasacral cord lesions. By about 12 weeks after injury, those patients who it is felt may manage without long-term catheters will have begun bladder training. In those with minimal detrusor-distal sphincter dyssynergia (DSD see below), suprapubic tapping and, if necessary, compression may be sufficient to empty the bladder. Initially, the post “voiding” residual volume is checked daily, either by “in-out” catheters, or using a portable bladder scanner. When this is <100ml on three consecutive occasions, bladder training is complete, and intermittent catheterisation is discontinued. Indwelling catheterisation In those patients unsuited to tapping and expression or intermittent self-catheterisation (ISC), consideration may be given to long-term indwelling catheterisation as a permanent method of bladder drainage. Wheelchair-bound 35 female patients with urethral catheters are especially prone to 30 urethral erosion and such patients (especially if they have hyperreflexic bladders) are unsuitable for long-term urethral 25 catheters, once they have mobilised. Women with strong bladder 20 contractions may expel both balloon and catheter, causing a 15 severe dilatation of the urethra. In men, pressure necrosis at the external urethral meatus 5 causes an increasing traumatic hypospadias and cleft penile 0 urethra. This is particularly important where the patient may be deemed eventually suitable for ISC. Patients with indwelling catheters are prone to develop 5 calculous blockage, and bladder washouts with water, saline or Suby-G solution are recommended on a weekly basis, especially 0 Urethral stricture disease Periurethral abscess if the urine is cloudy with sediment. Regular blockage should be investigated with 45 cystoscopy and removal of any stone fragments. These infections 25 and the resulting alkalisation are associated with a high 20 incidence of “struvite” stone (calcium apatite and magnesium ammonium phosphate) formation in both the bladder and the 15 upper tracts. Stag-horn calculi require early removal by 10 percutaneous or open pyelolithotomy, before the infected stone 5 results in the development of xanthogranulomatous 0 Vesicoureteric reflux Upper tract abnormalities pyelonephritis and an inevitable nephrectomy.

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