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By M. Asaru. Lubbock Christian University.

This meeting led to had walked so well without a support cheap lexapro 10 mg with visa, using only a firm lexapro 20 mg low cost, lasting association between the two men a cane for long distances buy 10mg lexapro with visa. Bosworth’s later move of recurrence of the giant cell tumor cheap lexapro 5 mg amex, and the back to New York City and orthopedic surgery lexapro 5mg on-line. He became energy was inexhaustible, and his collaboration a lecturer in anatomy at Columbia University in with Moore is an important landmark in the 1925 and finally discovered his calling in 1926, history of American orthopedic surgery. Bosworth made the New York area his home and orthope- dics his life’s work, to the benefit of both. Bosworth joined the American Medical Association in 1921 and was chairman of its orthopedic section in 1949. A Fellow of the New York Academy of Medicine, he served as chair- man of the orthopedic section in 1938. He was elected to head the orthopedic section of the Medical Society of the State of New York in 1943, and was a life member of the American College of Surgeons. In 1935 he became a member of the American Academy of Orthopedic Surgeons, and he actively participated in meetings and instruc- tional courses. He was elected to membership of the American Orthopedic Association in 1939 and served as president of that organization in 1957. He was also active in the International Society of Orthopedic Surgery and Traumatology. Other honors conferred on him included membership David Marsh BOSWORTH of the Japanese Orthopedic Association, the 1897–1979 Howmet Hall of Fame Award, a Citation of Merit from St. Luke’s Hospital, and election to the Born in New York City on January 23, 1897, the Alpha Omega Alpha fraternity. Bosworth was son of a minister, David Bosworth attended City the only foreign recipient of the Japanese award, College of New York and graduated from the the Second Order of the Sacred Treasure, which 31 Who’s Who in Orthopedics was awarded to him in April 1968 for his contri- Perhaps best known for his work in the surgi- butions to orthopedic surgery. Because of his many publications, it was only With his wife, Dorothy, Dr. Bosworth be appointed to the edi- made his home a welcome place for his many res- torial board of The Journal of Bone and Joint idents away from home. He held annual New Surgery, and he served for a time as assistant to Year’s Eve parties attended by his residents and the editor. He was also appointed to the Board of many a Sunday night was spent in his basement, Trustees of the Journal and served as treasurer for in a cloud of cigar smoke, with his staff, ironing his entire term as trustee. Many of his residents in Orthopedics at New York Polyclinic Medical can recall him quoting from memory during School, at Flower Fifth Avenue Medical School, long operations in the late afternoon—lengthy and as a lecturer in orthopedic surgery at passages from Hamlet or “Elegy in a Country Bellevue Medical College and the University Churchyard. Bosworth left New York His staff appointments included: Assistant City to return to his birthplace, Vermont, where Surgeon, Attending Surgeon, and Director of he was in active practice almost until his 82nd Orthopedic Surgery at St. David Marsh Bosworth died in Vermont on Seaview Hospital, the House of St. His 94 original Cripple, and Richmond Borough Hospital, all of orthopedic publications alone (from 1930 to New York City. He was also consultant to 22 1967) could fill a volume or two, and indicate the hospitals in New York and surrounding areas. Bosworth’s many community service efforts David Marsh Bosworth was affectionately included working as consultant surgeon of the known as “Uncle David” by all his ex-residents, New York City Police Department, beginning in although he was seldom called anything but Dr. His great surgical State Supreme Court, Department of Labor, and wisdom and experience have passed from him to the United States Department of Labor. When, as it must served as an examiner for the American Board of sometime happen to all of us, we encounter a dif- Orthopedic Surgery from 1940 to 1966. Bosworth, in order to cover more the most natural thing in the world to ask, “What ground faster, he early obtained his own airplane would Uncle David do here? In his earlier years, he would work all week in New York City, then fly to Vermont to teach and operate over the weekend, and return home to Harold Hamlyn BOUCHER begin again early Monday morning. Residents and coworkers learned that his work schedule 1899– stopped only for sleep. Evenings and Sundays, after hospital rounds, were reserved for photog- Harold “Hammy” Boucher was born in raphy (he did his own) or writing. He attended to waste any time when travelling between the McGill University and the McGill Medical many hospitals, he used to read journals or correct School, graduating in 1926. Bosworth’s hobbies the University of Iowa where he was a student of included boating, flying, and photography.

He was book is and will continue to be a contribution never thwarted by an unexpected condition or never to be forgotten in the annals of medical event generic lexapro 10 mg with visa, and he strove untiringly for perfection in literature 5 mg lexapro. His judgment was unerring and his deci- 48 Who’s Who in Orthopedics sions were promptly executed purchase lexapro 10 mg amex. Sterling Bunnell purchase lexapro 20 mg without prescription, world renowned surgeon purchase lexapro 20 mg with amex, always along the lines of basic principles, the teacher, and author of Surgery of the Hand died at details to fall in line as a natural expression of his his home in San Francisco on August 20, 1957. He was never a defeatist; he was always death ended an active life of scientific inquiry and hopeful, no matter how serious or complicated the accomplishment. His searching mind and the ready applica- Elizabeth Bunnell, and a son, Sterling Bunnell, Jr. Bunnell stressed the same sound principles of surgery he practiced himself and was critical if his student failed to rise to this standard. As a result, he has left us not only the fruits of his labors in the way of scientific accomplishment, but also the in- spiration that he so dynamically displayed during his lifetime. Through his efforts, surgery of the hand has been nourished and developed to the state of worldwide recognition it enjoys today. The acceptance of his scientific and surgical accomplishments came early, both in the United States and abroad, as evidenced by society mem- berships and awards. He was a licentiate of the American Boards of General, Plastic, and Ortho- pedic Surgery. He was an honorary member of the American Orthopedic Association, the American Academy of Orthopedic Surgeons, the Western Orthopedic Association, the California Society of Plastic Surgeons, the Societal Latino-Americana Sir Stanford CADE de Ortopedia y Traumatologia, an honorary fellow of the British Orthopedic Association, 1895–1973 and a foreign corresponding member of the Societas Ortopedica Scandinavica. Petersburg, member of the American Surgical Association, received his early schooling in Antwerp, and American Association of Plastic Surgeons, entered the Medical School of the University of American Society of Plastic and Reconstructive Brussels in 1913. In 1914, he joined the Belgian Surgery, American Association for the Surgery of Army, and at the fall of Antwerp, he was evacu- Trauma, American Society for Surgery of the ated to England where he resumed his medical Hand, and an emeritus member of the Hand studies. He was a Fellow of the where he was appointed to the surgical staff in American Occupational Therapy Association 1924. He was a broadly experienced general surgeon, He was consultant to the Surgeon General of but developed a special and overriding interest the United States Army, to the United States in the treatment of malignant diseases not only Navy, and to the Alaska Department of Health. He by surgery but also by radiotherapy and, in due received the United States Medal for Merit, Ordre course, chemotherapy. He was, thanks to the National de la Legion d’Honneur, and Ordem encouragement of Ernest Rock Carling, one of the Nacional do Cruzeiro do Sul. His enormous experience in this field is ternity and the Sigma Xi scientific society. In San encapsulated in his book Malignant Disease and Francisco, he was a staff member of the Stanford its Treatment by Radium, first published in 1940 University Hospital, the St. Francis Memorial with a four-volume second edition in 1948, which Hospital, and Children’s Hospital. He also wrote extensively on 49 Who’s Who in Orthopedics breast cancer, melanoma, and tumors of the when he felt it a duty to set a good example to musculoskeletal system. The approach discussed in his 1955 paper on Bartholomew’s Hospital Medical School. Cade’s Surgeons in 1852 and appointed house surgeon hospital career was interrupted by the Second to St. In July 1854 he World War in which he served in the medical became registrar and demonstrator of morbid branch of the Royal Air Force, making significant anatomy and thereafter never lost his interest in contributions to the safety of fighter pilots and this subject. He retired from the active staff tled “The Formation and Growth of the Bones of of Westminster Hospital in 1960 and was subse- the Human Face. In the same year, on the resignation of Sir James Paget, he was elected Surgeon to St. Bartholomew’s Hos- pital and Examiner in Surgery to the University of Cambridge. He practiced in Queen Anne Street and held the appointments of Surgeon to the Charterhouse and Professor of Anatomy at the College of Surgeons. He claimed that septicemia was almost unknown in his wards and, though he did not refer to Lister’s theories of asepsis, the principle of his treatment was, in fact, a modified Listerism. His last publication, on “The Avoid- ance of Pain,” was delivered to the Section on Surgery at the Bath meeting of the British Medical Association.

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Journal of Neurology 2002; 249: 549-553 Cross References “false-localizing signs”; Paraparesis; Suspended sensory loss “Give-Way” Weakness - see COLLAPSING WEAKNESS; FUNCTIONAL WEAKNESS AND SENSORY DISTURBANCE Glabellar Tap Reflex The glabellar tap reflex discount 10mg lexapro otc, also known as Myerson’s sign or the nasopalpebral reflex buy lexapro 5 mg fast delivery, is elicited by repeated gentle tapping with a finger on the forehead lexapro 20 mg sale, preferably with irregular cadence and so that the patient cannot see the finger (to avoid blinking due to the threat or menace reflex) cheap lexapro 5 mg with amex, while observing the eyelids blink (i buy lexapro 20 mg fast delivery. Usually, reflexive blinking in response to tapping habituates quickly, but in extrapyramidal disorders it may not do so. This sign was once thought useful for the diagnosis of idiopathic Parkinson’s disease but in fact it is fairly nonspecific, occurring in many akinetic-rigid disorders. Journal of Neurology, Neurosurgery and Psychiatry 2003; 74: 558-560 Cross References Blink reflex; Parkinsonism - 137 - G Glossolalia Glossolalia Glossolalia, or speaking in tongues, may be considered a normal phe- nomenon in certain Christian denominations, as divinely inspired, since it is mentioned in the Bible (1 Corinthians, 14:27-33, although St. Paul speaks of the importance of an interpreter, since “God is not the author of confusion”), but it is not confined to Christianity or even overtly religious environments. Others conceptualize glossolalia as a form of automatic speech, usually of a pseudo-language which may be mistaken for a foreign tongue. Such happenings may occur in trance- like states, or in pathological states, such as schizophrenia. London: Arnold, 2001: 237-240 “Glove and Stocking” Sensory Loss Sensory loss, to all or selected modalities, confined to the distal parts of the limbs (“glove and stocking”) implies the presence of a periph- eral sensory neuropathy. If the neuropathy involves both sensory and motor fibers, motor signs (distal weakness, reflex diminution or loss) may also be present. Cross References Neuropathy Goosebumps - see ANSERINA Gordon’s Sign Gordon’s sign is an extensor plantar response in response to squeezing the calf muscles, also called the paradoxical flexor response. As with Chaddock’s sign and Oppenheim’s sign, this reflects an expansion of the receptive field of the reflex. Cross References Babinski’s sign (1); Plantar response Gowers’ Sign Gowers’ sign is a characteristic maneuver used by patients with proxi- mal lower limb and trunk weakness to rise from the ground. From the lying position, the patient rolls to the kneeling position, pushes on the ground with extended forearms to lift the hips and straighten the legs, so forming a triangle with the hips at the apex with hands and feet on the floor forming the base (known in North America as the “butt-first maneuver”). Then the hands are used to push on the knees and so lift up the trunk (“climbing up oneself”). This sign was originally described by Gowers in the context of Duchenne muscular dystrophy but may be seen in other causes of proximal leg and trunk weakness, e. Gowers was not the first to describe the sign; Bell had reported it almost 50 years before Gowers’ account. London: Imperial College Press, 2003: 378-380 Graefe’s Sign - see VON GRAEFE’S SIGN Graphanesthesia - see AGRAPHESTHESIA Graphesthesia Graphesthesia is the ability to identify numbers or letters written or traced on the skin, first described by Head in 1920. Loss of this ability (agraphesthesia, dysgraphesthesia, or graphanesthesia; sometimes referred to as agraphognosia) is typically observed with parietal lobe lesions, for example in conditions such as corticobasal degeneration. Such a cortical sensory syndrome may also cause astereognosis and impaired two-point discrimination. Cross References Agraphesthesia; Astereognosis; Two-point discrimination Graphospasm - see WRITER’S CRAMP Grasp Reflex The grasp reflex consists of progressive forced closure of the hand (contraction of flexor and adductor muscles) when tactile stimulation (e. Once established, the patient is unable to release the grip (forced grasping), allowing the examiner to draw the arm away from the patient’s body. There may also be accom- panying groping movements of the hand, once touched, in search of the examiner’s hand or clothing (forced groping, magnetic movement). Although categorized a reflex, it may sometimes be accessible to mod- ification by will (so-called alien grasp reflex). The grasp reflex may be categorized as a frontal release sign (or primitive reflex) of prehensile type, since it is most commonly associ- ated with lesion(s) in the frontal lobes or deep nuclei and subcortical white matter. Clinicoradiological correlations suggest the cingulate gyrus is the structure most commonly involved, followed by the supplementary motor area. The incidence of the grasp reflex following hemispheric lesion and its relation to frontal damage. Brain 1992; 115: 293-313 - 139 - G Guttmann’s Sign Schott JM, Rossor MN.

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Neurogenic constipation further com- pounds the problem of bowel movement management in MM generic 10mg lexapro fast delivery. The goal is regular buy cheap lexapro 10mg, predictable 5 mg lexapro mastercard, fecal evacuation in a manner that is acceptable and efficient for the patient and family discount 5mg lexapro otc. In the first few years of life purchase 5mg lexapro otc, the focus is on stool consisten- cy=bulk. First step interventions include the use of suppositories and enemas, along with stool softening and bulking agents. Evacuations should be done on the toilet to enhance later toilet training. Periodic bowel cleanouts may be required using either high volume enemas or osmotic solutions (Go-Lytely or others) delivered via naso- gastric tube. As the child becomes more independent, these procedures become less acceptable. The MACE procedure, which creates an abdominal conduit into the cecum for the delivery of high volume fluids to the colon, has been very beneficial in producing fecal continence. Cognition=Behavior=Family A detailed discussion of development, cognition, behavior, and mental health of chil- dren with MMC is beyond the scope of this chapter. Mental retardation is present in about one-third of children with MMC; generally in the mild range (IQ 55–70). Indi- viduals with normal intelligence and shunted hydrocephalus often have visual-motor and perceptional defects that lead to poor school performance. Behavioral and emo- tional issues are critical to the optimum functional outcome of an individual and need to be a component of all treatment plans. The impact of this condition on family functioning over the lifespan of the affected individual is profound and requires careful monitoring with interventions as needed; ideally from multiple perspectives in a longitudinal and coordinated manner. HOLOPROSENCEPHALY Holoprosencephaly (HPE) is another complex developmental malformation of the central nervous system that can lead to severe–profound impairment of global neu- rological function. The HPE is associated with two fundamental abnormalities; underhemispherization of the brain and cerebral underdevelopment with resultant microcephaly. The problems of HPE are typically more severe than those in MMC and include severe to profound cognitive impairment, oromotor dysfunction severe enough to inhibit growth and development, endocrine dysfunction, seizures, autonomic dysregulation (especially temperature instability), and disorders of motor tone. A motor dysfunction syndrome, classifiable as a mixed cerebral palsy, is usually present. Higher levels of neurological function can be seen, particularly in milder forms of HPE. Occasionally hydrocephalus is observed, even in the setting of severe microcephaly, and the presence of deteriorating function should prompt obtaining a head CT. Confirming the Diagnosis The HPE is classified into three major types, although some investigators include a fourth type or middle interhemispheric fusion variant (MIHF). The most severe form, alobar HPE is characterized by a complete lack of cerebral hemispherization, Management of Myelomeningocele and Holoprosencephaly 11 resulting in a mono ‘‘hemisphere’’ with a single ventricle, and no evidence of an interhemispheric fissure. Deep cerebral structures, such as the caudate, putamen, and lentiform nuclei, are also fused due to a lack of midline brain structures. The severity and extent of this anatomic underdevelopment correlate roughly with the severity of functional impairment. The milder semilobar and milder still lobar HPE are characterized by lesser degrees of midline underdevelopment in a caudal to rostral gradient. The MIHF variant involves nonhemispherization of just the region of brain adjacent to the Rolandic fissure. Its characteristic MRI finding is underdevelopment or absence of the body of the corpus callosum with a seam of gray matter across the midline. The cerebral cortex rostral and caudal to the seam are either normal or exhibit neuronal migration defects. Misdiagnosis is common, since interpretation of neuroimaging (from fetal ultrasound to postnatal MRI) has tended to focus on ventricular architecture rather than on the presence of midline noncleavage of gray matter structures. For confirma- tion of HPE, there must be some degree of cerebral hemispheric nonseparation (non- cleavage). Many cases of alobar and semilobar HPE are accompanied by the presence of a dorsal cyst in the caudal most part of the supratentorial compartment. Additionally, most cases of HPE are associated with significant reductions in brain mass and microcephaly, unless hydrocephalus is present.

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