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Henning WALDENSTRÖM 1877–1972 Henning Waldenström was born in Stockholm Börje WALLDIUS and began his orthopedic career in the same city trusted 200 mg modafinil insomnia treatment guidelines. In 1936 order 200 mg modafinil with amex insomnia jr johansson, he became professor of orthopedics at 1913– the Karolinska Institute. In 1938, Waldenström suggested that the term Börje Walldius was born in 1913 in Kristianstad orthopedics be changed to orthopedic surgery, in southern Sweden. In 1909, college in 1932, he attended the medical school Waldenström described a condition of the hip at the University of Lund, receiving his medical joint in children that he called “the upper tuber- degree in 1942. He then process never passed over to the joint and was moved to the department of orthopedics at the prevented from doing this by the joint cartilage, Karolinska Hospital in Stockholm, with which he which formed an impenetrable cover. It was while he was of the condition was enigmatic and controversial, there that he obtained his PhD degree from the and Waldenström suggested the name coxa plana Karolinska Institute in 1957. Gornas Hos- Waldenström in 1938 to the American Academy pital in Stockholm, where he remained active of Orthopedic Surgeons, is one of the first until his retirement in 1978. Waldenström Knee Using an Endoprosthesis,” is an important became an honorary member of the American document because it is the first report of a group Academy of Orthopedic Surgeons, the British of patients treated with a hinged prosthesis. Orthopedic Association, the Société Française de Chirurgie Orthopedique et Traumatologique, and the Deutsche Orthopädische Gesellschaft. Waldenström played an important role in the future development of Swedish orthopedics. In testimony to his leadership, all of his disciples 345 Who’s Who in Orthopedics Frederick Oldfield WARD At this time he also speculated in many small patents and it is said that unsuspecting tradesmen 1818–1877 paid dearly for their infringement of forgotten patent rights of his inventions. In 1854, on the Frederick Oldfield Ward entered the medical recommendation of Lord Palmerston, Ward was school of King’s College in October 1833, when appointed commissioner of sewers and evolved a he was 15 years of age. The theory was time in Camberwell and his early education had acknowledged to be excellent, but was said to be been gained with a Dr. His impossible of execution: it was described as the career as a student appears to have been success- “quart-into pint-pot” plan. Political unrest at this ful enough and we know that he gained a medal period, combined, maybe, with his advanced and in chemistry in 1835 and a silver medal in botany eccentric ideas, caused him to lose his office, in 1837. While still a student, he wrote Human though he apparently continued his investigations Osteology, which was published in 1838. In into the subject of water supply, for in September the preface he said that his book was the result 1856 he addressed the International Congress of “partly of researches in the museum and dissect- Public Health in Brussels and in the same year ing room, prosecuted at intervals during the last prepared the second edition of Human Osteology. Apart from this, nothing is known of his activities for almost 20 years, though Sir John But holding that true brevity consists not in expressing Simons, Medical Officer of Health for London, ideas in a small space but in conveying them in a short who had been a fellow student at King’s College, time, I have not thought it inconsistent with this design mentions in his “Personal Recollections” that to dilate freely upon some obscure and difficult points before his death Ward suffered “enfeeblement. Whatever contradictory statements came under my notice in the course of this comparision Human Osteology. His mental and physical were noted down, and made the subject of careful powers deteriorated to such an extent that he research in several extensive anatomical collections entered St. Ward’s experiments to show the nature and The book is of small dimensions. The pages composition of bone provide interesting conclu- of the first edition measure only two and three- sions. On quarters by four and a half inches, the volume page 370 of Human Osteology, Ward illustrated being one and three-quarters inches thick. Though the triangle in the neck of the femur with which it cannot be said to present the attractions of the his name is still associated. A similar area is to be modern textbook, its text and illustrations achieve found in the calcaneum. He made this observation: qualifying medical examination, but we know that for some years he practiced as a surgeon. His The arrangement of the cancellous tissue in the ends of interests extended far beyond the confines of the femur is very remarkable; and, as it illustrates the medicine. In the lower who introduced him to Edwin Chadwick, both extremity of the bone, it consists of numerous slender of whom were pioneers of the new medicolegal columns, which spring on all sides from the interior group of sanitary reformers. Fired with their surface of the compact cylinder, and descend, con- enthusiasm, Ward wrote at this time a number verging towards each other, so as to form a series of of popular articles in which he criticized water inverted arches, adapted by their pointed form to supply and hygiene and proposed control under sustain concussion or pressure transmitted from below. These converging columns not only meet but decussate 346 Who’s Who in Orthopedics each other; and they are further strengthened by innu- succeeded in performing the first arthroscopic merable connecting filaments and laminae, which cross meniscectomy. Many of the world’s finest sur- them in all directions, so that no single arch could break geons, including Dr. Richard O’Connor, visited Tokyo Teishin Hospi- Hence, notwithstanding the tenuity and brittleness of tal to learn arthroscopy.

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In CML discount modafinil 200mg fast delivery 0bat insomnia, the proto-oncogene Transcription will not take place if a repressor protein is bound translocation results in overproduction of the enzyme tyrosine to the operator discount 200mg modafinil overnight delivery sleep aid without acetaminophen. Gleevec is an inhibitor of tyrosine kinase and works at which is a gene located to the left of the promoter. Although promoter is located immediately to the left of the operator there are several different types of tyrosine kinase in humans, gene and is outside the operon. The enzymes produced by STI-571 is specific to the form produced by the CML mutation this operon are responsible for the hydrolysis (a reaction that and does not affect other members of this enzyme family. The adds a water molecule to a reactant and splits the reactant into drug is therefore so specific, other cells and tissues in the body two molecules) of lactose into glucose and galactose. Once are not impacted, and there are few negative side effects glucose and galactose have been produced, a side reaction resulting in a therapy that is much more tolerable to the occurs forming a compound called allolactose. Early clinical trials showed such a high degree of suc- the chemical responsible for switching on the operon by cess that the trails were terminated early and the drug was binding to the repressor and inactivating it. There is now new Operons are generally encountered in lower organisms evidence to suggest that this drug also may be effective for such as. They are commonly encountered for certain other diseases, including some types of solid tumors. This is systems, suggesting that there is a strong evolutionary pres- clearly the way drug treatments will be designed in the future. Operons have By targeting only the defect and correcting that, a disease can not yet been found in higher organisms, such as multicellular be managed without impairing other aspects of a patient’s life forms. A mutation in the operator gene that renders it non-func- Other types of ongoing research include further elucida- tional would also render the whole operon inactive. As a direct tion of normal proto-oncogene function and how the onco- result of inactivation, the coded pathway would no longer genic mutations change cellular regulation. Even though the genes are still sepa- issues involving impact on apoptosis, programmed rate individual units, they cannot function by themselves, cell death, have become an important avenue of investigation. It has been shown that normal cells have a fixed life span but that cancer cells lose this characteristic and exhibit uncon- Genetic code; Microbial genetics trolled cell growth with aspects of immortality. A better under- standing of the role oncogenes play in this process may give insight into additional ways to treat cancer. Fluorescence hybridization (FISH); Opsonization is a term that refers to an immune process where Immunogenetics; Immunologic therapies; Mutations and particles such as are targeted for destruction by an mutagenesis immune cell known as a. The process of opsoniza- Penninger, Josef Martin Penninger, Josef Martin See also E. Water analysis for the bac- ing behavior and the formation of spores that occur in large terium provides an example. If the medium is dispensed in bot- biofilm, and the exodus of portions of the population from the tles, the presence of growing can be detected biofilm, in order to establish a new biofilm elsewhere. However, if the medium Historically, the first indication of quorum sensing was is dispensed in smaller volumes in a grid-like pattern, then the the discovery of the chemical trigger for luminescence in the number of areas of the grid that are positive for growth can be bacterium in the 1990s. At high den- related to a mathematical formula to produce a most probable sities of bacteria, luminescence occurs. Viable however, does not occur at lower numbers or densities of bac- bacterial counts can be determined for many other bacteria by teria. The phenomenon was correlated with the production of several other means. The The ability of bacteria to grow or not to grow on a same molecule has since been shown to trigger responses in media containing controlled amounts and types of compounds other quorum sensing systems in other bacteria. Examples of yields quantitative information about the nutritional require- these responses include the production of disease-causing ments of the microbes. For Quorum sensing enables a bacterial population to example, a technique involving reporter genes can show respond quickly to changing environmental conditions and, in whether a particular is active and can indicate the num- the case of biofilms, to enable regions within the mature ber of copies of the gene product that is manufactured. Gene biofilm to perform the different functions necessary to sustain probes have also been tagged to fluorescent or radioactive the entire community.

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They now say the immune system generic modafinil 200mg amex insomnia poem,” which might affect MS cheap modafinil 200mg mastercard insomnia wine, “is controlled by the brain. Wealthier people can afford to pay out-of-pocket for care, but costs accumulate over time. About 20 percent of people say they do not get physical or occupational therapy because they cannot afford it. Physical and occupational therapy were built into Medicare and Medicaid almost forty years ago, but with explicit limitations. Private coverage varies widely by plan, with insurers typically circumscribing the number and types of visits, setting strict limits. Insurers have only recently started paying for certain alternative therapies, primarily chiropractic. Esther Halpern feels that pool-based therapy is best for her painful back. The pool was nice and warm, and it’s much easier to do exercises in the pool. When they felt that I no longer needed it, I had to pay for it if I wanted water therapy. She was able to get herself dressed and undressed and—“ “I was able to get dressed and undressed by myself before that,” Esther interrupted. One day during my surgical rotation in medical school, my right leg suddenly collapsed, and the fall broke a small bone in my foot—the fifth metatarsal. It precipitated a barrage of eerily identical questions:“Did you have a skiing accident? Taking the rope tow up the beginner slope, unsteady on rented skis, I felt an unpleasant choking sensation. The twisting rope tow had somehow latched onto the fringe of the scarf peeking out below my parka. After they stopped the tow and unwound me, I sat out the rest of the day. Somehow social convention demands a more complete explanation, but my MS was private. If I, a medical student, men- tioned my MS, I reasoned, patients may lose faith in me or think I’m seek- ing sympathy. Bur- dening them with my disease, even by explaining my cane, seemed presumptuous. When propped in a corner, it in- variably fell, with a clatter, to the tile floor. If placed on the floor in cramped hospital rooms, someone, including me, could trip over it. Girded by these rationalizations, I began stashing—hiding—the cane at the nurse’s station or utility room before entering patients’ rooms, carefully clutching the doorjamb. Unlike Fred Astaire’s glossy, svelte walking stick, real mobility aids clearly aim to 181 182 mbulation Aids support or transport persons. These aids generally do their jobs well, eas- ing pain, enhancing balance, maximizing safety, helping people get around. Mobility aids can restore independence and conserve energy drained by enervating struggles to walk. Users of mobility aids openly admit—both to themselves and the exter- nal world—their lost physical function and consequent need. After in- juries, walking short-term with canes or crutches evokes sympathetic in- quiries about that presumed skiing or other accident. When I fractured my foot and adopted the cane, surgeons regaled me with stories of their own broken bones (but never asked about my injury). Long-term, however, mo- bility aids carry not only weight, quite literally, but also a hefty symbol- ism. One study found that about half of people with great difficulty walking one-quarter mile do not use any assistance; they probably simply avoid walking that far (Ver- brugge, Rennert, and Madans 1997, 386). Using equipment to aid mobility, however, enhances people’s sense of autonomy and self-sufficiency.

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