By P. Jesper. Lindenwood College. 2017.

His studies on the formation and constituents of gallstones were fundamental sildigra 120 mg otc. His early recognition of the need for blood replace- Nikolai Ivanovich PIROGOFF ment in surgical shock helped to revolutionize the surgical management of patients injured or con- 1810–1881 valescent from operation and made possible the greatly expanded surgical treatment that we know Nikolai Ivanovich Pirogoff was one of the great- today discount 50mg sildigra overnight delivery. Phemister’s own accomplishments in the well known in the English-speaking world since medical sciences would alone be sufficient to his contributions to the surgical literature were earn him a high place in medical history. He written in Latin, Russian, French, and German was most profoundly influential, however, as a and have not been translated into English. His personal qualities of intellectual eponym is attached to an osteoplastic amputation honesty, tireless energy, generosity, dignity, and of the foot in which the heel pad is affixed to the simplicity deeply affected all who came in contact distal tibia utilizing a portion of the os calcis to with him. In Russia, he had dealing with undergraduate students, residents, an enormous influence on medical practice and or staff doctors. After a private primary education, he To the many scientific societies in which he was admitted to the University of Moscow to took an active part, he brought the same high study medicine. It was during his visualization of anatomic relationships and was student days that Pirogoff developed a progres- widely adopted. The standard of medical edu- participated in the general decline of interest in cation at the University of Moscow at that time gross anatomy on medical school curricula, but was very poor. After graduation, he was selected the introduction of computed tomography and for further training at the University of Dorpat in nuclear magnetic resonance scans has revived Estonia, where the teachers were mostly German. He stayed there for 5 years and during these years In 1856, tired of the political battles and he studied anatomy and experimental surgery. He intrigues of the medical school, Pirogoff resigned then had the opportunity to study for 2 additional his position and became the inspector of educa- years in Berlin and Gottingen. In this role, he traveled Upon his return to Russia in 1835, Pirogoff extensively and made a valiant effort to improve hoped for an appointment as professor of surgery the educational system under his direction. Retir- at the University of Moscows but was forced to ing 5 years later, he spent the next 5 years living accept a similar but less prestigious position at in Berlin and Heidelberg. He stayed in this position for 5 years, with Russia, his liberal, western views were out of step only a leave of 5 months for study in Paris in the with the trend toward conservatism following the clinic of Velpeau.

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PARTICIPANT OBSERVATION There are two main ways in which researchers observe – direct observation and participant observation discount sildigra 50mg overnight delivery. Direct ob- servation tends to be used in areas such as health and psy- chology generic 25mg sildigra with amex. It involves the observation of a ‘subject’ in a certain situation and often uses technology such as video cameras or one-way mirrors. For example, the interaction of mother, father and child in a specially prepared play room may be watched by psychologists through a one- way mirror in an attempt to understand more about fa- mily relationships. In participant observation, however, the researcher becomes much more involved in the lives of the people being observed. Participant observation can be viewed as both a method and a methodology (see Chapter 10). It is popular amongst anthropologists and sociologists who wish to study and understand another community, culture or con- text. This may take months or years, as they need to build up a lasting and trusting relationship with those people being studied. Through participation within their chosen culture and through careful observation, they hope to gain a deeper understanding into the behaviour, motivation and attitudes of the people under study. HOW TO CHOOSE YOUR RESEARCH METHODS / 33 Participant observation, as a research method, received bad press when a number of researchers became covert participant observers; entering organisations and partici- pating in their activities without anyone knowing that they were conducting research (see Chapter 13). Overt participant observation, where everyone knows who the researcher is and what she is doing, however, can be a va- luable and rewarding method for qualitative inquiry. CHOOSING YOUR METHODS By now you should have thought quite seriously about your research methodology.

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Addi- tionally buy generic sildigra 120 mg on line, the extent of epileptiform activity has been defined by the spike-wave index buy generic sildigra 100mg on-line, which is the percentage of the time of slow-wave sleep time occupied by continuous spike-wave activity. In most cases of CSWS, the spike-wave index is greater than 85%, but some individuals may otherwise meet criteria for the disorder with a slightly lower spike-wave index. TREATMENT The major goal of therapy is to reverse the deterioration of cognitive and language function and to suppress ESES. The seizures associated with LKS usually are not severe and generally respond well to a variety of antiepileptic medications. The sei- zures that accompany CSWS may be more difficult to control, but seizures are not the major problem for either of these disorders. In contrast, cognitive and language dysfunction, as well as the associated ESES, do not respond well to standard antie- pileptic medications, but no controlled treatment studies of LKS or CSWS are available. Furthermore, the variable natural history of the disorders complicates assessment of the small case series and case treatment reports. Of the conventional antiepileptic medications, sodium valproate, ethosuximde, and various benzodiazepines, particularly clobazam, have shown benefit in some cases, but the responses have been inconsistent. Newer agents such as lamotrigine, levetiracetam, and vigabatrin have also shown benefit, but it should be emphasized that these are usually in isolated case reports. Conversely, isolated reports document that carbamazepine, phenytoin, and phenobarbital may exacerbate these conditions, but the data to support this conclusion are limited. Corticosteroids or ACTH (adrenocorticotropic hormone) administered in high doses generally is considered the most effective treatment for the language and cog- nitive dysfunction. In absent evidence of superiority of one form of treatment, corti- costeroids are preferred. Relapse rates are high with attempts to taper the steroids and multiple treatment courses may be necessary. The side effects of steroids, includ- ing weight gain, hypertension, immunosuppression and infection, glucose and elec- trolyte abnormalities, cataracts, and avascular necrosis of the hip, often limit continued treatment. Additionally, steroids may significantly worsen behavior, which can be difficult to distinguish from the effects of the underlying disorder. Con- version to an every other day treatment regimen or once per week pulse steroids administered over two days helps to minimize side effects.

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It is through the allegiance of Fairbank to Liverpool and to Robert Jones that I first met him buy sildigra 50mg on-line. Then I did not know that he was one of a family of five whose father cheap sildigra 100 mg on-line, 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.