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Jean VERBRUGGE 1896–1964 Henk VERBIEST The Belgian medical world order genuine vardenafil on line erectile dysfunction books, and especially its 1909–1997 orthopedic surgeons best purchase vardenafil erectile dysfunction treatment chinese medicine, mourn the passing of an eminent surgeon purchase vardenafil with amex erectile dysfunction pills don't work, a good man, and an incompara- Henk Verbiest was born in Rotterdam in 1909. After brilliant intermediary studies at student, Verbiest did research in pigeons on Antwerp, he graduated and gained his degree, in several neurological problems. After graduation, 1921, as a doctor of medicine, surgeon, and obste- Verbiest worked in the department of neurology trician from the University of Brussels, with the until 1937. He was almost immediately this period, he was granted a doctoral degree in awarded a scholarship as a Fellow of the Com- 342 Who’s Who in Orthopedics mittee for Relief in Belgium (CRB Educational stances that could and, indeed, would lead to Foundation) and spent 2 years, up to 1924, at the forgiveness. Instead, almost fessor Putti in Italy and Professor Leriche in embarrassed, he would say “I do not think that I France. As early as 1925, he started his career at would have set about it that way. For many years, he involved duties and contacts of every description, worked in trusted collaboration with this univer- but the young surgeon fresh from the university sally recognized surgeon, who may be said to received as kind and as amicable a welcome as have been the founder of the modern technique of the VIP. Orthopedic science as well as orthopedic Another characteristic of the man we mourn surgery owes a great deal to Jean Verbrugge, as was the price he attached to friendship. People of evidenced by his numerous books, papers, his generation and younger ones can bear witness reports, lectures—about 175 publications in all. All sorts of render a service, chat with his friends, meet them, honors naturally rewarded his brilliant efforts tease them in a good-natured fashion, such and, as was only to be expected, he was a member appeared to be one of his principal aims in life. In fact, how could such a man have anything but On several occasions, he represented Belgium friends? He was called to the his colleagues of the Société Belge de Chirurgie; presidency of the Belgian Orthopedic Association his attitude was in no way that of a president, stiff no less than three times. He presided over many and solemn, discharging an obligation toward the a congress in Belgium and in other countries in a members of a society: quite the opposite, in fact, smiling good-natured manner, which did not he behaved like a man affectionately surrounded exclude firm action when necessary. The reception was full of to meet socially as he was captivating to listen to warmth and a total success and, each time he and fascinating to follow as a scientist. Tact, spoke to his guests, he called them his “dear frankness, modesty, devotion, honesty, indul- friends,” which was, indeed, the term he used gence, kindness, I do not know which of these when speaking from the platform of a scientific qualities could best be cited as characteristic of society, since he never could imagine that one the man when describing him, for he was blessed could address one’s colleagues differently. But, above all, I think that he was His career and his works, which I have re- naturally of a kind disposition and that, to his rela- called, are not sufficient, however, to depict the tions, his students, his friends, and his colleagues, man of science; the most that one can say is that he was kindness personified. He was kind to his they enable one to sum up his contribution to patients, his friends, his assistants, his colleagues, science. Better still, teacher was clarity: in a few words, he simplified when somebody hurt him, he did not show his dis- a problem and a few movements sufficed to turn tress but confided in some close friend. For in keeping with his honest and indulgent outlook instance, in a clinical case discussion, he would on life and he always sought attenuating circum- enumerate five possibilities and, from that 343 Who’s Who in Orthopedics moment, one could be quite certain that there were no more. He then rejected progressively one after another of the four possible solutions and, finally, there remained only one, which his con- science, his common sense, and his experience told him was the best. Similarly, at scientific meetings, it was almost a relief to see Jean Verbrugge stand up after a somewhat labored exposé or a heated debate: in a few words, he would stress the principal points, which had either escaped notice or were hardly apparent, and everything became simple and comprehensible. He was outstanding in this field when a young speaker, intimidated by his audience or by ill- natured questioners, showed signs of losing his head.


  • Kidney problems, such as damage to the tubule cells
  • Swelling of the face, eyes, or tongue
  • Do NOT move the person if there has been a chest or airway injury, unless it is absolutely necessary.
  • Neutrophils (polymorphonuclear leukocytes)
  • Eating disorders, anorexia nervosa that have not been diagnosed yet
  • Fatigue or feeling slowed down 
  • Short stature (especially short trunk)
  • Watch the area for signs of infection such as redness, swelling, pain, or drainage.
  • Lack of prenatal care
  • How often you stop breathing for at least 10 seconds (called apnea)

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All syndromes are characterized by a limited purchase vardenafil line erectile dysfunction age 70, monophasic course with eventual recovery order vardenafil 10mg otc erectile dysfunction by age statistics. When evaluating patients with suspected GBS buy generic vardenafil 20 mg on-line hypothyroidism causes erectile dysfunction, other causes of acute weakness must be excluded (Table 2). Fever at the outset of neurologic symptoms should raise the possibility of alternative diagnoses. GBS is rare in children less than 1 year of age, increasing the possibility of other diagnoses such as botulism or poliomyelitis syndrome due to poliovirus or other enteroviruses. Spinal cord compression should always be considered and excluded, particularly in patients without cranial nerve palsies or when there is bowel or bladder sphincter involvement. Laboratory inves- tigations should include cerebrospinal fluid (CSF) examination to exclude infectious or lymphomatous polyradiculitis. Elevated CSF protein in the absence of cellular pleocytosis (albumino-cytologic dissociation) reinforces the clinical diagnosis of GBS, although CSF protein can be normal within the first week. Nerve conduction studies and electromyography can also help to exclude other diagnoses (such as myo- pathy and neuromuscular junction disease) and are useful in the classification of the type of GBS. In demyelinating forms of GBS, the earliest electrophysiologic findings are prolongation of distal motor latencies and loss or prolongation of F wave laten- cies. Focal conduction block also occurs early, but is often technically difficult to detect because it typically occurs at the proximal nerve roots. Severe decrease in compound Inflammatory Neuropathies: GBS and CIDP 169 Table 2 Differential Diagnosis in GBS Pseudoencephalopathy Meningitis Meningoencephalitis Cerebellar syndrome Postinfectious cerebellar ataxia Structural lesion Myelopathy Spinal cord compression Transverse myelitis Acute disseminated encephalomyelitis Anterior spinal artery distribution infarction Anterior horn cells Enteroviral infection Poliomyelitis Peripheral nerve Tick paralysis Diptheria Lyme disease Toxins=drugs Acute intermittent porphyria Critical illness polyneuropathy Mitochondrial disease Neuromuscular junction Botulism Myasthenia gravis Neuromuscular blockade Pseudocholinesterase deficiency Muscle disorders Acute myositis Infectious Autoimmune Metabolic myopathy Glycogen storage disorders, etc. The relative prognostic importance of diminished compound motor action potential amplitude in children is not known. Although serum antibodies to many peripheral nerve antigens have been found in GBS, their role in the pathogenesis of the disease remains unclear. Therapy Mortality rates from GBS have fallen dramatically in recent decades mainly because of improvements in nursing and critical care measures. Any child suspected of hav- ing GBS should be hospitalized until the maximum degree of clinical disability is 170 Sumner established. In the early stages of the disease, respiratory status should be monitored carefully with frequent measurement of vital capacity. Endotrachial intubation and mechanical ventilation should be initiated early, when proper intensive care specia- lists can be assembled in a careful and controlled manner, rather than waiting for a respiratory crisis. Generally, any sign of compromised airway during the progressive 3 phase of GBS, or vital capacity below 15 cm =kg, is an indication for intubation. In older, larger children preventive measures for deep venous thrombosis and pulmon- ary embolus should include use of leg stockings (TEDS) and subcutaneous heparin. It is essential to monitor patients for autonomic nervous system dysfunction such as blood pressure fluctuations, cardiac arrythmias, gastrointestinal pseudoobstruction, and urinary retention. Physical therapy with passive range of motion exercises should be started immediately to avoid con- tractures. Pain is common in children with GBS, and should be aggressively treated, sometimes with opiates.

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Neurology 1969; 19: 1145-1152 Cross References Pupillary reflexes Circumlocution Circumlocution refers to: ● A discourse that wanders from the point purchase vardenafil overnight erectile dysfunction caused by stroke, only eventually to return to the original subject matter generic vardenafil 10 mg without prescription impotence problems, as seen in fluent aphasias; ● A response to word-finding difficulties buy vardenafil pills in toronto erectile dysfunction miracle shake, as in early Alzheimer’s dis- ease or nonfluent aphasias: in response to familiar pictures, patients may comment that the name is on the tip-of-the-tongue but they cannot access it, and therefore give alternatives (e. Brain and Language 1996; 54: 196-215 Cross References Anomia; Aphasia; Dementia Clasp-Knife Phenomenon Clasp-knife phenomenon is the name sometimes applied to the sudden “give”encountered when passively moving a markedly spastic limb. Since the clasp-knife phenomenon is a feature of spasticity, the term “clasp- knife rigidity” is probably best eschewed to avoid possible confusion. Cross References Rigidity; Spasticity - 74 - Clonus C Claudication Claudication (literally limping, Latin claudicatio) refers to intermittent symptoms of pain secondary to ischemia. Claudication of the legs on walking is a symptom of peripheral vascular disease. Claudication of the jaw, tongue, and limbs (especially upper) may be a feature of giant cell arteritis. Neurology 1988; 38: 352-359 Claw Foot Claw foot, or pied en griffe, is an abnormal posture of the foot, occur- ring when weakness and atrophy of the intrinsic foot muscles allows the long flexors and extensors to act unopposed, producing shortening of the foot, heightening of the arch, flexion of the distal phalanges and dorsiflexion of the proximal phalanges (cf. This may occur in chronic neuropathies of early onset which involve motor fibers, such as hereditary motor and sensory neuropathies types I and II. Cross References Pes cavus Claw Hand Claw hand, or main en griffe, is an abnormal posture of the hand with hyperextension at the metacarpophalangeal joints (5th, 4th, and, to a lesser extent, 3rd finger) and flexion at the interphalangeal joints. This results from ulnar nerve lesions above the elbow, or injury to the lower part of the brachial plexus (Dejerine-Klumpke type), producing wast- ing and weakness of hypothenar muscles, interossei, and ulnar (medial) lumbricals, allowing the long finger extensors and flexors to act unopposed. Cross References Benediction hand; Camptodactyly Clonus Clonus is rhythmic, involuntary, and repetitive muscular contraction and relaxation. It may be induced by sudden passive stretching of a muscle or tendon, most usually the Achilles tendon (ankle clonus) or patella (patellar clonus). Ankle clonus is best elicited by holding the relaxed leg underneath the moderately flexed knee, then quickly dorsi- flexing the ankle and holding it dorsiflexed. A few beats of clonus is within normal limits but sustained clonus is pathological. Clonus reflects hyperactivity of muscle stretch reflexes and may result from self reexcitation. It is a feature of upper motor neurone dis- orders affecting the corticospinal (pyramidal) system. Patients with dis- ease of the corticospinal tracts may describe clonus as a rhythmic jerking of the foot, for example when using the foot pedals of a car. Clonus may also be observed as part of a generalized (primary or secondary) epilep- tic seizure, either in isolation (clonic seizure) or much more commonly following a tonic phase (tonic-clonic seizure).

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Try not to draw attention to the machine vardenafil 20 mg low price erectile dysfunction at age 35, but check the battery indicator light every now and again buy vardenafil 20 mg online zyrtec impotence. It is useful to take a pen and notepad with you to the in- terview order vardenafil 20mg with visa impotence quoad hoc meaning, even if you intend to use a recorder. You might find it useful to jot down pertinent points to which you want to return later, or use it to remind yourself of what you haven’t yet asked. This could be be- cause the research is on a sensitive issue, or it might be that the interviewee has a fear of being recorded. Taking notes If you intend to take notes, buy yourself a shorthand no- tepad and develop a shorthand style which you’ll be able to understand later (see Chapter 10). It is advisable to write up all notes into a longer report as soon as possible after the interview while it’s still fresh in your mind. It can be tiring taking notes in long interviews, so only arrange one or two per day. You must learn to try and maintain some eye contact while you’re writing, and make sure that you nod every now and again to indicate that you’re still listening. Try also to get one or two verbatim quotations as these will be useful for your final report. THE INTERVIEW SCHEDULE For most types of interview you need to construct an in- terview schedule. For structured interviews you will need to construct a list of questions which is asked in the same order and format to each participant (see Chapter 9). For 68 / PRACTICAL RESEARCH METHODS semi-structured interviews the schedule may be in the form of a list of questions or a list of topics. If you’re new to research, you might prefer a list of questions that you can ask in a standard way, thus ensuring that you do not ask leading questions or struggle for something to ask. However, a list of topics tends to offer more flexibil- ity, especially in unstructured interviews where the inter- viewee is left to discuss issues she deems to be important. By ticking off each topic from your list as it is discussed, you can ensure that all topics have been covered. Often interviewees will raise issues without being asked and a list of topics ensures that they do not have to repeat them- selves. Also, it allows the interviewee to raise pertinent is- sues which you may not have thought about. If you’re nervous about working with a list of topics rather than a list of questions, a good way to overcome this is to ask a few set questions first and then, once you and the interviewee have both relaxed, move on to a set of topics. With practice, you will feel comfortable interviewing and will choose the method which suits you best. If you take time to produce a detailed interview schedule, it helps you to focus your mind on your research topic, enabling you to think about all the areas which need to be covered. It should also alert you to any sensitive or con- troversial issues which could arise.

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