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In 1890 cheap 750mg keflex with visa, he married Beatrice buy keflex 500 mg on line, the second daughter of William Payne of the Chamber of London. Alfred Tubby was old enough to be familiar with the traditions of pre-antiseptic surgery and young enough to embrace the teaching of Lister. He was therefore well placed to hand on a written account of what was of permanent value in the teaching Kauko VAINIO of the early pioneers and yet well qualified to lead in the advance, under antiseptic precautions, of 1913–1989 open operative correction of deformity. Further- more he stood firm by the definition of orthope- Kauko Vainio a Finnish orthopedic surgeon of dic surgery as the surgery of the entire locomotor outstanding international achievement, was born system. By his incomparable textbook of 1912, he on May 1, 1913 in Sääminki, Finland. The world- helped to raise the prestige of British orthopedic wide application of orthopedic surgery in the surgery. In 1956 he was appointed first senior lecturer of orthopedic rheumatology at the 1. Plarr’s Lives of the Fellows of the Royal College of Since graduating from the Helsinki University Surgeons of England (1930) 2, 438. Bristol, printed Medical School in 1939, Vainio’s early pro- and published for the Royal College of Surgeons by fessional life was dominated by military field John Wright & Sons Ltd 4. Tubby AH (1896) Deformities: a Treatise on surgery, ultimately as a major during Finland’s Orthopedic Surgery. Tubby AH (1912) Deformities Including Diseases followed by the postwar hardship. Tubby AH (1920) A Consulting Surgeon in the Near the Orthopedic Hospital of the Invalid Foundation East. Ltd with a residency at the Anderson Orthopedic Hos- pital in the United States in 1949. Long before the current challenges of the growing organized international university exchange programs and projects, Vainio made unbelievable efforts to- ward a better understanding and relationship between colleagues around the orthopedic world, with special reference to his life’s work—the operative treatment of the rheumatoid limb as an integrated part of the overall plan for the rheuma- toid patient. He is said to have established a 341 Who’s Who in Orthopedics school of about 1,000 residents and visitors from 1939. From 1938 to 1939, Verbiest studied neu- Belgium, Canada, Czechoslovakia, Great Britain, rosurgery in Paris. The outbreak of World War II Israel, Japan, Norway, Poland, Romania, Sweden, forced him to return to Utrecht where, because of and the United States at his department in Heinola wartime conditions, he was appointed head of the until his retirement in 1975. After the war, Ver- Anniversary Vainio Meeting in Heinola was biest became well known for his research, for his attended by 50 international specialists in clinical acumen, and for his surgical skills. He was During his career Verbiest received many a man with innumerable friends and spare-time honors from his own government and from the activities. At a rather early stage in his orthope- international neurosurgical community. He is, dic career, Vainio drew fundamental guidelines perhaps, best remembered for his description of for the operative treatment of the rheumatoid spinal stenosis. One of the classic symptoms of deformities of the foot based on a thorough clas- spinal stenosis, intermittent claudication of the sification of the typical abnormalities and their spine, is called Verbiest’s syndrome. Jean VERBRUGGE 1896–1964 Henk VERBIEST The Belgian medical world, and especially its 1909–1997 orthopedic surgeons, mourn the passing of an eminent surgeon, 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.

McLaughlin and he wrote ridiculously long putts without appearing to look and lectured on the subject extensively discount 750 mg keflex visa. When doing nothing he did it thoroughly buy 250mg keflex amex, and to see him sitting in the sun at his beloved Ystrad “cottage,” gazing at the Denbighshire hills, was an education in relaxation. His kindness was warmed with an emotion that he himself would have denied. For 6 years after the loss of his first wife he was a very lonely man; but then the wound healed and after marrying again he enjoyed life more and more. In McMurray was exemplified British reluc- tance to commit clinical observation to writing until confirmed after many years. Some may still find difficulty in eliciting his sign for posterior horn tears of the meniscus, and others may wonder why oblique displacement osteotomy avails in the treatment of osteoarthri- tis of the hip, but none may discount his conclu- sions, which were based so firmly on long Thomas Porter McMURRAY observation. Many have seen him remove a meniscus Born in Belfast, McMurray graduated in medicine with the whole of its posterior horn in less than 5 at Queen’s University in 1910 and the next year minutes, and recent American visitors spoke of went to Liverpool as house surgeon to Sir Robert the fleetness of foot that was demanded of assis- Jones. In 1914, after serving for a short time in tants chasing round the operating table when a hip France as captain in the Royal Army Medical joint was disarticulated in little more than 10 Corps, he was recalled to the Alder Hey Military minutes. But it was the consummate skill and Orthopedic Hospital in Liverpool where many artistry of his technique that was even more English, Canadian and American surgeons were impressive than the speed of it; the speed was trained by Robert Jones and worked with him. He was forceful, dogmatic, and even intol- erant if the principles of Hugh Owen Thomas were denied. He was not an orator, but his words will long be remembered: “Feel it laddie”; “I think you’re splendid”; “Get on with it laddie”; “You’re a credit to us. It is dif- ficult to know the full extent to which he main- tained and enhanced the Liverpool tradition of orthopedic surgery, but a measure of it is in the words of his old students, from the four quarters of the world, inscribed in a recent presentation volume: Walter MERCER This book is signed and presented by your old students as a symbol of their respect and affection and to record 1891–1971 for ever the debt they and their country owe to you. By your skill and by your teaching you have enhanced a great tradition: this is now our treasured heritage and Sir Walter Mercer, Emeritus Professor of Ortho- by our deeds we will preserve it. He died from a heart attack in London on the University of Liverpool, Honorary Fellow of November 16, 1949, while on his way to South the American Orthopedic Association, the Asso- Africa to visit his son. He was chairman of the British editorial board of The Journal of Bone and Joint Surgery for 7 years. On the occasion of his 80th birthday in March 1970, a special issue was published in his honor (Journal of Bone and Joint Surgery, volume 52-B, no. There were tributes also to his authorship of a wonderfully written and now standard textbook on orthopedic surgery, and to his strength of char- acter in organization. He was acclaimed, though he modestly disowned, as the greatest “general surgeon” within our memory. He was presented 230 Who’s Who in Orthopedics with a leather-bound and gold-faced preparation scope with tubes 6 feet long, the distal part ster- of this issue at a ceremony in his home at Easter ilized to go into the wound but with earphones Belmont Road, Edinburgh, receiving representa- available to surrounding students who would tives of the editorial board still with the sparkle never forget the loud bruit of a patent ductus arte- in his eye, quick wit and warm-heartedness. George Watson’s College and the University of His skill in operative technique was phenome- Edinburgh, Walter Mercer graduated in medicine nal, and Lady Mercer has given permission to and surgery in 1912 with honors in practical reproduce the oil painting of him in theater dress. Already at this young age the wasted movement, never with apparent frustra- destiny of a great surgeon was defined clearly. In the first he was in the trenches of the speedy and atraumatic, the operative infection Messines Ridge, the desperate struggles of the rate was far below average in a pre-antibiotic era. He was Mercer’s presidency of the Royal College of invalided home but continued to work in the Surgeons of Edinburgh marked a renaissance military hospital at Bangour and on problems of from what his successor Sir John Bruce described tuberculosis at East Fortune Hospital until demo- as previously “almost entirely an examining body bilization in 1920. In the Second World War he and a parochial surgical society” to a live and was consultant orthopedic surgeon at Larbert inspiring College with vigorous postgraduate sur- base hospital and thoracic surgeon to Bangour gical training, teaching in basic sciences, restora- hospital. In reminding perhaps an occasional hemorrhoid, skin cyst or His Royal Highness the Duke of Edinburgh that bunion just to give verisimilitude to the otherwise the last royal sponsor of the College had been unconvincing title of “general. Then for some Prince Philip at once replied “I am bloody years his expert surgical technique was applied to grateful. He next Perhaps the most happy of all our memories is engaged in neurosurgery and soon became a the hospitality of his home. We will 231 Who’s Who in Orthopedics preserve these memories with Lady Mercer and served as a prototype for many of the outpatient her son David. Metcalf joined the faculty at the University of Utah and was appointed Professor of Orthopedic Surgery in 1983.

Ancillary studies to perform in the evaluation of childhood tremor should be dictated by the degree of suspicion for a symptomatic process buy keflex 250 mg mastercard. Since patients with longstanding tremor and a family history of similar tremor in all likelihood would have an essential tremor purchase keflex 750mg visa, little further investigation is necessary. However, if there is historical or clinical evidence that tremor is coexistent with systemic or CNS pathology, then an evaluation should proceed to identify the underlying cause. In these instances, thyroid function testing, liver function studies, toxic exposures to drugs or heavy metals, ceruloplasmin levels, and brain imaging may be warranted. TREATMENT Before attempting a therapeutic intervention, it is of paramount importance to deter- mine the etiology of a tremor. Although the cause of tremor ultimately may not be discernible, treatable causes such as Wilson’s disease, thyrotoxicosis, or toxin expo- sures must be addressed. Additionally, there are no published studies of controlled treatment interventions in childhood tremor, nor are there FDA approved medica- tions with indications for childhood tremor. Hence, since therapeutic interventions in childhood tremor have not been well studied, it is incumbent on the treating physician to assess whether the degree of disability or impairment related to the tremor warrants pharmacotherapy. Likewise, evaluation of the goals of therapy is a necessary component of a treatment plan. Essential Tremor There are no published series of treatment strategies in childhood ET. In general, younger children seldom require more than education and perhaps modifications in school regarding handwriting. Adolescents, however, will often request a treat- ment trial in order to avoid exhibiting tremor in public. In this author’s experience, pharmacologic agents such as primidone, b-adrenergic blockers, and topiramate have proven useful, as they have in adults. Clonazepam and botulinum toxin have been successfully used in adults with ET, but their use in childhood has not been 148 Dure Table 3 Drugs Used to Treat Essential Tremor Drug Dosage Potential side effects Propranolol, 5–10 mg starting dose, Hypotension, orthostasis, atenolol, other increasing as tolerated BID depression, may aggravate b-blockers preexisting reactive airways disease Primidone 125 mg=day increasing to Sedation, hypersensitivity, 250 mg TID ataxia Botulinum toxin Variable Weakness, pain upon administration Clonazepam 0. In terms of pharmacologic dosages, the treating physician is urged to start at a low dose and titrate upward depending on treatment effect. The appearance of side effects should be weighed against previously defined treat- ment goals. Other Tremors The use of agents to treat other tremors is based on anecdotal evidence of improve- ment. Other than attempts at using dopaminergic agonists such as carbido- pa=levodopa for the management of Holmes’ tremor, no specific recommendations can be made. Although carbidopa=levodopa may be helpful for rest tremor, its use is often limited by gastrointestinal side effects. Other agents to try for manage- ment of tremor would include primidone, propranolol, and clonazepam. However, the treatment of symptomatic tremor is often only marginally effective. SUMMARY For the clinician faced with a child manifesting tremor, every attempt should be made to consider a reasonable differential diagnosis. However, most cases of child- hood tremor do not require specific therapy, but rather treatment of an underlying cause if it exists. In children with tremor of a severity to result in some degree of disability or impairment, therapeutic options exist, although they have yet to be studied carefully in children. The clinician is urged to carefully weigh the potential risks when considering a drug intervention, and to develop reasonable expectations with respect to possible outcomes. Electrophysiological aids to the diagnosis of psychogenic jerks, spasms, and tremor. Pranzatelli National Pediatric Myoclonus Center, Department of Neurology and Pediatrics, Southern Illinois University School of Medicine, Springfield, Illinois, U. INTRODUCTION Myoclonus is one of the more challenging movement disorders to conceptualize and treat. Effective therapy is rooted in a thorough understanding of the pathophysiol- ogy, neurophysiology, and pharmacology of myoclonus.

The first part of the questionnaire is designed to generate statistics and the second part asks people for a more in-depth opinion discount keflex 750mg with amex. He has approached mem- bers of staff at the Maple Day Centre who are happy to 36 / PRACTICAL RESEARCH METHODS distribute his questionnaire over a period of one month buy discount keflex 500 mg line. Revised Statement 3: This research aims to find out how many people from our estate are interested in, and would use, a children’s play scheme in the school summer holi- day. Members of the tenants’ association approach the local school and ask the head teacher if a questionnaire could be distributed through the school. The head tea- cher feels that it is not appropriate so the tenants’ asso- ciation have to revise their plans. They’re worried that if they distribute a questionnaire through the post they won’t receive back many responses. Eventually, they de- cide to knock on each door on the estate and ask some simple, standard questions. They’re able to conduct this type of door-to-door, structured interview as they are a large group and are able to divide the work amongst everybody on the committee. If, at this stage, you are still unsure of the most appropri- ate methods for your research, read the following chapters as these explain in more detail how to go about using each method. This will give you more of an insight into what would be required of you if you were to choose that meth- od. As I stressed earlier, you need to think about your own personality, your strengths and weaknesses, your likes and dislikes. If you’re a nervous person who finds it difficult to talk to strangers, face-to-face interviewing might not be the best method for you. If you love working with groups, you might like to find out more about focus group re- search. If a particular culture has fascinated you for years and you know you could immerse yourself within that cul- HOW TO CHOOSE YOUR RESEARCH METHODS / 37 ture, perhaps participant observation would interest you. If you love number crunching or using statistical software, a closed-ended questionnaire may be the best method for you. Remember to think about choosing a method or meth- od(s) with which you are happy as this is important to keep your motivation levels high. X Three types of interview are used in social research: – Unstructured or life history interviews. X Focus groups are held with a number of people to ob- tain a group opinion. X Focus groups are run by a moderator who asks ques- tions and makes sure the discussion does not digress. X Questionnaires can be closed-ended, open-ended or a combination of both. X Participant observation is used when a researcher wants to immerse herself in a specific culture to gain a deeper understanding. X The chosen research methodology should help to indi- cate the most appropriate research tools. X The purpose of the research will provide an indicator to the most appropriate methods. X You should think about your personality, strengths and weakness, likes and dislikes when choosing re- search methods. This will help you to become more familiar with your topic and intro- duce you to any other research which will be of benefit to you when you begin your own project. PRIMARY RESEARCH AND SECONDARY RESEARCH There are two types of background research – primary re- search and secondary research (see Table 2). Primary re- search involves the study of a subject through firsthand observation and investigation. This is what you will be doing with your main project, but you may also need to conduct primary research for your background work, especially if you’re unable to find any previously pub- lished material about your topic. Primary research may come from your own observations or experience, or from the information you gather personally from other people, as the following example illustrates. I had noticed how some children didn’t fit the classic description of a truant and I wanted to find out more as I thought it might help me to deal with some of the problems children were experiencing. So I guess you’d say my own experience provided me with some initial data. Then I decided to go and have a dis- cussion with some of my colleagues and see if they’d noticed anything like me.