By V. Fasim. Norfolk State University.

It is based on the fact that when a recum- bent patient attempts to lift one leg buy malegra fxt 140 mg otc erectile dysfunction bp meds, downward pressure is felt under the heel of the other leg buy malegra fxt 140 mg online impotence of organic origin icd 9, hip extension being a normal synergistic or synkinetic movement. The finding of this synkinetic movement, detected when the heel of the supposedly paralyzed leg presses down on the examiner’s palm, constitutes Hoover’s sign: no increase in pressure is felt beneath the heel of a paralyzed leg in an organic hemiplegia. In addition, the synkinetic hip extension movement is accentuated when attempting to raise a contralateral paretic leg, whereas in functional weakness it is abolished. Practical Neurology 2001; 1: 50-53 Cross References “Arm drop”; Babinski’s trunk-thigh test; Functional weakness and sensory disturbance; Synkinesia, Synkinesis Horner’s Syndrome Horner’s syndrome is defined by a constellation of clinical findings, most usually occurring unilaterally, viz. The first two mentioned signs are usually the most evident and bring the patient to medical attention; the latter two are usually less evident or absent. Additional features which may be seen include: ● Heterochromia iridis, different color of the iris (if the lesion is con- genital) ● Elevation of the inferior eyelid due to a weak inferior tarsal mus- cle (“reverse ptosis,” or “upside-down ptosis”). Horner’s syndrome results from impairment of ocular sympa- thetic innervation. The sympathetic innervation of the eye consists of a long, three neurone, pathway, extending from the diencephalon down - 156 - Hyperacusis H to the cervicothoracic spinal cord, then back up to the eye via the supe- rior cervical ganglion and the internal carotid artery, and the oph- thalmic division of the trigeminal (V) nerve. A wide variety of pathological processes, spread across a large area, may cause a Horner’s syndrome, although many examples remain idiopathic despite intensive investigation. Recognized causes include: Brainstem/cervical cord disease (vascular, demyelination, syringomyelia) Pancoast tumor Malignant cervical lymph nodes Carotid aneurysm, carotid artery dissection Involvement of T1 fibers, e. London: Imperial College Press, 2003: 252-255 Cross References Anhidrosis; Anisocoria; Enophthalmos; Miosis; Plexopathy; Ptosis; Radiculopathy Hoyt-Spencer Sign This name is given to the triad of findings characteristic of chronic optic nerve compression, especially due to spheno-orbital optic nerve sheath meningiomas: Optociliary shunt vessels Disc pallor Visual loss “Hung-Up” Reflexes - see WOLTMAN’S SIGN Hutchinson’s Pupil Hutchinson’s pupil is unilateral pupillary dilatation ipsilateral to a supratentorial (usually extrinsic) space-occupying lesion, which may be the earliest sign of raised intracranial pressure. It reflects involve- ment of peripheral pupilloconstrictor fibers in the oculomotor (III) nerve, perhaps due to compression on the margin of the tentorium. Cross References Anisocoria; Mydriasis; Oculomotor (III) nerve palsy Hyperacusis Hyperacusis is an abnormal loudness of sounds, especially low tones, due to paralysis of the stapedius muscle, whose normal reflex function is to damp conduction across the ossicular chain of the middle ear. This most commonly occurs with lower motor neurone facial (VII) nerve (Bell’s) palsy, located proximal to the nerve to stapedius. Ageusia - 157 - H Hyperalgesia may also be present if the chorda tympani branch of the facial nerve is involved. Reduction or absence of the stapedius reflex may be tested using the stethoscope loudness imbalance test: with a stethoscope placed in the patients ears, a vibrating tuning fork is placed on the bell. Normally the perception of sound is symmetrical, but sound lateralizes to the side of facial paresis if the attenuating effect of the stapedius reflex is lost. Cross References Ageusia; Bell’s palsy; Facial paresis Hyperalgesia Hyperalgesia is the exaggerated perception of pain from a stimulus which is normally painful (cf. This may result from sensitization of nociceptors (paradoxically this may sometimes be induced by morphine) or abnormal ephaptic cross-excitation between primary afferent fibers. Cross References Allodynia; Dysesthesia; Hyperpathia Hyperekplexia Hyperekplexia (literally, to jump excessively) is an involuntary move- ment disorder in which there is a pathologically exaggerated startle response, usually to sudden unexpected auditory stimuli, but some- times also to tactile (especially trigeminal) and visual stimuli. The star- tle response is a sudden shock-like movement which consists of eye blink, grimace, abduction of the arms, and flexion of the neck, trunk, elbows, hips, and knees. Ideally for hyperekplexia to be diagnosed there should be a physi- ological demonstration of exaggerated startle response, but this criterion is seldom adequately fulfilled. Hyperekplexia syndromes may be classified as: ● Idiopathic: the majority ● Hereditary/familial: An autosomal dominant disorder with muscular hypertonia in infancy, leg jerks and gait disorder. Familial cases have been associated with mutations in the α1 subunit of the inhibitory glycine receptor gene ● Symptomatic: perinatal ischemic-hypoxic encephalopathy brainstem lesions (encephalitis, hemorrhage) thalamic lesions (inflammation, vascular) drugs (cocaine, amphetamines) Gilles de la Tourette syndrome Attacks may respond to the GABA agonist clonazepam. Boston: Butterworth, 1994: 418-433 - 158 - Hyperhidrosis H Shiang R, Ryan SG, Zhu Y-Z, et al. Annals of Neurology 1995; 38: 85-91 Cross References Incontinence; Myoclonus Hyperesthesia Hyperesthesia is increased sensitivity to sensory stimulation of any modality, e. Cross References Anesthesia; Hyperalgesia Hypergraphia Hypergraphia is a form of increased writing activity. It has been sug- gested that it should refer specifically to all transient increased writing activity with a noniterative appearance at the syntactic or lexi- cographemic level (cf.

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Rosenbaum and I have been from time to time) may ask purchase 140 mg malegra fxt with visa erectile dysfunction hotline, “How is it possi- ble to feel well when I am so sick? Our life experiences consist of what happens not just in our bodies but in our minds and hearts malegra fxt 140mg mastercard erectile dysfunction caverject injection. In fact, a greater part of our lives occurs inside rather than outside ourselves. If we are well in spirit, if we have a sense of well-being on the inside, if we love and feel loved, if we feel connected to the outside world, our bodies become a mere container for all that other good stuff. Our suffering can be transcended while we search for ways to cure it—and perhaps it is this very transcendence of our physical limitations that is a crit- ical part of our healing. The Meaning in Illness Sickness and pain are a universal experience; some statistics show that on any given day, only 12 percent of the population reports having no pain or other symptoms. So the difference between a mystery malady patient and any other person is simply that we don’t know the reason for our pain or ill- ness or how long we’ll have to live with it. The latter issue basically obliges us to find a way to cope for as long as we have to and still find a sense of greater wholeness and health; this in turn may bear directly on how soon and how well we recover physically. Rosenbaum and I are not authorities on this subject; we can only tell you what has worked for us. I (Lynn) will share my per- sonal conclusions about how to achieve this wider sense of health and well- being in the next few paragraphs. Since an early age, I (Lynn) have always been the kind of person who has to know the reasons for things. When I found myself in the midst of the mystery malady I described in Chapter 8, the question that dogged me most was why this had happened to me. While I was estranged from my father (a Holocaust survivor) for some time, I reconnected with him when he was dying of mantle cell Finding Health in Mind and Spirit 233 lymphoma. Typical of him, he observed, “When other people on this can- cer ward ask, ‘Why me? Acceptance is very important to gaining peace, but to me, that is only half the solution. Perhaps in reaction to my father’s fatalistic attitudes, I’d spent much of my life trying to find the “meaning. Years later, with more humility and possibly the wisdom gained from experience, I have softened. Still, there is the other half of the equation: finding the meaning in the happenstance and turning it into action. I believe there is an ultimate pur- pose and a meaning to whatever happens, even if I don’t see it or know it at the time. My father might have argued that this entire discussion is ridiculous and that life is simply about random chaos. He might have said that believ- ing in “purpose” is simply another way of trying to have a sense of control over things about which I am ultimately powerless. Perhaps my father was right, but if I didn’t believe my way, how else would Dr. Psychiatrist Victor Frankl was a survivor of the Nazi concentration camps. He endured the unimaginable, but like so many others who turn their tragedies into determination, Frankl developed an entire area of psy- chology that teaches us that anything is bearable if you find meaning and purpose in your experience. Many times we hear of someone who survives a dis- aster and says, “It’s turned out to be the best thing that ever happened to 234 Living with Your Mystery Malady me. Generally, it’s because the crisis caused them to get in touch with something else they really needed or wanted. It opened doorways to a new experience that otherwise wouldn’t have occurred. The Chinese character for crisis is said to be the combination of two seemingly antithetical con- cepts: danger and opportunity.

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Initial attempts to reconstruct a high dislocation Crowe group III or IV quality malegra fxt 140mg erectile dysfunction operations, using a secondary acetabulum with formed osteophytes best 140mg malegra fxt erectile dysfunction medication list, have been performed in two cases. In these patients, however, poor ambulation persisted and a biomechanically stable joint could not be obtained, resulting in loosening of the acetabular cup at an early postoperative stage. These experiences suggest a neces- sity to improve the biomechanical relationship between the femoral head and the pelvis by implanting the artificial joint at the level of the original acetabulum. This necessity has also been stated in the literature by Eftekhar, Arcq, Azuma, and Yamamuro. A second attempt to reconstruct the high dislocation, using a small-sized cup in the true acetabulum, had been performed, but this technique had a risk of abrasion of the high density polyethylene (HDP) and breakage of the com- ponent. Figure 2D–F shows a case in which the small-cup component was used, which A C B Fig. A 62-year-old woman: three-dimensional (3D) computed tomography (CT) findings of right hip, Crowe group IV. C Right lateral: narrow true acetabulum and pressure mark of the femoral head on iliac bone wall (double-headed arrow) THA for High Congenital Hip Dislocation 223 A B C D E Fig. C Upward migration (arrow) of the cup in a short period (2 years) after surgery. F Breakdown of the cup (arrow) in a short period (2 years) after surgery resulted in a breakdown of the cup in a short period after surgery. These failures taught us that we should reconstruct a biomechanically stable condi- tion around the hip by implanting the component in an anatomically correct position and keep in mind that using a normal-sized component is also of importance. Original Technique To satisfy this requirement, authors developed two new techniques: the first one is for the acetabular side and the second one is for the femoral side. In the first technique, to treat this narrow acetabulum, enlargement of its width is needed (see Fig. L- or T-osteotomy In the dislocated hip, in addition to the narrow true acetabulum the pelvic bone at the true acetabular level is narrow, especially in the anteroposterior direction. Next, the oste- otomized portion is enlarged while preserving the anterior and posterior walls (Fig. Then, bone grafting is done at the superior portion of the acetabulum and in the bone defect that is produced by the enlargement (Fig. If a very large enlargement is not needed, a L-shaped osteotomy is available (Fig. After enlargement, the metal shell component with multiple screw holes should be implanted. The screws stabilize the shell, while at the same time stabilizing the enlarged portion (see Figs. Case Reports Patient 1 A 60-year-old woman with a bilateral hip dislocation, Crowe group IV, is shown in Fig. The CT scan shows a narrow true acetabulum but a normal medullary canal of the femur on both sides (Fig. After enlargement of the true acetabulum, the metal shell was implanted in the first stage of the operation (Fig. The right leg was pulled down by skeletal traction while the patient was con- scious. For the left side, the same two-stage procedure was performed, and the total hip arthroplasty was successfully finished (Fig. Preoperative CT find- ings: narrow true acetabulum and normal medullary canal of the femur THA for High Congenital Hip Dislocation 227 A Fig. D Second stage of operation Figure 10 show the findings at 1 month (A) and at 15 years (B) after surgery. The patient is now 75 years old, and X-ray findings show slight wear of the HDP cup component on the left side, which indicates the process should be carefully followed up. Patient 2 A 50-year-old woman with Crowe group III dysplasia of the right hip is shown in Fig. After the enlargement of the true acetabulum, the patient received a 228 M. X-ray findings at 1 month (A) and 15 years post- operative (B) A B bipolar-type prosthesis, which showed central migration over a short period (Fig.

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This feeling quality malegra fxt 140 mg erectile dysfunction drugs canada, the many councils and associations of which if unhindered by anxious thought buy 140mg malegra fxt free shipping erectile dysfunction va form, will grow in he became president, including the Liverpool strength; and when the troubled times are over we shall Medical Institution, University Club, Merseyside be just that little bit more balanced in judgment, that branch of the British Medical Association and little bit more determined in character, and that little bit Liverpool Philomathic Society. Of these little bits is built up our the Robert Jones Dining Club, which meets each national character which renders unconquerable our year after the eponymous lecture at the Royal land and invincible our soul. College of Surgeons of England—an oration that he himself gave brilliantly, as he did also the first McMurray Memorial Lecture in Liverpool. He prepared assiduously, for example taking coach- ing lessons in French to improve his continental duties, culminating in the presidency of the Société Internationale de Chirurgie Orthopédique et de Traumatologie. We chaffed him that his French was spoken with a strong Liverpool accent; but we loved him the more. He would leave home at three o’clock in the morning to arrive in Anglesey before dawn for wild-fowl shooting, and a superb shot he was. It was not until after the age of 40 that he became an enthusiastic fish- erman, but so thorough was the preparation and practice that he could equal the skill of any High- land ghillie at Cape Wrath. Within a day or two 225 Who’s Who in Orthopedics suade the giants of industry and commerce to con- tribute to the rebuilding and upkeep of the College. Archie, as he was affectionately known to all his friends, was a great plastic surgeon and teacher. But he was also the most likeable of men, with an infinite capacity for enjoying life in the company of every stratum of society. Honors were given to him in abundance but, though accepted with obvious delight, they never altered his delightful character. He will be greatly missed by his many friends and colleagues all over the world—and not least by his patients, especially the badly burnt Royal Air Force boys of the Second World War, who banded together to form the Guinea Pig Club, which met annually at East Grinstead under his presidency. Archibald McIndoe died peacefully in his sleep Archibald Hector McINDOE from a coronary occlusion on April 12, 1960, at the age of 59. Later he came to London and joined his cousin, Sir Harold Gillies, the great pioneer of plastic surgery, who outlived him by a few months. Within a short time he was on the staff of St Bartholomew’s Hospital and his future in London was secure; indeed, for the last 20 years of his life, he was probably the most successful surgeon in any speciality in the metropolis. During the Second World War he was consultant in plastic surgery to the Royal Air Force. The writer became closely associated with him in the problems presented by burns combined with frac- tures, and in the management of patients with extensive skin and bone loss. This work, which George Kenneth McKEE started in Royal Air Force hospitals and at the Queen Victoria Hospital, East Grinstead, was 1906–1991 continued at the latter hospital until his death. On his election to the Council of the Royal Ken McKee, a pioneer of joint replacement College of Surgeons of England, he became surgery, was born at Ilford, Essex, the son of a intensely interested in the College, of which he medical practitioner who had migrated from had just ceased to be senior vice president when Northern Ireland at the turn of the century. There was little doubt that he would was educated at Chigwell School and St. He Zealander to hold the highest order in British then came under the influence of Elmslie, Higgs surgery. His loss is a sore one for, among his and Brockman at Chailey Heritage; proceeding to many qualities, was an outstanding ability to per- FRCS in 1934. McKee was appointed registrar at 226 Who’s Who in Orthopedics the Norfolk and Norwich Hospital in 1932 and metal-on-metal cemented hip joint, but unlike in 1939 joined H. Brittain on the staff as a Charnley he did not restrict the use of his inven- consultant. Metal debris and impingement were major Orthopedic surgery proved to be a fertile field problems and these were addressed by redesign for a man who was fascinated by all things of the Thompson component and by making the mechanical. His early interest in taking motorcy- femoral head slightly smaller than the socket to cles and cars to pieces prepared him for an out- diminish equatorial wear. He himself admitted McKee recognized Charnley’s brilliant scien- that “replacing worn joints was a fairly obvious tific and engineering skills but was always con- treatment to me. Curiously, he himself introduced ment from his more conservative and sceptical a metal-on-polyethylene variant of the peers. Their comments of the time were recorded McKee–Farrar prosthesis in 1972. Ken McKee by McKee: “£200 is very expensive for an oper- was pleased to know that orthopedic surgeons and ation that is doomed to failure” and “prosthetic engineers were, in 1991, taking a second look at arthroplasty should be reserved for the over 90s. In later years he would often recall, with a twinkle McKee’s mechanical aptitude was not limited in his eye, the eminent questioner at a Royal to total hip replacement.

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