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By V. Angar. Cleveland Institute of Art.

George’s Hospital in London cephalexin 250mg without a prescription, he spent the whole of his professional life in Sheffield buy cephalexin 250mg with visa. So he was a true Yorkshireman cephalexin 500 mg amex, and made no bones about it; which means that he was uncomplicated cheap cephalexin 750mg without prescription, direct, transparently honest, 145 Who’s Who in Orthopedics warm hearted, occasionally irascible, utterly reli- where once a week the entire staff presented their able, a bit stubborn (he used to say pig-headed), problem cases for discussion. The particular con- completely loyal and quite incapable of being ference that we attended developed into an almost spoiled either by power or success or anything gladiatorial contest with such orthopedic giants as else. Most people who scale the heights as he did Smith-Petersen, Joe Barr, Bill Rogers and Eddie are affected in some degree by it, but I doubt if Cave taking part. Frank Holdsworth, who had he changed in the slightest during the 30-odd visited many continental clinics where, in those years that I knew him so well. In those days there was no segregation of ferences were open to all orthopedic surgeons and orthopedics and trauma, but within a few years their junior staff in and around Sheffield, and the and with the help and encouragement of Sir atmosphere was delightful. They were completely Ernest, he was elevated to the staff and given informal and friendly, there was no showing off, the job of creating an orthopedic and accident and cases were presented only because they were service. He developed it, as everyone knows, into problems about which advice was needed. He one of the most famous units in Britain and a always insisted on starting the discussion at reg- “must” for every foreign orthopedic surgeon vis- istrar level and working up in order to discourage iting this country. His own that he later introduced the rotating registrar intellectual honesty somehow washed off onto system, an innovation that has since become everybody who became regularly associated with popular all over Britain, and he was justly proud him in this way, and although a little coat-trailing of the fact that in all the years of its operation only or kite-flying was occasionally permitted in order one registrar left the rotation without gaining the to liven up a discussion, the general rule was that, FRCS. He Working as he did in a highly industrialized was a particularly severe debunker of loose think- area of steel and coalmining, he always had a par- ing or armchair theorizing. On one occasion when ticular interest in accident surgery, and being the my own kite had got a little out of control he pref- kind of surgeon who, to use his own words, liked aced his summing up by saying that he had never to see the ball in the back of the net, he became heard me talk quite so much out of my hat and one of an early pioneer group who developed the then proceeded to take me apart and leave the concept of rehabilitation in this country. The juniors loved under the auspices of the then Miners’ Welfare it, of course, but at the end of the conference he Commission, before the advent of the National took me aside and asked if I would go along and Health Service. Later, under the same auspices, he see a patient with him because, as he said: “I think was one of a small group to visit Canada and the I’ve made a pig’s ear of it”—another favorite United States to study the problems of paraplegia, expression of his, which, translated into standard then a scourge in the mining industry. Paraplegia southern English, meant that it was not quite remained one of his major interests throughout coming up to expectations. It was small incidents the rest of his career and he became an interna- of this kind that revealed something of the char- tional authority on the subject. He he succeeded in establishing the spinal injuries had no time for sycophants or for any form of unit at Lodge Moor Hospital in Sheffield, not as insincerity, and every member of his team was a center for dealing with the terrible complica- expected to say what he thought and call a spade tions of paraplegia but as an early transfer unit a spade. He trained many fine surgeons, some of where these complications could be prevented. The unit always remained a team, the staff conference in action, notably in Boston, every member regarding him with great respect 146 Who’s Who in Orthopedics and affection. Indeed, this applied to everyone ugly uncivilised North,” he would say, “or they’ll who worked with him, including the many all come up from the South and spoil it. He left behind his wife Marjorie, herself a York- He was essentially a modest man and although shire woman endowed with many of his own ster- he had so strong a personality and such gifts of ling qualities, his son John and his daughter Mary. Indeed, he was always faintly surprised at finding himself famous and sought after, and although he knew for years that the writing was on the wall, he refused to make any concessions. To the despair of friends and medical advisers alike, he continued to drive himself as hard as ever in the many high offices to which he was called—President of the British Orthopedic Association, Senior Vice President of the Royal College of Surgeons of England, Examiner to the College and to many universities apart from his own, and a much sought after lecturer in many parts of the world. Even in his last year he visited the United States twice and on the last occasion was made an Honorary Fellow of the American College of Surgeons—an honor very rarely awarded to surgeons outside that country. His knighthood in 1967, followed by a professorship in 1969 in his own university, made a fitting climax to a brilliant career. Few people go so far Dame Agnes HUNT without leaving in their wake some enemies and detractors but Frank Holdsworth left none. Of his other interests, he liked traveling, No desert island was for sale. No Angora goats fishing, history, Westerns, good cooking, good were in Brisbane—indeed there were none conversation and good companionship. As a throughout the length and breadth of Australia; founder member of The Journal of Bone and Joint but Mrs. Hunt refused to believe it and said Surgery (he was on the original editorial board), that if there were no goats there ought to be.

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Neurobiology of Aging 2000; 21(suppl1): S217 (abstract 988) Cross References Confabulation; Misidentification syndromes; “Picture sign”; Prosopagnosia Mirror Writing As the name implies buy 250 mg cephalexin with mastercard, mirror writing is a mirror image of normal writ- ing cheap cephalexin 750 mg without a prescription, hence running from right to left cephalexin 750mg, with characters back to front generic cephalexin 750mg visa. This may occur spontaneously, apparently more often in left-handers, or in right-handers attempting to write with the left hand following left-sided brain injury (e. Leonardo da Vinci is the most celebrated mirror writer: it is possi- ble his left-handedness, and hence mirror writing, followed an injury to his right hand. The author Lewis Carroll occasionally wrote mirror let- ters but these differ from his normal script, unlike the situation with Leonardo whose two scripts are faithful mirror images. Carroll’s letters may thus reflect not an inherent capacity but a contrivance, designed to amuse children who corresponded with him. The device was also used by the author Arthur Ransome in his 1939 novel Secret Water. Jane Austen wrote one letter (1817) to a young niece in which script runs from right to left but with word order reversed within words (i. Various neural mechanisms are proposed to explain mirror writ- ing, including bilateral cerebral representation of language, motor pro- grams or visual memory traces or engrams. The mechanisms may differ between a true mirror writer like Leonardo and someone per- forming the task for amusement like Carroll. Double mirror writing (écriture en double miroir) is inverted top to bottom (i. Oxford: Oxford University Press, 1995: 324 - 199 - M Misidentification Syndromes McManus C. Mirror writing: Allen’s self observations, Lewis Carroll’s “looking glass” letters, and Leonardo da Vinci’s maps. Lancet 1999; 354: 2158-2161 Misidentification Syndromes These are defined as delusional conditions in which patients incor- rectly identify and reduplicate people, places, objects, or events. Examples include: Capgras syndrome; may be related to reduplicative paramnesia Fregoli syndrome Intermetamorphosis Phantom boarder sign Mirror sign References Feinberg TE, Roane DM. New York: McGraw-Hill, 1997: 391-397 Forstl H, Almeida OP, Owen AM, Burns A, Howard R. Psychiatric, neurological and medical aspects of misidentification syndromes: a review of 260 patients. Psychological Medicine 1991; 21: 905-910 Cross References Delusion; Intermetamorphosis; “Mirror sign”; Reduplicative paramnesia Misoplegia Misoplegia is a disorder of body schema in which there is active hatred of a paralyzed limb, with or without personification of the limb, and attempts to injure the paralyzed limb. It occurs with right parietal region injury (hence left sided limbs most often involved) and may occur in conjunction with anosognosia, left hemispatial neglect, and (so called) constructional apraxia. Journal of Neurology, Neurosurgery and Psychiatry 1996; 61: 210-211 Cross References Anosognosia; Apraxia; Hemiparesis; Hemiplegia; Neglect Mitbewegungen - see SYNKINESIA, SYNKINESIS Mitgehen An abnormality of induced movement, in which limb movement occurs in response to application of the slightest pressure despite the - 200 - Monoparesis, Monoplegia M patient having been told to resist (German: to go too); a manifestation of negativism. Cross References Negativism Mitmachen A motor disorder in which the patient acquiesces to every passive movement of the body made by the examiner, but as soon as the exam- iner releases the body part, the patient returns it to the resting position. Cross References Ballism, Ballismus; Hemiballismus “Monochromatopsia” The author has seen a patient with a diagnosis of frontotemporal demen- tia who persistently and consistently complained that everything he saw was red, even though he was aware that they were not red, for example his wife’s gray hair. His speech was fluent without paraphasia although impoverished in content, with recurrent themes repeated almost verbatim. Confronted with objects of different colors, he was unable to point to them by color since all appeared red to him. The features seem to be distinct from erythropsia (persistent) or phantom chromatopsia (normal visual acuity). The author proposes that this phenomenon might be termed “monochromatopsia. Monoparesis of the arm or leg of upper motor neurone type is usually cortical in origin, although may unusually arise from a cord lesion (leg more frequently than arm). Hoover’s sign and Babinski’s trunk-thigh test may be helpful in deciding whether mono- paretic/monoplegic leg weakness is of nonorganic origin; the “arm drop” or “face-hand test” in arm weakness. Peripheral disorders can sometimes present exclusively with single limb weakness, such as monomelic motor neurone disease (Hirayama disease), multifocal motor neuropathy with conduction block, and Guillain-Barré syndrome. Cross References Dysarthria; Hypophonia; Parkinsonism Moria Moria is literally folly, (as in Desiderius Erasmus’ Moriae Encomium of 1509, literally “praise of folly”).

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In (TIGR) in the technique of shotgun cloning that was employed the log phase buy 500mg cephalexin with visa, most of the bacteria in a population are growing in the sequence determination of the human genome buy cephalexin 500 mg without prescription. The resulting “library” could be expressed in ever in the closed conditions of a flask of growth medium buy cheap cephalexin 750 mg line. Subsequently cephalexin 500 mg amex, Nutrients begin to become depleted, the amount of oxygen these sequences could be reconstructed to produce the orderly becomes reduced, and the pH changes, and toxic waste prod- sequence of the actual genome. This approach proved to be ucts of metabolic activity begin to accumulate. The bacteria less expensive and quicker than the method known as directed respond to these changes in a variety of ways to do with their sequencing, where a genome was sequenced in a linear fash- structure and activity of genes. This plateau period is called the sta- human genome that have been expressed in Escherichia coli tionary phase. Here, the number of bacteria growing and by the use of BACs is now close to one million. In addition to dividing is equaled by the number of bacteria that are dying. The number of living bacteria declines sharply over With the realization of the sequence of the human time in what is called the death or decline phase. Indeed, BAC also exhibit these growth phases in different regions of a cloning kits are now available commercially for what is colony. For example, the bacteria buried in the oldest part of termed genomic profiling. Culturing of bacteria is possible such that fresh growth medium can be added at rate equal to the rate at which cul- BACTERIAL EPIDEMICS • see EPIDEMICS, BACTERIAL ture is removed. The rate at which the bacteria grow is 49 Bacterial growth and division WORLD OF MICROBIOLOGY AND IMMUNOLOGY Freeze fracture electron micrograph showing dividing Streptococcus bacteria. The division plane between the daughter cells is evident in some bacteria. The obvious events of growth and division that are Bacteria can be tailored to grow relatively slow or fast and, apparent from measurement of the numbers of living bacteria if the set-up is carefully maintained, can be maintained for a are the manifestation of a number of molecular events. Such sources include simple normal helical configuration and replicates. Nitrogen is the genetic material migrate to either end of the bacterium. Sulphur and phosphorus are also needed for the man- cisely at the middle of the bacterium. Other elements, such as as a ring from the inner surface of the membrane. When the potassium, calcium, magnesium, iron, manganese, cobalt and septum is complete, an inner wall has been formed, which zinc are necessary for the functioning of enzymes and other divides the parent bacterium into two so-called daughter bacte- processes. Bacterial division is initiated by as-yet unidentified sen- Depending on the species, bacteria exhibit a usually limited sors of either the volume or the length of the bacterium. The range in temperatures in which they can growth and repro- sensors trigger a series of events, including the formation of duce. In septum formation are number of proteins are peratures from 20°–50° C (68°–122° F). Outside this range recruited to the site where septal formation will begin. The Z-ring is analogous to a drawstring, and is likely sure, light and moisture. As well, the growth of the shape and the biochemical characteristics of the bacteria. The peptidoglycan is the Examples of protobacteria include the photosynthetic purple stress-bearing structure of a bacterium. Therefore, the inser- bacteria, Pseudomonas, and bacteria that dwell in the intes- tion of new material into the existing peptidoglycan must be tinal tract of warm-blooded animals (e. The second eubacterial kingdom is comprised of the While proteins important in bacterial growth and divi- Gram-positive bacteria.

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