By G. Riordian. Duquesne University. 2018.

BIOTECHNOLOGY Biotechnology For example purchase levitra super active 20mg without a prescription erectile dysfunction consult doctor, metal-polluted waste waters can be treated by encouraging the vigorous growth of certain types of vascular The word biotechnology was coined in 1919 by Karl Ereky to plants discount levitra super active 40 mg amex erectile dysfunction weed. This bioremediation system, also known as phytore- apply to the interaction of biology with human technology. Accurately, biotechnol- then be harvested to remove the metals from the system. Decreasing the aqueous concentrations of toxic change in the last half century. Modern biotechnology is 74 WORLD OF MICROBIOLOGY AND IMMUNOLOGY Bioterrorism greatly based on recent developments in molecular biology, attempt at producing live animals by embryo cloning was especially those in genetic engineering. Organisms from bac- reported by a research group in Scotland on March 6, 1997. Also, new methods of disease gene ponent of biotechnology, it is not alone. Biotechnology has isolation, analysis, and detection, as well as gene therapy, been used by humans for thousands of years. First, scientists decide the changes to be occur because of the process of fermentation. It is desirable in some seventeenth century, bacteria were used to remove copper cases to alter a human DNA molecule to correct errors that from its ores. Around 1910, scientists found that bacteria result in a disease such as diabetes. In other cases, researchers could be used to decompose organic matter in sewage. A might add instructions to a DNA molecule that it does not method that uses microorganisms to produce glycerol synthet- normally carry: instructions for the manufacture of a chemi- ically proved very important in the World War I since glycerol cal such as insulin, for example, in the DNA of bacteria that is essential to the manufacture of explosives. Scientists also mod- See also Fermentation; Immune complex test; Immunoelec- ify existing DNA to correct errors or add new information. Finally, scientists nologic therapies; Immunological analysis techniques; look for a way to put the recombinant DNA molecule into the Immunosuppressant drugs; In vitro and in vivo research organisms in which it is to function. Once inside the organ- ism, the new DNA molecule give correct instructions to cells in humans to correct genetic disorders, in bacteria (resulting in the production of new chemicals), or in other types of cells BBioterrorismIOTERRORISM for other purposes. Bioterrorism is the use of a biological weapon against a civil- Genetic engineering has resulted in a number of impres- ian population. Dozens of products that were once include the undermining of morale, creating chaos, or achiev- available only from natural sources and in limited amounts are ing political goals. Biological weapons use microorganisms now manufactured in abundance by genetically engineered and toxins to produce disease and death in humans, livestock, microorganisms at relatively low cost. In addition, the first trials with the alteration of used to achieve similar destructive goals, but unlike chemical human DNA to cure a genetic disorder began in 1991. They are easy to trans- on a daily basis to replicate various genetic materials such as port and resist detection by standard security systems. The process of molecular cloning general, chemical weapons act acutely, causing illness in min- involves isolating a DNA sequence of interest and obtaining utes to hours at the scene of release. For example, the release multiple copies of it in an organism that is capable of growth of sarin gas by the religious sect Aum Shinrikyo in the Tokyo over extended periods. Large quantities of the DNA molecule subway in 1995 killed 12 and hospitalized 5,000 people. In can then be isolated in pure form for detailed molecular analy- contrast, the damage from biological weapons may not sis. The ability to generate virtually endless copies (clones) of become evident until weeks after an attack. If the pathogenic a particular sequence is the basis of recombinant DNA tech- (disease-causing) agent is transmissible, a bioterrorist attack nology and its application to human and medical genetics. Positional cloning is a rela- Bioterrorism can also be enigmatic, destructive, and tively new approach to finding genes. A particular DNA costly even when targeted at a relatively few number of indi- marker is linked to the disease if, in general, family members viduals.

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A shorter skin incision is made and similar muscle dissection down to the joint is performed purchase levitra super active 40 mg on-line impotence of proofreading poem. They wanted to assess the accuracy and reproducibility of implantation discount levitra super active 20mg free shipping erectile dysfunction at 30, determine if obesity influenced the outcome and technique, and compare operative and post- operative outcomes. They found that the advantages of MIS were that the patients had a decreased transfusion requirement, had a better functional recovery, ambulated significantly earlier, required significantly less transfer assistance, and required sig- nificantly less skilled nursing care after discharge. There was no difference in the accuracy of implant positioning, and obesity did not adversely alter patients’ opera- tive approach or outcome. Posterior Approach Technique This “mini-incision” posterior approach is the most commonly used less-invasive surgical technique for total hip replacement. The less-invasive posterior approach involves a 10-cm oblique incision which, unlike the two-incision approach, is non- proprietary (Figs. Cemented or cementless prostheses can be implanted through this approach implant malpositioning hip. Acetabular socket retroversion (or varus posi- tioning of the femoral stem) are more common with this approach (Figs. Mean hospital stay was 3 days with 87% of patients discharged to their own home, the remaining 13% to a rehabili- tation facility. Results of computer navigation in association with a mini-incision posterior approach technique were reported by DiGioia et al. He found that the mini-incision group had less limp and better stair-climbing at 3 months, and less limp and improved stair-climbing and distance walked at 6 months. This report included a randomized trial in which 22 patients with a mean inci- sion length of 8cm were compared to 24 patients with a standard 15-cm incision. Complications encountered were 4 dislocations, 1 femoral fracture, 2 neuropraxias, and 2 wound haematomas. Conclusion The evidence to date in support of minimally invasive total hip arthroplasty is not convincing. Current practice of this technique requires careful patient selection, a body mass index less than 30, and a routine uncomplicated total hip arthroplasty. Intraoperative soft tissue balancing is important to prevent dislocation, as is the use of larger femoral heads (32 or 36mm), lipped acetabular liners, and cross-linked polyethylene. The interest in minimally invasive total hip replacement is growing and will con- tinue to grow. It has sparked a reevaluation of all aspects of hip replacement surgery: reduction and management of postoperative pain, minimization of blood loss, reduc- tion in length of hospital stay, promotion of earlier rehabilitation, and improved cosmesis. Most surgeons recognize that the potential for complications increases with the limited exposure that is afforded by MIS techniques [16,17]. Advocates of less-inva- sive procedures suggest that the marriage of the technologies of MIS and computer- assisted surgery may be the future. This is a reasonable hypothesis, but computer navigation adds an additional complexity and cost to the operative procedure. Careful review of component positioning following minimally/less-invasive tech- niques shows greater acetabular cup retroversion and femoral stem placement in 190 C. Clinical photograph of right hip scar following MIS posterior approach varus (Figs. Several authors have reported increased implant malposition when a minimally invasive technique was undertaken. The National Institute of Clinical Excellence (NICE) is an independent British organization responsible for providing national guidance on promotion of good health and prevention and treatment of ill health. It has published guidance on mini- mally invasive hip arthroplasty, which recommends that “there is insufficient evi- dence on the safety and efficacy of the two-incision technique for it to be performed without special arrangement for consent, audit or research”. Guidance on single mini-incision hip replacement recommends that “there may be benefits to this pro- cedure but it should only be used in appropriately selected patients by clinicians with adequate training in the technique”. Bourne Despite its purported popularity among surgeons, a minimally invasive approach for total hip arthroplasty surgery is performed by less than 10% of surgeons in Canada. The initial enthusiasm for minimally invasive total hip arthroplasty seems to be waning due to less-precise component positioning and the greater risk of complica- tions associated with this technique. Berry DJ, Berger RA, Callaghan JJ, et al (2003) Minimally invasive total hip arthro- plasty.

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From the inner surface of this into it generic 40 mg levitra super active mastercard injections for erectile dysfunction, it contracted and forced up the matter order levitra super active 40 mg otc erectile dysfunction drugs walgreens. The cyst there projected a solid tumour, which appeared to patient was well from that time; the wound healing very be made up of numerous folds giving it a plicated favourably, and he has never had any return of the appearance, covered by membranes continuous with disease... When the tibia is enlarged from a deposit that lining the cyst; and when cut into, it looked like of bone externally—when there is excessive pain, such very slightly organized fibrine... The disease, as I as may be supposed to depend on extreme tension, the have said before; is not cancerous; but still it should pain being aggravated at intervals, and these symptoms be removed; because if allowed to remain, the local continue and become aggravated, not yielding to med- irritation will destroy the life of the patient; and if icines or other treatment that may be had recourse to— removed, it will not return. If you operate at all, you then you may reasonably suspect the existence of must remove the whole of the breast, for it is no use abscess in the centre of the bone. It is better to perform the suppose, that there is no abscess because the pain is not operation whilst the tumour is small; nevertheless you 44 Who’s Who in Orthopedics are not to be deterred by its magnitude, because it is reached the climax of his career when he was not in this disease as in carcinoma; there is, in fact, no elected President of the Royal Society, a position danger: and I have seen a great many cases where the he filled with dignity and distinction. It was par- operation has been performed and the disease has never ticularly gratifying to him that his heir occupied returned... I have given no name to this affection the chair of the Chemical Society at the same time because I think, it is an error of modern times to be con- and that he had previously been awarded the tinually giving new names to diseases, but if it must have a name, I think it should be called sero-cystic Royal Medal of the Royal Society. In his last years Brodie wrote a short work on metaphysics entitled Psychological Inquiries. It bears the influence of Berkeley and is cast in the Interest in Medical Education form of a dialogue; it first appeared in 1854 and passed through four editions. He treats the ques- Next to his interest in diseases of joints, Brodie tion of the existence and creative energy of God gave a good deal of attention to maladies of the as settled and teaches that mind and matter are urinary system. In pre-antiseptic days, lithotomy different in their nature, so that mental phenom- was not without serious risks; to avoid them ena cannot be regarded as the product of material Civiale introduced lithotrity. He attributes great importance to the appreciate the greater safety of this procedure and imagination and its training by education; the pos- took a leading part in England in advocating session of this great faculty distinguishes man lithotrity in place of lithotomy. All philosophies rest on at Betchworth, Surrey, which he purchased in certain assumptions and one such for Brodie was 1837. Furthermore, he gave more attention to “the existence of one’s own mind is the only thing medical education and reform, both of which had of which one has any positive and actual knowl- always interested him. The object of this institution was “to unto himself, to find out his own deficiencies and insure the introduction into the profession of a endeavour to correct them, to doubt his own observations until they are carefully verified. By this though not perhaps handsome; his frame was instrument all power of election was vested in the slight and small but he had consuming energy. In Fellows; retention of office for life by examiners private life he was known for his playful humor and members of Council was abolished; the and fund of anecdote. As a lecturer “none who offices of president and vice-president were heard him can forget the graphic yet artless restricted to members of the Court of Examiners. A reg- leading surgeon in England, added to which he ister was to be established of persons holding a had more intimate contact with leaders of science diploma or license from a licensing body after and literature. Brodie was chosen to be the first a rare combination of surgeon, scientist and president of this Council. He had a Hunterian attitude towards 45 Who’s Who in Orthopedics surgery in that he regarded scientific research to be the handmaid of practice. He made a lasting contribution towards medical education whereby preliminary instruction in the arts and professional training were greatly improved. By his advocacy of reform of the Royal College of Surgeons, he helped to raise its status as a gov- erning body and enhanced the quality of those whom it approved to practice surgery. For the last few years of his life he suffered from double cataract, for the relief of which Sir William Bowman operated. In July 1862, he began to complain of pain in his right shoulder, caused by malignant disease; he died on October 21. Twenty-eight years before, he had fallen from a pony and dislocated this joint. British Journal of Surgery (1918) Sir Benjamin Gurdon Buck was a New Yorker, born on Fulton Collins Brodie. After graduating from the Nelson Classical Brodie’s Tumour, and Brodie’s Abscess.

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Generalized spikes buy 20 mg levitra super active with amex erectile dysfunction treatment washington dc, and in some patients multifocal spikes cheap levitra super active 20 mg amex impotence kidney stones, can be seen throughout the recording. Neuropsychologic Disturbances Mental retardation is almost universal in LGS, with fewer than 10% of patients pre- serving near-normal intellectual functioning. Children may appear normal or near normal at onset with an abrupt deterioration following the onset of uncontrolled sei- zures, or may have a preceding encephalopathy, including infantile spasms. Overall, cognition progressively deteriorates, compounded by repeated trauma from falls and the effects of multiple anticonvulsants. Behavior problems abound and include autis- tic spectrum disorders, aggressiveness, and hyperactivity. EVALUATION—ETIOLOGY The differentiation of LGS from other catastrophic onset childhood epilepsies is important for prognosis and management. The seizure pattern may not appear char- acteristic initially and suggestive EEG patterns may not appear for several months. Therefore, it is not unreasonable to pursue diagnostic testing that may be suggested by the individual’s presentation—for example, that of progressive myoclonic epi- lepsy in a patient in whom the initial presentation includes myoclonic seizures. Very few patients with LGS, however, have documented abnormalities of metabolism. Concerns that LGS may be related to a developmental channelopathy or be an immune-mediated process have yet to be substantiated. In some series, 17–30% of patients with LGS have a history of infantile spasms. Therefore, central nervous system insults known to predispose to infantile spasms have been implicated in the pathogenesis of LGS. These include congenital infec- tions, sequela of neonatal hypoglycemia, hypoxic–ischemic encephalopathy, and traumatic brain injury. Lennox–Gastaut Syndrome 81 Structural abnormalities are the most common underlying etiology of sympto- matic LGS. Rarely, brain tumors have been known to cause LGS, although this raises the difficulty of differentiating true LGS from secondary bilateral synchrony. Tuberous sclerosis or other neurocutaneous syndromes are found in children with LGS, but not as frequently as in association with infantile spasms. Developmental brain malformations are the most common structural lesion to be reported in LGS, especially subcortical band heterotopia, bilateral perisylvian syndrome, and focal cortical malformations. It is therefore important to perform magnetic reso- nance imaging when considering the diagnosis of LGS, as there are reported cases of seizure reduction with focal surgical resection of lesions. Other types of neuroima- ging, including PET and SPECT scans, have not been uniformly helpful and are cur- rently better research than diagnostic tools. The majority of cases of LGS remain cryptogenic despite extensive metabolic evaluation and neuroimaging. Evaluation aimed at maximizing supportive care, such as neuropsychological assessment to identify baseline neurodevelopmental state and aid in appropriate educational placement are also important. It is helpful to differentiate LGS from other seizure syndromes, especially from myoclonic astatic epilepsy (Doose syndrome), that may have a more favorable prog- nosis. Children with myoclonic astatic epilepsy have the occurrence of multiple types of generalized seizures suggestive of LGS (i. However, it is always idiopathic, axial tonic seizures are rare or absent, onset is younger than in LGS (typically between 18 months and 4 years), EEG demonstrates photosensitivity, and there is a strong genetic predisposition. Prognosis for seizure control and devel- opmental outcome is more benign than in LGS. Similarly, an entity named atypical benign partial epilepsy of childhood occurs in children between 2 and 6 years, with prominent nocturnal partial seizures, myoclonic, and atonic seizures without tonic seizures. Electroencephalogram is remarkable for diffuse slow spike and wave in sleep and 3-Hz spike wave in the waking record. Seizures remit in late childhood in most patients and developmental regression is limited. Other seizure types that may be mistaken for LGS include frontal lobe epilepsy and multifocal epilepsy with rapid propagation. TREATMENT The therapy of LGS is disappointing, complicated by the variety of seizure types and the occasional worsening of seizure control and cognitive functioning with polyphar- macotherapy. Carbamazepine and phenytoin may exacerbate atypical absence and atonic seizures.

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