By C. Nerusul. Simpson College, Indianola Iowa.

Recognized causes of altitudinal visual field defects include: ● Monocular: Central retinal artery occlusion (CRAO) Acute ischemic optic neuropathy (AION) Retinal detachment Choroiditis Glaucoma Chronic atrophic papilledema ● Bilateral: Sequential CRAO buy amitriptyline 75 mg with visa pain medication for dogs hips, AION Bilateral occipital (inferior or superior calcarine cortices) lesions Cross References Hemianopia; Macula sparing purchase amitriptyline 25 mg on line pain treatment center hartford ct, Macula splitting; Quadrantanopia; Visual field defects Amaurosis Amaurosis is visual loss cheap amitriptyline 25mg with amex pain medication for dogs over the counter, with the implication that this is not due to refractive error or intrinsic ocular disease. The term is most often used in the context of amaurosis fugax, a transient monocular blindness, - 20 - Amnesia A which is most often due to embolism from a stenotic ipsilateral inter- nal carotid artery (ocular transient ischemic attack). Giant cell arteri- tis, systemic lupus erythematosus and the antiphospholipid antibody syndrome are also recognized causes. Gaze-evoked amaurosis has been associated with a variety of mass lesions and is thought to result from decreased blood flow to the retina from compression of the central retinal artery with eye movement. Amblyopia Amblyopia refers to poor visual acuity, most usually in the context of a “lazy eye,” in which the poor acuity results from the failure of the eye to establish normal cortical representation of visual input during the critical period of visual maturation (between the ages of six months and three years). This may result from: Strabismus Uncorrected refractive error Stimulus deprivation. Amblyopic eyes may demonstrate a relative afferent pupillary defect, and sometimes latent nystagmus. Amblyopia may not become apparent until adulthood when the patient suddenly becomes aware of unilateral poor vision. The finding of a latent strabismus (heterophoria) may be a clue to the fact that such visual loss is long-standing. The word amblyopia has also been used in other contexts: bilateral simultaneous development of central or centrocecal scotomas in chronic alcoholics has often been referred to as tobacco-alcohol ambly- opia, although nutritional optic neuropathy is perhaps a better term. Cross References Esotropia; Heterophoria; Nystagmus; Relative afferent pupillary defect (RAPD); Scotoma Amimia - see HYPOMIMIA Amnesia Amnesia is an impairment of episodic memory, or memory for per- sonally experienced events (autobiographical memory). This is a com- ponent of long-term (as opposed to working) memory, which is distinct from memory for facts (semantic memory), in that episodic memory is unique to the individual whereas semantic memory encom- passes knowledge held in common by members of a cultural or lin- guistic group. Episodic memory generally accords with the lay perception of memory, although many complaints of “poor memory” represent faulty attentional mechanisms rather than true amnesia. A precise clinical definition for amnesia has not been demarcated, per- haps reflecting the heterogeneity of the syndrome. Amnesia may be retrograde (for events already experienced) or anterograde (for newly experienced events). Retrograde amnesia may - 21 - A Amnesia show a temporal gradient, with distant events being better recalled than more recent ones, relating to the duration of anterograde amnesia. In a pure amnesic syndrome, intelligence and attention are normal and skill acquisition (procedural memory) is preserved. Amnesia may occur as one feature of more widespread cognitive impairments (e. These include the Wechsler Memory Score (WMS-R), the Recognition Memory Test which has both verbal (words) and visual (faces) subdiv- isions, the Rey Auditory Verbal Learning Test (immediate and delayed free recall of a random word list), and the Rey-Osterreith Complex Figure (nonverbal memory). Retrograde memory may be assessed with a structured Autobiographical Memory Interview and with the Famous Faces Test. Poor spontaneous recall, for example of a word list, despite an adequate learning curve, may be due to a defect in either storage or retrieval. This may be further probed with cues: if this improves recall, then a disorder of retrieval is responsible; if cueing leads to no improve- ment, or false-positive responses are equal or greater than true posi- tives, then a learning defect (true amnesia) is the cause. The neuroanatomical substrate of episodic memory is a distrib- uted system in the medial temporal lobe and diencephalon sur- rounding the third ventricle (the circuit of Papez) comprising the entorhinal area of the parahippocampal gyrus, perforant and alvear pathways, hippocampus, fimbria and fornix, mammillary bodies, mammillothalamic tract, anterior thalamic nuclei, internal capsule, cingulate gyrus, and cingulum. Basal forebrain structures (septal nucleus, diagonal band nucleus of Broca, nucleus basalis of Meynert) are also involved. Classification of amnesic syndromes into subtypes has been pro- posed, since lesions in different areas produce different deficits reflect- ing functional subdivision within the system; thus left temporal lesions produce problems in the verbal domain, right sided lesions affect non- verbal/visual memory. A frontal amnesia has also been suggested, although impaired attentional mechanisms may con- tribute. Functional imaging studies suggest medial temporal lobe acti- vation is required for encoding with additional prefrontal activation with “deep” processing; medial temporal and prefrontal activation are also seen with retrieval. Many causes of amnesia are recognized, including: ● Acute/transient: Closed head injury Drugs - 22 - Amusia A Transient global amnesia Transient epileptic amnesia Transient semantic amnesia (very rare) ● Chronic/persistent: Alzheimer’s disease (may show isolated amnesia in early disease) Sequela of herpes simplex encephalitis Limbic encephalitis (paraneoplastic or nonparaneoplastic) Hypoxic brain injury Temporal lobectomy (bilateral; or unilateral with previous contralateral injury, usually birth asphyxia) Bilateral posterior cerebral artery occlusion Korsakoff’s syndrome Bilateral thalamic infarction Third ventricle tumor, cyst Focal retrograde amnesia (rare) Few of the chronic persistent causes of amnesia are amenable to specific treatment. Plasma exchange or intravenous immunoglobulin therapy may be helpful in nonparaneoplastic limbic encephalitis associated with autoantibodies directed against voltage-gated potassium channels. Functional or psychogenic amnesia may involve failure to recall basic autobiographical details, such as name and address. Reversal of the usual temporal gradient of memory loss may be observed (but this may also be the case in the syndrome of focal retrograde amnesia). Practical Neurology 2003; 3: 292-299 Cross References Confabulation; Dementia Amusia Amusia is a loss of the ability to appreciate music despite normal intel- ligence, memory, and language function.

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In the latter case buy discount amitriptyline 25mg line pacific pain treatment center santa barbara, the unsuccessful result may not have been recorded in the literature purchase amitriptyline 75mg on-line pain medication for dogs spayed. For both these reasons generic amitriptyline 50mg with amex pain management for dogs with kidney disease, a strategy based simply on literature searching is unlikely to be competitive with the best synthetic chemists, who would, of course, use the literature to aid their synthetic designs. It may seem, then, that organic synthesis will remain a skill in which computers cannot compete with humans for some considerable time to come. Information technology enables computers to know the chemistry lit- erature better than any person, but this, in itself, is not sufficient to design syntheses of new compounds. The use of information technology, coupled with methods for the computational analysis of novel reactions, may enable computers to design better syntheses. The development of the WWW has shown that it is possible for com- puters to communicate on a global scale, and this, coupled with develop- ments in theoretical chemistry, may lead to computers making useful contributions to synthetic strategies in the near future. The internet has World champion chemists 55 been growing very rapidly, but it is unlikely to grow without limit. The Cambridge Chemistry WWW server now handles about seventy thousand requests for information each week and has been running for five years. After two years, the growth in use appeared to be approximately exponen- tial, and so it was possible to estimate how the load on the server would increase. Based on just two years of data, the general shape of the follow- ing three years of growth was predicted with surprising precision, despite the constant addition of new material and new techniques. When the growth of the internet levels off, the access to this server is also likely to level off. A recent report suggests that this may happen as early as 2003, with around fifty million computers connected together. This suggests that accessible computer power is growing at many times the Moore’s law prediction, but it is unlikely to continue to do so for very much longer. It will not give the thirty or so orders of magnitude that are required in order to solve organic synthesis by a brute force approach. The internet allows the linking of computers which are tuned for data- base searching (and which may access a world wide database of informa- tion, which is not limited by the published literature but also includes research results which are available only on the internet) with computers which are capable of calculating chemical reactivity. It is now easy for me, for example, to do different sorts of literature searches on computers in Bath, Daresbury, and in Manchester, and to analyse the data using comput- ers in Cambridge, all without leaving my office. The next step would be to allow computers which can calculate chem- ical properties to interact automatically with computers which can search the chemical literature. This would enable the literature results to be extended to the precise systems of interest for a particular synthesis. If a new alcohol is being oxidised, then the effect of the surroundings could be calculated, while the experimental protocol could be taken from the paper. The calculations would also guide the literature searching, because the calculation may suggest a side reaction which could be checked in the literature. Literature precedent may be a more reliable guide than calculation as to which of several possible reactions is likely to work best. It is only just becoming possible to use information technology to rou- tinely search the chemical literature and to do chemical calculations which are directly useful to synthetic chemists. Each of these fields is likely to develop in a powerful way in its own right over the next decades. GOODMAN However, it is the interaction between these field which gives the best chance of computers becoming the world’s best synthetic chemists. Chess is not solved, in the way the simple game noughts and crosses is solved, because the outcome of every game is not completely predict- able. In the same way, it may not be necessary for computers to analyse all possible routes to a molecule to be best at organic synthesis. This makes the problem much easier, if it is assumed that there are many good routes. The computer would begin by guessing a route, and if it did not work, partially retracing steps, and trying again, thus reusing the information which had already been gathered or calculated so far as possible. Thoroughly exploiting the information that was developed with each potential synthesis would be a crucial step. The time required for conformation searching is dramatically reduced, if similar molecules have already been investigated. For example, PM-toxin has a very compli- cated potential energy surface, which may be searched directly by tradi- tional methods, or which may be mutated from the conformation search of an alkane, which is easier as it is particularly susceptible to a genetic algorithm based approach. It depends how difficult syntheses are (and will provide a way of quantifying this).

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Brown to the After his retirement to Rhode Island amitriptyline 25mg without a prescription dna advanced pain treatment center pa, he con- Palace and thanked them for their care of the tinued his interest in teaching as a consultant at British seamen buy cheap amitriptyline 10 mg pacific pain treatment center victoria bc. Peabody received his training in orthopedic Administration Hospital in Providence amitriptyline 50mg mastercard pain treatment and management. Peabody was a Fellow of the American 1922, shortly after completing that residency College of Surgeons, a member and for several program, he accepted an invitation to join the staff years secretary of the American Orthopedic Asso- of the Henry Ford Hospital in Detroit, Michigan. He was also a member of the American He organized the department of orthopedic Academy of Orthopedic Surgeons, the Central surgery. Subsequently he became surgeon-in- Surgical Society, and the Orthopedic Correspon- chief of the Detroit Orthopedic Clinic, and was on dence Club. He published more than 50 clinical the staff of the Children’s Hospital of Michigan. Charles William Peabody, after a good and the orthopedic service at the 600-bed Harper useful life, died in the Rhode Island Hospital, Hospital, where he was successful in developing November 6, 1963, at the age of 72 years. Peabody was general surgeon of Framingham, Massachusetts; in 1926 while I was an intern at the Henry Ford two daughters, Mrs. Ann Goldthwaite of Northport, Long dic service, and I was warned by some of the Island; and a sister, Mrs. Florence Wade of senior interns that members of the house staff Baltimore. They were correct about that, but I consider my tour of duty on his service one of the most valu- able experiences of my life. Before the 2 months were up, I knew that I could only be happy in my life work as an ortho- pedic surgeon. When I was permitted the service of my choice for my second year at Ford, there 264 Who’s Who in Orthopedics Such are the bare facts, but there was much more than that. The years 1929 to 1939 were the great days of the orthopedic department of St. The force and power of Rowley Bristow, loyally assisted by George Perkins, could not be resisted and a powerful department grew up. Perkins was the “eminence grise,” the assistant surgeon in the best sense of the words, whose assistance was based on loyalty and respect. In 1948, Perkins created a professorial depart- ment of surgery out of the tattered remains of the old surgical unit. This was an extremely success- ful innovation since he was essentially a clinical surgeon who was happiest when teaching the fun- damentals of his subject in the clinic or at the George PERKINS bedside. His conception of the treatment of frac- tures is well known and continues to be practiced, 1892–1979 but when he was first teaching his method, which did not require immobilization of the fracture, it George Perkins was born on September 22, 1892, was revolutionary. He was educated at Herstmonceux Perkins had a realistic appreciation of his abil- School, Hertford College, Oxford, and St. Within 2 he was a persuasive teacher, he could not tolerate years, in the East African Campaign, he had been unquestioning adherence to tradition for its own awarded the MC and been captured by the sake and the Sister who looped a Samways tourni- Germans. After a time spent at the Military Orthopedic Hospital, Shepherds Bush, I like to imagine George Perkins today walking where he was in contact with Sir Robert Jones and (perhaps striding would be the more appropriate Naughton Dunn, he became chief assistant to word) through the Elysian Fields. He might be Rowley Bristow in the newly formed orthopedic reflecting how different they were from those at department of St. He became Lincoln’s Inn but, since he always contrived to assistant orthopedic surgeon in 1929, but in the disregard his environment, I fancy his thoughts meantime he had joined and resigned from the would be directed toward people and ideas. It took him most of the he had left behind: what had become of them war time to regain his health, but in 1944 he and, more important, what of the ideas he had joined the staff of Queen Mary’s Hospital, bequeathed to them? He succeeded Rowley Bristow in Certainly he would not have cast a single back- 1946 as head of the department in St. Thomas’ and also remained as head of the at Oxford, of his military valor in two world wars, orthopedic department until 1955, when he retired his headlong rise to fame, first as an orthopedic from the professorial unit, though continuing as surgeon, then as professor of general surgery, of orthopedic surgeon until he retired in 1957. On the contrary, he in paper panegyrics nor in stone statues; it is ideas embraced it—with enthusiasm.

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