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Biomedical subjects

H R Tyler

Publications and source records attributed to H R Tyler.

At least 19 recordsLinked to original sources

The shorthand publications of Sir William Richard Gowers.

OBJECTIVE: To examine the shorthand publications of Sir William Richard Gowers. BACKGROUND: Gowers developed an almost obsessional interest in Pitman shorthand. During the later part of his active career (1894-1910), the bulk of his professional writing, comprising nearly 100 articles, was printed entirely in Pitman shorthand in the Phonographic Record of Clinical Teaching and Medical Science. The obscurity and rarity of this periodical, and the increasingly arcane nature of Pitman shorthand, has left the bulk of these articles "buried in obscurity and locked up in code" (M. Critchley, 1949). DESIGN/METHODS: A complete set of Gowers' shorthand publications as listed in his standard bibliography was compiled. Transcription of the Pitman shorthand outlines was performed by a qualified Pitman shorthand transcriber and verified using the contemporaneous Phonographic Outlines of Medical Terms (1902) as an authoritative guide. RESULTS: The first transcription of Gowers' shorthand publications has now been completed. The history of Gowers' interest in shorthand and his efforts to proselytize the medical profession is reviewed. Selected excerpts are presented from his shorthand articles, which include papers devoted to problems in practical diagnosis, notes on clinical teaching, and the shorthand transcriptions of his lectures at Queen Square and at University College Hospital on such diverse subjects as myelitis, neurosyphilis, polio, muscular dystrophy, tumors, vascular disease, epilepsy, and the nervous system in old age. CONCLUSIONS: The previously unpublished transcriptions of his shorthand articles represent a major and previously inaccessible part of Gowers' neurologic opus. These articles exemplify Gowers as a practicing neurologist and teacher, and significantly expand our insights into one of neurology's most significant and influential figures.

England↗

Neurology was there in 1865.

In 1865 Americans saw the end of the Civil War, and their president, Abraham Lincoln, was assassinated. Slavery was abolished by the Thirteenth Amendment. The Atlantic cable linking Europe and the United States was completed. Bismarck and Napoleon III had a meeting resulting in Prussian supremacy in Germany. Lister had shown that antiseptic surgery was feasible and great surgical advances were made possible. Maxwell published his treatise defining the laws that related electricity to magnetism. Mendel's laws of heredity were formulated, and Pasteur saved the silk industry by curing silkworm disease. Alice in Wonderland was written by Lewis Carroll; Twain, Whitman, Homer, Inness, Wagner, and Rimsky-Korsakov all added to our cultural heritage.

History, 19th Century↗

Morton Prince.

Explore the source record for details and available documents.

Boston↗

Abnormalities in the sensory action potential in patients with amyotrophic lateral sclerosis.

Sensory function in patients with amyotrophic lateral sclerosis (ALS) is thought to be normal; however, there is convincing morphologic evidence that sensory systems are affected in addition to motor systems. In this study, compound sensory action potentials were recorded with near nerve electrodes from 18 patients with ALS. Up to 1024 responses were averaged at high gain to determine minimum conduction velocity; that is, the conduction velocity of the slowest conducting component of the sensory action potential. Nine of 18 patients had abnormally reduced minimum conduction velocity, even when peak-to-peak amplitude and maximum conduction velocity (calculated from the latency to the initial positive peak) were normal. Only 3 of 18 patients showed abnormalities in peak-to-peak amplitude. Thus, subtle abnormalities in the sensory action potential can be detected in many patients with ALS.

Action Potentials↗

Kenneth McKenzie, Harvey Cushing, and the early neurosurgical treatment of spasmodic torticollis.

In 1923, Dr. Kenneth McKenzie trained at the Peter Bent Brigham Hospital under Dr. Harvey Cushing. At that time, a patient with spasmodic torticollis came to Cushing and was treated with an innovative operation for this disorder with good results. This case sparked an interest in Dr. McKenzie, who published the case 1 year later. In reviewing the surgical histories from the Peter Bent Brigham Hospital, we have found the original records of this well-documented case. The record includes postoperative drawings of the intraoperative field by Dr. Cushing, a sketch by Dr. McKenzie illustrating the postoperative sensory examination, and pre- and postoperative photographs of the patient.

History, 20th Century↗

Trials of ganglioside therapy for amyotrophic lateral sclerosis and diabetic neuropathy.

Double blind placebo controlled trials of dialy intramuscular injections of 40 mg of mixed gangliosides were carried out in ALS and diabetic neuropathy. Forty patients with ALS were treated for six months and monitored with tests of strength and pulmonary function. No effect of gangliosides was found. Forty patients with symptomatic diabetic neuropathy will be treated for three months. Some of the data from the first 25 patients to complete the study were analyzed in a preliminary fashion. While no difference in nerve conduction studies was found in the treated group compared to the control group, there was greater symptomatic improvement in the patients treated with gangliosides.

Amyotrophic Lateral Sclerosis↗

Ganglioside therapy for amyotrophic lateral sclerosis: a double-blind controlled trial.

A 6-month double-blind study of bovine brain gangliosides was carried out in 40 patients with ALS. Thirty-two patients completed the study; 18 were treated with gangliosides and 14 with placebo. Using 10 different objective tests of muscle strength, we failed to show a significant difference between the two groups in the progression of weakness. Daily intramuscular injections of 40 mg of brain gangliosides for 6 months had no beneficial effect in ALS.

Adult↗

Charles Edouard Brown-Séquard: professor of physiology and pathology of the nervous system at Harvard Medical School.

Brown-Séquard's career as Harvard's first professor of the physiology and pathology of the nervous system is chronicled in a unique and previously unpublished series of his private letters and university archival material. At Harvard, Brown-Séquard tried to modernize the curriculum by adding laboratory exercises and animal experiments in the teaching of physiology. He dreamed of constructing a great physiologic institute to study fundamental problems in neurology, including epilepsy, paralysis, muscular atrophy, nerve injuries, and a wide variety of other problems. His letters reveal Brown-Séquard as a disarmingly "modern" professor who avoided faculty meetings, complained constantly about lecture schedules, his salary, and the improper care of his animals--and threatened to resign regularly!

History, 19th Century↗

Radicular vessels are the most probable source of needle-induced blood in lumbar puncture: significance for the thrombocytopenic cancer patient.

Despite knowledge of the bleeding hazard to thrombocytopenic cancer patients undergoing lumbar puncture (LP), a retrospective analysis of physician behavior at one hospital revealed no consistent use of platelet transfusions in patients with less than 20,000 platelets/mm3 on the day of LP. A review of the literature and laboratory cerebrospinal fluid (CSF) data in two institutions, and the performance of an LP experiment revealed that: (1) Batson's epidural venous plexus is an unlikely source and spinal radicular vessels are the most probable source of needle-induced blood in lumbar puncture; (2) the frequency of encountering needle-induced blood at LP is high, 73% (3) the frequency of brushing a nerve root, with the associated risk of lacerating the radicular artery or vein on its surface with the bevel of the LP needle, is high and may be on the order of 26%; and (4) while the passage of an LP needle, obturator in place, through a blood filled vein may carry red cells into a red cell-free medium, this does not always occur. These new considerations argue for more consistent adherence to the already published recommendation of platelet transfusion immediately prior to LP in patients with low platelets. This issue is of particular relevance to the rapidly growing population of thrombocytopenic cancer patients with extended survival on multiple chemotherapeutic regimens requiring lumbar puncture.

Adult↗

Surgical treatment of post-lumbar puncture dural CSF leak causing chronic headache. Case report.

A 58-year-old woman experienced incapacitating headache and occipital paresthesiae for 5 years after lumbar myelography. Conservative methods of treatment failed. Successive investigations for a suspected cerebrospinal fluid (CSF) leak were unrevealing. Leakage of CSF from the subarachnoid space into the epidural space in the lumbar region was finally confirmed when oil-soluble contrast material (Pantopaque), injected into the cervical subarachnoid space, was revealed by a specific technical modification to be escaping from the lumbar sac. Repair of the dural defect with dorsolumbar fascia resulted in almost complete alleviation of symptoms. This case is unusual because of the radiographic technique used, the duration of symptoms, and the rarity of reports of successful surgical treatment for this serious complication of lumbar puncture.

Cerebrospinal Fluid↗

Transmissible spongiform encephalopathy (Creutzfeldt-Jakob disease). Atypical clinical and pathological findings.

A middle-aged neurosurgeon had an 18-month illness characterized by abnormal sleep patterns, paresthesias, and necrotizing cutaneous lesions with vasculitis and signs of cerebral, brainstem, vestibulocerebellar, and progressive spinal cord involvement. Biopsy specimens of nerve and skin showed an acute vasculitis with endovascular cellular proliferation in the pattern of a Köhlmeier-Degos lesion and focal epidermal necrosis. Mental changes and cranial-nerve signs developed. Myoclonus occurred occasionally during sleep. Akinetic mutism ensued. At autopsy, major abnormalities were limited to the nervous system and skin. Spongiform encephalopathy typical of Creutzfeldt-Jakob disease was found with amyloid kuru plaques. A cribriform change distinct from the spongiform change was seen focally in the white matter. Scarred skin lesions and a healed, partially obliterative arteritis were noted. Inoculation of brain and lung into nonhuman primates resulted in a spongiform encephalopathy.

Brain Stem↗