DOCSLIB.ORG

Neven Olivari • Endocrine Ophthalmopathy Endocrine Ophthalmopathy

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Neven Olivari • Endocrine Ophthalmopathy Endocrine Ophthalmopathy Neven Olivari • Endocrine Ophthalmopathy Endocrine Ophthalmopathy Surgical Treatment Transpalpebral Decompression by Removal of Intraorbital Fat by Neven Olivari with contributions by E. Eder, D. Richter, G. Noever, G. Deutsch and B. Stark Dr. med. Neven Olivari Professor for Plastic Surgery, University of Cologne (Ret.), Chief, Department of Plastic Surgery (Ret.) Dreifaltigkeits Krankenhaus Wesseling Hohlenberg 26 53332 Bornheim, Germany Photography: Inge Goldberg, Wesseling Drawings: Neven Olivari Translation: Douglas Fear, MA, Heidelberg Language Editing: Brian D. G. Morgan, MB FRCS, London Die Deutsche Bibliothek – CIP-Einheitsaufnahme Olivari, Neven : Endocrine ophthalmopathy : surgical treatment : transpalpebral decompression by removal of intraorbital fat / by Neven Olivari. With contrib. by E. Eder… – Heidelberg : Kaden, 2001 ISBN 3-922777-35-x © 2001 Kaden Verlag, Heidelberg, Germany Typesetting: Ch. Molter, Kaden Verlag, Heidelberg, Germany Printing: Druckhaus Darmstadt, Darmstadt, Germany Binding: Buchbinderei Schaumann, Darmstadt, Germany ISBN 3-922777-35-x This book is protected by copyright. Reprinting, translation, copying of illustrations, copying by means of photomechanical devices or similar, storage in data processing systems or on electronic data storage media, as well as provision of the content in the Internet or other systems of communication only with previous written permission from the publisher. Any infringement of these rights, even in the form of excerpts, is punishable by law. The advice and recommendations contained in this book have been given by the author and the publisher according to their best knowl- edge and have been carefully checked. Nonetheless, any and all responsibility on the part of the author or the publisher is expressly dis- claimed. All liabilities for damage to persons, property or other are categorically excluded. Insofar as registered trademarks, trade names, and registered names are mentioned or used in this book, these are subject to the corre- sponding protective regulations, even when not expressly identified as such. This book is dedicated to my wife Anna-Maria and my sons Alexander and Nicolas Foreword Endocrine ophthalmopathy, or Graves disease, is a strating a technique which he has pioneered and devel- condition which, over the years, has repeatedly taxed oped over many years. To many, the method and its the ingenuity of ophthalmic surgeons and a small execution has been something of a mystery. All has group of plastic surgeons interested in this condition. now been revealed in this very clear and well produced Initially the operations were technically relatively treatise. This is undoubtedly a giant step forward in the minor but with the advent of craniofacial surgery more treatment of this condition which affects so many of major procedures were developed and performed. our patients. The book must, however, be read Unfortunately, these led to only a minimal improve- extremely carefully and even after having done this I ment in results and sometimes the complications, such would advise for those who are inexperienced to prac- as diplopia, were significant and frequent. The real tice on a cadaver, if possible, using the textbook like a problem in terms of treatment was the lack of an ade- dissection manual. Those who are experienced in quate analysis of the problem. This has now been orbital surgery, of course, will not require this but they greatly helped by more sophisticated imaging tech- must follow the step-by-step instructions provided by niques such as MRI scanning together with the aid of the author. In this way good results will be obtained three-dimensional CT scanning techniques. It has and complications avoided. now become obvious that it is the increase in conal fat We must sincerely thank Neven Olivari for pro- which seems to be the most significant factor in the ducing this publication. He has done a great service to causation of this distressing deformity. orbital surgery and to the unfortunate patients who The method described by Neven Olivari, and so suffer from the problem of endocrine ophthalmopathy. beautifully presented in this book, is logical. I am sure that this will be instrumental in many Unfortunately, when it is presented or demonstrated by patients retaining their sight who otherwise would Neven Olivari, it seems simple to execute. However, at not have done so. This may be the greatest comple- that point we are watching or listening to a master sur- ment that can be applied to this account of his lifelong geon with a huge amount of experience in all aspects study of this distressing problem. of plastic surgery but particularly in the orbit, demon- Ian T. Jackson MD, DSc (Hon), FRCS, FACS, FRACS (Hon) Institute for Craniofacial and Reconstructive Surgery Southfield, Michigan, USA Foreword Endocrine orbitopathy represents one of the main tions have decisively aided many patients. The cos- challenges in the therapy of Graves’ disease, even metic results, so important for women in their social today. Although medicational and definitive treatment surroundings, are surprisingly favourable. Professor of Graves’ hyperthyreosis by means of radioactive Olivari here summarizes his many years’ experience in iodine or surgery is effective and can be carried out particular of surgical treatment of endocrine orbitopa- with a calculable risk, the benefit for the manifestation thy, and in so doing has created a standard work for all and long-term development of endocrine orbitopathy those interested in Graves’ disease. The superb didac- has remained uncalculable to a great extent. Improved tic structure and the clear illustrations explain many diagnosis using ophthalmological examination, deter- connections much more quickly than ever so many mination of the activity score, and also imaging proce- words would do. dures has brought progress in the estimation of illness during the last few years: the severe forms of endocrine I would like to congratulate the author and the pub- orbitopathy, with their considerable physical and psy- lisher on the appearance of this extensive work, which chological impairments, remain a serious challenge can be recommended without reserve, especially to nonetheless. The progress in surgical treatment of those colleagues working in this area. endocrine orbitopathy represent a milestone here. A particularly special aspect is the transpalpebral decom- pression by means of resection of the fatty body. Prof. Dr. med. Klaus Mann Improved and optimized short- and long-term post- Director of the Endocrinological Department operative care in prospectively structured investiga- University Clinic Essen Preface The fate of patients suffering from Endocrine Oph- pression, and I recommended a clinic to him in which thalmopathy (EO) is not an easy one. The basic illness, such operations were performed. Dr. Mies was of the that is immune hyperthyroidism, can be healed in 95% opinion that he had done his homework, and refused an of cases by means of either surgery (thyreoidectomy), ossary decompression for his wife. However, he thyreostatic medication, or radioactive iodine therapy. requested that I treat his wife from the aesthetic The success of therapy for EO is modest, however. aspects, as she suffered greatly with her appearance. Conservative therapy in the acute stages improves the It was clear to me that the enormous swelling of the changes in the soft tissue area of the lids, but has eyelids could be corrected by removing fatty tissue. I hardly any influence upon the protrusion of the eye- performed a classic plastic surgical blepharoplasty. ball, visual acuity, and optic motility. According to Upon opening the orbital septum, a large quantity of optimistic estimates, exophthalmos reduces sponta- fat prolapsed outward under pressure. I removed as neously in about 10% of cases. The rate of remission is much as possible from the upper and lower lids, but probably around 5%, but only in the first 6–12 months. also from the deeper regions of the orbits. After two years at the latest, the protrusion is stable To my surprise, not only did the patient’s aesthetic and cannot be influenced by medication. situation improve, but the Hertel values were reduced. EO is a severe blow for many of the patients. They The well-known nuclear medicine specialist Dr. are affected not only by reduced visual acuity, double Mödder, also from Cologne, heard of this operation vision, and other typical symptoms of EO, but also the and asked me to operate on some of his many patients protruding eyeballs, often seems to change the facial suffering from EO, who had undergone conservative expression quite dramatically. The eyes are the centre treatment for years without benefit. He himself has of the face. Exophthalmos changes the entire face, written numerous books and many papers on thyroid indeed, frequently the entire personality. In a later illnesses. phase, patients show a certain helplessness. Once I let myself be introduced to the complexities of attractive, outgoing persons are shy and unsure of EO by him, in the course of long, friendly discussions. themselves. Such a patient develops inferiority com- After studying the literature concerning EO, anatomy, plexes and depressions; social contacts are drastically and the operative procedures hitherto applied, I decid- reduced. The patient visits his or her endocrinologist, ed to perform individual operations. ophthalmologist, and nuclear medicine specialist During the years 1985–87, a period of three
Load more

Recommended publications
  • Thomas Peel Dunhill, the Forgotten Man of Thyroid Surgery
    THOMAS PEEL DUNHILL, THE FORGOTTEN MAN OF THYROID SURGERY by I. D. A. VELLAR* THE MODERN surgeon approaches the surgery of thyrotoxicosis with confidence, the confidence derived from the excellence of modem anaesthesia, the euthyroid state of the patient and the knowledge that blood transfusion, antibiotics and the specific management of the occasional crisis are always available to extricate the patient from any of these complications. Though full of confidence in his own and others' abilities, he usually matches this by a profound ignorance of the contribution of the thyroid pioneers whose activities at the turn of the century helped to lay the foundation for the safe management of the thyrotoxic. One of these pioneers was an Australian, Thomas Peel Dunhill (fig. 1), whose contributions to thyroid surgery have been almost entirely forgotten. To understand fully the role of Dunhill, it is important to look at the position of thyroid surgery and in particular, the surgery of toxic goitre at the turn of the nineteenth century and in the first two decades of the twentieth century. It will then be possible to appreciate more fully the achievements of these thyroid pioneers, who enabled the mortality of the surgery of toxic goitre to be reduced from 30-50 per cent (it was 30 per cent at St. Thomas's Hospital, London, as recently as 1910) to a minute fraction of one per cent today. The early history of the surgery of the thyroid gland may be traced in Halsted's painstaking compilations included in his article. 'The operative story of goitre- the author's operation' in the Johns Hopkins Hospital Reports, 1920.1 However, the recognition of goitre goes back many thousands of years.
    [Show full text]
  • Trinity Medicine: 1711-2011
    TRINITY MEDICINE POISED FOR FURTHER SUCCESS For centuries, the Trinity College Dublin School of Medicine has contributed to medical education, research and practice not just in Ireland but at a global level. Eminent physicians such as William Stokes and Robert Graves not only wrote the textbooks used in medical education around the world but were the clinical researchers of their day, identifying and describing the conditions that to this day bear their names. These were the medical leaders of their time and we intend to preserve their legacy by educating and preparing exceptional doctors who can lead the profession in the 21st century. Furthermore, it is our responsibility will help improve and save the lives of academics to help us leverage the to ensure that excellence in medical many. Research in bioengineering is School’s existing strengths and to education and research at Trinity has producing new medical devices some of enhance other areas where we can a real impact on the lives of patients. which are now entering clinical trials. have major impact. In our School and teaching hospitals, with their public service ethos, we are I am committed to building on our To do this, we need the support and extremely fortunate to have world- strong traditions combined with latest involvement of a wider community and class doctors who are committed to achievements to further strengthen we hope that our alumni can lead the making a difference. At Trinity College the School’s international standing, way. The Tercentenary Board members Dublin, we are very excited about the ranking highly at a global level.
    [Show full text]
  • Graves Family Newsletter, June 1994
    -49 - June 1994 ISSN 0146-0269 Volume 17, Number 99 TTHHEE GGRRAAVVEESS FFAAMMIILLYY NNEEWWSSLLEETTTTEERR Dec. 1912 in Smith Co., KS, and died CONTENTS Christmas day, 25 Dec. 1993. Graves Family News...........................49 Address Changes ...............................49 ADDRESS CHANGES New England Graves Reunion in Mansfield, MA .................................49 Mrs. Marie Greene, descended from Tracing Your Ancestry -- Speakers at WILLIAM LYNCH GRAVES of VA & TN, the New England Reunion ..............50 has changed her P.O. Box number. Her new Graves Family Reunions ....................50 address is P.O. Box 483, Angel Fire, NM Graves Family Books..........................51 87710. Trip to England in May 1995...............51 Membership Directory Updates ..........52 Some Graves/Greaves Families of NEW ENGLAND GRAVES REUNION IN England, With Pictures....................52 MANSFIELD, MA Questions and Information..................56 Ancestor Chart of Margaret Eileen A reunion of all Graves families of New Graves of St. Mary’s Co., MD .........57 England was held on June 3-4 at the Holiday Some Descendants of Greaves of Inn in Mansfield, MA. Staffordshire, England, and George The speakers both Friday evening and Frederick Greaves ..........................59 Saturday morning were excellent. See the Descendancy Chart of Amos Graves following article for more information. and Charlotte ------ of NY ................61 People attending (with their ancestry) were: Descendants of Arthur Huntley Graves From Rear Adm. Thomas Graves of of VT ...............................................62 Charlestown: Mrs. Adeline M. Beier, Park Ancestor Charts of Herman Benton Ridge, IL; Mr. Robert Allen Greene, East Gordon of AL...................................69 Greenwich, RI; Mr. and Mrs. Vincent Hayden Ancestor Chart of Edward Douglas (Doris), West Babylon, NY. Graves of IN....................................71 Thomas Graves of Hartford, CT: Mrs.
    [Show full text]
  • Richard Bright in Guy's Hospital
    RICHARD BRIGHT OF GUY’S HOSPITAL By DeLANCEY ROCHESTER, M.D. BUFFALO, N. Y. ^~|| ■MHE latter part of the eighteenth were greatly trained. Upon his return from s and the early part of the nine- Iceland he pursued his medical studies as I teenth centuries formed the one of the medical officers of Guy’s Hospital _il , golden age in clinical medicine as where he attended lectures given by James evidenced by the remarkable activity in Currie and Astley Cooper. From the latter clinical and pathological investigations in he imbibed a sense of the value of morbid France by Pinel, who will always be held in anatomy and even at that time executed the highest regard for his work in putting a drawing of the appearance of the kidney insanity in the category of disease and in that malady in the investigation of which in treating the insane as patients in a he afterwards made himself famous. At hospital instead of as criminals; by Bichat the same time he became interested in who must be considered the founder of geology and in 1811 read a paper to the that remarkable school of pathological and Geological Society on the strata in the clinical investigation of which the two neighborhood of Bristol. shining lights were Louis and Laennec. In 1812 he returned to Edinburgh and In the so-called New Vienna School, the graduated in September of that year, the work of Wunderlich, Rokitansky and Skoda title of his graduation thesis being, “De stand out preeminently. erysipelate contagioso.” Then after two In Great Britain in the Dublin School, terms at Cambridge University he returned remarkable work was being done by John to London and studied in the public dispens­ Cheyne, Abraham Colles, Robert Adams, ary under Dr.
    [Show full text]
  • Provided by the Author(S) and University College Dublin Library in Accordance with Publisher Policies
    Provided by the author(s) and University College Dublin Library in accordance with publisher policies. Please cite the published version when available. Title The Dublin Journal of Medical and Chemical Science Catalogue Authors(s) Mullen, John; Wheelock, Harriet Publication date 2010 Series UCD Irish Virtual Research Library and Archive Research Report Series; 7 Publisher UCD Irish Virtual Research Library and Archive Item record/more information http://hdl.handle.net/10197/2487 Downloaded 2021-09-04T23:17:45Z The UCD community has made this article openly available. Please share how this access benefits you. Your story matters! (@ucd_oa) © Some rights reserved. For more information, please see the item record link above. IVRLA1 RESEARCH REPORT: THE DUBLIN JOURNAL OF MEDICAL AND CHEMICAL SCIENCE CATALOGUE John Mullen and Harriet Wheelock (Researchers) 1. CONTEXT The aim of this project is to provide a full and complete catalogue of The Dublin Journal of Medical and Chemical Science (DJMS)2 from its establishment in 1832 to 1949. DJMS is the longest established medical periodical in Ireland, and is an invaluable source for the history and development of medicine in Ireland. Amongst its contributors and editors are some of the most famous Irish medical practitioners of the nineteenth and twentieth centuries. In their survey of the literature on Irish medical history Malcolm and Jones have shown that in the past histories of medicine of Ireland have tended to be narrowly focused on institutions, biography and public health, and to be descriptive in nature (1). This project aims to open up DJMS as a source for medical historians who are developing an analytical and contextual approach to their subject, and will hopefully develop further interest in the history of Irish medical publications.
    [Show full text]
  • Walter Edwin Griesbach (1888-1968) Life and Work
    Viola Angelika Schwarz Walter Edwin Griesbach (1888-1968) Life and Work This thesis was submitted for the degree of a doctor of medicine at the “Institute of Medical History”, Eberhard-Karls-University of Tübingen/Germany, supervisor Prof. Dr. Dr. D. Goltz (grade: magna cum laude) Partly translated from German into English by John S. Dawson†, MA (NZ), PhD (Toronto), Dunedin, 2002 Edited by Andrew Brook†, D.V.Sc., Narooma, Australia Published in German by: Peter Lang GmbH, Frankfurt/Main, Germany, 1999 ISBN 3-631-34446-5 Medico Magistrali I may not expect that, from the flight of fate, years have passed me by without a trace. Each one seized the spokes of my wheel, Spun it around, stopped, and left its mark. One struck me in the gall bladder, another slowly bowed my neck, Many of them laid their hands on my face: Light spread inside me, yet the day’s beams faded. That in turn had its effect on the joints of my sole and foot, My step grew heavy, my ankle began to twist. This took the pleasure from vigorous slurping and munching, It tortured my fingers in claw-like cramp. One stroked over my hair, so that it was streaked with grey, And banished me from the daughters to the mothers. The gloss fades, just as on the antique sideboard – The dowling splits, the drawer screeches: you’re out of fashion! But stand tall, with lively spirit, when the naked whirlwind Wildly tears at old trees and clumps of branches, And invisibly my little bird cuts victoriously through the thunderous song of the giant: My bird’s heart beats powerfully, Whether it is rejoicing or afraid, for it is not made to linger in limbo.
    [Show full text]
  • The Life and Labours of Robert James Graves, M.D
    THE DUBLIN JOURNAL oF I IEDICAL SCIENCE. JANUARY 1, 1878. PART I. ORIGINAL COMMUNICATIONS. ART. I.--The Life and Labours of Robert James Graves, M.D2 By JAMES FOULIS DUNCAN, M~.D.; ex-President, King and Queen's College of Physicians, &c. MR. PRESIDENT,--I have been requested by the Committee appointed to erect a statue to the memory of the late Professor Graves to give a short account of their proceedings, now that their labours have been brought to a close, and to make a few remarks introductory to the proceedings of the day. Some four years ago Dr. Hudson, who then filled the Chair which you now so worthily occupy, on the completion of his pre- sidential career, requested the College to appropriate the then vacant space on your right to a memorial of the late Professor Graves, corresponding in character and dimensions to the other figures which now adorn this hall. This suggestion was at once cordially agreed to. Shortly afterwards a meeting was called of members of the profession and other persons likely to sympathise with the movement, when a large and influential Committee was appointed to carry out the design, Dr. Stokes and Dr. Hudson, with the late Sir W. Wilde, being appointed secretaries. And here, it is only justice to say, that the late Sir W. Wilde, whose untimely death every true-hearted Irishman must deeply lament, a An Address delivered at the unveiling of the statue of Dr. Graves in the tta]l of the College of Physicians, Wednesday, December 19, 1877. VOL.
    [Show full text]
  • Humores Y Hormonas
    Historia de las Hormonas Academia Nacional de Medicina HISTORIA DE LAS HORMONAS Más de un siglo de endocrinología 2007 ALFREDO JÁCOME ROCA INDICE 1. Glándulas y humores en la antigüedad Los cuatro humores de Hipócrates Alfredo Jácome Roca 1 Historia de las Hormonas Las primeras glándulas Patologías endocrinas en la edad antigua 2. Las enigmáticas glándulas sin conducto De los anatomistas y otros observadores Teorías filosóficas, aportes médicos Pintores de la patología endocrina Casos y teorías La hermosa voz de soprano de los castrati 3. Addison y Gull, precursores ingleses La Inglaterra de la Reina Victoria Addison y la Insuficiencia Suprarrenal Gull y el Mixedema Otros investigadores de la tiroides Aportes del Reino Unido al conocimiento de las glándulas de secreción interna 4. Enfermedades endocrinas en el siglo diecinueve Investigadores teutones Diabetes por pancreatectomía Se descubren los islotes pancreáticos Experimento pionero de Berthold Alemanes, suizos y austriacos hace aportes Cuando la medicina habló francés Francia y los conocimientos endocrinos del ochocientos Claude Bernard y el medio interno Brown-Sèquard, otro precursor de la endocrinología Pierre Marie y la acromegalia Boussingault y el bocio endémico Contribuciones de otros países 5. Las primeras hormonas Secretina y gastrina Medula suprarrenal y catecolaminas Fitohormonas La opoterapia 6. La insulina y el enorme reto de la diabetes La idea de Banting Los que –casi- descubren la insulina Por fin, la insulina McLeod Hormonas diabetogénicas El metabolismo intermediario Hipoglicemiantes orales 7. Hormonas de las suprarrenales y de la tiroides Alfredo Jácome Roca 2 Historia de las Hormonas De la cuasi-ignorancia al hallazgo de la Cortina Cortina: mezcla de compuestos esteroideos La tiroxina: aportes de Kendall y Harington Cortisona, la droga milagrosa Primeros usos de corticoides en Colombia Aldosterona y presión arterial 8.
    [Show full text]
  • The Glories of Ireland
    ,'/?^ tr'^ .^ .//-"". 1 ^ ^>vv.^ .\- '1/ UNIVERSITY OF ILLINOIS LIBRARY AT URBANA-CHAMPAIGN BOOKSTACKS Return this book on or before the Latest Date stamped below. A charge is made on all overdue books. U. of I. Library !1AR iUH 1) JAN 2 '3! 1^^ 7, 'lr f. O T^l r» DEC 03 m IM l««*f !JEtl4\<iW 9324-S THE GLORIES OF IRELAND EDITED BY JOSEPH DUNN. Ph.D.. »•> AND P. J. LENNOX, IJttD., PttOFESSORS AT THH CATHOLIC UNIVEESITT OF AMEBICA PHOENIX. UMTTED WASHINGTON. D. C. 1914 Copyright, 1914, by Phoenix, Limited All Rights Reserved ap' & TO THE IRISH RACE IN EVERY LAND 4o46i:)9 : Ireland: 'All thy life has been a symbol ; we can only read a part God will flood thee yet with sunshine for the woes that drench thy heart." John Boyle O'Reilly. PREFACE We had at first intended that this should be a book without a preface, and indeed it needs none, for it speaks in no uncer- tain tones for itself; but on reconsideration we decided that it would be more seemly to give a short explanation of our aim, our motives, and our methods. As a result of innumerable inquiries which have come to us during our experience as educators, we have been forced to the conclusion that the performances of the Irish race in many fields of endeavor are entirely unknown to most people, and that even to the elect they are not nearly so well known as they deserve to be. Hence there came to us the thought of placing on record, in an accessible, comprehensive, and permanent form, an outline of the whole range of Irish achievement dur- ing the last two thousand years.
    [Show full text]
  • Dr. Med. Carl Adolph Von Basedow – Berühmter Arzt Und Spross Einer Angesehenen Familie* Dr
    244 Von den Wurzeln unseres Fachs Dr. med. Carl Adolph von Basedow – berühmter Arzt und Spross einer angesehenen Familie* Dr. med. Carl Adolph von Basedow – Physician of Renown and Son of a Respectable Family Autor H.-D. Göring Institut Tumorzentrum Anhalt am Städtischen Klinikum Dessau e.V. Bibliografie Zusammenfassung disease“ verwendet, aber auch Autorennamen DOI http://dx.doi.org/ ! wie Parry und Flajani finden Berücksichtigung. 10.1055/s-0034-1365751 Carl Adolph von Basedow nimmt durch die Be- Basedows Erkenntnisse waren ein Meilenstein in Akt Dermatol 2014; 40: 244–250 schreibung der sogenannten Merseburger Trias der Erforschung von Schilddrüsenerkrankungen © Georg Thieme Verlag KG Stuttgart · New York (Exophthalmus, Struma, Tachykardie) bei Hyper- und regten andere Ärzte zur Fortsetzung von ISSN 0340-2541 thyreose einen dauerhaften Platz in der Medizin- Untersuchungen auf diesem Gebiet an. Auch geschichte ein. Im Ergebnis eines jahrelangen Basedows andere, etwa 60 Veröffentlichungen Korrespondenzadresse Prioritätsstreites um die Erstbeschreibung dieser über gonorrhoische Gelenkentzündungen, An- Prof. Dr. med. habil. charakteristischen Befundkonstellation hat sich thrax, Thrombophlebitis, Arsenvergiftungen so- Hans-Dieter Göring Tumorzentrum Anhalt zumindest im deutschsprachigen Raum der syno- wie chirurgische und gynäkologische Problem am Städt. Klinikum Dessau e. V. nyme Gebrauch von Morbus Basedow für das reflektieren das Tätigkeitsfeld und wissenschaftli- Auenweg 38 auch dermatologisch relevante Krankheitsbild che Interesse des aus einer angesehenen Dessauer 06847 Dessau der Schilddrüsenüberfunktion bei Ärzten und Familie stammenden praktischen Arztes, der auf [email protected] Laien eingebürgert. Im anglo-amerikanischen sich allein gestellt und ohne wesentliche Hilfsmit- Schrifttum wird vorwiegend der Begriff „Graves’ tel Hervorragendes und Bleibendes geleistet hat. Einleitung teln. Damit blieb auch das Ziel, durch das Philan- ! thropinum ständische Grenzen zu überwinden, Carl Adolph von Basedow (●" Abb.1) entstammt insgesamt Illusion.
    [Show full text]
  • Phenylindalnedione As an Anticoagulant
    BRmsH 650 MARCH 21, 1953 PHENYLlNDANEDIONE AS AN ANTICOAGULANT MEDICAL JOURNAL CLINICAL TRIAL OF Rapidity of Action and Recovery In practically all cases 200 mg. of phenylindanedione PHENYLINDALNEDIONE AS AN ((divided into two equal doses) was given in the first 24 hours, followed by 100 mg. (in two equal doses) in the next ANTICOAGULANT 24 hours. On this dosage only 6 cases out of the 68 failed reach an level in 4& BY to adequate therapeutic prothrombin hours, whilst in only one of these was the prothrombin M. TOOHEY, M.D., M.R.C.P. level above 40% at this time. In many cases in which the time was estimated at 36 hours it was found Physician, New End Hospital, London prothrombin that an adequate therapeutic level had been attained by this time. In most of the 68 cases an appreciable lowering At present dicoumarol and ethyl biscoumacetate (bis-3, of the prothrombin concentration to 50% or below was 3'-(4-oxycoumarinyl)-ethyl acetate; "tromnexan") are reached by 24 hours. the two drugs with a prothrombopenic action which are The effective action of phenylindanedione passes off fairly in common use as anticoagulants. DicoumaroL was the rapidly, and therefore the risk of cumulative effects is slight first prothrombopenic drug to come into use, but its except where very large doses are given. Twenty-four hours, there was either no or toxic effect (due, however, in many instances to indis- after stopping the drug change only a small fall in the times in those patients in crimipate heavy overdosage and also to lack of proper prothrombin whom the prothrombin had previously been maintained at control, including unreliable estimations of the pro- a full therapeutic level (10-20%) for at least several days.
    [Show full text]
  • The Electronic Version of This Text Has Been Created As a Part of the "Publishing in Irish America: 1820-1922" Project
    l > • ,I " • • .... I ~ ~ .. ~ • ., In~ltilJrd.;m Yinn_~h.,('I-.'\\tn-l ..kt'.\n:ligh . The electronic version of this text has been created as a part of the "Publishing in Irish America: 1820-1922" project that is being undertaken by the CUNY Institute for Irish-American Studies, Center for the Preservation of Irish-American Publications. Project: Publishing in IA Date Created: 08116/07 ObjectlD' 00000140 Object Name: rhe Glories of Ireland Author' Joseph Dunn & PJ, Lennox editors Date Published: 1914 Publisher' Phoenix. Limited Donor: Lehman College Librar} Funding: Metropolitan New York Librar} Council FRIENDS OF IRISH FREEDOM NATIONAL BUREAU OF INFORMATION MUNSEY BUILDING WASHINGTON, D. C. ~HE FRIENDS OF IRISH FREEDOM U take pleasure in presenting to the library a copy of "The Gloriesof Ireland" a collection of authoritative essays on Irish contributions to universal culture. Under separate cover is being sent a compli- mentary copy of a pamphlet entitled "English Atrocities in Ireland" which gives some facts of present conditions in that sorely oppressed nation. 5380 (\ .t)\SC r.pr{~ '" \ frn 1'uhlitt,ihrar~ Nwfields, N. H. Cl L1...' IS THE GLORIES OF IRELAND EDITED BY JOSEPH DUNN. Ph.D.• AND P. J. LENNOX. Litt.D.. 1'80 .. 118110•• AT THa CATHOLIC VIUVII.SITT 0 .. .&MlIIlIC.& PHOENIX. lJMITEI) 'WASHINGTON. D. c. 1914 CorBtCBT, 1914. BY PHOSlflX, LuuTIlD Au. RIGHTS tusuvm TO THE IRISH RACE IN EVERY LAND Ireland: "All thy life has been a symbol; we can ~n1y read a part: God will flood thee yet with sunshine for the woes that drench thy heart." JOHN BoYI.E O'R.J.:II.LY.
    [Show full text]