Orthopedic surgery or orthopedics spelled orthopaedics, is the branch of surgery concerned with conditions involving the musculoskeletal system. Orthopedic surgeons use both surgical and nonsurgical means to treat musculoskeletal trauma, spine diseases, sports injuries, degenerative diseases, infections and congenital disorders. Nicholas Andry coined the word in French as orthopédie, derived from the Ancient Greek words ὀρθός orthos and παιδίον paidion, published Orthopedie in 1741; the word was assimilated into English as orthopædics. Though, as the name implies, the discipline was developed with attention to children, the correction of spinal and bone deformities in all stages of life became the cornerstone of orthopedic practice; as with many words derived with the "æ" ligature, simplification to either "ae" or just "e" is common in North America. In the US, the majority of college and residency programs, the American Academy of Orthopaedic Surgeons, still use the spelling with the digraph ae, though hospitals use the shortened form.
Elsewhere, usage is not uniform: in Canada, both spellings are acceptable. Many developments in orthopedic surgery have resulted from experiences during wartime. On the battlefields of the Middle Ages the injured were treated with bandages soaked in horses' blood which dried to form a stiff, but unsanitary, splint; the term orthopedics meant the correcting of musculoskeletal deformities in children. Nicolas Andry, a professor of medicine at the University of Paris coined the term in the first textbook written on the subject in 1741, he advocated the use of exercise and splinting to treat deformities in children. His book was directed towards parents, while some topics would be familiar to orthopedists today, it included'excessive sweating of the palms' and freckles. Jean-André Venel established the first orthopedic institute in 1780, the first hospital dedicated to the treatment of children's skeletal deformities, he developed the club-foot shoe for children born with foot deformities and various methods to treat curvature of the spine.
Advances made in surgical technique during the 18th century, such as John Hunter's research on tendon healing and Percival Pott's work on spinal deformity increased the range of new methods available for effective treatment. Antonius Mathijsen, a Dutch military surgeon, invented the plaster of Paris cast in 1851. However, up until the 1890s, orthopedics was still a study limited to the correction of deformity in children. One of the first surgical procedures developed was percutaneous tenotomy; this involved cutting a tendon the Achilles tendon, to help treat deformities alongside bracing and exercises. In the late 1800s and first decades of the 1900s, there was significant controversy about whether orthopedics should include surgical procedures at all. Examples of people who aided the development of modern orthopedic surgery were Hugh Owen Thomas, a surgeon from Wales, his nephew, Robert Jones. Thomas became interested in orthopedics and bone-setting at a young age and, after establishing his own practice, went on to expand the field into general treatment of fracture and other musculoskeletal problems.
He advocated enforced rest as the best remedy for fractures and tuberculosis and created the so-called'Thomas Splint', to stabilize a fractured femur and prevent infection. He is responsible for numerous other medical innovations that all carry his name:'Thomas's collar' to treat tuberculosis of the cervical spine,'Thomas's manoeuvre', an orthopedic investigation for fracture of the hip joint, Thomas test, a method of detecting hip deformity by having the patient lying flat in bed,'Thomas's wrench' for reducing fractures, as well as an osteoclast to break and reset bones. Thomas's work was not appreciated in his own lifetime, it was only during the First World War that his techniques came to be used for injured soldiers on the battlefield. His nephew, Sir Robert Jones, had made great advances in orthopedics in his position as Surgeon-Superintendent for the construction of the Manchester Ship Canal in 1888, he was responsible for the injured among the 20,000 workers, he organized the first comprehensive accident service in the world, dividing the 36 mile site into 3 sections, establishing a hospital and a string of first aid posts in each section.
He had the medical personnel trained in fracture management. He managed 3,000 cases and performed 300 operations in his own hospital; this position enabled him to improve the standard of fracture management. Physicians from around the world came to Jones’ clinic to learn his techniques. Along with Alfred Tubby, Jones founded the British Orthopaedic Society in 1894. During the First World War, Jones served as a Territorial Army surgeon, he observed that treatment of fractures both at the front and in hospitals at home was inadequate, his efforts led to the introduction of military orthopedic hospitals. He was appointed Inspector of Military Orthopaedics, with responsibility over 30,000 beds; the hospital in Ducane Road, Hammersmith became the model for both British and American military orthopedic hospitals. His advocacy of the use of Thomas splint for the initial treatment of femoral fractures reduced mortality of compound fractures of the femur from 87% to less than 8% in the period from 1916 to 1918.
The use of intramedullary rods to treat fractures of the femur and tibi
Intensive care medicine
Intensive care medicine, or critical care medicine, is a branch of medicine concerned with the diagnosis and management of life-threatening conditions that may require sophisticated life support and intensive monitoring. Patients requiring intensive care may require support for cardiovascular instability lethal cardiac arrhythmias, airway or respiratory compromise, acute renal failure, or the cumulative effects of multiple organ failure, more referred to now as multiple organ dysfunction syndrome, they may be admitted for intensive/invasive monitoring, such as the crucial hours after major surgery when deemed too unstable to transfer to a less intensively monitored unit. Medical studies suggest a relation between ICU volume and quality of care for mechanically ventilated patients. After adjustment for severity of illness, demographic variables, characteristics of the ICUs, higher ICU volume was associated with lower ICU and hospital mortality rates. For example, adjusted ICU mortality was 21.2% in hospitals with 87 to 150 mechanically ventilated patients annually, 14.5% in hospitals with 401 to 617 mechanically ventilated patients annually.
Hospitals with intermediate numbers of patients had outcomes between these extremes. ICU delirium and inaccurately referred to as ICU psychosis, is a syndrome common in intensive care and cardiac units where patients who are in unfamiliar, monotonous surroundings develop symptoms of delirium; this may include interpreting machine noises as human voices, seeing walls quiver, or hallucinating that someone is tapping them on the shoulder. There exists systematic reviews in which interventions of sleep promotion related outcomes in the ICU have proven impactful in the overall health of patients in the ICU. In general, it is the most expensive, technologically advanced and resource-intensive area of medical care. In the United States, estimates of the 2000 expenditure for critical care medicine ranged from US$15–55 billion. During that year, critical care medicine accounted for 0.56% of GDP, 4.2% of national health expenditure and about 13% of hospital costs. In 2011, hospital stays with ICU services accounted for just over one-quarter of all discharges but nearly one-half of aggregate total hospital charges in the United States.
The mean hospital charge was 2.5 times higher for discharges with ICU services than for those without. Intensive care takes a system-by-system approach to treatment; as such, the nine key systems are each considered on an observation-intervention-impression basis to produce a daily plan. In addition to the key systems, intensive care treatment raises other issues including psychological health, pressure points and physiotherapy, secondary infections. In alphabetical order, the nine key systems considered in the intensive care setting are: cardiovascular system, central nervous system, endocrine system, gastro-intestinal tract, integumentary system, microbiology and respiratory system. Intensive care is provided in a specialized unit of a hospital called the intensive care unit or critical care unit. Many hospitals have designated intensive care areas for certain specialities of medicine, such as the coronary intensive care unit for heart disease, medical intensive care unit, surgical intensive care unit, pediatric intensive care unit, neuroscience critical care unit, overnight intensive-recovery, shock/trauma intensive-care unit, neonatal intensive care unit, other units as dictated by the needs and available resources of each hospital.
The naming is not rigidly standardized. For a time in the early 1960s, it was not clear that specialized intensive care units were needed, so intensive care resources were brought to the room of the patient that needed the additional monitoring and resources, it became evident, that a fixed location where intensive care resources and dedicated personnel were available provided better care than ad hoc provision of intensive care services spread throughout a hospital. Common equipment in an intensive care unit includes mechanical ventilation to assist breathing through an endotracheal tube or a tracheotomy. Critical care medicine is an important medical specialty. Physicians with training in critical care medicine are referred to as intensivists. In the United States, the specialty requires additional fellowship training for physicians having completed their primary residency training in internal medicine, anesthesiology, surgery or emergency medicine. US board certification in critical care medicine is available through all five specialty boards.
Intensivists with a primary training in internal medicine sometimes pursue combined fellowship training in another subspecialty such as pulmonary medicine, infectious disease, or nephrology. The American Society of Critical Care Medicine is a well-established multiprofessional society for practitioners working in the ICU including nurses, respiratory therapists, physicians. Most medical research has demonstrated that ICU care provided by intensivists produces better outcomes and more cost-effective care; this has led the Leapfrog Group
General surgery is a surgical specialty that focuses on abdominal contents including esophagus, small bowel, liver, gallbladder and bile ducts, the thyroid gland. They deal with diseases involving the skin, soft tissue, peripheral vascular surgery and hernias and perform endoscopic procedures such as gastroscopy and colonoscopy. General surgeons may sub-specialize into one or more of the following disciplines: In many parts of the world including North America and the United Kingdom, the overall responsibility for trauma care falls under the auspices of general surgery; some general surgeons obtain advanced training in this field and specialty certification surgical critical care. General surgeons must be able to deal with any surgical emergency, they are the first port of call to critically ill or gravely injured patients, must perform a variety of procedures to stabilize such patients, such as thoracostomy, cricothyroidotomy, compartment fasciotomies and emergency laparotomy or thoracotomy to stanch bleeding.
They are called upon to staff surgical intensive care units or trauma intensive care units. All general surgeons are trained in emergency surgery. Bleeding, bowel obstructions and organ perforations are the main problems they deal with. Cholecystectomy, the surgical removal of the gallbladder, is one of the most common surgical procedures done worldwide; this is most done electively, but the gallbladder can become acutely inflamed and require an emergency operation. Infections and rupture of the appendix and small bowel obstructions are other common emergencies; this is a new specialty dealing with minimal access techniques using cameras and small instruments inserted through 3 to 15mm incisions. Robotic surgery is now evolving from this concept. Gallbladders and colons can all be removed with this technique. Hernias are able to be repaired laparoscopically. Bariatric surgery can be performed laparoscopically and there a benefits of doing so to reduce wound complications in obese patients. General surgeons that are trained today are expected to be proficient in laparoscopic procedures.
General surgeons treat a wide variety of major and minor colon and rectal diseases including inflammatory bowel diseases, diverticulitis and rectal cancer, gastrointestinal bleeding and hemorrhoids. General surgeons perform a majority of all non-cosmetic breast surgery from lumpectomy to mastectomy pertaining to the evaluation and treatment of breast cancer. General surgeons can perform vascular surgery if they receive special training and certification in vascular surgery. Otherwise, these procedures are performed by vascular surgery specialists. However, general surgeons are capable of treating minor vascular disorders. General surgeons are trained to remove all or part of the thyroid and parathyroid glands in the neck and the adrenal glands just above each kidney in the abdomen. In many communities, they are the only surgeon trained to do this. In communities that have a number of subspecialists, other subspecialty surgeons may assume responsibility for these procedures. Responsible for all aspects of pre-operative and post-operative care of abdominal organ transplant patients.
Transplanted organs include liver, kidney and more small bowel. Surgical oncologist refers to a general surgical oncologist, but thoracic surgical oncologists, gynecologist and so forth can all be considered surgeons who specialize in treating cancer patients; the importance of training surgeons who sub-specialize in cancer surgery lies in evidence, supported by a number of clinical trials, that outcomes in surgical cancer care are positively associated to surgeon volume—i.e. The more cancer cases a surgeon treats, the more proficient he or she becomes, his or her patients experience improved survival rates as a result; this is another controversial point, but it is accepted—even as common sense—that a surgeon who performs a given operation more will achieve superior results when compared with a surgeon who performs the same procedure. This is true of complex cancer resections such as pancreaticoduodenectomy for pancreatic cancer, gastrectomy with extended lymphadenectomy for gastric cancer.
Surgical oncology is a 2 year fellowship following completion of a general surgery residency. Most cardiothoracic surgeons in the U. S. first complete a general surgery residency, followed by a cardiothoracic surgery fellowship. Pediatric surgery is a subspecialty of general surgery. Pediatric surgeons do surgery on patients age lower than 18. Pediatric surgery is 5 -- 7 years of a 2-3 year fellowship. In the 2000s minimally invasive surgery became more prevalent. Considerable enthusiasm has been built around robot-assisted surgery, despite a lack of data suggesting it has significant benefits that justify its cost. In Canada, New Zealand, the United States general surgery is a five to seven year residency and follows completion of medical school, either MD, MBBS, MBChB, or DO degrees. In Australia and New Zealand, a residency leads to eligibility for Fellowship of the Royal Australasian College of Surgeons. In Canada, residency leads to eligibility for certification by and Fellowship of the Royal College of Physicians and Surgeons of Canada, while in the United States, completion of a residency in general surgery leads to eligibility for board certification by the
The Carbuncle Cup is an architecture prize, given annually by the magazine Building Design to "the ugliest building in the United Kingdom completed in the last 12 months". It is intended to be a humorous response to the prestigious Stirling Prize, given by the Royal Institute of British Architects; the cup was launched in 2006, with the first winner being Drake Circus Shopping Centre in Plymouth by Chapman Taylor. A shortlist is announced by the periodical each year, based on nominations from the public, in the same week as the Stirling Prize shortlist. Free voting via the magazine's website was at first used to select the winner. Since 2009 a small group of critics has selected the winner; the award was inspired by the Carbuncle Awards of Scottish architecture magazine Urban Realm Prospect, had been presenting to buildings and areas in Scotland since 2000. The names derive from a comment by Charles, Prince of Wales, an opponent of certain modernist styles and forms and a staunch defender of existing characterisations and points of interest, who in 1984 described Ahrends and Koralek's proposed extension of London's National Gallery as a "monstrous carbuncle on the face of a much-loved and elegant friend"
Drake Circus Shopping Centre
Drake Circus Shopping Centre is a 425,000-square-foot covered shopping mall in the centre of Plymouth, which opened in October 2006. The new building was designed by London-based architects Chapman Taylor and built by Bovis Lend Lease. Situated behind the ruined Charles Church, preserved as the city's civilian war memorial, the building provoked a mixed reception. Just after it opened, the shopping centre won the inaugural Carbuncle Cup "for crimes against architecture", as the worst new building in the United Kingdom. In 2007 it won two retail industry national awards, one of, the Retail Week magazine's "Shopping Location of the Year"; the term'circus' as used here refers to an open space circular, where a number of roads meet. Drake Circus was a large oval roundabout built in the early 20th century at the junction of four main roads and several minor ones; the roundabout consisted of Edwardian buildings housing shops, from 1937 its south end carried the "Guinness Clock", visible to people travelling up Old Town Street and was a landmark in the city of the time.
The circus survived the Plymouth Blitz of World War II intact, but it was demolished in 1966-7 as part of the Plan for Plymouth, was replaced by a new open roundabout to the north. Around this time the lower section of the main road to Tavistock off this new roundabout was renamed Drake Circus. A two-level shopping centre with open malls and a large C&A store was built over the site of the original circus, it opened in 1971 and was named Drake Circus. Initial proposals to redevelop this mall in the early 1990s failed, but the developers, P&O Estates, tried again in the early 2000s. Plans were drawn up for a much larger centre, after Allders signed up as the first "anchor" tenant in 2001, work started in February 2004 on demolishing the old centre and the adjoining Charles Street multi-storey car park; the scheme suffered a setback in January 2005. New tenants Next and Primark committed in 2005 and the building opened in October 2006. On 3 February 2005 it was announced that the shopping centre had been sold by P&O Estates to Morgan Stanley Real Estate Fund for £55m.
On 20 November 2006 it was announced that Kandahar Real Estate had taken a 50 per cent stake in the centre. The centre was bought by British Land for £240 million in January 2011. In 2007, the centre's management introduced a code of conduct which, like one the Bluewater centre introduced in 2005, banned hooded tops and baseball caps. Official website BBC Devon special feature on Drake Circus
Robert Liston was a pioneering Scottish surgeon. Liston was noted for his skill in an era prior to anaesthetics, when speed made a difference in terms of pain and survival, he was the son of Margaret Ireland and Scottish clergyman and inventor Henry Liston, whose father—Robert Liston—was the Moderator of the General Assembly of the Church of Scotland. Liston received his education at the University of Edinburgh, became first'The Great Northern Anatomist' of Blackwell's Magazine, in 1818 became a surgeon in The Royal Infirmary of Edinburgh. In 1832/1833 he is listed as living at 99 George Street in the centre of Edinburgh's New Town, he lived from 1840 to 1847 at 5 Clifford Street, off Bond Street in Mayfair, in a building and area now of historical significance, hence Richard Gordon's specific mention of this address in his section on Robert Liston. Liston's legacy comprises both that which has made its way into the popular culture, that found within the medical fraternity and related disciplines.
In 1837, he published Practical Surgeries arguing the importance of quick surgeries. Following Liston's death, a meeting was held of his friends and admirers, who "unanimously resolved to establish some public and lasting Testimonial to the memory of this distinguished surgeon". A committee of some 78 people was formed, which resolved that the testimonial should consist of a marble statue to be placed in some designated public spot, the inauguration of a Gold Medal, to be called the "Liston Medal", "and awarded annually, as the Council of University College, may decide". Richard Gordon describes Liston as "the fastest knife in the West End, he could amputate a leg in 21⁄2 minutes". Indeed, he is reputed to have been able to complete operations in a matter of seconds, at a time when speed was essential to reduce pain and improve the odds of survival of a patient. In Florence Nightingale's Notes on Nursing, she states "there are many physical operations where ceteris paribus the danger is in a direct ratio to the time the operation lasts.
Gordon described the scene thus: He was six foot two, operated in a bottle-green coat with wellington boots. He sprung across the blood-stained boards upon his swooning, strapped-down patient like a duelist, calling,'Time me gentlemen, time me!' to students craning with pocket watches from the iron-railinged galleries. Everyone swore that the first flash of his knife was followed so swiftly by the rasp of saw on bone that sight and sound seemed simultaneous. To free both hands, he would clasp the bloody knife between his teeth. Gordon's prose is more than just caricature, he describes how the link between surgical hygiene and iatrogenic infection was poorly understood at that time. At an address by Dr Oliver Wendell Holmes to the Boston Society for Medical Improvement on 13 February 1843, his suggestions for hygiene improvement to reduce obstetric infections and mortality from puerperal fever "outraged obstetricians in Philadelphia". In those days, "surgeons operated in blood-stiffened frock coats – the stiffer the coat, the prouder the busy surgeon", "pus was as inseparable from surgery as blood", "Cleanliness was next to prudishness".
He quotes Sir Frederick Treves on that era: "There was no object in being clean... Indeed, cleanliness was out of place, it was considered to be affected. An executioner might as well manicure his nails before chopping off a head". Indeed, the connection between surgical hygiene and maternal mortality rates at Vienna General Hospital was only made in 1847 by Vienna physician Dr Ignaz Philipp Semmelweis from Hungary, after a close colleague of his died, he instituted the hygiene practices exhorted by Holmes, the mortality rate fell. Such was the era. Gordon states that Liston was "an abrupt, argumentative man, unfailingly charitable to the poor and tender to the sick was vilely unpopular to his fellow surgeons at the Edinburgh Royal Infirmary, he relished operating in the reeking tenements of the Grassmarket and Lawnmarket on patients they had discharged as hopelessly incurable. They conspired to bar him from the wards, banished him south, where he became professor of surgery at University College Hospital and made a fortune".
In writings on Liston, he is portrayed as a man of strong character and ethics, the source of some of his confrontational style. In one case, he confronted a medical colleague over the treatment of a young woman who it transpired was murdered, with Knox thought complicit in the murder, she was in Knox's dissecting rooms within four hours of her death, kept in whisky for three months before dissection, during which time she was on voyeuristic display. Liston's response is documented in a letter from himAccording to Liston, he saw Mary Paterson's body in Knox's rooms and suspected foul play, he knocked Knox down after an altercation in front of his students – Liston assumed some students had slept with her when she was alive, that they should dissect her body offended his sense of decency. He removed her body for burial. While Liston's pioneering contributions are paid tribute within popular culture such as Richard Gordon, they are best known within the medical fraternity and related disciplines.
Liston became the first Professor of Clinical Surgery at University College Hospital in London in 18
Gower Street, London
Gower Street is a street in Bloomsbury, central London, running from Montague Place in the south to Euston Road at the north. The street continues as North Gower Street north of the Euston Road. To the south it becomes Bloomsbury Street. University College London and the Royal Academy of Dramatic Art are located along Gower Street as is part of University College Hospital. UCL maintains two student residences along the street: John Tovell Houses. Of the many UCL buildings along Gower Street, the Cruciform Building is notable, both for its striking red exterior and its obvious form when viewed from the road. Old boys of University College School are known as "Old Gowers" after the street where it founded and co-located with UCL. Euston Square Underground station is located at the north end of Gower Street, at the corner of Euston Road. Gower Street is named after Lady Gertrude Leveson-Gower, daughter of John Leveson-Gower, who in 1737 became the second wife of Bloomsbury landowner Lord John Russell.
Notable residents of Gower Street have included the architect George Dance the Younger, painter William de Morgan, the Shaws. John Shaw, Sr. and John Shaw, Jr. formed a famous 19th century architectural partnership. Thomas Budd Shaw was a professor of English literature to the grand dukes of Russia; the painter John Everett Millais had a studio here. This was the birthplace and childhood home of the artist Philip Zec and his eleven other siblings, although, when it was still called George Street. On 26 March 1835 the Rev William Agutter died here. In March 1837, Giuseppe Mazzini moved to 187 North Gower Street together with Italian poet and patriot Giovanni Ruffini, his brother Agostino Ruffini and Angelo Usiglio, living there for three years until 1840. On 29 December 1838, Charles Darwin took the let of the furnished property at 12 Upper Gower Street, wrote to tell his fiancée Emma Wedgwood of his delight at being the "possessor of Macaw Cottage"; as their daughter Etty recalled, "He used to laugh over the ugliness of their house in Gower St, the furniture in the drawing-room, which he said combined all the colours of the macaw in hideous discord", Darwin had christened the house "Macaw Cottage" in "allusion to the gaudy colours of the walls and furniture."
He moved in on 31 December, with Emma moved in on the day of their marriage, 29 January 1839. The development of Darwin's theory of natural selection made progress in this house, their children William Erasmus Darwin and Anne Darwin were born there. In 1842 the family moved to Down House in the Kent countryside, the Gower Street house became part of the warehouse system of Messrs Schoolbred. On 13 December 1904 a London County Council blue plaque was put up, to "Charles Darwin Naturalist"; the house suffered from bomb damage in 1941 during the Blitz, was not repaired. In 1961 the site became part of the Biological Sciences building of University College London, with a new plaque; the long thin garden which backed on to Gower Mews North was incorporated into Foster Court car park in 1978. The etymologist and philologist Hensleigh Wedgwood, Charles Darwin's cousin and brother-in-law, lived at 94 Gower Street. On the wall of the University College building, an elaborate wall plaque carries the legend: "Close to this place Richard Trevithick Pioneer of High Pressure Steam ran in the year 1808 the first steam locomotive to draw passengers."
It was erected by "The Trevithick Centenary Memorial Committee". The Pre-Raphaelite Brotherhood was founded in the Millais family house on Gower Street in the winter of 1848–49. Millicent Fawcett, a leading figure in the constitutional wing of the British women's suffrage movement, lived at No. 2 Gower Street. The Walloon poet Henri Michaux resided in Gower Street in February 1931. From 1976 until 1995 the headquarters of MI5 were an anonymous grey office block at 140 Gower Street, adjacent to the Euston Road; the site has since been redeveloped. Many of the Georgian houses on Gower Street have been converted into small hotels. North Gower Street, the northern continuation of Gower Street beyond Euston Road, is not accessible from Gower Street at street level for vehicles or pedestrians. For pedestrians, the most direct access is via a subway along the concourse of Euston Square station. From Euston Road, North Gower Street continues past Drummond Street and ends, with a footpath continuing north to connect with the Hampstead Road.
It is lined with Georgian terraced houses now converted into hotels and student accommodation or rebuilt, council housing. The BBC crime drama Sherlock has used 187 North Gower Street, posing as 221B Baker Street, for many external shots of Sherlock Holmes's flat; the location is recognisable by the adjacent Speedy's cafe and sandwich shop, shown in most external shots in the series. The blue plaque for former resident Giuseppe Mazzini visible on Google Street View, is covered by a fake lamp for filming. Freeman, R. B; the Works of Charles Darwin: An Annotated Bibliographical Handlist, 2d online edition, The Complete Works of Charles Darwin Online, retrieved 2010-06-15 Litchfield, Henrietta Emma, Emma Darwin, A century of family letters, 1792-1896, edited by her daughter Henrietta Litchfield, London: John Murray, retrieved 2009-09-15 LondonTown.com information