The Neurosurgical Clinic at the Ludwig-Maximilians University in Munich

ThE NEUROSURGICAL CLINIC at the Ludwig-Maximilians University in Munich began as a small unit of the university's surgical clinic. Eduard Weber, who in 1952 became the first surgeon fully trained in the specialty of neurosurgery to join the surgical clinic's faculty, worked, until his death in 1962, to advance the new specialty. Neurosurgery became an independent department of the university in 1965, and the neurosurgical clinic moved to a new location at Beethovenplatz. Further expansion led the neurosurgical clinic to move again, in 1975, to the newly constructed Klinikum Grosshadern at the periphery of Munich. Frank Marguth, chairman of the department of neurosurgery from 1964 to 1991, had superb skill as an organizer and greatly enhanced the reputation of the department of neurosurgery. Today, the faculty of the department consists of 10 full-time staff members, 10 joint appointment staff members, and 16 residents and fellows. Annually, 2200 to 2300 procedures are performed in the neurosurgical clinic. The current philosophy in the department places heavy emphasis on subspecialization and academic training. Political and economic changes in Germany during recent years have affected the nation's public health system and pose major challenges to the department of neurosurgery.     

Neurosurgery in Rome: 1880-1970

Among many factors contributing to the birth of Neurosurgery, the "awareness of feasibility" of neurosurgical procedures is especially significant. June 1st, 1885 is the arbitrary birthdate of Neurosurgery in Rome: Francesco Durante, Professor of Surgery at the Royal University, successfully resects an olfactory groove meningioma, arising admiration worldwide. Roberto Alessandri succeeds Durante in 1919. In roman hospitals outstanding surgeons perform from time to time neurosurgical procedures, sometimes with satisfactory results: Paolo Postempski, Cesare Antonucci, Guido Egidi and Raffaele Bastianelli, first director of the "Regina Elena" Cancer Institute (IRE) (April 1933) and friend of Harvey Cushing. Angelo Chiasserini sr. is however the first roman surgeon constantly committed to Neurosurgery and founder of the first neurosurgical unit in Italy, in 1937; also, from 1941 to 1944 he directs a neurosurgical service at the "Celio" military hospital of Rome, to which patients from the various battle theatres are referred. While Mario Margottini and Piero Frugoni follow Bastianelli's steps at the IRE, the roman neurosurgeons Felice Visalli and Libero Ugelli serve in the Army, during the greek-albanian conflict and in Russia, respectively. In May 1955 Beniamino Guidetti, an Olivecrona pupil, is called at "La Sapienza" University of Rome and elevates the neurosurgical clinic at the highest standards. The other main neurosurgical pole is founded in 1958 at the San Camillo Hospital: within both institutions modern neurosurgical teams are formed along with neuroradiological and neuroanesthesiological staffs.     

The case of General Wood

The first successful operation ever on a parasagittal meningioma was performed in 1910 by Harvey Cushing. The operation turned out to be critical event in his career as a neurosurgeon and made him confident about the possibilities of brain surgery. The patient was Leonard Wood, Major General and Chief of Staff of the United States Army, who was a military surgeon turned career officer. In the election campaign or the president to succeed Woodrow Wilson in 1920, Leonard Wood, the personification of competence, became the Republican favorite. General Wood was, however, eliminated from the presidential election campaign by complicated intrigues. From the next year on, General Wood experienced increasing warning signs of a recurrent tumor, which he unfortunately neglected. Not until 1927 did Wood again come under the care of Dr. Cushing, who had just returned from Britain, where in the course of a single month he had been awarded no less than seven distinctions from different medical societies. Deeply concerned at Wood's condition. Cushing decided to attempt extirpation of the recurrent tumor. General Wood died a few hours after the operation. No tragedy caused Cushing more distress than the death of General Wood, who 7 years earlier had been on the verge of being President of the United States.     

Harvey Cushing: first guest at "The Divine Banquet of the Brayne"

Harvey Cushing will remain forever ensconced in surgical memory as the visionary who established contemporary neurosurgery. Raised in Cleveland in a middle-class family with a medical background, he gave little indication early of his later prowess. A college education at Yale University yielded a modest performance, although he showed somewhat better promise as a medical student at Harvard University. During his surgical training at the Johns Hopkins Medical School, he emerged as a bright, industrious young man with a glint of steel to his intellect. From Halsted he learned the academic basis of surgery and the meticulousness necessary for technical success. Osler became his friend and provided him with a foundation in the history of medicine and the recognition of its importance in shaping the future. The decision to spend a year in Europe visiting clinics and renowned surgeons may have laid the foundations for the subsequent configuration of his career. In Britain he saw firsthand the glorious museums and libraries of the Hunters and the legacy that their schools of surgery had endowed to the nation. In Paris and London he mixed with the surgical aristocracy of the times and learned the power of societies and the traditions of their patrons. In Berne he was exposed to the surgical purity and physiologic expertise of Kocher, supported by the estimable scientific practice of Kroneker. As an "arbeid," Kocher posed him the problem of establishing the mechanism of the regulation of cerebral perfusion. This question, which he so rapidly and successfully unraveled, probably played a large part in igniting his enthusiasm toward the study of the brain as a future career. In his travels he encountered diverse intellects and experienced a wide panoply of European medical thought. He conversed widely at both a social and professional level and integrated all information into meticulously kept diaries that served as not only a record but also a template from which later plans were derived. A final 6-week sojourn in Liverpool working on the primate cortex with Sherrington, the greatest neurophysiologist of that time, may have sealed his decision to turn his initial project with Kocher into the opus of a lifetime. The 14-month tour of Europe transformed Cushing from a relative unsophisticate into a figure of giant proportions. All that he experienced became part of his life and was integrated into his subsequent career.(ABSTRACT TRUNCATED AT 400 WORDS)     

Samuel Theobald M.D. Ophthalmology at the Johns Hopkins Hospital before the Wilmer Institute 1889-1925

Although ophthalmology today at the Johns Hopkins Hospital is synonymous with the name of Wilmer, it should be remembered that the Wilmer Ophthalmological Institute was not founded until 1925. Thus, to appreciate fully the ophthalmic heritage of Johns Hopkins we must look back to the beginnings of the medical institutions. When the Johns Hopkins Hospital opened in 1889 and the medical school followed in 1893, Samuel Theobald, M.D., was appointed ophthalmic and aural surgeon, and later clinical professor of ophthalmology and otology. Dr. Theobald, a native Baltimorean, was a member of the prestigious Smith family, which distinguished itself in early American medicine. He was raised in the home of his grandfather, Dr. Nathan Ryno Smith who directed his education. Dr. Theobald studied ophthalmology and otology abroad before opening a practice in Baltimore in 1871. Before his appointment at Johns Hopkins he was one of the founders of the Baltimore Eye, Ear and Throat Charity Hospital in 1882. In addition to his teaching at the medical school and his work in the dispensary, he contributed many articles in journals, and presentations to society meetings. He is especially remembered for his development of 'Theobald lacrimal probes', the introduction of boric acid as a collyrium, and his text book Prevalent Diseases of the Eye. He was a member of the American Ophthalmological Society for 50 years and its 14th President. In 1925 at the age of 79 years, he retired and became emeritus.     

William Jason Mixter (1880-1958). Ushering in the "dynasty of the disc"

William Jason Mixter was born in 1880 and graduated from the Harvard Medical School class of 1906. Like his father, Mixter was a prominent surgeon at the Massachusetts General Hospital, and in 1911 the two shared the job of overseeing all neurosurgery at that institution. By the early 1930s, W. J. Mixter was considered to be one of the nation's leading experts in spinal surgery, and he went on to become the first chief of the neurosurgery department at Massachusetts General Hospital. He served in the U. S. Army in both world wars and was actively involved in his local church community in Boston for many years. In 1934, at the age of 54, Mixter and Joseph S. Barr published an article on the intervertebral disc lesion in the New England Journal of Medicine. That article fundamentally changed the popular understanding of sciatica at that time, and for this work Mixter is generally credited by his contemporaries as being the man who best clarified the relation between the intervertebral disc and sciatica. Mixter and Barr's landmark report helped to establish surgery's prominent role in the management of sciatica at the time. Over the next few decades, discectomy surgery increased in popularity tremendously, and some refer to that period as the "dynasty of the disc."     

The contribution of Davide Giordano (1864-1954) to pituitary surgery: the transglabellar-nasal approach

This report describes the fundamental contribution made by Davide Giordano, proposing the transglabellar surgical approach in a period in which transfacial and transbasal operative approaches to the pituitary gland were considered inadvisable because of their risk. His idea was to gain access through bilateral paranasal and frontal skin incisions, allowing removal of the ethmoid bone and the anterior wall of the sphenoidal cube. With the anterior and inferior aspects of the sella turcica thus exposed, bone is removed and the gland is exposed by incision of the dura mater. The technique proposed by Giordano is undoubtedly a forerunner of the transsphenoidal route to the pituitary gland. The importance of his contribution was confirmed by Cushing, who reported his first use of the approach of Giordano in 1909 in a patient with a pituitary adenoma. The efforts of Giordano clearly inspired surgeons of his era to perform this operation clinically, giving impetus to the further development of neurosurgery.     

The FMR1 and FMR2 mutations are not common etiologies of academic difficulty among school-age children

The Department of Pediatrics at The Mount Sinai Hospital was founded more than 120 years ago. During the ensuing years it had five outstanding leaders, Drs. Abraham Jacobi, Henry Koplik, Bela Schick, Horace Hodes, and Kurt Hirschhorn. The evolution of its beginning as a "small" clinic to its present position as one of the outstanding pediatric centers in this country reflects its interest in and devotion to the care of children.     

Obituary: Bruce Victor Moore (1891-1977).

Bruce Victor Moore was the first person to receive the PhD in industrial psychology in America. It was awarded to him in 1921 by the Carnegie Institute of Technology, now Carnegie-Mellon University. Moore was born in Kokomo, Indiana, on September 9, 1891. Prior to his work at Carnegie Tech, he received an AB and an MA in psychology from Indiana University, taught high school for two years, and started further graduate work at Columbia University. This was interrupted by World War I. He was one of the first enlisted men in the U.S. Army's Division of Psychology, where he was assigned as a psychologist at Walter Reed Hospital. Following the war he went on to Carnegie Tech, which quickly became a center for industrial psychology. In 1920, while completing his graduate work, Moore was made assistant professor of psychology at the Pennsylvania State College (now University). By 1928 he had attained the rank of professor and had been appointed head of the Psychology Department. He served very efficiently as an administrator until his first retirement in 1952. Following his retirement from Penn State in 1952, Moore joined the central office staff of the American Psychological Association, where he served for seven years as the Executive Officer for the Education and Training Board. His excellent work there was a measure of his outstanding administrative talents. Next he was invited to be a visiting professor of psychology at the University of Miami, specifically to assist in the development of the graduate program. He remained at Miami for three years, 1959-1962; during the final year he served as department head. His last 15 years were spent in State College, Pennsylvania, where he died on November 14, 1977. Moore was moderately tall, slight of build, quiet in manner, persistent in his motivation, steadfast in meeting his responsibilities, and universally respected. His two marriages were very successful and brought him security and happiness. The first, to Elsie Kohler in 1924, terminated in her death in 1967 and gave him one daughter, Mary Ellen Moore Kinnaird. The second was in 1969 to Winona Morgan, a fellow child psychologist who still resides in State College. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Herbert H. Meyer (1917-2006).

Presents an obituary for Herbert H. Meyer, one of psychology's most distinguished scientist-practitioners. Meyer became interested in industrial psychology after his discharge from the service in 1946. He obtained a part-time position with Detroit Edison, where his work led to his dissertation, which resulted in a new projective and valid test of supervisory judgment. He also worked at the Psychological Corporation in New York City, primarily on executive appraisals, and later joined GE as the founder of a new corporate personnel research function. After 20 years, he sought an academic position, a became the director of the University of South Florida's new doctoral program in industrial and organizational psychology. Meyer continued to teach and lend his wisdom to the program and department even after retirement and election to emeritus status in 1988. During his career, Meyer authored more than 60 publications and was a frequent speaker at professional gatherings worldwide. He was also in high demand as a consultant. He taught for the University of South Florida's program through the spring semester of 2006. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Neurosurgery at the Montreal Neurological Institute and McGill University Hospitals

For the past 60 years, the Montreal Neurological Institute and Hospital and three associated McGill University teaching hospitals have provided a broad course of instruction in neurosurgery and the related neurosciences. This integrated program offers a wealth of experience in adult and pediatric neurosurgery, based on a total of 140 beds, covering a full range of general and subspecialty neurosurgery. The institute, recognized for many years as a world center for epilepsy surgery, has traditional strengths in the treatment of brain tumors and cerebrovascular and spinal disorders; it has been at the cutting edge of brain imaging in all modalities applied to neurosurgical diagnosis and cerebral localization, including three-dimensional monitoring in the operating room. New approaches to stereotactic procedures have been developed in conjunction with imaging technology, including functional neurosurgery and the versatile McGill double rotation method for radiosurgery with a linear accelerator. Experience in managing trauma, pediatric cases, and general neurosurgical problems is gained at the Montreal General Hospital, the Montreal Children's Hospital, and the Jewish General Hospital. Well-established research units, including burgeoning groups in neurogenetics, molecular neurobiology, and neural regeneration, provide a wide variety of academic opportunities to provide trainees with a sound basis for coping with the rapidly advancing field of neurosurgery.     

Updated overview of the Swedish Randomized Trials on Breast Cancer Screening with Mammography: age group 40-49 at randomization

The purpose of this overview is to estimate more precisely the long-term effect of mammography screening by adding four more years of follow-up to women aged 40-49 years in the four Swedish trials on mammography screening. Data from the four, trials were merged and linked to the Swedish Cancer and Cause of Death Register for 1958-1993 and 1951-1993 respectively to identify date of breast cancer diagnosis and cause and date of death. The invited and control groups comprised 48,569 and 40,247 women respectively. At the December 1993 follow-up, 602 and 482 breast cancer cases were identified in the two groups respectively, of which 104 and 111 had breast cancer as the underlying cause of death. This corresponds to a relative risk (RR) of 0.77 (95% CI: 0.59-1.01) for the two groups. In the 40-44 age group at randomization, 94% of breast cancer patients in the study and 89% in the control group were diagnosed before the age of 50; however, among breast cancer deaths in this age group, only two in the invited and five in the control group died after age 50. At follow-up of women 40-44 years at randomization 208 women in the invited and 184 in the control group were reported to the Cancer registry with breast cancer. Out of these 195 (94%) and 163 (89%) respectively were reported before the age of 50. Further, the relative risk for the age group 40-44 years at randomization by age at follow-up was 1.11, 0.51 and 0.46 for the age groups 45-49, 50-54, and 55-59 at follow-up. This study shows a 23% reduction in the breast cancer mortality in women 40-49 years at randomization achieved from a median trial time of 7.0 years, a median follow-up time of 12.8 years, and a screening interval of 18-24 months. Almost all of the effect in the 40-44 year age group at randomization was due to screening before the age of 50.     

Tumor suppressor genes: at the crossroads of molecular carcinogenesis, molecular epidemiology, and human risk assessment

BACKGROUND AND PURPOSE: Marfan syndrome is a heritable disorder of connective tissue caused by a deficiency of the glycoprotein fibrillin. In several publications and neurological textbooks, a relationship between Marfan syndrome and intracranial aneurysms has been assumed. METHODS: The records of 135 patients classified as having Marfan syndrome who visited the Amsterdam Marfan clinic or were admitted to the departments of neurology and neurosurgery and the records of all patients with a subarachnoid hemorrhage or intracranial aneurysm who visited or were admitted to the departments of neurology and neurosurgery between January 1, 1982, and January 1, 1994, were retrieved. The literature was reviewed regarding Marfan syndrome and intracranial aneurysms. RESULTS: No patient visiting the Marfan clinic had a symptomatic intracranial aneurysm. No patient with Marfan syndrome had been admitted with a ruptured intracranial aneurysm at the departments of neurology or neurosurgery in this period, while during that period 826 patients with symptomatic intracranial aneurysms had been admitted. During follow-up of 129 of the 135 patients with Marfan syndrome (2850 retrospective patient observation years and 581 prospective patient observation years), none presented a symptomatic intracranial aneurysm. The suggested relationship between Marfan syndrome and intracranial aneurysms is based mainly on 10 case reports. However, the diagnosis of Marfan syndrome is doubtful in several of these reports. Several large studies of patients with Marfan syndrome did not mention a ruptured intracranial aneurysm as a clinical manifestation. CONCLUSIONS: We conclude that there is insufficient evidence to presume a relationship between symptomatic intracranial aneurysms and Marfan syndrome on the basis of currently available data.     

James Carroll: a biography

James Carroll was born in England in 1854; at the age of 15, he emigrated to Canada where he worked at various odd jobs. At age 20, he crossed the border and volunteered for the US Army, in which he remained for the rest of his life. Appointed as Hospital Steward, he became interested in medicine. He was permitted to take basic courses at St Paul University and later at Bellevue Hospital in New York. He received his MD degree in 1891 from the University of Maryland while still a sergeant. He then took the course in bacteriology offered by Welch at Hopkins. At an 1893 international exposition in Chicago, Carroll was put in charge of the Army's exhibit on bacteriology. He was then called to become Assistant Professor of Microscopy at the new Army Medical School; his senior there was Walter Reed. Both men were offered professorships in pathology and bacteriology at George Washington University, and in 1900, both were appointed to the US Board sent to Havana. After several weeks, the Board determined that the alleged agent causing yellow fever was Bacillus cholerae suis (Sanarelli). Visiting British researchers informed the Board of their favorable view of Carlos Finlay's theory that the disease was transmitted by the mosquito. The Board then visited Finlay, who gave them eggs of the particular species of mosquito that he had discovered to be the culprit. Board members Lazear and Carroll submitted themselves to the bite of an infected mosquito; both developed severe fever and Lazear died. The Board then carried out a well-planned experiment which proved that Finlay had been right for 20 years. Further experiments by Carroll showed that the agent could pass through a Berkefeld filter and was not bacterial.     

Recent results from the Swedish Two-County Trial: the effects of age, histologic type, and mode of detection on the efficacy of breast cancer screening

The effect of mammographic screening in reducing mortality from breast cancer is known to be smaller and more delayed in women aged 40-49 than in women over 50. In this study, we investigated how these phenomena relate to histology-specific breast cancer incidence and mortality. The data are from 2,468 women with breast cancer who participated in the Swedish Two-County Trial. The overall relative breast cancer mortality of invited to noninvited women aged 40-49 was 0.87, and the relative mortality from poorly differentiated (grade 3) ductal carcinoma was 0.95. These results were not statistically significant. The corresponding relative risks for invited women aged 50-74 were a statistically significant 0.65 and 0.61. We conclude that in this trial, with a two-year interscreening interval, the smaller and later effect of invitation to screening on breast cancer mortality in women 40-49 years old is due to the failure of screening to reduce mortality from grade 3 ductal carcinoma in this age group.     

Popularity of less frequent follow up for breast cancer in randomised study: initial findings from the hotline study

OBJECTIVE: To compare the experiences of patients with breast cancer who were conventionally monitored with those in whom routine follow up was restricted to the time of mammography. DESIGN: Randomisation to conventional schedule of clinic visits or to visits only after mammography. Both cohorts received identical mammography and were invited to telephone for immediate appointments if they detected symptoms. SETTING: Combined breast clinic, Chelsea and Westminster Hospital. SUBJECTS: 211 eligible outpatients with a history of breast cancer. MAIN OUTCOME MEASURES: Acceptability of randomisation, interim use of telephone and general practitioner, satisfaction with allocation to follow up. RESULTS: Of 211 eligible patients, 196 (93%) opted for randomisation in the study. Of these, 55 were under 50 years, 78 were diagnosed fewer than five years before, 90 had stage T2-4 tumours, and 71 had involved axillary nodes. Patients who did not participate were more likely to be under 50 years, to be two to five years after diagnosis, and to have had aggressive primary disease. Twice as many patients in both groups expressed a preference for reducing rather than increasing follow up. No increased use of local practitioner services or telephone triage was apparent in the cohort randomised to less frequent follow up by specialists. CONCLUSIONS: Reducing the frequency of routine follow up has so far proved popular among patients with breast cancer at standard risk in this cohort. A multicentre study is needed to determine the effectiveness and cost-effectiveness of routine follow up with respect to disease outcomes.     

Paul Meehl: Past and future lessons for the field.

Paul Everett Meehl (1920-2003) was an intellectual giant who made important contributions to several fields of thought. The present special section focuses on his contributions to psychopathology, personality, and methods of psychological inquiry. The editors identified six specific topic areas within these broad domains and invited a specialist on each topic to write a discussion. These authors were invited to review Meehl's contributions and clarify their historical significance and current relevance. In addition, two authors contributed personal perspectives on Meehl, revealing that Meehl profoundly affected psychological science by routes other than his publications and formal talks. Rather, his voluminous correspondence and his personal relationships allowed him to engage numerous colleagues in his passionate pursuit of ideas and insights. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Obituary: Frederick Wyatt (1911–1993).

Memorializes F. Wyatt, who founded the Psychological Clinic at the University of Michigan in the 1950s. The clinic, devoted to the teaching and practice of psychoanalytically oriented therapy, achieved a reputation as the nation's best training agency of its type. Among his other achievements, Wyatt was president of Division 10 (Psychology and the Arts) of the American Psychological Association and president of the Society for Projective Techniques. He was editor or consulting editor of five scholarly journals and was three times a Fulbright Scholar. He published over a hundred articles and reviews on the widest range of topics, not only on psychotherapy and clinical issues, but also on philosophy, education, the family, and social change. (0 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

HIV seroprevalence in a London same-day testing clinic

OBJECTIVES: To determine the prevalence of HIV infection among people attending a confidential, non-genitourinary medicine based testing clinic that provides HIV antibody test results on the day of consultation. METHODS: Retrospective analysis of data collected on 2635 individuals attending the Same-Day HIV Testing Clinic at the Royal Free Hospital, London between March 1992 and February 1993. RESULTS: A total of 1612 men and 1023 women were tested for HIV antibody. The primary risk for HIV infection was heterosexual (71.7%; 1889 out of 2635) and homosexual contact (24.5%; 646 out of 2635). Fifty-four individuals were given positive HIV test results (46 men, median age 34 years; eight women, median age 27 years). Overall HIV seroprevalence was 2.0% (95% confidence interval, 1.5-2.5). HIV seroprevalence was highest among homosexual men (6.5%; 41 out of 635) and injecting drug users (5.7%; four out of 70). The rates for heterosexual men and women were 0.2% (two out of 915) and 0.7% (seven out of 974), respectively. Of the 54 individuals who were HIV-antibody-positive, 44 were Centers for Disease Control and Prevention stage II/III, eight stage IV and one was tested at the time of seroconversion (stage I; data were not available for one patient). Of the total numbers attending this clinic 27% (702 out of 2635) had previously been tested and received a negative result. Of a total of 54 HIV-antibody-positive individuals, 40% (21) had previously received a negative test result. CONCLUSIONS: The data suggest that seroprevalence amongst homosexual men attending a designated HIV testing clinic in London is lower than that reported by genitourinary clinic based testing sites. The large number of repeat testers who subsequently became infected with HIV suggests that there is a population requiring specific targetting for HIV risk reduction.     

Gudmundur Finnbogason, "Sympathetic understanding," and early Icelandic psychology.

Gudmundur Finnbogason (1873-1944) was a pioneer of Icelandic psychology. He was educated at the University of Copenhagen where he finished his M.A. in 1901 in philosophy, specializing in psychology. During the years 1901-1905, Finnbogason played a major role in establishing and shaping the future of primary education in Iceland. He defended his doctoral thesis on "sympathetic understanding" at the University of Copenhagen in 1911. This work deals with the psychology of imitation. In it Finnbogason defends the view that imitation is basically perception so that there is a direct link from perception to motor behavior. Through imitation people tend to assume the countenance and demeanor of other people, thus showing, in Finnbogason's terminology, "sympathetic understanding." Finnbogason's theory of imitation in many respects anticipates contemporary approaches to the psychology of imitation. In 1918 Finnbogason became professor of applied psychology at the recently founded University of Iceland. Here he attempted to establish psychology as an independent discipline. In this he was unsuccessful; his chair was abolished in 1924. (PsycINFO Database Record (c) 2010 APA, all rights reserved)