Is the conservative management of the acute scro- tum justified on clinical grounds? Suspected testicular torsion: A survey of clinical practice in North West England order levitra 20 mg with mastercard erectile dysfunction differential diagnosis. Capsaicin effectively prevents apoptosis in the contralateral testis after ipsilateral testicular torsion purchase 20mg levitra overnight delivery impotence following prostate surgery. Glucocorticoid hormone can suppress apoptosis of rat testicular germ cells induced by testicular ischemia. Docherty Part A: Selected Obstetric Emergencies Ectopic Pregnancy Definition • Any pregnancy occurring outside the uterine cavity Location • 95% of all ectopic pregnancies occur in the fallopian tubes with 5% being ovarian or abdominal pregnancies. Incidence • Annually 70,000 cases of ectopic pregnancy occur in the United States with a current incidence of 20 ectopics per 1000 pregnancies. Clinical Presentation • Classic triad—Seen in <50% of patients • Abdominal or pelvic pain • Missed menstrual period with associated abnormal vaginal bleeding • Pelvic examination demonstrates a tender adnexal mass • The pelvic pain when it is present is usually unilateral, severe and sudden, although there may be significant variability in quality, intensity, duration and location. Differential diagnosis of ectopic pregnancy • Appendicitis • Salpingitis • Ovarian torsion • Threatened abortion • Gastroenteritis • Urinary tract infection in early pregnancy • Urolithiasis in early pregnancy • Dysfunctional uterine bleeding • Normal intrauterine pregnancy • Corpus luteum cyst • The presence of a palpable adnexal mass or fullness with associated tenderness is present in up to two-thirds of patients however its absence does not rule out the possibility of an ectopic pregnancy. Uterine decidual tissue casts may be passed in 5-10% of patients and can be mistaken for tissue from a spontaneous abortion. In the case of ec- topic pregnancy rupture, peritoneal signs may be present on abdominal examination secondary to hemoperitoneum. In the unruptured ectopic pregnancy, the vital signs are more likely to be normal. Rupture of an Ectopic Pregnancy • Rupture of an ectopic pregnancy is associated with: • syncope • sudden onset of severe pelvic/abdominal pain • hypotension • When an ectopic pregnancy ruptures, there occurs hemorrhage into the peritoneal cavity leading to peritoneal signs. A progesterone level >25 ng/ml is consistent with a viable intrauterine pregnancy with a 97. Lower levels however do not reliably correlate with the location of the patient’s pregnancy. Initial values may be normal, however a low Hg/Hct initially or an acute drop over the first several hours is concerning when considering the possibility of ectopic pregnancy in your differential diagnosis. May be helpful for identifying other potential entities in your differential diagnosis once ectopic pregnancy has been ruled out. The possible options are laparoscopy with appropriate surgical intervention if an ectopic pregnancy is identified. Indications for methotrexate usage in ectopic pregnancy • Ectopic pregnancy unruptured and <3. The procedure is done by aspiration of the con- tents from the pouch of Douglas entered by way of the posterior fornix. The aspira- tion of nonclotting blood is considered a positive test that is suspicious for ectopic pregnancy. Vaginal Bleeding in the First Half of Pregnancy Forty percent of pregnant patients present with some degree of vaginal bleeding 7 during early pregnancy. The vast majority of these spontaneous abortions occur prior to 8 wk of gestation. At least half of all spontaneous abortions are due to genetic abnormali- ties; the rest being due to a combination of factors such as uterine abnormalities, incompetent cervix, progesterone deficiency, tobacco or alcohol use. Once again, one must always consider ectopic pregnancy in the differential when evaluating the pregnant patient with vaginal bleeding. The patient with unilateral pelvic pain and vaginal bleeding needs thorough evaluation to differentiate early abortion from ectopic pregnancy. Definitions • Threatened Abortion—Uterine bleeding in the first 20 wk of pregnancy without any passage of tissue or cervical dilatation. These patients present with vaginal bleeding in the first half of pregnancy 90% of the time. Diagnostic Evaluation • Standard laboratory testing to be obtained in the setting of vaginal bleeding in the first half of pregnancy should include all of the following. Patients with a visualized intrauterine pregnancy with a closed cervical os can be considered to have a threatened abortion. Correlation of ultrasound results with the patient’s history and physical findings will allow the type of abortion to be identified. They should be instructed to return to the Emergency Department if vaginal bleeding increases and/or returns, if they notice any passage of tissue, or if they de- velop significant pelvic pain or fever. The patient should be placed on pelvic rest which means no intercourse, no douching and physical activity. Vaginal Bleeding in the Second Half of Pregnancy Vaginal bleeding after 20 wk of gestation can present a complicated clinical management situation with the lives of the mother and fetus often both in serious jeopardy. Abruptio Placentae/Placental Abruption • Definition—The complete or partial placental separation from the decidua basalis (uterine implantation site) after 20 wk of gestation. When this separation develops, 7 blood vessels are ruptured leading to hematoma formation which leads to significant hemorrhaging and fetal hypoxia. Incidence • Abrubtio placentae occurs in approximately 1/100 pregnancies and is the cause of approximately 14% of all stillbirths in the United States. Clinical Presentation • Variability of clinical presentation is related to the quantity and location of hemor- rhaging. The patient may complain of back and/or abdominal pain, and the pain is usually relatively sudden in its onset and constant in nature. Early awareness of this possibility may become apparent if the patient is noted to have excessive hemorrhaging at venopuncture or intravenous access sites, mucosal/gingival hemorrhaging, easy bruising and/or hematuria. Emergency Department Management • Intravenous access should be immediately obtained. Causes of vaginal bleeding in the 2nd half of pregnancy • Abruptio placentae/placental abruption • Placenta previa • Premature labor • Premature rupture of membranes • Lesions of the cervix and lower genital tract • Uterine rupture • Vasa previa Table 7A. Risk factors for placental abruption • Hypertension • Preeclampsia • History of prior placental abruption • Trauma • Cigarette smoking • Increasing maternal age 7 • High multiparity • Illicit drug use (cocaine abuse) • Excessive alcohol consumption • A Kleihauer-Betke test should also be obtained to detect fetal cells in the maternal circulation. When abruption is visualized on ultrasound it appears as a hypoechoic area between the placenta and the uterine wall. In the presence of more severe placental abruption, expedited vaginal delivery or emergent cesarean section may be necessary. Placenta Previa Definition • Placenta previa describes a situation where any part of the placenta implants in the lower uterine segment and be associated with a high risk of significant serious mater- nal hemorrhaging. Risk factors for placenta previa • Multiparity • Multiple gestation pregnancies • Previous cesarean section • Prior uterine scar for any reason • Increasing maternal age • Previous abortion • Prior placenta previa • Diabetes mellitus • Erythroblastosis fetalis • Any process that increases placental size • Marginal Placenta Previa—The placenta is located adjacent to the patient’s internal os but is not covering it. Incidence • Placenta previa occurs in approximately 1/200 pregnancies in the United States. Emergency Department Management • When placenta previa is clinically suspected emergent obstetrical consultation should be obtained. Hyperemesis Gravidarum • It is normal to have some degree of nausea and vomiting for most patients during the course of pregnancy and these episodes are especially frequent in first 12 wk. Frequently used antiemetics are promethazine (phenergan), prochlorperazine (compazine) and trimethobenzamide (tigan).
All patients should be screened at the start of treatment and regularly thereafter for visual field defects discount levitra 20 mg free shipping erectile dysfunction solutions pump. Lacosamide (Vimpat) is an adjunctive treatment for partial-onset seizures with/without secondary generalisation in epileptic patients aged at least 16 years order 10mg levitra visa erectile dysfunction from alcohol. It may be associated with depression, headache, somnolence, asthenia/fatigue, dizziness/vertigo, problems with balance/gait (may fall), pruritus, nausea/vomiting/constipation/flatulence, tremor, nystagmus, double and blurred vision, memory/cognitive impairment, and skin laceration. It is used as an add-on drug for partial seizures, with/without secondary generalisation. It can cause sedation, fatigue, ataxia, dizziness, nystagmus, headache, tremor, nausea and vomiting, diplopia, amblyopia, rhinitis, pharyngitis, dysarthria, nervousness, dyspepsia, amnesia and myalgia. Rare associations include pancreatitis, increased liver enzymes, erythema multiforme, Stevens Johnson syndrome, and (of unproven association) unexplained death. An add-on therapy for partial seizures, with/without secondary generalisation, it does not interact with oral contraceptive drugs, and predictable effects are due to linear pharmacokinetics. Topiramate, an add-on therapy for epilepsy, has a 3064 spectrum similar to phenytoin or carbamazepine. Acute myopia and secondary angle-closure glaucoma have been reported, typically within first month of therapy (acute onset of decreased visual acuity and/or ocular pain with myopia, redness, shallow anterior chamber, raised intraocular pressure with or without mydriasis: stop the drug quickly and treat any raised intraocular pressure). It is employed as adjunctive treatment for partial seizures with or without generalisation. Side effects include somnolence, asthenia, dizziness, agitation, hostility , emotional lability, depression, ataxia, and (rare) psychosis. Zonisamide causes renal stones in 2-4% and it carries a small risk of Stevens Johnson syndrome. Pregabalin (Lyrica): Used as adjunctive therapy for partial seizures and for anxiety disorders, fibromyalgia, and neuropathic pain of diverse aetiologies. Maprotiline and bupropion (especially if dose > 450 mgs/day and in eating disorders) can be particularly epileptogenic. The patient/guardian must understand the issues involved, seizures should be disabling despite appropriate medication trials (at least 2 different drugs) and not be due to idiopathic generalised epilepsy, and tests results must suggest that surgery will be helpful (an eptileptogenic zone should be identified so 3069 that just the right amount of tissue is resected). Comprehensive presurgical evaluation is not always readily available and patients often come to surgery after many years of epilepsy. This delay, added to long waiting lists, does not help to improve seizure and functional outcomes. Procedures include focal resection of epileptic tissue, modified hemispherectomy, corpus callosectomy, stereotactic procedures, and multiple subpial resections. About 60% of patients are seizure free at 10 years post-surgery compared to 5-14% who are not operated on. Combined with carbamazepine it may cause agranulocytosis, or sedation and weight gain if used with valproate. A hand-held magnet can trigger intermittent pulses if an aura is 3070 experienced. Transplantation surgery: Phenytoin and phenobarbital may reduce immunosuppressant drug levels with the risk of precipitation of graft rejection. When the fitting stops put the person in the semi-prone position and stay with him/her until all drowsiness and confusion clears. Dangerous activities: Anything that poses a danger should be discouraged until over 6 months seizure- free, e. One French study in the 1960s found that 1/200 admissions to a psychiatric unit had a brain tumour. Interestingly, a low grade tumour is more likely to present with a seizure than is a rapidly infiltrating neoplasm. Ross ea (2003) found that of survivors of cancer in childhood and 3070 Nucleus solitarius in the brainstem, hippocampus and cortex. Brain tumours can lead to compression symptoms, meningitis, dementia, cerebellar degeneration, degeneration of posterior root ganglia, peripheral neuropathy, and myopathy. Depression , delirium and dysmnesia are also found in association with malignant disease. Panic attacks are not uncommon presenting features of brain tumours, including tumours of the pituitary gland. Limbic system involvement may be associated with a clinical diagnosis of ‘schizophrenia’. A detailed clinical history and a careful physical examination are still the best predictors of brain pathology. Steroid therapy may cause irritability, insomnia, lability of affect, and psychosis. Whilst dexamethasone- induced mania often abates quickly, prolonged attacks may occur and necessitate lithium or anticonvulsant drug therapy. Dexamethasone may cause insomnia, delirium, psychosis, peptic ulceration, myopathy, osteopenia, or increase the risk for Pneumocystis carinii pneumonia. Radiotherapy may cause acute cognitive dysfunction or a sub-cortical dementia that may not present for months or even decades. Chemotherapy rarely causes cognitive dysfunction when employed to treat 3076 primary brain neoplasia. Debulking can improve psychological function, although oedema may need to resolve before this becomes obvious. Prolactinoma: These are benign neoplasms, accounting for 40% of pituitary tumours. Prolactinomas are divided into microadenomas (<10 mm in diameter) and macroadenomas (>10 mm in diameter). Idiopathic hyperprolactinaemia should be followed up in case small tumours are missed. Hyperprolactinaemia may be detected after stopping the anovulant pill, but there is no evidence incriminating the anovulant pill to prolactinoma formation. Although rarely present at the start, impotence, infertility, and decreased libido can occur, and galactorrhoea and gynaecomastia are uncommon. Reduced spinal bone density occurs with prolonged hyperprolactinaemia in both sexes, and a return of prolactin levels to normal leads to increased but still reduced bone density. A single prolactin level documents hyperprolactinaemia but, because of the pulsatility of prolactin production, the test should be repeated if prolactin levels are 25-40 μg/L. Most causes of increased 3075 Depression was the most important determinant of quality of life in a group of patients with cerebral tumours. Aripiprazole may normalise haloperidol-induced hyperprolactinaemia whilst the patient remains on haloperidol. Disconnection hyperprolactinaemia: pituitary tumour presses on pituitary stalk blocking tonic inhibition of dopamine from hypothalamus on secretion of prolactin. Pseudotumour cerebri: This condition includes raised intracranial pressure, classically in a young obese woman. Cases are divided into 3079 primary (idiopathic intracranial hypertension) and secondary.
Factor Xa and its co-factor Va form the prothrombinase complex order levitra 10 mg visa erectile dysfunction medication for sale, which activates prothrom- bin to thrombin purchase levitra 10mg without prescription erectile dysfunction pump australia. It forms on a phospholipid surface in the presence of calcium and is responsible for the activation of factor X. Its primary role is the conversion of ﬁbrinogen to ﬁbrin, the building block of a haemostatic plug. Thus what may have begun as a tiny, localised event rapidly expands into a coagulation cascade. In adding the γ -carboxyl group to glutamate residues on the immature clotting factors, vitamin K is itself oxidised. Another enzyme, vitamin K epoxide reductase, reduces vitamin K back to its active form. Vitamin K epoxide reductase is pharmacologically impor- tant as a target for the anticoagulant drugs warfarin and related coumarins (acenocoumarol, phenprocoumon and dicumarol). These drugs create a deﬁciency of reduced vitamin K by blocking the epoxide reductase, thereby inhibiting maturation of clotting factors. Warfarin is also used as a rat poison, causing death by lethal (internal) bleeding. A major physiological anticoagulant, this is a vitamin K-dependent serine pro- tease enzyme that is activated by thrombin. Protein C is activated in a sequence that begins with it binding, together with thrombin, to the cell-surface protein thrombomodulin. Quantitative or qualitative deﬁciency of either may lead to thrombophilia (a tendency to develop thrombosis). Recombinant protein C is now available to treat people threatened with inappropriate clotting, as a result of widespread infection (sepsis) for example. It is constantly active, but its adhesion to these factors is increased by the presence of heparin sulphate (a glycosaminoglycan) or the admin- istration of heparins (different heparinoids increase afﬁnity to factor Xa, thrombin, or both). Some surgical patients, especially those receiving hip or heart valve replacements and those at risk of ischemic stroke (clots in the brain), are given heparin. Generated by proteolytic cleavage of plasminogen, a plasma protein synthesised in the liver. Plasmin proteolytically cleaves ﬁbrin into ﬁbrin degradation products, which inhibits excessive ﬁbrin formation. This inhibits the release of granules that would lead to activation of additional platelets and the coagulation cascade. Although plas- minogen cannot cleave ﬁbrin, it has an afﬁnity for it and is incorporated into the clot when it is formed. Plasminogen contains secondary structure motifs (‘kringles’) which speciﬁcally bind lysine and arginine residues on ﬁbrin. When converted from plasminogen into plasmin, it functions as a serine protease, cutting C-terminal to these lysine and arginine residues. Fib- rin monomers, when polymerised, form protoﬁbrils, each consisting of two strands arranged anti-parallel. Thus, plasmin action on a clot initially creates nicks in the ﬁbrin that lead to digestion and solubilisation. These convert plasminogen to the active plasmin, thus allowing ﬁb- rinolysis to occur. Injected within the ﬁrst hours after a heart attack, it dissolves the clot blocking the coronary artery, restoring blood ﬂow before the heart muscle becomes irreversibly damaged. Decrease in platelet numbers may be due to various causes, including insufﬁcient production (e. Most consumptive conditions lead to platelet activation, and some are associated with thrombosis. Haemophilia C is a much more rare autosomal recessive disorder, most commonly seen in Ashkenazi Jews (Ashkenazi Jews are those that are descended from the medieval Jewish communities of the Rhineland in the west of Germany). It is the most common hereditary bleeding disorder, inherited autosomal recessive or dominant. Contributes to bleeding disorders as clotting factor maturation is dependent upon this vitamin. Clots formed may detach and become mobile, forming an embolus, or grow to such a size that they occlude the vessel in which they developed. An embolism is said to occur when the embolus migrates to another part of the body, interfering with blood circulation and hence impairing organ function downstream of the occlusion. Most cases of thrombosis are due to acquired extrinsic problems (surgery, cancer, immobility, obesity, ‘economy class syndrome’), but some are due to predisposing conditions, known collectively as thrombophilia (e. Procoagulants include: • The use of adsorbent chemicals, such as zeolites and other haemostatic agents, to seal severe injuries quickly. Thrombin and ﬁbrin glue are used surgically to treat bleeding and to throm- bose aneurysms. Warfarin (and related coumarins) and heparin are the most commonly used anticoagulants. Aspirin, clopidogrel, dipyridamole and ticlopidine are among the anti-platelet agents. A newer class of drug, the direct thrombin inhibitors, are under development; some members (such as lepirudin) are already in clinical use. Focus on: anaemia Anaemia is deﬁned as a qualitative or quantitative deﬁciency of haemoglobin, which may lead to hypoxia (lack of oxygen) in organs. The three main ways in which anaemia may arise are: • excessive blood loss (acutely, such as a haemorrhage, or chronically through low-volume loss, e. Anaemia is the most common disorder of the blood; there are several kinds, produced by a variety of underlying causes. Anaemia may be classiﬁed by a ‘kinetic’ approach, which involves evaluating the production, destruction and loss of red blood cells, or a ‘morphologic’ approach, based on red blood cell size. Anaemia often goes undetected; signs and symptoms can be related to the anaemia itself or to the underlying cause. Types of anaemia Microcytic anaemia is primarily a result of a failure or deﬁciency of haemoglobin synthesis, which may be caused by several aetiologies: • Haem synthesis defect, for example iron-deﬁciency anaemia and anaemia of chronic disease (more commonly presenting as normocytic anaemia). Red blood cells often appear hypochromic (paler than usual) and microcytic (smaller than usual). Iron-deﬁciency anaemia is caused by insufﬁcient dietary intake or absorption of iron, or by loss of blood, for example bleeding lesions of the gastrointestinal tract. Worldwide the most common cause of iron-deﬁciency anaemia is parasitic infestation (hookworm, amoebiasis, schistosomiasis and whipworm). Macrocytic anaemia is deﬁned as one in which the red blood cells are larger than normal. Megaloblastic anaemia is the most common cause of macrocytic anaemia, caused by a deﬁciency of either vitamin B12 or folic acid (or both). Deﬁciency in folate and/or vitamin B12 may result from either inadequate intake or malabsorption. Pernicious anaemia is caused by a lack of intrinsic factor, which is required to absorb vitamin B12 from food (see below).
The Director of the This gift will be used to support research in Department of Oncology purchase levitra pills in toronto impotence and age, Dean of the School macular degeneration and other disorders order cheapest levitra and levitra impotence urinary. Freida Derdeyn, a Leonard & Madlyn Abramson Profes- retired teacher who became acquainted with sorship in Neurodegenerative Diseases the work of the Wilmer Institute through a local : Ted M. Funding provided by Abramson Family Theodore and Ingrid Baramki Profes- Foundation. Theodore Baramki, The income from the principal will be used for a member of the faculty of the Department of prostate cancer research and held in the Sid- Gynecology and Obstetrics and the estate of ney Kimmel Comprehensive Cancer Center, Clarice Reiss. Health Care Professorship in Philip Bard Directorship in the Depart- Medicine Genetics : Garry Cutting, M. O’Connor, Vernon Mountcastle, Timothy Alzheimer’s Research in Psychiatry and Harrison, and various donors in honor of Behavioral Sciences : Constantine Philip Bard, Professor of Physiology, 1933 to Lyketsos, M. Funding provided for researching the cause, Baxley Professor of Pathology : J. Henry Willis Andelot Professor of Laryngology and Baxley (1824-1876) provided funding for the Otology : Unoccupied. The Andelot name was selected war practiced his profession in Baltimore and by Mr. Stanhope Bayne-Jones Professorship in Dana and Albert “Cubby” Broccoli Profes- Medicine : David L. As an expert in infectious used to endow a Professorship in Oncology, diseases, he served on the faculty of the Uni- having an initial focus on research and treat- versity of Rochester and Yale Medical Schools, ment of breast cancer. Brody Professorship in Radiol- he was made a brigadier general in the Army ogy : Martin G. Brody who was the Director Bendann-Iliff Professorship in Ophthal- of the Department of Radiology from 1987- mology : Nicholas T. Brody was appointed Pres- Funding provided by Constance, Maurice, ident of the Johns Hopkins University. Bernheim Research Pro- in the Division of Hand Surgery : fessorship in Surgery : James Black, Thomas M. Thornhill to provide faculty support in the by members of the Bernheim family to honor Division of Hand Surgery, Department of Bertram M. Professorship for of the faculty of the Department of Surgery, Alimentary Tract Diseases in the Depart- he was responsible for pioneering research ment of Surgery  Richard D. Neurosurgery : Benjamin Carson, Funding for this Chair was by contributions M. Alfred Blalock Funding for this professorship was provided was Director of the Department of Surgery by Mr. Tom Clancy Professorship in Ophthalmol- Funding for this Chair was provided by the ogy : Unoccupied. McCarthy-Cooper Estate, patients, and resi- Funding for this professorship was provided dents of Dr. Bordley, who was Direc- by Tom Clancy, a friend of Johns Hopkins tor of the Department of Otolaryngology for Medicine and Johns Hopkins Board of Visi- 17 years (1952-1969). Clayton Professorship in Oncology : Boury Professorship in Molecular Biology Bert Vogelstein, M. Clayton of This Professorship was funded by a bequest Houston, Texas created the Clayton Fund in the will of Mr. Boury which was used to support projects in car- was a native of Baltimore who moved to New diovascular disease under the direction of Dr. Breast Cancer Research Professorship in Professorship in the Clinical Care and Oncology : Occupied by Vered Stea- Research of Pediatric Endocrinology rns, M. Plotnick’s retirement, the name Richard Bennett Darnall Chair in Surgery of the endowed professorship will become : Unoccupied. Professorship in Funding provided by a bequest in the will the Clinical Care and Research of Pediatric of Mrs. Richard Bennett Darnall Professor Emeri- Funding provided from the bequest of Mrs. Funding provided by the estate of Admiral Funding provided by a bequest in the will of Conner. DeLamar, who was born in the chair shall be the Director of the Harriet Holland in 1843 and came to America after the Lane Clinic. On the advice of Funding provided from income from the prin- his attorney, he divided his $30 million estate cipal which will be used “in honor of Dr. David between the “three best medical schools of the Hellmann and that the holder of the chair be day -Johns Hopkins, Harvard and Columbia”. Cudahy, the Funding provided by contributions of current founder of Marquette Electonics, which pro- and former faculty, fellows, and house staff duces medical, diagnostic, monitoring and of the Department of Radiology. Otolaryngology - Head and Neck Surgery Clarence Doodeman Professorship in : Unoccupied. Funding provided by Edward and Loretta Harvey Cushing Professorship in Neuro- Downey to honor Mrs. Funding provided by the Eccles Foundation Firor as a fne surgeon, teacher, and humani- and by Mrs. Edgerton Endowment in Pediatric Epilepsy : for an endowed professorship for the Director Unoccupied of the Department of Plastic and Reconstruc- Funding will be used for pediatric epilepsy. Jonas Friedenwald Professorship in Oph- Doctor Dorothy Edwards Professorship in thalmology : Unoccupied. Gynecology and Obstetrics : Harold Named for father of experimental ophthalmic E. Fries Professorship in Medicine Edwards, who attended the Johns Hopkins : Unoccupied School of Medicine from 1917-1921. Funding provided by the Garrett Fund for the Eudowood Professorship in Pediatric Immu- surgical treatment of children founded by nology : Jerry A. Eudowood was the name of a tubercu- losis hospital offcially known as The Hospital William Thomas Gerrard, Mario Anthony for Consumptives of Maryland, which joined Duhon and Jennifer and John Chalsty with other institutions to form the Children’s Professorship in Urology : William B. King Fahd Chair in Molecular Medicine Given Foundation Professorship in Pedi- : Andrew P. Funding provided by the Kingdom of Saudi Funding provided by the Irene Heinz Given Arabia. The King Fahd Professorships in the and John LaPoute Given Foundation of New School of Medicine represent “an indication of York for the purposes of medical research and the mutual human interest and mutual support teaching. Goldberg Professorship in Oph- King Fahd Chair in Pediatric Oncology thalmology : Ran Zeimer, M. Professorship sorship in Ophthalmology : Michael : William Baumgartner, M. Funding provided by various residents, Established by Robert and Maureen Fedu- patients and friends of Vincent L. Green Professorship in Macular Bayard Halsted Professorship in Cell Biol- Degeneration and Other Retinal Diseases ogy and Anatomy : Unoccupied. Funding provided by a bequest in the will of Funding provided by a bequest from Joseph Mr. Richard Green Professorship of Oph- nature, causes, means of prevention, and thalmology : Richard D.