Репозиторий Университета

© 2018, © 2018 Taylor  &  Francis. American neurologist and epileptologist Francis M. Forster (1912–2006) was the last survivor of the “Four Horsemen,” a nickname given to the four neurologists—Forster, Abe Baker, Russell DeJong, and Adolph Sahs—who were most instrumental in founding the American Academy of Neurology under Baker’s leadership in 1948. Forster was a consulting physician for many high-profile patients, including President Dwight Eisenhower, President Quirino and Archbishop Reyes of the Philippines, Provisional President Lonardi of Argentina, and Cardinal Albert Meyer of Chicago. Forster was also an expert witness for the prosecution in the trial of Jack Ruby, who killed Lee Harvey Oswald. Forster’s greatest legacy, though, was as a teacher: During his career as chairman of two robust academic neurology departments, he trained more than 100 residents, at least 17 of whom went on to become chairmen of neurology departments in the United States, Europe, Asia, and South America.

© 2018, © 2018 Taylor  &  Francis. “The Four Horsemen” was the nickname given to the four neurologists—Abraham Baker, Francis Forster, Russell DeJong, and Adolph Sahs—who were most instrumental in founding and developing the American Academy of Neurology (AAN) beginning around 1948. Forster later humorously added “and their nags” to the epithet to reflect the cohesion of the founders and their wives. This article presents the personal recollections of these founders from correspondence and oral histories. When the AAN was founded, private-practice neurologists and residents were excluded from the academically oriented and restrictive American Neurological Association (ANA). Baker conceptualized the AAN as an inclusive professional society that would accept all neurologists of whatever age and level of training, and that would strive to strengthen their knowledge, competencies, and skills through continuing medical education and guideline development. Baker recruited supportive colleagues to help create and develop the organization. Their intention was not to compete with or subvert the ANA, but to offer an inclusive professional organization for all neurologists. Nevertheless, their efforts produced opposition among ANA members. To defuse the antagonism, neurologist Alphonse Vonderahe proposed an influential House–Senate formulation of the AAN–ANA relationship, modeled after the U.S. Congress, both as a supporting rationale for the AAN and as a conceptual model for the functional relationship between the two organizations. The inclusive approach greatly augmented the ranks of the fledgling AAN, whereas those of the ANA stayed relatively stagnant, with the AAN ultimately becoming the dominant neurological society. These neurologic pioneers laid the groundwork for an invigorated, well-trained, scientifically based specialty of neurology in the second half of the twentieth century.

© 2018, Media Sphera Publishing Group. All rights reserved. Aim — the study purpose was to analyze the efficacy of intra-arterial administration of verapamil (IAV) in the treatment of angiospasm in SAH patients and to determine optimal parameters of the procedure. A number of studies demonstrated the efficacy of intra-arterial administration of vasodilators, in particular verapamil, in the treatment of angiospasm after aneurysmal SAH, which served the basis for inclusion of this method in the recommended protocol for treatment of SAH patients [1―7]. Material and methods. We analyzed the efficacy of IAV in 35 patients in the acute period of SAH, with 77.2% of the patients having a Hunt-Hess score of III―V. The inclusion criteria were as follows: IAV within two weeks after SAH; excluded aneurysm; verapamil dose per administration of at least 15 mg; follow-up for at least three months. Efficacy endpoints were as follows: changes in spasm according to angiography and transcranial dopplerography (TCDG); development of ischemic lesions; clinical outcome according to the modified Rankin scale. Results. A total of 76 IAV procedures were performed. The verapamil dose per procedure was 36.7±9.7 mg, on average; the number of procedures varied from 1 to 5. One arterial territory was treated in 12 cases, two arterial territories were treated in 48 cases, and three arterial territories were treated in 15 cases. Typical adverse reactions included decreased blood pressure, a reduced heart rate, and elevated ICP. In all cases, TCDG revealed signs of reduced angiospasm ― a 20―40% decrease in the LBFV in the M1 MCA. Four (11.4%) patients died; of these, only one died due to angiospasm progression. On examination at 3 months or more after discharge, favorable outcomes were observed in 74.3% of cases. Conclusion. IAV is associated with a low risk of significant complications. IAV should be performed under control of systemic hemodynamics and ICP. The indications for IAV include signs of moderate worsening or severe angiospasm according to TCDG and/or angiography. The IAV procedure may be performed every day. Further clarification of the IAV procedure and evaluation of clinical outcomes under prospective study conditions are required.