with or without the preceding apostrophe

• 4 x 4s ...sm - gauze question
  • with or without the preceding apostrophe - SoCal
  • like the other poster(s) said......nm - No apostrophes with 4 x 4s or TMs
    • what is your source? personal opinion? - nm
  • if your company or client is using BOS - sm
    • And yet it would be wrong in the rest of the world. Go figure. - nm
  • this link may be useful to you also-sm - Debra
    • at least it says this...........sm - that link you supplied isn't working
  • No apostrophe!!! - nm
  • 4 x 4's nm - flybye
    • as poster above stated, I was going with BOS rules...relax! :) nm - flybye

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When the following phrase is dictated:

"He is a well nourished appearing patient,"

What is the most appropriate transcript format? With, or without hyphens? One of our staff Doc.s keeps dictating this phrase and we are stumped. Of course, this one phrase does not appear to be in BOS!

Thanks for your help!

Also known as:
Crohn's colitis
Crohn-Lesniowsky disease
Crohn-Lesniowsky syndrome
Enteritis regionalis Crohn
Morbus Crohn

Synonyms:
Enteritis regionalis, ileitis terminalis, regional enteritis, regional ileitis, chronic granulomatous enterocolitis, segmental enteritis, segmental ileitis, terminal ileitis.

Associated persons:
Burrill Bernard Crohn

Antoni Lesniowski


Description:
A subacute and chronic inflammatory disease with symptoms variable according to anatomic location and amount of involvement. It was originally believed to be limited to the terminal ileum, but subsequently recognized as involving other parts of the intestine, especially the distal ileum, colon, and anorectal region. Abdominal pain and cramps may indicate narrowing of the lumen and partial obstruction of the intestine. Associated with abscesses and fistulas. Etiology unknown. Slight prevalence in males, Jewish people most frequently affected. Onset at any age; average 25 years.

The first reported case of granulomatous enterocolitis is ascribed to Giovanni Battista Morgagni (1682-1771), who discussed the clinical course in a 20 year old man with a protracted, sometimes bloody diarrhoea and colic pains. The patient died from a perforation of the terminal ileum.

Another case was described in Sweden by John Berg at the Serafimerlasarettet in Stockholm in 1898 (John Wilhelm Berg, 1851-1916?) and yet another by Antoni Lesniowsky from Warsaw in 1904. At the 1913 meeting of the British Medical Association, the Scottish physician T. Kennedy Dalziel in a lecture reported nine cases of disseminated thickening of, in most cases, the distal small intestine but in some cases also of the right colon.

The American clinician and pathologist Eli Moschowitz (1879-1964) and A. O. Wilensky of the Mount Sinai Hospital in New York in 1923 published a work titled "Non-specific granulomata of the intestine". They described a case with non-specific intestinal granulomas, thickening of the distal ileum, as well as an intestine to skin fistula.

At a meeting of the American Medical Association in New Orleans on May 13, 1932, Burrill Bernard Crohn, Leon Ginzburg, and Gordon Oppenheimer delivered a lecture titled "Terminal ileitis: A new clinical entity". They reported 14 cases of a granulomatous inflammation of the distal ileum. J. A. Bargen, in a contribution protested the designation "terminal" ileitis. He maintained that, as most of the patients had survived, the term "terminal" was inappropriate. He suggested that the disease instead be termed "regional ileitis". Crohn and his associates accepted this view and, when the work was published later that year, the article was titled “Regional ileitis; a pathologic and clinical entity". Of the three original authors Ginsburg and Oppenheimer were the most experienced, but Crohn's name, for "alphabetic reasons", appeared the first on the publication.

This was the first time this condition was reported i a larger, widespread journal, and the article thus received a lot of attention. During the following years a multitude of descriptions, of single cases or series of cases, were published. It was soon obvious that the disease did not only affect the distal ileum, but also other parts of the gastro-intestinal tract.

Bibliography:

• A. Lesniowski.
  Przyczynek do chirurgii kiszek.
  Medycyna, Warsaw, 1903, 31: 460-464, 483-489, 514-518.
  
  
  
• B. B. Crohn, L. Ginzburg, G. D. Oppenheimer:
  Regional ileitis; a pathologic and clinical entity.
  Journal of the American Medical Association; Chicago, 1932, 99: 1323-1329.

I'm confused regarding using an apostrophe for abbreviations that are plural like cc's or MI's.  I thought the apostrophe was used to show posession, but abbreviations just don't seem to look right without the apostrophe.  Anyone know which is correct? (ccs/cc's or MIs/MI's).

Thanks!

One year, one month, etc. - one month's time (you rephrase it in your mind, and if it makes sense to have it bolstered to "one month of time," then the apostrophe can be put to use. 

Three months' duration.  Three months of duration - again, the apostrophe can be used. 

Five months' pregnant.  Five months of pregnancy. 

Apgar 8 and 9 is incorrect.

Apgars 8 and 9 is correct -- the "s" is needed to indicate plural.

Virginia Apgar

American anaesthesiologist, born June 7, 1909, Westfield, New Jersey; died August 7, 1974, New York City.


Associated eponyms:
Apgar's score
The Apgar score is a system for point score evaluation of the physical condition of a newborn one minute after birth.








Biography:
Virginia Apgar was born in Westfield, New Jersey, in 1909, the daughter of Helen Clarke Apgar and Charles Emory Apgar. She entered Mount Holyoke College in 1925, majored in zoology, and was active in the college community. She received her Bachelor of Arts at the Mount Holyoke College in 1929. Her scant economy forced her to support herself on extra work; one of her jobs was catching cats for the physiological laboratory. A dedicated musician since childhood, she found time to play her cello and violin.

At a time when few women even attended college, Apgar was determined to make medicine her life's work. Following her BA she studied medicine in New York, graduating M.D. from the Columbia University's College of Physicians and Surgeons, in 1933. From 1933 to 1936 she was surgical intern and resident under Alan (Allen Oldfather) Whipple (1881-1963) at the Columbia Presbyterian Hospital. Her superior, who had seen former female surgeons educated by him encounter problems in commencing their own practice and supporting themselves, advised her instead to switch to anaesthesiology, which needed reinforcement at the Columbia P & S.

Into anaesthesiology
After two frustrating years of practice, Apgar, convinced that as a woman she could not support herself in the predominantly male field of surgery, followed Whipple's advice and turned to the newly emerging field of anaesthesiology, which had long been relegated to the domain of nursing. During the years of 1936 and 1937 she learned the basics of anaesthesiology by the nurse anesthetisists at the Columbia Presbyterian; at this time there were no anestehesiologists at the hospital. During the years 1937–1938 she was a resident for six months each with two of the fathers of American anaesthesiology, Ralph Waters at the University of Wisconsin in Madison, and Emory Rovenstine at the Bellevue Hospital in New York.

Thus prepared, in 1938 Apgar returned to the Columbia Presbyterian Hospital/Columbia-Presbyterian Medical Center, division of anaesthesia. In 1939 she received her Board Certification from the American Society of Anesthesiologists, the second woman to get this diploma. The same year she was appointed anaesthesiologist-in-chief at the division of anaesthesia under the department of surgery at the Columbia Presbyterian Hospital, becoming the first woman to head a department there.

Among other things, she developed programs for residents in anaesthesiology and student's courses. From the beginning there were major problems in the cooperation with the surgeons, who were previously used to work only with nurse anaesthetists. It was also a toil to get paid for narcoses given, as this at first depended on what the surgeons were prepared to let their patients pay.

The war years were characterized by an increasing clinical and administrative workload, as many of her colleagues had been drafted for war service. This workload may have contributed to her giving up her administrative duties, when in 1948 an independent Department of Anesthesia was established at the hospital. In stead it was her friend, the scientifically trained Emmanuel Papper from the Bellevue Hospital who assumed the position of professor at the newly established clinic of anaesthesia. Dr. Apgar, however, in 1949 was appointed simultaneously professor of anaesthesiology - the first woman with a professorship at the College of Physicians & Surgeons at the Columbia University.

Relieved of the burdens as chief of clinic Virginia Apgar now moved into obstetric anaesthesia and became Attending Anesthesiologist at the Sloane Hospital for Women, where for ten years she was to devote herself to the evaluation of the newborn child in the period immediately after delivery.

After introducing her score, Virginia Apgar went on to do further important research in neonatal acid-base status, especially in terms of hypoxia and acidosis, and also on the effects of maternal anaesthesia on the neonate. She also introduced the anterior approach to the stellate ganglion in 1948.

Virginia marches on
During a sabbatical year in 1959 Virginia Apgar read in a master of public health examination at the Johns Hopkins University in Baltimore, receiving a master's degree in public health. This, and her increasing interest in following up children in a broader perspective after birth led her to various tasks with The National Foundation for Infantile Paralysis. This foundation, originally the heart child of Franklin D. Roosevelt, was founded in 1938 to fight polio and promote medical research through large nationwide collections under the name of March of Dimes.

The foundation today presents itself thus on the Internet: We're the March of Dimes Birth Defect Foundation. Our mission is to improve the health of babies by preventing birth defects, infant mortality and low birth weight.

When Apgar joined the foundation in 1959 as director for the division of congenital malformations, research programs mobilized and funded by the foundation had virtually eliminated polio disease in the U.S.A., and was therefore reoriented towards congenital malformations. She headed programs in research in the causes, prevention and treatment of birth defects. She was director for the division of congenital malformations (1959-67), vice president and director of basic research (1967-72) and senior vice president in charge of medical affairs (1973-74).

Much of Apgar's time with the National Foundation-March of Dimes was spent working to generate public support and funds for research on birth defects. A spectacular fundraiser Apgar is credited with the foundation's dramatic financial growth. As an educator of the public she greatly increased both visibility and attention to the problems of birth defects.

Honours
Virginia Apgar received many honorary assignments and titles, among them, in 1959, Lecturer in Medicine at Johns Hopkins, and the same year clinical professor of paediatrics at the Cornell University, New York. In 1961 she received the Distinguished Service Award from the American Society of Anesthesiologists. She was appointed Honorary Associate Fellow of the American Academy of Pediatrics, and Associate Fellow of the American College of Obstetricians & Gynecologists. In 1973 she enjoyed the attention of the general public as Woman of the Year on national television. That year she was appointed lecturer in the Department of genetics at the Johns Hopkins School of Public Health. She served as an alumna trustee at Mount Holyoke College from 1966 until 1971.

She served American Society of Anesthesiologists as Treasurer from 1941 to 1945 and was awarded the ASA Distinguished Service Award in 1961. She was the first woman officer of ASA.

In 1973 she was the first woman to receive the Gold Medal for Distinguished Achievement in Medicine from the College of Physicians and Surgeons, Columbia University. In 1994, Apgar was pictured on a U.S. postage stamp, as part of the Great Americans series.

A lady of many facets
Virginia Apgar enjoyed a contentful and fascinating life with a wide scope of interests beyond medicine. An eminent lecturer - though at a machine gun-like pace – she was in high demand and a widely travelled person. This gave her the opportunity to pursue one of her great hobbies, angling, frequently in exotic places like the salmon rivers of Scotland and on the Great Barrier Reef. She was also an avid stamp collector, who herself was to be portrayed on a stamp. Her greatest, life-long interest, however, was music, no doubt influenced by her father who was an amateur musician and held family living-room concerts during her childhood. During her working years she played in three orchestras: The Teaneck Symphony of New York, The Amateur Music Players, and the Catgut Acoustical Society, the latter with a studenticosical note to its name. Dr. Apgar usually carried the cello or viola with her on her frequent travels and often joined chamber music groups in cities she visited for a night of playing.

The instrument builder
An accomplished cellist and violinist, Dr. Apgar built her own stringed instruments. It was a visit to a preoperative patient in 1956 that led to Dr. Apgar's interest in constructing stringed instruments. This patient was Carleen Hutchings, a high school science teacher and musician. Her interest in how stringed instruments produce sound prompted Mrs. Hutchings to do studies in a home laboratory and, eventually, to construct fine stringed instruments based on her scientific studies. She had one of her self-made violins with her when she was in the hospital for surgery, and she invited Dr. Apgar to play it during her preoperative visit.

Enchanted by the excellent sound quality of the instrument, Apgar joined Mrs. Hutchings in her studies and later learned instrument construction from her. Working from 12:00 midnight to 2:00 a.m. (much to the chagrin of her neighbours who were trying to sleep), she produced four stringed instruments – a violin, mezzo violin, cello and viola – in her small apartments bedroom filled with woodworking tools and a workbench.

The "phone booth caper."
A legend illustrating her commitment to musical excellence was reported in a New York Times article published a year after Dr. Apgar's death. The episode is known as the "phone booth caper."
In 1957, the article reported, Dr. Apgar and Carleen Hutchings, "liberated" the curly maple shelf from a pay telephone booth in the lobby of the Harkness Pavilion of Columbia-Presbyterian Medical Center, to make the back of a viola. Because Dr. Apgar had been unsuccessful in getting the wood through proper channels, the two women devised a plot to steal it. When they found the piece of wood they brought to replace the shelf was too long, they had to use a women's lounge to shorten the piece with a saw, Dr. Apgar standing guard in the hall, dressed in her hospital uniform, told a nurse who heard the sounds coming from the lounge, "It's the only time repairmen can work in there."

The stuff that legend is made of
In remarks at Dr. Apgar's memorial service in September 1974, Dr. L. Stanley James, professor emeritus of paediatrics and of obstetrics and gynaecology, called Dr. Apgar a student until the day she died. "Learning was the focal point of her life. Her curiosity was insatiable . . . she never became rigid. This rare quality enabled her to progress through life without becoming walled in by tradition or custom. It kept her young and vital. She started flying lessons a few years ago and even wanted to fly under the George Washington Bridge."

David Little, a longstanding friend and for periods a close associate of Virginia Apgar, began his memorial speech occasioned by a reprint of Apgar's first publication from 1963 with the following words: "The speciality of anaesthesiology lost one of its most distinguished ladies last year when Ginny Apgar died on August 9. She was a physician in every sense of the word, a true scientist, everybody's friend - but above all, a lady."

In her obituary in the Winter issue of P & S Quarterly, predecessor of P & S Journal, Dr. Leonard Brand, professor emeritus of clinical anaesthesiology, wrote: "Anybody who met her had a 'Ginny' story to tell, whether it had to with her interest in music, playing the violin and cello, or building her own string instruments. Or whether it had to do with her love of fishing . . . There were stories about her stamp collecting and her love of baseball and golf. There were stories about her driving her automobile as if it were an airplane.

These stories could fill several pages, and they have filled several pages of publications, books, eulogy notes, speeches, and other materials. Whether they reflect the sense of humour she showed as a teacher or as a guest on the Johnny Carson show or whether they recount the numerous times she saved lives by carrying a small surgical knife and tubing for emergencies, the stories collectively portray the kind of person Virginia Apgar was. Here are a few examples:

"Time was precious to her and her mind and hands were never still. I remember once watching a World Series baseball game on television with my children when the game was interrupted by rain and simultaneously our phone rang. My daughter said, "That must be Ginny. She only calls during rain delays."
Dr. Leonard Brand, P & S Quarterly obituary.

"One of the few things she could not do was talk slowly. Some people believed she had another hole for breathing. After a talk to several hundred physicians at an international meeting, it was later apparent that many had not understood a word she said, but they were enraptured and loved her. Somehow they got the message."
Eulogy delivered by Dr. L. Stanley James.

"Whenever Virginia was expected to our house, my teen-age son and his friends would spend half a day in the library, concocting difficult questions to spring on her. She never failed to get the answers right."
Columnist Joan Beck, co-author with Dr. Apgar of "Is My Baby Alright?" in 1973.

"One of her favourite anaesthetic agents for delivery was cyclopropane, which she firmly believed to be completely safe and harmless to the infant. When her research fellows found out that infants born under cyclopropane were slightly but significantly more depressed compared to other infants, she was horrified. After looking at the data, she accepted the verdict without question and immediately announced at luncheon in a loud voice: "There goes my favourite gas."
Eulogy by Dr. James.

Virginia Apgar is one of only two anaesthesiologists to be honoured on a U.S. stamp, the other being Crawford Long. The stamp, 20-cent, part of the Great Americans series, was released on October 24, 1994, during the annual meeting of the American Academy of Pediatrics in Dallas, Texas. The meeting featured string quartet musicians playing a cello Dr. Apgar made and two violins and a viola she helped make.

The American Academy of Pediatrics gives an annual award called the Virginia Apgar Award in Perinatal Pediatrics.

On October 14, 1995 Virginia Apgar was inducted into the National Women's Hall of Fame in Seneca Falls, New York

We thank Jeff Tompkins for pointing out an error in our original entry. Jeff Tompkins is a neonatologist in Perth, Western Australia.

We also thank Dr. Andrew Hume and Frederick Rhine for correcting errors.



Bibliography:

• V. Apgar, Joan Beck:
  Is My Baby All Right? 1973.
  
  
  
• Virginia Apgar Papers.
  Mount Holyoke College, Archives and Special Collections, South Hadley, Massachusetts. Access unrestricted.
  
  
  
• Selma Harrison: Calmes:
  Virginia Apgar: A Woman Physician's Career in a Developing Speciality.
  Journal of the American Medical Women's Association, November/December 1984.
  
  
• Anesthesia: Essays on its History ("Development of the Apgar Score”).
  Springer-Verlag, Berlin, 1985.
  
  
  
• A. Skolnick:
  Apgar quartet plays perinatologist's instruments.
  Journal of the American Medical Association, Chicago, 1996, 276: 1939-1940.
  Corrections, JAMA: 1997, 277: 1819.

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