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David G. Kline

reports of both military and civilian cases have suggested that surgery is usually not indicated or, if undertaken, that neurolysis suffices since GSW's usually (but not always) produce lesions in continuity. 10, 12, 15 Several solitary case reports have documented successful repair, 2, 6 while others have reported only small groups of patients 10, 11 or presented their outcome solely in respect to pain management. 5, 7 A sizable civilian experience has now accumulated in one center (Louisiana State University Medical Center, LSUMC) and received a preliminary

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David G. Kline

for several days on preparing the second edition of a book originally published in 1995, trying to find the original photographs from the first edition. Some photographs were at home, but most were at my Medical School office at 1542 Tulane Avenue. I went to my office, collected the photographs spread out on my desk and sofa, and placed them in a drawer in my desk. I returned some messages on the answer machine, including those from two patients due to undergo surgery on Wednesday at Ochsner Hospital. These individuals were from Rhode Island and Mississippi and were

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David G. Kline

certain of the psychological aspects of such disorders. Along with Benjamin Rush, Mitchell was a founder of neurology and an early pioneer in psychiatry in America. 11 Acknowledgments Thanks to Prof. Thomas Brushart, Department of Hand Surgery and Orthopedics, Johns Hopkins, for giving me his books of Mitchell's fiction and to Steve Legendre, Medical Photography at Ochsner, for help with the figures and manuscript. References 1 Anonymous : The strange case of George Dedlow . Atl Mon 18 : 1 – 11 , 1866 2 Bailey P : Silas Weir Mitchell (1829

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David G. Kline and Stephen Mahaley Jr.

of the 23 approved boards and a number of other medical organizations such as the American Hospital Association, the Association of American Medical Colleges, the Council of Medical Specialty Societies, the Federation of State Medical Boards, the National Board of Medical Examiners, and several members of the public. Thus, when those supporting a certificate in vascular surgery as a subspecialty of surgery brought their proposal to the ABMS in 1983, the issue was weighed and debated at length. As a result, significant changes were suggested and subsequently made in

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David G. Kline and Daniel H. Kim

months. Because even early evidence of spontaneous recovery can take longer to be evident in the deltoid than in some other muscles, such as the biceps or triceps, patients were observed for 4 to 6 months. Surgery was performed because there was poor recovery of deltoid function, as assessed by clinical and electromyographic examination. Some patients were referred long after injury and thus the preoperative interval varied between 3 and 10 months with a mean of 6.5 months. Patients selected for surgery had undergone x-ray studies and sometimes magnetic resonance

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Daniel H. Kim, Yong-Jun Cho, Robert L. Tiel and David G. Kline

B rachial plexus injuries tend to occur in young, otherwise active and healthy individuals. Whereas plexus injuries themselves are not fatal, they can cause disability and can be very difficult to reverse. 35, 38 Although early results of surgery for these injuries were not encouraging, 5, 12, 15, 18, 34, 48, 57 microsurgical refinement of grafts and the use of intraoperative electrophysiological studies have renewed interest in their operative management. 1, 30, 39, 40, 42, 49 To date, favorable surgical outcomes have been reported in only approximately 60

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David G. Kline and Donald J. Judice

S ome disagreement persists concerning the value of operative intervention for brachial plexus lesions. Thus, a few clinical investigators believe that most gunshot wounds (GSW) to the plexus recover without surgery; some view with some justifiable skepticism operations for stretch palsies of the plexus; others consider that some tumors intrinsic to the plexus are not resectable without serious loss of function, and that perhaps the rewards from repair even of sharply transected plexus elements are small due to their proximal location and the distance that

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Peter Gruen and David G. Kline

✓Hypertrophic localized mononeuropathy is a condition that comes to clinical attention as a painless focal swelling of a peripheral nerve in an arm or leg and is associated with a slow but progressive loss of motor and sensory function. Whether the proliferation of perineurial cells is neoplastic or degenerative—an ongoing controversy among nerve pathologists—for some patients resection of the involved portion of a nerve with autologous interposition grafting results in better functional outcome than allowing disease to follow its natural course. Patients with a painless focal enlargement of a nerve associated with progressive weakness and/or sensory loss may benefit from surgery for resection and grafting.

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C-8 and T-1 input. Any statements about the value of replantation or any other operative technique on the plexus for reducing or eliminating pain are speculative at best. Pain can reduce or disappear over time in some of these patients, even when surgery is not performed. It appears to hold true that if significant movement is restored to an area of the limb, pain sensation in that area lessens in some patients, although not in all, with such recovery. However, the reduction of pain is usually greater than the amount of motion restored in most of these cases

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David G. Kline and George J. Hayes

of irreducible gaps in man. Presented at meeting of the Harvey Cushing Society, Philadelphia, Pa., April 18, 1963. 4. Campbell , J. B. , Bassett , C. A. L. , Husby , J. , Thulin , C.-A. , and Feringa , E. R. Microfilter sheaths in peripheral nerve surgery: a laboratory report and preliminary clinical study. J. Trauma , 1961 , 1 : 139 – 157 . Campbell , J. B., Bassett , C. A. L., Husby , J., Thulin , C.-A., and Feringa , E. R. Microfilter sheaths in peripheral nerve surgery: a