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Martin H. Weiss and Frank E. Nulsen

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Frank E. Nulsen and Donald P. Becker

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Diphtheroid infections of cerebrospinal fluid shunts

The changing pattern of shunt infection in Cleveland

Harold L. Rekate, Teresa Ruch and Frank E. Nulsen

✓ In the process of trying to decrease infection rates, gentamicin has been used to irrigate shunt systems at the time of surgery. The infection rate did not change, but the epidemiology of infecting organisms changed from Staphylococcus epidermidis to diphtheroids. These indolent and sometimes asymptomatic infections can progress to cause systemic disease with nephritis, peritonitis, or blocked shunts, and are difficult to detect. Laboratory values of cerebrospinal fluid and blood may not be helpful, but prolonged culture incubation on anaerobic media will subsequently yield the organism. Systemic and intraventricular antibiotics may rid the system of diphtheroids and avoid morbidity of shunt revision if the infection is found before systemic disease occurs.

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Antibiotic neurotoxicity

Laboratory and clinical study

Martin H. Weiss, Theodore Kurze and Frank E. Nulsen

✓ By ventriculocisternal perfusion, a series of newer antibiotics were circulated through the central nervous system to ascertain the potential toxicity of these drugs to the nervous parenchyma. Ampicillin, carbenicillin, gentamycin sulfate, and polymyxin B sulfate appear to be well tolerated whereas cephalexin monohydrate and penicillin G caused a repeated pattern of significant CSF pleocytosis, histological evidence of periventricular perivascular infiltrates, and evidence of clinical toxicity. A regime for treatment of central nervous system infections is presented, derived from the data presented above. Preliminary experience in a clinical series appears to support this program.

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M. Deborah Hyde-Rowan, Harold L. Rekate and Frank E. Nulsen

✓ This study reports six cases of hydrocephalic children with the “slit ventricle syndrome” who evidenced reexpansion of the ventricular system following insertion of high-resistance valves and anti-siphon devices. The authors contend that slit ventricles and subsequent ventricular coaptation can be prevented by elimination or early replacement of low-resistance valves, and maintenance of normal- or nearly normalsized ventricles by shunt revision with valve upgrade and/or an anti-siphon device, as judged by the appearance of the ventricles on computerized tomography.

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Richard A. Roski, Robert F. Spetzler and Frank E. Nulsen

✓ The results in 57 consecutive patients treated with carotid ligation for an intracranial aneurysm were analyzed to define the risks of late complications. The average age for the group was 46 years. Eighty percent of the aneurysms were located on the internal carotid artery (ICA). The acute morbidity and mortality of the treatment and the natural history of the disease was 29%. Twenty-four patients were discharged with a common carotid artery (CCA) ligation, and 21 patients with an ICA ligation. Three patients from each ligation group could not be located for review. The follow-up period for the 21 patients with CCA ligation ranged from 1 to 15 years, with an average of 8.4 years, and for the 18 patients with ICA ligation it ranged from 2 to 19.5 years, with an average of 12.5 years.

Excluding deaths from unrelated causes, five of the 21 patients with CCA ligation developed a late complication. Two patients had a transient ischemic attack (TIA). Two patients had a subarachnoid hemorrhage (SAH), one of which was fatal and was preceded by a TIA. Two patients developed monocular blindness. None of the patients had a stroke. Excluding deaths from unrelated causes, five of the 18 patients with ICA ligation developed a late complication. One patient had a fatal SAH. Three patients had a TIA, two of which were followed by a stroke. One patient had a stroke in the cerebral hemisphere contralateral to the side of the carotid ligation.

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Thomas J. Croft, Jerald S. Brodkey and Frank E. Nulsen

✓ Cortical evoked potentials in anesthetized cats were recorded by a noninvasive averaging technique as a means of estimating spinal cord damage. Graded pressure on the spinal cord produced reversible blocking of these potentials. With this type of trauma, block of motor transmission through the cord paralleled the block of sensory transmission, and each seemed to be a sensitive indicator of spinal cord function. The possible use of such monitoring in anesthetized patients undergoing spinal operations is discussed.

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Martin H. Weiss, Frank E. Nulsen and Benjamin Kaufman

✓ Hydrocephalic dogs treated with intraventricular radioactive colloidal gold showed a sustained decrease in cerebrospinal fluid flow and intraventricular pressure associated with a reversal of progressive hydrocephalus. Gamma scanning and isotopic sampling, however, indicated a more diffuse distribution of the isotope than previously thought, although pathological changes up to 7 weeks post-instillation of the radioactive colloid appeared confined to the choroid plexus.

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Franc D. Ingraham, Orville T. Bailey and Frank E. Nulsen