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William F. Meacham

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William F. Meacham

✓ The president of the American Association of Neurological Surgeons (AANS) reviews the history of the AANS and discusses some national issues affecting the practice of neurosurgery in America: government influence and control, inadequate funding for training programs and research, neurosurgical manpower, professional liability, continuing education, recertification and relicensure, medical fees, and the influence of current social, economic, and political philosophies.

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The Chemotherapy of Intracranial Infections

IV. The Treatment of Pneumococcal Meningitis by Intrathecal Administration of Penicillin

Cobb Pilcher and William F. Meacham

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B. L. Rish and William F. Meacham

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William F. Meacham and Joe M. Capps

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Byron Young, William F. Meacham and Joseph H. Allen

✓ Small aneurysms may sometimes be considered junctional dilatations but may also progressively enlarge and cause spontaneous subarachnoid hemorrhage, as in the case reported. These small aneurysms should be treated precisely as an aneurysm directly responsible for bleeding. When found in conjunction with other aneurysms, they should either be treated simultaneously or followed until clinical developments indicate the need for such surgery.

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Nonketotic hyperglycemic hyperosmolar coma

Report of neurosurgical cases with a review of mechanisms and treatment

Bert E. Park, William F. Meacham and Martin G. Netsky

✓ Seventy-eight critically ill patients who died while on the neurosurgical service were studied retrospectively to establish the prevalence of nonketotic hyperglycemic hyperosmolar coma (NHHC). All patients had been comatose before death, and all underwent necropsy. Criteria for the diagnosis of NHHC included moderate-to-severe hyperglycemia with glucosuria, absence of significant acetonuria, hyperosmolarity with dehydration, and neurological dysfunction. This study revealed seven cases of unequivocal NHHC (9%), and six of hyperosmolarity but with incomplete records. Five of the seven confirmed cases of NHHC demonstrated no evidence of cerebral edema, transtentorial herniation, or brain-stem damage, and showed central nervous system (CNS) lesions compatible with survival. Fatal complications of this syndrome, such as acute renal failure, terminal arrhythmias, and vascular accidents, both cerebral and systemic, were common in this series. The mechanism of coma in NHHC is believed related to shifts of free water from the cerebral extravascular space to the hypertonic intravascular space, with subsequent intracellular dehydration, accumulation of metabolic products of glucose, and brain shrinkage. It is uncertain whether injury to specific areas in the CNS is a predisposing factor to the development of NHHC. Factors documented to be significant in its development include nonspecific stress to primary illnesses, hyperosmolar tube feedings, dehydration, diabetes, and mannitol, Dilantin, or steroid administration.

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Edward H. Oldfield, Robert J. Plunkett, William A. Nylander Jr. and William F. Meacham

✓ Ischemia is the pathophysiological mechanism in many types of spinal cord injury. In the present study, the infrarenal segment of the aorta was occluded for 25 minutes to produce spinal cord infarction in rabbits. Paraplegia occurred in 100% of control animals. Thiopental administered before aortic occlusion resulted in paraplegia in only 40% of animals so treated (p < 0.01). Histological study of the spinal cord demonstrated infarction of the gray matter in all paraplegic animals, whereas the microscopic appearance was normal in animals without neurological deficit. The protective influence of thiopental therapy in spinal cord ischemia was demonstrated.

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Timothy C. Wirt, Zell A. McGee, Edward H. Oldfield and William F. Meacham

✓ Four pediatric neurosurgical patients with Gram-negative meningitis and ventriculitis were treated with parenteral and intraventricular amikacin, a new aminoglycoside. The organisms infecting these patients were resistant to multiple antimicrobial drugs but were sensitive to amikacin. Treatment was continued for 14 days after cerebrospinal fluid cultures became negative. All four patients were cured and have demonstrated no nephrotoxicity, ototoxicity, or evidence of persistent infection on follow-up examination.

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C. Hunter Sheldon, Robert H. Pudenz, Wallace B Hamby and William F. Meacham

✓ In the second and final series of comments solicited for the Journal of Neurosurgery's 50th anniversary, four additional authors, each of whom was an original contributor to the first volume of the Journal, share some thoughts and anecdotes regarding their first articles.