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William J. German

concerning the serious potentialities of chronic leak of cerebrospinal fluid into the nose. A series of twenty-one cases from the literature was reviewed by Johnston; 8 injury was an etiologic factor in six instances. The rhinorrhea persisted in nine cases and the patients were alive at the time of report; the flow had ceased in six cases. Six of the patients were dead when the reports were published. Chronic cerebrospinal rhinorrhea may appear after an interval of several weeks following the injury. Gissane and Rank 6 designated this type as “delayed post

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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

I n a previous study , 1 penicillin administered intrathecally, even in relatively small doses, was found to be beneficial in experimental staphylococcal meningitis in dogs. We wish here to report a similar study of meningitis due to the pneumococcus, Type I. A virulent strain of this organism was inoculated into the cerebrospinal fluid of a number of successive dogs until the resulting meningitis was relatively consistent in its course, nearly always terminating fatally in two to seven days, with viscid, grossly purulent cerebrospinal fluid. A large amount

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The Lucite Calvarium—A Method for Direct Observation of the Brain

I. The Surgical and Lucite Processing Techniques

C. Hunter Shelden, Robert H. Pudenz, Joseph S. Restarski and Winchell McK. Craig

used in the development of the method. Many difficulties were encountered, the outstanding of which were the clouding of the cerebral surfaces due to the deposition of fibrin on the leptomeninges, the obtaining of a secure fit of the plate to prevent leakage of cerebrospinal fluid, and the proper treatment of the skin. The formation of the filmy layer of fibrin over the surface of the brain has been prevented by meticulous hemostasis of the dura and bone and by drainage of the “subdural” space for several days following the second stage of operation. Daily

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The Use of Products Prepared from Human Fibrinogen and Human Thrombin in Neurosurgery

Fibrin Foams as Hemostatic Agents; Fibrin Films in Repair of Dural Defects and in Prevention of Meningocerebral Adhesions

Franc D. Ingraham and Orville T. Bailey

defect and the edges passed underneath the cut margin of the dura. The use of a large piece of film to protect the cerebral cortex under markedly increased pressure in lead encephalopathy is shown in Figs. 15 – 20 . Fig. 15 Fig. 16 ( left ). Right hemisphere of patient with severe lead encephalopathy exposed at operation. (Cerebrospinal fluid pressure 750 mm. of water.) ( right ). Fibrin film has been placed over the cortex exposed by retraction of the dura. Fig. 17 Fig. 18 Fig. 19 ( left ). The operative field shown in Fig. 16 is

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A. H. S. Holbourn

subject. The technical meaning of the word stress is a force per unit area. It is quite different from strain, which is roughly speaking a displacement of one part of a body relative to another part. A strain may often be regarded as the consequence of a stress. A hydrostatic pressure is an example of a simple type of stress. It is uniform in all directions. The pressure of cerebrospinal fluid in the ventricles is a true hydrostatic pressure. But elsewhere in the brain, at any rate in many pathological conditions, the stress system is vastly more complicated, so

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W. M. Craig

ninth nerves for Ménière's disease and glossopharyngeal neuralgia, hemilaminectomies in the cervical region of the spinal cord and various other operations about the neck and head have been facilitated by having the patient in the upright position. The escape of blood and cerebrospinal fluid by gravity leaves the operative field clean and the exposure unobstructed. This upright or sitting position has been used almost universally for the section of the fifth cranial nerve for the relief of trigeminal neuralgia. Certain other operations on the parietal and temporal

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increased the dosage was considerably reduced. In one of three cases tested, a wound of the temporal lobe not involving the ventricle (Case 20), a trace of penicillin was found in the lumbar cerebrospinal fluid 12 hours after injection of penicillin into the wound. In addition, penicillin-sulphanilamide (1,000 or 2,000 units per gm.) was applied to the wound during dressings and occasionally during operations; the amounts expended were small, and wastage was best avoided by the use of the R.A.F. sulphonamide blower. Intramuscular penicillin was also given to three

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

the safety of the material and to compare its behavior with that of other hemostatic agents in neurosurgery, especially muscle. THROMBIN IN THE SUBARACHNOID SPACE In the application of fibrin foam soaked in thrombin solution to various parts of the central nervous system, it is probable that at times an excess of thrombin solution enters the subarachnoid space and from thence it may be disseminated by the cerebrospinal fluid. The concentration of thrombin thus circulated would of necessity be small unless the foam were applied with gross carelessness. It

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Franc D. Ingraham and Orville T. Bailey

. Fig. 2. Roentgenogram in 1943. Calcification is seen through the suboccipital defect. Operation III . At exploration, the vermis was divided and tumor was encountered adjacent to the aqueduct at a depth of about 5 cm. A small piece of tumor was removed and circulation of cerebrospinal fluid restored. It was obviously impossible to do a total extirpation. Course . The patient recovered slowly. During convalescence she was given a course of roentgen therapy to the region of the tumor (cross-fired through two portals, 1500 r each) and discharged July 14

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J. Grafton Love

roentgenologist and a tilting roentgenoscopic table, and which may leave traces of opaque medium in the spinal subarachnoid space, are not essential. Fig. 2, Fig. 3 Lateral roentgenogram of the lumbar and sacral portions of the spinal column after the cerebrospinal fluid had been replaced with air. There is a defect at the fourth lumbar interspace due to a protruded intervertebral disk. The protrusion was so large it had blocked the spinal canal and the air could not get by the block to visualize the lumbosacral space. An oblique roentgenogram of the lumbar and