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Robert C. L. Robertson

was compounding of the fracture with destruction of brain and exposure of brain to the atmosphere for periods longer than thirty hours. Yet these patients were operated upon and tantalum cranioplasty was done following debridement and sulfonamide therapy without later difficulty. We believe that in soiled or infected fields sulfonamides and penicillin make early surgery possible, whereas before these drugs were available, it entailed too great a risk. Also tantalum is well tolerated by tissues. Soiled intracranial wounds, containing various amounts of foreign bodies

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Mark Albert Glaser and Frederick P. Shafer

epileptic seizures than that located in the posterior portion. This is not only true of trauma, but of brain tumors. 19 Surgery was performed in all of the cases, except one. This patient had a depressed fracture at birth and developed seizures twenty-four years after injury. From these facts, it is quite apparent that early surgery is not always instrumental in preventing seizures. It would definitely appear as if the original damage to the brain, or the late formation of adhesions, cysts, etc., are the responsible factors. The depth of fractures in 3 (18.7 per cent

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John Martin and Eldridge H. Campbell Jr.

useful operation where early surgery had been inadequate or totally lacking. The presence of dead tissue is of considerably more danger than the breaking of newly formed “barriers of resistance,” save when the last boundary before a ventricle or mesothelial-lined space is concerned. While it might appear desirable to postpone operative intervention until abscess formation has occurred, it should be pointed out that encapsulation, if occurring at all, is sometimes quite tardy and that much mischief can be done by the infection in the interim. Further destruction of

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Donald D. Matson

back slightly, and sand-bags, shoes, or a blanket-roll placed beside the head to prevent lateral deviation or rotation. The prone position is satisfactory often for short moves except in cervical lesions. INDICATIONS FOR EARLY LAMINECTOMY Perhaps the most difficult and controversial problem for the surgeon is the determination of which injuries due to gun-shot and shell-fragment wounds of the spine should be subjected to early surgery. Those that warrant laminectomy in forward units (i.e., Field Hospitals, Evacuation Hospitals, and General Hospitals in the

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Milton Tinsley

is further stated by these men that the patient does better from a nutritional and physiological standpoint if a complete debridement, or in other words a laminectomy, has been performed early. A laminectomy performed by a competent surgeon does not increase the mortality and cuts down the dangers of infection. The above two cases are a ray of light in a depressing group of patients. The presence of a complete immediate paralysis does not indicate a hopeless situation. It is felt that if the patient's condition is good, early surgery will give the patient the

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Ernest Sachs Jr. and Gilbert Horrax

pilonidal sinus, particularly over the higher spinal segments , should lead to earlier surgery with less disability in a group of patients whose ultimate prognosis should be excellent if the tumor is removed before serious cord damage has taken place. The present communication serves to put on record two examples of these uncommon intradural dermoids as well as to review the literature concerned with these tumors. Comprehensive reviews on the subject of spinal dermoids are to be found in papers by Fraser, 15 Gross, 18 Bradford, 6 Boldrey and Elvidge, 4 List 28 and

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Russell Meyers, John R. Knott, F. Miles Skultety and Robert Imler

. , and Schwidde , J. T. Hemiballismus: an extrapyramidal disorder in which early surgery is indicated. Trans. Amer. neurol Ass. , 1949 , 79 – 81 . Meyers , R., Sweeney , D. B., and Schwidde , J. T. Hemiballismus: an extrapyramidal disorder in which early surgery is indicated. Trans. Amer. neurol Ass. , 1949, 79–81. 68. Meyers , R. , Sweeney , D. B. , and Schwidde , J. T. Hemiballismus: aetiology and surgical treatment. J. Neurol. Neurosurg. Psychiat. , 1950 , m. s. 13 : 115

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M. Hunter Brown and M. N. Walsh

of subthalamic hyperkinesia in primates. Trans. Amer. neurol. Ass. , 1949 , 81 – 84 . Mettler , P. A., and Carpenter , M. B. The modification of subthalamic hyperkinesia in primates. Trans. Amer. neurol. Ass. , 1949, 81–84. 4. Meyers , R. , Sweeney , D. B. , and Schwidde , J. T. Hemiballismus: an extrapyramidal disorder in which early surgery is indicated. Trans. Amer. neurol. Ass. , 1949 , 79 – 81 . Meyers , R., Sweeney , D. B., and Schwidde , J. T. Hemiballismus: an extrapyramidal

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Carl J. Graf

intracranial aneurysm should be deferred, if possible, 3 weeks following the subarachnoid hemorrhage. The mortality of operation within this period is as great as when the disease is allowed to run its natural course over the same time interval. There is little question that early operation is dangerous but the hazard is caused not solely by early surgery when “vasospasm” is felt to be a most important factor, but in great measure by the profound neurological deficit which may or may not be incident to an expanding destructive hematoma. In cases of supraclinoid lesions, in

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Pomeroy Nichols Jr. and L. O. J. Manganiello

treatment of these lesions may be difficult unless the progressive nature of the lesion is determined. It is obvious that the earlier surgery is instituted, the better the chance for recovery. Guthkelch, 1 in reporting his 8 cases of extradural hemangiomas, had 1 patient with a remitting paraplegia. In the case presented below, there was also a remitting paraplegia. REPORT OF CASE A 15-year-old white male was referred by Dr. Wallace McNair of Aiken, S.C. on Feb. 1, 1956. His past history was significant only in that he had been having intermittent attacks of pain