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Gilbert Horrax

in penetrating gunshot wounds of the brain. 20 The radical operation of sensory root division or avulsion for trigeminal neuralgia had, during the first two decades of the twentieth century, become a fairly standardized procedure with an increasingly low mortality rate in the hands of skilled neurosurgeons. Among the best, however, this rate was somewhere between 1 and 2 per cent. In 1920, 22 Cushing published the statistics of his entire series of 322 ganglion or sensory root operations in which there had been but 2 deaths, a mortality of 0.6 per cent

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Claude C. Coleman

later direct suture more difficult and sometimes impossible. In median and ulnar lesions, delayed nerve repair allows for the development of advanced atrophy of the intrinsic hand muscles, periarticular fibrosis and other crippling effects which permanently mar the results of later suture. We are more concerned at the present time with nerve lesions produced by gunshot wounds of the extremities. The diagnosis of nerve lesions in such conditions must take into consideration certain concussional effects of missiles of high velocity which may cause a temporary

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R. Glen Spurling

( Fig. 1,A – E ). The chief objection to the sling stitch in the past has been the inflammatory reaction occurring around the suture material. With fine tantalum wire this objection has been removed. When the sling stitch is tied, great care must be exercised so that the cuff surfaces of the proximal and distal stumps just touch each other. Too much tension on this stitch causes wrinkling of the tubes—too little leaves an undesirable dead space. Fig. 1-A. Line of incision used for exploration of axillary portion of brachial plexus. Note healed gunshot wound

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Colonel C. G. de Gutiérrez-Mahoney

pronated and flexed, and the hand and fingers powerfully flexed. The same reflex movement has been observed immediately after gunshot wounds of large nerve trunks of the arm and has been so forceful as to have remained etched in the memory of the subject. The vividness of the phantom has been explained by Foerster 2 as due to a cortical engraving which was made by the strength of the impulses originating at the time of the amputation or trauma. This engraving then is more readily receptive to subsequent unorganized peripheral stimuli and is prepared to interpret them as

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preliminary report on the treatment of head wounds with penicillin,” and is signed by Brigadier H. Cairns, the late Major K. C. Eden, R.A.M.C. of No. 4 M.N-S.U. and Major J. Shoreston, R.A.M.C. of No. 5 M.N-S.U. For the Sicilian campaign No. 4 Mobile Neurosurgical Unit was attached to 48th General Hospital at Tripoli and No. 5 Mobile Neurosurgical Unit to 71st General Hospital at Sousse. In these two units 50 gunshot wounds and 23 head wounds due to blunt injury were treated ( Table I ). Cases were fewer than had been expected and arrived for treatment much later than in

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Edgar F. Fincher, Bronson S. Ray, Harold J. Stewart, Edgar F. Fincher, T. C. Erickson, L. W. Paul, Franc D. Ingraham, Orville T. Bailey, Frank E. Nulsen, James W. Watts, Walter Freeman, C. G. de Gutiérrez-Mahoney, Frank Turnbull, Carl F. List, William J. German, A. Earl Walker, J. Grafton Love, Francis C. Grant, I. M. Tarlov, Thomas I. Hoen and Rupert B. Raney

applications in military neurosurgery. We have had a good many gunshot wounds of the head, evacuated for reparative neurosurgery. In the repair of the resulting skull defect, fibrin foam has been a most effective agent in the control of diffuse hemorrhage from dural and cerebral scar resections. Its potential value in acute war injuries to the brain is illustrated by a recent experience. A soldier sustained a bilateral frontal lobe injury while welding a large drum. Gasoline fumes exploded and a fragment of the drum lacerated the inferior surfaces of both frontal lobes. The

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Mark Albert Glaser and Frederick P. Shafer

attacks in 2. The percentage of patients with generalized convulsions associated with linear fracture and concussion is low (1.8 per cent). 11 In gunshot wounds the incidence is higher (34.0 per cent), epilepsy occurring most often in the first two weeks after injury. 1, 15 Trauma may produce meningocerebral cicatrix with migration of the ventricles toward the lesions, cysts, localized and diffuse cortical atrophy, but rarely hydrocephalus. Permanent seizures never developed immediately after injury. In two cases the seizures developed two months after injury and

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R. Glen Spurling, W. R. Lyons, B. B. Whitcomb and Barnes Woodhall

I t is the purpose of this report to analyze the histologic changes in a number of whole fresh homogenous nerve grafts, placed in peripheral nerve defects in man subsequent to extensive gunshot wounds of the upper and lower extremities. Tn each of the eight grafts studied, there was no clinical evidence of nerve regeneration after an appropriate time interval had elapsed following transplantation of the neural tissue. When failure of clinical regeneration was manifest, the grafts were exposed under local anesthesia and stimulation studies with a bipolar

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E. S. Gurdjian and H. M. Smathers

's fracture have been described by Abbott and Saunders. 1 We have seen an example of late neuritis of the sciatic nerve, due to gunshot wound, eleven years after injury. The explanation of tardy ulnar neuritis is as follows (Mouchet 14 ): Injury, usually in childhood, to the lateral condyle with improper union eventuates in valgus deformity of the elbow. Several years later increasing tension on the nerve in its course through the epicondylar groove results in evidences of ulnar neuritis including sensory and motor phenomena and pain. That this is the pattern in a great

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E. G. Butler, W. O. Puckett, E. Newton Harvey and J. H. McMillen

high speed. Elect. Engng., Chicago , 1941 , 60 : 432 – 435 . Ehrke , L. F., and Slack , C. M. Radiography at high speed. Elect. Engng., Chicago , 1941, 60: 432–435. 4. Horsley , V. The destructive effects of projectiles. Not. Proc. roy. Instn. , 1894 , 14 : 228 – 238 . Horsley , V. The destructive effects of projectiles. Not. Proc. roy. Instn. , 1894, 14: 228–238. 5. Horsley , V. Remarks on gunshot wounds of the head. Made in opening a discussion at the Medical Society of London on