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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

be taken as a guide to dosage in human beings. Penicillin may produce a moderately severe irritative meningeal reaction when injected intrathecally, 1 but Rammelkamp and Keefer 2 have injected as much as 10,000 units into the lumbar subarachnoid space in normal men without serious after-effects. Similarly, intravenous and intramuscular dosage should be much larger and more frequent than in these experiments. SUMMARY The effects of intrathecal administration of penicillin in Type I pneumococcal meningitis have been studied in 96 experiments on dogs. This

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Gilbert Horrax

pressure chart, the preparation of the operative field with bichloride solution and alcohol, and the device of scratching out on the scalp the proposed line of incision. There follow minute directions as to the control of hemorrhage in the various tissues encountered, the performance of osteoplastic craniotomy and other operations, as well as the steps of certain intracranial procedures ( Fig. 4 ). The reduction of increased intracranial pressure by means of lumbar puncture during the course of an operation was advocated—a new feature and extremely important at this

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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

revealed a thin pale child with a rather large head. There was a soft prominence in the mid-parietal region as shown in Fig. 21 . There was bilateral papilledema, ankle clonus and positive Babinski sign. Fig. 21. Patient A. R. after the intracranial pressure had been relieved by tapping the subdural cystic cavity. Note the prominence of the right parietal region. Roentgenograms showed separation of the coronal suture and irregular destruction of the right parietal bone. A lumbar puncture needle was passed through the coronal suture and brown

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Dedication of the Cushing General Hospital, Framingham, Massachusetts, 24 January 1944 March 1944 1 2 83 93 10.3171/jns.1944.1.2.0083 A Study of Gnosis, Praxis and Language Following Section of the Corpus Callosum and Anterior Commissure Lt. Comdr. Andrew J. Akelaitis March 1944 1 2 94 102 10.3171/jns.1944.1.2.0094 The Physiological Basis of Concussion A. Earl Walker Jerry J. Kollros Theodore J. Case March 1944 1 2 103 116 10.3171/jns.1944.1.2.0103 The Results of Surgical Removal of Protruded Lumbar Intervertebral Discs

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Burton M. Shinners and Wallace B. Hamby

approximately 2 per cent in the lumbar region. They stated that complete relief of symptoms should occur in 80 per cent of cases. A “small group” of patients continue to have backache, although relieved of their sciatic pain. We have made an attempt to determine the symptomatic relief provided patients by removal of protruded intervertebral discs in the period between 1937 and July 1943. The shortest period following operation was six months. MATERIAL The material consists of all cases explored surgically for a protruded intervertebral disc from 1937 to July 1943, in

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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

seemed advisable, however, to determine experimentally whether the thrombin prepared by the fractionation of human plasma would set up inflammatory or other undesirable reactions in the meninges when introduced into the subarachnoid space. Three monkeys ( Macaca mulatta ) were used as test animals. In each monkey a lumbar puncture was performed under nembutal anaesthesia. Two cc. of cerebrospinal fluid were withdrawn and replaced by 2 cc. of a saturated solution of human thrombin. One monkey was sacrificed after 3 hours, another after 24 hours, and the third after 6

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J. Grafton Love

, lumbosacral fusion and, six months later, fasciotomy without relief of low back and left sciatic pain of four years' duration. An intradural and extradural neurofibroma was removed from beneath the bone graft, with immediate relief of the patient's symptoms. In this case, lumbar puncture had not been performed prior to the fusion operation. The scar of the fusion operation is indicated between the two arrows on the left, and that of the laminectomy for removal of the tumor, between the two arrows on the right. During the past several years, my neurosurgical

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Edgar F. Fincher

almost every instance are so much alike that a clinical picture can be described which, with a few minor individual variations, is typical of all of them. They all have been first-born. The deliveries have been pathologic, with a short or difficult labor, or the use of pituitrin or forceps, and more than half of the infants required artificial respiration. General convulsive seizures occurred within the first two or four days of life. Eight of the 12 had bloody spinal fluid on lumbar punctures. Symptomatic treatment was instigated, and by the time the mother's post

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Robert C. L. Robertson

which was removed and replaced with tantalum. Fig. 9, Fig. 10 ( left ). Case 13. Posterior-anterior skull film showing tantalum replacement. Three “glazier points” used to fix the plate can be identified. ( right ). Case 13. Lateral skull film following one-stage cranioplasty. Tantalum hemostatic clips indicate level of amputation of right frontal lobe. Postoperative Course . Repeated aspirations were required to remove blood-stained cerebrospinal fluid beneath the galea for about two weeks. Several lumbar punctures were also done. His