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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

method of therapy, even with small dosage, was found to reduce the mortality rate and prolong the survival time. The beneficial effects of intrathecal therapy were markedly increased by the addition of the intravenous administration of penicillin (since secondary infection of the blood stream was invariably present and lobar pneumonia frequently developed if intravenous therapy were not employed). REFERENCES 1. Pilcher , C. , and Meacham , W. F. The chemotherapy of intracranial infections. III. The treatment of experimental staphylococcic

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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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Burton M. Shinners and Wallace B. Hamby

the same year, Dandy 3 reported that he had seen no recurrences in his patients. Echols 4 followed up 40 of 50 patients: 29 were classified as having had successful results, 8 improved and 8 unimproved. In 1943, VerBrugghen 7 reported the results of 66 patients followed up in a group of 75. They were classified as excellent (15 per cent), good (68 per cent), fair (11 per cent), and poor (6 per cent). In the same year, Love and Walsh 5 wrote concerning the results in 750 cases. The mortality rate was less than 0.25 per cent and the rate of recurrence

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brain wounds; total mortality rates vary widely with the distance of the neurosurgeon from the front line. It will be seen from Table II that in the last war about one-third of Cushing's brain injuries died of intracranial infection. In this war behind the German Army in Russia one-third of Sorgo's cases died of intracranial infection. In the present series from Sicily and an earlier series (K.C.E.) from the Western Desert-Tunis battles the incidence of fatal intracranial infection was less than 1 in 10. In Eden's Western Desert series fewer wounds were closed and

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I. M. Tarlov and J. A. Epstein

tissue derived from the epineurium and perineurium of the filaments of the cable was thought to be disadvantageous in that the downgrowth of axis cylinders from the central stump might be impeded. Moreover this procedure necessitated the excision of 5 to 6 intercostal nerves and the dogs and monkeys did not tolerate this operation well—the mortality rate was high. For these reasons, chiefly the second, it was decided to use cable grafts formed from thicker strands of dog cadaver nerve. The cable was formed from 4 to 5 strands of brachial nerves (twice or more as thick

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H. V. Slemon

, and a large loculated abscess was evacuated. His wound later healed by granulation. The high mortality in cases complicated by meningitis can partly be explained by the fact that these patients had all been on full doses of sulphadiazine since operation, but despite this had developed meningitis. The armamentarium of treatment was exhausted, since it was before the days of intrathecal and intraventricular penicillin therapy. MORTALITY The mortality rate has very little significance since it depends on the time interval between wounding and arrival at the C

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Richard Upjohn Light

the avenues of approach, and the relative depth at which work is done, all combine to make hemostasis with the ligature virtually an impossibility. It has fallen upon neurosurgery, therefore, to devise methods of bleeding control that are workable under the peculiar circumstances of its several fields of activity, with the result that an impressive catalogue of methods has grown up during the three-score years by which neurosurgery counts its age, each one in turn resulting in a drop in the mortality rates, a strengthening of surgical courage, and a shortening of

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Walter G. Haynes

. Deep, narrow missile tracts, particularly prone to infection, rarely became infected when liquid penicillin was instilled into their depth. Adequate surgery cannot be replaced by drugs. Non-viable brain tissue must be resected to healthy margins, but to conclude, because of a lower incidence of infection and a lower mortality rate, that our technique is superior to that of the master surgeon, Cushing, is stupid. The author concluded that penicillin was a drug that was non-irritant to brain tissue and primarily non-convulsive. He ascribes the great reduction in

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M. Hunter Brown and Lester D. Powell

Anterior sacral meningocele is a meningeal cyst which presents anteriorly through a unilateral congenital defect in the sacrum, in contrast to the usual posteriorly situated midline meningocele. In recent years the condition has aroused increasing interest due to its rarity and to the unhappy complications resulting from incorrect diagnosis and treatment. In their extensive review of the literature Coller and Jackson 1 , uncovered 23 cases, of which 18 were treated surgically with a case mortality rate of 44 per cent, and eight patients of this group were

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Extensive Brain Wounds

Analysis of 159 Cases Occurring in a Series of 342 Penetrating War Wounds of the Brain

Walter G. Haynes

cerebral venous drainage. The respiratory tree was kept clean by aspiration. Oxygen, caffeine and whole blood were used when indicated. Cautious ventricular and lumbar punctures were used to combat cerebral edema. Fluid and caloric requirements were met, in the comatose patient, through a Levine tube. Sulfadiazine and penicillin therapy was carried out routinely. Intrathecal or intraventricular penicillin was given to each infected, or potentially infected patient. Paraldehyde was used for restlessness. PROGNOSIS The over-all mortality rate of wounded during the