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Paul Weiss

wholly unwarranted. Rate of axon downgrowth has not yet been established. After 5 weeks, the peripheral stump was densely populated with regenerated axons at a level 20 mm. beyond the original cut surface. There is no record of just how much farther they had advanced, except that they had not yet reached the next distal sample level, 55 mm. from the cut. The whole picture, however, is such that the later outcome can be predicted on the basis of past experience with many hundreds of nerve unions studied both histologically and functionally. Unions such as the ones

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Jurgen Ruesch

factors such as “attention” determine to a considerable extent the outcome of visual testing. Goldstein, 6 Halstead, 8 Ruesch 16, 17, 19 , and others have shown that the degree of awareness is lowered in patients suffering from brain disease or injury. Impairment of awareness, however, may also occur in distractable, self-preoccupied, or fatigued persons. 3, 21 In the application of visual tests to head-injured patients, these different etiological factors must be considered. In late post-traumatic syndromes the frequent combination of residual signs of brain injury

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Paul Weiss

surroundings—axons, sheath cells, fibroblasts, macrophages, erythrocytes, leucocytes, plasma, collagen, capillaries, etc.—all these contribute in some degree to the outcome of nerve regeneration, and their various peculiarities and requirements want to be taken into account. Every technique of nerve union, in turn, consists of a variety of steps and measures each of which is apt to affect differentially the various tissue components, some beneficially, and some adversely. The net balance decides the outcome for nerve regeneration as a whole, whether beneficial, harmful or

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I. M. Tarlov and J. A. Epstein

determining the outcome following these operations. However, in one instance in which an autologous sciatic nerve graft was used to bridge a defect in a dog's sciatic nerve, examination of the graft 156 days after operation revealed reduction in its diameter to the extent of approximately 75 per cent and much of the graft had undergone fibrous tissue replacement. In fact complete absorption of the graft occurred in 4 of 50 autografts in 33 dogs followed for periods ranging from 33 to 380 days after operation. A reduction in calibre of the graft of about 50 per cent occurred

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W. K. Livingston, E. W. Davis and K. E. Livingston

the intra-neural pattern, and damage to the intrinsic blood supply to the nerve. Yet in spite of every effort to overcome these obstacles to success, the surgeon must accept a certain hazard, as far as end-result is concerned, in every case in which he resects a lesion in continuity. The choice which the surgeon must make at the operating table is between two courses of action, with the outcome predictable in neither one. His first important problem is to decide what the chances may be for a spontaneous recovery. We do not believe that this decision can, with

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Mark Albert Glaser and Frederick P. Shafer

I n a series of fifteen hundred cases of head injury under observation over a period of time varying from one to fourteen years, 111 were depressed fractures of the skull. Certain principles, based upon the experimental work of Naffziger and Glaser, 18 were followed in their treatment. The purposes of this paper are: (1) to ascertain the final outcome of this type of treatment with relation to the sequelae, and (2) to analyze the cases as to the effects of the injury. The problem of treatment of depressed fractures consists specifically of: (1) the

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Histologic Studies of the Brain Following Head Trauma

I. Post-traumatic Cerebral Swelling and Edema

Joseph P. Evans and I. Mark Scheinker

earlier, he had been repeatedly beaten over the head with a shotgun and left for dead. Subsequently he regained consciousness and after some hours was brought to the hospital from a physician's office. On admission he was deeply cyanotic and gasping for breath. The difficulty was promptly relieved by elevation of the chin and establishment of a proper airway (one can only speculate what the effect of the prolonged cyanosis may have been on the outcome of the case). Further examination showed him to be deeply comatose, flaccid, and unresponsive to painful stimuli. The

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Harry S. N. Greene and Hildegarde Arnold

10 animals used and a similar proportion was obtained in the homologous transfer of guinea pig meninges (11 out of 15). Heterologous transplantation, surprisingly, also gave rise to takes, although the incidence was considerably lower than that observed in homologous transfer (6 out of 25). The successful transplants in both homologous and heterologous species showed no observable increase in size and a determination of the outcome of transfer in living animals was based on vascularization and the absence of degenerative changes. Fragments that failed to take

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Stuart N. Rowe and Oscar A. Turner

T he prevention and control of infection in penetrating head wounds forms the basis of much of the treatment from the time of injury until healing occurs and is one of the major responsibilities of the Army neurosurgeon. The almost universal employment of sulfonamides and penicillin has resulted in material changes in the frequency, the symptomatology, the course, and the outcome of wound infections. These changes in turn have modified the surgical treatment of cranio-cerebral injuries and their sequelae. The following observations relative to these

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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

shows no signs of improving after an adequate time lag to await the peak. This is done with the full realization of the probable outcome, but it seems mandatory to offer the benefit of surgery even to the moribund. There is no objection to waiting even 48 hours for stabilization of vital signs if improvement is noted. That the above plan is a meritorious practice is shown by the fact that some 50 per cent of these apparently doomed patients survive. Sodium pentothal, supplemented by local procaine infiltration of the scalp, was the usual anesthetic agent. The more