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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

dura and cerebral cortex in the course of a secondary exploration. Fig. 6. Control of bleeding from the human dura and cerebral cortex with fibrin foam. A more detailed example of the use of foam is given in the following case history: K.G. CH #238090. A well developed and nourished 12 year old school girl was admitted with complaint of headache and vomiting. Four years previously she had had an incomplete removal of a cystic astrocytoma of the right cerebellar hemisphere. Physical examination showed high grade papilledema, ataxia; in short

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Neurosurgical Unit he was alert and rational. Slight papilloedema. Left facial weakness. His wound was bulging and its silkworm gut stitches were cutting out. X-rays showed indriven bone fragments and a large metal foreign body between the scalp and skull. At operation on 20th July, six days after injury, the scalp wound was excised. The subcutaneous piece of metal was removed; the galea in contact with this was ulcerating and further scalp excision was necessary to remove this area. The bone defect (3 by 2 cm.) and dural defect (1.8 cm. diameter) were occupied by soft red

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Franc D. Ingraham and Orville T. Bailey

depth of 5 cm. came down upon yellowish fluid mingled with dark blood. About 15 cc. of fluid were removed. Since the cystic tumor was obviously too deep to be removed, the wound was closed carefully in layers as usual. The patient was in good condition at the end of operation.” Course . At the time of discharge 26 days after admission the patient had recovered remarkably. She was able to walk without assistance and the papilledema had almost entirely subsided. Interval Note . Two years later (1926) a report by letter stated that she was in perfect health and was

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Robert C. L. Robertson

diopters of papilledema, secondary retinal changes, etc.). The residual bulging decompression was disqualifying for full military duty. Because the need for decompression no longer existed the cerebral hernia was reduced at operation and a tantalum plate was fixed in position. POSTOPERATIVE COMPLICATIONS AND SEQUELLAE Postoperative complications have been few and none were ascribable to the presence of tantalum. One patient who had a severe, soiled, compound skull fracture containing much foreign material, a few days after operation developed impetigo contagioso

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Axel Olsen and Gilbert Horrax

any more reliable criteria of increased intracranial pressure than headache, since 13 patients without visual complaints had choked disks and 6 without headache likewise showed papilledema. Four patients with both headache and visual symptoms had no elevation of the optic disks. Vertigo . This, either constant or in attacks, was conspicuous by its infrequency, being noted in only 13 patients (31 per cent). Its duration was from two weeks to two years. Subjective complaints related to adjacent cranial nerve involvement, except the fifth, were almost absent. In

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Arthur D. Ecker and Eugene W. Anthony

had no error of refraction and had a visual acuity of 20/15. There was bilateral papilledema of 4 diopters with one small recent hemorrhage at the edge of each disc. The blind spots were enlarged. Otherwise the visual fields were normal except for a central scotoma, 3 or 4 degrees in diameter, in the right field, which was revealed only by the 1 mm. and 3 mm. test objects at a distance of two meters with the plus 6.00 correction in place. In view of the marked degree of hyperopia in the right eye as well as emmetropia in the left, the central scotoma was considered

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Unusual Size and Extension of a Pituitary Adenoma

Case Report of a Chromophobe Tumour with Unusually Extensive Compression of the Base of the Brain, and Review of the Literature on the Pathways of Extension of These Tumours

James C. White and Shields Warren

supraoptico-hypophysial tract. Since tumour filling the third ventricle blocks the outflow of the cerebrospinal fluid, headache of the severest type with papilloedema may occur in this variety. (3) Temporal extension : A lateral escape of tumour cells between the optic chiasm and the cavernous sinus may result in proliferation of the growth in the middle fossa. It will then compress the optic tract and the medial portion of the temporal lobe. This will result in an homonymous hemianopsia, and frequently in Jacksonian seizures preceded by an olfactory aura. Striking

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I. Mark Scheinker

acute pulmonary edema. On previous admissions he had complained of repeated attacks of nausea, vomiting, rotatory vertigo, headaches and tinnitus. During the last ten years he had noticed a slowly progressing impairment of hearing. For several months prior to his final admission he complained about gradually increasing ataxic gait and he experienced difficulty in swallowing. Examination on admission in 1938 disclosed a primary optic atrophy on the left and early papilledema with small hemorrhages on the right. There was a fine horizontal nystagmus on looking to

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David L. Reeves and Cecil F. Baisinger

the right leg. On this occasion a lumbar puncture disclosed an initial pressure of 380 mm. of spinal fluid. The cell count was 326, all lymphocytes, the Pandy was three plus and the culture revealed no growth. Another episode of projectile vomiting occurred on 5 December. Examination disclosed bilateral papilloedema and bilaterally positive Babinski signs. He failed to improve and on 27 December right homonymous hemianopsia and aphasia were demonstrable, indicating a lesion in the left occipito-parietal region. A slight inflammation of the right external auditory

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Subdural Hygroma

A Report of Seven Cases

Henry T. Wycis

Intracerebral Pressure Spinal Fluid Subdural Fluid Roentgenograms Surgery and Results Mayo 1894 11 M 6 wks. − − + Lt. dilated Headache, aphasia, hemiplegia, 25 convulsions. Bulging dura − 4 oz. clear fluid − Unilateral trephine. Rapid recovery. Payr 1916 4 cases − M − − − + − − − − 500 cc. − Punctured corpus cal losum. Cohen 1927 20 M None 46, − − + Equal Headache, aphasia, dizziness, vomiting, convulsions. Papilledema 4D Pressure +, xanthochromic, 70 lymphocytes 2300 cc, 9