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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

remove a bit of the upper rim of the sacrum for good exposure because often there is not much depth at that spot. We have been impressed with the advantages of operating with the patient lying on his involved side and the table pumped up to eye level. In particular this position allows blood to run out easily and improves the exposure. Finally, I think Dr. Grant's point of view is highly important. He is using the clinical judgment which he has developed over a period of years in dealing with tic douloureux. He has learned that it is unwise to operate for pain between

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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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Benjamin B. Whitcomb and George M. Wyatt

antiseptic solution, from about L-1 to the sacrum with about 3- or 4-inch margins on each side. A sterile towel is then placed over the trousers and upper buttocks. No other drapes are used because of their tendency to slide when tilting the table. Extensive drapes contaminate the field, give a false sense of security, and also obliterate the outline of the back, thus obscuring the spine for accurate alignment of the needle. The head of the table is tilted up about 25 degrees in order to increase the pressure in the lumbar sac. This gives more resistance to the needle on

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John S. Chaffee

stressed the importance of maintaining a normal plasma protein level. Unfortunately, the vicissitudes of war with its attendant nursing shortage do not permit of such ideal care for these often forgotten patients in army and civilian hospitals. The author has observed 34 overseas returnees with complete transverse myelitis from spinal cord injuries at levels ranging from the 4th cervical to the 2nd lumbar vertebra. All but one of these patients displayed decubitus ulcers varying from 4 to 12 cm. in diameter and depth from skin maceration to bony sacrum and ilium. The

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Donald D. Matson

of the skin in the entire area below the level of the lesion, with especial attention to the sacrum, trochanters, and heels, is highly important. This entire area (not just the back) should be washed with soap and water, lightly massaged, carefully dried and powdered at least once and preferably twice daily. The patient's position on the litter or cot should be adjusted at least every 4 hours day and night. This does not necessarily mean moving from back to abdomen or even from side to side. The buttocks can be raised alternately 2 to 3 inches by the use of small

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The Posterior Tibial Reflex

A Reflex of Some Value in the Localization of the Protruded Intervertebral Disc in the Lumbar Region

R. M. Peardon Donaghy

Since the recognition of the protruded intervertebral disc as a pathological entity great interest has been shown in clinical localizing signs by neurologist, orthopedist, and neurosurgeon. For example, it is frequently pointed out that such lesions between the 3rd and 4th lumbar vertebrae may lead to depression of the knee jerk on the affected side and that protrusion between the 5th lumbar vertebra and the sacrum may cause diminution or absence of the ankle jerk. As far as we know there is no reflex commonly used for detection of protrusions between the 4th

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William G. Kuhn Jr.

presence of a decubitus ulcer. In the patient with skin intact but devoid of its nerve supply a decubitus ulcer can develop within 4 hours from constant pressure on an area. This is strikingly brought out in the development of decubiti over bony prominences such as the sacrum, trochanters, and iliac crests. The general treatment of a bed sore, once it has developed, is to provide nursing care of the highest degree. These patients must not only be watched carefully to prevent a pressure sore from forming but intense active means must be taken to prevent its extension

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J. Jay Keegan

herniation is at the same stage as that of herniation of a lower lumbar disc ten years ago when the diagnosis of sciatic neuritis was in vogue, with many hypothetical explanations of its cause, now discarded. The cervical spine and the lumbar spine are similar in their mobility, with frequent forward-bending strain placed upon them and occasional fracture or dislocation in these regions from violent force. In the lumbar region heavy weight bearing on a poor mechanical angle with the sacrum is the most important factor in causation of posterolateral herniation of the

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Eugene E. Cliffton and John R. Rydell

the exception that he had always been aware of a small dimple over the sacrum, but this had never troubled him, had never drained, and he had not restricted his activities as a student because of it until the onset of the present illness in April 1943. In March 1943, he was inducted into the Army, and it was while he was engaged in basic training that he developed his first symptoms, which consisted of undue stiffness and soreness in the right lower extremity. This continued intermittently with increasing severity, and he reported to sick call from time to time and

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L. Willard Freeman and Robert F. Heimburger

T he usual course for patients who have suffered trauma to the spinal cord follows from flaccidity immediately after injury, to spasticity in a matter of weeks, to paraplegia in flexion, and then to death in general and urinary sepsis within several years. Nursing care becomes increasingly difficult when the limbs cannot be properly positioned because of spasm, and bed sores develop over the trochanters and sacrum, advancing in some cases to complete destruction of the hip joints and sacrum. One is left with the impression that something drastic must be done