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James C. White and Robert W. Gentry

there they run over posterior roots into the spinal cord. This technique has been used in the last 20 patients out of a total series of 76. The results have been satisfactory in 85 per cent of these patients, followed from one to twenty-seven months; 14 of them have had complete relief from their distressing attacks, and 3 have had their former intractable pain so reduced that it could be satisfactorily handled with routine medical methods. There were 2 failures, and 1 patient died of a painless coronary occlusion shortly after the injection. The two failures were due

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Gilbert Horrax

and work of Harvey Cushing, we must for a moment look at the status of this newly launched specialty up to the time when he appeared upon the scene. Not until the era of anesthesia and antisepsis, and particularly not until the beginnings of cerebral localization ( circa 1870) had operations upon the brain and spinal cord advanced appreciably since medieval or ancient times. Soon after this, in the middle eighties of the nineteenth century, a very few, and very occasionally successful, operations upon brain tumors, brain abscesses and spinal cord tumors were

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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

as a dural substitute and in the prevention of meningocerebral adhesions. PART ONE—FIBRIN FOAMS Bleeding from medium sized vessels in the central nervous system and its coverings can be satisfactorily managed in most instances by the use of the conventional methods of hemostasis, such as silver clips and electrocoagulation. The oozing from vessels on the surface of the dura and in the substance of the brain and spinal cord is less easily controlled by these means. Pressure from cotton patties soaked in warm or hot saline solution is often effective while

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Claude C. Coleman

particularly difficult insofar as determining the extent or level of the neural damage. A traction lesion is most common in the brachial plexus around the shoulder joint, in the external popliteal, and in the musculospiral from fracture of the humerus with wide dislocation of the fragments. In civilian practice, injury to the brachial plexus from blows or falling on the shoulder is a frequent lesion. These lesions, unfortunately, are generally avulsion of the cords of the plexus from the spinal cord. The lower cords of the plexus often remain intact, enabling the patient to

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A. Earl Walker, Jerry J. Kollros and Theodore J. Case

immediately or within a few seconds after a concussive blow, a rise in blood pressure of varying degree occurs. This arterial hypertension is, like the respiratory arrest, due to the effect of the trauma upon the brain stem, for it may be produced by concussion in the decerebrate animal. Harvey Cushing 3 showed that the rise of blood pressure did not occur if the spinal cord were cut. If a curarized animal (anesthetized) which has previously had both vagus nerves sectioned is subjected to cerebral trauma sufficient to produce the concussive phenomena and within one

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Intracranial Dural Cyst

With Report of a Case

Webb Haymaker and Miles E. Foster Jr.

thoracic vertebra, was encountered. Incision of its dorsal wall released 8.0 cc. of clear fluid. Examination of the interior of the cyst revealed a smooth and glistening lining. No communication with either the subdural or the subarachnoid space could be found. When the ventral wall of the cyst was incised the dorsal part of the spinal cord could be clearly seen. Obviously, then, both walls of the cyst were dural. The incision in the ventral wall of the cyst was repaired and the entire dorsal wall was removed. Microscopic examination of the cyst wall disclosed “the usual

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W. M. Craig

purpose that was inexpensive, of relatively small size, and combined certain essential features that could be universally used by the Army as well as the Navy. At the Naval Medical Center in Bethesda where the usual operating tables were included in the surgical equipment, such an apparatus was designed and the rough model was tried. It proved so valuable for operations on the brain and cervical portion of the spinal cord that the original apparatus was modified by the manufacturer and is now available. † Removal of cerebellar tumors, resections of the eighth and

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silk. In two of these cases there was prompt linear healing of the skin wound. The third gaped in part, but subsequently healed. It is too early yet to assess the result on nerve healing. Spinal Cord Injuries . In two back wounds a missile penetrated the spinal canal. In the first of these there was a cerebrospinal fluid leak through a wound infected with Staphlococcus aureus and Proteus . During a course of sodium penicillin intramuscularly this wound was excised and closed in layers. The leak ceased and the wound healed, partly by granulation, without any

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Franc D. Ingraham, Orville T. Bailey and Frank E. Nulsen

days. During the period of observation, no physiological abnormalities appeared. The spinal cords and brains were then removed and fixed in 10 per cent formalin. After hardening, numerous blocks were selected so as to include many levels of the spinal cord both near to and remote from the site of injection, as well as various areas of the brain. These blocks were embedded in paraffin and sections stained with hematoxylin and eosin. The sections of the monkey sacrificed after three hours were entirely normal except for one minute area in the meninges over the pons

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J. Grafton Love

intradural neurofibroma, removal of which resulted in relief. Fig. 5. Postero-anterior roentgenogram after subarachnoid injection of pantopaque, revealing a defect in the column of pantopaque at the third lumbar interspace due to protrusion of the third lumbar disk, which produced sciatic pain. The patient who has a tumor of the spinal cord ordinarily gives a history of insidious onset of pain that gradually progressed, without intermittency, until he became more or less incapacitated by it. The physical findings frequently are scant but the