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James C. White and Robert W. Gentry

corresponding vertebral bodies. Fig. 4 illustrates a frequent cause of failure to block the important first thoracic ganglion. Due to the moderate kyphosis of the upper thoracic spine, the operator tends to insert the upper two needles in an increasingly caudal direction and, because 7 to 8 cm. of the 10 cm. needle lies hidden beneath the skin, it is hard to realize that the tip of the first may actually be placed caudal to the second. In this case no alcohol will reach the first thoracic ganglion, and the relief of angina pectoris will often be incomplete. We believe that

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Henry T. Wycis

James Paget's description of the disease in 1876. The great flattened head seemed to “mushroom” on top of the cervical spine. The veins and arteries of the temporal areas were unduly prominent. The movements of the head were limited in all directions but particularly in the lateral deviations to the shoulders. Palpation showed marked atrophy of the posterior cervical group of muscles. The spinous processes appeared thickened and prominent. The pupils were equal, but light reaction was sluggish in the right eye due to the presence of a corneal scar. The light reflex in

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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

of blast pressure to the brain, a bellows effect of the chest upon vascular (venous) pressure is suggested. DISCUSSION Dr. John F. Fulton : It seems to me that blast injuries of the head are closely linked not only with the problem of impact concussion but also with the various sequelae of gunshot wounds of the head with high velocity fragments. Dr. Gurdjian has reported a case in which, following a gunshot wound in the cervical spine, there was contusion of the frontal lobe. This suggests that missiles of high velocity may increase for a very brief space of

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Paul C. Bucy and Ben W. Lichtenstein

spinal nerve roots (Lichtenstein 7 ). It is found very frequently in infants suffering from extreme degrees of spina bifida (Arnold, 3 Chiari, 4 Lichtenstein, 7 Schwalbe and Gredig, 10 and Jacob 6 ). Its occurrence in adults has generally been in conjunction with bony anomalies of the craniovertebral junction, such as basilar impression, or platybasia, and fusion abnormalities of the cervical spine (Klippel-Feil's syndrome). Examples of such combinations have been reported by List 8 and by Gustafson and Oldberg. 5 The occurrence of an Arnold-Chiari deformity of

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William G. Peacher and Robert C. L. Robertson

negative. Copleman 9 mentions nausea and vomiting in one case in which 1 cc. of pantopaque entered the cranial cavity following examination of the dorsal spine. One other unexplained complication occurred in this series. Following routine removal of a typical “disc,” bladder retention developed without other neurological findings. Subsequent pantopaque studies and operation revealed an extensive arachnoiditis involving the cauda equina. In this patient, the pantopaque had been completely removed after remaining in the subarachnoid space for about 10 to 15 minutes

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H. V. Slemon

recorded below. The usual classification is used, i.e. those involving scalp only, those involving bone, and those involving brain. 1. Brain wounds 239 2. Bone involved—dura intact 127 3. Scalp wounds 299 4. Spines 24 5. Miscellaneous 11 ___  Total 700 It was not possible to evacuate all the patients with non-dural penetrating wounds to the base neurosurgical team and consequently no follow-up on these is available. Of 239 penetrating brain wounds, due to missiles, operated on by the

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David L. Reeves and Cecil F. Baisinger

diameter, are covered frequently with radial spines. These contain many spore-like bodies which increase in diameter to 4 or 5 microns and acquire a visible double-contoured wall while still in the mother cell. In the patient's lesions and in those of inoculated animals, the round or oval cells of blastomycosis vary from 4 to 20 microns in diameter. They are rather refractile bodies containing granules of various sizes and often vacuoles, and are surrounded by a capsular-like membrane. In contrast to the coccidioides, like yeasts, multiplication occurs only by budding

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Herbert Jasper and Preston Robb

not affect the denervated ones. SUBJECTS Traumatic injuries of peripheral nerves due to gunshot or shrapnel wounds formed the bulk of our clinical material. Other conditions studied were ruptured intervertebral discs, fracture dislocation of the spine, sympathectomies and hysterical anaesthesias. A summary of the cases studied is shown in Table I . TABLE I Summary of cases Peripheral Nerve Lesions No.  Ulnar..................................................... 6  Median

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M. Hunter Brown and Lester D. Powell

examination indicated hypesthesia in the left second and third sacral segments and relaxation of the anal sphincter. Funduscopic inspection was normal and the routine urine, blood and spinal fluid analyses gave no unusual findings. Roentgenograms of the lumbosacral spine and coccyx presented the characteristic “scimitar sacrum” associated with anterior meningocele ( Fig. 1 ). There was a large semicircular defect of bone in the left half of the third, fourth, and fifth sacral segments, with a curving deviation of the remaining sacrum and coccyx to the right, and fusion of

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Arthur B. Soule Jr.

left femur. No other ossifications were present and the bones showed no evidence of osteoporosis. The second (Case 26) was a 31-year-old soldier who had been wounded in action in France by a bullet which penetrated his right posterior thorax and dorsal spine, producing an immediate complete paraplegia with dermatome level at T-9. A broncho-pulmonary fistula was complicated by persistent pneumothorax and empyema. Several days after injury, laminectomies were performed and the bullet was removed. The cord appeared to be contused but not severed. About 5 days