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R. Glen Spurling

scarred area, resection with end-to-end suture is undertaken. All cases of suture—or neurolysis for that matter—should be observed carefully week by week for evidence of new functional activity. If at any time satisfactory progress seems to have stopped, re-exploration should be recommended. The value of the Tinel's sign in diagnois has been discredited by many observers because of the frequency with which percussion impulses can be transmitted through scarred soft tissue to a distant neuroma. If the percussing stroke is heavy no doubt the jarring will invalidate it

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Colonel C. G. de Gutiérrez-Mahoney

phantom foot and leg. But these ceased immediately on the occurrence of the cerebral lesion; the stroke which abolished all recognition of posture destroyed at the same time the phantom limb. The part which the autonomic system plays has been emphasized by Leriche and Livingston through relief of pain, although temporary, which has followed interruption of the sympathetic nerves. There were also not a few supporters of a purely psychological explanation. Pick 12 was probably the first of these, and since him others have gone so far as to maintain that the phantom

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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

in the degree of resistance in anesthetic areas on stimulation, such as stroking the foot. If such changes were shown this would indicate incomplete interruption of sympathetic fibers and would be even a better test in determining regeneration than a comparison of the degree of resistance. In the last case shown, that of the cerebral vascular accident in which normal skin resistance existed in an area of impaired sensation in the foot, were there signs of motor involvement also? We have made a few observations on stimulation of the cerebral cortex in humans at the

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Intracranial Angiography

I. The Diagnosis of Vascular Lesions

Carl F. List and Fred J. Hodges

the circulation of the external carotid artery. As a matter of routine, we strangulate the external carotid artery at the time of injection to obviate this difficulty. Case 2. A.W.R., 494930, male, age 34 . Upon admission, 3 weeks following a stroke, this patient was found to have complete spastic hemiplegia on the right and total aphasia. A provisional diagnosis of extensive vascular brain lesion was made and angiography was employed to provide a more detailed understanding of the suspected disturbance of circulation in the cerebral vessels. The first attempt

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Treatment of Causalgia

An Analysis of 100 Cases

Theodore B. Rasmussen and Howard Freedman

succeeding days. Stroking or squeezing the involved area or moving the joints nearly always aggravated the pain. Patients whose pain was severe enough to prevent use of the hand and whose pain was not promptly relieved, quickly developed trophic changes, such as glossy cyanotic appearance of the skin, tapered fingers and periarticular fibrosis. Evidence of these changes was seen as early as 4 weeks after the injury. Diagnostic Aspect of Paravertebral Injection of Procaine . At least 1 injection was done in 91 of the patients. In cases with involvement of the upper

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Electrospinogram (ESG)

Spinal Cord Action Potentials Recorded from a Paraplegic Patient

James L. Pool

only evident common factor preceding all three bursts was the fact that the lower extremities were stimulated 6 or more times at intervals of 30 to 90 seconds, by touching the skin, stroking the sole of one foot, or passively bending the toes or flicking a toe of one foot. Almost every stimulus of this kind elicited a flexor withdrawal spasm of the affected extremity. With strong stimuli, such as toe bending, both extremities withdrew and contractions were observed in the lower back and abdominal muscles also. During the ESG bursts described, however, there was no

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John E. Scarff and James L. Pool

worse, until they were quite severe and recurred spontaneously almost constantly. They could be initiated if the foot were stroked, the legs passively moved, or the patient ingested food. On 14 October 1945, under novocain anesthesia, laminectomy was performed from T-8 to T-12 laminae, inclusive. The arachnoid membrane was moderately thickened, suggesting a previous widespread inflammatory reaction. The lightest possible touch applied with the tip of the forceps to the dorsal columns caused massive spasms of the lower extremities. Similarly, any mechanical stimulus

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J. Lawrence Pool and John A. Brabson

of burning. On stroking the skin with cotton, dysesthesias could be induced over the volar aspect of the thumb, index finger and thenar eminence, but none over the 3rd finger. All forms of sensation were readily appreciated over the dorsal aspect of these fingers within the radial nerve distribution. On Mar. 26, 1945 the second-stage repair was carried out under local anesthesia only. The previous first-stage “bulb” suture and neuromata were resected following 2 per cent procain block of the proximal segment of the median nerve. When this had been done, bipolar

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J. Jay Keegan

dermatome area of paresthesia could be outlined by stroking the pin from the normal to the involved zone. Testing of temperature sensation by ice tube likewise identified the dermatome area. Fibrillations and weakness were noted in the triceps muscle and definite atrophy in the small muscles of the hand, with inability to open or close this hand completely on the ulnar side ( Fig. 9 ). Circumference of the left forearm and upper arm was 2 cm. less than on the right. Pressure over the scalenus anticus muscle and brachial plexus caused no unusual pain, but pressure over the

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Henry A. Shenkin, Eugene B. Spitz, Francis C. Grant and Seymour S. Kety

further lowering the carotid sinus pressure. This would seem to be borne out by the fact that the increase in cardiac output was principally the result of increase in pulse rate rather than in stroke volume. From this study it is suggested that a survey of the systemic circulation may be helpful in establishing the diagnosis of a large cerebral arteriovenous anomaly. If such a diagnosis is considered, an enlarged heart and a lower than normal blood pressure (particularly the diastolic) would be suggestive, as would an increase in cardiac output. If facilities