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The Lucite Calvarium—A Method for Direct Observation of the Brain

I. The Surgical and Lucite Processing Techniques

C. Hunter Shelden, Robert H. Pudenz, Joseph S. Restarski and Winchell McK. Craig

findings in these investigations will be forthcoming. In this communication the surgical technique and the method of processing the lucite plate are presented. METHODS AND MATERIALS Macacus rhesus monkeys have been used in all of the experiments. The technique leading to a successful preparation of a lucite calvarium is divided into four stages: 1. The first stage of operation. 2. The lucite processing technique. 3. The second stage of operation. 4. Post-operative care. Each of these stages is discussed separately. 1. The

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of gram-positive cocci. The cellular components of the abscess wall showed nothing remarkable. Comment . In the first of these three fatal cases penicillin was applied too late to control the effects of the pneumococcal infection. In the second case infection was never severe, and death was due to intracranial haemorrhage. The third patient died as a result of an error of surgical technique. If adequate drainage had been provided for the gram-negative pus he would almost certainly have survived, for his other wounds, including the compound fracture of the femur

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Edgar F. Fincher

surgical procedure used in these cases was a linear craniotomy from the zygoma to the vertex across the longitudinal sinus. A 3-centimeter sacrifice of the skull was made and the dura and its attached membrane removed as this bony exposure permitted. Care was exercised against opening the arachnoid ( Fig. 6 ). Fig. 6. Artist's concept of the linear craniotomy and the subdural pathologic changes. PATHOLOGY The subdural pathology revealed on these exposures has been uniformly the same and this rather than the surgical technique or results of

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Francis C. Grant

and surgical technique. This paper has to do solely with operative results as indicated by post-operative examination of the patients at periods ranging from five years to six months. But two reports, by Verbrugghen 2 and Shinners and Hamby 1 , have been found which deal solely with the condition of the patient following removal of the disc. All the other communications we have found have given methods of diagnosis and operative technique in large groups of patients, but have been noticeably vague about end results. Frankly, we have not been overly enthusiastic

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Walter G. Haynes

upon as many as twelve difficult, penetrating brain wounds in twenty-four hours and still maintain Halsted-Cushing technique. A trained team consisting of instrument nurse, anesthetist, and two medical corpsmen, plus invaluable surgeon-assistants † , constituted the direct solution to the demand for speed and efficiency. Surgical technique and routine must be standardized, despite necessary improvisations. This series of penetrating brain wounds is collected from the experiences of the author in the North African, Sicilian and Western European campaigns. They are

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Richard U. Light and Hazel R. Prentice

blotted to dampness on gauze before implanting. Five sites of implantation were chosen, all in the cranial chamber. They are serialized as follows: Series A . Epidural, on the incised and bleeding superior sagittal sinus. Series B . Subdural, on intact brain. No intended bleeding. Series C . Subdural, on pricked and scarified brain. Series D . A block of cortex removed and replaced by the matrix. Series E . Subcortical implant. Sterile surgical technique was followed. General anesthesia (cylopal, 100 mg. per kg. of body weight) was

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Extensive Brain Wounds

Analysis of 159 Cases Occurring in a Series of 342 Penetrating War Wounds of the Brain

Walter G. Haynes

penetrating brain wounds as to type, location, pathologic and surgical peculiarities and prognosis. One such category, that of extensive brain damage, is exemplified in this group of 159 cases. 2. Pathologic and clinical peculiarities are described. 3. Necessary surgical technique and results therefrom are presented. 4. Comparison of results with over-all picture of war surgery is made. 5. Encouraging results are attributed to swift evacuation to the neurologic surgeon; primary, definitive repair; and sulfonamides and penicillin

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James Greenwood Jr.

injection at the stylomastoid foramen caused a complete, though not permanent, paralysis and injections of smaller divisions were too inaccurate to produce any uniform success. Injection cannot result in permanent relief. The persistence of these people in their search for help and their gratitude when even minor improvements occurred led to an improvement in alcohol injection. Their willingness to submit to repeated injections made us search for a surgical technique that has fewer disadvantages than previous methods. A modification of German's method was used for

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L. Willard Freeman and Robert F. Heimburger

often intolerant of a suprapubic catheter. Most patients had proven transection of the cord or had failure of return of function after one year. However, lack of proof of transection did not serve as a deterrent factor when debility was advanced. In a few cases the presence of large decubitus ulcers extending to the projected operative area caused a delay in the initiation of the procedure. SURGICAL TECHNIQUE The surgical technique used by the authors in 15 cases was as follows: Preoperative roentgenograms of the lumbodorsal area were obtained. In early cases of

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C. Hunter Shelden, Robert H. Pudenz and Collin S. MacCarty

. The satisfactory functional and anatomical results in these three patients have prompted this preliminary report. When sufficient time has elapsed to evaluate the maximum return of function, a detailed account of each patient will be made. CONCLUSION Three patients with extensive combined median and ulnar nerve lesions have been successfully treated by a two-stage procedure, using the ulnar nerve as an autograft. The surgical technique is described. The possibility of repair of other extensive peripheral nerve lesions by this method is suggested.