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The Chemotherapy of Intracranial Infections

IV. The Treatment of Pneumococcal Meningitis by Intrathecal Administration of Penicillin

Cobb Pilcher and William F. Meacham

method of therapy, even with small dosage, was found to reduce the mortality rate and prolong the survival time. The beneficial effects of intrathecal therapy were markedly increased by the addition of the intravenous administration of penicillin (since secondary infection of the blood stream was invariably present and lobar pneumonia frequently developed if intravenous therapy were not employed). REFERENCES 1. Pilcher , C. , and Meacham , W. F. The chemotherapy of intracranial infections. III. The treatment of experimental staphylococcic

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Franc D. Ingraham and Orville T. Bailey

hypothesis—that the tumor was a medulloblastoma in 1924 with an unusually long survival period, perhaps extended by the inadequate roentgen therapy. If so, the tumor must have behaved in a most unusual way for the roentgen therapy was not repeated as it should be to hold a medulloblastoma in check and no radical attack has been made upon the tumor surgically. Whichever one of these hypotheses is correct, and there seems to be no definitive way of choosing among them, the history of this patient seems significant in illustrating unusual possibilities in the behavior of

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Robert C. L. Robertson

A utogenous bone transplant repair of cranial defects is not completely satisfactory. It entails an extended or separate operative procedure to secure bone, the size and contour of which leaves something to be desired. A “crows-nest” appearance may result from a multiple fragment repair and there is some question of the survival of the bone fragments as osseous tissue. An ideal substitute material has yet to be discovered. Such a substance should be readily available, easily worked, preferably workable when cold, strong enough to withstand ordinary trauma, and

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Orville T. Bailey and Franc D. Ingraham

the time of operation and the patient has remained well for a period of six years. Histologically, the neoplasm was indistinguishable from those of the diffuse type. However, there was no cyst and the localized nature of the lesion made possible its complete eradication by radical surgery. The prognosis, therefore, was quite different from the prognosis of the diffuse saccular fibrosarcomas. In view of the cellular signs of malignancy, however, the long period of survival without recurrence has proved surprising. It indicates that radical extirpation of

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I. M. Tarlov and J. A. Epstein

remaining 19 dogs, 3-cm. segments of the nerve were excised and then cross-switched. Fat-areolar tissue flaps were applied unilaterally to the nerve grafts in 19 dogs and muscle flaps were sutured to one of the grafts in each of 11 dogs. In 22 of these animals, in which the survival period varied from 3 to 125 days, roentgenographic studies of the nerve were made following the injection of a mixture of red lead and glue. Also histological preparations of these nerves were studied. In 4 of these animals the combined studies indicated better vascularization and less

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R. Glen Spurling, W. R. Lyons, B. B. Whitcomb and Barnes Woodhall

fibers. 4. The Postoperative Course . This was uneventful except in Cases 5 and 6, where the wounds suppurated. Judging by the appearances of the grafts at the time of removal, they had not been involved in the infection. Roentgenological study of the tibia in Case 7 revealed an osteomyelitic focus and there had been an infection in the region of the graft bed one month before its insertion. Again, the graft did not appear adversely affected by this contiguous infection. Up to this point, the factors influencing the survival of the grafts were little different

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Harry S. N. Greene and Hildegarde Arnold

days after transfer. Note ganglion cells in this and two following photographs. Hematoxylin and eosin, ×500. Homologous transplant of embryonic rabbit brain. Rabbit bearing transplant was killed 144 days after transfer. Hematoxylin and eosin, ×600. Despite the failure to recognize the cell type, available evidence indicates that the cell mass was derived from survival and growth of a neuroglial element contained in the transplanted brain rather than from a reactive proliferation on the part of the host. Comparable cells have not been observed in anterior

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Richard U. Light

. of thrombin intravenously in the course of 4 minutes, died of intravascular clotting, and the injection time had to be prolonged to 10 to 20 minutes to permit survival by the rest. b) The potency of the solution of thrombin used intravenously is given as 100 Iowa units 13 per mg., but the strength of the alum precipitated material is not recorded, nor is mention made of the nitrogen content. c) The potency of the human thrombin supplied by the Harvard Medical School that was used to detect cross-sensitization was unknown to Dr. Seegal. d) On the basis of maximum

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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

necessary to combat the cerebral insult. There was no substitute for whole blood, although plasma contributed to recovery. Oxygen was used freely, as was caffeine in small, repeated doses. The respiratory tree was kept clear by aspiration and the patient was kept warm. Paraldehyde was used for restlessness. Usually, within 2 to 12 hours, the vital signs stabilized and the patient reached the optimal level for surgery. Operation must be effected at this time. Once this peak has passed, his chances for survival are lessened. He is given the opportunity of surgery if he

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John Martin and Eldridge H. Campbell Jr.

later had brain damage that was compatible with survival. The chief hazards to be faced are the complications of wound healing, which are for the most part overlooked, or recurrent hematoma, masses of necrotic brain tissue and infection; most of these stemmed from incomplete debridement. Those of us who have had the privilege of operating in forward medical installations during heavy fighting realize all too well the difficulties under which surgeons must work. These are well known and require no elaboration, save perhaps on two points. The first is the need for