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Claude C. Coleman

warfare an effort must be made to differentiate clinically between a lesion causing slight structural damage from which the patient may recover spontaneously, and one in which the nerve is severely damaged, requiring suture. To make this differentiation between the recoverable and nonrecoverable nerve lesions is not always easy. In the First World War the problem of diagnosis often was met by delaying exploration of the nerve to test spontaneous recoverability and, in some cases, because of persisting wound infection, this delay was required. However, if the nerve

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Burton M. Shinners and Wallace B. Hamby

all stages of the development of our knowledge of this lesion. There were 140 patients explored, and 160 operations were performed, 20 patients having two operations. There have been no fatalities and one mild wound infection. In 116 patients protruded discs were found at the first operation. In 8 patients recurrences were subsequently found at the same level. In 3 patients second disc protrusions were found at a new level. These total 127 examples of disc protrusion. Twenty-four of the 140 patients (17 per cent) were explored without discovery of disc protrusions

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

early nerve grafting. 2. The Condition of the Wound . This factor should be considered in sequence since the time interval between injury and repair may influence the immediate environment of the graft, that is, the graft bed. Potential infection should be of little concern with the recent advances in bactericidal substances. Wound infection followed in Cases 5 and 6, originally infected at the time of injury, and must always be considered a hazard when tissue, such as a graft, is inserted into an operative wound. In subsequent grafts, pre- and postoperative

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H. V. Slemon

, but for one period powder containing 5000 units penicillin per gram was used. In periods when penicillin was not available, sulphathiazole powder was used. No routine use was made of parenteral or intrathecal penicillin in the forward area. INFECTIONS In the whole series of brain wounds, infection occurred in 28 cases. This represents an infection rate of 12.9 per cent of the total. If the deaths due to primary brain destruction are deleted from the total, the figure is 13.9 per cent. Although sulphathiazole powder alone was used in only 32 cases, a

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Stuart N. Rowe and Oscar A. Turner

T he prevention and control of infection in penetrating head wounds forms the basis of much of the treatment from the time of injury until healing occurs and is one of the major responsibilities of the Army neurosurgeon. The almost universal employment of sulfonamides and penicillin has resulted in material changes in the frequency, the symptomatology, the course, and the outcome of wound infections. These changes in turn have modified the surgical treatment of cranio-cerebral injuries and their sequelae. The following observations relative to these

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Richard U. Light and Hazel R. Prentice

operation) First Second Third 55 0 3 6 Died 4 hr. p.o. without reacting from anesthesia 56 0 3 * 18 57 0 3 ** 18 58 0 3 6 27 54 0 3 6 35 53 0 3 6 48 * Omitted due to poor general condition of animal. ** Omitted due to wound infection following second operation. Implantation site: Series A only. Surgical Note . It will be observed that 16 operations were performed in 6 animals, 10 of the operations being re-exposures of implants made 3 days

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Richard U. Light

, bleeding was reinstigated, and a new piece of sponge laid down to effect hemostasis; the wound was then closed. Again 3 days later the wound was reopened, and the process repeated. It was my hope to prepare 6 animals in this manner. However, one died soon after the conclusion of the third operation; another was considered strong enough only for two operations, and one developed a wound infection following the second operation which, though held in check by penicillin, prohibited further surgical exposures. Despite these inadequacies 5 animals contributed to the

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Barnes Woodhall and Fritz J. Cramer

surgeon is more concerned immediately with the possible complications of tantalum cranioplasty that must be faced in the early period after operation. There is little doubt but that a delayed type of wound infection involving the extradural extent of the cranioplasty is the one most frequently encountered. Case 1 described in a previous discussion of this subject 7 developed an infection ten months after tantalum cranioplasty and several months after discharge from the Army. The plate was removed by the attending surgeon. It is of some interest that the original injury

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John T. B. Carmody

16. He complained of increasingly severe headache and “fainting spells.” His condition progressed and on May 24 he became drowsy. For the first time he vomited. There was clinical evidence of increasing intracranial pressure. During this period his blood pressure averaged 102/84. Operation II On May 25, 1944 the bone flap was elevated and a portion of the frontal lobe was removed for decompressive purposes. Further exploration of the tumor failed to reveal any cystic areas. Course A superficial wound infection became evident on the 5th day

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John Martin and Eldridge H. Campbell Jr.

benign , was made up of 13 instances of local cerebritis associated with superficial wound infection and an open dura. The herniae grew slowly, were seldom large, shaggy or friable, nor were they associated with high intracranial pressure nor progressive neurological changes. None was accompanied by deeper infection. There were no deaths in this series. Hot wet dressings were employed but otherwise no special treatment was required, since the natural tendency was toward healing and retraction of the hernia. In but one early case was the mass excised. It was 3 to 4 cm