Carotid occlusion in a 27-year-old man: a case report.

A 27-year-old man developed premature carotid atherosclerosis some 15 years after mantle radiation to the head and neck for nasopharyngeal lymphoepithelioma.

Endarterectomy for atheromatous hypoglossal artery. Case report.

A 57-year-old white man developed transient ischemic symptoms of the posterior circulation in August, 1981. Serial arteriography revealed stenosis of a large right hypoglossal artery which narrowed from 50% to 90% after only 2 months. The hypoglossal artery occurs in the 4-mm human embryo, normally from Days 21 to 26 of gestation. This is the first reported case of hypoglossal endarterectomy.

SEM evaluation of endothelial damage following temporary middle cerebral artery occlusion in dogs.

Microsurgical clips and tourniquets were used to occlude middle cerebral arteries of dogs for 45-minute periods. Scanning electron microscopy and light microscopy studies revealed significant endothelial damage in many of these arteries. Less traumatic microsurgical clips are needed for temporary small vessel occlusion.

Dorsal longitudinal myelotomy.

An evaluation of dorsal longitudinal myelotomy in the management of spasticity of the lower limbs has been done in 17 patients. The follow-up has varied from 1 month to over 2 years. Most patients achieved satisfactory relief from spasticity. Eight patients have died after the operation in chronic care hospitals. In all except one, the spasticity had been relieved. Eight out of the nine living patients have benefited from myelotomy. Recurrence of spasticity following the first operation occurred in four patients, two of whom improved after a repeat myelotomy. In the presence of fixed contractures of the hip and knee joints, a satisfactory clinical result may not be obtained after the myelotomy.

Middle cerebral artery microneurosurgical embolectomy.

Cerebral embolism carries significant mortality and morbidity rates. Middle cerebral artery embolectomies which have been carried out in man with variable results, have been reported by different authors, In order to define a time limit for embolectomies before irreversible damage has been incurred, an experimental embolus model was used in dogs. It was observed that embolectomy carried out at 2, 3, and up to 5 hours after embolism was relatively safe and effective. Beyond 5 hours, embolectomy carried an increased risk of death and morbidity.

Acute acromegalic dyspnea.

A case of acute "acromegalic dyspnea" due to vocal cord fixation and subglottic mucosal hypertrophy is reported. The patient was treated by intubation, tracheostomy, stereotactic implantation of radioisotopes 192Ir and 198Au via the transsphenoidal route.

Chymopapain in the treatment of ruptured lumbar discs. Preliminary experience in 48 patients.

The results of chemonucleolysis in 48 patients with lumbar disc disease revealed marked improvement in 58%, slight improvement in 23%, and no improvement in 19%. Serious anaphylactic reactions occurred in two patients. These results and those of other neurosurgical and orthopaedic studies are summarized and compared with the 70% improvement rate obtained with a placebo in a recent double blind controlled cooperative study. Only those few investigators participating in the double blind study are now permitted to use intradiscal chymopapain. It is concluded that the ultimate place of chemonucleolysis, if any, in the treatment of ruptured lumbar discs remains to be determined.

Microsurgical lumbosacral ganglionectomy, anatomic rationale, and surgical results.

Recent anatomic and physiologic work suggests that there may be substantial numbers of unmyelinated sensory axons in the ventral roots. The cell bodies of origin for these unmyelinated axons would presumably be located in the dorsal ganglion. We have performed 18 microsurgical lumbosacral ganglionectomies over the past two years for chronic lumbosacral pain syndromes. In spite of preoperative nerve block trials, good results were obtained in only 10 of 18 patients. Four patients obtained some pain relief, and four patients no pain relief whatsoever. Microganglionectomy in the lumbosacral area is probably easier technically than the more traditional intradural rhizotomy, but may not yield any better results.

Experimental middle cerebral artery microsurgical embolectomy.

The canine middle cerebral has been embolized using the method of Molinari. Microsurgical embolectomies were done at two hours and six hours post-embolism. Animals done at two hours remained virtually intact neurologically, and hence fared better than control dogs whose embolus remained in place. Animals done six hours post embolism had increased neurologic morbidity and mortality as compared to the controls. Pathologic study revealed hemorrhagic infarctions in 50% of the animals done six hours post embolism.

Penetrating intracranial foreign bodies in children.

Four cases illustrating low-velocity penetrating injuries from foreign bodies are presented. The importance of formal intracranial exposure is emphasized. When used in these four cases, all patients had good recoveries. In children, penetration of the brain is likely because of the fragility of the orbital roof. The English-language literature on penetrating intracranial foreign bodies is also reviewed.

Delayed post-traumatic subdural empyema.

A case of subdural empyema is reported, treated through a frontal bone flap, with exenteration of the infected frontal sinus at operation, and subdural instillation of antibiotics for 48 hours postoperatively. Diagnostic findings are reviewed, and the likelihood of anaerobic infection this case and similar cases discussed.

Multiple spine fractures in ankylosing spondylitis.

1. Concomitant cervical and thoracic spine fractures are reported in a patient with advanced ankylosing spondylitis (second reported case). 2. The thoracic T9-10 interspace fracture-dislocation was grossly unstable, as well as the C7-T1 fracture-dislocation. 3. The higher incidence of cord injury following spinal fracture-dislocations in these patients is discussed. 4. The dangers of inadequate postinjury immobilization in those patients fortunate enough to be neurologically intact following spinal fracture are stressed.