Edward Hitchcock

Hypothermic subarachnoid irrigation for intractable pain.

Abstract Twelve cases of intractable pain due to various lesions at different levels of the body have been treated by hypothermic subarachnoid irrigation. Worth-while relief has been obtained in seven patients, in five patients the effect was transient or unsuccessful. It is suggested that the unmyelinated C fibres are particularly susceptible to the permanent effects of cooling. No demonstrable sensory deficits and no bladder complications have been noted.

OSMOLYTIC NEUROLYSIS FOR INTRACTABLE FACIAL PAIN

Abstract The intractable pain experienced by patients in the terminal stages of facial carcinoma poses difficult problems—nerve section, medullary tractotomy, or thalamotomy are not always suitable. In seven patients with advanced facial carcinomas who were in poor general health and severe pain, the technique of cisternal injection of hypertonic saline solution was tried. Between 6 and 20 ml. of saline solution was injected, the temperature ranging between 4 and 36°C and the osmolarity being greater than 1000 in all but one instance. Pain relief was immediate, but variable in duration (3-105 days). The injection was sometimes followed by transient vertigo, vomiting, or facial weakness.

HYPERTONIC SALINE IN MANAGEMENT OF INTRACTABLE PAIN

Abstract 108 patients with intractable pain from malignant disease or benign conditions were given intrathecal saline (10-15%). Three months later over 50% of cancer patients were still experiencing pain relief as judged by their need for mild analgesics only or none at all. Muscle weakness (3%) and sphincter disorders (8%) were the most important complications.

Stereotaxic Neurosurgery in the Management of Cerebral Palsy

Ten children with cerebral palsy are presented on whom stereotaxic operations on the central nervous system were performed with the aim of ameliorating athetosis and spasticity. There were seven alert and co‐operative children with spastic hemiplegia or diplegia, of whom six received benefit from thalamotomy or dentatotomy. The seventh, a child with diplegia, had improvement of his left lower limb, but the right became worse. One child with spastic diplegia, in whom a thoracic meningocoele had been closed at birth, was not improved by bilateral dentatotomy. Two severely quadriplegic children each had bilateral dentatotomy; one was a child with dystonic and spastic quadriplegia as the sequel of kernicterus, the other suffered a post‐traumatic spastic quadriplegia. In both cases the resulting reduction in tone and extensor spasm rendered the nursing of these patients much easier.