J. Hume Adams

The structural basis of moderate disability after traumatic brain damage

The objective was to discover the nature of brain damage in survivors of head injury who are left with moderate disability. Macroscopic and microscopic examination was carried out on the brains of 20 persons who had died long after a head injury that had been treated in a neurosurgical unit. All had become independent but had various disabilities (moderate disability on the Glasgow outcome scale) Most deaths had been sudden, which had led to their referral from forensic pathologists. Post-traumatic epilepsy was a feature in 75%. An intracranial haematoma had been evacuated in 75%, and in 11 of the 15 with epilepsy. Diffuse axonal injury was found in six patients, five of the mildest type (grade 1) and one of grade 2. No patient had diffuse thalamic damage but one had a small focal ischaemic lesion in the thalamus. No patient had severe ischaemic brain damage, but three had moderate lesions which were bilateral in only one. No patient had severe cortical contusions. In conclusion, the dominant lesion was focal damage from an evacuated intracranial haematoma. Severe diffuse damage was not found, with diffuse axonal injury only mild and thalamic damage in only one patient.

Transection of the pituitary stalk in man: anatomical changes in the pituitary glands of 21 patients

In recent years hypophysectomy (Luft and Olivecrona, 1953) and adrenalectomy (which is nearly always combined with ovariectomy) have been used as methods of treating cases of advanced cancer of the breast (Atkins, Falconer, Hayward, MacLean, and Schurr, 1966) and the results of comparative trials suggest that hypophysectomy is slightly the more effective of these two operations (Atkins, Falconer, Hayward, MacLean, Schurr, and Armitage, 1960). As an alternative to hypophysectomy neurosurgeons have sometimes used the operation of pituitary stalk section for relieving such cases and also for treating patients with cancer of the prostate (see Schurr, 1966). In addition pituitary stalk section has been used for patients with advancing diabetic retinopathy (Field, Schepens, Sweet, and Appels, 1962; Cullen, Harris, Munro, and Duncan, 1965; Fager, Rees, and Bradley, 1966). In assessing the merits of this particular operation as a means of depressing pituitary function, it is important to know the extent to which the structure of the gland is altered and its functions impaired. There are few reports in the literature on the effects of stalk section on the human pituitary (Dandy and Goetsch, 1911; Russell, 1956; Daniel, Prichard, and Schurr, 1958; Le Beau and Foncin, 1960; Nicolaidis, 1962; Adams, Daniel, Prichard, and Schurr, 1963), although much information has now been obtained on the effects of the operation on several species of animal (Harris, 1950; Barrnett and Greep, 1951; Greep and Barrnett, 1951; Benoit and Assenmacher, 1953; Campbell and Harris, 1957; Daniel and Prichard, 1958; Holmes, 1961, 1962; Laszlo, David, and Kovics, 1962; Adams, Daniel, and Prichard, 1963a, b, c; 1964a, b, c; 1966a, b; Jacobsohn, 1966). We have now had the opportunity of examining the glands of 21 human patients surviving for various periods of time after stalk section and in this paper we report our findings in these pituitary glands. MATERIAL AND METHODS

Some Effects of Transection of the Pituitary Stalk

As we look at this whole field, the most challenging, and the least conquered and understood, is that set of phenomena which we associate with the mind. Here is the great challenge to the physician and to the scientist. To the physician because it is particularly in this respect that one individual differs from another, and because the meeting and mutual understanding of minds constitute the essence of the doctor-patient relationship ; to the scientist because here is presented an elementary problem of scientific method?namely, that of classifying the facts in such a way that allows numerical values to be assigned to them, and formulation of these in terms of a simple hypothesis. This challenge has been offered before to the scientific method, and

NEUROECTODERMAL TUMOURS OF THE CENTRAL AND PERIPHERAL NERVOUS SYSTEM

limited value on its own. The first 37 figures are myelin preparations of transverse sections of spinal cord, medulla, pons, and mid-brain. These are unlabelled. Figures 38 to 52 are myelin preparations of the right cerebral hemisphere reproduced from Jelgersma. This is the most valuable section of the book as the gyri in most figures are labelled, unlike the original. The remaining nine figures are useful line drawings on which the levels and planes of the preceding sections are indlicatetr1 and a fe-w lahelle-d mve-lin nre-narationn of horizontal and sagittal sections of the spheres.