Loyal Davis

An analysis of the results of treatment of intracranial vascular lesions by carotid artery ligation.

FOR CENTURIES, controversy has existed about the residual function of the brain following ligation of one of the common carotid arteries. Even after evidence began to accumulate in the surgical literature, John Abernethy, Astley Cooper, Jean-Louis Petit, Matthew Baillie and other surgeons, whose words were less authoritative, presented conflicting views. Amos Twichell, a young New Hampshire surgeon, was ignorant of antecedent ligations of the common carotid artery but had he read Abernethy, he could have held but little hope for his own patient who made an uneventful recovery. Recently, there has developed an opinion that ligation of the common carotid artery is a dangerous procedure of little value in the treatment of intracranial vascular lesions, and that a direct attack on these lesions is necessary and desirable. A high mortality rate or serious neurological damage following common carotid artery ligation have been encountered by the general surgeon, especially in the surgical treatment of malignancies about the head and neck. It has been our opinion that common carotid artery ligation has been an effective method of dealing with intracranial aneurysms, arteriovenous fistulas, and other vascular anomalies of the brain which are congenital in origin, and that it has not been a particularly hazardous procedure. The clinical course of 108 patients with carotid

Decerebrate rigidity in animals.

Decerebrate rigidity (DR) in animals is caused by a release of spinal neurons from supraspinal inhibition, which results in a caricature of reflex standing and includes tonic neck and labyrinthine reflexes. The reticular formation, cerebellum, vestibular complex, spinal cord, and muscle spindle system and their neurophysiological interaction are critical to DR. Its discovery and investigation were essential to Sherringtons concept of the integrative action of the nervous system. There are two types of DR with different anatomical and physiological bases. Intercollicular decerebration yields rigidity in extensor muscles that results from bilateral destruction of the central tegmental tracts, is abolished by posterior root section, and is due to a facilitation of gamma motoneuron discharge (gamma animal). Anemic decerebration is characterized by excessive extensor rigidity, depends upon the release of tonic labryinthine reflexes from cerebellar inhibition, is independent of posterior root section, and is caused by excessive alpha motoneuron discharge (alpha animal). DR has provided an insight into the mechanisms of posture and standing, but the correlation of laboratory observations and results from animals to humans must be made with caution.

Diagnosis and localization of organic lesions of the central nervous system using radioactive diiodofluorescein.

In 1911, it was said that fluorescein had a special affinity for tumor cells. At that time, Wasserman used peptobromofluorescein (eosin) as a vehicle to carry toxic selenium to the tumor for chemotherapeutic purposes. It was not until 1929 and 1931 that there was a renewed interest in the use of fluorescein, when Cope-man and his co-workers used sodium fluorescein, both topically and intravenously, in conjunction with high-voltage roentgen therapy or radium, in the study and treatment of tumors of the breast and bone. Fluorescein was used primarily, however, in the study of capillary permeability in diseases of the central nervous system, in the study of the blood-aqueous humor barrier, and in investigations of the circulation time. Experimental studies on neoplastic growths in lower animals indicate that other vital dyes localize selectively in the cancer tissue, not in the cancer cell itself but in the intercellular stroma, probably as a result of the altered permeability of the stromal blood vessels. L...

Die chirurgische Behandlung unbeherrschbarer Schmerzen

1. Die visceralen afferenten Schmerzempfindungen werden durch die Nervi splanchnici in das Ruckenmark geleitet, wo sie in kurzen kettenformigen ubereinandergeschaltenen Neuronen in der grauen Substanz zentralwarts passieren. 2. Chordotomie, wenn nicht genugend tief ausgefuhrt und wenn die Lasion die graue Substanz nicht zerstort, hebt die Organschmerzen nicht auf, wahrend die somatischen Schmerzen vollig unterdruckt werden. 3. Die Durchschneidung der Hinterwurzeln, wenn nur eine genugende Anzahl derselben durchtrennt wird, hebt die Organschmerzen auf. 4. In einem Falle wurden die Schmerzen bei Angina pectoris durch Hinterwurzeldurchschneidung aufgehoben. Solche Operation greift die afferenten Leitungsbahnen der Schmerzempfindungen sicher an, wirkt jedoch auf den acceleratorischen Herzmechanismus nicht storend ein. 5. Die Reizung der efferenten sympathischen Fasern ruft an der Peripherie Veranderungen hervor, die in der Folge die gewohnlichen somatischen schmerzleitenden Fasern reizen. Die Schmerzaufhebung durch die Sektion der sympathischen Fasern ist daher auf die Unterbrechung der efferenten Leitungsbahnen zuruckzufuhren. 6. Die Durchschneidung aller Hinterwurzeln der oberen Extremitat, beim Menschen und bei Tieren, unterbricht alle Formen der oberflachlichen und Tiefensensibilitat. 7. Es gibt keinen Beweis fur das Vorhandensein der sensiblen Bahnen in den Vorderwurzeln.