Winchell McK. Craig

Livedo reticularis: A peripheral arteriolar disease☆

Abstract We have reported a series of thirteen cases of peripheral vascular disease affecting chiefly the legs and feet which seems to us to be best classified under the term “livedo reticularis,” as described in the literature. The clinical manifestations differ distinctly from those of Raynauds disease, acrocyanosis, and thromboangiitis obliterans. These patients did not have evidence of tuberculosis or syphilis, and the circulatory disturbance developed during adult life. The etiology in our cases is not known. The available data in our cases and others indicate that in livedo reticularis there are usually organic changes in the arterioles of the skin, with chronic vasospasm, which result in regional atony and dilatation of capillaries and slowing of the blood flow. The condition may be complicated by ulceration of the legs and superficial gangrene of the toes. Lumbar sympathetic ganglionectomy resulted in definite improvement in circulation and prevention of further attacks of gangrene in two of our cases and was unsuccessful in one case. It is our opinion that sympathectomy is a justifiable procedure in cases of livedo reticularis in which (1) no definite etiological factor can be found, and (2) superficial gangrene is present.

Chorionepithelioma: An unusual case in which cerebral metastasis occurred four years after hysterectomy

Abstract A case of chorionepithelioma is presented in which a latent period of four years had elapsed between the removal of the primary tumor and the development of clinical metastasis. The date of inception of the disease was established by the time of a previous hysterectomy. Pathologic proof of cerebral metastasis was furnished by examination of the lesion at biopsy. Urine collected shortly after craniotomy gave a negative reaction to the Friedman test.

The selection of cases of thrombo-angiitis obliterans and other circulatory diseases of the extremities for sympathetic ganglionectomy

Abstract Sixty-seven cases of thrombo-angiitis obliterans have been studied to determine the prognostic value and relation of the peripheral vasodilatation attained with systemic fever to the increase of surface temperature following sympathetic ganglionectomy. A close approximation is shown. This correlation is higher in the feet than in the hands. Other factors in the selection of cases of this form of vascular disease for operation are important, particularly those of the integrity of the coronary arteries, the rate of progression and stage of the disease, and the ability to demonstrate healing and relief of pain by medical measures. About one-third of the cases are suitable for operation. Preoperative determinations of the vasomotor component are less essential in the pure vasomotor disorders and in arthritis. Maximal grades of vasodilatation will result if the operation is complete.

A method of repair for intranasal encephalocele

Summary A case of intranasal encephalocele in a girl aged fifteen years is presented herein. This longstanding congenital defect, with widening and flattening of the nasal bridge simulating hypertelorism, was successfully repaired via an extracranial approach. The procedure consisted of ligation and removal of the sac and lining the cavity with a skin graft. At a second operative procedure continuity was established between the nasal fossae and the skin-lined cavity that had contained the encephalocele. This method represents, it is believed, a new, or at least thus far unreported, definitive surgical approach which would appear applicable in many cases of intranasal encephalocele formerly requring a more extensive intracranial operation, generally combined with an intranasak one to dispose of the sac. It would further seem to eliminate the hazard of cerebrospinal rhniorrhea previously associated with the strictly intranasal operation of mere ligation and amputation of the sac.

Treatment of intractable sciatic pain due to protruded intervertebral discs

Abstract Intractable sciatic pain which is persistent, intermittent, and does not respond satisfactorily to any type of treatment should be suspected as being due to a protruded intervertebral disc. In a large percentage of cases a careful and complete examination will elicit certain evidences of underlying pathologic change, although it may be necessary to localize and identify the lesion by means of roentgenologic examinations following the injection of radiopaque oil within the subarachnoid space. The presence of increased protein in the cerebrospinal fluid and the positive Lasegue sign, changes in reflexes, and tenderness in the sciatic nerve, are helpful although not essential in making the diagnosis. The treatment of choice is laminectomy, with removal of the protruded intervertebral disk as well as a possible associated hypertrophied ligamentum flavum. There were no deaths in a series of 100 cases. Postoperatively, the patient should be cautioned not to return to work too soon, and for a long period of time no heavy labor should be attempted. As a group the patients suffering from intractable sciatic pain caused by protruded intervertebral discs are permanently relieved of their pain and disability.