Yearbook, Issue 27

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Page 46 - If a m'an can write a better book, preach a better sermon, or make a better mouse-trap than his neighbor, though he build his house in the woods, the world will make a beaten path to his door.
Page 21 - The most accurate means now known for ascertaining th« presence or absence of an increased intracranial pressure is the measurement of the cerebro-spinal fluid at lumbar puncture by the spinal mercurial manometer. It is similar to a blood pressure apparatus, as safe as a lumbar puncture when properly performed, and by it the varying degrees of intracranial pressure can be carefully recorded. The normal pressure is 5-9 mm. of mercury, so that if a pressure higher than 15 mm.
Page 23 - Cranial operations for brain injuries in this stage of shock were frequently performed in the past and most disastrously, and thus operations were almost discredited in the treatment of brain injuries. The natural reaction following these early operations in the period of severe shock was to wait until there could be no possible doubt that the patient was going to die, unless, as was thought, a cranial operation was performed ; that is, the patient was permitted to reach the period of extreme medullary...
Page 24 - ... of medullary compression, then undoubtedly the mortality of these patients will be 50 per cent., and even higher. Patients should not be allowed to reach this dangerous stage of medullary compression; this stage should be anticipated, and it can be by repeated ophthalmoscopic examinations and the measurement of the pressure of the cerebrospinal fluid at lumbar puncture. In selected cases of mild intracranial pressure, due to trauma, very frequently the convalescence can be shortened, the headaches...
Page 20 - ... accurate diagnostic methods now known and if a marked increase of intracranial pressure is ascertained, then an early relief of it should be advised, not only to save the life of the patient but to lessen the post-traumatic conditions of changed personality either of the excitable or the depressed type, persistent headaches, early fatigue, occasionally epilepsy and that long train of posttraumatic conditions...
Page 23 - ... choked disks" to occur in these cases of traumatic intracranial lesions with or without a fracture of the skull, yet the earlier, and, therefore, milder degrees of an edema of the optic disks should be most carefully "watched for...
Page 23 - To advise a cranial operation upon a patient — no matter how badly the skull is fractured, nor how extensive the intracranial hemorrhage seems, and that patient is in the condition of severe shock with a pulse-rate of 120 and higher, then the operation at that period of shock takes away whatever chance the patient may have of surviving the shock; the operation is but an added shock and merely hastens the exitus. No patient having a brain injury should be operated upon in this condition of shock;...
Page 27 - ... of 60 and in some cases below 60 — that is, the usual clinical signs of an increased intracranial pressure; an ophthalmoscopic examination had rarely been made. Many of these patients still showed the results of the increased intracranial pressure in their fundi and at lumbar puncture, and these were the ones upon whom a cranial decompression even at this late date caused a marked improvement; the operative findings were always associated with a "wet...
Page 24 - In these cases, it is not so important to remove the hemorrhage as it is to offset its pressure effects. In cases of depressed fractures of the vault, showing definite signs of a high intracranial pressure, it is better surgical judgment to precede the elevation or removal of the depressed area of bone by a subtemporal decompression, so that when the depressed bone is removed there will be little or no danger of the underlying cerebral cortex being damaged by its protrusion through the bony opening....
Page 23 - I feel that if these two extremes can be avoided and the latter of these, medullary collapse, can certainly be anticipated in the operative treatment of brain injuries and their signs cannot be overlooked, that the rational treatment from an operative standpoint depends upon the presence or not of a definite increase of the intracranial pressure whether there is a fracture of the skull or not ; in some of the most serious cases no fracture was present — either to be ascertained at operation in...

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