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The treatment of tetanus
PROGRESS IN SURGERY Selections from Recent Literature
FREEDLANDER, SAMUEL OSCAR, Cleveland. The treatment of tetanus. Ann. Surg., March, 1927, Ixxxv, 405. Twenty-five consecutive cases of tetanus were treated with large frequentIy repeated intravenous injections of antitoxin, with a mortality rate of 36 per cent. EIeven of these had an incubation period of less than ten days with a mortaIity rate of 45.5 per cent. If the six cases which died before sufficient antitoxin could be administered are excluded, the mortality rate would be 12 per cent. The relatively low mortality rate in this series adds to the impression that tetanus antitoxin given in large doses intravenousIy has some therapeutic value. TEACHENOR, FRANE; R., Kansas City. Intracranial compIications of fracture of skuI1 invoIving frontal sinus. J. Am. M. Ass., March 26, 1927, Ixxxviii, 987. Sixteen cases of fractures of the skul1 invoIving the fronta sinus are reviewed.Teachenor divides these cases into two series of eight each. In the first series there were three operations, but they were done after the onset of the complications. In the second series prompt operation was done in each case as a preventive measure. In the first series of eight patients, there were seven deaths. Two died from brain injury accompanying fracture; one of intradural frontal abscess; one of extra-dura1 abscess and meningitis, and three of meningitis. In one case of cerebrospinal rhinorrhea the patient recovered. In the second series of eight patients, there were three deaths. Two died from brain injury accompanying fracture, and one of meningitis; five recovered without intracrania1 complications. In the first series the gross mortality was 87.5 per cent; 25 per cent was from brain injury accompanying the fracture of the skull, and 76.5 per cent resulted from intracrania1 infection; 12.5 per cent recovered. In the second series all the patients had prompt fronta sinus drainage. The gross mortaIity was 37.5 per cent; 25 per cent was from brain injuries accompanying the fracture of the skull, and 12.5 per cent from intracranial infection. The one death from 519
meningitis was the result of delayed operation. The death from meningitis twenty-nine hours after injury, and the failure to save the patient by operation thirty-six hours after injury, illustrate the necessity of early diagnosis and operation. In addition to drainage of the sinus, a free exit must be provided for air forced into the sinus from the nasal cavity. In cases of cerebrospinal rhinorrhea or pneumocephaIus the dural lacerations shouId be sought and cIosed. MAES, URBAN, New OrIeans. Some conclusions on crania1 injuries. South. Med. J., &larch, 1927, xx, 178. While the immediate recovery of the patient is a serious consideration, the remote consequences of the injury are equaIIy importa.nt. The subtemporal decompression devised by Cushing is the most valuabIe measure in these conditions; it shouId never be done during the period of shock, and it is wise to suppIement it by lumbar puncture or by the use of dehydrating agents. In miId cases Iumbar puncture alone may be adequate, but expectant treatment is seldom justified. OLIVECRONA, HERBERT, Stockholm. On section of the root of the trigeminus at the pons. Acta Chir. Scandinav., Feb. 22, 1927, lxi, 371. In cases of trigeminal pain due to intracranial or extracrania involvement of the fifth nerve by maIignant tumors of the nasopharynx root, section is recommended. The tempora1 route for section of the root of the fifth nerve should not be used since the tumor may invoIve the gangIion itself or its neighboring structures. The operation of choice is an intradural approach from a suboccipital craniotom>and section of the root at the side of the pons. PRICE, JOHN W., JR., LouisvilIe, ment of infections of the face. March, 1927, IXXXV,329.
Ky. TreatAnn. Surg.,
The treatment of infections of the nose, upper lip and upper part of the face may be outlined according to the degree of the infection.
FREEDLANDER, SAMUEL OSCAR, Cleveland. The treatment of tetanus. Ann. Surg., March, 1927, Ixxxv, 405. Twenty-five consecutive cases of tetanus were treated with large frequentIy repeated intravenous injections of antitoxin, with a mortality rate of 36 per cent. EIeven of these had an incubation period of less than ten days with a mortaIity rate of 45.5 per cent. If the six cases which died before sufficient antitoxin could be administered are excluded, the mortality rate would be 12 per cent. The relatively low mortality rate in this series adds to the impression that tetanus antitoxin given in large doses intravenousIy has some therapeutic value. TEACHENOR, FRANE; R., Kansas City. Intracranial compIications of fracture of skuI1 invoIving frontal sinus. J. Am. M. Ass., March 26, 1927, Ixxxviii, 987. Sixteen cases of fractures of the skul1 invoIving the fronta sinus are reviewed.Teachenor divides these cases into two series of eight each. In the first series there were three operations, but they were done after the onset of the complications. In the second series prompt operation was done in each case as a preventive measure. In the first series of eight patients, there were seven deaths. Two died from brain injury accompanying fracture; one of intradural frontal abscess; one of extra-dura1 abscess and meningitis, and three of meningitis. In one case of cerebrospinal rhinorrhea the patient recovered. In the second series of eight patients, there were three deaths. Two died from brain injury accompanying fracture, and one of meningitis; five recovered without intracrania1 complications. In the first series the gross mortality was 87.5 per cent; 25 per cent was from brain injury accompanying the fracture of the skull, and 76.5 per cent resulted from intracrania1 infection; 12.5 per cent recovered. In the second series all the patients had prompt fronta sinus drainage. The gross mortaIity was 37.5 per cent; 25 per cent was from brain injuries accompanying the fracture of the skull, and 12.5 per cent from intracranial infection. The one death from 519
meningitis was the result of delayed operation. The death from meningitis twenty-nine hours after injury, and the failure to save the patient by operation thirty-six hours after injury, illustrate the necessity of early diagnosis and operation. In addition to drainage of the sinus, a free exit must be provided for air forced into the sinus from the nasal cavity. In cases of cerebrospinal rhinorrhea or pneumocephaIus the dural lacerations shouId be sought and cIosed. MAES, URBAN, New OrIeans. Some conclusions on crania1 injuries. South. Med. J., &larch, 1927, xx, 178. While the immediate recovery of the patient is a serious consideration, the remote consequences of the injury are equaIIy importa.nt. The subtemporal decompression devised by Cushing is the most valuabIe measure in these conditions; it shouId never be done during the period of shock, and it is wise to suppIement it by lumbar puncture or by the use of dehydrating agents. In miId cases Iumbar puncture alone may be adequate, but expectant treatment is seldom justified. OLIVECRONA, HERBERT, Stockholm. On section of the root of the trigeminus at the pons. Acta Chir. Scandinav., Feb. 22, 1927, lxi, 371. In cases of trigeminal pain due to intracranial or extracrania involvement of the fifth nerve by maIignant tumors of the nasopharynx root, section is recommended. The tempora1 route for section of the root of the fifth nerve should not be used since the tumor may invoIve the gangIion itself or its neighboring structures. The operation of choice is an intradural approach from a suboccipital craniotom>and section of the root at the side of the pons. PRICE, JOHN W., JR., LouisvilIe, ment of infections of the face. March, 1927, IXXXV,329.
Ky. TreatAnn. Surg.,
The treatment of infections of the nose, upper lip and upper part of the face may be outlined according to the degree of the infection.