Trial Preparation after the Preliminary Inquiry

The legal team continues to prepare its defense. American attorney Carroll Brewster, hired by the Kinseys, consults with medical experts in America, including a prominent neurological surgeon at the Yale Medical School, who advises on the impact of the drugs Peppy was taking. The medical evidence becomes the primary focus, while psychiatric issues and insurance on Peppy’s life—with Bill as beneficiary—also are examined. Peace Corps officials in Washington become very concerned about press coverage of the case. Bill’s Tanzanian attorney presses the court for an early trial date, with little success. Bill remains in jail, and his parents wonder if they should travel to Tanzania to support him. Efforts are made to bring Peppy’s mother to Mwanza to appear as a defense witness.

Transcranial Doppler ultrasonography in neurological surgery and neurocritical care

Transcranial Doppler (TCD) ultrasonography is an inexpensive, noninvasive means of measuring blood flow within the arteries of the brain. In this review, the authors outline the technology underlying TCD ultrasonography and describe its uses in patients with neurosurgical diseases. One of the most common uses of TCD ultrasonography is monitoring for vasospasm following subarachnoid hemorrhage. In this setting, elevated blood flow velocities serve as a proxy for vasospasm and can herald the onset of ischemia. TCD ultrasonography is also useful in the evaluation and management of occlusive cerebrovascular disease. Monitoring for microembolic signals enables stratification of stroke risk due to carotid stenosis and can also be used to clarify stroke etiology. TCD ultrasonography can identify patients with exhausted cerebrovascular reserve, and after extracranial-intracranial bypass procedures it can be used to assess adequacy of flow through the graft. Finally, assessment of cerebral autoregulation can be performed using TCD ultrasonography, providing data important to the management of patients with severe traumatic brain injury. As the clinical applications of TCD ultrasonography have expanded over time, so has their importance in the management of neurosurgical patients. Familiarity with this diagnostic tool is crucial for the modern neurological surgeon.

TP3-11 Sir geoffrey jefferson, a father of the SBNS, a remarkable life

ObjectivesThe foundation of a Society of Neurological Surgeons was Jefferson`s idea. How did this come about? The objective is to research this period of our history and its development.DesignA review of papers and articles held in the University of Manchester, The University of Oxford and abstracts from a biography of Jefferson by Peter Schurr, enables an historic presentation to the SBNS and the ABN.SubjectsIn 1926 Sir Geoffrey Jefferson was closely connected to the leading minds in British neurology and neurological surgery. His friendship and correspondence with Cushing was a major force in his drive for a specialist society. These players on the neurosurgical stage are the subjects of this presentation.MethodsAs in the design, the author will survey all available material including photography and handwritten manuscripts.ResultsOn the very next day after being appointed a consultant neurological surgeon at the Manchester Royal Infirmary, Jefferson arranged a meeting at the Athenaeum Club to consider the formation of our society. This was held on December the 2nd 1926 and the first formal scientific meeting was held on the 3rd at Queen Square!ConclusionsThe formation of this small society was crucial in presenting British neurosurgery as a specialty in its own right to medicine in the United Kingdom. No other neurosurgical society existed in Europe at this stage. Jefferson is indeed the father figure of our society today.

New York City at the dawn of neurological surgery

Although there are many cities that can claim to have been the incubator of modern neurological surgery, the rise of this surgical subspecialty in New York City in the late 19th and early 20th century mirrors what was occurring around the world. The first confirmed brain tumor operation in the US was performed there in 1887. The author describes the role of several pioneers in the development of neurological surgery. Charles Elsberg was the first dedicated neurological surgeon in New York City and was instrumental in the development of the Neurological Institute and the careers of several other notable neurosurgeons.

HISTORICAL CHARACTERIZATION OF TRIGEMINAL NEURALGIA

TRIGEMINAL NEURALGIA IS a well known clinical entity characterized by agonizing, paroxysmal, and lancinating facial pain, often triggered by movements of the mouth or eating. Historical reviews of facial pain have attempted to describe this severe pain over the past 2.5 millennia. The ancient Greek physicians Hippocrates, Aretaeus, and Galen, described kephalalgias, but their accounts were vague and did not clearly correspond with what we now term trigeminal neuralgia. The first adequate description of trigeminal neuralgia was given in 1671, followed by a fuller description by physician John Locke in 1677. André described the convulsive-like condition in 1756, and named it tic douloureux; in 1773, Fothergill described it as “a painful affection of the face;” and in 1779, John Hunter more clearly characterized the entity as a form of “nervous disorder” with reference to pain of the teeth, gums, or tongue where the disease “does not reside.” One hundred fifty years later, the neurological surgeon Walter Dandy equated neurovascular compression of the trigeminal nerve with trigeminal neuralgia.