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With the Report of a Case of Resection of All the Roots IVhich Go to Make Up the Brachial Plexus.* By George W. Jacoby, M. D., New York. The operation of resection of the posterior roots of a number of spinal nerves for the relief of in- tractable pain seems to have been first planned and advocated by C. L. Dana. Acting upon his sugges- tion. Robert Abbe divided the posterior roots in a case of severe persistent neuralgia sildenafil citrate 50mg of the arm and forearm in December. 1888. cutting both the motor buy sildenafil citrate and sensory roots of the sixth and seventh cervical nerves buy eriacta online outside the dura, and two days later per- forming an intradural section of the seventh, wdiich had previously been cut extradurally, and also of the eighth cervical nerve. About this time W. H. Bennett, in England, per- ' The author showed here sections and photomiriocraphs. • Read at the meetltif: of the American NeuroloKical .\ssocla- tlon eriacta tablets held In Washington. D. C., May order eriacta sildenafil citrate 100mg 7, 1907. August o. I90T.J JACOBY: RESECTION OF SERVES. 193 formed an intradural resection of the third, fourth, and fiftli lumbar, and first and second sacral pos- terior roots in a man suffering from acute spasmod- ic pains in the leg of nine years' duration. Since then this operation has been carried out so many times that it may to-day well ranbaxy eriacta be looked upon as one of the classical operations in surgery. Yet the general impression among surgeons and neu- rologists seems to be that it is order sildenafil citrate an operation to be feared and one in which the results to be attained are not commensurate with the risk incurred. This impression is voiced by Oppenheim, who but re- cently wrote that nothing positive concerning the indications ranbaxy eriacta 100 and the value of the procedure was to be gleaned from the published reports, and that only so much was certain, " that the operation endangers the spina! cord to a high degree, since it has in sev- I'li;. 1. .\ii'as of r.ndli'ulnr ilisd-lbiitlon nf thp spinal nerves. (.\ft.T KoiliiM-. ( Front view. eral cases been follow id liy the Brown-Sequard symptom complex. " Yet tile indication> fur the operation have been carefully formulated i)y .\l)be and (. hipault, and the success of most of the operations is eriacta uk manifest. The dangers, as shown in the published oases, resolve themselves into a persistent Brown-.'^equard paraly- sis of moderate ilegree occurring ;is a result of the operation, in a single case, and into deatli buy sildenafil citrate online foUowinu; tile operation in two others. purchase sildenafil citrate The occurrence cheap sildenafil citrate of tlie crossed sensorimotor paralysis in the case of Mor- ton Prince was undoulUedly caused liy the opera- tion as sudi, yet was probably due to jiressure upon the cord in consequence of the formation of a clot, granulation tissue, or callus, which caused the pa- tient but little inconvenience relatively when meas- cheap eriacta ured by the amount of relief from pain eriacta online gained through the operation. Certainly the section of the nerve roots bore no part in the causation of the palsy. Chipault attributes the death of the two patients, one his own. the other Bennett's, to congestion of the brain and spinal cord and haemorrhage as a re- sult of decompression in consequence of a prolonged outflow of cerebrospinal fluid and its insufficient reproduction. To those who have witnessed much of buy eriacta the earlier brain surgery and have seen persist- ent outflow of cerebrospinal fluid for days and even weeks, this explanation will hardly seem tena- ble, and as a matter of fact, in one of Victor Hors- ley's cases (Case \'III of table) of posterior root resection, there was an escape of cerebrospinal fluid lasting three weeks without injurious effect. Bennett's patient, on the other hand, was, prior to the operation, rapidly approaching a state of e.x- haustion, and it was feared that death might occur unless he could be relieved of his suffering. In this patient Bennett did not suture the dura : there was a constant but diminishing flow of cerebrospinal fluid for a week; then vomiting, headache, and coma set in, with death ensuing twelve days after the opera-

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