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The brains of 27 deceased parkinsonian patients who had undergone stereotaxic thalamic surgery were examined anatomically to define the exact location of the surgical lesion in each case. A correlative study was then carried out between the site of these lesions and any language or speech deficits which might have resulted from the thalamic surgery. The following conclusions were drawn: A lesion strictly confined to the ventrolateral nucleus (VL) of the thalamus may be followed by language and/or speech deficits. No definite relationship existed between postoperative language or speech deficits and partial involvement of thalamic nuclei surrounding VL nucleus; H fields of Forel; subthalamic nucleus or red nucleus. Also, mild encroachment on the internal capsule could be tolerated without language or speech deficits, so long as the pyramidal tract remained intact. The size of the lesion was not related to postoperative language and/or speech deficits. Postoperative language deficits were mild and improved in time; whereas speech disturbances could be either mild, moderate, or severe. When language deficits did occur, they followed surgery on the left dominant hemisphere in most instances. In contradistinction, no definite relationship was found between the side of surgery and speech deficits. Language and speech disturbances are most frequently associated with bilateral rather than with unilateral surgery, regardless of the cerebral hemisphere involved in the second operation.

RYLIC plastics have been used extensively in the repair of skull defects 10.12 and have been tried not too successfully as replacement therapy for worn-out intervertebral discs, 2,'~ for internal fixation in fractures, and in arthritic spines?-4,7-9,n Dott of Edinburgh 3 mentioned his use of acrylic plastic in atlanto-axial subluxation from rheumatoid arthritis, and his associate Harris ~ has written of further uses including the fixation of fractures of the cervical spine. Clinical and aninml work has shown that acrylic plastic properly used is no more irritating than vitalium or stainless steel and that the heat of polymerization is a handicap only when in direct contact with delicate nerve structures or when uncooled by cold saline irrigation. With these facts in mind, it occurred to us that acrylic polymer might well constitute a rapid method of vertebral internal fixation or replacement in spinal metastatic disease where the patient has only a limited life expectancy and should not spend his last months immobilized in bed in casts or traction. This is a preliminary report on its trial in three such cases, plus confirmatory animal studies. Case Reports Case 1. A 59-year-old woman had metastatic breast carcinoma with lytie collapse of the ~nd cervical vertebra and cord compression. She was hospitalized on April 11, 1963. She had severe neek pain and pyramidal tract signs. There was also metastatic invasion of the skull, lower cervical spine, skin, and liver.

Thirty experiments were performed in dogs to assess the effects of freezing on carotid and femoral arteries. These vessels withstood freezing and thawing without rupture. Blood within the vessels did not clot and was lysed during thawing. Histological changes of vessel walls consisted of early degeneration followed by a reparative process. Occasional secondary thrombosis occurred close to bifurcation of ligated branches and was related to extent and frequency of freezing and thawing.

In 1960, it was first reported by one of us (Cooper, 1960a) that intention tremor could be relieved by a surgical lesion placed in the ventrolateral nucleus of the thalamus. Since then, a number of reports have appeared in the literature (Cooper, 1960b;Broager and Fog, 1962; Cooper, 1962b;Krayenbuhl and Yasargil, 1962; Cooper, 1965;Laitinen, 1965;Fox and Kurtzke, 1966), corroborating the therapeutic value of thalamic surgery for intention tremor.It is the purpose of this report to summarize our results and sequelae of cryothalamectomy, carried out on 73 consecutive cases of intention tremor of diverse aetiology. These operations were performed during the period of 10 August 1966 until 26 July 1968. MATERIAL AND METHODSThe seventy-three patients were examined pre-operatively by the investigative team on the neurosurgical service at St. Barnabas Hospital. In the clinical analysis of the symptoms, intention tremor was rated on a five-point scale, ranging from 0 for absence of the tremor to +4 for maximum rating. Pre-and post-operative motion pictures were obtained in each case. In addition, a special objective method (Dierssen, Lorenc, and Spitaleri, 1961) of evaluation of individual motion picture frames before and after surgery, provided a measurable index of intention tremor (Fig. 1).Language and speech assessments were made one to three days before surgery, within two weeks after surgery, and in some cases during follow-up re-evaluation of varying periods.Pre-operative psychological data on each patient were derived from clinical interviews conducted by an experienced psychologist. On the basis of these initial interviews each patient was rated on a three-point scale as a good, fair, or poor candidate for surgery. Usually, patients with 'poor' pre-operative psychological ratings did not, and do not, undergo surgery. However, since the decision regarding advisability of surgery must take into account medical condition, neurological factors, and other variables, in addition to psychological findings, some patients with a 'poor' psychological rating may ' The causes of intention tremor in the present series were as follows: familial (26 cases); multiple sclerosis (25 cases); cerebellar degeneration of unknown origin (seven cases); post-traumatic (five cases); posterior fossa tumour (one case); Leber's disease (one case); and associated with torticollis in two cases and Parkinsonism in six cases. Thirty-nine patients were males and 34 were females. There was male preponderance in the familial group in contrast with the multiple sclerosis cases. The age incidence varied from 15 to 79 years with a mean of 42-3 years. All the patients, except one, were right handed. The average duration of the tremor was 17-9 years with a range of two to 50 years. The tremor was unilateral in three cases and bilateral in the remaining. The upper extremities were affected more than the lower; and the right side slightly more than the left. In 13 patients, there was neck tremor in addition to limb tremor. In all cases, the tremor was se...