Since 1984, a consecutive series of patients with cervical spondylotic myelopathy has been treated by central corpectomy and strut grafting. This report focuses on 40 cases operated on between 1984 and 1987 and followed from 2 to 5 years. The perioperative complication rate was 47.5%, with a 7.5% incidence of persistent sequelae: severe C-5 radiculopathy in one patient, swallowing dysfunction in one, and hypoglossal nerve palsy in one. No single factor (age, duration of symptoms, or severity of myelopathy) was absolutely predictive of outcome; however, syndromes of short duration had the best likelihood of cure. Similar outcomes were associated, individually, with long duration of symptoms, age over 70 years, and severe myelopathy. After factoring a 5% regression of improvement, the long-term cure rate was 57.5% and the failure rate was 15%. Myelopathy worsening was not documented.

1. Unanaesthetized rainbow trout, when subjected to a lowered Po2 of the inspired water, show an increase in amplitude of pressures recorded from the buccal and opercular cavities. Pressure amplitudes were commonly found to be 0.5 cm of water in resting trout and increased 4- or 5-fold as inspired Po2 was reduced. Differential pressures across the gills also increased with hypoxia. 2. Typically the minute volume in a 400-600 g trout increased from about 0.2 to 0.6 l/kg/min when the inspired Po2 was lowered from 150 to 80 mm Hg, but rose to 1-5l/kg/min at lower Po2. Increased minute volumes are mainly due to increases in stroke volume; respiratory frequency remains fairly constant at Po2 's above about 8o mm Hg. 3. The relation between differential pressure and minute volume is fairly linear over much of the range, but minute volume increases more rapidly than differential pressure. 4. Oxygen consumption of the non-swimming fish increases during hypoxia and is related to the increased ventilation and differential pressure across the gills. 5. Estimates of the oxygen cost of breathing were made from the increased oxygen consumption during hyperventilation. Comparison of these estimates with estimates of the work done, using the pressure and volume measurements, gave figures for the overall efficiency of the pumping mechanism of about 10%.

Spinal opiate receptor tolerance is the major limitation of continuous intraspinal narcotic analgesia delivered by implanted reservoir pump. Six intractable pain patients receiving continuous epidural morphine were given trials of low dose bupivicaine HCL in order to assess the effects on implanted reservoir function, analgesia, and safety. Daily infusion of 2.6-18.8 mg bupivicaine HCL had no consistent effect on flow rates. Subjectively, three patients had at least partial relief of pain while their intraspinal morphine doses were weaned. No sympathectomy was appreciated at these doses. The future of continuous intraspinal analgesia might require further advances in implantable infusion pump technology to allow manipulation of both daily infusion doses and multiple intraspinal analgesics. Further study is needed to assess the safety and effectiveness of higher continuous intraspinal bupivicaine doses for chronic pain relief.

A small number of human fetal hydrocephalics have been treated by ventriculoamniotic shunts of silastic tubing. The Colorado device appears to be the one most commonly used. The original experimental device tested on a primate model resembled a hollow shingle nail. This was designed by Michedja and Hodgen, contained a spring valve, measured approximately 32 X 4 mm and was placed by hysterotomy. An attractive feature of this design was its fixation by impaction in the skull, preventing displacement by fetal activity, a reported disadvantage with the silastic devices. To our knowledge, no one has used this nail-like design and tailored it to transuterine percutaneous placement in a human case.

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