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The common causes for intractable pain are presented. Minor and major neurosurgical procedures for its relief are listed. Table VIII Table VIII. Death within fourteenth days after various neurosergical procedures for the relief of intractable pain Operations No. No. of Deaths Cause of Deaths Chordotomy Unilateral 14 0 Bilateral 20 0 Rhizotomy Unilateral 7 0 Bilateral 9 0 Chordotomy and Rhizotomy 2 1 Bronchopneumonia (12 days) Rhizotomy, 5th and 9th cranial, C1, C2, C3 3 1 Postoperative shock (18 hr.) Medullary spinothalmic tractotomy 2 2 Medullary softening (24 hr.) cardiac metastasis with hemopericardium (6 days) Mesencephalic spinothalamic tractotomy 1 0 Sympathectomy 4 0 Total 62 4 (6.4%) The advantages and disadvantages of subarachnoid and paravertebral alcohol injections are compared with those of chordotomy, rhizotomy and sympathectomy. Fifty-seven cases of intractable pain in which operation was performed by the authors are then presented in the following groups: (1) malignancies, nasopharynx and neck, paraveretbral, gastrointestinal, pelvic and skeletal; (2) vascular: neurosyphilis with and without tabetic crises, causalgia with and without phantom pain, cardiac (angina); (3) miscellaneous: tuberculosis of the bladder, arachnoiditis, herpes zoster and fracture of the thoracic vertebra; (4) unknown etiology with neurosis. The relief of pain, mortality from operations and complications, are listed in tables. Each group is then analyzed and the results compared with those published by others. Conclusions were then made as to the relative merits of the various procedures and contraindications to their use. The possibilities of recent procedures such as resection of the sensory cortex and prefrontal lobotomy are discussed.

1. There is a unanimity of opinion that psychotherapy is the treatment of first choice for anxiety associated with the psychoneuroses. It is only when this approach has failed or cannot be utilized that any of the somatic procedures may be indicated. 2. Insulin subshock therapy would seem to be definitely of benefit in allaying anxiety both in the neuroses and the psychoses. 3. The work of D. E. Cameron on autonomous anxiety and its treatment by adrenalin-desensitization is valuable from a theoretical aspect and promising from the therapeutic angle. 4. The use of the barbiturates to lessen tension and diminish anxiety has been amply reviewed and confirmed by many observers. 5. In contradistinction: Electric shock therapy seems to have limited value in anxiety states, and, indeed, in some cases it is claimed that anxiety has been enhanced because of a residual fear of treatment. 6. The now classical procedure of prefrontal lobotomy has unquestioned value in relieving anxiety-tension states but produces undesirable by-effects such as convulsions, diminution of intelligence, and “blunting of the personality” characterized by childishness, lack of foresight, impaired judgment and shallowness of feeling. 7. The latest procedure is thalamotomy which is aimed to obtain the beneficial results of lobotomy, i. e, relief of tension and anxiety without the aforementioned undesirable complications.

Summary Control of major and minor seizuresin a 10-year-old boy with tuberous sclerosis is reported. In conjunction with roentgenographic studies a striatal focus was located by depth electroencephalography, and circumscribed lesions were produced in this area and the corresponding ansa lenticularis. The recording as well as the coagulating electrodes were inserted by means of the steroencephalotome. The practical and theoretical implications of these observations are discussed.

Purpose: Head and neck cancer (HNC) is the sixth most common cancer worldwide with a 5-year survival rate of less than 50%. The PI3K/AKT/mTOR signaling pathway is frequently implicated in HNC. Recently, IQ motif–containing GTPase-activating protein 1 (IQGAP1) was discovered to scaffold the PI3K/AKT signaling pathway. IQGAP1 gene expression is increased in HNC, raising the hypothesis that IQGAP1 contributes to HNC. Experimental Design: We performed a combination of in vitro studies using human cancer cell lines treated with a cell-permeable peptide that interferes with IQGAP1′s ability to bind to PI3K, and in vivo studies utilizing mice genetically knocked out for the Iqgap1 (Iqgap1−/−). In vivo EGF stimulation assays were used to evaluate PI3K signaling. To study the role of IQGAP1 in HNC, we used a well-validated mouse model that drives HNC via a synthetic oral carcinogen, 4-nitroquinoline 1-oxide (4NQO). Results: IQGAP1 is necessary for efficient PI3K signaling in vitro and in vivo. Disruption of IQGAP1-scaffolded PI3K/AKT signaling reduced HNC cell survival. Iqgap1−/− mice had significantly lower cancer incidences, lesser disease severity, and fewer cancer foci. IQGAP1 protein levels were increased in HNC arising in Iqgap1+/+ mice. The level of PI3K signaling in 4NQO-induced HNC arising in Iqgap1−/− mice was significantly reduced, consistent with the hypothesis that IQGAP1 contributes to HNC at least partly through PI3K signaling. High IQGAP1 expression correlated with reduced survival, and high pS6 levels correlated with high IQGAP1 levels in patients with HNC. Conclusions: These data demonstrate that IQGAP1 contributes to head and neck carcinogenesis.

1. Stimulation of the anterior nucleus in anesthetized cats and man induces slowing or arrest of respiration. The effect upon the blood pressure in cats is variable, though a depressor effect is frequently observed.

Electrography of the striatum and pallidum was guided by the consideration that it may provide an answer as to the participation of these structures in the mechanism of extrapyramidal and convulsive disorders. In an individual case such recordings may help to decide whether elimination or reduction of the activity, particularly of parts of the pallidum, may serve a useful purpose: postoperatively, such recordings may give an indication as to whether the procedure employed was able to change the functional state of the pallidum. MATERIAL AND METHODS Since the recordings and operative procedures had to be performed in several stages, a new type of stereoencephalotome (Model V) was constructed. It permits one to apply the apparatus repeatedly in exactly the same position. The apparatus is fixed to the skull by means of four screws that carry small steel balls, to which the feet of the stereoencephalotome may be attached in any

1. 1. Increase or depression of Parkinson tremor may appear on stimulation of the prerubral area; this may be due partly to stimulation of pallidofugal fibers and partly of cerebello-rubro-thalamo-pallidal and of corticofugal fibers that pass through, or synapse in, the field H. 2. 2. Close to the prerubral field there are, in the human brain, cell groups or fibers of the cranial part of the oculomotor nucleus innervating the internal rectus muscle. 3. 3. Various vegetative effects were observed on stimulation of the field H: changes of the pupil, of the vasomotor system, of the heart rate and EKG, and appearance of a galvanic skin reaction. Apparently, hypothalamofugal fibers are stimulated; the participation of indirect stimulation of the hypothalamus cannot be excluded. 4. 4. Cortical recruitment responses could also be elicited; they are apparently chiefly due to stimulation of reticulo-thalamic fibers. A surface positive deflection may precede in records from the frontal lobe and is explained by stimulation of cerebello-rubro-thalamic fibers. 5. 5. This study shows the complexity of Forel's field H that contains various systems of different physiologic significance.

The importance of subcortical systems located as far down as the rhombencephalon for the propagation of corticofugal epileptic discharges became evident when it was demonstrated that the generalization of impulses originating in the motor cortex of one side was not prevented in dogs by median sagittal section of the prosencephalon, diencephalon, and mesencephalon (Spiegel and Falkiewicz 40 ). Furthermore, it is known that not only the pyramidal tract (Hering, 20 in experiments on dogs) but also all the fiber systems contained in the cerebral peduncles are dispensable for the centrifugal conduction of cortically induced discharges (von Economo and Karplus 9 in cats). Thus, an extrapyramidal conduction of corticofugal impulses must play a significant part in the propagation of epileptic discharges; this was also suspected by Krisch, 28 on the basis of clinical observations. Important evidence in this direction has been presented by the recent experimental studies of Hayashi 19 in dogs

A method is described for inserting stereotactically directed electrodes into the human brain under local anesthesia. This method is being used for the insertion into the subcortex of recording or stimulating electrodes and for production of subcortical lesions.