W rE ARE reporting a case of occlusion of the basilar artery within a longitudinal fracture of the clivus. There have been two previous reports of traumatic incarceration and occlusion involving the vertebral-basilar system. In one, the basilar artery was occluded ;3 in the other, the left vertebral artery was involved. ~

HIS is a study of the ballistic characteristics of shotgun injuries to the central nervous system. The usual clinical observation provides no obvious correlation between the degree of injury to the central nervous system and factors such as range of the shot, number of pellets striking the head, size of shotgun, or size of pellet (Fig. 1). Examination of the clinical records of the University of Missouri School of Medicine from 1957 to 1966 revealed 19 shotgun injuries of the head with sufficient information to afford a detailed ballistic analysis, on the basis of which it was possible to establish four distinct types of injury. Experimental studies of human cadaver calvaria added more precise definition of these types of injury and some understanding of the factors involved. Shotgun Characteristics The shotgun was designed to kill small

✓ An experimental study is presented of the histopathological reaction of the brain to shotgun pellets surgically implanted in cats. Hardened lead shot produced the least reaction, copper-coated pellets the most, and nickel-coated shot an intermediate reaction. Seven histological changes and neurological deficits were apparent in cats with implanted copper-coated pellets; a marked migration of copper-coated shot was revealed by x-ray and autopsy examination. Three clinical cases are presented to illustrate the clinical significance of the laboratory data.

No abstract

F' the large solid tumors which may be encountered in newborn infants, the sacrococcygeal teratoma is by far the most common. This tumor is usually benign when treated early; otherwise it often undergoes malignant degeneration. Our experience and review of the literature indicate that many of these are still incorrectly diagnosed and are not treated early.Presented here is a brief survey of the subject including pertinent points in diagnosis and treatment, and three case histories of patients with this lesion recently treated in our hospital. Our purpose is to emphasize to pediatricians the presentation, prognosis, and treatment of this tumor in order to improve the survival rate of the infants. Case ReportsCase 1. C. S. This patient was first admitted to UMMC September 3, 1965 at nine months of age, with a chief complaint of a large sacral mass evi-dent since birth and now rapidly increasing in size.This essentially normal and active 7-lb. infant was delivered at home of a 15-year-old Negro mother after a fullterm uncomplicated pregnancy, labor and delivery. The only noted abnormality was a 50-cent-sized raised lesion on the right buttock, described as a &dquo;bump.&dquo; The infant developed normally until eight months of age when he fell on the raised area. This then increased in size and became tender, and fever, lethargy, decreased appetite, and diarrhea developed.Physical examination on admission revealed an emaciated, alert, slightly irritable Negro female, with a 10-cm. non-erythematous, non-edematous, movable skin-covered mass in the midline sacral area. Deep tendon reflexes were absent in the lower extremities and the Babinski response was positive bilaterally. No abdominal masses were felt. The rectum was pushed anteriorly by the tumor.Intravenous pyelogram, myelogram, and barium enema all showed a 9 X 9 X 9 czxa. mass displacing the urinary bladder, coccyx and rectum and having no connection with the spinal cord. The diagnosis of probable sacral teratoma was made.The operative procedure performed on the I 1 tla hospital day revealed mass involvement not only of the sacrum and coccyx but also of' the lower lumbar vertebrae and the posterior pelvic cav:~y. The tumor could be only partially -emoved. Postoperatively the child had no dimculties.The tissue removed contained large sheets of highly anaplastie eells forming papillary projections and sworls, as well as other tissue elements from all germinal layers. The diagnosis was malignant sacrococcygeal teratoma.