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In the cases reported the only constant finding has been that diabetes mellitus has been present for a long period of time. Nerve damage, with involvement of the peripheral nerves, of the nerve roots, or of the posterior columns, has been the most consistent pathological finding. It is manifested by sensory, vibratory, and reflex changes. Benefit from the use of ACTH seems to be present. It has probably resulted in lessening of the leg pain and healing of pathological fractures.

The 38 cases of spondylolisthesis and 48 of pseudospondylolisthesis were analysed based on clinical symptoms and functional radiograms.In spondylolisthesis, 17 patients complained of low-back pain alone, 10 complained of transient pain in the lower limbs, 6 complained of leg pain with decreased or disappeared ankle jerk, and 5 had sciatica with motor and sensory disturbances. 25 patients had stable lumbar spine and 10 had unstable spine.In Pseudospondylolisthesis, 12 patients complained of low-back pain alone, 11 complained of transient pain, 8 complained of leg pain with decreased ankle jerk and 9 had real radicular sciatica.The cases with sciatica with motor or sensory disturbances had the poorest result in conservative treatments. As for instability, the result of management had no relation in light worker but had poor result in heavy worker.In 14 out of 21 operatively treated cases, the causes of sciatica were identified: Arachinitis localisata in 3 cases, extradural scar tissue and thickened lig. flavum in 3 cases, adhesion of L5 nerve root or dura mater to the lysis part in two cases and no causes found in 5 cases.

Summary Fifty-six patients who had undergone fifty-seven operations for low back and leg pain thought to be associated with a prolapsed intervertebral disc have been reviewed. Forty-two had only mild residual signs and symptoms or none at all. The patients selected for surgery were those with intractable signs and symptoms which had not improved with conservative treatment, and some were chronic low back invalids. Myelography is a desirable adjunct in some patients when localization or diagnosis is in doubt. In addition to the forty-two patients who had a successful outcome, five patients were improved and five who eventually had recurrences were successful at first. The figures therefore show that some measure of relief resulted from fifty-two out of fifty-seven operations performed. The results of operation for carefully selected patients with presumptive prolapsed lumbar intervertebral disc are good. The operation is expected to relieve leg pain but more than half the patients will continue to have some discomfort or paraesthesiae. More relief from backache occurs than might be expected in view of the pathology and nature of the surgical procedure. Most patients can return to their former occupation even though arduous. Those accustomed to wear low back supports for years are able to stop doing so after surgery. A small proportion of patients with initial successful results develop recurrence of back and leg symptoms. Most subside with conservative treatment and may arise from rupture of adhesions but re-exploration is sometimes necessary. The results after the fenestration operation were not convincingly superior to those after laminectomy. Bearing in mind that the fenestration procedure was usually done on those with clear-cut signs and positive localization, it does not appear that there is anything to be gained by doing this rather more difficult operation.

Twenty-six children with acute bilateral lower-limb myositis of 1-5 days' duration were investigated virologically and found to have an associated influenza-virus infection. Upper-respiratory-tract signs and symptoms had begun to wane before the onset of severe leg pain associated with walking. Affected leg muscles were tender on palpation and serum-creatine-phosphokinase levels were elevated during the acute phase of illness. No neurological changes were evident. Twenty-two of these patients with myositis were seen in March/April, 1969 (influenza B virus), three in January, 1970 (A2 Hong Kong virus strain), and one in April, 1970 (influenza B virus).

Venous intravasation during myelography is of rare occurrence. A single instance was observed in 575 myelographic studies made in this hospital. A white married female, aged 44, was admitted to the hospital with a history of low back pain for four years and right leg pain for two months. Four years before admission, while lifting a basket of clothes, she became conscious of something “giving way” in her back and of a dull aching pain on the right side. She went to an osteopath, who “manipulated” her back, and she was relieved. This she did several times. Two months before she was seen at the hospital, she had a cold, during which she coughed and sneezed repeatedly. At that time she suddenly had a severe pain in the back radiating down the right leg to the toes. This remained constant, and at the time of entry the patient had noticed a weakness of the right leg and numbness of the lateral part of the right foot. The findings on physical examination were not significant. Neurological examination showed the ...

Disk disease is a causative factor in only 22.3% of patients with low-back and leg pain. Tumors, peripheral nerve lesions, vascular lesions, and infections are other causes that are occasionally missed in diagnosis. The case reports presented here illustrate diagnostic pitfalls to be avoided.

The exercise test as described in this study gives graphic evidence of the deficit in muscle blood flow during exercise in patients with intermittent claudication. It is easy to perform and can be done on an outpatient basis. The equipment cost is reasonable, NaI 131 is available in most hospitals, and the amount of radioactive material received by the patient is very small. Two people can perform the test on both legs of a patient in 45 minutes. Records are easy to interpret; if the isotope disappearance stops, the counts need not even be plotted to determine if the test is abnormal. The exercise test can be used in the diagnosis of leg pain of uncertain etiology, to study the effects of medical or surgical treatment, and in the clinical investigation of the symptoms of intermittent claudication.

The management of gravitational ulcers and the "bottle leg" present many problems. Much time is given over to the treatment of the conditions both in hospital wards and out-patient departments. Recurrence of ulceration is only too common. The pathogenesis of the condition now seems clear. A previous thrombosis in the deep veins of calf or thigh can be incriminated with certainty in the vast majority. Bauer, 1 who has done much work in this field, found that 80% of his patients, attending because of gravitational ulceration, gave a history of such a thrombosis. Dodd and Cockett 6 believe that 75% of patients who have had a thrombotic incident suffer subsequently from edema, induration, ulceration, or bursting leg pain. The time that elapses before the patient has symptoms may be such that the original incident has been forgotten, and, indeed, a deep venous thrombosis may be silent, particularly in the bilateral

ENDOCARDITIS due to Histoplasma capsulatum is rare. To our knowledge only 16 documented cases have been reported in the literature.1 Histoplasmosis is responsible for approximately a third of all reported cases of fungal endocarditis.2 , 3 The purpose of this paper is to present a case of histoplasma endocarditis that was undetected clinically. Case Report A 59-year-old married retired Air Force sergeant from Tennessee entered the hospital on May 6, 1965. He had been well until August, 1964, when he had a thromboembolectomy of the left iliac artery at another hospital after a short history of leg pain and swelling. Subsequently, he . . .

We have described a case of orthostatic hypotension following bilateral percutaneous cordotomy for relief of severe, chrome back and leg pain. The blood pressure of 40/0 mm Hg with the patient standing was corrected to normal levels by the use of an anti-G flight suit with minor modifications.

THE morphine alkaloids have had little success in controlling posterior-root pains in tabes dorsalis. Because of this a case in which a tabetic patient was relieved by intravenous administration of procaine after other analgesic measures had failed is presented. Case Report A 61-year-old man was first seen in 1943 because of unsteady gait and severe, stabbing leg pains. Cerebrospinal-fluid findings were consistent with neurosyphilis. After a course of bismuth and arsphenamine the spinal fluid became normal, and the patient did well for the next 5 years. Infrequent attacks of leg pain that were refractory to most measures then recurred. As . . .

✓ A patient with weakness and muscular atrophy of the right leg was shown to have a myelographic block caused by a redundant lumbar nerve loop. Decompressive laminectomy was followed by a marked degree of recovery.

The patient is a male of 52 year old and holds managerial position. He suddenly devloped left leg pain and low back pain seven years ago, which were followed by similar pain on his right leg and visited this hospital one year later. On X-ray examination, his right femoral head showed an image of spotty sclerosis and his left femoral head showed a punched-out image of sclerosis and spurs in its inside. As time went by, his symptoms were aggravated, and deformities of femoral heads and bone sclerosis progressed. However, owing to conservative treatment, his clinical symptoms have been alleviated and he walks quite normally now, but with a moderate limitation on internal rotation of hip joints. On X-ray, defor mities of both femoral heads are moderate, but bone sclerosis appears to have become less conspicuous and to be remedied. It would be necessary to follow up this case for an extended period of time.

Osteomalacia in the adult is usually attributed to defect in renal tubular reabsorption, or to the failure to respond to vitamin D, or to the loss of excessive amounts of calcium in the feces.1The case reported presents severe osteomalacia with pseudofractures in a patient who ingested large amounts of aluminum hydroxide. Report of Case During the last five years, a 50-year-old housewife gradually developed an increase in diffuse back and leg pain. She noted much discomfort in her feet from time to time, with difficulty in "taking-off." Several physicians had seen her and various shoe changes had been suggested and tried. None, however, provided any relief of the symptoms. An internist felt that there was some osteoporosis and administered estrogen therapy. She herself stopped this hormone treatment because of a lump in her breast. She was seen occasionally by one of us during the past two years. When

A case of atheromatous microembolism to the lower extremities illustrated some typical findings: sudden onset of leg pain, cool legs with normal peripheral pulses, petechiae, livedo reticularis, and elevated, tender nodules which represented muscle necrosis. The dominant clinical picture was consistent with acute polymyositis. Diagnosis of atheromatous microembolism with muscle necrosis was confirmed by muscle biopsy.