, ,: :d v~ability of the head was tbund h in four patients in whom a diagnosi: arried out as a secondary proceduõ r investigation which have been given ~by Mr H. J. Seddon of the Royal Na'" ul. Royal Infirmary and by MrL. WpU°nal u~d me to the bone needle which ~l~e.ẽ o th.e .ease with" wh!ch the investio~_°~,~, ,~,a caũ nfalhng cooperation and encouragement. of the Femur.

Ninety-seven patients who had received their primary and definitive surgical treatment for a soft-tissue sarcoma during the years 1956--1976 were studied with respect to local recurrence, metastasis, and survival. The aim of the treatment was to eradicate the tumor while preserving good function. The influence of host and tumor properties and different diagnostic and surgical procedures on the prognosis was studied by means of nonparametric multivariate analysis. Ninety-four percent of the tumors were located in the extremities. Malignant fibrous histiocytoma was the most common histologic type. A four-grade scale of histologic malignancy was used. Eighty-eight percent of the tumors were Grade III or IV. In 85% of the patients with an extremity lesion, local extirpation was carried out. The overall local recurrence rate was 21.7% and in 76 patients who underwent an adequate surgical procedure it was 6.6%. The overall five-year survival rate was 59%. The survival depended on the local control of the primary tumor, which was related to the adequacy of the surgical procedure and to the histologic grade of malignancy. No patient with a Grade I or II tumor died. The five-year survival rate for patients with Grade III tumors was 68% and for patients with Grade IV tumors 47%.

Summary. Focal muscular degeneration in two diabetics is described. In both instances the muscular lesion was excised on the grounds of clinical suspicion of tumour. The gross and microscopical pictures agreed with those of muscular degeneration following ischaemia. Accordingly, the vascular lesions that were demonstrated, diabetic mieroangiopathy and arteriosclerosis, m a y have been of importance in the pathogenesis.Rdsumd. Une ddgdndreseence museulaire locale a 6t@ observde ehez deux diabdtiques. Dans les deux eas la ldsion musculaire a @t@ excis@e, une tumeur ayant dt6 eonsid@r@e possible. L'apparence maeroscopique et mieroscopique dtait celle d'une dggdndrescence museulaire cons@-cutive ~ une isch@mie. Nous avons done eonsid6r6 que les ldsions vasculah'es ddmontr@es, microangiopathie diabgtique et art@rioseldrose, ont probablement eontribud ~ la pathog6n~se de ces d6gdn6reseences musculaires.Zusammenfassung. Bei zwei Diabetikern werden umsehriebene muskulgre Degenerationsherde gesehildert. In beiden F/illen wurden die krankhaft ver/~nderten Muskelgebiete wegen des klinisehen Verdaehtes auf Tumor exzidiert. Die makro-und mikroskopischen Befunde waren die gleiehen wie bei Muskeldegeneration nach Iseh~mie. Demnaeh waren fiir die Pathogenese m6glieherweise die naehgewiesenen Gef~13ver/inderungen, die diabetische Mikroangiopathie und Arteriosklerose, yon Bedeutung.

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The anorectal function in 3 patients with bilateral and 4 patients with unilateral well-defined loss of sacral nerves after radical tumour excision was studied by clinical examination and by simultaneous registration of the following variables: volume and pressure in the rectum, pressure in the internal anal sphincter area and myoelectrical activity in the external anal sphincter. The patients with bilateral loss of sacral nerves had serious impairment of function. Constipation was their only safeguard against incontinence. The preservation of the first and second sacral nerves bilaterally was not sufficient for discrimination between different qualities of rectal contents passing the anal canal. The sensation of rectal distension was also impaired. The reflex pattern of the internal anal sphincter was, however, intact. The external anal sphincter displayed a weak spontaneous myoelectrical activity in the patients who had at least one second sacral nerve intact, and a weak increase of the activity could be induced voluntarily. The normal transient increase of myoelectrical discharge from the external anal sphincter in response to rectal distension could not, however, be elicited. In patients with total unilateral loss of the sacral nerves no significant impairment of anorectal function was noted. Total one-sided denervation implied deficient sensibility of the anal canal unilaterally, but no disturbance of sphincter function as judged from the reflex response of the internal and external anal sphincters to rectal distension.

1. A forty-nine-year-old man had a chondrosarcoma arising from the body of the seventh thoracic vertebra. The tumour protruded into the mediastinum and also into the spinal canal where it displaced the spinal cord. 2. At operation all the seventh thoracic vertebra and parts of the sixth and eighth were removed together with the tumour. The thoracic spine was reconstructed by inserting two iliac bone-blocks between the cut bodies of the sixth and eighth vertebrae and by wiring two strong "A. O." plates to the transverse processes of the third to the sixth and the eighth to the tenth vertebrae. 3. The patient was nursed in a plaster-of-Paris bed for three and a half months. 4. One year and three months after operation, the patient was walking and well, with no signs of recurrence or metastasis. Radiographs showed that a block-vertebra had been created from the iliac grafts and the two cut vertebrae.

Major sacral resections up to the level of S 1 and even higher have been performed. This has raised the question of the degree to which such operations weaken the pelvic ring. Fifteen cadaver pelves, including the fifth lumbar vertebra, were loaded to failure, five unresected, five after resection of the sacrum between S 1 and S 2, and five after resection about 1 cm below the promontory. The weakening of the pelvic ring amounted to approximately 30 per cent with the former type of resection and 50 per cent with the latter. Taking into consideration the calculated normal load on L 5 in upright standing it seems safe from this study to allow patients to stand with full weight-bearing at an early stage postoperatively after submaximal resection of the sacrum.

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