Four cases of non-familiar acropathia ulcero-mutilans (Bureau-Barriere) are described. In all cases there was a history of alcoholism, abnormal liver function, painless foot ulcers and polyneuritis. The radiological changes were confined to the lower extremities. There were osteolytic changes in the metatarsal heads and the bases of the proximal phalanges, particularly of the great toes; in addition, there was general demineralisation of the bones of the feet. One case was remarkable in that the tarsal bones and the proximal protions of the metatarsals were also involved. A variety of bone deformities were observed, and there were pathological fractures as well as subluxation and dislocation. The differential diagnosis between familial and non-familial acro-osteolysis, and of some other bone abnormalities is discussed. A multifactorial pathogenesis of the disease is suggested.
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