SUMMARY One hundred patients with lumbar disc protrusions were studied. Thirty six "control" patients were admitted in the same time period with low back pain and sciatica but with subsequently "normal" myelograms and no surgery. The aim of this paper was to relate history and clinical signs to the myelograms and surgical findings. Ninety nine per cent of our patients presented with sciatica (controls 94%). The most frequently found sign in patients with a disc protrusion was reduction of ipsilateral straight leg raising (98%). However, 55% of controls also showed this sign.There were three signs that, when present, particularly indicated a disc protrusion; "crossed straight leg raising" (pain on contralateral straight leg raising), measured calf wasting and impaired ankle reflex: the latter being especially indicative of an L5-SI disc protrusion. There were two further important signs, weakness of dorsiflexion of the foot and scoliosis of the lumbar spine.However, such signs occurred in about half the patients and so clinical diagnosis in the remaining half depended on obtaining a good history of sciatica, and paying due regard to severity of the pain, the mobility of the patient, the ability and desire to work and the overall personality. Satisfactory results of surgery simply depend on finding and removing a definite disc protrusion. Using these methods of selection, 98% have returned to their original employment, 86% within 3 months of the operation. For a patient with no abnormal signs and a normal myelogram, surgical treatment should not be advised.The operation of lumbar laminectomy and the removal of a protruded intervertebral disc is now an extremely common procedure, some 200,000 being performed in the USA each year.' The success rate, assessed by the number of patients achieving loss of pain and being able to return to work, varies from 60% to 99% [1][2][3][4] For a patient suffering low back pain and sciatica, deciding which mode of therapy to employ depends very much upon the underlying pathology. If due to a protruded intervertebral disc, resolution of the pain will occur in the majority of cases using conservative methods of treatment.1 45 The surgical removal of the protruded disc is indicated acutely in those who have symptoms and signs of cauda equina compression, and electively6 in those who fail to respond Address for reprint requests: Mr C B T Adams, The Radcliffe Infirmary, Oxford OX2 6HE, UK.Received 2 December 1986 and in revised form 24 June 1987. Accepted 26 June 1987 to conservative therapy and have evidence of a definite protrusion.This study was undertaken in an attempt to delineate which criteria are the most reliable indicators of a lumbar disc protrusion. MethodA retrospective study of 100 consecutive cases of protruded lumbar intervertebral discs, assessed and treated at The Radcliffe Infirmary, was carried out. In addition 36 patients suffering with back pain and sciatica, but relatively normal myelograms, were used for comparison. All the cases were reviewed preoperatively b...
Osteosarcoma uncommonly arises in craniofacial bones and has only rarely been reported to arise in the ethmoid sinus. Most primary osteosarcomas arising in paranasal sinuses are high-grade malignancies. A low-grade osteosarcoma arising in the ethmoid sinus has not previously been described. We report the clinical, radiological and histological findings of a case of low-grade (parosteal osteosarcoma-like) osteosarcoma which arose in the ethmoid sinus.
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This article describes an unusual presentation of disseminated oligodendroglial-like leptomeningeal tumour. A previously healthy 23-year-old Caucasian woman presented with headache, photophobia and recurrent seizures. Initial investigations were suggestive of subarachnoid haemorrhage. Her symptoms deteriorated rapidly and within weeks she developed complete blindness and diffuse sensory ataxia. The aim of this article is to increase awareness of this rare disease, especially in patients who present with acute, rapidly progressive neurological symptoms with signs of acute or chronic central nervous system bleeding.
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