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Capillary hemangiomas are benign tumors found in the skin and soft tissues in younger people. They occur in the central nervous system only rarely, and intradural occurrence is extremely rare. We report here a 60-year-old man presenting with thoracic girdle pain and progressive gait disturbance. Magnetic resonance images of the thoracic spine showed a12×8×20 mm, well-defined intradural mass at the T2 level, compressing the spinal cord laterally. Relative to the spinal cord, the mass was hypo- to isointense on T1-weighted images and relatively hyperintense on T2-weighted images, with strong enhancement on contrast-enhanced T1-weighted images. The patient underwent T1-2 hemilaminectomy with resection of the intradural extramedullary tumor, which showed characteristics of a capillary hemangioma on histologic examination. The patient’s symptoms improved following the surgery and no clinical or radiological evidence of recurrence was noted at the 2-year follow-up. We present this case with a review of the literature, highlighting features for differential diagnosis.

Data on the severity of signs and symptoms of lumbopelvic pain (LPP) during pregnancy are scarce. Therefore, this cross-sectional study examines the severity of LPP and pain-related signs and symptoms. Women with an uncomplicated pregnancy of 20-30 weeks were invited to participate. They rated their pain and fatigue on a numerical rating scale, and pain location was indicated on a drawing. Disability was scored on the Quebec Back Pain Disability Scale (QBPDS) and urine incontinence on a Likert scale. Physical examination consisted of the Active Straight Leg Raise (ASLR) test, the Posterior Pelvic Pain Provocation (PPPP) test and pain score, and force during isometric bilateral hip adduction. Of all 182 participants, 60.4% reported LPP. Mean pain level was 3.6 (SD 2.2); in 20.0% of the women the score was >5. The mean score on the QBPDS was 27 (SD 16); in 20.9% the score was >40. Compared to women without LPP, women with LPP more frequently suffered back pain in the past (p

Object The author describes a technique of thoracic discectomy that has evolved from the posterolateral transfacet and the transpedicular approaches but that spares the pedicle and most of the facet joint. Methods This approach was used to remove a total of 11 discs (T6–12) in seven patients. The follow-up period ranged from 8 months to 3 years. In four patients with axial and/or girdle pain significant improvement was demonstrated. The paraparesis in one patient with myelopathy improved postoperatively; that in another patient improved but recurred 8 months postoperatively. In one patient who experienced preoperative leg weakness, the weakness was slightly increased postoperatively, but this sequela was only transient. There were no other complications, and there were no deaths. Conclusions This technique appears safe and effective. It can be adapted to the conventional laminectomy known to spine surgeons and requires no specialized instruments. Further trials appear warranted.

Acupuncture has been used in numerous diseases and for many types of symptoms. It has been also used for obstetric complaints, such as nausea and vomiting, insomnia and low back and girdle pain. There has long been concern that some points—called forbidden—might harm pregnancy owing to a potential abortifacient effect, but it is difficult to confirm this proposition. The small number of available publications on this topic seems to show that this is not correct. Animal research examining possible harmful effects and a systematic review would be welcome to throw some light on this question.

We describe a case of dumbbell hydatid cyst of the T(10) pedicle. This cyst had both extradural and retroperitoneal components,leading to spinal cord compression and abdominal pain. Following surgical excision and irrigation with hypertonic saline the patient made a full recovery, and is recurrence-free after 18 months follow-up.

Tumours arising from the paraganglia (paragangliomas) are characteristically of low malignant potential, with only 10% developing distant metastases (North et al, 1990). Malignancy in paragangliomas is defined either by local invasion or spread to distant sites normally devoid of paraganglia (Irons et al, 1977; Jackson et al, 1982). We present a case with several unusual features: (1) the primary site of the tumour is in the extradural space at D7 and L3 levels (lesion at L3 not biopsied), (2) multiple skeletal metastases at a short interval after primary diagnosis, and (3) absence of mitoses both in the original specimen and the metastatic deposit. A 29-year-old man presented in December 1989 with girdle pain in the upper abdomen for 3 months, descending numbness and paraparesis for 3 weeks and incontinence for 1 week.

Calcified psoas abscesses are a characteristic feature of tuberculosis of the thoraco-lumbar spine. We present a case in which well established calcification has almost completely disappeared, several years after any antituberculous treatment. A review of the English literature has revealed no previous report of this finding. The patient, now a 48-year-old woman, first presented at the age of 6 with back pain and radiographic features of spinal tuberculosis at T12/L1. Bilateral calcined psoas abscesses developed over thenext few months. Management was first by bed rest and later, at the age of 12, by postero-lateral drainage with spinal fusion. By this time abscess calcification was well established. The patient then remained relatively well until the age of 33, when she developed girdle pain due to further vertebral destruction at a higher level (T8–T12).

Summary 1. We are reporting here a case of spinal lues, which showed clinically an attack of gastric crisis (peristaltic unrest and abdominal distress) accompanied simultaneously with hypersensibility (girdle pain sensation). 2. The autopsy findings revealed that the pathological changes are found in the spinal cord, meninges and spinal root fibers extending between the 5.-10. thoracic segments. Nerve fibers in the sglanchnic nerve are also found partly degenerated. These findings correspond exactly to the clinical symptoms of motor and sensory disturbances. 3. There is no change in the vagus nerve, so the cause of the gastric crisis can not be attributed to lesion of the vagus nerve. We would rather ascribe the crisis symptom to the lesin of the posterior root of the spinal cord. We believe that the lesion of the Fosterior roots causes simultaneous appearance of sensory irritation (girdle pain) and peristaltic unrest of the stomach.

Brucellosis in Britain is usually caused by Bruceila abortus and mainly affects those in direct contact with cattle or their un pasteurised milk products.1 2 Bone and joint brucellosis consti? tutes about 9% of brucellosis infections and the spine is the commonest site of skeletal infection.1 3 Brucellar spondylitis most often presents with back pain and leg pain, resembling an inter vertebral disc protrusion. Girdle pain has been reported.1 2 4 Para vertebral abscesses are uncommon in brucellosis.4 It is most unusual for brucellar spondylitis to present as right upper quadrant pain. A paravertebral abscess could produce nerve root and diaphragmatic irritation, resulting in right hypochondrial pain with radiation to the right shoulder tip. In skeletal brucel? losis the cultures are frequently negative in keeping with the late stage of the disease.3 4 Early serological studies may be crucial to the diagnosis. Treatment with tetracylines and streptomycin is successful in most cases.1-4 Surgery is indicated for spinal brucellosis only if there is instability, vertebral collapse with cord compression, or failure of a thick walled paravertebral abscess to respond to medical treatment.4

Patient. —J. C., aged 37, single, admitted Oct. 6, 1910, to the Buffalo General Hospital. Family history, negative. Usual diseases of childhood. Railroad accident at the age of 7 leaving right ankle ankylosed. Typhoid at 17; recovery complete. At 19, acute rheumatism of joints of legs for six months; another attack at the age of 21, which lasted nine months; recovery. Two attacks of gonorrhea at ages of 23 and 25, leaving moderate stricture; chancre at age of 35; patient had been treated for that and for the stricture. Present Illness. —For some time past, patient had a sensation about the body like a girdle pain and some numbness of the legs; had some trouble in walking. Sept. 25, 1910, he felt a sudden shock like an electric current go through the body; abdominal muscles grew tense; patient had to be taken home and later entered the General Hospital. Complaint

Pain has been considered rather uncommon in multiple sclerosis, as a survey of textbooks will reveal. Yet in a necropsy study of 46 cases, Carter et al 1 recorded pain in 42% of them and it was the first symptom in 11%. Their patients had a severe form of the disease, having reached the hospital and remained there until death. McAlpine et al 2 found that pain, especially in the low back, may be early or late in the course of the disease. They noted that Abb and Schaltenbrand defined a pseudorheumatic type of multiple sclerosis characterized by muscle and joint pains or by neuralgia, but without fever. Pain in the limbs occurred in about one third of the patients of McAlpine et al with the spinal form of the disease, but girdle pain and neck pain were rarer. Head pain or trigeminal neuralgia are unusual in multiple sclerosis. However