Judging from the reported literature cauda equina compression secondary to lumbar disc prolapse is a rare entity. Not more than hundred such cases appear to have been reported since 1929 when Dandy published two cases of progressive paraplegia following trivial trauma who at operation were found to have herniated disc. Voris (1945), Ver Brugghen (1945), Peyton and simmons (1947), O’Connell (1951), Eyre-Brook (1952), Ford (1954), Fairburn and stewart (1955), Jennett (1956), Shephard (1959), Wilson (1962), Brown & Pont (1963), Armstrong (1965) and Scott (1965) have all referred to this complication. In our experience this complication is more frequent in proportion to the number of disc prolapse cases that we see. The frequency and gravity of this condition is not recognized generally and surgery is usually denied till too late, thereby precluding the chances of recovery. The purpose of this communication is to highlight the clinical picture of this condition and to emphasize the risk of permanent disability if the lesion is not recognized and treated as a surgical emergency.

The French philosopher Rene Descartes (1590-1646) may be considered the Father of scientific materialism. At least he was the first to express in a comprehensive form the mathematical-mechanical theory of the behaviour of both living and inert matter. Although technical failures prevented him contributing any considerable advances to biological knowledge, nevertheless, his method, as outlined in a “Discourse on method� (published in 1673), is still an invaluable guide for the scientific investigator of natural phenomena. In it he starts by doubting everything which is not clearly, obviously and certainly known, and, starting from what is known for certain, by rigid processes of logic and inference he proceeds to a general body of knowledge; this so-called Cartesian method of analysis is the one I would like to try to use in the present paper. Therefore, taking as our starting point the anatomical details of the various deformities of the spine and having described these, from them we infer both the probable causes of these deformities, their probable future effect and development and the factors in them which will resist correction to a more normal anatomical alignment. Secondly, in considering treatment we will take as our starting point the resistances to correction of the various tissues and structures, and the corrective forces, both conservative and operative which we have available. From this point I proceed to discuss the circumstances under which various procedures are applicable, and in particular the circumstances in which corrective wedge osteotomy of the spine can be usefully employed.

Henry and MacFee (1963) stated that psoas abscess is a condition in which pusgains access to subfascial planes of psoas muscle and with increasing pressure descends into iliac foassa and under inguinal ligament, at the lateral margin of the femoral vessels. From this point the abscess may take a number of courses but the most frequent one is into the femoral triangle where it points superficial to the attachment of psoas muscle to the lesser trochanter. The commonest cause of psoas abscess is tuberculosis of the vertebral bodies as discussed by Pott’s in 1779. A pyogenic variety is now known for nearly over 85 years after the first clear description of the condition by Herman Mynter (1881). Since then, various attempts have been made to get this condition a wide recognition (Zadek 1950, Lam and Hodgson 1966). It may mimic hip, sacro-iliac joint and spinal disease and appendicular or perinephric abscess. It is often impossible to pinpoint the portal of entry for this infection. The purpose of this paper is to present clinical features, differential diagnosis, investigations and treatment in 36 cases of pyogenic psoas abscess. Various possible aetological factors have been enumerated. Lymphatic system in the region has been investigated by a dye injection technique in an attempt to verify or exclude the role of lymphatics in the causation of this condition.

Recurrent dislocation of the patella is an uncommon but not a rare condition. The largest series of cases in English literature was one presented by Harrison (1955) consisting of 26 cases. It is said in Liverpool that Hugh Owen Thomas subjected the lateral condyles of the femur to periodic hammering to stimulate their growth. This treatment is considered to have controlled the dislocation at least in two cases. According to Brattstrom (1964) it was Roux who first described the operative treatment of this condition in 1888 by transferring medially the attachment of ligamentum patellae. Hauser (1938) described the operation of total transplantation of patellar tendon along with a block of bone. Bryan McFarland (1948) believed in excision of patella in all cases. Scandinavian literature contains more references to this condition and the largest series among these reports is by Thestrup Anderson (1955) who published a series of 292 cases, treated in various clinics in Denmark during a period of 30 years from 1920 to 1951. Brattstrom (1964) has reported on radiological and clinical investigations on 131 cases, treated in the clinics of Sweden and Denmark between 1945 and 1961. The condition called Luxation of Patella has been described in working bulls in veterinary surgical literature. This is being effectively treated by intra-articular injection of Lugol’s iodine or surgically by the subcutaneous division of a tight ligament on the outer aspect of the knee. The main purpose of this paper is to present a modified surgical technique which sounds logical and has consistently given good results. Cases considered here are those where there has been some congenital anomaly and minor trauma has acted as a possible predisposing factor. Cases where a gross genu valgum due to other causes secondarily produces a dislocation of patella have not been included in this study.

Simple ganglia involving or compressing the lateral popliteal nerve have been described to give rise to a symptom complex of pain in the region of the fibular head often radiating down the course of cutaneous distribution of the nerve, varying degree of motor and sensory paralysis, and a palpable swelling in the region of the head of the fibula (Brooks 1952, Parkes 1961, Clark 1961, Stack, Bianco and MacCarty 1965) Clark (1961) has reviewed the literature and analysed the clinical picture, operative and histological findings, treatment and results in twelve cases of lateral popliteal nerve ganglia reported earlier. Twenty more cases have been reported since including Clark’s 3 cases. From the description of operative findings available, seventeen of the thirtytwo reported cases appear to belong to what Parkes (1961) has described as intraneural ganglia of the nerve. The case reported here had typical morphological and histological features of an intraneural ganglion of the lateral popliteal nerve with somewhat atypical clinical features.

Intraspinal arachnoidal cyst is a rare entity. The functional recovery following its removal is fairly dramatic. A case of this rare entity is being reported with a review of the literature.

Mycetoma as the name suggests is a disease resulting in tumefactions and is characterized by the presence of mycotic granules (grains) in the infected tissue. Although it is a single clinical entity many different fungi are involved as aetiolgical agents. Carter (1860) had established the fungal origin of mycetoma more than a century ago and named the condition as “Madura foot�. It is a common practice to use the term maduromycosis as a synonym of madura foot or even as a synonym of mycetoma of any aetiology. The aetiological agents of mycetoma have been differentiated into (i) actinomycetes producing actinomycotic type of mycetoma and (ii) true fungi producing maduromycotic mycetoma or maduromycosis (Chalmers and Archibald 1916). The agents in the latter group again fall into two classes, ascomycetes (e.g. Allescheria boydii and Leptosphaeria senegalensis) and fungi imperfecti (e.g. Madurella, Phialophora, Cephalosporium, Glenospora, etc.). These fungi have nothing in common yet are capable of causing a very similar clinical picture-the “mycetomas�. The essential lesion in mycetoma is a non-specific granuloma, the suppurative center of which contains the granules. These granules have characteristics which permit differentiation of the aetiologic agents. Besides variation in the number, size, colour and shape the granules from a fresh specimen exhibit different staining characters and tissue reaction on histological examination. The study of the causative agent is completed by cultural characteristics and biochemical reactions. Unfortunately, often this is not possible due to fixation of the tissue in formalin or due to heavy secondary bacterial infection. But with reasonable care and experience it is possible to identify the causative agent in the tissue sections. The present paper deals with 25 case of mycetoma, in only 11 of which the aetiologic agent could be grown from the granules. However, aetiological diagnosis could be established in each case by a careful morphological and histological study of the granules.