Alcohol-induced hypoglycaemia.

Medical Memoranda BaLURNT in the legs. The pathological process was confined to vessels supplying the leg muscles and the skin in two cases and to the leg muscles alone in one case. In each case the subsequent course of the disease was benign, in that there has been no evidence of visceral involvement and no clinical deterioration has appeared during the period of follow-up. .t sRj6r ~~* = 4 A Cise 3. Histological section of biopsy specimen from calf muscle. The leg pains were always severe at the onset, and were aggravated by standing and walking. The histological and electromyographic changes of myopathy were always of mild degree, being secondary to the arterial changes-for example, in Case 3 the myopathy occurred only in proximity to involved arteries and the electromyogram was normal on several occasions. In primary polymyositis, where therc are definite myo-pathic changes, muscle contractures occur at an early stage and electromyograms are definitely abnormal. Unlike polymyositis (and other forms of myopathy) leg pains in polyarteritis appear to be associated with active arteritic lesions and not with the relatively minor degree of associated muscle involvement which sometimes occurs. Possibly the pains are partially due to muscle ischaemia consequent on complete or partial arterial obliteration by endarterial thickening. Generalized polyarteritis often presents with pain in muscles and around joints. Rose (personal communication) has stated that out of 111 cases of polyarteritis studied 14 had muscle pains as an initial manifestation, most often in the legs. Six of his patients had cutaneous polyarteritis of the legs, with or without muscle and joint pains, which remained as the only manifestation of disease for months or years. Rotstein and Good (1958) followed a case in which the manifestations were limited to skin and muscle for 11 years, and in reviewing the literature-including accounts by Lindberg (1931) and Boyd (1940>-they suggested that so long as the viscera are not affected the condition can be considered benign and eventual cessation of the active disease process may be anticipated. They stated that in such cases systemic steroid therapy does not appear to ameliorate the symptoms or the pathological process, and that prolonged high doses of systemic corticos-teroids should be reserved for the severer forms of the disease, particularly when there is cardiorenal involvement. In one of our patients (Case 2) steroids had no beneficial effect on the symptoms, but in the others relatively small doses produced …