High-pressure injection injuries to the hand are uncommon, but often result in poor outcome or even amputation. We report a review of the 28 cases treated surgically in our department over the last 10 years and have examined the factors leading to increased morbidity. The severity of these injuries was related to the nature of the injected material, involvement of the tendon sheath and proximal spread of the injected substance. All cases in which the digit was noted to be poorly perfused from the outset resulted in amputation. We conclude that early amputation should be considered in cases in which the affected digit is initially cool or poorly perfused.

Six patients with epilepsy were found to have intracranial aneurysms, mainly in the middle cerebral territory. The mechanism of production of these presenting symptoms is considered to be a minor haemorrhage with localized destruction of brain, or calcification in the aneurysmal wall behaving as a hamartoma. In the differential diagnosis of factors causing epileptic attacks, an intracranial aneurysm should be considered, and its presence should be excluded by angiography before any blind surgical procedure for epilepsy is undertaken.

A case of cauda equina compression by ossification in extradural fat at a level above the site of Paget's disease in a vertebra is described. Good recovery followed laminectomy and exposure of the dura mater.

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