Case of Ectopia Testis with Seminomatous Change and Torsion

Abstract

Spastic paralysis has been reported in severe classical pellagra.Thus Heatley-Spencer and Biggam, in the British Encyclopaedia of Medical Practice, state: "Sensory changes are common in the lower limbs and consist of various paraesthesiae and numbness.Objective sensation usually remains intact and there is no alteration of deep sensibility.Romberg's sign is rare.Pain in the dorsal or lumbar regions is common: peripheral neuritic pain may be severe and is often a late symptom.Stiffness and some loss of power, with painful cramps in the lower limbs, are common.The reflexes are variable, the knee- jerks being in some cases exaggerated, with a spastic rigidity, and in others lost.Mental changes are important and begin with mental dullness, slow response, and loss of memory."Manson-Bahr, in his Tropical Diseases, inclu'des ptosis, dip- lopia, amblyopia, and rarely epileptiform convulsions among the signs and symptoms, and states that later the gait becomes uncertain and of the spastic paraplegic type.This author mentions a very acute form of pellagra, described under the title of " pellagra typhus," characterized by intense prostration, high temperature, muttering delirium, pronounced -nervous tremors, generalized rigidity, and convulsions.The acute cases reported in this paper seem not dissimilar.The additional point that this syndrome arose in the course of other manifestations of vitamin B deficiency which are recognized as part of the classical picture of pellagra lends support to the view that it is itself an isolated manifestation of, that disease.The B complex comprises several factors, and the experience gained in our camp suggested that there was a different time factor for each before evidence of deprivation showed itself, the mucous membrane and dermal lesions of pellagra appearing first and the nervous lesions later.It is of interest that not more than one-third of the cases of pellagrous encephalopathy here reported showed other evidence of defici- ency, but this lack of association was reported by Spillane and Scott (1945) in their account of deficiency manifestations among German prisoners of war in the Middle East.Conclusion The above findings are based on 63 cases of a deficiency syndrome, which has been given the name of pellagrous encephalopathy, occurring among prisoners of war in Singapore.There appears to be sufficient evidence to include it among the manifestations of vitamin B deficiency and as part of the pellagra symptom complex.Previous reports have been made in the literature of limb weakness, and spasticity with and without extensor plantar responses (Wilkinson, 1944; Spillane and Scott, 1945; Clarke and Sneddon, 1946; Pallister, 1940), in association with other deficiency manifestations, but a clear- cut syndrome as reported here appears to be unique.My thanks are due to all those medi-cal officers in the Changi Prisoner-of-War Hospital under whose care these patients were admitted; ahd to Dr. D. Denny-Brown, of the