In Filing, Casino Operator Admits Likely Violation of an Antibribery Law

 In its annual regulatory report published by the commission on Friday, the Sands reported that its audit committee and independent accountants had determined that “there were likely violations of the books and records and internal controls provisions” of the Foreign Corrupt Practices Act.

 The disclosure comes amid an investigation by the Securities and Exchange Commission as well as the Department of Justice and the Federal Bureau of Investigation into the company’s business activities in China.

 It is the company’s first public acknowledgment of possible wrongdoing. Ron Reese, a spokesman for the Sands, declined to comment further.

The company’s activities in mainland China, including an attempt to set up a trade center in Beijing and create a sponsored basketball team, as well as tens of millions of dollars in payments the Sands made through a Chinese intermediary, had become a focus of the federal investigation, according to reporting by The New York Times and The Wall Street Journal in August.

 In its filing, the Sands said that it did not believe the findings would have material impact on its financial statements, or that they warranted revisions in its past statements. The company said that it was too early to determine whether the investigation would result in any losses. “The company is cooperating with all investigations,” the statement said.

 The Sands’ activities in China came under the scrutiny of federal investigators after 2010, when Steven C. Jacobs, the former president of the company’s operations in Macau, filed a wrongful-termination lawsuit in which he charged that he had been pressured to exercise improper leverage against government officials. He also accused the company of turning a blind eye toward Chinese organized crime figures operating in its casinos.

 Mr. Adelson began his push into China over a decade ago, after the authorities began offering a limited number of gambling licenses in Macau, a semiautonomous archipelago in the Pearl River Delta that is the only place in the country where casino gambling is legal.

 But as with many lucrative business spheres in China, the gambling industry on Macau is laced with corruption. Companies must rely on the good will of Chinese officials to secure licenses and contracts. Officials control even the flow of visitors, many of whom come on government-run junkets from the mainland.

 As he maneuvered to enter Macau’s gambling market, Mr. Adelson, who is well known in the United States for his financial and political clout, became enmeshed in often intertwining political and business dealings. At one point he reportedly intervened on behalf of the Chinese government to help stall a House resolution condemning the country’s bid for the 2008 Summer Olympics on the basis of its human rights record.

 In 2004, he opened his first casino there, the Sands Macau, the enclave’s first foreign owned gambling establishment. This was followed by his $2.4 billion Venetian in 2007.

 Some Sands subsidiaries have also come under investigation by Chinese authorities for violations that included using money for business purposes not reported to the authorities, resulting in fines of over a million dollars.

 Success in Macau has made Mr. Adelson, 78, one of the richest people in the world. He and his wife, Miriam, own 53.2 percent of Las Vegas Sands, the world’s biggest casino company by market value. Last year, Forbes estimated his fortune at $24.9 billion.

 Mr. Adelson became the biggest single donor in political history during the 2012 presidential election, giving more than $60 million to eight Republican candidates, including Newt Gingrich and Mitt Romney, through “super PACs.” He presides over a global empire of casinos, hotels and convention centers.

Michael Luo and Thomas Gaffney contributed reporting.

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U.S. Judges Offer Addicts a Way to Avoid Prison

Todd Heisler/The New York Times

Emily Leitch of Brooklyn, with her son, Nazir, 4, was arrested for importing cocaine but went to “drug court” to avoid prison.

Federal judges around the country are teaming up with prosecutors to create special treatment programs for drug-addicted defendants who would otherwise face significant prison time, an effort intended to sidestep drug laws widely seen as inflexible and overly punitive.

The Justice Department has tentatively embraced the new approach, allowing United States attorneys to reduce or even dismiss charges in some drug cases.

The effort follows decades of success for “drug courts” at the state level, which legal experts have long cited as a less expensive and more effective alternative to prison for dealing with many low-level repeat offenders.

But it is striking that the model is spreading at the federal level, where judges have increasingly pushed back against rules that restrict their ability to make their own determination of appropriate sentences.

So far, federal judges have instituted programs in California, Connecticut, Illinois, New Hampshire, New York, South Carolina, Virginia and Washington. About 400 defendants have been involved nationwide.

In Federal District Court in Brooklyn on Thursday, Judge John Gleeson issued an opinion praising the new approach as a way to address swelling prison costs and disproportionate sentences for drug trafficking.

“Presentence programs like ours and those in other districts mean that a growing number of courts are no longer reflexively sentencing federal defendants who do not belong in prison to the costly prison terms recommended by the sentencing guidelines,” Judge Gleeson wrote.

The opinion came a year after Judge Gleeson, with the federal agency known as Pretrial Services, started a program that made achieving sobriety an incentive for drug-addicted defendants to avoid prison. The program had its first graduate this year: Emily Leitch, a Brooklyn woman with a long history of substance abuse who was arrested entering the country at Kennedy International Airport with over 13 kilograms of cocaine, about 30 pounds, in her luggage.

“I want to thank the federal government for giving me a chance,” Ms. Leitch said. “I always wanted to stand up as a sober person.”

The new approach is being prompted in part by the Obama administration, which previously supported legislation that scaled back sentences for crimes involving crack cocaine. The Justice Department has supported additional changes to the federal sentencing guidelines to permit the use of drug or mental health treatment as an alternative to incarceration for certain low-level offenders and changed its own policies to make those options more available.

“We recognize that imprisonment alone is not a complete strategy for reducing crime,” James M. Cole, the deputy attorney general, said in a statement. “Drug courts, re-entry courts and other related programs along with enforcement are all part of the solution.”

For nearly 30 years, the United States Sentencing Commission has established guidelines for sentencing, a role it was given in 1984 after studies found that federal judges were giving defendants widely varying sentences for similar crimes. The commission’s recommendations are approved by Congress, causing judges to bristle at what they consider interference with their judicial independence.

“When you impose a sentence that you believe is unjust, it is a very difficult thing to do,” Stefan R. Underhill, a federal judge in Connecticut, said in an interview. “It feels wrong.”

The development of drug courts may meet resistance from some Republicans in Congress.

“It is important that courts give deference to Congressional authority over sentencing,” Representative F. James Sensenbrenner Jr., Republican of Wisconsin, a member and former chairman of the Judiciary Committee, said in a statement. He said sentencing should not depend “on what judge happens to decide the case or what judicial circuit the defendant happens to be in.”

At the state level, pretrial drug courts have benefited from bipartisan support, with liberals supporting the programs as more focused on rehabilitation, and conservatives supporting them as a way to cut spending.

Under the model being used in state and federal courts, defendants must accept responsibility for their crimes and agree to receive drug treatment and other social services and attend regular meetings with judges who monitor their progress. In return for successful participation, they receive a reduced sentence or no jail time at all. If they fail, they are sent to prison.

The drug court option is not available to those facing more serious charges, like people accused of being high-level dealers or traffickers, or accused of a violent crime. (These programs differ from re-entry drug courts, which federal judges have long used to help offenders integrate into society after prison.)

In interviews, the federal judges who run the other programs pointed to a mix of reasons for their involvement.

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IHT Rendezvous: Muslims Seek Dialogue With Next Pope

LONDON — As the Catholic Church’s cardinal electors gather at the Vatican to choose a new pope, Muslim leaders are urging a revival of the often troubled dialogue between the two faiths.

During the papacy of Benedict XVI, relations between the world’s two largest religions were overshadowed by remarks he made in 2006 that were widely condemned as an attack on Islam.

In a speech at Regensburg University in his native Germany, Benedict quoted a 14th-century Byzantine emperor as saying, “Show me just what Muhammad brought that was new, and there you will find things only evil and inhuman, such as his command to spread by the sword the faith he preached.”

In the face of protests from the Muslim world, the Vatican said the pope’s remarks had been misinterpreted and that he “deeply regretted” that the speech “sounded offensive to the sensibility of Muslim believers.”

For many in the Muslim world, however, the damage was done and the perception persisted that Benedict was hostile to Islam.

Juan Cole, a U.S. commentator on the Middle East, has suggested that although the pope backed down on some of his positions, “Pope Benedict roiled those relationships with needlessly provocative and sometimes offensive statements about Islam and Muslims.”

Despite the Vatican’s efforts to renew the interfaith dialogue by hosting a meeting with Muslim scholars, hostilities resumed in 2011 when the pope condemned alleged discrimination against Egypt’s Coptic Christians in the wake of a church bombing in Alexandria.

Al Azhar University in Cairo, the center of Islamic learning, froze relations with the Vatican in protest.

Following the pope’s decision to step down, Mahmud Azab, an adviser on interfaith dialogue to the head of Al Azhar, said, “The resumption of ties with the Vatican hinges on the new atmosphere created by the new pope. The initiative is now in the Vatican’s hands.”

Mahmoud Ashour, a senior Al Azhar cleric, insisted that “the new pope must not attack Islam,” according to remarks quoted by Agence France-Presse, the French news agency, and said the two religions should “complete one another, rather than compete.”

A French Muslim leader, meanwhile, has called for a fresh start in the dialogue with a new pope.

In an interview with Der Spiegel of Germany this week, Dalil Boubakeur, rector of the Grand Mosque in Paris, said of Benedict, “He was not able to understand Muslims. He had no direct experience with Islam, and he found nothing positive to say about our beliefs.”

Reem Nasr, writing at the policy debate Web site, Policymic, this week offered Benedict’s successor a five-point program to bridge the Catholic and Muslim worlds.

These included mutual respect, more papal contacts with Muslim leaders and a greater focus on what the religions had in common.

“There has been a long history of mistrust that can be overcome,” she wrote. “No one should give up just yet.”

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Heat top Grizzlies 98-91 for 13th straight win

MIAMI (AP) — LeBron James endured his worst shooting night of the season, and still delivered the biggest basket of the game.

That's how things are going these days for the Miami Heat.

Dwyane Wade scored 22 points and set up James for a critical 3-pointer in the final half-minute, and the Heat extended their winning streak to 13 games by beating the Memphis Grizzlies 98-91 on Friday night.

"I thought this was one of our better wins of the season," Heat coach Erik Spoelstra said. "It was tough. We had to work for everything. We had to find a different way to win, deal with frustration ... and then make some plays down the stretch."

On a night when he shot just 4 for 14, James finished two rebounds shy of a triple-double, with 18 points and 10 assists. Shane Battier scored 14, Chris Bosh added 13 and Ray Allen had 10 for Miami, which snapped Memphis' eight-game winning streak.

But down the stretch, James — who had 14 points, four rebounds and four assists in the fourth quarter alone — was simply too much to handle.

"He made the big shot and that's all that matters," said Memphis' Marc Gasol, who led all scorers with 24. "He wasn't having the usual (numbers) he normally gets. I think we did a good job. He took a shot like he's supposed to and made it so kudos, move on."

Gasol tied the game with a pair of free throws with 2:44 left, before the Heat scored the next five — and quickly — to build a bit of breathing room. Bosh had a three-point play, and Wade took off in transition for a slam that put Miami up 90-85.

Memphis wasn't done. Gasol made two more free throws, then scored off a dribble-drive with 42.5 seconds left to get the Grizzlies within 90-89.

But that was the last gasp.

On the next Miami possession, James hit a 3-pointer with 24 seconds remaining, and the Heat made free throws from there to close out the win.

"I've got confidence I'm going to knock it down, just like all the other ones I've missed," James said. "I had confidence in those too, but they just don't go down. That's how the ball goes sometimes. But I'm always confident in my next shot. D-Wade gave me a great pass and I was able to knock it down."

The Grizzlies got 14 points from Zach Randolph, who said he was bothered throughout after turning his left ankle on the game's first possession. Mike Conley added 14 for Memphis, which got 10 from Quincy Pondexter.

"I have no problem with the game," Grizzlies coach Lionel Hollins said. "We were right there. They just made a few more plays than we did down the stretch."

For the Heat, this week was filled with attention for things like pregame dunking exhibitions and their version of a "Harlem Shake" video — which generated more than 5 million views on YouTube in about 24 hours of being posted.

Then came a basketball game, the likes of which had not been seen in the NBA for almost 20 years.

According to STATS LLC, the most recent time before Friday that there was a game between two teams that were carrying at least 12- and eight-game winning streaks was Dec. 3, 1993, when Atlanta (which had won nine straight) beat Houston (which had won 15 straight).

In fact, the Heat-Grizzlies game was just the eighth in NBA history pitting two teams with active winning streaks of at least eight in a row.

Want more significance? Spoelstra and Hollins were announced earlier in the day as the Eastern and Western Conference coaches of the month, respectively. And news came just before tipoff that James was picked yet again as the East's player of the month, making him 4-for-4 in that department this season.

"Just a residual of team success," Spoelstra said.

Added Hollins: "I'm the head coach and I get the credit and I get the blame, but those guys have been playing extremely well ... coming together with all the turmoil and all the chaos that we've had."

So of course, in a game between the NBA's two hottest teams, the start was ice cold. The teams combined to miss 23 of their first 32 shots.

And for James, things were downright frigid.

After the best shooting month of his career — the three-time MVP made 64 percent of his shots in February, the best month of any NBA player with 200 attempts since Kareem Abdul-Jabbar shot 65 percent in March 1983 — James' run in March started in a decidedly different manner.

James made a 3-pointer on his first attempt of the night, then missed his next eight tries, and had just four points after three quarters.

A dunk with 9:19 left in regulation was just his second made field goal of the night, and he hit a runner midway through the fourth to reach double-digit scoring for the 475th straight regular-season game, going back to Jan. 6, 2007.

"You won't see that happening too many times," Wade said. "It was great that on a night where he didn't have it going offensively, he had trust in his guys and didn't force up 20-odd shots. He played to pass and he still was aggressive. We'll take it. We'll take it, him getting those numbers and us getting the win."

NOTES: The Heat had the blessing of team officials when they took a half-hour before practice Thursday to tape the "Harlem Shake" video in their locker room. "We don't need to be serious all the time," Bosh said. ... Battier has at least one 3-pointer in 14 straight games, the fourth-best such streak of his career. ... Miami is at New York on Sunday, facing a Knicks team that has already beaten the Heat twice — by 20 points each time. "Our guys will look forward to playing this game," Spoelstra said.

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Hasbro Expands Transformers Brand Into New Media

Marcus Yam for The New York Times

Ryan Yzquierdo, who has been a Transformers fan since he was 7, is introducing his daughter to the franchise.

To Hasbro, no one is too young or too old to play with a Transformers robot, watch a Transformers television show or play a Transformers video game.

The toy maker started the Transformers franchise with a Japanese partner in 1984. The concept — robots disguised as everyday objects — was originally aimed at 5-year-old boys. But as those boys have grown up and had children and even grandchildren, Hasbro has expanded the brand into other media and added new toy lines to appeal to everyone from toddlers to adults.

Take Rescue Bots, for example.

The main Transformers brand contains mature themes, with big robots battling for control of the planet. To engage children ages 3 to 7, Hasbro introduced Rescue Bots in 2011, featuring toy robots as first responders.

“The goal there is to take what you have and bring an age-relevant message, which is to get away from the battle and the fighting and focus on the heroic nature of Transformers,” said Jay Duke, global vice president for the Transformers brand at Hasbro.

That was enough to convince Ryan Yzquierdo, who has been a Transformers fan since he was 7, that Rescue Bots were a good way to introduce Transformers to his 3-year-old daughter.

“Each toy focused on a different motor skill, which was a big selling point for me and my wife,” said Mr. Yzquierdo, who started a Web site, Seibertron.com, devoted to Transformers in 2000.

When buying toys and games for their children, parents often look to favorites from their own childhood. Their nostalgia for beloved toys from their past helps create a bonding experience with their little ones.

Toy makers have long tried to build enduring brands that can be passed down to the next generation. Those intellectual properties are cheaper to develop because the toy companies do not have to pay a licensing fee to an outside partner. They also bring in added revenue through licensing fees paid by other companies, like makers of apparel and school accessories.

In Transformers, Hasbro has one of the most valuable brands among toy makers. In 2011, the year the third Transformers movie was released, Hasbro recorded $960 million in sales from products related to Transformers and Beyblade, a spinning top game, according to the company’s latest annual earnings report.

When it was developed in 1984, Transformers consisted of a toy line and an animated television series.

But in 2007, Hasbro began a new strategy to build the brand into a worldwide franchise that now includes live-action movies, video games, publishing and even theme park rides.

“There are not a lot of brands like that in the world that have that strong emotional resonance across generations,” said John A. Frascotti, global chief marketing officer at Hasbro.

For older boys, Hasbro has extended the brand into mobile apps, video games and comic books. For adults, the company has licensed an annual Transformers convention called BotCon and organizes events at conventions like Comic-Con International in San Diego.

But the growth of the Transformers franchise has had its pitfalls, too. When there is not a Transformers movie rumbling through theaters, the toy line stumbles. Hasbro reported net income of $130.3 million for the fourth quarter of 2012, a 6.3 percent decline from the previous year. Sales in its boys business fell 23 percent in the quarter from the same period in 2011, the year the last Transformers movie came out.

Analysts say it is important for Hasbro to keep the Transformers brand fresh in non-movie years.

“Hasbro focuses on these big, home-run movies. When they don’t have one, they get punished for it,” said Jaime M. Katz, an analyst at Morningstar.

Investors expect sales in the boys category to decline this year as well, but to rebound in 2014 when the next Transformers movie is released, said Felicia R. Hendrix, a Barclays analyst. “The real problem around this is that their boys’ line seems to be very movie-driven,” Ms. Hendrix said, adding that Hasbro should try to make the brand more evergreen.

Toward that end, the company showed previews of two new Transformers toy lines, Beast Hunters and Construct-Bots, last month at the annual Toy Fair in New York. The Beast Hunters theme, which features robots that morph into predatory animals, will encompass several areas, including television, toys and licensing, while Construct-Bots will allow boys to build their own Transformers.

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Jane C. Wright, Pioneering Oncologist, Dies at 93

Dr. Jane C. Wright, a pioneering oncologist who helped elevate chemotherapy from a last resort for cancer patients to an often viable treatment option, died on Feb. 19 at her home in Guttenberg, N.J. She was 93.

Her death was confirmed by her daughter Jane Jones, who said her mother had dementia.

Dr. Wright descended from a distinguished medical family that defied racial barriers in a profession long dominated by white men. Her father, Dr. Louis T. Wright, was among the first blacks to graduate from Harvard Medical School and was reported to be the first black doctor appointed to the staff of a New York City hospital. His father was an early graduate of what became the Meharry Medical College, the first medical school in the South for African-Americans, founded in Nashville in 1876.

Dr. Jane Wright began her career as a researcher working alongside her father at a cancer center he established at Harlem Hospital in New York.

Together, they and others studied the effects of a variety of drugs on tumors, experimented with chemotherapeutic agents on leukemia in mice and eventually treated patients, with some success, with new anticancer drugs, including triethylene melamine.

After her father died in 1952, Dr. Wright took over as director of the center, which was known as the Harlem Hospital Cancer Research Foundation. In 1955, she joined the faculty of the New York University Medical Center as director of cancer research, where her work focused on correlating the responses of tissue cultures to anticancer drugs with the responses of patients.

In 1964, working as part of a team at the N.Y.U. School of Medicine, Dr. Wright developed a nonsurgical method, using a catheter system, to deliver heavy doses of anticancer drugs to previously hard-to-reach tumor areas in the kidneys, spleen and elsewhere.

That same year, Dr. Wright was the only woman among seven physicians who, recognizing the unique needs of doctors caring for cancer patients, founded the American Society of Clinical Oncologists, known as ASCO. She was also appointed by President Lyndon B. Johnson to the President’s Commission on Heart Disease, Cancer and Stroke, led by the heart surgeon Dr. Michael E. DeBakey. Its recommendations emphasized better communication among doctors, hospitals and research institutions and resulted in a national network of treatment centers.

In 1967, Dr. Wright became head of the chemotherapy department and associate dean at New York Medical College. News reports at the time said it was the first time a black woman had held so high a post at an American medical school.

“Not only was her work scientific, but it was visionary for the whole science of oncology,” Dr. Sandra Swain, the current president of ASCO, said in a telephone interview. “She was part of the group that first realized we needed a separate organization to deal with the providers who care for cancer patients. But beyond that it’s amazing to me that a black woman, in her day and age, was able to do what she did.”

Jane Cooke Wright was born in Manhattan on Nov. 30, 1919. Her mother, the former Corinne Cooke, was a substitute teacher in the New York City schools.

Ms. Wright attended the Ethical Culture school in Manhattan and the Fieldston School in the Bronx (now collectively known Ethical Culture Fieldston School) and graduated from Smith College, where she studied art before turning to medicine. She received a full scholarship to New York Medical College, earning her medical degree in 1945. Before beginning research with her father, she worked as a doctor in the city schools.

Dr. Wright’s marriage, in 1947, to David D. Jones, a lawyer, ended with his death in 1976. She is survived by their two daughters, Jane and Alison Jones, and a sister, Barbara Wright Pierce, who is also a doctor.

As both a student and a doctor, Dr. Wright said in interviews, she was always aware that as a black woman she was an unusual presence in medical institutions. But she never felt she was a victim of racial prejudice, she said.

“I know I’m a member of two minority groups,” she said in an interview with The New York Post in 1967, “but I don’t think of myself that way. Sure, a woman has to try twice as hard. But — racial prejudice? I’ve met very little of it.”

She added, “It could be I met it — and wasn’t intelligent enough to recognize it.”

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Malaysia Said to Open Fire on Armed Filipinos

MANILA — The Malaysian police opened fire on a group from a Muslim royal clan from the Philippines that has occupied a village in Malaysia and ignored pleas to leave, the group’s leader said Friday.

The group claims the territory in Malaysia’s Sabah State as its own, and has rejected a plea from President Benigno S. Aquino III of the Philippines to leave. The group’s seizure of the coastal village has complicated relations between the Philippines and Malaysia.

The group’s leader, Prince Rajah Mudah Agbimuddin Kiram, told the Philippine radio station DZBB that the Malaysian police had opened fire on members early Friday, according to The Associated Press. He was quoted as saying that the group was fighting back and that there had been Filipino casualties.

The episode began Feb. 12, when the group, which is seeking to revive a historical claim to part of Borneo, arrived by boat from the Philippines and seized the land. The Philippines on Monday sent a navy vessel to the area with medical and diplomatic personnel to pick up the group or escort them back to the Philippines, hoping to resolve the situation.

Mr. Aquino said Tuesday that his government had sent emissaries to meet with Mr. Kiram to resolve the issue.

“These are your people, and it behooves you to recall them,” Mr. Aquino said to the leader in his Tuesday statement. “It must be clear to you that this small group of people will not succeed in addressing your grievances, and that there is no way that force can achieve your aims.”

The Philippines has been coordinating with the Malaysian government to resolve the issue peacefully, but Malaysian police officials in the area where the standoff is taking place had earlier suggested that they were prepared to use force if necessary.

Floyd Whaley reported from Manila, and Gerry Mullany from Hong Kong.

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F-35 Jets Returned to Service by Pentagon

The Pentagon lifted its grounding of the new F-35 jet fighter on Thursday after concluding that a turbine blade had cracked on a single plane after it was overused in test operations.

The office that runs the program said no other cracks were found in inspections of the other engines made so far, and no engine redesign was needed.

It said the engine in which the blade cracked was in a plane that “had been operated at extreme parameters in its mission to expand the F-35 flight envelope.”

The program office added that “prolonged exposure to high levels of heat and other operational stressors on this specific engine were determined to be the cause of the crack.”

All flights were suspended last week for the 64 planes built so far once the crack, which stretched for six-tenths of an inch, was found during a routine inspection.

Pratt & Whitney, which makes the engines, investigated the problem with military experts. The company, a unit of United Technologies, said on Wednesday that the crack occurred after that engine was operated more than four times longer in a high-temperature flight environment than the engines would in normal use.

The F-35, a supersonic jet meant to evade enemy radar, is the Pentagon’s most expensive program and has been delayed by various technical problems. The program could cost $396 billion if the Pentagon builds 2,456 jets by the late 2030s.

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Well: Think Like a Doctor: The Man Who Wobbled

The Challenge: Can you solve the medical mystery of a man who suddenly becomes too dizzy to walk?

Every month, the Diagnosis column of The New York Times Magazine asks Well readers to try their hand at solving a medical mystery. Below you will find the story of a 56-year-old factory worker with dizziness and panic attacks. I have provided records from his two hospital visits that will give you all the information available to the doctor who finally made the diagnosis.

The first reader to offer the correct diagnosis gets a signed copy of my book, “Every Patient Tells a Story,” and the satisfaction of solving a case that stumped a roomful of specialists.

The Patient’s Story:

The middle-aged man clicked his way through the multiple reruns of late-late-night television. He should have been in bed hours ago, but lately he hadn’t been able to get to sleep. Suddenly his legs took on a life of their own. Stretched out halfway to the center of the room, they began to shake and twitch and jump around. The man watched helplessly as his legs disobeyed his mental orders to stop moving. He had no control over them. He felt nauseous, sweaty and out of breath, as if he had been running some kind of race. He called out to his wife. She hurried out of bed, took one look at him and called 911.

The Patient’s History:

By the time the man arrived at Huntsville Hospital, in Alabama, the twitching in his legs had subsided and his breathing had returned to normal. Still, he had been discharged from that same hospital for similar symptoms just two weeks earlier. They hadn’t figured out what was going on then, so they weren’t going to send him home now.

The patient considered himself pretty healthy, but the past year or so had been tough. In 2011, at the age of 54, he had had a mild stroke. He had no medical problems that put him at risk for stroke — no high blood pressure, no high cholesterol, no diabetes. A work-up at that time showed that he had a hole in his heart that allowed a tiny clot from somewhere in his body to travel to the brain and cause the stroke. He was discharged on a couple of blood thinners to keep his blood from making more clots. He hadn’t really felt completely well, though, ever since. His balance seemed a little off, and he was subject to these weird panic attacks, in which his heart would pound and he would feel short of breath whenever he got too stressed. Mostly he could manage them by just walking away and focusing on his breathing. Still, he never felt as if he was the kind of guy to panic.

And he had always been quick on his feet. The first half of his career he had been in the steel business — building huge metal trusses and supports. He and his team put together 60-plus tons of steel structures every day. For the past decade he had been machining car parts. After his stroke, work seemed to get a lot harder.

The Dizziness:

A few weeks ago, he stood up and wham — suddenly the whole world went off-kilter. He felt as if he was constantly about to fall over in a world that no longer lay down flat. His first thought was that he was having another stroke. He went straight to his doctor’s office. The doctor wasn’t sure what was going on and sent him to that same emergency room at Huntsville Hospital. After three days of testing and being evaluated by lots of specialists, his doctors still were not sure what was going on. He hadn’t had a heart attack; he hadn’t had a stroke. There was no sign of infection. All the tests they could think of were normal.

The only abnormal finding was that when he stood up, his blood pressure dropped. Why this happened wasn’t clear, but the doctors in the hospital gave him compression stockings and a pill — both could help keep his blood pressure in the normal range. Then they sent him home. He was also started on an antidepressant to help with the panic attacks he continued to have from time to time.

You can read the report from that hospital admission below.

You can also read the consultation and discharge notes from that hospital visit here.

He had been home for nearly two weeks and still he felt no better. He tried to go back to work after a week or so at home, but after driving for less than five miles, he felt he had to turn around. He wasn’t sure what was wrong; he just knew he didn’t feel right. Then his legs started jumping around, and he ended up back in the hospital.

The Doctor’s Exam:

It was nearly dawn by the time Dr. Jeremy Thompson, the first-year resident on duty that night, saw the patient. Awake but tired, the patient told his story one more time. He had been at home, watching TV, when his legs started jumping on their own and he started feeling short of breath. His wife sat at the bedside. She looked just as worried and exhausted as he did. She told the resident that when he spoke that night at home, his speech was slurred. And when the ambulance came, he could barely walk. He has never missed this much work, she told the young doctor. It’s not like him. Can’t you figure out what’s wrong?

The resident had already reviewed the records from the patient’s previous hospital admissions. He asked a few more questions: the patient had never smoked and rarely drank; his father died at age 80; his mother was still alive and well. The patient exam was normal, as were the studies done in the E.R.

The first E.R. doctor thought that his symptoms were a result of anxiety, culminating in a full-blown panic attack. The resident thought that was probably right. In any case he would discuss the case with the attending in a couple of hours during rounds on the new patients. Till then, he told the worried couple, they should just try to get a little sleep.

An Important Clue:

Dr. Robert Centor was definitely a morning person. His cheerful enthusiasm about teaching and taking care of patients made him a favorite among residents. At 7:30 that morning, he stood outside the patient’s door as Dr. Thompson relayed the somewhat frustrating case of the middle-aged man with worsening dizziness and panic attacks. Then they went into the room to meet the patient. He was a big guy, tall and muscular with the first signs of middle-aged thickening around his middle. His complexion had the look of someone who spent a lot of time outdoors. Dr. Centor introduced himself and pulled up a chair as the rest of the team watched. He asked the patient what brought him to the hospital.

“Every time I get up, I get dizzy,” the man replied. Sure, he had had some balance problems ever since his stroke, he explained, but this felt different – somehow worse. He could hardly walk, he told the doctor. He just felt too unstable.

“Can you get up and show us how you walk?” Dr. Centor asked.

“Don’t let me fall,” the patient responded. He carefully swung his legs over the side of the bed. The resident and intern stood on either side as he slowly rose. He stood with his feet far apart. When asked to close his eyes as he stood there, he wobbled and nearly fell over. When he took a few steps, his heel and toes hit the ground at the same time, making a strange slapping sound.

Seeing that, Dr. Centor knew where the problem lay and ordered a few tests to confirm his diagnosis.

You can see the review report and notes for the patient’s second hospital visit below.

Solving the Mystery:

What tests did Dr. Centor order? Do you know what is making this middle-aged man wobble? Enter your guesses below. I’ll post the answer tomorrow.

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Rules and Regulations: Post your questions and diagnosis in the Comments section below. The correct answer will appear tomorrow on Well. The winner will be contacted. Reader comments may also appear in a coming issue of The New York Times Magazine.

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India Ink: India’s Slowing Economy Forces Budget Decisions

NEW DELHI — Not too long ago, when India’s economy was roaring amid predictions of high growth rates for years to come, the finance minister could be forgiven for strutting during budget week. He got to march into India’s Parliament with the ceremonial briefcase bearing a budget stuffed with goodies.

But on Thursday, when the current finance minister, Palaniappan Chidambaram, arrives in Parliament, his steps will be heavier, and the mood is likely to be, too. Faced with slowing growth, persistent inflation and sagging investor confidence, India’s government is pinned between conflicting pressures: economists warn that tough steps are needed to avoid long-term fiscal problems, even as political leaders are leery of introducing unpopular measures before important elections this year.

On Wednesday, the government sought to change the pessimistic narrative, as the Finance Ministry released its annual economic survey and projected that economic growth would jump somewhere above 6 percent during the next fiscal year, predicting that the downturn was “more or less over and the economy is looking up.” Some economists were skeptical, given that similar rosy predictions in recent budgets have proved wrong.

“Let me remind you that last year the economic survey spoke of about 7.6 percent projected growth — and what we had was 5 percent growth,” said Ajay Bodke, head of investment strategy and advisory at Prabhudas Lilladher, a Mumbai brokerage. “That is not just a miss but a humongous miss.”

The consequences of the budget plans are especially high because India, once a darling of global investors and an anointed power-in-waiting, is struggling to regain its lost luster.

India’s estimated 5 percent growth rate for the current fiscal year compares with 8 percent in 2010. Ratings agencies have threatened to downgrade the country’s investment rating to “junk” status. Meanwhile, India’s political class has spent more than three years enmeshed in scandals, as a bickering Parliament has accomplished almost nothing.

“It’s a supercritical moment, actually,” said Rajiv Kumar, an economist with the Center for Policy Research in New Delhi. “If you get it right, and this is a budget that can shore up the government’s credibility, they can turn it around.”

For investors and business leaders, the question is whether the government will make tough calls to address the country’s large fiscal and account deficits, curb huge subsidies for diesel fuel and petroleum products, unclog bureaucratic bottlenecks on stalled manufacturing, energy and infrastructure projects and create incentives to entice new investment.

Only a year ago, Pranab Mukherjee, then finance minister, unveiled a budget now regarded by many analysts as a major mistake. Desperate to increase revenues, the government spooked investors by giving broad latitude for tax collectors to pursue multinationals for billions of dollars in new, unexpected taxes. Investment slowed markedly, while investors and political opponents complained that India’s coalition government, led by the Indian National Congress Party, was endangering one of the world’s fastest-growing economies.

“The economy is in a deep crisis at the moment,” said Yashwant Sinha of the opposition Bharatiya Janata Party, a former finance minister, “and I only hope the crisis doesn’t become any deeper with more pre-election sops.”

Mr. Sinha and many independent economists warn that the economy cannot afford a repeat of 2008, when the government was preparing for national elections the following year. Then, the pre-election budget was filled with big spending measures, including pay raises for government workers and the forgiveness of billions of dollars in loans to farmers. The government was easily re-elected in 2009, but the new spending contributed to a fiscal deficit that rose to roughly 6 percent, from about 2 percent the previous year.

Neha Thirani Bagri contributed reporting from Mumbai, India.

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