Some morphological observations on osteoclasts. Osteoclasts of the peripheral portions of the endocranial aspect of young rat parietal and frontal bones were studied by scanning electron microscopy of glutaraldehyde fixed, critical point dried specimens. These studies show osteoclasts to have a much more complicated form than has previously been realised. Extensively branching, elongated, smooth-surfaced cells, which are for the most part elevated above the level of the surrounding bone matrix surface and sometimes above portions of osteoblasts or other osteoclasts, were identified as motile non-resorbing cells. Portions of the former and other entire cells may be embowered in Howship's lacunae, have microvilli on their dorsal surface, and are surrounded by a serrated border of microprojections which have an apparently firm attachment to the matrix surface. Osteoclasts in short term culture show additional free surface ruffles which are not encountered in specimens taken fresh from the animal. No evidence of recruitment of osteoblasts or osteocytes into osteoclasts was found. Disinterred osteocytes retained an ability to migrate from their lacunae on to surrounding bone matrix surface.


The effects of aging on satellite cells in skeletal muscles of mice and rats. Myosatellite cells were examined and quantified at the fine structural level of resolution during aging of skeletal muscles in mice and rats. Satellite cells in the soleus and gastrocnemius muscles of animals between eight and 30 months of age appeared, according to morphological criteria, metabolically less active than those examined in immature muscles. In the soleus muscle of the mouse, satellite cells decreased in number from 4.6% at eight months of age to 2.4% at 30 months. This decrease appeared to be due to the passage of some satellite cells into the interstitial space as a result of the formation of external lamina material around the entire satellite cell surface.


Ultrastructure of the neurohypophysis of the teleost Poecilia latipinna in relation to neural control of the adenohypophysial cells. The structure of the neurohypophysis of Poecilia latipinna (green molly, sailfin molly) was studied with the electron microscope. Profile diameters of neurosecretory granules in the non-myelinated neurohypophysial nerve fibres were measured and mathematically corrected for error due to section thickness. Six different types of nerve fibres could be distinguished by statistical classification of their granules and by other ultrastructural features. One fibre-type (type B) contained granules with a mean diameter of 85 nm, and the other five types (types Ala, Alb, A2, A3 and A4) all contained granules with mean diameters greater than 100 nm. Synaptic contacts were observed between type B fibres and all the adenohypophysial cell-types, although in the case of the ACTH cells the synapses were separated from the cell membrane by a continuous double basement membrane. Type A fibres were observed to contact the cells of the proximal pars distalis and pars intermedia, but did not form synapses. However, synapses occurred between type A fibres and pituicytes, and between type A fibres and the pericapillary basement membrane in the interior of the neurohypophysis. The possible roles of the different types of nerve fibres in controlling the adenohypophysial cells are discussed in the context of evidence from other teleosts.


Complete nucleotide sequence of the 5' noncoding region of human alpha-and beta-globin mRNA. The 5' noncoding regions of human alpha-and beta-globin mRNAs, 37 and 50 nucleotides in length, have been sequenced. A variation of the "plus and minus" gel technique described by Brownlee and Cartwright (1977) was used, and the results were cross-checked by the Maxam and Gilbert (1977) procedure. These studies completed the knowledge of all the noncoding region sequences of both mRNAs, and it was then possible to calculate their exact size. Human alpha-and beta-globin mRNAs are 575 and 626 nucleotides in length, excluding the poly(A). Furthermore, because the coding and 3' noncoding regions of the latter were known from previous studies (Marotta et al., 1977; Proudfoot, 1977), the primary structure of human beta-globin mRNA is now complete except for six ambiguities in the coding region. The human and rabbit 5' noncoding region sequences are about 80% homologous. This suggests that they are under a moderate selective pressure.


Differential control of the synthesis of two hemoglobin beta chains in normal mice. A fetal-to-adult switch in the proportion of the mouse minor hemoglobin is described. Although mice have no fetal hemoglobin per se, the timing of this switch in the mouse suggests that the mechanism of its control may directly parallel that of the human switch from fetal to adult hemoglobin expression. The mouse minor hemoglobin is expressed only in strains with the "diffuse" allele for the beta chain complex locus. Fetal liver cells of these mice synthesize a much greater proportion of the betaminor globin chain that do adult hematopoietic cells. Consequently, circulating fetal erythrocytes carry a high level of the minor hemoglobin containing it. By the time of birth, a lowered proportion of betaminor is synthesized in the liver. This low proportion continues to be expressed during early erythroid maturation in the adult. The fetal-to-adult switch is the first indication that in normal mice, the two beta chain loci can be expressed noncoordinately. The similarity between the patterns of the decline of the minor hemoglobin in mice and of the disappearance of fetal hemoglobin in humans suggests that the minor hemoglobin in the "diffuse" mouse may function to some degree as a fetal hemoglobin in the period between the disappearance of the embryonic hemoglobins and the time of birth.


Sequences associated with intracisternal A particles are reiterated in the mouse genome. Using a 3H-cDNA for RNA sequences specifically associated with murine intracisternal type A particles, we have found multiple copies of this information in high molecular weight nuclear DNA from tissues of both Mus muscules (BALB/c, NIH Swiss, A/Jax and feral) and Mus cervicolor. Reiteration frequencies varied from 1050-1800 per haploid genome, except that fewer copies (450) were found in BALB/3T3 cells. In the series studied, the reiteration frequencies in the DNA of A particle-rich tumor cells (myeloma and neuroblastoma) were not higher than those in normal tissues (liver and sperm). Multiple copies were retained when cellular DNAs were sedimented through alkaline sucrose gradients, indicating that the sequences are integrated in the mouse genome. In situ hybridization with cDNA showed that the sequences were associated with many chromosomes and were concentrated over certain regions of some chromosomes. Only low levels of homologous sequences were detected in rat, hamster and guinea pig DNA under stringent conditions of hybridization. The presence of reiterated sequence transcripts in poly(A) RNA from a neuroblastoma A particle fraction was confirmed by direct hybridization of the RNA with cellular DNA.


Unstable, heterogeneous physical states of nuclear bodies during the post-hepatectomy dedifferentiation-replication-redifferentiation sequence. Nuclei are shown to undergo generalized changes of state during regeneration, as reflected by changes in equilibrium density of sucrose density gradients. The time-course of these phenomena suggests an association with changes occurring after S-phase and mitosis. Such changes are no longer observable in extensively purified nuclei (washed, polyamine-stabilized nuclei), but are apparent only in nuclei with minimal purification, rapidly isolated by centrifugation from liver homogenates. This effect implies that there exists a serious risk of selective loss of some nuclear types during standard purification procedures that use 2.1-2.4 M sucrose cushions. Although these nuclear states may largely reflect the metabolic state of the cells of origin, evidence is presented to suggest that loss and redistribution of macromolecules during handling procedures causes distortion of in vivo properties.


Amphibian embryo protease inhibitors. IV. Studies on an inhibitor of chymotrypsin and papain. Amphibian embryo chymotrypsin and papain inhibitor (ACPI) purified by the procedure described in this paper produces a single band on sodium dodecyl sulfate (SDS) gel electrophoresis and a single peak on Sephadex G-75 chromatography. Except for its enzyme specificity, ACPI is very similar to amphibian embryo trypsin inhibitor (ATI). Its molecular weight is about 10,500 and its amino acid composition is typical of many naturally occurring protease inhibitors. Inhibition develops slowly, is retarded by the presence of substrate and is temporary. ACPI is localized in the yolk platelets and its disappearance both from whole embryos and from select tissue types corresponds closely with that of ATI. Possible roles for amphibian embryo proteases and protease inhibitors in development are discussed.


Isolation of a substance activating foot formation in hydra. We have developed an assay for a substance from hydra that accelerates foot regeneration in the animal. This substance is specific for the foot as evidenced by the following findings: (1) It is present in the animal as a steep gradient descending from foot to head, paralleling the foot-forming potential of the tissue (2) It does not accelerate head regeneration, nor do the head factors of hydra discovered by Schaller (1973) and Berking (1977) accelerate foot regeneration. We propose that the foot-activating substance is a morphogen responsible for foot formation in hydra. The foot activator can be extracted from hydra tissue with methanol and separated from other known morphogens of hydra by gel filtration and ion-exchange chromatography. A substance with similar biological and physicochemical properties can be isolated from sea anemones.


[Benign lymphoepithelial lesion of the salivary glands]. A series of eight observations serves for demonstrating the clinico-pathological picture of the benign lymphoepithelial lesion of salivary glands. The glandular lesion was associated with joint symptoms, one of the female patients developed malignant lymphoma.


[Formation and release of antibodies in lymphocytes]. An immunohistochemical study proved that lymphocytes were the dominant cell type responsible for the production of antibodies during the local humoral immune response to human serum albumin in the mouse omentum. Ultrastructurally, specific antibodies were detected on ribosomes and polysomes linked to the perinuclear cisterna and placed in it, as well as on the free intracytoplasmic ribosomes and polysomes. In no case antibodies were found in other cell organelles involved in protein synthesis. Most probably the mechanismus of antibody release from lymphocytes are different from similar processes taking place in plasma cells.


[Development of arrangement and degradation of the system of rough endoplasmic reticulum in antibody-producing plasma cells]. During the immune response of the cells of murine omentum to horseradish peroxidase which had been administered intraperitoneally together together with endotoxin or endotoxoid acting as an adjuvans the plasma cells showed several different patterns of the rough endoplasmic reticulum [RER] system. Irregular to bizarre RER structures occurred plasma cells during the initial phase of the immune reaction only, whereas the plasma cells found at later stages had characteristic highly organized RER systems. The irregular "atypical" RER patterns have been regarded by some authorities as fully functional structures developed under the influence of a rapid differentiation of immunocompetent cells following administration of mitogens as well as due to a variously pronounced toxic influence of mitogens upon cell organelles. The possibilities of RER system degradation and the fate of antibodies which had not been discharged by the plasma cells has been discussed.


[Neuroectodermal tumors of the skin (a normative study)]. A group of bioptically examined neuroectodermal tumours of the skin and soft tissues consisting, in particular, of 170 Schwannomas and 350 tumours has been reevaluated in a retrospective study. The following common classification of these tumours has been recommended: I. Tumours of Schwann's cells: 1. neurilemmoma [A and B], 2. neurofibroma [with the following variants v. Recklinghausen's type, plexiform, pigmented, Paccinian, with Meissner-Wagner's bodies and meningiomatous], 3. amputation neuroma, 4. neurosarcoma, 5. others. II. Melanogenic tumours: A. pigmented naevi (junction, mixed, intradermal, epithelioid, clear cell, halo, neurocutaneous, fibrous, blue, proliferating blue, melanotic progonoma, others). -B. praecancerous melanosis. -C. malignant melanoblastoma (common type, from praecancerosis). III. Tumours of ganglion cells: 1. ganglioneuroma, 2. neuroblastoma, 3. paragangliomas (with granules, without granules, alveolar soft part sarcoma).


The effect of manganese and ferric ions on the in vitro formation of dihydrodihydroxy metabolites of benzo(a)pyrene. The effect of ferric and manganese ions on the in vitro metabolism of benzo(a)pyrene (BP) to dihydrodihydroxy (diol) metabolites by rat liver microsomal preparations was studied. Of the 3 diols separated by high-pressure liquid chromatography (HPLC) and called diols 1, 2 and 3 in order of elution, diol 1 was identified by its U.V. spectrum as the 9,10-diol; diols 2 and 3 have not yet been identified positively but are probably the 4,5- and 7,8-diols respectively. Higher concentrations of both metals altered the diol profile; 10 and 50 mumol Fe3+ per incubation caused the disappearance of diols 1 and 2 and an increase in diol 3; 10 mumol Mn2+ caused a significant decrease in diol 2 while 50 mumol reduced diol 2 to a negligible amount and inhibited the formation of diol 1; both concentrations caused a relative increase in diol 3. If the tentative identification of diol 3 as the 7,8-diol is correct, manganese and ferric ions could be significant in the metabolism of BP to the active metabolite, the 7,8-diol-9,10-epoxide.


Inhibition of butylated hydroxytoluene-induced mouse lung cell division by oxygen: time-effect and dose-effect relationships. Mice were injected i.p. with 250 or 400 mg/kg of butylated hydroxytoluene (BHT). In vivo incorporation of thymidine into pulmonary DNA was measured on days 1-7 after BHT. 2, 3 and 4 days after BHT, DNA synthesis was inhibited by a 24-h exposure to 100% oxygen, whereas on days 5, 6 and 7 after BHT, oxygen failed to depress synthesis. A similar pattern was observed when incorporation of leucine into protein was measured: 2 and 4 days after BHT, oxygen decreased leucine incorporation, but had no effect 6 days after BHT or in animals not pretreated with BHT. It is concluded that the cells proliferating early after BHT, the type II alveolar cells, are more susceptible to the cytotoxic effects of oxygen than are interstitial and capillary endothelial cells.


Changes of activity of daunorubicin, adriamycin and stereoisomers following the introduction or removal of hydroxyl groups in the amino sugar moiety. The results of a study of the effects of hydroxyl groups at positions, 2, 4 and 6 of the amino sugar on the activity of daunorubicin, adriamycin, and stereoisomers are presented. While the 4'-deoxy derivatives showed a slightly increased biological activity as compared with the parent compounds, the derivatives containing an additional hydroxyl group were less active. It is suggested that the changes in the polarity and in the DNA binding ability of these derivatives are the main factors accounting for the difference in the in vivo activity. The possible relations among the pKa values, the DNA binding properties, and the cellular uptake of the compounds are discussed with particular reference to their therapeutic effectiveness.


Changes in liver nuclear protein metabolism after a single dose of urethane to suckling mice. Treatment of 8-9-day-old C57BL/A mice with a single carcinogenic dose of urethane, at 1.2 mg/g body wt., resulted in an immediate decrease in liver DNA synthesis reaching a maximum at about 16-18 h after injection, the rate of synthesis returning to normal after 48 h. When the nuclear proteins were radiolabelled, the non-histone protein (NHP) fraction showed a significant decrease in specific activity 8-18 h after injection of urethane and slight increase in specific activity after 24 h. Histone and residual proteins did not show any significant change. The liver NHP were analysed by isoelectric focusing (IEF) and sodium dodecyl sulphate (SDS) electrophoresis in polyacrylamide gels. The latter technique failed to show any distinctive differences but IEF results indicated some quantitative and qualitative changes in protein content and synthesis were induced by the urethane treatment. The most noticeable change in the stained gels was an increase in a protein component having a pI of 7.35 and the appearance of new bands at pI's of 7.85 and 5.55 in the 18 h treated livers. However, the [3H]tryptophan labelling pattern indicated that this was not due to an increased synthesis of these components. 24 h after urethane there appeared to be an increased rate of synthesis of some of the major components of the mixture, particularly at the pI 5.65 region. Histone and residual protein fractions were also analysed by electrophoresis and showed no difference between treated and control livers.


The stability of methyl and ethyl phosphotriesters in DNA in vivo. C57BL male mice were injected with N-methyl-N-nitrosourea (MNUA) or N-ethyl-N-nitrosourea (ENUA) and the concentration of alkyl phosphotriesters in the DNA of lung, liver, brain, kidney, spleen and thymus determined from the extent of degradation induced in isolated DNA by alkali. The same total dose of reagent was given either as a single injection (i.p.) or by weekly injections carried out over 5-20 weeks. Methyl phosphotriesters induced in liver, lung and kidney by the single injection were lost with a half-life of about 7 days, in brain the loss was more rapid, t1/2 = 2-3 days. During the multiple injections the observed t1/2 was 16 days. Ethyl phosphotriesters formed in the DNA of lung, liver, kidney and brain were much more stable than the methyl derivatives, t1/2 = 10-15 weeks. Phosphotriesters formed in the DNA of spleen and thymus disappeared very quickly after the single injection presumably as a result of dilution due to DNA replication. No accumulation of phosphotriesters occurred in the DNA of these tissues during the multiple injections. The general pattern of the results suggests that phosphotriesters are not excised by cellular repair systems.


The formation and stability of methyl phosphotriesters in the DNA of rat tissues after treatment with the carcinogen N,N-dimethylnitrosamine. Following the injection i.p. of N,N-dimethylnitrosamine (DMN) into Chester Beatty (CB) hooded, female rats (2 mg/kg) measurable concentrations of methyl phosphotriesters were found in the DNA of liver, lung and kidney but not in spleen, thymus or brain. In lung and kidney these lesions were stable for at least 14 days but in liver there was a steady loss (t 1/2 9-11 days). Administering the same total dose in 10 weekly injections produced the same concentration of phosphotriesters in lung and kidney DNA as the single injection but in liver only half of the concentration induced by the single injection was found. It was calculated that the half-life of methyl phosphotriesters in the liver DNA of animals given repetitive injections was of the order of 6 weeks.


Accommodation of hydroxyl groups and their hydrogen bond system in a hydrocarbon matrix. From data of a single crystal analysis of 12-D-hydroxyoctadecanoic acid methyl ester principles for the incorporation of hydroxyl groups into a hydrocarbon chain matrix can be deduced. In the crystalline compound infinite hydrogen bond systems are accommodated in an orthorhombic perpendicular chain arrangement. The orthorhombic perpendicular hydrocarbon subcell is expanded towards a hexagonal packing pattern, allowing more space and optimal geometry for the hydrogen bond system. The arrangement of the bond system in the orthorhombic perpendicular subcell requires that hydrogen bonded carbon chains carry alternatingly hydroxyl groups with opposite configuration. For the enantiomeric compound this requirement is met by a head to tail packing of molecules in a single layer arrangement. The corresponding racemates on the other hand pack head to head in double layers as confirmed by X-ray powder and IR studies. In monolayers both enantiomers and racemates behave identically. The hydrogen bonding of the hydroxyl groups apparently leads to the formation of lipid clusters, in which the geometric conditions for both a close packing of hydrocarbon chains and the formation of an extensive hydrogen bond system do not exist.


Molecular arrangements of sphingolipids. The monolayer behaviour of ceramides. A series of synthetic ceramides have been studied at the air-water interface by recording the surface pressue-area isotherms at continuous compression. Ceramides that contain a 4,5-trans-double bond in the long chain base were found to condense into a close-packed arrangement with vertical chains already at a very low surface pressure. The corresponding saturated compounds adopt a similar close packed arrangement only at high surface pressue. At 30 dynes/cm, a lateral pressure representative of biological membranes, the area per molecule and compressibility was further found to depend on the number and configuration of the hydroxyl groups. The presence of a 2-D-hydroxyl group in the fatty acid generally promotes the condensation. A similar effect is observed if the long chain base contains a 4-D-hydroxyl group. Cis-double bonds or methyl branches in the fatty acid chain, which increase the space requirement, limit the lateral interaction of the polar group. However the 15-cis-double bond of nervonic acid can be accomodated without any distortion of the close-packing arrangement.


NMR and calorimetric studies of changes in phase transition of head group modified phospholipids. The 13C- and 31P-NMR spectra and DSC thermograms of unsonicated dispersions consisting of phospholipids of varying methylation stages of the propanolamine head group were investigated. Methylation of the head group was accompanied by a corresponding reduction in the phase transition temperatures. In the liquid crystalline state the 31P-anisotropy of the chemical shift is about equal for all studied compounds, demonstrating that the motion of the phosphate group is not influenced by modifications of the propanolamine group.


The dispersion of cholesterol with phospholipids and glycolipids. Of the polar lipids studied (phospholipids and glycolipids), only phosphatidylcholine and sphingomyelin can disperse in water with up to 2 mol cholesterol/mol polar lipid. However, mixtures of phosphatidylethanolamine with small amounts of phosphatidylcholine and mixed lipids from mitochondria and myelin will also form sterol-rich dispersions. Steroids in which the 3beta-OH group is replaced by an oxo function do not form such steroid-rich dispersions. Electron microscopy and optical rotatory dispersion (ORD) show that sterols disperse with cerebrosides and gangliosides to form cylindrical structures with the regions around C atoms 3 and 7 of the sterol in less polar environments than those they occupy in phospholipid liposomes. It is proposed that choline-containing phospholipids facilitate entry of sterol molecules into the outer leaflet of cell surface membranes but that the phospholipid composition itself will not give rise to an asymmetric distribution of sterol in membranes with a high cholesterol content.


Effects of alpha-adrenergic blockade on coronary blood flow of dogs in hemorrhagic shock. The present study was designed to test the hypothesis that the vasoconstrictive effects of alpha-adrenergic receptors are responsible, at least in part, for the lack of a maximal vasodilatation of coronary arteries during hemorrhagic shock. Open-chested, anesthetized, mongrel dogs were bled so as to reach an arterial pressure level of 44 mm Hg, and were monitored using an electromagnetic, non-cannulating flowmeter. During shock, two intracoronary injections were made, one of saline, the other of phenoxybenzamine (Dibenzyline). Control dogs had 2 injections of saline. Following phenoxybenzamine, coronary blood flow increased by 32%. These results indicate that although coronary blood flow may be mainly under local control, the sympathetic nervous system limits maximal coronary vasodilatation during hemorrhagic shock by virtue of activated alpha-adrenergic receptors.


Influence of dopamine on liver dynamics in hemorrhagic shock. The present study was conducted to examine the effect of dopamine on arterial blood pressure, liver blood flow, cathepsin D activity, and free amino nitrogen concentration in hemorrhagic shock. Dopamine at a dose of 4 microgram/kg/min increased both mean arterial blood pressure and liver blood flow in postoligemic shock, but failed to prevent the marked increases in circulating cathepsin D and free amino nitrogen. In fact, dopamine infusion resulted in an increased plasma cathepsin D activity in shock. This increased accumulation of a lysosomal marker enzyme probably results from increased washout of the enzyme from the splanchnic or hepatic vascular bed in response to increased blood flow in these areas rather than from a direct effect of dopamine on lysosomal integrity. The increase in hepatic artery and portal vein flows appeared to result from stimulation of dopaminergic receptors since the dopamine dose was in the dopaminergic range and because haloperidol, a dopamine blocker, abolished the improved hemodynamic effects of dopamine. This study suggests that dopamine benefits the animal in hemorrhagic shock hemodynamically, but does not reverse the metabolic and cellular problems in shock. Perhaps, in combination with a drug opposing the biochemical basis of shock, dopamine may provide a greater anti-shock action.


Regional blood flow redistribution during early burn shock in the guinea pig. The distribution of blood flow was determined with radioactive microspheres following scald injury in guinea pigs. Burn was induced in halothane-anesthetized guinea pigs by a 3-sec immersion to the xiphoid process in 100 degree C water. Cardiac output and fractional blood flow measurements were made at preburn, 15-min postburn, and 75-min post-burn. In the scalded animals cardiac output decreased 58% by 75 min postburn. Three different blood flow responses to burn were noted: a) Brain, heart, hepatic artery, and adrenals received an increased fraction of the cardiac output; b) the fractional distribution of the diaphragm, liver (portal), spleen, gastrointestinal tract, muscle (from burned portion of the body), and bone remained constant; while c) the pancreas, burned skin, nonburned skin, and adipose tissue received a reduced fraction of the cardiac output. Although some regions of the body (i.e., brain and heart) received a greater percentage of the total cardiac output after burn injury, the cardiac output decrease was sufficient to cause a depression in absolute blood flow to all but two sites (adrenals and hepatic artery).


The children's waiting room at Charing Cross Hospital. The children's waiting room at Charing Cross Hospital was opened on April 2 1973 as part of the Department of Paediatrics. It is run by the authors who have had a Nursery Nurse training and are employed by the hospital as Play Therapists. It is attended by hundreds of different families a year. Some come to the hospital just once or twice, but others have been coming for many years.


Hemodynamic reflex in muscle in response to brief occlusion of the mesenteric artery. Brief occlusion of the superior mesenteric artery in the cat produces increases in systemic pressure and in muscle blood flow. Capillary filtration in muscle, measured during occlusion of the superior mesenteric artery, exceeds that of the controls. Propranolol, which blocks the evoked increase in muscle  blood flow, reduces capillary filtration during occlusion to less than the control. Cutting the mesenteric nerve returns capillary filtration to the control level. Passive redistribution of blood, such as might follow occlusion of a large vascular region, is not the basis for the evoked changes in muscle hemodynamics. They are abolished by cutting the mesenteric nerve and by propranolol, and are demonstrable during constant pressure perfusion of muscle. The evidence suggests that occlusion of the mesenteric artery produces an increase in capillary filtration by balancing a reflex sympathetic beta-adrenergic vasodilation in pre-capillary resistance vessels with an increase in resistance in the precapillary sphincters.


Living in one-parent families: relationships and attitudes of 16-year-olds. The proportions of 16-year-olds in the National Child Development Study who are not living with both their natural parents in 1974 are examined and compared with proportions in earlier follow-ups. The children who have ever lived in one-parent families are selected for more detailed examination, such as the reasons for their parental situation, the age their families broke up and the ratio of motherless to fatherless at each age. The children's view of their relationship with their parents or new parent figures and their attitudes towards their own future marriage and family are considered and compared with those of children still living with both their own parents. The overall conclusion is that the differences in these respects between children in one and two-parent families are very slight, suggesting that the attitudes of children in one-parent families towards their future family life have not been greatly affected by their own childhood experiences.


Modified paper chromatographic method for assay of myocardial depressant factor. A simplified paper chromatographic technique for assaying myocardial depressant factor (MDF) is presented. In addition to a serine standard, deproteinized plasma samples from rabbits subjected to hemorrhagic shock were applied to paper and chromatographed. The spot in the chromatograms occurring at a migration distance of 1.6 to 1.8 times that of the standard (RS = 1.6-1.8) was found by bioassay to contain the MDF. The chromatographic spots were developed with ninhydrin and eluted with 3 ml of 1% NaHCO3. The absorbance at 570 nm (A570) of each eluate was measured and compared against the A570 value of the eluted serine standard. A direct linear relationship was shown between MDF chromatographic and bioassay values for each animal. This technique for paper chromatographic assay of MDF is as sensitive, specific, and reliable as bioassay, but offers clear advantages of small sample volume requirement, reduced analysis time, and ease of performance with routinely available laboratory equipment.


A child's relationships after admission to residential care. In a group of 92 children in longterm residential care it was found that those children visited infrequently by their mothers were less likely than those visited frequently or not at all to relate well to their houseparents. That the child's relationship with the houseparents was of considerable significance was suggested by the finding that prolonged contact with the same houseparent was associated with lower rates of psychiatric disorder and deviant behaviour in the child. The implications of these findings for child care practice are discussed.


A method for the analysis of chlorhexidine in serum. A colorimetric method for the determination of chlorhexidine in serum or plasma has been elaborated; the limit of detection of the method is 25 ng/ml, based on 10 ml of serum or plasma.


An evaluation of commercial kits for creatine phosphokinase assay. 1. The evaluation of seven colorimetric and twelve kinetic or ultra-violet (UV) creatine phosphokinase (CPK) kit methods for their reliability as a diagnostic tool in clinical laboratories has revealed that over 35% of such commercial products readily available in Canada do not yield reliable results. 2. Six out of seven colorimetric kits failed to meet the criteria of minimum reliability as did one of the twelve UV kinetic kits.


Triglyceride assay using the ABA-50 and Boehringer Mannheim Triglyceride reagent kit. 1. A procedure for the assay of triglycerides on the ABA-50 is described. 2. The Boehringer Mannheim Triglyceride (Fully Enzymatic method) reagent kit has been evaluated with this method and was found to be satisfactory.


Male pseudohermaphroditism with gynaecomastia due to testicular 17-ketosteroid reductase deficiency. A 28-year-old male pseudohermaphrodite with gynaecomastia was raised as a female until the age of 17 years, at which time he developed masculine features (deepening of the voice, development of facial hair, male distribution of body hair and male body habitus) and assumed a male gender role. He had a small phallus with perineal urethra, absence of labioscrotal fusion, presence of vaginal pouch and undescended testes. The testicular biopsy showed hyalinization of the tubular basement membrane, lack of spermatogenesis and hyperplastic Leydig cells. Baseline peripheral plasma studies showed androstenedione concentrations ten times normal, low testosterone, elevated oestrone and elevated gonadotrophins. The in vitro incubation of testicular tissue showed no significant conversion of androstenedione to testosterone. However, two types of peripheral tissues, skin fibroblasts and erythrocytes, had a normal conversion, as did the body overall as measured by the technique of androstenedione constant infusion. These studies demonstrate that the 17-ketosteroid reductase deficiency of the patient was limited to the testes.


Serum prolactin and oestradiol levels at different stages of puberty. Serum prolactin and oestradiol levels were measured in 183 children who were staged for pubertal development. Mean serum prolactin levels are higher in girls than in boys at stage 3 of pubertal development. In girls prolactin levels rise at stage 2, and are higher after menarche; in boys there is no change in prolactin levels. In this study serum oestradiol correlates with prolactin in the girls, but not in the boys.


Thyroid hormone kinetics: improved method for quantitative separation and measurement of the various radioiodothyronine injection. An accurate and reproducible method for measurement of radioactive species in blood after in vivo injection of labelled iodothyronines is described. By extraction with high-affinity antisera, radioactive reverse T3 and T3 are separated from serum quantitatively. Radioiodide is quantitatively separated from radio-thyronine species and serum proteins by Sephadex G50 filtration. The residual mixture of radio-T4 and iodoprotein is quantitatively resolved by ion-exchange adsorption. Minimal misclassification of radiospecies occurs, and can be corrected for. Mean recoveries of various radiospecies added to serum were: radioiodide 98.9%, radio-rT3 87.6%, radio-L-T3 94.5%, radio-T4 98.0% and radioiodoprotein 94.5%. The performance of the method is superior to that of chemical methods such as trichloracetic acid precipitation, ion-exchange or alkaline Sephadex extraction, and chromatographic separation.


The value of signs and symptoms in the diagnosis of enlarged adenoids. The purpose of this study is to investigate the relationship between preoperative signs and symptoms and the actual size of the adenoid found at operation in a group of children listed for adenoidectomy.


Neural correlates of electrically-induced cochlear dysfunction. Prolonged low intensity galvanic currents produce scattered but sharply cicumscribed areas of destruction in the guinea pig cochlea. As well as providing opportunities for studying possible electrically-induced injuries during artificial auditory stimulation of the deaf, such preparations present an unusual opportunity to study the relations between patterns of compound auditory nerve action potentials and morphological changes, which could be useful in evaluating the various computer models of cochlear function at present being developed.


Experiences in homograft membrane tympanoplasty. Experience of a short series of 37 cases of tympanoplasty involving the use of a homograft tympanic membrane is presented, with a discussion of the problems involved. The initial results correspond to the earlier series' anatomical success rates and indicate that these grafts will become widely used as an effective method of tympanoplasty.


Replacement of the central arch of the mandible by an implant. The use of an alloplastic implant to fill the defect after resection of the central part of the mandible is described. This procedure makes the post-operative course more acceptable for the patient, and facilitates later reconstruction by a free bone graft in the absence of recurrence.


Phosphate excretion in chronic renal failure: evidence for a mechanism other than circulating parathyroid hormone. The mechanism of the increased phosphaturia of chronic renal failure was investigated in seven patients with creatinine clearances ranging from 22 to 63 ml/min. Phosphorus deprivation for 2 to 7 weeks resulted in a marked and rapid reduction in urinary total and fractional phosphate excretion. Serum immunoreactive parathyroid hormone concentration initially remained unchanged and eventually decreased slowly from 330 +/- 50 microliterEq per ml (control) to 252 +/- 58 microliterEq per ml (P less than 0.025), but persisted substantially elevated above the normal range (10-60 microliterEq per ml). Thus, phosphate excretion in chronic renal failure can be regulated to a major extent by the dietary phosphorus intake independently of parathyroid hormone.


Clofibrate treatment of hyperlipidemia in chronic renal failure. The pharmacokinetics of the hypolipidemic agent, clofibrate have been studied in anuric patients on intermittent hemodialysis. In addition we have tried to determine whether the treatment of hyperlipidemia of chronic renal failure with clofibrate was safe and efficacious. Seven healthy volunteers and five uremic patients received a single dose of 25 mg/kg body weight of clofibrate. Mean peak plasma levels of clofibrate were comparable in both groups and were reached 3.5 hr after drug ingestion in the control subjects and after 6.5 hr in the uremic patients. The mean plasma half-life of clofibrate was 16.7 hr and 68.4 hr in the control subjects and in the patients, respectively (P less than 0.001). Following a short loading period a daily oral maintenance dose of 5 mg/kg body weight was given leading to a plasma clofibrate level of 75-100 microgram/100 ml. Five hyperlipidemic uremic patients received this dose for 3 months. Their plasma clofibrate and creatine kinase levels were constantly monitoried to detect clofibrate myotoxicity which we have observed in uremic patients at plasma levels generally considered safe in patients with normal renal function. Significant decreases in serum total lipid, triglyceride, and cholesterol levels were observed when compared to pretreatment values. In two of the 5 patients serum lipids remained decreased for 10 and 14 months. It is concluded that clofibrate treatment of hyperlipidemia in uremic patients, when carefully monitored, is safe and efficacious.


Folic acid status of patients with chronic renal failure maintained by dialysis. Twenty-five uremic patients on chronic hemodialysis were followed over a period of 9 months with regard to hemoglobin, mean corpuscular volume and folate concentration in serum and erythrocytes. The daily dietary intake of folic acid was estimated at 80-90 microgram, and no folic acid supplements were given. None of the patients developed macrocytic anemia. At the end of the period all patients had a normal erythrocyte folate content. Serum folate was normal in 17 and below normal in 8 patients. These 8 patients were in a negative folate balance at the time of investigation. In 7 patients dialyzed with a RP VI dialyzer the maximum loss of folic acid was 75 microgram/dialysis, and in 6 patients on chronic intermittent peritoneal dialysis the maximum loss was 13 microgram/dialysis. Thus there is no need for oral folic acid supplementation in uremic patients on chronic dialysis provided that daily dietary intake of folic acid is adequate.


Impaired lymphocyte function and neutrophil damage during the first hours of hemodialysis. Tests of T lymphocyte function, as lymphocyte stimulation by phytohemagglutinin (PHA) and concanavalin A (Con A), decreased during the first 2 hours of dialysis to approximately 20% of the predialysis value but returned to near normal within 4 hr. No change in the percentage of T cells was noted. Lymphocyte function in blood obtained from the arterial side fo the dialyzer 1 hour after the start of dialysis was better than that in blood from the venous side, though lower than before dialysis. Neutrophils in blood from the venous side of the dialyzer showed decreased density and decreased carbonyl iron phagocytosis. These changes were not found in blood from the arterial side of the dialyzer, suggesting that damaged neutrophils were retained in the patient. Neutrophil damage persisted during the first 4 hours of hemodialysis.


Elevation of serum levels of beta-aminoisobutyric acid in uremic patients and the toxicity of the amino acid. A reliable method for the determination of beta-aminoisobutyric acid in serum was developed utilizing an automated amino acid analyzer. The serum concentrations of beta-aminoisobutyric acid were determined in 20 normal subjects and in 71 uremic patients. The mean serum level of beta-aminoisobutyric acid was markedly increased in the uremic patients to 0.856 +/- 0.910 (mean +/- SD) mg/100 ml as compared with a normal value of 0.026 +/- 0.027 mg/100 ml. The distribution of serum beta-aminoisobutyric acid level in uremic patients was wide-spread, and there was no correlation between the serum levels of the amino acid and those of urea nitrogen, creatinine and uric acid. The toxicity of beta-aminoisobutyric acid on mice with acute renal failure induced by uranyl acetate was investigated and compared with that of alpha-amino-n-butyric acid and gamma-amino-n-butyric acid. All mice given more than 4 g/kg body wt of beta-aminoisobutyric acid showed twitching and cramps, and some of them died. However, the control mice given an equivalent dose of alpha-amino-n-butyric acid or gamma-amino-n-butyric acid showed no change. These results suggest that beta-aminoisobutyric acid might be a factor influencing the development and progression of uremic toxemia.


A non-operative salvage of surgically-resistant pseudarthroses and non-unions by pulsing electromagnetic fields. A preliminary report. This report documents, for the first time, to the authors' knowledge, the therapeutic use in humans of low energy, electromagnetic fields pulsing in the extremely low frequency (E.L.F.) range. These fields, established outside the body, were used to treat congenital and acquired pseudarthroses and non-unions. Energy of this type appears to affect biological processes, not through heat production, but through electrically-induced changes in the environment of cells within the organism. Of the 29 patients included in the study, 17 had experienced at least one failure of surgical repair and, in each of these, amputation had been recommended. The overall success rate, including those patients treated with inadequate pulse characteristics and those who failed to follow the protocol, was in excess of 70 per cent. Improvements in the specificity of pulse characteristics hold promise for increasing the rate of success. The simple, clinical methodology, which is conducted on an out-patient basis, appears to be both safe and effective. It can be applied with or without surgery. This approach requires additional controlled investigations before it is ready for general use in the orthopaedic community. The indications for amputation of surgically-resistant pseudarthroses, however, should be reassessed. The principles and technology, which have been established during this endeavor, may have physiologic and practical significance for processes other than pseudarthrosis and non-union.


Selective arterial embolization for hemorrhage following hip arthroplasty. A case is presented in which selective embolization of gelfoam was used to control late postoperative bleeding, developing in a patient following hip arthroplasty. Although primarily used in gastrointestinal bleeding, diagnostic and therapeutic angiography, selective embolization is clearly applicable to postoperative bleeding encountered in orthopedics.


Treatment of pulmonary embolism in total hip replacement. From 1962-73 7,959 total hip replacements were performed by a standardized technique at Wrightington Hospital with 628 (7.89%) non-fatal emboli. Of 603 available for study the effect of different forms of anticoagulant therapy were compared with no therapy. The various antithromboembolic regimens in 295 cases had recurrent emboli in 13 per cent, while without anticoagulant therapy in 308 there were only 3.2 per cent recurrent pulmonary emboli.


The bone mineral content and cortical thickness in young women with femoral neck fracture. The bone mineral content in the shafts of the forearm in 17 women with cervical fracture of the upper end of the femur was low. The cortex of the femoral neck was also lower than normal. Thus women with hip fractures at an early age may have lower than average total skeletal tissue density. This may be due not simply to systemic osteoporosis but possibly to constitutionally thin bone cortices.


Osteoporosis in patients with fractured femoral neck in Jerusalem. In an epidemiological survey on fractures of the femur in Jerusalem, the highest incidence occurred in Oriental males and the next highest in European females. In the same series of patients the frequency of senile osteoporosis was noted to be higher in the Oriental group (both male and female) as compared with that in the European group. Similarly in a randomly chosen sample of the population, osteoporosis in the Oriental sector was twice as high as in the European sector. Osteoporosis was also seen to be three to four times more common in each age group when the fracture series was compared with the randomly chosen sample. No evidence of osteomalacia was noted in these patients.


Compression fractures of the thoracic and lumbar spine from compensable injuries. Compression fractures of the thoracic and lumbar spine have a worse prognosis than is commonly realized. A study of 142 patients with this type of injury reveals several important features which affect the long term prognosis in these injuries. Severe compression, comminution, disc space narrowing adjacent to the fracture site, a low anatomical level of the fracture site, a low anatomical level of the fracture, and body cast immobilization in those with mild or moderate type fractures, are some of the factors associated with persistent long term back problems.


Congenital absence of the lumbo-sacral spine. A report of an unusual case. A 47-year-old woman with complete absence of the lumbar and sacral spine had complete fecal and urinary continence, as well as successful social and functional adaptation without any surgical, prosthetic or rehabilitative assistance.


Ununited fracture of the lateral condyle of the humerus. A 50 year follow-up. This is a case report of a 74-year-old man with an ununited fracture of the lateral condyle of the humerus of 50 years duration. There was minimal loss of motion, a moderate cubitis valgus deformity, and a definite ulnar nerve palsy. Despite the deformity and ulnar palsy, he was able to provide for himself and to perform satisfactorily as a laborer.


The external compression syndrome of the ulnar nerve at the cubital tunnel. Diagnosis of the cubital tunnel external compression syndrome, and subsequent avoidance of further external pressure, minimizes the possibility of progressive crippling of the hand. The usual clinical features are local tenderness over the cubital tunnel, often accompanied by distal paresthesias, and neurological deficit in the ulnar nerve distribution with sparing of the flexor digitorum profundus and flexor carpi ulnaris muscles; the elbow flexion test, described by the author, awaits evaluation in the diagnosis of the syndrome. Clinicians and others concerned with positioning patients on the operating room table or caring for patients in the ward should be aware of the syndrome. Avoidance of a position of the elbow which predisposes to external compression of the cubital tunnel is mandatory and active elbow movement should be encouraged in bedridden and chair-bound patients. Surgical treatment is sometimes indicated, at least to halt progression of the palsy. A classification of the cubital tunnel syndrome is proposed: physiological, acute and subacute due to external pressure (both forming the cubital tunnel external compression syndrome) and chronic (space-occupying lesions and loss of volume due to lateral shift of the ulnar as a consequence of childhood injury to the capitular epiphysis). Nerve conduction studies may be helpful in the diagnosis of the doubtful cubital tunnel syndrome, particularly when there is definite impairment of power or sensation in the hand.


The influence of electric potentials on plated bones. Twenty-seven rabbits were treated with bilateral tibial osteotomy and compression plates. One tibia in each animal received three to 15 microamperes constant direct current for 21 days. The breaking strengths of the stimulated tibiae were higher in 19 animals, as compared to controls (70.4% stimulation rate). The mean value of the additional maximum stress to break the stimulated tibiae was 0.73 kg. Fifteen other rabbits were similarly treated but with electrical stimulation being applied to only one tibia in each animal. There was an increase in endosteal and periosteal callus formation and greater vascularization on microangiography of the callus and the stimulated side. The fissure gap at the osteotomy site was smaller, and bone in the fissure was mature lamellar bone only on the stimulated side. The uptake of fluochromes was greater on the stimulated than control untreated side. Both tibiae in each of five rabbits were doubly fixed with compression plates. A simulated piezoelectric potential was applied to one tibia in each animal. There was a 20 per cent higher calcium and phosphate content of the stress protected cortex, as well as an increased uptake of fluorochormes, in the stimulated tibia as compared to that of the control tibia in three out of five of the animals.


Distal radial fracture with tendon entrapment. A case report. Entrapment of the extensor pollicus longus tendon can occur in distal radial fractures of the Smith type. This can be recognized by failure to obtain good reduction and inability of the patient to extend the thumb after reduction. The treatment is surgical and should be through a dorsal approach which allows repositioning of the tendon and internal fixation of the fracture.


Spontaneous tendon ruptures in patients treated by chronic hemodialysis. Patients with renal failure treated by chronic hemodialysis tend to spontaneous tendon ruptures. In five out of 35 patients, 8 ruptured tendons have been found--four quadriceps and four finger tendon ruptures. Finger tendon ruptures are usually ignored by the patients because of the low disabling factor in the presence of more vital problems. Secondary hyperparathyroidism was found in all patients who had tendon ruptures and may possibly be the major disposing factor. The patients with tendon ruptures in our series were significantly younger than those without ruptures and had been treated for a longer period of time by hemodialysis, indicating that, whatever the reason for the ruptures, it seems to be a time-related phenomenon.


Delayed fracture healing in primary hyperparathyroidism. The incidence of fractures in primary hyperparathyroidism is highly variable. The possibility that there might be an increased susceptibility to fracture is discussed. Healing in most is without delay. Three cases of delayed or nonunion following fracture are presented. In all three, healing accelerated dramatically after excision of a parathyroid adenoma. A pathological fracture secondary to the hyperparathyroidism of parathyroid carcinoma healed after excision of the tumor allowed regression of the osseous lesions. The endocrinologic mechanisms which cause nonunion in a small percentage of cases have not been clearly elucidated.


Rupture of the short head tendon of the biceps brachii. Subcutaneous rupture of the short head tendon of the biceps brachii is a very rare lesion, with only five cases previously reported. The case of a 67-year-old farmer whose tendon ruptured following a mild muscle effort is presented. The degenerative changes revealed by histological examination of the injured tendon were so severe as to lead to the conclusion that its tensile strength must have fallen considerably prior to rupture. The most characteristic clinical signs of this rupture are a sizeable bulge in the middle third of the injured arm, and a hollow in the site normally occupied by the short head of the biceps. Suture of the ruptured tendon to that of the coracobrachialis led to full functional recovery.


Periosteal chondroma.

Periosteal chondroma. Periosteal chondroma is an uncommon benign cartilagenous lesion, and its importance lies primarily in its characteristic radiographic and pathologic appearance which should be of assistance in the differential diagnosis of eccentric lesions of bones. The pathologist must be aware of this tumour because at a histologic level, it may closely resemble a more ominous cartilagenous lesion. He can exclude this lesion in a differential diagnosis of a primary cartilagenous bone neoplasm by familiarity with the clinical and radiological appearance of the lesion. In all cases reported so far, treatment has been that of wide local excision. There are no recorded cases of metastases in follow-up periods ranging up to 8 years after surgery. In those cases where local recurrences were reported, inadequate initial excision is the admitted cause, and subsequent re-excision led to complete eradication of the residual tumour.


Articular cartilage repair. Behavior of rabbit chondrocytes during tissue culture and subsequent allografting. Chondrocytes from rabbit articular cartilage were freed from their matrix by enzymatic digestion. Under appropriate conditions of culture, these cells proliferated through many generations while maintaining their chondrocytic differentiation. They produced a cartilage-like matrix which was studied by histologic, electron microscopic, and chemical techniques. Chondroid tissue from subculture on decalcified bone, allografted into the rabbit knee, repaired a large articular defect in 10 days.


Comparison of regional bone blood flow in areas with differing osteoblastic activity in the rabbit tibia. The relationship between regional bone blood flow (measured using the hydrogen washout method) and regional osteoblastic activity (inferred from presence of osteoblasts on histological sections) was studied in the rabbit tibia. The rate of blood flow in epiphyses with marked osteoblastic activity (0.283 +/- .053 ml/min/ml) was significantly faster than that in epiphyses with minimal activity (0.097 +/- .007 ml/min/ml). Metaphyseal blood flow was significantly faster in areas with marked activity (0.253 +/- 0.040 ml/min/ml) than those with moderate (0.153 +/- .007 ml/min/ml) or minimal (0.126 +/- 0.013 ml/min/ml) osteoblastic activity. Diaphyseal bone blood flow was significantly faster in immature (0.082 +/- 0.005 ml/min/ml) than in mature (0.062 +/- 0.004 ml/min/ml) animals. The results indicate that there is a positive association between regional bone blood flow rate and osteoblastic activity in normal bone.


Osteogenesis imperfecta: biochemical studies of bone collagen. The biochemical properties of tibial bone collagen, obtained from patients with osteogenesis imperfecta, were studied by investigating amino acid composition, subunit composition and crosslink formation. Direct comparison of this bone was made with normal bone, age and sex matched, which had been removed from the tibiae of individuals within 48 hours after accidental death. The amino acid compositions of OI and normal bone collagen were almost identical and the pepsin solubilized collagen fraction as well as the CNBr peptides of insoluble bone collagen were very similar, indicating that no differences in collagen genetic type occurred in OI compared to normal. The crosslink contents and the specific radioactivities of the insoluble collagens were determined following NaB3H4 reduction. The specific radioactivity values of OI bone collagen were found to average 50 per cent higher than normal collagen. Analyses of OI collagen showed abundant formation of the major reducible aldehydes and crosslinks. Compared to the controls there were much higher proportions of the reduced aldehyde, dihydroxynorleucine and the reduced crosslink, dihydroxylysinonorleucine. These results may indicate delayed maturation of crosslinking in OI bone collagen and may reflect diminished stability of such collagen during bone development.


Premature closure of the triradiate cartilage. A case report and animal experiment. Traumatic premature fusion of the triradiate cartilage is a rare complication of fractures of the pelvis in children. Only five cases were reported, leading eventually to subluxation of the hip. A case of premature closure of the triradiate cartilage where the injury occurred at the age of four years is reported. Severe hip subluxation with marked shallow acetabulum and widening of its medial wall was noted at the age of 15 years. Intrapelvic epiphysiodesis of the triradiate cartilage, without disturbing the hip joint, was performed in young rabbits, leading to thickening of the acetabular medial wall and subluxation of the hip. Fusion of the triradiate cartilage in young age leaves the growth plate inside the acetabulum intact, it continues to grow, displacing the acetabulum laterally. As the acetabulum becomes more shallow, the hip progresses to subluxation.


The classification of loose bodies in human joints. A histopathological analysis of 119 surgically excised loose bodies revealed that the cases could be separated into three categories: (1) loose bodies due to synovial osteochondromatosis; (2) loose bodies due to osteochondral fracture; (3) loose bodies due to joint surface disintegration. Three different types of cartilage were identified in the nidus of a loose body--articular, osteophytic, and lobular. Attached bone could be seen from any of the three types of loose bodies but was rare in those specimens secondary to synovial osteochondromatosis. Three mechanisms for the generation of loose bodies in cases of degenerative arthritis or avascular necrosis are proposed: (1) fragmentation of the joint surface; (2) fractured osteophytes; (3) osteochondral nodule proliferation in the pararticular soft tissues. Correlation of the gross and microscopic pathology with the clinical history, roentgenograms and surgical findings usually resulted in a comprehensive understanding of the pathogenesis of any particular case.


The development of loose bodies in human joints. Loose bodies in joints in 119 patients were analyzed histopathologically. A gradual growth in size and configuration of different specimens was due to surface proliferative changes of chondroblasts and osteoblasts. Cartilaginous layering was present in 86.6 per cent of the cases. Osseous layering was present in 79.8 per cent of the cases. Resorption within the new layers of cartilage and bone was manifested both by viable osteoclasts on the surfaces of many specimens and previously formed resorption cavities which had been refilled by the layering phenomenon. Refilled resorption cavities were present in 68.1 per cent of the cases while osteoclasts were observed in 49.6 per cent. It is proposed that osteoblastic and osteoclastic differentiation and function is not dependent upon a blood supply since the specimens from the 119 cases were free of any synovial attachments. Revascularization which occurred when free osteochondral bodies became reattached to the synovium was a distinct process that was differentiated from the accretion and resorption that was observed in the free specimens. Calcification occurred within the necrotic portions of both the nidus and deeper new layers of any particular specimen. Dystrophic calcification was observed histologically in 91.6 per cent of the cases.


Meniscal regeneration and postmeniscectomy degenerative joint disease. The failure of meniscal regeneration via a fibrous semilunar mold can be correlated with an increased incidence of degenerative joint disease. Experiments on rabbits revealed a statistically significant relationship between the failure of meniscal regeneration and the development of degenerative joint disease, characterized by osteophyte formation, cartilage pitting and erosions, and loss of carbilage proteoglycan. Similar results in limited studies utilizing adult fox hounds supported this observation. In dogs, variation in the extent of tissues resected about the meniscus, including synovectomy, did not inhibit the reformation of a fibrous semilunar mold. No specific "zone of regeneration" responsible for meniscal regeneration was identified.


Leaching out from acrylic bone cement. Experimental evaluation. Using common salt and C.M.W. bone cement mixture with Barium it has been shown that even with relatively high concentrations, only a small proportion of salt is released. This release seems to be a purely surface phenomenon and the amount released is directly proportional to the surface are of the cement. If a water soluble antibiotic and NaCl are released from the bone cement by a comparable mechanism, the inclusion of antibiotic/methylmethacrylate is difficult to justify in clinical practice.


Electrical stimulation of osteogenesis in periodontal defects. Although the literature on bioelectrical phenomena is extensive, there is a paucity of research on its application in the field of dentistry. This study was designed to evaluate the effect of bioelectric phenomena on pathological osseous defects in the periodontium of Beagle dogs. Galvanic and thermocouple generators were designed to deliver a current in the nanoampere range. The galvanic unit implanted in the area of periodontal osseous defects in five dogs. These sites were randomly designated as experimental, active controls, and passive controls. The experimental and control units were implanted submucoperiosteally with the negative electrodes extending into the osseous defects. The bone was labeled with Procion Red H-8Bs at one week. Clinical and radiographic evaluation revealed no significant changes in the depth of the defects. The animals were sacrificed at 45 days and block sections were prepared. Histological measurement suggested that endosteal apposition was enhanced in all experimental sites as compared to controls. The results were discussed in relation to magnitude of current used, the influence of pathological bone, the potential of each type of experimental unit for clinical use, and the direction of further research in the area.


Electrical callus and callus formation by electret. The callus formed by passing an electric current through bone is called electrodynamic callus. The amount of electrical current determines the quality of the callus (osseous, cartilagenous, or fibrous). Callus forms first at the negative pole and grows toward the positive pole. The callus formed by placing a teflon film electret near the surface of bone is called electrostatic callus. The amount of this callus is larger when the bone is wrapped by the electret film than when the film is laid over the bone.


Electret induced callus formation in the rat. Wrapping the mid-femoral shaft of the rat with a Teflon film electret produced a bony callus in 9 out of 10 animals. This model of electret-induced callus formation should lend itself to the histo-biochemical study of electrically induced osteogenesis.


Cranial nerve injury from halo traction. Six of the 70 patients treated with skeletal traction at the Alfred I. duPont Institute exhibited cranial nerve complications. The sixth cranial nerve was most commonly affected by distraction and resulted in weakness in lateral gaze. A combined lesion of the ninth, tenth and twelfth nerves was not an infrequent complication and presented as abnormalities in swallowing, quality of speech, and of tongue movement. It has not been singled out for its significance in the literature but it is potentially the most lethal of the complications. From our review it appears that patients who have had radiation treatment and who have presented with myelomeningocele experience a higher risk of complication in cranial skeletal traction. A definite clinical-pathological correlation could not be made. Frequent monitoring of the patients in skeletal traction is necessary, and prompt recognition of the clinical signs of these complications must be stressed. The complications in the patients of our series subsided upon release of the distraction force.


Spinal cord monitoring during operative treatment of the spine. Twenty-six orthopedic and 8 neurosurgical patients undergoing spine surgery had spinal cord monitoring before, during, and after operation using somatosensory, averaged cortical evoked responses. Although no inherent risks were apparent in the technical application of this form of spinal cord monitoring, there are limitations that have yet to be evaluated. Classically, somatosensory evoked responses have been considered a function of the posterior columns; however, the results of these studies indicate that more than the function of the dorsal columns alone can be evaluated with this technique. In addition, much remains to be learned regarding the changes in signals noted and the corresponding clinical conditions. Techniques more sophisticated than visual evaluation of response patterns must be established and more sophisticated methods of analysis must be developed. Despite the need for more knowledge of the nature of this system and the correlation between evoked responses and clinical conditions, the system has proved to be effective and to have great potential for improving spine and spinal cord surgery.


Studies on skin fibroblasts of patients with idiopathic scoliosis. Previous examinations of skin biopsies suggested that connective tissue may be abnormal in patients with idiopathic scoliosis. The fibroblast culture system has proven a powerful technique for approaching many diseases of known connective origin, and therefore, seemed an appropriate method with which to study scoliosis. Present observations on collagen synthesis, skin collagen extractability, and glycosaminoglycan (GAG) synthesis and degradation appear normal. Idiopathic scoliosis does not prove to be a generalized connective tissue disorder. While factors other than collagen and GAG metabolism seem not to be at fault, other possibilities seem not to be taken into consideration by basic research on the spinal column: genetics, biochemistry, and physiology.


Combined biochemical and clinical investigation of chemonucleolysis failures. To attempt to understand the etiology of failures of chemonucleolysis, biochemical analyses were performed on intervertebral disk material to determine if the enzyme had actually digested the nucleus pulposus proteoglycans. This information was then correlated with the clinical laboratory data to see if a pattern evolved for the failures. Nine chymopapain treated disks, 6 untreated herniated disks and 6 lumbar disks from scoliotic patients were obtained at surgery. The results indicated that 6 out of 9 patients treated with chymopapain had a marked reduction in the proteoglycan (hexosamine) content of their disk compared to the untreated controls. There was a significant inverse correlation of intrinsic lysosomal enzymes and hexosamine content in those cases where the chymopapain failed to destroy the proteoglycan. The other 3 patients, however, had hexosamine levels virtually identical to those disks not treated with chymopapain. The clinical evaluation, consisting of preoperative myelograms, diskograms, the surgeon's observations at laminectomy and evaluation of the postoperative regimen did not explain the failures. This study suggests that the chymopapain failures are not the result of inactivity of the enzyme or failure to digest the nuclear material in at least 6 of the 9 cases. However, there were 3 patients where either the enzyme was not reaching the nuclear material or it was inactive.


Osteochondroma of the cervical spine. Case report. Only 1 well-documented case of osteochondroma in the posterior elements of the cervical spine has been previously reported. Although unusual, osteochondroma should be considered in the differential diagnosis of benign appearing tumors in the cervical spine.


Congenital pseudarthrosis of the clavicle. This is a report of 5 cases of congenital pseudarthrosis of the clavicle, a rare disorder of the shoulder girdle. Little more than 100 cases have been reported in the literature; 3 of our 5 cases represent a very rare form of left side involvement with dextrocardia. The pseudarthrosis mass generally protrudes under the skin and may need surgical correction. When unilateral, there is marked and unexplained predominance for the right side. Three cases required no treatment; 2 were successfully treated by excision of the bone ends, bone grafting and internal fixation.


Jefferson fracture with disruption of the transverse ligament. A case report. A 20-year-old male incurred a vertex injury of the skull, disruption of the transverse ligament of the atlas, and a Jefferson fracture--lateral displacement of the lateral masses of the atlas in relation to the lateral margins of the second cervical vertebra. The combination of Jefferson fracture with transverse ligament disruption was not appreciated initially (or even late) because of the head injury. The hospital course was complicated by the patient's initial unconsciousness and restlessness caused by associated intracranial injury. Roentgenograms in all views of the cervical spine were essential to its recognition and had to be carefully examined. Laminograms of the cervical spine showed a small anterolateral fragment on the right at the location of the tubercle attachment of the transverse ligament. Surgical stabilization is essential in this complex injury to protect the spinal cord from damage by subluxation and/or dislocation at the C1-C2 interval. Posterior cervical fusion of C1-C2 was performed at 4 1/2 weeks postinjury to allow time for healing of the ring of the atlas.


Coxa vara, avascular necrosis and osteochondritis dissecans complicating solitary bone cysts of the proximal femur. In 2 children with cysts in the upper end of the femur, there were 3 complications: coxa vara, avascular necrosis and osteochondritis dissecans. Coxa vara occurred in both cases and was due in 1 case to pathological fracture, and in the other case to growth disturbance. Avascular necrosis of the femoral head, a hitherto unreported complication of bone cyst of the upper end of the femur occurred in 1 patient following pathological fracture and resulted in osteochondritis dissecans of the femoral head.


Anatomy of the achondroplastic lumbar canal. The narrowed bony canal in the achondroplastic spine cases varied neurologic problems. The specific anatomic areas seem not to have been directly measured in an autopsy specimen. An achondroplastic spine was examined radiographically and found to show decreased interpediculate distance, thick pedicles, inferior facet thickness, and for animal stenosis in the lumbar canal. These findings have direct application to surgical treatment insofar as simple laminectomy for achondroplastic dwarfs may be insufficient to produce neural canal decompression. The problem is likely to require thorough exposures of facets and foramen.


Study of wrist motion in flexion and extension. During flexion and extension of the wrist, the total range of motion is determined by the radiocarpal and the midcarpal joints. The angular contribution of each carpal row has been differently quantitated by previous investigators. A radiographic investigation of the wrist motion in flexion and extension was undertaken in 55 normal wrists to determine the contribution of the radio--carpal and mid carpal joints. The angular relationships of the radial and carpal components were also analyzed. In neutral position, the lunate and capitate are coaxial with the radius in a small percentage: lunate 11%, capitate 16%. In neutral position, the radio--lunate, lunate--capitate angles neutralize each other in a zig-zag manner in only 11%. During maximum flexion, the motion is 40% radio--carpal and 60% mid carpal. During maximum extension, the motion is 66.5% radiocarpal and 33.5% mid carpal. Functionally the scaphoid belongs to the 1st carpal row in flexion and to the second row in extension.


Osteoid osteoma in a distal radial epiphysis. Case report. The distal radial epiphysis is a very unusual location for osteoid osteoma. Curettement resulted in symptomatic and radiographic resolution of the tumor.


Early spica cast management of femoral shaft fractures in young children. A technique utilizing bilateral fixed skin traction. A review was made of 20 of 27 consecutively treated patients under 9 years of age with femoral shaft fractures treated by early application of bilateral fixed skin traction spica cast. The patients were re-evaluated two or more years after treatment, clinically and radiologically. All patients were asymptomatic and unaware of any disability. Orthodiagrams revealed no disparity of leg length greater than 7 mm. Residual anterior bow of 12 degrees was present in two patients and in 5 rotational malalignment of 10 to 20 degrees was present. As compared with results treated in traction, this method provides improved length control, comparable control of angular and rotational alignment and considerably shortened hospital stay. The technique should only be used by experienced, careful orthopedists in individually selected cases.


Prevention of the development of the typical dislocation of the hip. Applying a diaper and baby clothing without changing the naturally flexed leg requires education of mothers and nurses. Retaining the flexed position which is present from the very beginning of postnatal life, markedly reduces the incidence of click sign. A program on neonatal diapering, clothing, and general care, reduced the incidence of congenital dislocation of the hip in 3 to 7 months old infants in a sample population of 200,000.


The etiology of idiopathic scoliosis.

The etiology of idiopathic scoliosis. A multiple-factor approach to the puzzling diagnosis of idiopathic scoliosis is presented in an effort to shed some light on the ever-pervasive shadows of the unknown. Each factor, i.e., nutrition, hormonal influence, genetic tendency, and spinal mechanics, is discussed in detail and with excerpts and summaries from substantive recent literature are presented. Research in molecular chemistry, enzymes, coenzymes, genes, proteins, hormones, etc., at last is beginning to reveal secrets to those who have persevered in the laboratory. It would appear that a relatively minor deficiency in the disk collagen can cause the idiopathic scoliotic development in the spine. A nutritional deficit during the vulnerable growing years (hormonal influence) may initiate the scoliotic process, with the genetic tendency being a recessive factor. Thereafter, given the initial deficit, the spine has no choice--it must react to force, time and direction (mechanics of the spine)--and ultimately produce scoliosis.


Recurrent Legg - Calve - Perthes' disease. A case report. This is a report of the fifth known case of recurrent Legg--Calve--Perthes' disease. Roentgenograms of the hips after the first avascular episode, at the age of 3 years and 6 months resemble to a certain extent, Dysplasia Epiphysealis Capitis Femoris.


Anaerobic infection after total hip replacement. Report of three cases. In a series of 387 consecutive total hip replacements there were nine infections (2.3% infection rate). Three of the infections were caused by an anaerobic gram positive cocci, Peptococcus. This is an increased incidence of infection for this previously rare pathogen. The anaerobic infections occurred despite prophylactic antibiotic coverage with Keflin. No causative factors such as hospital, operating time, operating personnel, medical disease, or blood loss could be associated with the observed anaerobic infections. Two of the anaerobic infections appeared late. This is consistent with other reports of anaerobic infections in implants. Drainage after total hip arthroplasty operation must be cultured for anaerobes as well as aerobes, especially late infections in patients on prophylactic antibiotics. Drainage which is sterile to aerobic culture should alert the physician to a possible anaerobic infection.


Sciatic nerve paralysis in posterior dislocation of the hip. A case report. This is a case report of a 19-year-old male with an unusual case of a complete sciatic nerve paralysis which happened during the treatment of posterior dislocation of the hip. It was presumed that open reduction played a role of a trigger for the sciatic nerve palsy; because an almost complete recovery was obtained by release of the nerve from the ectopic bone mass, it is reasonable to assume that paralysis developed from massive ectopic bone formation around the nerve.


Removal of methylmethacrylate in failed total hip arthroplasties. An improved technique. Extraction of methylmethacrylate from the proximal shaft of the femur following failure of total hip replacement arthroplasty can be accomplished efficiently by osteotomy of the greater trochanter and the use of variable sized carbide drills and a long flexible penlight.


Results of posterior iliopsoas transfer for hip instability caused by cerebral palsy. The incidence of subluxation or dislocation of the hip in 185 cerebral palsied patients was 25.4%. Posterior iliopsoas transfer will decrease hip deformities but complications such as weakness of hip flexion or abduction contracture are to be expected in some cases. Posterior iliopsoas transfer did not give uniformly satisfactory results; 9 out of 17 patients were fair to poor even combined with innominate osteotomy and/or versus derotation osteotomy of the femur. Early prophylactic surgery of lesser extent such as adductor release is desirable since treatment of established subluxation or dislocation is often unsatisfactory.


Avascular necrosis of the femoral head in children under the age of three. Avascular necrosis of the femoral head in very young children may be secondary to traumatic, septic, metabolic, iatrogenetic causes. In most cases, however, the etiology is unclear and generally described in the orthopedic literature in ambiguous terms. Radiologically, the femoral head ossification center may be condensed, deformed or fragmented. Etiologically, the cases placed in 3 groups: idiopathic osteochondritis of the femoral head or early discovered Perthes' disease; dysplasia capiti femoris or a malformation belonging to the group of spondylo epiphyseal dysplasia; deformation of the femoral head through malposition such as C.D.H. Though it is a typical complication of the treatment of dislocated hips, avascular necrosis may occur in association with untreated and even mild subluxation.


Transient monoarticular synovitis of the hip joint in adults. Clinical, laboratory, and radiological investigation of 6 cases of idiopathic monoarticular adult hip synovitis demonstrates that unlike the syndrome in children, in the adult the onset is very acute, short in duration, and followed by a short tapering off period with no sequelae to date. The ESR is the best index of the severity and course of the illness. Hip aspiration is of diagnostic value. Viral etiology was suspected, but not proven. Recognition of this syndrome in the adult will prevent an unnecessary arthrotomy for "septic arthritis" of the hip joint.


Kinesiologic measurements of functional performance before and after geometric total knee replacemtn: one-year follow-up of twenty cases. Kinesiologic measurements were made in patients with severe arthritis before and after geometric total knee replacements to evaluate the nature, rate and extent of change in their functional ability. Preoperatively, patients with rheumatoid arthritis functioned at lower levels than patients with osteoarthritis. Most patients with rheumatoid arthritis improved steadily after surgery, while progress of those with osteoarthritis was often irregular. The group with rheumatoid arthritis improved more than those with osteoarthritis, but they did not generally reach the functional level attained by the patients with osteoarthritis, and neither group reached the lower limits of normal variability 1 year postoperatively. On the average, both groups gained knee extensions, lost knee flexion, and gained isometric knee flexor muscle strength postoperatively. Every patient with osteoarthritis lost extensor muscle strength 1 year after surgery, while most with rheumatoid arthritis gained. During quiet standing, most patients had straighter knees postoperatively and bore a greater percent of body weight on the operated limb. Patients with rheumatoid arthritis improved more than patients with osteoarthritis in the type and amount of force applied to canes and crutches. Most patients walked faster postoperatively, took longer and more rapid steps, improved the pattern of knee motion used, and had smoother forward, lateral and vertical head motion.


Excision of the cruciate ligaments in total knee replacement. The cruciate ligaments (and the intercondylar eminence of the tibia) should be removed when the knee is replaced. A mechanically unlinked prosthesis can be designed which will then be capable of restoring "cruciate" stability, i.e., anteroposterior stability of the tibia in the flexed knee. A knee replaced with such a prosthesis will only be stable if the prosthesis is inserted using the correct instruments and technique. Stability depends as much on precise surgical technique as it does on prosthetic design.


The Fabella Syndrome.

The Fabella Syndrome. The Fabella Syndrome is recognized by a sharp pain, local tenderness, and intensification of pain in the area of the fabella by full extension of the knee. After diagnostic tests with local anesthesia and ineffective conservative treatment, surgical extirpation may produce lasting relief of symptoms.


The dashboard knee injury.

The dashboard knee injury. An in-depth study of 74 motor vehicle accidents involving 222 people revealed that 57 of the 153 people injured sustained 69 knee injuries from contact with the instrument panel. There were 51 mild, 10 moderate, and 8 severe knee injuries. Low force contact caused bruising, and more serious injuries occurred when a greater magnitude of force was applied. Injury was most severe when this force was concentrated in a small area and caused lacerations, fractured patella, and open wounds of the joint. Legs trapped under the dashboard with simultaneous rotational, varus, valgus, or frontal forces by the inertial motion of the body produced serious injuries similar to those recieved in sports. Degenerative arthritis was more likely to occur in the seriously injured knees, but generally was not predictable. Long-term disability might be mitigated by early diagnosis and treatment of the specific injury.


Diastasis of the tibiofibular mortise, hypoplasia of the tibia, and clubfoot, in a neonate with cleft hand and cardiac anomalies. A case report. In a newborn girl diastasis of the distal tibiofibula joint was associated with cleft hand deformity, and cardiac anomalies. While at least 3 cases of congenital distal tibiofibular diastasis have been reported previously, this patient seems to be the first to have had hand and cardiac defects. The diastasis is believed to be secondary to tibial hypoplasia. The initial presentation was that of an apparent clubfoot deformity and emphasizes the point that roentgenograms of all equinovarus deformities in the newborn should be mandatory.


Talonavicular coalition.

Talonavicular coalition. The diagnosis in 4 symptomatic cases of talonavicular coalition was made from anteroposterior roentgenograms of the feet. The pedigrees suggested a recessive mode of transmission. There were no associated anomalies of the hand.


Extra-articular arthrodesis of the subtalar joint: a clinical study and review. A series of 73 Grice extra-articular arthrodeses in 54 children with hind foot valgus is presented with an overall satisfactory result in 79% of these cases. The diagnostic categories in which we have used this procedure include: cerebral palsy, poliomyelitis, meningomyelocele, pes plano valgus, convex pes valgus, osteogenesis imperfecta, congenital hydrocephalus, partial adactylia, and congenital calcaneovalgus. The results with 11 meningomyelocele deformities are encouraging as only 2 of these children required a triple arthrodesis; 5 out of 6 patients in whom the opposite foot could serve as a control developed a smaller foot on the opposite extremity as a result of this procedure. This operative procedure was considered definitive treatment in 47% of the cases (264 operative feet) and produced satisfactory results in 74% of the cases (573 operative feet) reported in the literature.


Allescheria boydii osteomyelitis following multiple steroid injections and surgery. This is a report of a 46-year-old male who developed an Allescheria boydii infection secondary to excision of an interdigital neuroma. Previously reported cases of infection occurred in an immunosuppressed patient and in patients on systemic corticosteroid therapy, but not associated with a surgical wound. This patient received multiple local corticosteroid injections which may have produced local as well as systemic immunosuppression. Fungal cultures were not taken for many months and thus the true etiology of the infection was not discovered until late. The importance of obtaining fungal cultures particularly in patients receiving corticosteroid therapy, either local infiltration or systemic, cannot be overemphasized.


External rotational deformities in club feet. External rotation of both a structural and functional nature occurs in the lower limb of some patients with club feet. These external rotational deformities are due to two unrecognized and untreated combined deformities within the hindfoot and mid-foot: hindfoot varus and talo-navicular subluxation. If allowed to persist, they will eventually produce external rotation above the level of the ankle. This results in a condition that may be named "The Medial Malalignment Syndrome."


Biomechanical gait analysis of the diseased knee joint. Clinical and roentgenographic examinations do not provide objective information on the functional performance of a diseased knee joint. In the present study, biomechanical parameters of knee joint function for 95 patients (162 knees) with rheumatoid arthritis and degenerative joint disease were studied in a gait laboratory and compared with those for 29 normal subjects. Gait abnormalities of the patient groups were significant and were related more to the functional status of the knee than to patient age and sex or the specific diagnosis. Knee joint disease produced an inefficient gait that seemed to mitigate joint pain (by reducing poorly tolerated compressive forces on the joint) and to increase proprioceptive feedback (in order to increase dynamic muscular control of the unstable joint). Biomechanical parameters were statistically correlated with some clinical and roentgenographic features to allow standardization of functional assessment of the diseased knee joint.


Salmonella spondylitis. Report of 2 cases. Two cases of Salmonella spondylitis with unusual features appeared in patients who have no sickle cell disease and no history of typhoid fever. One case presented with paraparesis, was misdiagnosed and originally treated for Pott's disease. The other case was diagnosed correctly by specific laboratory tests, but failed to respond to the conventionally accepted conservative antibiotic treatment and required surgical excision and drainage. Salmonella spondylitis with paraparesis may not have been reported heretofore.


Progressive infantile idiopathic scoliosis. Infantile idiopathic scoliosis is unique in that it differs considerably from idiopathic scoliosis seen in the older child. Early recognition of the progressive type is essential if serious deformity is to be prevented. Treatment must be aimed at controlling the curvature by serial casts and the Milwaukee brace to support the spinal column  without interference with the local mechanics of growth. Most children eventually require spinal fusion, but this should be delayed until early adolescence. If a curvature cannot be controlled satisfactorily, however, surgical fusion may be indicated earlier than desired. Never should a curve be allowed to progress beyond 60 degrees. Two cases are presented to illustrate these principles.


Aggressive chondroblastoma. Report of a case with multiple bone and soft tissue involvement. A 14-year-old male had a recurrent chondroblastoma in his right talus which involved the right calcaneus and the soft tissue of that ankle. While the initial lesion had a typical, benign appearance, the recurrent lesion and the soft tissue nodules showed a significantly elevated mitotic rate. Although some extraosseous involvement by chondroblastomas may be secondary to soft tissue or hematogeneous seeding at the time of surgery, and aggressive variant of chondroblastoma appears to exist. Previous reports of these aggressive cases show a poor correlation between histologic appearance and biologic behavior. When objective quantitation of cytologic features such as mitotic rate are made, we believe that these features may serve as a marker for identification of those cases of chondroblastoma which have a propensity for aggressive behavior.


Histochemical demonstration of adrenergic fibers in the fascia periosteum and retinaculum. Adrenergic nerve fibers were demonstrated in the fascia, periosteum and retinaculum using the formaldehyde method of Falck--Hillarp and the recently developed glyoxylic acid method. A typical adrenergic plexus was seen around the vessels. The arteries and arterioles received a dense adrenergic nerve supply. The veins had a sparse adrenergic innervation and the venules and capillaries were apparently without adrenergic innervation. These distribution patterns of adrenergic fibers were fundamentally similar to those seen in various organs. A difference in the pattern of innervation was seen, however, in the arterioles betweeen the fascia, and periosteum and retinaculum. Furthermore, chemical sympathectomy induced by injection of 6-hydroxydopamine resulted in the disappearance of noradrenaline fluorescence and marked vasodilation in the fascial vascular bed, and a moderate vasodilation in the periosteum and retinaculum. These findings suggest that the role of adrenergic fiber is vasoconstrictor and these fibers regulate the circulation in the fascia, periosteum and retinaculum.


Osteoid osteomas in siblings. Case reports. Osteoid osteomas occurred in siblings with a nearly simultaneous onset of symptoms, and with some unusual neoplastic characteristics. The combination of simultaneous occurrence and neoplastic change suggests that a viral or other infectious etiology is possible.


Glycosaminoglycans and endochondral calcification. Present controversy about endochondral calcification and ossification is concerned with changes in glycosaminoglycans. Some authors report a rise in amounts of glycosaminoglycans while others a fall. Cartilage was carefully sliced under microscopic control to provide samples of material from different functional zones of the developing tissues. The following zones were studied histochemically and analyzed for their content of total nitrogen, hydroxyproline, total hexosamines, uronic acid and phosphorus: the resting zone; the zone of proliferating and maturing cells; the calcifying zone, characterized by degenerating hypertrophic cells and early mineral deposition; the ossifying region, where early bone formation takes place. Serial analyses provided evidence that glycosaminoglycans increases before calcification starts. Afterwards, part of the glycosaminoglycan content is removed. This biphasic process appears to occur during the calcification of other tissues too, such as secondary bone and dentine.


The reversibility of disuse osteoporosis. Fluoride treatment and bone strength. The biomechanical strength of femur of adult rats was tested after immobilization for 9 weeks and remobilization for 12 weeks of 1 hind leg. Some rats were also given a fluoride supplement of 200 ppm in the drinking water. As reflected in the ultimate torque and stiffness there was a decrease in bone strength due to immobilization. After 12 weeks of remobilization the stiffness remained lower than in normal animals of the same age. Fluoride supplement partially counteracted the effect of immobilization but after the remobilization period no positive effect of the fluoride supplement was observed. Remobilization per se is of much more significance than fluoride in restoration of bone strength.


Effect of salicylate therapy on cartilage destruction in experimental pyarthrosis. An experimental rabbit pyarthrosis model was utilized to investigate the effects of sodium salicylate therapy on cartilage destruction. Animals were innoculated with 10(3) organisms of Staphylococcus aureus 502A. The opposite knee was injected with sterile saline. Infection was documented 48 hours post innoculation, procaine penicillin therapy initiated, and the adequacy of therapy evaluated at sacrifice. One half of the animals began salicylate feedings one week prior to injection and this continued until sacrifice at 14 or 49 days. Salicylate levels were 12.5 +/- 6.9 mg %. There was a significant loss of cartilage in both the salicylate treated and untreated animals. The levels of salicylate obtained in this study were not protective to cartilage in a septic joint.


Bone collagen in dysbaric osteonecrosis. Experimental dysbaric osteonecrosis associated with inadequate decompression has been induced in mature female swine. The bone collagen from the radiologically defined lesion in the femur has been analyzed. The total collagen contents were the same for the epiphyseal (F-1), the metaphyseal (F-2), and the diaphyseal (F-3) regions. Soluble bone collagen content obtained by sequential extraction of the samples with acetic acid urea, guanidine, lithium chloride and potassium thiocyanate, decreased by approximately 20% in going from the F-1 to the F-2 to the F-3 regions for both experimental and control samples. The amino acid compositions and acrylamide gel electrophoresis patterns were the same for control and experimental samples. Spectral changes with the MBTH reaction were different for control and experimental collagen samples from all bone regions. The spectral shift and pattern changes which occurred from pH 4 to pH 1 suggested a higher average content of unsaturation in the collagen associated aldehyde groups in the experimental than in the control samples. These findings suggest an enhanced ability to remodel collagen which would be consistent with the histological observation of increased derangement of collagen fibers in the experimental bone samples.


Screening for spinal deformities in Minnesota schools. Early detection of spine deformities by school screening has proven to be an effective mechanism for early diagnosis. The forward bending test is a simple rapid method of detection and has been used in the Minnesota State screening program. Screening in Minnesota began in 2 rural communities and spread to include the whole state. Over 570,000 children have been screened to the end of the 1975/1976 school year. The prevalence rate of 4.0% of rational prominences is the same as that found in other screening programs. The findings of a large number of small curves and the nearly equal sex ratio were unexpected, but reflect the recent literature. Even though a large number of normal spines are referred for physician evaluation by the screening, the benefits are great. The curves are detected when they are small, allowing progressive deformities to be detected early, promptly braced and deterioration prevented. The need for future surgical correction is thus decreased. The routine screening in Minnesota of school children for spine deformities has proved to be an effective method for the early detection of spine deformities. The screening test is rapid and easy--"a 30-second investment for a lifetime of dividends."


Scoliosis prevalence: a call for a statement of terms. Recently published prevalence studies of scoliosis reveal a disconcerting variability, largely due to the use of different diagnostic "cutting points", which are frequently unstated. A statistical analysis of the prevalence of moderate and severe scoliotic curves shows that the distribution of scoliotic curves conforms best to a log normal distribution. Using this analysis, and using 10 degrees as the "cutting point" for the diagnosis, the adolescent scoliosis population consists of approximately 25 per 1,000.