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The bowed appearance of the lower extremities is most often caused by internal rotation of the tibia in relationship to the femur. It is most commonly seen as the infant commences ambulation. This so-called physiologic bowing usually spontaneously resolves with growth and the maturity of the lower extremities. In older children, tibia varum may occur, in which there is a local arrest of growth on the posterior medial aspect of the tibia producing a true structural angulation. In certain long-standing metabolic or genetic bone disorders, the effects of weight bearing produce a true bowing of the extremities with changes about the hips, knees, and ankles. The most important aspect in the evaluation of a child with a bowed appearance of the lower extremities is to determine which conditions require aggressive treatment and which ones require simply giving the parents reassurance that the condition will spontaneously regress.

The absorption of Novantrone (Mitozantrone), Adriamycin (Doxorubicin Hydrochloride), Cerubidin (Daunorubicin) and methotrexate to 0.2-microM endotoxin-retentive end-line filters was studied under simulated infusion conditions. The drugs were injected into a burette containing saline and then infused using an infusion pump set at 100 ml/h or 80 ml/h. Filtrate samples were collected over a total period of 2.5 h and assayed spectrophotometrically. Recovery of all four drugs following filtration was 96% or greater; indicating absence of absorption by the end-line filters used.

Platelet-aggregating factor (PAF) was removed from bovine plasma by human platelets fixed with 2% formaldehyde. The degree of adsorption was directly related to the platelet concentration and the length of incubation. Fixed washed platelets (FWP) aggregated with bovine plasma could be deaggregated by 1M KCl, Evans blue, and 8M urea but not by beta-galactosidase. Incubation with 1M KCl eluted some but not all of the PAF, as the deaggregated platelets spontaneously aggregated upon removal of the deaggregating conditions. Also, fixed platelets adsorbed PAF even in the presence of 1M salt or after treatment with Evans blue. Platelet aggregation was not affected by thrombin (20 micron/ml) but was abolished by trypsin at concentrations as low as 4 X 10(-1) microgram/ml. The data suggest that deaggregation is not the result of elution of the loosely bound aggregating factor from the platelet surface, but rather the disruption of noncovalent interplatelet bridging between one or more PAF molecules bound to a specific receptor.

A clinical study of 62 patients with Duchenne Muscular Dystrophy has suggested 2 pathways in the pathogenesis of the spinal deformities. In the first pathway, the patients develop an initial kyphosis due to the loss of paravertebral muscle thus placing the intrinsic ligamentous spine in an unstable position. The spine then develops a lateral curve accentuated by pelvic obliquity. In the final form, axial rotation of the spine and pelvis occurs to produce a severe deformity. In the second pathway the intrinsic spine assumes the more stable position of hyperextension with a level pelvis. This position remains relatively unchanged during the period of wheelchair confinement even though muscle deterioration progresses. A significant increase in the severity of the deformity occurs with age in those patients with unstable spines. None of the other factors examined affected the severity of the lateral curvature. A spinal brace has been designed to keep the spine extended and the pelvis level while the patients sits in his wheelchair. The purpose is to encourage the inexorable progression of muscular deficiencies to follow the second pathway. Various modifications of wheelchairs also may help to maintain spinal stability.

In a clinical and roentgenographic study of spinal deformities in sixty-two patients in the later stages of Duchenne muscular dystrophy, many patients had marked scoliosis and kyphosis, while others with hyperextended spines had comparatively little scoliosis. Based on an analysis of the data, it is suggested that the development of spinal deformity in patients with Duchenne muscular dystrophy may progress in two ways: one leading to the early establishment of a position of extension and a maximum intrinsic stability with minor deformity, and the other leading to progressive deformity. It was concluded that management for these patients should be designed to guide the early straight spine toward the late extended pattern by attempting to prevent kyphosis and pelvic obliquity.

Spinal tuberculosis with paraplegia, although decreasing in incidence, remains a problem in certain sections of the United States and in most underdeveloped nations. Evacuations of the tuberculous abscess, debridement of necrotic bone, and fusion of the anterior spine are maneuvers performed increasingly by thoracic surgeons. Twenty-two patients with Pott's disease and symptoms of back pain, gibbous deformity, and neurological deficit underwent thoracotomy. Nine were paraplegic prior to operation. Postoperatively, spinal fusion occurred in all cases. All paraplegic patients can walk now, and 17 of the 22 treated operatively have been completely rehabilitated and are in school or working. The average hospital stay was 2.4 months. There was 1 operative death. Medical treatment for Pott's disease consisted of bed rest and chemotherapy and resulted in progressive neurological deficit in 2 patients with an average hospital stay of 2.2 years. We believe operative treatment offers two distinct advantages: excellent reversal of even long-standing paraplegia and markedly shortened hospital stay.

Rectal temperature was recorded from 22 mares at 0700, 1500 and 2300 h daily for seven days pre-partum and one day post partum. A circadian variation in rectal temperature was present with the lowest temperature recorded at 0700 h. Because of this, the mares were divided into three groups based on time of parturition; those foaling between 0700 and 1500 h (n = 2); between 1500 and 2300 h (n = 13); and between 2300 and 0700 h (n = 7). On the day prior to delivery (Day -1) the circadian pattern was absent because the nocturnal increase did not occur. A significant decrease in temperature was recorded prior to parturition in the group foaling between 1500 and 2300 h. A distinct decrease in temperature occurred in the majority of mares in the other two groups but this was not statistically significant. After parturition, rectal temperature increased to supranormal levels before returning to normal.

We report a 59-year-old woman who developed massive, painless ascites attributed to systemic lupus erythematosus. Extensive investigations, including exploratory laparotomy, failed to demonstrate hepatic, renal, cardiac, infectious, or malignant disease. Therapy with systemic corticosteroids resulted in dramatic disappearance of ascites which has not recurred after 2 years.

There is considerable difference in the management of musculoskeletal injuries in the pediatric athlete. The biomechanical characteristics of the growing bone react differently to applied stresses. Plastic deformation, green-stick, torus, and epiphyseal fractures are types seen only in the pediatric age group. The pediatric athlete fortunately has a much greater remodeling capacity, thus, altering the approach to the treatment of injuries. An understanding of the different types of injuries in the skeletally immature athlete is essential for those treating this age group.

Treatment of murine peritoneal exudate macrophages (PEM) by tumor-promoting phorbol esters (TPA) results in a rapid loss of binding activity to radioactive-labeled colony-stimulating factor ([125I]-CSF-1) on the cell surface. The inhibitory effect of TPA on PEM is transient; treated cells recover full [125I]-CSF-1 binding activity in less than 6 hr at 37 degrees C either in the presence or after the removal of added TPA. The role of phorbol ester receptors in the induction of [125I]-CSF-1 binding inhibition was studied. The biologically active ligand [3H]-phorbol 12,13-dibutyrate ([3H]-PDBu) bound specifically to cultured murine PEM. At 0 degree C, stable and equilibrium binding occurred after 2-3 hr. Scatchard analysis revealed linear plots with a dissociation constant and receptor number per cell of 20.9 nM and 3.9 X 10(5)/cell, respectively. Treatment of PEM with biologically active phorbol esters at 37 degrees C rapidly inhibited the binding activity of [3H]-PDBu on cell surface (down-regulation) and rendered these cells refractory to the TPA-induced [125I]-CSF-1 binding inhibition by the subsequent TPA treatment. The inhibition of phorbol ester binding activity on TPA-treated PEM is caused by a reduction in the total number of available phorbol ester receptors rather than by a decrease in receptor affinity as judged by Scatchard analysis. The disappearance of [3H]-PDBu binding activity is reversible and transient. However, unlike CSF-1 receptors the restoration of phorbol ester receptors on TPA-treated PEM is a very slow process; a prolonged incubation of up to 72 hr after the removal of TPA was required for PEM to regain fully its [3H]-PDBu binding activity. Furthermore, the degree of TPA-induced CSF-1-receptor down-regulation is closely associated with the number of available phorbol ester receptors present on PEM at the time of treatment. Thus, the refractoriness to TPA diminished as the phorbol ester receptors on PEM recovered. A 72-hr incubation time at 37 degrees C was needed for PEM to lose their refractoriness and again become fully sensitive to TPA-induced CSF-1-receptor down-regulation. This study provides evidence that the loss of CSF-1-receptors induced by TPA treatment requires the presence of phorbol ester receptors and proceeds presumably via a co-internalization of both CSF-1 and phorbol ester receptors; the refractoriness to TPA is thereby induced by a transient loss of available phorbol ester receptors.

We are reporting five cases of a seldom-reported complication following fracture of the distal end of the humerus during childhood. The complication consists of dissolution of a variable portion of the trochlea at a variable time after fracture. The fractures ranged from non-displaced to severely displaced supra-condylar fractures along with a lateral condylar fracture and a Salter-Harris Type-I fracture. The severity of the fracture did not correlate with the severity of the deformity. When the defect in the trochlea was wide enough to permit migration of the ulna proximally, the range of flexion and extension was severely affected. Excision of the olecranon in one twelve-year-old boy resulted in a moderate increase in extension.