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This paper reports a longitudinal study of carpal bone development in 125 children (98 boys, 27 girls) attending a clinic for Perthes' disease. The age at appearance of ossification in each carpal bone was estimated by studying consecutive radiographs obtained at six-months intervals. The results were compared with the findings for normal children published by Stuart et al. Three radiologic groups of carpal bone maturation are defined: not delayed (capitate and hamate); markedly delayed (triquetral and lunate); and slightly delayed (scaphoid, trapezium, and trapezoid). Overall, the bone age delay is severely abnormal at three to five years of chronologic age and indicates the time in development when general abnormalities occur. The mean age at diagnosis (and standard deviation) for 34 boys with skeletal standstill was 4.49 +/- 1.07 years, compared with 7.28 +/- 2.40 years for 51 boys without such standstill; the mean age at appearance of carpal bones was not significantly different between these two groups, suggesting an equally profound delay of carpal maturation in the group of later-diagnosed boys. Boys with bilateral hip disease show a significant delay in age at ossification of the trapezoid compared with boys who have unilateral disease. The immaturity of bone age may be present during a latent period and be of etiologic significance in the onset of the hip disease, but at present the evidence links it only with bilateral disease.(ABSTRACT TRUNCATED AT 250 WORDS)

The somatomedin activity (SMA) was assayed in 247 plasma samples from 30 patients with moderate or severe injuries. The injury severity score (ISS) was assessed for each patient and ranged from 9 to 50. The plasma SMA was reduced or eliminated within 4 days of injury. The activity then increased in the patients who recovered, normal levels being attained within 1 or 2 weeks of the injury. Five patients had at least one further fall in plasma SMA during treatment. Seven patients died and 4 of these had little or no SMA before death. The magnitude and duration of the depression of SMA after injury correlated both with the ISS and with the probability of mortality. The plasma cortisol concentration was elevated in all but 4 patients within 48 hours of injury. There was no relationship between the plasma SMA and the cortisol concentration. When plasma samples from 10 patients taken soon after injury were mixed with normal human serum, samples from only 1 patient were found to contain an inhibitor(s) of SMA. The reduced plasma SMAs in the remaining patients may have resulted from the impaired production of somatomedins (SM), the degradation of SM, the dilution of circulating SM with transfusion fluids or the binding of SM to damaged tissues.

This paper reports a study of the serum somatomedin activity in 67 boys with Perthes' disease and in 43 control boys aged three to 11 years. It was undertaken to evaluate some abnormalities of growth in children with Perthes' disease that have been previously reported. A brief account is given of knowledge relating to somatomedins in postnatal and fetal life. Serum somatomedin activity was measured using a bioassay based on the principle that somatomedins stimulate the synthesis of both DNA and proteoglycans in porcine costal cartilage. In control boys, the serum somatomedin activity increased with age, which is consistent with previous reports for normal children. In affected boys, the normal increase in serum somatomedin activity with age did not occur. The somatomedin activity in affected boys is higher than in control boys at three to five years but not at six to 11 years of age. Findings support the hypothesis that some children with Perthes' disease have an abnormality of the growth hormone-dependent somatomedins. The serum findings together with those of both skeletal age delay and impaired skeletal growth distally in the limbs are consistent with the view that the general disorder of some children with Perthes' disease results from an imbalance in mechanisms that determine the postnatal transition from the "fetal" to the "basic" component of the normal human growth curve.

The components of Mehta's empirical rib-vertebra angle difference (RVAD) were observed as indicators of the prognosis in infantile idiopathic scoliosis (IIS). The following components were investigated in a retrospective study of 169 children with IIS: (1) convex rib-vertebra angle (RVA); (2) concave RVA; (3) RVAD; (4) initial spinal curve angle; and (5) age at diagnosis. The convex RVA, but not the concave RVA, was found to correlate significantly with the initial spinal curve angle. This is consistent with the hypothesis that factors that determine spinal curve progression in IIS are related to those that lead to drooping of the ribs on the convexity of the thoracic spinal curve. In terms of prognosis, the convex RVA, which entailed one measurement, was as accurate as the RVAD, which entailed two measurements and a calculation. A convex RVA of less than 68 degrees on the initial radiograph usually indicates that a spinal curve will progress.

A new ultrasound method was used to measure femoral anteversion (torsion) of both hips in children with unilateral Perthes' disease, children with previous irritable hips, and healthy children of a similar age. In children with Perthes' disease, the mean femoral anteversion of affected hips is significantly higher compared with normal controls. In the opposite hips, femoral anteversion for right and left hips separately is not significantly different from that of controls. The affected hips show a significantly greater scatter of anteversion than do normal hips, which could be secondary to the disease; but the opposite hips also show a significantly wider scatter of anteversion than do normal hips, which suggests a developmental abnormality of femoral torsion in the femur of the unaffected limb. In children with Perthes' disease, femoral anteversion asymmetry is characteristic, marked, and significantly different from that of normal hips, with the affected hips usually being the more anteverted (with two exceptions). Irritable hips show significantly greater femoral anteversion asymmetry than do normal hips, with the affected femur usually being less anteverted than the opposite femur. These observations may have relevance in Perthes' disease with respect to both etiology, femoral osteotomy, and prognosis.

The somatomedin activity in synovial fluids from 50 patients with a variety of joint diseases has been studied and compared with the activity in each of the patient's own serum and a standard reference serum (SRS). The porcine costal cartilage bioassay of Van den Brande and Du Caju (1974a) has been used with the isotopes 3H-thymidine and 35S-sulphate. Synovial fluids from most patients with post-traumatic and post-operative effusions, osteoarthritis and arthritis associated with psoriasis, Reiter's disease, and ankylosing spondylitis stimulated the synthesis of DNA and proteoglycans in cartilage. Synovial fluids from patients with rheumatoid arthritis either had impaired capacity to stimulate DNA synthesis, or they inhibited it; a similar, but less evident pattern was observed for proteoglycan synthesis. Some synovial fluids from patients with miscellaneous synovitides stimulated, while others inhibited cartilage metabolism. It is concluded that the synovial fluid from patients with rheumatoid arthritis and from some patients with miscellaneous synovitides contained an inhibitor(s) to DNA and possibly proteoglycan synthesis. The sera from nearly all the patients stimulated both DNA and proteoglycan synthesis, but the somatomedin potency ratios for serum in terms of SRS were generally less than 1.0. There was a significant inverse correlation between the serum somatomedin potency ratio and the age of the patient.

The purpose of this study was to evaluate an ultrasound method on dried femora to decide if it is sufficiently reliable to consider its application to living subjects in health and disease. It reports the application of a standard static image B-mode ultrasound scanner to measure femoral anteversion (strictly torsion) on dried bones. The method involves creating images of bony surface contours at both the upper and the lower ends of the femur placed in a water bath. The calculation of femoral torsion involves measuring the angular difference between a head-neck line at the upper end and a transcondylar line at the lower end of the femur. This approach, using the surface contour of the bone at the upper end of the femur, is similar to that used by Lange & Pitzen (1921) and differs from conventional ways of measuring anteversion in dried bones using a central femoral head-neck axis. It is shown that in ultrasound scanning of the upper end of the dried femur to measure femoral anteversion, the head-neck line must be at, or rostral to, the base of greater trochanter. The intra- and inter-observer reliability was assessed in 10 femora, each scanned ten times by two observers. It is shown that femoral torsion can be measured by the ultrasound method to an accuracy of +/- 2 degrees (95% confidence limits) without a significant difference between the observers. The ultrasound method is compared with a new mechanical method for creating surface contours at both ends of the femur and found not to be statistically different in 37 femora. Two real-time ultrasound methods reported by other workers for measuring femoral anteversion in dried bones are reviewed. It is suggested that in applying ultrasound to measure femoral anteversion in living subjects, the B-mode static image scanner is superior to the use of real-time scanners.

The TW2 method (Tanner et al. 1975) was used to evaluate skeletal maturation in 173 children from Nottingham and 120 children from London WC1 . All of the children from Nottingham had hand-wrist injuries and were attending the Accident and Emergency Department of the Children's Hospital, Nottingham. The London children were all a part of a longitudinal growth study, which started in 1952-1953. When compared with the TW2 centiles, the Nottingham children showed retardation, and the London children advancement in skeletal maturation.

This paper reports a study of café-au-lait spots of a minimum diameter of 1 cm in 732 white schoolchildren. Three groups were identified, according to the number of café-au-lait spots on each child: (1) those with none (74%), (2) those with fewer than 5 (25%), and (3) those with at least 5 (5 children, 2 considered to be normal, and 3 siblings each presumed to have neurofibromatosis, one having died from leukaemia). Excluding the last group, the number of café-au-lait spots in the sample was not significantly related to age or sex. Some support is given for using the number of café-au-lait spots as an empirical threshold to diagnose neurofibromatosis.

Transplants of bone marrow into the anterior chamber of the eye were observed by Pfeiffer to produce migration, regression, and degeneration of myelogenous and hematopoietic cells at the same time that reticular cells proliferate and differentiate into bone. This key observation raised the question of whether the bone formation is the result of proliferation and osteogenetic activity of the reticular cells, or whether mesenchymal-type cells of the host are also induced by the transplant to differentiate into bone. From a comparison of bone marrow with epiphyseal cartilage, fracture callus, cancellous bone, muscle, and other tissues. Urist and McLean suggested that in the anterior chamber of the eye, one or another, or both, mechanisms are operative. Urist demonstrated that new bone formation occurs in postfetal life by the mechanism of induction alone in an implant of demineralized bone matrix in a muscle pouch. In recent years, the inductive agent and inductive response have been under intensive investigation with the aid of new and improved biochemic concepts and methods (Lindholm and Urist).