Mary S. Sherman

The Nerves of Bone

Iii 1846 a French anatomist dissect-ed a horse and a cow and showed his audience a nerve ‘hieh accompanied the nutrient artery into the horse’s femur and gave off twigs to the periosteum . Although he claimed to have carried his gross (lissection through the medullary canal and into the epiphysis, no one else could see the nerve beyond the nutrient canal, even in the bones of a horse. Fhirt-y-five years later a pair of skeptical compatriots s’ho doubted the met-hod bitt 1)elieved in the idea (levise(l a iie ’ way of looking for nerves within bone. Variot ttli(l ilemy, unal)le to find nerves in histological sections, studied tiny samples of marrow from amputated human arms, from one human fetus, from dogs of various ages, and from several other animals. The small bits

Psoriatic Arthritis: Observations on the Clinical, Roentgenographic, and Pathological Chances

From the study of this group of patients, the following conclusions seem to be justified: 1. There is a type of arthritis which is peculiar to persons who have psoriasis and which has a predilection for the distal joints of hands and feet. The clinical and roentgenographic findings are characteristic and quite different from those of rheumatoid arthritis. 2. The pathological changes in this type of arthritis are constant, but are not sufficiently specific so that the diagnosis can be made with certainty from the microscopic section alone. 3. Both arthritic and skin manifestations respond to ACTH and cortisone, but the former responds to significantly lower doses. Improvement with hormone therapy is not permanent. 4. The disabling deformities of the toes can be greatly relieved by radical surgery.

LATE RESULTS IN LEGG-PERTHES DISEASE

1. In the natural course of Legg-Perthes disease there is a wide variation in the severity of the process. 2. Marked changes in the femoral neck and lateral expansion or central depression of the femoral head indicate a bad prognosis. In general, the younger tile patient at the onset of the disease, the better the prognosis. 3. Premature symmetrical or asymmetrical growth arrest of the capital femoral epiphyseal cartilage plate may occur and contribute to the deformity. 4. In tile presence of gross changes on the roentgenograms, there may be few or no symptoms in early adult life. However, as the patient becomes older, progressive disability does occur. 5. Therefore, patients should be treated and treated early. Inasmuch as there seems to be no significant difference in the results obtained by ambulatory or non-ambulatory treatment, non-weight-bearing on cruteches is sufficient in a cooperative patient with unilateral involvement.

Bone changes in chronic circulatory insufficiency; a histopathological study.

1. In normal adult bone there is a variable amount of focal necrosis which occurs as part of the normal aging of the skeleton. 2. The extent of this necrosis increases with age and is related to the physiological aging of the vascular system and not to abnormalities of the osseous system. 3. Chronic peripheral vascular disease greatly increases the amount of necrosis of bone. 4. In the presence of severe chronic vascular insufficiency, there may be such massive necrosis as to include most of a long bone, such as the tibia, without any resulting changes in the clinical or roentgenographic picture.

ESTROGENS AND BONE FORMATION IN THE HUMAN FEMALE

In a woman of fifty-eight years, many of whose bones had almost disappeared as a result of Pagets disease, together with a severe postmenopausal osteoporosis, massive estrogen therapy was followed almost at once by a remission of clinical symptoms and by actual reconstitution of bone. Withdrawal of the estrogen produced an exacerbation; its readministration was again followed by improvement. For over two years the patient has been kept on daily doses of from 2,000 to 10,000 rat units (0.33 to 1.66 milligrams) of estradiol benzoate; during this time she has maintained her improvement and has showed no untoward symptoms.

Giant-Cell Tumor in the Metaphysis in a Child

Iii the last twenty years, especially inn the United States, there inns beenn a gradual, profounnd change in the thinik.inng about giant-cell tumnoms. This conceptual revolution has beemn well suinimniarized by Lichtcnmsteimi who, with ,Jaffe arid Portis, did so iniuch to bring it ai)out. If omne adheres to tine diagnostic criteria of these authors, it is evident. that giaint-cell tumor is mun urneoiiimonn lesion. Finn-then-more, it is so n-are in paticints younigemthan twcnnty year-s of age tinat, as Lichtenisteinr \\‘n(Ite, the odds am-c ven-y mmcm againnst anyone ‘ho ventures a diagnmosis (If giant-

Fatal agranulocytosis following sulfathiazoletherapy

Summary A case of acute and fatal agranulocytosis with toxic dermal lesionsproduced by therapeutic doses of sulfathiazole, occurring in an infant 8 weeks old, is reported. At the time of this writing, no other cases of agranulocytosis following sulfathiazole medication in infants have been recorded, although instances of extreme granulocytopenia in children due to other members of the sulfonamide group have been observed. An experience of this sort re-emphasizes the necessity of exercising the utmost care in the therapeutic use of sulfathiazole in infants and children and of making frequent blood examinations as well as of determining the concentration of the drug in the blood. Despite the fact that absolute proof of this sulfonamide being the sole cause of agranulocytosis is lacking, the circumstantial evidence in our case strongly suggests that both intoxication by and sensitization to this drug played significant roles in the production of the toxicodermatosis as well as of the agranulocytosis which resulted in the death of the patient.

A report of four proved cases of tuberculous bone or synovial infection treated with streptomycin.

1. Four cases of tuberculous arthritis in children were treated. 2. In the one case in which involvement seemed limited to the synovial structures, streptomycin therapy alone appears to have arrested the disease. See Images in the PDF file 3. In the three cases in which there was a concomitant focus of tuberculous osteomyelitis, surgical curettage of the bone focus together with streptomycin therapy seems to have been effective. 4. All wounds healed per primam . Synovectomy, open packing, and intra-articular injections of streptomycin were not employed. 5. In three of the four cases, no immobilization was employed. 6. We feel that good results may be obtained from the early treatment of tuberculous arthritis by streptomycin.