Since collagen is the only protein in the animal tissue containing hydroxproline in significant amounts, determination of hydroxyprolin is a practical acid for studies of collagen. It is now accepted that the ribosomal synthesis of collagen occurs in fibro-blasts, osteoblasts and chondroblasts in the same way as protein synthesis in general. However, hydroxyproline of collagen is not derived from the free amino acid but from proline, hydroxyproline during the biosynthesis of tropocollagen molecules. These molecules pass into the extracellular space and the formation of fibres, associated with the maturation of collagen, is extracellular (Laitinen 1967). The rate of metabolism of collagen in bone is an inverse function of age (Kao Tang, Vernier and McGavack 1965). Bone collagen accounts for about 55 percent of the total body collagen. In most clinical conditions associated with hydroxyprolinuria, bone lesions appear to play a primary role (Laitinen, Nikkia and Kivirikko 1966). Hydroxyproline in the urine originates from the degradation of both soluble and insoluble collagen (Lindstedt and Prockop 1961,Prockop and Sjoerdsma 1961, Laitinen 1967). The concept that bone collagen is the major source of urinary hydroxproline is acceptable for practical purposes (Goidanich, Lenzi and Silva 1965). Because of the direct relationship between bone collagen catabolism and the excretion of hydroxyproline in urine, one may expect significant changes in urinary hydroxyproline levels after bone fracture. Experimental fracture is a practical model for biochemical studies of bone collagen. It is known that a significant and progressive increase of hydroxyproline occurs in the callus and in the shaft of fractured bone (Bolognani and Ponseti 1962, Udupa and Prasad 1963, Udupa and Singh 1964, Udupa 1966) and, already one week after fracture, plenty of mature collagen fibrils may be found in the callus (Solheim 1965, 1966). This increase of collagen is evidently a part of the process of the connective tissue repair. (Dunphy and Udupa 1955, Dunphy, Udupa and Edwards 1956,Abercrombie and James 1957, Jacob and Houck 1959, Verzar and Willenegger 1961, Kowalewski and Yong 1967a). The hormones affecting body growth and protein synthesis influence the formation, deposition and catabolism of collagen and, consequently, alter the excretion of hydroxyproline (Jasin, Fink, Wise and Ziff 1962, Benoit, Theil and Watten 1963, Smiley and Zift 1964, Kowalewski 1965, Kowalewski and Young 1967 a, b). Thyroid hormone affected the synthesis of collagen (Freihoffer and Wellband 1963, Kowalewski and Yong 1967a), stimulates the excretion of urinary hydroyxproline and corrects the reduction of hydroxyproline excretion in hypothyroidism (Kivirikko, Koivusalo, Laitinen and Leismaa 1963, Kivirikko, Koivusalo and Laitinen 1964, Kivirikko, Koivusalo, Laitinen and Lamberg 1964, Chiumello and del Guercio 1965, Laitinen, Nikkila and Kivirikko 1966). Most previous studies on the biochemistry of fracture healing were concerned with ground substance and collagen in the callus of fractured bone of animals, normal or treated with hormones (Kowalewski and Gouws 1957, Kowalewski and Morrison 1957, Kowalewski 1958, Solheim 1965, 1966, Udupa 1966). In the present study, attempt was made to correlate the changes in fractured bone thyroid rats with fractured humerus were used (Kowalewski and Yong 1967b).

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The report of this condition in an Egyptian mummy by Simons and Zorab (1961) makes us believe that this disorder is as old as man himself. The passage of dark coloured urine with or without associated symptoms was observed by physicians of the Middle Ages (quoted by O’Brien, La Du and Bunim 1963). The reducing nature of the substance responsible for the colour of urine in these patients was detected by Boedeker in 1961. He named this substance as alkaptone. Virchow in 1866 on the other hand recognized this condition in a post-mortem and named it ochronosis. Albrecht in 1902 was the first to establish the association of alkaptonuria and ochronosis during autopsy of a person known to be suffering from alkaptonuria without any associated symptoms. The first clinical diagnosis of ochronotic arthopathy was made by Sir William Osler in 1904 and since and then three different phases of the disease have become well established. In India this conditions has been reported by Bose and Ghosh (1929), Sarin and Bhargava (1957), Sinha (1930), Natarajan (1960) and Sachdeva and Wahi (1966). Pathogenesis- Alkaptonuria is an inherited error of metabolism, transmitted by a single recessive autosomal gene. Primary lesion is the absence of the enzyme homogentisic acid oxides from the liver and kidneys of the patient. This enzyme plays an important role in tyrosin breakdown. As a result of this the tyrosin breakdown stops short at the level of homogentisic acid which is passed in the urine. This acid has reducing property and on exposure to air gives brownish or black colour to the urine. The metabolic abnormality is present since birth and remains symtomless initially, being discovered only accidentally by the staining of diapers or clothes. In due course of time homogentisic acid gets deposited in the connective tissue of dermis, scleare, articular cartilages, ligaments and tendons and the skeletal symptoms commonly appear between 4th to 6th decades. The purpose of this paper is to present four cases of this rare disease with bilateral spontaneous rupture of tendo-achilles in one. It appears that only two cases of spontaneous rupture of tendo-achilles in ochronosis have been described in the literature so far.

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Achondroplastic dwarfs have generally been employed as court jesters and have been known for their strength and wit. These are persons with odd body built but do not differ from other human beings in morbidity and life expectancy. However, contrary to general belief that achondroplastic changes are limited to the bones of extremities, it has been shown that the spine is also involved (Donath and Vogl 1925). This involvement of the spine rarely may predispose growing achondroplastics to progressive crippling lesion of the spinal cord, causing paraparesis and even quadriplegia. In the literature, about forty-eight cases of achondroplasia who developed neurological deficit varying from nerve root irritation of complete paraplegia or even quadriplegia have been reported upto 1967, including some unpublished cases and personal communications cited by Vogl in 1962. Although eight reports of paraplegia in achondroplastics appeared between 1905 and 1925, most of the remaining cases have been recognized during the last two decades. Vogl and Osborne (1949) reviewed nine case reported till then and added one more case of their own. Spillane (1952) reported three cases and pointed out another case reported by Poynton in 1907 which had not been included in the case reviewed by Vogl and Osborne. Vogl (1962) stated that twenty three cases of achondroplasia with neurological involvement had been reported between 1949 and 1960 including some unpublished cases and personal communications. These twenty-three cases included three cases of spillane (1952), two cases of Schreiber and Rosenthal (1952), one case of Epstein and Malis (1955) and one case of Vogl and Osborne (1949). This brought the total number of cases reported till 1960 to thirty-three. Report of five cases by Duvoisin and Yahr in 1962, eight cases by Hancock and Phillips in 1965 and two cases by Cohen, Rosenthal and Matson in 1967 has brought the total number to forty-eight upto date. The purpose of this paper is to stress the need to be aware of the possibility of cord and root compression in achondroplastic dwarfs specially because early treatment many offer the only chance for recovery, to review the available literature and to discuss certain important features of the syndrome in the light of our own observations in one case.

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Polyostotic fibrous dysplasia is a skeletal disorder of unknown aetiology appearing at puberty and is characterized by the involvement of the diaphysis of multiple long bones usually on one side of the body, bending of the weight bearing bones and occasionally, growth disturbances. Histologically, it is recognized by the presence of fibro-osseous tissue in the affected part of the bone. In females, this disorder may sometimes be associated with precocious puberty and abnormal pigmentation of the skin. The tendency of this disorder to involve predominantly one side of the body may perhaps be due to some developmental defect (Jaffe 1958). Occasionally only one bone may be involved when it is called monostotic fibrous dysplasia. In both the types, involvements of the bones of hands and feet is rare. A case of monostotic fibrous dysplasia of calcaneum is being reported in view of the rarity of this lesion at this site.

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Displaced supracondylar fractures of humerus in children are usually treated by manipulation and plaster in flexion of the elbow, in most hospitals all over the world. The results of fractures with marked displacement are not consistently good even in best hands. Jensenius (1948) published his series where only 43 percent had ‘good’ results, 40 percent had ‘fair’ results and 17 percent had ‘bad’ results, after this treatment. Hammond (1952) wrote regarding manipulation that, ‘The method is not worth the risk, when the function of the extremity is at stake,’ and he advocated traction method in such circumstances.

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Giant cell tumour of bone was first described by Sir Astley Cooper in 1818. The suggestion that the tumour might recur after removal and even behave like a malignant condition was made by Virchow in 1862. Lichtenstein (1956) started that the more he saw of giant cell tumours of bone, the more wholesome was his respect for them. Many authors felt that the treatment of giant cell tumour left much to be desired. This study was undertaken to evaluate the clinical features and the results of the various forms of surgical treatment of this tumour.

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Embryonal sarcoma is a type of rhabdomyosarcoma occurring in infancy and childhood. It is a rare tumour and almost equally affects the head and neck, the genitourinary tract and the extremities (Patton and Horn 1962). The rhabdomyosarcoma has been classified on the basis of microscopic appearance, into (i) pleomorphic occurring in 5th and 6th decades, (ii) Alveolar in adolescents and (iii) Embroynal. A variant of embryonal sarcoma, called the butryoid sarcoma by virtue of its grape like gross appearance, occurs at a still younger age and has been reported in submucous regions in the nasopharynx, the common bile duct and the maxillary antrum but never in the extremities (Horn and Enterline 1958). The embryonal sarcoma is a rare lesion affecting more commonly the orbit, the nasopharynx, the urinary bladder, the prostate, the cervix uteri and the parotid area. Out of thirty-three cases of embryonal sarcoma described by Patton and Horn (1962) ten were in the extremities, six in the upper and four in the lower. Out of these four only one case was reported to arise from the leg. A case of embryonal sarcoma of the leg is being reported here because of its rarity and unusual clinical presentation.

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Infantile cortical hyperostosis or Caffey’s disease was first described by Caffey and Silverman in 1945 as a new syndrome in infants, characterized by sudden appearance of a swelling of the soft tissue and subsequent periostel new bone formation in the underlying bone. Later a similar group of cases were described in children (Smyth, Potter and Silverman 1946), in a baby at birth (Kitchin 1951) and still later in a 31 week old foetus examined radiologically (Bennet and Nelson 1953). The purpose of this paper is to present 13 new cases of this syndrome to stress the special features observed therein.

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A modified bone wax, prepared locally from purified bees wax, cornoil and salicylic acid has been tried in three hundred operations during the last two and half years without incurring any untoward effects. When compared to imported bone wax the local product proved to be as effective in achieving haemostasis and is certainly more economical.

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Although the homogenous transplantation of certain organs such as kidney and heart in human beings has reached a climax, there still remain a number of problems in bone transplantation. Autogenous bone grafts undoubtedly are the most desirable so far but in circumstances where either the defect to be filled is too large or the bone available for autogenous transplantation is too little, as in children, it becomes impracticable. Fresh homogenous transplantation of bone also can be used but since it involves an additional operation on another normal individual, is cumbersome and not always feasible. As ideal bone graft, therefore, will be the one which is readily available in the form of bank bone which has of necessity to be obtained from a heterogenous source and treated and preserved in such a way that is has retained its osteogenicity and scaffolding property but is devoid of any antigencity. The antigenicity of any transplant is due to its protein content which has been known to incite antibody formation in the host leading to the rejection of the transplant through antigen-antibody reaction. Various vain attempts have been made to eliminate the antigenicity of foreign bone by different physical and chemical means such as boiling, freezing, irradiating, treating with merthiolate etc. The commercially available heterogenous bone is supposed to be treated in a way that is not disclosed. However, no large series of its successful use has so far been published to the best of our knowledge. It has the further disadvantage of its high cost. Sachs and Goldberg (1943) found that tissues can be transplanted amongst individuals of species low in the phylogenetic scale. Favour (1958) observed that the resistance to foreign tissues is more highly developed in mammals. In the present work an attempt has been made to study electrophoretically the patterns of bone proteins of different animals selected on an ascending phylogentic scale from different classes of subphylum vertebrata.

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The problem of antigenicity of bone is a comparatively recent field of study. Through there is evidence in the literature that foreign bone tissue is antigenic and is rejected by immune phenomenon, there still remains a doubt about the capacity of bone tissue to produce circulating antibodies. A number of procedures evolved to demonstrate the presence of serum antibodies in response to transplantation of various tissues generally failed due to various reasons, chief among them being the fact that histocompatibility antigens are insoluble and most of these techniques required antigens to be in the soluble from (Siegrist and Enneking 1960, Aoike and Iiji 1960). However, a number of workers reported successful attempts and demonstrated serum antibodies in response to various tissue transplantations by various procedures like haemaggultination, cytotoxicity, leukagglutination, lymphogglutination, mixed agglutination, antiglobulin consumption test (Amos 1953, Terasaki, Cannon and Longmire 1959, Abeyounis, Milgrom and witebsky 1964, McDonald, Milgrom and Witebsky 1964, McDonald, Milgrom, Abeyounis and Witebsky 1965). The present study was undertaken to determine the antigenicity of bone by demonstrating serum antibodies, employing double diffusion technique of ouchterlony (1949) and the immuno-electrophoretic technique of Garbar (1959), after repeated injections of human, calf pigeon, frog and fish bone extracts in rabbits.

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Ever since Little described this condition in 1853, its treatment has undergone a marked transition from indifference to a planned multidisciplinary approach to the problem. The treatment of cerebral palsy has generally been in the hands of orthopedic surgeons, physiotherapists and other members of the rehabilitation team. Till recently there was an attitude of defeatism in respect of dealing with the basic defect in the central nervous system. Very often the various orthopaedic operations failed because of the unrelieved hypertonus, abnormal movements like dystonia or athetosis and low intelligence. The object of this presentation mainly is to evaluate the treatment of hypertonus and/or abnormal movement in cerebral palsy, so as to help the patient’s future management either by surgery or other means.

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Aneurysmal bone cyst, a rare benign lesion of bone, was first described by Jaffe and Lichtenstein in 1942. It causes distension of the affected part of the bone limited peripherally by a thin bony shell as seen radiographically. The lesion occurs in many parts of the skeleton but is mainly seen in the shafts of the long bones and the vertebral column. The following case has been reported because of the infrequency of the lesion and its uncommon site.

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