Protein turnover in patients before and after elective orthopaedic operations

Whole body protein turnover was measured in 11 patients before and after elective orthopaedic operations by giving 15N-glycine orally every 4 hours for 32 hours. The patients were maintained throughout on a constant protein intake. In two control subjects a comparison was made between intermittent dosage and continuous infusion of 15N-glycine for the estimation of total turnover. With intermittent dosage the 15N abundance in urinary urea reached a constant level after about 24 hours. Rates of total protein synthesis and breakdown were calculated from the 15N abundance at the plateau level. After surgery there was a moderate increase in urinary N output. The apparent N balance (intake - urinary N) was -0.25 ñ 1.31 g/d (mean ñ s.d.) before operation and =7.51 ñ 4.5g/d/ after operation. The rate of protein synthesis fell from 3.83 ñ 0.73g kg-1d-1 before operation to 2.94 ñ 0.83 g kg-1d-1 after operation. This difference is statistically significant (0.05 > p > 0.01). There was no significant change in the rate of protein breakdown. The possibility remains that a block in protein synthesis, probably mainly in muscle, may be partly responsible for the so-called 'catabolic' loss of nitrogen after injury, but this has not been proved. (AU)

Idiopathic chondrolysis of the hip

The radiographic changes in nine cases of chondrolysis of the hip joint are described. The series consists of eight Negro girls and one Indian girl, whose ages ranged from eleven to eighteen years. The incidence of periarticular osteoporosis, joint space narrowing, erosion of articular cortex, femoral head enlargement, increase in width of the femoral neck and growth plate narowing are reported. The difficulty in the diagnosis of chronic monarticular disease of the hip is stressed and the observed changes are discussed with particular reference to monaticular rheumatoid arthritis. The material presented supports the view that `chondrolysis of the hip' is a distinct entity (AU)

Haemoglobin SC disease in Jamaica

A skeletal survey was carried out on 84 cases of haemoglobin SC disease. The radiological features noted were increased translucency of bone, abnormal trabecular pattern, medullary expansion, wide vascular channels in phalanges, and radiological evidence of infarction, both medullary and cortical. The frequency of bone lesions thus demonstrated increased with age. The most characteristic lesions in this region were those of vascular necrosis; contributing factors such as the high haemoglobin level characteristic of the condition are discussed. An interesting feature was the lack of correlation betweeen clinical severity and degree of radiological change. (AU)

Chondrolysis following slipped capital femoral epiphysis in Jamaica

We reviewed the cases of all patients with slipped capital femoral epiphysis at the University Hospital of the West Indies. Forty-seven hips in thirty-six Black patients were evaluated, and in 40 per cent of those hip chondrolysis developed. The appearance of roentgenographic changes of chondrolysis was predictable. There was a high percentage occuring within one year of diagnosis of slipped epihysis and within six months of closure of the proximal femoral growth plate. The persistent absence of motion in all planes following slipping of the capital femoral epiphysis was a constant finding in patients with chondolysis. This loss of motion can be diagnostic of impending chondrolysis and is usually present before the appearance of the roentgenographic changes. The microscopic changes suggest that the primary lesion is not necrosis of cartilage but a replacement of articular cartilage by pannus formation (Summary)