Treatment of septic arthritis of the hip by arthroscopic lavage.

Since 1987, nine cases of septic arthritis of the hip joint in children were treated by arthroscopic lavage. The technique of arthroscopic hip examination is described. This treatment, when combined with standard medical therapy, was effective in ablating septic disease in all patients. No complications were attributable to the surgical procedure. We emphasize the value of large-bore, large-volume lavage, direct suction to remove joint debris, and postoperative suction drainage. The technique is an attractive alternative to arthrotomy and offers low surgical morbidity, effective joint cleansing, and early return of joint mobility.

Ewing's sarcoma: long-term follow-up in 49 patients treated from 1967 to 1989.

PURPOSE: Review of long-term results of therapy for Ewing's sarcoma in terms of survival, local tumor control, distant failure and complications rates. METHODS AND MATERIALS: Retrospective review of the records of patients with Ewing's sarcoma of bone and soft tissues treated at The Prince of Wales Children's and Prince of Wales Hospitals, Sydney, between 1967 and 1989 and followed-up to July 1991. RESULTS: There were 49 patients with median age 16 years (range 3-33 years) and average potential follow-up time 12.3 years (range 2-24 years). Forty patients presented with localized disease (three with regional lymph node involvement) and nine with distant metastases. Local therapy for the primary was by amputation in three patients, by resection and postoperative radiotherapy in five, and by definitive radiotherapy in 41 (median dose 50 Gy). Forty-four patients received adjuvant multi-agent chemotherapy. The overall actuarial survival rate was 33% (SE = 7%) at 5 years and 30% (SE = 7%) at 10, 15, and 20 years. The factors predictive of shorter survival were distant metastases at diagnosis (p = 0.036) and older age (p = 0.025). The actuarial local control rate for all 49 patients was 75% (SE = 8%) at 5, 10, 15, and 20 years. The only factor predictive of local failure was an inadequate target volume irradiated (p = 0.003). In 40 patients who presented with localized disease only, the actuarial rate of freedom from distant failure at 5 years was 44% (SE = 8%) and at 10, 15, and 20 years was 40% (SE = 8%). Seven patients experienced severe or fatal complications (defined as requiring investigation and treatment in hospital), namely stress fracture in two, fatal osteogenic sarcoma in one, fatal cardiotoxicity in one and severe hemorrhagic cystitis in three. The rate for severe or fatal complications at 5 years was 19% (SE = 8%), at 10 years was 29% (SE = 12%) and at 15 and 20 years was 53% (SE = 21%). CONCLUSION: Survival to 5 years appears to confer probable cure and one third of our patients have achieved this. Long-term follow-up also reveals that an increasing number of patients experience treatment-related complications, the majority of which, however, can be corrected.

Brain benzodiazepine receptors in fathead minnows and the behavioral response to alarm pheromone.

Fathead minnows (Pimephales promelas) exposed to 1 or 10 mg/l chlordiazepoxide showed normal alarm behavior during the presentation of alarm pheromone. Fish exposed to 20 mg/l drug, however, showed little or no behavioral alarm and did not appear sedated. A food extract stimulus presented after alarm pheromone led to a large foraging response by fish exposed to 20 mg/l chlordiazepoxide. Control fish or fish exposed to 1 to 10 mg/l drug showed less tendency to begin foraging. Exposure to 1, 10, or 20 mg/l chlordiazepoxide for 3 hr did not affect whole-brain concentrations of tryptophan, 5-hydroxytryptamine, 5-hydroxyindoleacetic acid, tyrosine, or dopamine. The binding of [3H]diazepam to specific brain receptor sites (KD = 10 nM, estimated Bmax = 3.3 fmol/mg wet weight) could be displaced by chlordiazepoxide (IC50 = 1.6 microM). These results suggest that benzodiazepine receptors in the central nervous system of lower vertebrates may function in ways similar to those in mammals, i.e., in the modulation of behavior in anxiety-like states.