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SUMMARY Measurements were made of distal radius, mid‐radius, tibia and metatarsal bone‐density of 80 patients with myelomeningocele (17 thoracic, six L1/L2, 13 L3, 30 L4, 14 L5/sacral). For the upper extremity the bone density primarily was low in the thoracic patients, but in the tibia and metatarsal it showed a more linear correlation with neurological levels. The effect of age was highly significant at all sites; after controlling for this, the neurological level was a significant determinant of bone density at all sites, and this effect was greater in older children. Patients with impaired ambulation had decreased bone‐density in the distal radius, tibia and metatarsal, but not in the mid‐radius. Race had no significant effect on density after accounting for differences in neurological level. Weight for height and multiple fractures did not correlate with bone density. Although ambulatory status (weight‐bearing stresses) and neurological status (muscle stresses) are both important factors in bone density, this study suggests that the latter is a more important determinant. Résumé Densité osseuse dans le myéloméningocèle: effet du statut ambulatoire et autres facteurs La densité osseuse a été mesurée à radius distal, mi‐radius, sur le tibia et les métarsiens chez 80 sujets présentant un myéloméningocèle (17 de niveau thoracique, six L1/L2, 13 L3, 30 L4, 14 L5/sacré). A l'extrémité supearieure, la densité osseuse était fondamentalement basse chez les sujets à atteinte thoracique, mais la densité osseuse montrait une meilleure corrélation linéaire avec les niveaux neurologiques sur le tibia et les métatarses. L'effet de l'âge était hautement significatif sur tous les os; après correction de l'âge, le niveau neurologique influencait significativement la densité osseuse sur tous les os étudtés, cet éffet etant plus marqué chez les enfants plus âgés. Chez les sujets sans déambulation, la densité osseuse était abaissée à la partie distale du radius, sur le tibia et les métatarsiens mais non à mi‐radius. La race n'avait pas d'effet significatif sur la densite apres correction des differences liees au niveau neurologique. Ni le poids pour la taille, ni les fractures multiples n'apparaissaient avoir d'action sur la densité osseuse. Bien que le statut ambulatoire (effet de pesanteur) et le statut neurologique (effet de traction des muscles) sont tous deux des facteurs importants de la densité osseuse, cette étude suggère que ce dernier statut est les plus important. ZUSAMMENFASSUNG Knochendichte bei Myelomeningocele: der Einfluß der Gehfähigkeit und anderer Faktoren Bei 80 Patienten mit Myelomeningocele (17 thorakal, sechs L1/L2, 13 L3, 30 L4, 14 L5/sakral) wurden im Bereich distale Radius, mittlerer Radius, Tibia und Metatarsus Knochendichten gemessen. In der oberen Extremität war die Knochendichte hauptsächlich bei Patienten mit thorakaler Läsion niedrig, in Tibia und Metatarsus dagegen zeigte die Knochendichte eine mehr lineare Korrelation mit dem neurologischen Befund. Bei alien Lokalisationen fand sich ein hochsi...

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he frequency of occupational orthopedic injury and illness to the thumb parallels the use of the hand as an important tool. The thumb provides a stable post about which the rest of the hand may perform activities of pinch and grasp. The special functions of the thumb account for up to 50% of overall hand use. Exposure to twisting, jamming, and contusing forces, as well as repetitive stress, is an everyday occurrence in the workplace. Because problems of differing severity can present with quite similar appearances, it is important for occupational health nurses and nurse practitioners (OHNPs) to be able to quickly assess, treat as appropriate, and refer any problems that may require specialized care. Although problems of the thumb will be the focus of this article, some of the problems can be applied to the hand generally. Details regarding evaluation, management, and treatment of thumb problems are outlined so that primary care is initiated. The care described is legally supported with collaborative protocols between the nurse and physician, along with other clinical guidelines as appropriate. More complicated problems can be referred and appropriately case managed.

A limited number of investigations have appeared in the literature which have attempted to estimate the age of rhesus monkeys on the basis of dental development. These studies have shown that tooth emergence can be used as a guide for age estimation of normal, healthy rhesus monkeys.Twenty-one infant rhesus monkeys (Macaca mulatta) were used in this study. The animals were fed a high protein laboratory diet and were in good health. The emergence of the deciduous dentition was ascertained at weekly intervals for each animal. The criterion employed for tooth emergence was the appearance of any part of the crown of the tooth above the oral mucosa. Tooth emergence was expressed in number of days after birth and in hundredths of a year (one day.= .00274 year, 3.65 days -.01 year). Since the teeth were observed weekly, it was assumed that most eruption occurred halfway between the inspections and thus one half of a week was subtracted from each observed eruption value.On the average, the first deciduous teeth to erupt were the mandibular central incisors, closely followed by the maxillary central incisors.After the appearance of these teeth, the following sequence of eruption was noted: mandibular lateral incisors, maxillary lateral incisors, maxillary canines, mandibular canines, maxillary first molars, mandibular first molars and maxillary second molars. The greatest variability in this sequence occurred in the relative eruption of the canines and the first molars. In contrast to the above sequence of tooth eruption, the maxillary canine and maxillary first molars erupted at the same time in six animals and the first molar erupted prior to the canine in two other animals. With respect to the mandible, the first molars and the canines erupted simultaneously in two animals; the first molars erupted before the canines in three other animals.The average values for the emergence of the deciduous dentition found in the present study are similar to those reported previously by Hurme and Van Wagenen but they are slightly lower than those reported by Schultz. This difference may be related to the criterion employed for tooth eruption (i.e., full emergence of the crown of the tooth) in the latter study. The range of variability reported in the present study is also slightly greater than that found by Hurme and Van Wagenen. The values reported for the age or eruption of the deciduous dentition in the present study, however, agree with previous findings to the extent that the composite of such values can be used to estimate reliably the age of growing M mulatta when birth records are unavailable. BLE MAXILLARY DECIDUOUS DENTITION Days I1 12 C MI MI Years I1