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Multimodal, limb-saving therapy is the treatment of choice in children with osteosarcoma. However, few data are available on long-term functional problems and disabilities in surviving patients. Seventy-eight children treated for Stage II-B osteosarcoma who were treated between 1970 and 1997 were evaluated. Beyond the clinical examination, functional results were assessed using the scoring system of the Musculoskeletal Tumor Society. Patients reported their physical disabilities when completing the Toronto Extremity Salvage Score. The most recent cohort of patients who had tumor resection combined with preoperative and postoperative chemotherapy had the best 10-year survival rate at 70%. Thirtyfour children (44%) were treated by limb-sparing therapy with 25 children requiring an endoprosthesis. Ten of these 25 children (40%) required one or in some cases several replacements of the endoprostheses because of complications. The original prostheses were in place for a median of 4.9 years before the first exchange (range, 2.0-12.0 years). Evaluations with rating scales showed that the subjective estimation of disabilities by the Toronto Extremity Salvage Score was significantly higher than a rating of limb functions by a doctor using the Musculoskeletal Tumor Society score. Best results were observed in children with an endoprosthesis of the distal femur who achieved as much as 90% ability to do their daily life routine. Limb-saving therapy in children with osteosarcoma enables a return to activities of daily living in long-term survivors with a minimum of remaining disability.

Summary A total number of 51 cases of progressive muscular dystrophy were treated in two groups: one group received 19‐norandrostenolone‐decanoate together with digitoxin over a period of 3 months, a second group was treated with the steroid alone over a period of 3–5 months. The doses for the steroid were 50 mg per week, for digitoxin 0.1 mg daily. In the first group (steroid +digitoxin) of 21 cases. Controls of 15 different enzymes in muscle tissue showed a decline in activity in all of the enzyincs. The depletion of muscle enzymes was significant for CPK, GOT, GPT, ICDH and LDH. At the same time, a significant raise in serum enzyme activity could be demonstrated for ALD and CPK in the Duchennc‐typc and for ALD, CPK and LDH in the other more benign types of the disease. In the second group (steroid only) clinical observation revealed no functional improvement. I n some of the Duchenne cases the physical weakness was slightly accelerated. Laboratory findings showed no demonstrable changes in histopathology in this group. The increase of serum enzyme activitics was not Significant. MDH show‐ ed a significant fall in activity. Changes in tissue enzyme activities were not typical. I n none of the groups a raise of extractable muscle protein was seen. I n addition to rather severe virilizing effects in most of the cases, an increase of joint‐contractures in some of the cases of both groups could be observed. The increase of serum enzymes under the treatment with the steroid which can only be explained by enhanced loss of enzyme proteins from the diseased muscle tissue as a result of the increasing cell permeabilky becumes most obvious and significant when the steroid treatment is combined with digi‐ toxin. The study demonstrates that the treatment of progressive muscular dystro‐ phy with 19‐nd shows no use and involves unfavorable side effects while the combined use of the steroid with digitoxin leads to a clear and significant acceleration of the process of muscle wasting.

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