Plasma prostaglandin E2 concentration in nephrotic syndrome.

of palliative shunts for coarctation repair, pulmonary artery banding, or ductus arteriosus ligation often result in local damage to one or two ribs, which may be accompanied by spreading of ribs and distortion of the bony architecture. The follow-up studies available in our patients suggest that prostagtandin periostitis may be a benign, self-limited process with no apparent effect on subsequent bone growth and development: Complete resolution occurred in most of the bones reexamined six months to one year later. Bone resorption secondary to prostaglandins is well documented. 6.7 Periosteal new bone formation in dogs in response to long-term (14 to 30 days) PGE~ infusions has been experimentally demonstrated. 8 Recent work has suggested that alterations in the ratio of PGE1 and PGF may result in periosteal new bone formation. 7'9 In addition, inhibition of prostaglandin production with salicylates significantly reduced bone destruction and new bone formation in rabbits with experimental osteomyelitis. 7 This research affords a theoretical basis for the periosteal changes noted. Prostaglandin-induced periostitis must be considered in any infant receiving PGE~ who develops periosteal reaction of irregular, asymmetric distribution. Other causes related to postoperative trauma, metabolic bone disease, Caffey disease, battered child syndrome, and hand-foot syndrome have their own distinctive clinical findings and must be excluded? ~ It would also be prudent to investigate possible infectious causes such as congenital syphilis. REFERENCES 1. Freed MD, Heymann MA, Lewis AB, Roehl SL, Kensey RC: Prostaglandin E~ in infants with ductus arteriosus-dependent congenital heart disease. Circulation 64:899, 1981. 2. Ueda K, Saito A, Nakano H, Aoshima M, Yokota M, Muraoka R, lwaya T: Cortical hyperostosis following longterm administration of prostaglandin E~ in infants with cyanotic congenital heart disease. J PEDIATR 97:834, 1980. 3. Sone K, Tashiro M, Fujinaga T, Tomomasa T, Tokuyama K, Kuroume T: Long-term low-dose prostaglandln E~ administration. J PEDIATR 97:866, 1980. 4. Lewis AB, Freed MD, Heymann MA, Roehl SL, Kensey RC: Side effects of therapy with prostaglandin E~ in infants with critical congenital heart disease. Circulation 64:893, 1981. 5. Ringel RE, Brenner JI, Haney P J, Burns JE, Moulton AL, Berman MA: Prostaglandin-indueed periostitis: A complication of long term PGE~ infusion in an infant with congenital heart disease. Radiology 142:657, 1982. 6. Dietrich JW, Raisz LG: Prostaglandin in calcium and bone metabolism. Clin Orthop 11:228, 1975. 7. Dekel S, Francis MJO: The treatment of osteomyelitis of the tibia with sodium salicylate: An experimental study in rabbits. J Bone Joint Surg 63B:178, 1981. 8. Lund JE, Brown WP, Tregerman L: The toxicology of PGEI and PGI2. Presented at the Conference of Prostaglandins in Cardiovascular and Thrombotic Disorders, Chicago, May 1981. 9. Dekel S, Francis MJO: Cortical hyperostosis after administration of prostaglandin Ex. J PEDIATR 99:500, 1981. 10. Swi.scuk LE: Radiology of the newborn, and young infant, ed 2. Baltimore, 1.980, Williams & Wilkins, pp 663-665.