1. 頸部砂時計腫の3例につき, 検討を加え報告した.
2. とくに症例1は発育期における広範囲椎弓切除例であり, 今後脊柱変形発生の問題を残している. このことに関し, 若干の文献的考察を加え報告した.

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We reported short results of synovectomy of rhumatoid elbow using our postero-lateral approach. In reference to the ROM of 8 elbows, CPM was applied postoperatively for one week and the results were compared with 8 elbows with long arm cast for 10 days postoperatively. The former gained ROM more and earlier than the latter. CPM can be applied by our approach, because of continuity of triceps aponeurosis to the olecranon. We found out that the CPM was effective after our approach. Finally we emphasized that radial head should be excised as minimally as possible, while synovectomy around radial head should be carried out completely.

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大腿骨頭壊死における早期診断法と core decompression の有用性を調査した. 対象は Ficat のいう early stage (stage 0-II) の患者5例7関節に限った. これらの患者は術前全例MRIで低信号域を認めた. 手術に際しては, 8mmのトレフィンをイメージ透視下に大転子下部より穿孔したが, その組織学的所見は全て Ficat の云う壊死所見を呈していた. 術後平均1年の近隔調査では, その臨床成績は stage 0 (1/1) の100%, stage I (3/4)の75%, stage II (1/2) の50%が成績が優良であった. X線評価では, stage 0 (1/1)の100%, stage I (1/4)の100%, stage II (1/2)の50%で進行が停止しており, 目下 collapse を生じた例はない.

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Posterior cruciate insufficiency has been treated either conservatively or surgically by a number of different procedures utilizing both artificial ligaments and autogenous structures. Each procedure has its own limitation and advantage. We present two patients with chronic posterior cruciate insufficiency who underwent transfer of the medial head of gastrocnemius.
Case 1 (22 years, male) suffered a right knee injury in a traffic accident in October 1984. Posterior sag and pain persisted until he presented to our clinic in July 1985. Arthroscopy showed a complete tear of the posterior cruciate ligament. The Hughston technique was performed on his right knee in August 1985. Case 2 (19 years, male) suffered open fractures of the tibia and the calcaneus, which were treated with primary osteosyntheses in June 1986. He had residual pain and instability of his right knee. In July 1987, he was also operated using same procedure. Follow-up time after surgery was 38 and 15 months, respectively. The outcome was good subjectvely, functionally and objectively (Hughston's criteria), although the posterior drawer sign persisted. The Hughston technique is not difficult and good functional results can be expected. This procedure is useful in old injuries with severe instability or fresh injuries where primary repair is impossible.

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The etiology of dissociated motor loss or cervical spondylotic amyotrophy outlines two hypotheses at present; one relates to damage of ventral spinal root and the other to damage of anterior horn. This time, we performed laminoplasty in a case characterized by a lifting disorder of the right upper extremity and pyramidal signs and obtained favorable improvement. In this paper, we report the case. This case was considered to be one type of myelopathy which occurred due to spondylotic changes and multiple canal stenosis into the spine and OYL-like ossification at C4/5 level.

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A rare case of a parosteal osteosarcoma of the rib was reported. A 40-year-old woman visited our hospital in July 1983 because of a painful tumor. The tumor was solid and localized in the middle segment of the left 7th rib. A simple resection of the tumor was performed and the diagnosis was osteochondroma. In August 1987, tumor recurred at the same region of the left chest.
A diagnosis of parosteal osteosarcoma was made after an excisional biopsy and a wide resection was additionally performed with excision of the left 6 and 7th ribs. The defect of the chest wall was repaired with dacron sheet.
The patient was well alive 15 months without any sign of recurrence.

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Usually osteoid osteoma occurs in the long bones of the lower extremity of adolescents and young adults, and rarely in other bones. Recently, we experienced an osteoid osteoma of the patella of a thirteen year old boy with marked atrophy of the quadriceps muscle. The diagnosis was clinically difficult, and in ordinary radiographs no nidus was defined. The diagnosis of the osteoid osteoma was ascertained from computed radiography (CR). At the time of the operation the lesion was excised en bloc, and grafting of the iliac bone was performed. Subsequently, his knee pain was relieved. Five months after the operation his muscle atrophy was still not improved, but he was having no difficulty in his daily activities.
The stained samples with H.E. demonstrated the typical pathological features of an osteoid osteoma with irregular osteoid trabeculae lying in a vascular fibrous stroma forming a nidus, and the surrounding bone showed sclerosis. Nerve fibers in the nidus were well detected in the Bodian's stain.
CR can be very useful in diagnosing such cases when a tumorous condition is situated near a joint.

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We present 3 cases operated upon for their well differentiated chondrosarcoma. They have been free of recurrence without chemotherapeutic agents as of now.
Case 1. A sixty one year-old man had his right shoulder operated on using the Tikhoff-Linberg procedure (wide tumor resection). During the course of the 9 months following, the patient was able to write letters with a grip strength of 26kg. although his shoulder function was abolished.
Case 2. A tumor resection was performed on a fifty six year-old man. The tumor was superimposed on an exostosis rising from the left proximal fibula associated with multiple exostosis. During a follow up one year later he could kneel.
Case 3. A thirty year-old man was forced to have his left leg amputated above the knee. The tumor was superimposed on an enchondroma rising from the left tibia associated with Ollier disease. During an examination six years after the amputation it was observed that he could walk with an orthosis.

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A persistent sciatic artery is a very rare anomalous continuation of the internal iliac artery which provides the major blood supply to the popliteal artery. We accidentally found it in an 83-year-old woman who suffered from a fracture of her left femoral neck. The persistent sciatic artery had close proximity to the sciatic nerve while replacing the hip joint with the prosthesis. It was detected on an arteriogram which showed that it originated from the internal iliac artery and traveled to the popliteal artery. The superficial femoral artery was also found to be hypoplastic. This anomaly should be kept in mind in the clinical assessment of any neurovascular disease.

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Ingrown toenail is one of the most common affliction of the foot and is often required surgical intervention. Since the cause of it is not well understood, many methods of surgical treatment have been described. we report the results of surgical procedures for 30 ingrown toenails.
During the last 4 years, labiomatricectomy which consisted of resection of the nail wall, nail, nail bed, and nail matrix, was done on 30 ingrown toenails (29 great toes and one 2nd toe) in 24 patients (10 males and 14 females). The age at the surgery ranged from 13 to 68 years with a mean age of 28.7. The average duration of symptom was 19.2 months (range; 4 days∼10 years), and 12 toes had previously been treated by ablation or partial resection of the nail and/or other surgical procedures. The average period of follow-up was 7.5 months with a range of one to 24 months. In 13 out of 30 toes, bacteriological examinations were carried out.
26 out of 30 toes had no signs of recurrent ingrown toenails. In 4 toes, some problems were recognized (3 recurrences of infection with granulation, one inflammation of nail wall). The recurrence rate was 13per cent. The cultures of 13 specimens obtained during surgery proved to be positive in all cases, and the organisms were Staph. aureus in 10 toes, Staph. epidermidis in 3, Enterobacter cloacae in one, and Strept. pyogenes in one.
In conclusion labiomatricectomy obtained satisfactory results in 30 ingrown toenails. Managements of pre- and postoperative infection were claimed to be necessary for gaining a good outcome.

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The case was a 55-year-old male with no occupation. At initial examination, a tumor of about 2×3cm in size which was elastic soft without adhesion to the skin was found at hypothenar region of the left hand. Consistent with the tumor, Tinel's sign was positive and sensory disturbance was found in the region of the palmar branch of the ulnar nerve. Atrophy of the interosseous muscles and hypothenar muscles was found, and the ring finger and the little finger presented claw fingers. The terminal latency on the abductor digiti minimi was 2.9msec in the right hand but it was 3.8msec and delayed in the left hand. At operation, the superficial branch of the ulnar nerve was found to be pushed to the radial side by the tumor in the ulnar tunnel. The deep branch was divided into fine nerve bundles and ran over the surface of the tumor, but it was flat and atrophied. The tumor was of a yellowish-white color and covered with a thin membrane. Histopathologically the tumor was diagnosed as schwannoma. Five months postoperatively, sensory disturbance was alleviated but muscle atrophy remained.

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