It is known that dehydroepiandrosterone sulfate (DHA-S) is an important precursor of placental estrogens in human pregnancy. In order to study the fate of DHA-S derived from the mother or the fetus, the following experiments were undertaken. Maternal C₁₉ and C₁₈steroids were measured by GC-MS, in anencephalic (n6) and normal pregnancy (n=30) . In an anencephalic pregnancy, maternal peripheral steroid levels were also measured before and after the administration of DHA-S to the maternal vein or to the fetus. 1) Except for DHA-S and free androstenedione, the levels of E₁, E₂, E₃and DHA were significantly lower in anencephalic than in normal pregnancy. 2) Administration of DHA-S to the anencephalic fetus resulted in a significant increase of 16-DHA and E₃levels. This result indicates that DHA-S originated from the fetus may serve as an important precursor of 16-steroid in maternal circulation. 3) Direct conversion of DHA-S to 16-DHA-S in the maternal site was also suggested from the results of a significant rise of 16-DHA-S following the administration of DHA-S, while free 16-DHA was not alter. 4) The increment of E₁and E₂levels after DHA-S administration to the anencephalic fetus was similer to that of the maternal vein. 5) Maternal DHA-S concentration rose 1.6 times of the control levels by the administration of DHA-S to the anencephalic fetus suggesting the transferal of this steroid from the fetus to the mother when excess amounts were secreted. Since it is known that DHA-S plays an important role for ripening of the uterine cervix, administration of DHA-S to the fetus may be useful to induce the delivery of the anencephalic fetus.

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The field of vertebral surgery includes a variety of techniques for interbody spinal fusion. Among them, anterior fusion is considered to be the best since it uses an anterior approach and provides secure results that are well-grounded in anatomical structure. However, the operation requires technical skill and may be associated with certain risks. In this regard, we speculated that more secure anterior fusion might be possible if interbody fusion could be implemented by percutaneous drug infusion. Various studies have been carried out on spinal fusion using biological agents, especially drugs, bone morphogenetic protein (BMP) . In the present study, rat caudal intervertebral discs were treated with percutaneously infused recombinant human BMP-2 ( rhBMP-2), and the resulting changes were assessed radiographically and histopathologically. Radiologically, no apparent changes were evident at 1 week. However, calcification appeared in the BMP at 4 weeks, and this became marked at 8 weeks in comparison with the control group, especially in the ligament of the intervertebral disc where BMP had been infused. Histopathologically, hypertrophic change of the endplate cartilage tissue and enchondral ossification in the annulus f ibrosus were observed in the BMP groups at 4 and 8 weeks. However, no osseous interbody continuity was evident. This may be partly explained by the poor blood flow in the intervertebral disc and participation of the bone guidance factor except in areas whose circulating blood cannot reach, due to the difference between differentiated cartilaginous tissue and the cartilage endplates. However, changes resemblingf bridge formation from enchondral ossification were noted around the ligament part of the intervertebral disc where BMP was infused on the abdominal side of the vertebral body, due to the action of rhBMP-2. In some cases, bone bridge formation through the cartilage endplate was found. This suggests that a type I collagen disc treated with rhBMP-2 assists in the organization of the intervertebral disc, and that percutaneous infusion of rhBMP-2 can help achieve interbody fusion.

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Fracture callus is well known to have multiple potentiality. In this report, we attempted to show the ability of fracture callus to differentiate to cartilage by grafting the callus to the cartilage defect.
Osteotomies were performed on the iliac bones of mature rabbits. In two weeks, callus was extracted from the fracture callus and grafted into the cartilage defect in the patellar groove of the femur. In another group, osteochondral defects in the knee were left engrafted. The animals were sacrificed at 2, 4, 8 and 24 weeks after the callus graft. The knees were prepared and examined histologically and immunohistologically.
The grafted fracture callus showed precartilage tissue including undifferentiated mesynchymal cells. Two weeks after the callus graft, chondroblasts were recognized. In 24 weeks, the major cartilage was replaced by hyaline cartilage showing type II collagen. In the control group, the defect was repaired by a f ibrocartilage, or enchondoral ossification was present.
Fracture callus has pluripotential ability. It might differentiate fracture into the bone, fibrous tissue, or cartilage when certain environmental conditions are met. For example, under an environment of low-oxygen-pressure continuous shearing stress, fracture callus is capable of developing into hyaline cartilage.
An intraarticular cartilage defect was repaired with hyaline cartilage by a fracture callus graft.

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Concerning rheumatoid arthritis (RA), accompanied by bone cartilage destruction, several studies of the joint destruction have been carried out. We examined the expression of MMP-1, 9 in the joint fluid, serum, synovial tissues and synovium tissues of MMP-3 in mutilans RA. Mutilans RA has not been clearly defined yet, therefore, we divided the definition into three groups from the clinical target evaluation and compared them.
Materials and Methods : Often total knee arthoroplasty, collected serum, joint fluid and synovial tissues wee examined by hematoxylin-eosin and immunohisttochemical staining to measure the expressed MMPs (MMP-1, MMP-3, MMP-9) . The amount of albumen of MMP-1 and MMP-9 in the serum, the joint fluid, the MMP-1, 3, 9 positive cells in the synovial tissues were compared in the three categories.
Result : The Histological feature in the Mu and s-Mu groups of our classification included severe destruction of the cartilage and the bone by invasion of non-specific granulation tissues composed of many small vessels, neutrophils and osteoclasts. The expression of MMP-1, 3 was in the synovial tissue surface. The expression of MMP-9 went into the large area from the synovial tissue surface to the depth. The expression was especially conspicuous in the neutrophils and osteoclasts in the area of bone destruction and granulation tissues. There was no distinct correlation non significant comparison in the three categories. However, with the histochemical study of synovial tissues, the participation of MMP-9 was suggested as one of destruction of the joint such as mutilans RA.

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The use of prefabricated osteomusculocutaneous flaps using free calvarial bone was evaluated in a rat model. Prefabricated osteomusculocutaneous flaps were created by femoral muscle implantation with the femoral vessel and free bone harvested from the parietal region beneath the abdominal skin. Wistar rats (n=50) were divided into 5 groups according to prefabrication time : 5, 7, 9, 11 and 14 days. All groups contained 10 rats which were divided into two groups according to the presence (n=5) or absence of the periosteum (n=5) . The prefabricated osteomusculocutaneous flaps were then transferred as an island flap. Flap viability was assessed on postoperative day 7 by skin color. The result suggested that neovascularization of the flaps perhaps started from the 9th day.
Some of the surviving flaps were evaluated by macroscopic observation at 5 and 7 weeks after the bone implantation. Bone mineral density was measured by microf ocus X-ray computed tomography (MCT) . Bone implanted with the periosteum always had a higher mineral density than the bone without periosteum. These results were also supported by histologic findings.

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Patients with vertigo were examined and assessed for any relationship between their background factors and their cardiovascular reactions during a postural test.
A total of 629 cases were entered in this study. A postural test was conducted using the Schellong test. Two indirect, continuous manometers were used as the measuring device, with the left and right index fingers selected as the sites for measurement. The results indicated that, regardless of drug use, the recumbent heart rate was higher in groups with dizziness than in groups without dizziness, showing that the“presence of dizziness”most strongly affected recumbent heart rate. As for changes in heart rates that occurred during the postural test, a marked age-related phenomenon was seen : the younger the patient, the greater the degree of increase, and the older the patient, the smaller the increase. This phenomenon, however, was seen among normal adults as well. The increase in heart rate was affected very little by the diagnostic classification used and other factors, while many subjects showed differences in the blood pressure recovery patterns between their left and right. R-R interval power spectral densities were found to be less with vertigo in both the LF and HF components than in normal adults. No differences in BRS were seen between normal and vertigo patients, between those with and without vertigo, and between the left and right index fingers. However, differences in blood pressure were seen between the left and right. These findings suggest that background factors such as“dizziness”and“aging”were responsible for changes in the underlying and dynamic autonomic functions with vertigo. BRS was found to be unrelated to any of the background factors. However, due to the bilateral differences (left and right) and decreased responses observed, abnormalities or decreased responsiveness in the cardiovascular regulatory system may have a role in the onset of dizziness or may be associated with background factors in vertigo patients.

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In recent years hydoroxyapatite (HAP) has often been used in the field of plastic surgery as a bone substitute to treat craniomaxillofacial bone deformities and defects, instead of performing autologous bone transplantation. While HAP onlay grafts offer the advantage of no donor sacrifice, the sinking phenomenon has been found to occur, although there are differences in degree. In the present study, we investigated the effect of the site of the onlay graft and differences in its porosity on the sinking phenomenon. The experiment was performed by inserting HAP blocks with 0 %, 30%, 50%, and 70% porosity under the periosteum at three sites, the frontal bone, the zygoma, and the mandible, of 4- to 6-week old male New Zealand White (NZW) rabbits. Three NZW rabbits were allocated to a sham group, and 24 rabbits were sacrificed 8 weeks after grafting. Villanueva's bone stain was used to histologically examine the interface between the HAP and recipient bone for autogenous bone substitution and migration, identified by the presence of a mixture of osteoblasts and osteoclasts. The order of severity of the sinking phenomenon according to site was : mandible>zygomatic bone>frontal bone, and accoding to porosity: 70%>50%>30%>0 % ; and clear differences from the sham groups were shown. Based on the above findings, the results of the experiment showed that selecting porosity after considering the strength of the implant and the site to be grafted is an important fafter when applying HAP clinically.

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Twenty-six cases (5 males, 21 females over 65 years old of femoral trochanteric fractures utilizing the Captured Hip Screw system were investigated concerning clinical results and radiographic assessment. The average age at surgery was 80.8 (range: 65-92 years. Ten cases were stable and 16 cases were unstable by Evans classification. Eleven cases (stable type 5 cases, unstable type : 6 cases began full weight bearing and walking exercise within 14 days after surgery (A-group) ; fifteen (stable type : 5 cases, unstable type : 10 cases) started full weight bearing and walking exercise after 15 days (B-group) . Walking ability upon leaving the hospital, period of hospitalization, reduction loss of fractured area, telescoping phenomenon, time of bone union and complications were compared between the two groups. One case of the A group and 7 cases of the B group showed a deterioration of walking ability upon leaving the hospital (p<0.05) . Four cases of the A group and 4 cases of the B group showed a reduction loss of the fractured area of more than 10 mm (n.s.) . Early weight bearing and walking exercise maintains walking ability and is useful as postoperative management for aged femoral trochanteric fractures, even though some cases showed a reduction loss of the fracture area.

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A rare case of rupture of the flexor digitorum prof undus muscle tendon accompanied by avulsion fracture of the distal phalanx is described. The patient was a 24-year-old male. On November 15, 1998, he noted pain in his ring finger when he lifted a heavy object and became unable to actively bend the finger. The DIP joint of the right ring finger was swollen, showed subcutaneous hemorrhage, and was incapable of active flexion.
Plain X-ray examination revealed a fracture of the distal phalanx and a free bone fragment on the palmar side of the middle phalanx.
The detached bone fragment was caught by a A4 pulley. The bone fragment was reduced by traction and fixed with a soft wire.
Passive mobility training began on the second postoperative day, and active mobility training started in the third postoperative week. Presently, 6 months after surgery, the DIP is capable of active 50°flexion and-10°extension.
This case was classified as type III by Leddy's classification and was considered to be one of hyper-extension injury. The outcome of this injury is generally favorable for all types with early surgical treatment. Our case which was also treated surgically early after injury, had an uneventful course.

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The case of a patient in whom pedal arthritis became notable after a subcutaneous tumor with rice bodies in the foot joint was removed is reported here. This case is a rare case due to the following findings : the subcutaneous tumor contained rice bodies, and not gouty tophus, initially, and marked pedal arthritis accused after removal of the subcutaneous tumor, and many rice bodies were present in the foot joint. The reason for the presence of rice bodies was assumed tobe due to sepation of the granular nodes with necrosis in the synovial membrane. The reason why the arthritis was not manifested was assumed tobe due to the following : Inflammatory substances leaked with the articular fluid and subcutaneous pustule was then formed. Consequently, due to removal of the tumor, symptoms of crystal induced synovitis appeared in the closed joint and the pedal arthritis became manifested.

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