JOURNAL OF THE KYORIN MEDICAL SOCIETY

In this study the features of auto-correction of deformities and prognosis of overgrowth after the fracture of tibia in children were investigated. Ninety cases, 62 boys and 28 girls with an average of 7.3 years were followed up. Sixty four cases were closed fractures and 26 were open. The follow-up period was between one to 13 years, with an average of 4 years. Conservative treatment was used in 81.2% and surgery in 18.8%. Results: All cases except one achieved bone union with an average of 77.3 days. Bone union in closed fractures was 64.4 days for group A (aged 5 and under), and in open fractures 85.2 for group C (aged between 9 and 12). Overgrowth occurred in 96% of group A with an average of 9.4mm and in group C 54%, 4.2mm. Auto-correction of varus and valgus deformities occurred in 92% of group A and 70% of group C, also found in 83.1% of anterior and posterior convex deformities at the time of union, 87.5% of which exhibited auto-correction. Conclusion: Overgrowth occurred within two years after the injury, continuing to four years before it almost stopped. We observed good results in auto-correction of deformityelled when angles of varus and valgus deformities were 10 degrees or less, and in anterior and posterior convex deformities 20 degrees and under. Age had no influence in correcting anterior and posterior convex deformities, but the infants excelled over other age groups in correcting varus and valgus deformities.

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Down syndrome critical region 4 (DSCR4) gene located on 2lq22.2 of human chromosome 21. The DSCR4 genome consists of three exons, and the size of cDNA is 1083bp. The open reading frame (ORF) encodes a predicted protein of 118 amino acids. Although the functional sites such as TNF ligand family like domain are expected from the predicted amino acid sequence, the function of DSCR4 is unknown. Northern hybridization and RT-PCR analysis of various human tissues showed that DSCR4 was expressed only in placenta. By RT-PCR analysis of various human cell lines, choriocarcinoma cell lines, BeWo and JEG3, were positive for DSCR4 expression. By treatment with TPA in BeWo cells, expression of DSCR4 mRNA was increased a little. The expression vector coding DSCR4 ORF with Histag was transformed into E.coli. The recombinant protein was induced by IPTG and then purified. The antibiodies were made against this fused protein and the oligopeptide (aa46-61) of DSCR4 protein. The specificity was confirmed by Western analysis and Enterokinase cleavage. The stable transfectant cell (HeLa-DSCR4) was established. DSCR4 protein phosphorylation in the stable transfectant was studied. By the treatment with EGF or insulin, and no treatment, DSCR4 protein phosphorylation was not found. Anti-DSCR4 antibody and anti-DSCR4 peptide antibody were used for immunostaining of human placenta tissue and JEG3 cells. The placenta tissue of nine weeks of pregnancy were specifically immunostained in trophoblasts and decidual cells. JEG3 cells were also Immunostained and DSCR4 protein was found mainly in the cytoplasm. DSCR4 may contribute to the development of embryo in the placenta tissue of early pregnancy.

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Calcium phosphate cement (CPC95), vancomycin (VCM), and polylactic acid (PLA) were used in this study. VCM and PLA were heated and stirred, then ground into a powder and mixed with CPC95, the mixture referred to hereinafter as CPC95VP. Eighty Japanese white rabbits were used in this study. CPC95VP was injected into the femoral intramedullary canal in the experimental group of rabbits ("intramedullary implant"), and was implanted between muscle and the lateral aspect of the iliac bone in another group of rabbits. ("extra-iliac implant") . The maximum value of VCM's release was 1.37μg/ml an hour after intramedullary injection of CPC95VP, and 1.50μg/ml after extra-iliac implantation of the material. In both groups, VCM's release into the blood was under 0.6μg/ml at twenty-four hours after the operation and continued at that level until 12 weeks. VCM concentration in the adjacent tissue maintained more than 90% of the MIC value (1.56μg/g) for eight to twelve weeks. In hard tissue specimens it was observed that the intramedullary implants adhered to the femoral bone marrow completely, and that new bone formation took place between them. Compared to the control group (CPC95 only), there was no significant difference in the rate of bone formation or the calcification of newly grown bone, thus CPC95VP does not interfere with bone formation. In addition, the pH values around the implant were between 7.50 and 8.00, which is in a range that is known not to affect the rate of new bone formation. Renal damage was not observed. Based on this study, it is concluded that CPC95VP is a useful material for preventing and treating methicillinresistant Staphylococcus aureus (MRSA) infections in bone and joints. Thus it could be useful for clinical treatment of osteomyelitis with bony defect, cases of infection after total joint replacement, and so on.

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A 54-year-old man was clinically diagnosed with diabetes mellitus in 1995, but was not treated. From the end of August 2001, he suffered from lumbar pain and several days later, edema of the right lower limb appeared. Edema also gradually developed on the left lower limb and he was admitted into our hospital on September 20, 2001. The results of physical examination on admission revealed pitting edema of the bilateral lower limbs and dilatation of superficial veins of the bilateral lateroabdominal regions. In the contrast enhanced computed tomography of thoracico-femoral region, we had the interesting findings that inferior vena cava (IVC) lower than the level of the inflow region of hepatic veins was not visualized while the azygos and hemiazygos veins were markedly dilated. Furthermore, vascular lumina were continuously filled with organized thrombi from the bilateral deep femoral veins to hemiazygos veins. In magnetic resonance angiography of the thoracico-abdominal region, numerous veins were concomitantly visualized that were regarded as collateral circulation. Based on these results, the diagnosis was absence of the IVC associated with extensive deep vein thrombosis (DVT). Due to extensive development of collateral circulation, edema in both lower limbs was ameliorated through conservative therapy. It seems likely that stagnation in blood flow can develop in the case of absence of the IVC due to the resulting abnormal perfusion. However, the clinical manifestation of DVT has been rarely reported. In the present case, however, complications associated with diffuse DVT were observed and this may be attributed to the fact that low food intake due to severe lumbar pain caused dehydration resulting in increased blood viscosity. In addition, the immobility of the patient may have contributed to the enhanced tendency toward blood coagulation occasionally seen under diabetic condition.

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