In a case of autopsy of the fracture dislocation of XII. thoracal vertebra with spinal cord lesion, degeneration of nerve cells of posterior spinal ganglions was detected. The degree of degeneration was severest in the posterior ganglion, which belonged to the injured spinal segment, decreasing apart from there. Such lesions of the posterior ganglions might be caused by the strong and sudden tension of the posterior nerve roots at the time of trauma.
A coal-miner aged 41 years was get under coal and forced to hyperflex his body. His I. and IV. lumbar vertebral bodies and right transverse processes of IV and V lumbar vertebrae were broken. The fracture line of IV. lumbar vertebral body lied almost longitudinally and the fragment dislocated laterally. After recumbency of 7 months, he was treated with fusion operation. After 2 and a half months from operation recovered his initial paralysis to the extend of hypaesthesia on dorsum of feet and the weakness of muscle powers in his right leg. He can walk around without crutch or any supports.
In the accidents of coal mine, miners encountered sometimes the spinal cord injuries caused by the fractures of spines. Because of the total paraplegia, they were forced, hitheto, to be in beds. The author succeeded in letting many of them to walk by followings trainings; 1. After two months of immobilization, they excercise to sit up by their own efforts. 2. They try to prostrate themselves, to lift their bodies and to move their pelvis. 3. After two to four months of the first and second trainings, they try to walk with walking calipers in such a manner as placing their body weights on their paralysed legs. 4. After they become skilled in the third training, they walk with crutches.
The determination of prognosis of cerebral lesion is not always without difficulties. The author examined the cerebro-spinal fluid as an aid for this purpose. By the exanination of 89 cases, the author classified the following three groups; 1. The pressure of spinal fluid is above 301mm. (in water) 2. From 201 to 300mm. 3. Below 200mm. The prognosis is worst in the first group, next in the second and best in the third. The hemorrhage in cerebro-spinal fluid is noticed in 55 cases. In the cases of commotio cerebri, the intracranial hemorrhage may be much more frequent than is realized before.
In the treatment of the transverse or short oblique fractures of long bones, the author prefered the open reduction and transfixation by Kirschner wires. One or few short Kirschner wires inserted obliquely through fracture sites were enough to maintain the reduced fragments. The operative technic was quite simple and the operation could be furnished in a short time.
As a method for determination of abnormal mobility of vertebra in spondyloiysis, the author measured so-called arch angles, and distance from superior to inferior articular processes in the obliquely projected roentgenograms of the fifth lumbar vertebra. The so-called arch angle means the angle between the upper border and the line which was connected with superior and inferior articular processes. Although the average degrees of arch angle in 200 cadavers were 90.7 degrees, they were 101 degrees in 29 cadavers with pseudarthrosis of arch. The author concluded that the abnormal mobilities of spine with spondylolysis were clinically detected by the fact that the arch angles increased by flexion of spine, and the distances from superior to inferior articular processes by extension.
A man, aged 26 years, was treated malaria in May, 1942, by spinal injection of “Bagnon” (Quinine preparat). Directly after injection he was attached by severe nervous symptoms, from which he recovered completely after a half year, and returned to normal works. From October, 1950, he was caught by reffered low back pain and paresis of legs. By the laminectomy of X and XI thoracal spines, severe adhesions of spinal cord with arachinoidea and dura was detected, which were detached gentlely between arachinoidea and dura, especially in ythe regions of nerve roots. After one month from operation., he was free from pain, but paresis of legs remained unchanged. It is interesting to notice that the nervous symptoms caused by adhesive spinal meningitis occur after interval of several years, and worth while to indicate that the detachment of adhesions in the regions of nerve roots is important to relieve pains.
The arthrodesis is indicated in the cases of advanced rheumatoid arthritis, which are unable to improvee by conservative treatments and show roentgenographically the severe destruction of articular cartilages and spur formations. Four casess of such rheumatoid arthritis of knee joint were treated by arthrodesis with excellent results. Concerning the operative methods, the authors prefer the Putti's method to Hibbs's.
The proteins in joint fluid of twenty chronic arthritis were examined by the electrophoretic method. The content of the protein in joint-fluid showed no changes in quality in comparison with those of blood serum. The total protein content of joint-fluid in chronic infectious arthritis increased in parallel with the severeness of inflammation, decreasing albumin and increasing globulin. In the acute rheumatic fever increased the plasma albumin. The total protein content in osteoarthritis was small, showing no changes in plasma protein.
34 coal miners, who were working with the percussion hammer, were examined by radiograph and 21 of them were found some changes of bones and joints of their upper limbs. The locations of the changes were as following table; The conclusions are as follows; i. The changes are most frequent in elbow joints. ii. The changes are encountered more frequent and severer in the right arms. iii. The degrees of changes are proportional to the duration of use of machines, but disponsition of patients cannot be neglected.
One hundred cases of tuberculous spondylitis were observed and the results obtained were as following; 1. X-ray findings were various and two cases of central tuberculosis were found. 2. The third lumbar vertebra was most frequently involved, then D11, D12, and L1. 3. As number of affected vertebrae, 2 were most common, and over 5 were found in 3 cases. 4. Age at onset was most frequent in second decade and male was two times frequenter than female. 5. The most frequent initial complaint was back pain. 6. 25% of these cases had a history of pleurisy and pulmonal tuberculosis. 7. Joint tuberculosis was found in 9 cases. 8. 42% had palpable abscesses and fistulae. 9. 11 cases had paraplegia. 10. Wasting period before consultation was within one month in 21 cases, 1 to 6 monthes 31 cases, and over 2 years 14 cases.
Eight patients of joint tuberculosis with fistulae were treated by intra-articular operation combined with chemotherapy. After the acute symptoms have subsided by means of the conservative treatments, the surgical operation was indicated. After curetting of the joints, the cavities were packed with homogenous bone chips of ribbs; in some cases the fusion operations were attempted. The chemotherapy by streptomycin and penicillin was started from two days before operation, and continued after operation. The total dosis of streptomycin were 10gr. and that of penicillin million units, from the economical standpoint of the patients. At the time of operation, streptomycin in dosis of 0.3gr. and penicillin 100, 000units were administrated locally. Although the follow-up period was to date only one year, the results obtained were excellent but one relapse, which was operated in acute stage. The duration of treatment may be reduced by means of surgical treatments combined with chemotherapy.
Four brothers in a family casing marble bone disease are under-developed and each experienced fractures 1 to 7 times. They have more or less bigger heads, peculiar faces and club-fingers. Their blood are lpmphocytosis and eosinophilia. Radiograms of bone show generally severe calcification, thickening of cortioalis and narrow marrow cavities. Cancellous bone have been replaced by compact bone.
The patient, a male of 17 years of age, complains of motor disturbances in the whole body and swelling in the right thigh. Ossifications in tendons, muscles, cartilages and in various parts of the body are clinically and radiographically recognized. It may be said that this disease is diagnosed as myositis ossificans progressiva multiplex.