Postapopleptic patients have been trained for rehabilitation in the past two or more years since our hospital started to function. Here is reported an evaluation of 86 patients who were discharged after training. They were divided into three groups of severity, mild, moderate and severe cases with no difference of number among three groups. Age distribution of the patients revealed a peak between age 56 and 60. Most of the patients were admitted 4 to 12 months after the cerebrovascular accident. The relation of the interval before admission and the initial grade of disability to recovery of function was studied, and it was found that restricted function of the joints was found in higher incidence among those who were admitted 4 months or more after the cerebrovascular accident, regardless the severity of disability. Recovery of motor function of the upper extremities and of walking ability has proved no distinct relation with severity, but the recovery was poor in the group who had elapsed longer than 2 years before admission. Recovery of function was less in the upper extremities than in the lower extremities, probably owing to the need of skill movement in the upper extremities. Recovery of upper extremities did not depend on the side of paralysis, but the patients with left hemiplegia seem to be satisfied to use the left hand only to help the right extremity.
Among such poisonous gases as carbon monoxide, nitrogen oxide, ozone and sulfur dioxide, carbon monoxide is porbably the most widespread poisoning hazard. Here is carbon monoxide poisoning refered to. CO is only toxic because it reacts with hemoglobin to form carboxyhemoglobin (HbCO). The affinity of hemoglobin for CO, expressed as K, is 200-300 times its affinity for O2. In a given blood with the value of K, heat decreases the affinities of both gases for hemoglobin, but affects that of CO more than that of O2. Light greatly lowers the affinity of CO for hemoglobin, but has relatively little effect on the affinity of oxygen. Hence increase in either temperature or illumination lowers the value of K and assist oxygen in displacing CO from the hemoglobin molecule. If one expects to treat CO poisoned patients not only by oxygen administration but also by decreasing the affinity of CO for hemoglobin, an application of extracorporal circulation is necessary to perform above procedure. This past decade has wittnessed the introduction and subsequent development of temporary total or partial extracorporal circulation as a routine and useful surgical technique. Our order-made plastic chamber has multiple abilities to oxygenate, thermoregulate and illuminate the blood in the extracorporal circuit. Using this chamber we studied the rate of decrease in HbCO under such various conditions as at 40°C, illumination of a 10W. ultra-violet lamp and oxygenation with 10% CO2 containing oxygen. Following results were obtained in our circuit; oxygenation alone decreased 68% of HbCO to 45%, oxygenation plus 40°C heat decreased 74% to 35%, oxygenation plus illumination 66% to 36, and oxygenation plus lowered pH 63% to 37%. The oxygenation plus heat, illumination and lowered pH together decreased 65% to only 36%, showing no additive effects of those combined. When much improvement of oxygenator is made to facilitate above-mentioned procedure, the rapid removal of CO from lethally saturated blood is possible with the use of equipment that is cheap, rapid to assemble, and already widely available.
A case of multiple tuberculous osteomyelitis, the right tibia and the left ankle jojnt, was reported. A woman, 35 years old, had the pain, swelling and fistula on the right leg and the left ankle joint since 2 years. In the pathological findings, it was diegnosed multiple tuberculous osteomyelitis. The chemical therapy and operation were very effective.
It is told that the results of arthroplasty for severe rheumatoid arthritis of the elbow are usually satisfactory. Three patients with good ligaments and muscles were operated by means of J K. Membrane Arthroplasty in our clinic for these 3 years. Two patients have satisfactory result in the range of motion and stability after 1 year and 2 years of surgery. The other has gained the ankylosis again.
At the treatment of patients with rheumatoid arthritis, it is great important to prevent articular deformities, because, once a deformity is established, these correction is very difficult. Recently, we have made an attempt at various corrective procedures; indirect or direct traction, Quengel plaster cast, arthrodesis and protective apparatus, for nine patients with such articular deformities of the leg caused by rheumatoid arthritis. Five of nine were inability of gait, four of nine difficulty. An analysis of our end results shows that five patients were able to walk with no stick, one with stick, and three no change.
We reviewed the early therapeutic results of sixty-one patients, treated with Riemenbügel band. This series contains forty-three joints with acetabular dysplasia, six with subluxation, and thirty-six with complete dislocation. We divided the therapeutic results into excellent, good and fair. In cases with acetabular dysplasia, good results were obtained. 80.9per cents of subluxated and dislocated patients treated with Riemenbügel band only were excellent. 81per cents of dislocated cases were reduced. But in the cases of marked degree of dislocation, reduction was impossible or maintenance in a reduced position was difficult. 9.3per cents of cases treated with Riemenbügel band only developed deformity in the femoral head.
The results of 75 shelf operations on 61 patients were followed up over one year. They were 2 years and 7 months to 15 years and 10 months of age, an average of 8 years and 7 months. The average period of observations was 5 years and one month. Zinnaka's method was used on most of them. Results of the operation were evaluated on the functional condition and X-ray findings. Better functional results were obtained in the case operated at the position of the original acetabulum than in those at the dislocated position. Good results were obtained in 76per cent of all cases. Cases operated at less than 7 years of age showed better results than those of over 7 years of age. The results of roentgenogram were good in 44per cent and poor in 56per cent of the cases. Poor results were attributed to construction of shelf which were inaccurately placed, absorbed, or fractured. Cases obtained good results in X-findings were also good in function. Therefore, the shelf should be constructed as close to anatomical shape as possible.
We applied various operative procedures to eight patients with coxa vara et magna. By means of trochanter plasty or trochanteric transplantation, coxa vara was improv ed and symptoms were considerably relieved. In the cases with relatively good acetabulum, simple use of subtrochanteric valgusosteotomy or trochanter plasty and trochanteric transplantation were effective to some extent. In the cases of poorly developed acetabulum it is necessary to perform shelf operation. Generally, perfect satisfaction could not be obtained for various factors such as deformities in the femoral heads etc. Judging from our experience, according to symptoms, detorsion osteotomy or displacement osteotomy should be indicated in addition to above-mentioned methods.
A case of saphenous nerve entrapment was reported. Man, 19, had suddenly paresthesia in the medial aspect of the right knee, leg and foot while doing “shodo” (Japanese calligraphy). The paresthesia became progressively worse with development of pain and limitation of flexion of the knee joint. Some conservative therapy such as nerve block with predonisolon and the use of other anti-inflammatry agent prodused no relief. In the bloodless field the saphenous nerve was showed constriction at its emergence through the subsartorial fascia. After the nerve was released through a wide incision in the fascia, pain and paresthesia rapidly disappered.
Case 1. 35 years old man: After osteosynthesis of the left clavicular fracture, he complained of numbness sensation, cyanosis, and hypaesthesia of the same side upper extremity in a hanging position. Case 2. 43 years old woman: She complained of numbness sensation, edema and hyperesthesia in the right fingers. Case 3. 36 years old man: He complained of strong fatique sensation in both shoulders and upper extremities. In those cases above described, we found that Eden's test and plethysmographic test were positiv, that X-photo suggested narrowing between 1st rib and clavicule. They were treated conservatively
A case of lateralisation of the patella, 21 year old female, was reported. The patient complained of pain and weakness in her left knee after sprain. On examination the patella slipped laterally from slight flexion to acute flexion but it returned to the normal position at the maximum flexion angle of the knee joint. Her right knee was revealed to have the same abnormality slight degree without symptoms. The medial retinaculum was surgically sutured to the separated M. vastus medialis and the lateral retinaculum was insiced along the lateral border of the patella. Results of operation was satisfactory and the lateralisation was thought to be congenital in nature and to be exaggerated by sprain.
Recently many papers about avascular necrosis of bone; which is probably an injurious side effect of systemic corticosteroid therapy, have been reported. However, multiple lesions are very uncommon; those most often reported are lesions of the femoral head. It is here proposed to describe a case of avascular necrosis of the right femoral head and both lateral femoral condyles after systemic conticosteroid therapy. Case Report A 18-year-old man was hospitalized elsewhere for the treatment of the palsy of the left facial nerve about 1 1/2 years before admission to this hospital and treated with a total of about 2, 300mg of predonisolone during 3 months. Nine months after the initiation of corticosteroid therapy, the patient began to experience pain in the right knee and shortly after in the right hip and left knee. Radiographs showed avascular necrosis of the right femoral head and both lateral femoral condyles. In the right hip, bone span transplantation was performed.
It has been experienced clinically that the scar of primary surgical suture in paralytic area in patient with leprosy or spinal cord injury does not develop hypertrophic scar or keloid formation. Observation was carried out clinically for the scar of primary surgical suture and was concluded that these surgical procedure which would give rise to neurotic paralysis or hypoesthesia around the incised skin region, was one of the factor which suppressed the enlargement of scar in cosmetic view. The investigation was carried out in young adult rabbites. One side of brachial plexus of each animals was cut, resulting paralysis and forearmes were wounded bilaterally, exposing subcutaneous tissue, then produced primary sutures. Each pair of woundes were removed together at intervals from 1 hour to 15 days, and were examined histochemically, using alkaline and acid phosphatase, phosphorylase and PAS reactions. It was revealed that primary wound healing in denerved side was more retardated than in controlled healthy side both in epithelium and corium.
In multiple wiring of the fracture of the femoral neck, the operative involvement is very little. This method is easy, but the ability of this fixation is rather strong. We often use this method because of its aptitude to old persons. Recently we operated the peritrochanteric fracture of 84 year old female by this method, and the fixation was made with five Kirschner's wires. But while still in plaster, we found that one of the Kirschner's wires was in the pelvic cavity by roentgenography. By urgent laparatomy, we found the wire sticking in the uterus and pulled it out. Such a case was our first one, and in general very rare. In the inner fixation to the advanced osteporosis, we must the coiled wires or bend the end of the Kirschner's wires.
We have made this experiment to know the dynamic mechanical characteristics of the lumbar vertebra. Experimental approach 1. Material: 4 lumbar vertebrae. 2. The mechanical system of the pendulum: Mechanical impulse was exerted on the inferior articular process of the lumbar vertebra. 3. An holder: It is made from cement, and hold the body of the lumbar vertebra. 4. Desk-Top analog computor: simulated the vibration of the lumbar neural arch. 5. Recording: Recorded by means of two channel oscilloscpoe. Results The mechanical impulse response of the lumbar vertebrae seems to be will fitted by a simple underdamped second order equation. Approximate values found of the equivalent mechanical parameter are: Natural frequency: 1900 c. p. s. logarithmic decrement: O. 14.
At our previous study, we designed a device to add a mechanical impulse to clarify some dynamic mechanical properties of bones and demonstrated that a bone vibration in natural frequency with high and low-frequency components and with logarithmic decrement was developed. This report demonstrates that logarithmic decrement and natural frequency is constant every site of a femur, but its stress in a bone exerted by one mechanical impulse is varied every site. And differences of the logarithmic decrement between ages and between males and females is not clearly. We make sure them, using Desk-Top Analog Computor. Furthermore, we illustrate the distribution of stresses in one femur in the medial side in detail and in three femurs in both sides.
Ten poliomyelitis patients with bone shortening of the lower limbs were induced femoral arterio-venous fistula and observed longer than one year. The results, indication and complications are discussed with case demonstration.
We had recently three cases which suggested the tumors of cervical spine in the roentgenographic findings. One of three cases was really a metastatic carcinoma that had the primary site in stomach. But, in the other cases, one was recognized as the caries after several months, and the other was a nonspecific chronic inflammation although an alkylating agent and a radiation therapy took a remarkable effect to the lesion.
Clinical and electromyographic evaluations were carried out in 44 patients with whiplash injuries. The psychoneurotic complaints persisted on the majority of the patients. Electromyographic examinations revealed the appearances of complex motor unit and fibrillation wave forms in the muscles supplied by the cervical plexus and the brachial plexus in some cases. Then the recovery curves of monosynaptic reflex were determined on the tibial nerve. It was proved that the excitability of motornerves increased in the patients suffering from whiplash injuries.
A 48-year-old female and a 28-year-old male with low back pain diagnosed as tuberculous spondylitis of the 4th and 5th lumbar spine were reported. Plain X-rays and tomographies showed a marked narrowing of the intervertebral space and localized destructive changes of the vertebral bodies. According to the findings at anterior spinal fusion, histological study and satisfactory results of the operation, the low back pain in these two cases was caused by degenerative changes of the intervertebral disc. The authors emphasized that disc degeneration besides tuberculous spondylitis should always be considered in the patient with low back pain whose X-ray showed the abovementioned changes.
Statistic survey of the 86 congenital anomalies of fingers and toes in our clinic from 1957 to 1966 was reported These cases occupied 0.28% (male: 46 persons, female: 40 persons) of all our patients (30417 persons). Distributions of the patients was the lowest (0.15%) in 1957 and the highest (0.45%) in 1958. As previous authors reported, polydactilism, syndactilism of fingers and toes were the most frequently observed. 2 cases belonged to the consanguineous families and 3 cases were interesting in the heredity, but 6 cases were related to abnormal pregnancy.
A 22-year-old man was suffering from the pain in his right elbow. His weight was 43.5kg and height was 164cm. Ocular manifestations were myopia gravis, ptosis of the eyelids and microcornea. Although no cardiovascular involvement was detected except slight elctrocardiographic abnormality, a positive family history was demonstrated. Skeletal manifestations were; he had spiderlike bony fingers, but roentgenolograms revealed normal phalanges and metacarpals whose metacarpal index was about 7. 1. The chest appears elongated and narrow. Scoliosis of mild degree was seen. In the lumbar area, there was widening of the spinal canal associated with concavity of the posterior margins of the vertebral bodies. Body of the second lumbar vertebra was cuneiform, laminae and spinous processes of the lumbar vertebrae were hypoplastic. Of greater interst was the deformities in the elbows. Bilateral radial heads dislocated posterolaterally, pseudoarthrosis was found on the boders of olecranon and diaphysis of the right ulna. At the first surgery, after the resection of dense fibrous tissue between these two fragments and sclerotic bone tissue, olecranon was fixed to the diaphysis by a tibia-bolt, and bonegraft was performed. Six weeks later, right radial head was resected, the articular-cartilage on the both postero-lateral surface of the capitulum humeri and antero-medial surface of the caput radii were disappeared as if had been worn out.
Generally there are various changes of bone in Recklinghausen's disease, but pseudarthrosis of the lower leg occurs less frequently. We had encountered three cases of Recklinghausen's disease. The three cases were incomplete form with Cafe' au lait spots and pseu-darthrosis of the lower leg. Osteosynthesis with bone graft was carried out. In all cases the results were followed up, and bone union did not occur in two cases. Therefore, the amputation was done for the two patients. In the other one a bone union was gained enough to walk with apparatus.
In 1955 F. Schajocowicz et al reported the study of aspiration biopsy in bone lesions, especially cytological and histological technique, and they considered that the smear is generally sufficient to diagnose eosinophilic granuloma, myeloma, metastatic carcinoma and to diffirentiate between Ewing's sarcoma and osteomyelitis, or between giant-cell tumor and osteolytic osteogenic sarcoma. We also studied the smear of bone tumors. The tissues obtained from tumors at surgery were drawn lengthwise on a slide, and was stained by Papanicolau's staining. The diagnostic characteristics shown in the smears from tumors were compared with the sections on which the histological diagnosis were made. Giant-cell tumor 2 cases, Chondroma 2 cases, Polyostotic fibrous dysplasia 1 case, Ewing's Sarcoma 1 case, Metastatic Carcinoma 3 cases, Chordoma 1 case were examined. The smear from giant-cell tumor is sufficient to study the finer cytological details of giant-cell, and also sufficient to diagnose.