It is commonly believed that blood leukocytes are more effective in inducing transplantation immunity. Now, genetic relationship between rabbits was explored by observing the rejection type of grafted skin in the rabbits preimmunized with homologous leukocytes. In this experiments, some rabbits were selected at random. Subject A was intracutaneusly injected by blood leukocytes from subject B and then full thickness skin graft from subject C was transipanted to subject B and 10 days after multiple intracutaneus inoculations. Plaster jacket protecting the graft was removed on 8th day and daily observation was continued until rejection was completed. The rejection types of the grafted skins in subject A and B were explored macro-and microscopically and determined the genetic similarity between the subject B and C. There was no recipient response to homologous erythrocytes and homologous plasma. In this results, the more the rejection type of testgraft of subject A was violent, the longer the grafted skin from subject C to sucject B was survived Consequently, it was possible to immunize the rabbits by multiple intracutaneus inoculations of blood leukocytes and determine the genetic similarity between donor-recipient pairs.
Clinical examinations were done in 6 Hospital on 206 infants. We observed 160 infants in which 131 (81.9%) had exchange transfusion and others 29 (18.1%) had non-exchange transfusion. In exchange transfusion group, 18 typical cerebral palsy (c. p.) was found (13.7%). In non-exchange transfusion group 1 typical c. p. was found. (non-typical or questionable type was avoided.) Typical c. p. in 160 infants after jaundice were 19 infants (12%). In our studies hyperbilirubinemia on typical c. p. showed over 25mg/dl, but 10 infants over 30mg/dl Bilirubinemia was no c. p. and under 20mg/dl Bilirubinemia a few c. p. was seen. So the exchange transfusion showld be done according to hyperbilirubinemia and clinical findings (conf. Praah' Stadium). From standpoint of orthopedist we hope that the early diatnosis and treatment of c. p. must be done with co-work by pediatrists, obstetricians and orthopedists.
Electromyographic investigations by evoked method were performed on 23 patients of cerebral palsy aged from six to sixteen male and female. 14 patients of them are spastic type, 3 are ataxic, and others are mixed. The H wave was recorded from calf muscle following stimulation of the posterior tibial nerve in the popliteal fossa. The results of the repetitive evoked electromyography and recovery curves were compared with normal ones. On repetitive evoked method, in both low and high frequency, the H wave schowed high amplitude and undulations in many cases. In high frequency, 20 cps, spastic, ataxic, and mixed type seemed to schow different patterns. The recovery curves vary much in many cases. To observate the effect of the drugs, Diazepam and Chlormezanon, two patients of spastic type were selected. Diazepam (6mg per day) was given to one, Chlormezanon (3 tab. per day) was to another for one month. The recovery curves before and after medication were compared.
Conduction velocities in morter fibers of ulnar have studies in both normal control and after suprachondylar fractures of humerus. Conduction velocities of evoked nerve potential of the ulnar have measured in 30 fractures of the elbow as compared with another side. Latency has measured by 50 counters of using computer. A supramaximal electric stimulus, 0.3 millisecounds in duration, has deliveded through monopolar silver elecrodes on the skin along the course of the ulnar nerve at the rate of one per second. The ulnar nerve has stimulated in the above elbow and the wrist, and then has recorded from the hypothenar muscle (abductor digitiquinti). The latency has measured the internal from the onset of the stimulus artifact to the onset of the response. It has measured directly from photograph and converted to velocity (=distance divited by latency). The distance between stimulating electodes has obtained from surface measurements on the extrimity in the extended position. These above measurement of the conduction velocities has had diagnostic value in finding clinical and electrophysiological studies. Normal conduction velocities in ulnar has never appeared more slowly than injured side in all cases. Among the patients has treated by traction, these has clinical sign, paresis and muscle atrophy of ulnar side. The results of operative treatment has showed to be not so good as those obtained traction in only conduction velocities. The normal ulnar conduction velocities have been showed 56.1±15.6m/sec. The injured ulnar motor nerve velocities have been showed 46.2±10.5m/sec at 22-27°C roomtemperatures. Change in carrying angle of elbow after supra-chondylar fractures of humerus has caused by medical or lateral angulation of the distal fragment.
The statistical observations were carried out with regard to 3 cases with radial nerve injuries. The extent of radial nerve injuries were classified into three types-complete degeneration type, partial degeneration type and neuropraxia type-based on the results of clinical functional examinations, nerve conduction test and electromyography. In the cases with complete degeneration type regardless of cause of the nerve injuries and partial degeneration type with open wounds, the authors ascertained the extent of the injured nerves operatively before or after three weeks following injury to decide the indication of the nerve repair. In the cases with partial degeneration type without open wounds and neuropraxia type, the conservative treatment were performed in principle. The authors concluded that the methods as has been previously mentioned will provide specific information concerning the treatment of peripheral nerve injuries.
The fine structure of the skeletal muscle from the rabbit given glucocorticoid were studied. Predonisolone was injected in doses of 10mg per kg into the back muscles of the experimental rabbits once daily. Hormone injection periods lasted for a week to four weeks. Gastrocnemius and iliopsoas muscles were prepared for the examinations. The degenerative changes were found microscopically to be localized in a small number of muscular fibers in the rabbits injected for three weeks to four weeks. Electron microscope showed the extensive and distinct involvement of mitochondria and myofibrill. Mitochondria lying in sarcoplasma were enlarged and bizarre, and decreased in number. In the area of the progressive mitochondrial degenerations, the myofibrillar breakdown and the irregularity of Z line of single sarcomere were found. Sarcoplasmic space became distented to several times their normal size, that might be caused by the presence of edema fluid. EMG findings in the treated rabbits indecated the low potentials and no neurogenic patterns.
The clinical and experimental studies had been performed in order to know the effective points of steroid hormone on rheumatoid arthritis. The methods were as follows: (1) The latex fixation test was examined using the human serum with rheumatoid arthritis, 68 years old, female, stage 3, class 4, classical. (2) The steroid hormone was added on it after the complete agglutination had been observed. (3) The patients' serum was incubated with steroid hormone at 37 C-degree for one hour and then the agglutination test was examined with the latex reagent. (4) The reaction between the 1/2 diluted latex reagent with the physiological salts solution and the serum was demonstrated as a control. (5) The latex test reagent was incubated with steroid hormone and then, the agglutination test was examined with the patients' serum. The results were as follows: In the reaction of (1), (2), (3) and (4), above mentioned, it showed the stronger agglutinating nature. But in the last reaction, in case of using the incubated latex reagent with the steroid hormone it was lesser agglutinated. This facts indicate the effectiveness of steroid hormone on rheumatoid arthritis are not only by the antiinflammatory nature, but also by the direct influences on antigenantibody reaction itself.
Sixty-three cases of rheumatoid arthritis recieved chrysotherapy and the clinical effects were summarized as follows. 1) Antirheumatic effects were good in 48 (76 per cent) of 63 cases with R. A. 2) The improvement of morning stiffness was shown in 45.5 per cent of all the cases. 3) In chrysotherapy, the improvement of erythrocyte sedimentation rate was most remarkably found in the one-hour value and in the patients of Stage I and Class 2. 4) Of all the cases, 17 (33 per cent) showed the improvement or normalization of RA test and 28 (53 per cent) that of CRP test. 5) In haemogram, the normalization of WBC was found. 6) The patients with rheumatoid arthritis recieving corticosteroid therapy was able, in 66 per cent to secess from the therapy. 7) Side effects, mostly dermatitis and stomatitis, were noted in 59 per cent of all the patients with rheumatoid arthritis recieving gold salts. 8) Clinical effect were remarkable in the group recieving a total of more than 1 gram gold salts.
Tuberculous tenosynovitis is said to be a rare case, which, together with the decreasing tendency of bone and joint tuberculosis, leads us to have less interest and make an error in diagnosis. Our investigation has revealed the fact that there are only forty-seven cases in Japan. Now we'll inform you of the treatments of tuberculous tenosynovitis, which we have recently experienced; two of them are that of flexor tendon of wrist, and the other, of extensor tendon of wrist. The patients are all of advanced age, …seventy-one years, seventy-three years, and sixty-three years, …and their cases were diagnosed as tuberculous tenosynovitis on the histological examination after the operation. One of the three cases was complicated with tuberculous arthritis, and another had the history of two years' treatment of infectious tenosynovitis after the injury in the ring finger and little finger fourteen years ago. All the three cases are progressing favorably owing to the use of anti-tuberculous drugs and also by the surgical treatment, that is, by the excision of tendon-sheaths in granulative hyperplasia, and there is no tendency of a return of inflammation.
1) 102 cases of the fracture of distal end of radius treated in the Department of Orthopedic Surgery, Nagasaki University School of Medicine and Nagasaki Municipal Hospital, from 1957 to 1968. The most of them were treated by the conservative treatment. 2) Of radiological findings, 70 cases, were classified into three types, described by Gartland; i) Type I 46 cases, ii) Type II 16 cases, iii) Type III 8 cases. The most of young patients had a simple fracture, with comminuted fracture were found in older. 3) In the clinical end-results of 21 patients, (a residual) deformity of radius remained in 9 cases, 7 cases complained still pain. But only one of these cases had decreased in ADL. 4) The great majority of Type II and III showed a decrease of volar tilt and radial deviation in radiological finding. In young patients, a length of the radius presented a increase as compared with normal site. 5) In arthrographical study of the distal radio-ulnar joint, 7 out of 14 cases showed varying change in the discus and capsule. But in the most of these cases presented a satisfactory function.
The fracture in injury of the femoral neck is rare in children, and the prognosis of this fracture is bad since there are complications such as ensuing necrosis of the femoral head. Nine cases of children with the fracture of the femoral neck have been on this radiographical and functional results of conservative treatment. 1) Union of the fractured bone was shown in all cases. 2) With seven cases one year or more after fracture, results of the treatment were good in five cases and bad in two cases. The prognosis the intertrochanteric fracture is good, but that of the cervicotrochanteric fracture bad. 3) Weight-bearing as well as the complete reposition and the fixation of the fracture is an important factor for prevention of the following complications
Dislocation of the Patella appears to be rare and is almost always to the lateral not to the medial side. 1) Three cases of traumatic lateral subluxation are described. In one of these underdevelopment of the lateral femoral condyle is presented. There was no history of injury. In all cases the knee was immobilized for 3 weeks with a plaster splint. 2) Two cases of recurrent dislocation is presented. Tavernier's technique for a boy and Campbell's technique for a girl were practiced. When five cases were last seen from three to fourteen months after treatment the patella was stable and flexion of the knee full.
From 1961 through 1967, thirty two patients with congenital muscular torticollis was treated surgically at the Tamatsukuri Orthopedic Hospital. We examined fifteen cases of the patients, one year or more after the operation. The results obtained so far may be summerized as follows. 1) All cases have not residual wry neck, but have slight motor disturbance of the neck. 2) Two patients of 19 and 23 years old have had the asymmetry of the face and moderate motor disturbance of the neck. All others had good results. 3) Partial resection on the insertion of the sternocleidnmastoid muscle gives relatively poor results. 4) The asymmetry of the skull and face will correct itself as long as growth is present.
A boy of five years was admitted to our clinic for the pain in his bilateral hips and thighs. He had a fracture of the right humerus, and ostemyelitis of the left mandibula in his history. A hydrocephalus and nystagmus appeared in the second year of life. There was apparent mental slowness and optic atrophy. The serum calcium level was within normal limit, but alkaline and acid phosphatase ranged in high levels. Hematologic examination provided no evidende of anemia. There was greatly increased uniform density of all the bones, typical of osteopetrosis. The base of skull was greatly thickened and dense. The vertebrae showed “thick sandwich” appearance. The long bones of the upper arm and thigh had abnormally thick shaft, and greatest increase in density was found in the upper third and lower half of the femora and upper half of the humeri. In these regions, apparent transverse striations were seen. On the other hand, longitudinal striations were seen in the middle third of the femora and the upper half of the forearm bones. Upper parts of the femora were greatly deformed. The neck were dense and widen, apparent coxa vara was seen. At the border between the necks and the shafts, there appeared opaque zones, suspected as the fractures by unusual stress.
A girl aged eighteen years fell down in her school on April 30, 1968. She was diagnosed as the right tibial fracture and treated. But abnormal bone sclerosis was found radiologically and she was referred to our clinic. She has fracture history of the right tibia three times. There is no imbalance in her four limbs and trunk but she is considerably short. A large head and small face are unbalanced. There are palpable grooved concavities along the sutures and fontanelles. The row of teeth is irregular. Both index fingers are clubbed and development of the nails is poor. Roentgenographic examination revealed separation of the coronal, sagittal and lambdoid sutures. The fontanelles were open. The mandibular angle was flattened. There was no pneumatization of the frontal, maxillary or sphenoid sinuses. Configuration of the sella turcica was normal. A transverse fracture line was found in the middle of the right tibia. The uniform sclerosis of all bones was similar to marble bone disease. But the alternate dense and less dense bands seen in the osteopetrosis were not found. Laboratory examinations were normal, Chromosome analysis revealed no abnormality. A case of pycnodisostosis was presented with some discussions of the literature.
The brace for active and passive extension of the spine has been used in 20 cases of the scoliosis of growing individuals. The brace and the methods of exercise are partially modified from original ones. Stretching of the spine, and correction of deformity is reliably performed as well as certain increase of vital capacity in all cases. Exercise of the back muscles prevents atrophy during the long application of the other brace.
The results of anterior spinal fusion operation according to Cloward's method were observed on 30 patients with cervical osteochondrosis. Out of the 30 patients, 22 had syndromes of the spinal cord compression and the remaining 8 had only radicular syndrome. The results of the operation were satisfactory, being good in 71%, and effective in 20%. Better results were obtained in the latter group than in the former. As to the relationship between the results and duration from onset to the operation, better results were obtained in the cases of the former group, whose onset was within 6 motnhes, although there was no relationship in the letter group.
In the last 8 years, 1407 patients were diagnosed as cervico-omo-brachial syndrome in our out-patient clinic. We could classify the various disorders considered as a cause of the cervico-omo-brachial syndrome on the basis of the clinical findings, plain and functional radiograms. In these disorders, there are cervical osteochondrosis (subdivided into radicular syndrome and spinal cord compression groups), scalenus anticus syndrome, cervical rib, costo-clavicular syndrome, hyperabduction syndrome, Pancoast tumor and tumors in the cervical spine etc. But in the cases of undetermined cause we classified them as other. 342 of 435 patients of cervico-omo-brachial syndrome were of radicular syndrome (79%) and 93 of them of spinal cord compression groups (31%). Others were 922 cases (67%). We discussed each group according to age, sex, occupation, cause, sign and symptoms with their localization, radiological findings and end results.
For a means of the therapy of low back pain, the lumbagoband is prescribed. During the past two years (1966-1967), 456 patients with low back pain were treated by putting on the lumbago-band. For the purpose of investigating the effects of these lumbagobands, questionnaires were sent out and answers gathered from 223 patients. Here we report and discuss about these results.
Annual changes of patients with low back pain in our clinic from 1953 to 1967 were statistically analysed on 8, 412 outpatients (20.2%) and 852 inpatients (14.1%). As to the break-down of diseases in outpatients, lumbago was 46.2%, sciatica 16.8%, spondylolysis and spondylolisthesis 10.9%, tuberculosis 4.2%, fracture and dislocation 3.3% and tumor 1.1%. Spondylolysis and spondylolisthesis, spondylosis deformans and osteoporosis increased gradually in ratio, Tuberculosis of the spine decreased remarkably and the other diseases were constant.
In the literature, there are a few reports on the posterior apophysis occurred in the posterior margin of the vertebral bodies. Recently we experienced operations of the two cases of this disorder. Case 1: A twenty-two aged man, sustained low back pain when he lifted up a heavy weight 20 days before admission. On physical examination, straight-leg-raising test was positive at 155 degrees on the right and at 120 degrees on the left. Mild degree of muscular atrophy in the thigh was recognized but no sensory disturbances in the lower extremities detected. Radiological examination revealed a small area of bone dafect in the postero-inferior margin of the 4th lumbar vertebra and a fragment posterior to the defective area. Myelographic examination confirmed the radiological findings. A free-body was removed operatively. Case 2: A thirty-nine aged man had fallen down from the height about 5ms, about seven years before. There after he had been suffering from low back pain. Last year pt. had received laminectomy but symptome were aggravated, followed by neuralgic pain in both lower extremities. On physical examination, straight-leg-raising test was positive at 120 degrees on the right and at 130 degrees on the left. Muscular atrophy was detected. There was sensory disturbance in the left foot-dorsum. Roentgenological examination revealed the findings similar to Case 1. After myelography, a free-body was removed operatively.
Recently, we experienced the treatment of 4 cases with lumbago and sciatica which resulted from nerve root compression by a small ossified fragment of the posterior longitudinal ligament in location of the L4-5 intervertebral space of the lumbar spine. Radiologically, the ossified fragment was the thin lens-shaped and situated a little apart from the posterior surfaces of the intervertebral space and the vertebral body. Laminectomy and posterior spinal fusion were performed on 2 cases with severe symptoms. At operation, it was noticed that the ossified fragment was pushed up by the protruded intervertebral disc. Microscopically, it was proved that the ossified fragment was produced by ossifing metaplasia of the posterior ligament. It is undoubted that localized ossification of this ligament may be closely related to disc degeneration, irritation to the ligament at movements of the lumbar spine and local disposition for ossification. Therefore, it is presumed that this condition may be originally included into early special pattern of spondylosis deformans.
A 46-year-old woman with slight low back pain for nearly 15 years complained of severe radiating pain in her left leg since 3 months. The 4th lumbar disc hernia was suspected by physical and roentgenographic examination. At Love's operation, a extradural tumor was found beneath the nerve root. The tumor mass was dark red in color and tip of the little finger in size. Histological examination revealed that the tumor was chordoma composed of vacuolated cells with a little intracellular mucin.
A case of paragonismus in the intraspinal canal With myelopathy. A rare case of paragonimiasis with intraspinal localization at the level between the 11th thoracic and 3rd lumbar vertebrae was experienced in our clinic. in this case severe myelopathy developed, probably due to cyst formation in the spinal canal. Case: A 5-year-old girl lived in the basin of the river Shimata. She frequently ate river crabs. Ten months before admission to our clinic, gradually difficulty in walking developed. Shortly after the first appearance of symptom paresthesia developed, followed by urinary and fecal in continence. At first patient was placed in a treatment under the diagnosis of Guillain-Barre syndrome. However she was admitted to our clinic for further aggravation on the disease. An tumor in the etradural space was suspected myelographycally and laminectomy was carried out. The tumor was identified as a cyst in the spinal canal. Histo-pathological examination of the cyst revealed evidences of adult parag. Westermani, worm and paracyte eggs surrounded by a reactive connective tissues. One month after operation the sensory disturbance in the lower limbs and urinary and fecal incontinences were improved. 8 months after operation difficulty in walking was also improved considerably.
A sixty-three years old man have complained the low back pain with the radiation pain to the right thigh since January 1968. He admitted to our hospital with the limitation of extension of the right hip due to the pain in February 1968. After two weeks of hospitalization, he had dysuria motor loss of both legs and saddle block sensory disturbance. The spinal tumor was suspected and the blockage below the third lumbar vertebra was demonstrated on myelogram. On march 21, 1968, the operation was performed. The tumor was placed in extradural space (L3-L5) and removed. Microscopic examination revealed the reticulum cell sarcoma. The patient's postoperative course was becoming worse and died forty days after operation. At autopsy same tumor in the origin of right Psoas Major Muscle from 4th lumbar vertebral body to the 5th was found. But the tumor was not demonstrated in the lymphonodes which was able to be examined. Our case is thinkable a reticulum cell sarcoma that arose primarily from spinal extradural space and right psoas major muscle apart from lymphonodes.
In our clinic, twenty three patients with spinal cord tumor were observed since 1952. Thirteen of these patients were males and ten were females. Of our series, four cases were intramedullary, fourteen were intradural extramedullary, three were extradural and two were intradural-extradural. In this series, five tumors occured in the cervical column, sixteen in the thoracic column and two in the lumbar column. The majority of the histological structure of tumors were meurinoma, totalling ten cases. Histologically each of other tumors were one or two cases. The final result was satisfactory in eleven patients of twenty (fifty five per cent). All cases of intramedullary tumor did not relieved after surgery.
We have as yet very little reports as to haemangioma of soft tissue, especially primary intramuscular haemangioma with venous stone. In recent four years, these four cases were operated in our clinic. Little is known about the mechanism of the celcification of venous stone. We tried therefore the histochemical research about it in relation to acid-mucopolysacharide.
A woman aged sixty years was admitted to the Nagasaki-Rosai Hospital on July 16, 1968, with the complaint of a lump on the outer side of her right forearm in the upper third which she had noticed for the past four years. There were no motor or sensory deficits in the right upper extremity. Radiograph showed a well-difined radiolucent mass measuring 7×4cm. situated adjacent to the proximal end of the radius. At operation the tumor was found buried beneath the fibers of the supinator brevis muscle. The supinator muscle was thinned and atrophic. The superficial radial nerve was stretched over the convexity of the tumor. The tumor was soft, yellow and well encapsulated. The basal part of the tumor was firmly attached to the proximal end of the radius. The appearance of the cut surface of the tumor was characteristically yellow and greasy. Microscopic sections showed benign adipose tissue.
Recently we have experienced two cases of fibrocystic disease of bone. Case 1 A boy of thirteen complained of pain in both knees and a clinical diagnosis of Osgood Schlatter's disease was made. Radiographs revealed a lesion in the left tibia considered to be fibrous cortical defect. This lesion is subperiosteal. The histological picture was that of fibrous cortical defect. Case 2 A girl of twelve complained of pain in left knee. Radiographs revealed a lesion in the left tibia considered to be non-osteogenic fibroma. This lesion is endosteal. The histological picture was that of non-osteogenic fibroma. From accounts in our cases, there appears to be valid clinical distinction in that the fibrous cortical defect never gives rise to symptoms or signs whereas the non-osteogenic fibroma can do so by virtue of its size and pathological fracture. Radiologically there is a distinction in that the one tends to be subperiosteal, the other endosteal. Histologically there is little to distinguish the two. We belive that fibrous cortical defect is a local developement aberration and non-osteogenic fibroma is a beneign neoplasm.
We have encountered 5 cases of multiple myeloma since 5 years, 4 cases had died, 1 case is alive. The chief complaints were the pain on the low back, back and breast, and anemia. Diagnosis: 2 Cases by the examinational excision. 2 Cases by the marrow puncture smears. 1 Case by the clinical views and the radiographic appearances. The anemia and the accentuation of the red cell sedimentation rate were counted on the case of all. Hyperglobulinemia: 2 cases. Bence-Jones Proteinuria: 1 case. Radiograph showed osteoporosis, punched out rundish rarefactions and fractures. The differential diagnosis from osteoporosis, increasing recently, schould be careful.
Cases of metastatic cancer to the peripheral bones are rarely seen. This is a case report of a patient with metastatic cancer to the left fifth metacarpus. The patient, 44 years old, male, had complained of painful swelling in his left hand for a few months' duration. Roentgenographically an osteolytic lesion was discovered in his left metacarpus. At first enchondroma or giant cell tumor was suspected, but cytological examination demonstrated cancer cells, and histological examination revelaed adenocarcinoma. The involved bone was resected. One month after the surgery, a tumorous mass appeared at the supraclavicular lymph node, and osteolytic lesions in the skull and right calcaneus were discovered. The primary lesion was found in the lung after the general survey for two months.