Bone metastasis of the breast cancer was seen in 43.8% of all advanced cases in the routine clinical examination. 25.6% of patients with bone metastasis responded objectively to adrenalectomy, while patients with pleural or pulmonary metastasis responded better (44.4%, 33.3% respectively). A close relationship between responsiveness to adrenalectomy and urinary 17-ketosteroid excretion was recognized in patients with advanced breast carcinoma. Patients who excreted more than 4mg of 17-KS per day responded satisfactorily to the treatment. Good response of bone metastasis to the treatment was accompanied by remarkable elevation of serum alkaline phosphatase. Hypercalcemia due to bone metastasis was seen in 6% of advanced patients. More than 50mg of prednisolone accelerated urinary calcium excretion in about 50% of the cases. A patient with marked osteosclerotic bone metastasis showed anemia and hypocalcemia.
Osteopoikilosis is a rare bone disease, and was first described by Albers-Schoenberg in 1915. Since that time, over handred cases in the world and about ten cases in our country have been reported. It has no practical significance, and has been discovered by roentgenologic examination for coincidental disease. In the roentgenolograms, numerous small islands of compacta are scattered throughout the spongiosa of the carpal bones, the tarsal bones, the short and long tubular bones and pelvis. Recently, we have encountered a case of this disease, who is a man of twenty years old. Therefore we examined his pedigree to find out the other patients of this disease and the examination gave 4 other cases. It is suggested that this disease is of a simple dominant mode of inheritance.
A boy, aged 8 years, was admitted with the chief complaint of low back pain radiating down to the right lower limb and nocturnal pain of ten months' duration. X-ray examination showed destruction of the lamina and spinous process of the 5th lumbar vertebra. Alkaline phosphatase was 18.7 unit (Bodansky). Under the diagnosis of bone tumor or tuberculous spondylitis, needle biopsy was performed. Histological examination of the specimens revealed giant cell tumor. A rare case of benign osteoblastoma with operative findings and histological studies was reported.
A 14 year-old boy visited us complaing of the low back pain. The diagnosis of juxtacortical chondroma of the fouth lumbar spine mas made based on the histological examination and roentogenograms. Histological examination of the specimen showed atypical chondroma.
A female, aged 24 years, who had been diagnosed as grade II or grade III of giant cell tumor in the right iliac crest by radiological examination and biopsy about 8 months ago and received the resection of the tumor, was readmitted with the chief complaint of the relapsed tender swelling in the same region. Under the diagnosis of the recurrence of the giant cell tumor, the right hemipelvectomy was performed. The histological examination revealed grade II or grade III of giant cell tumor. The canadian type of hip disarticulation prosthesis was applied. Postoperative clinical course is uneventful. This operation may be indicated in the recurrent giant cell tumor of the hemipelvis as well as in the malignancies.
Indication of surgical treatments for the malignant tumors has been well developed even to the hemicorporectomy with recent advances in anesthesiology. The first hemipelvectomy was performed by Billroth in 1891, and the numerous reports of the results in the large series of successful cases has been published in other countries while very few in this country making a total of about thirty cases. The authors report an experience of the hemipelvectomy for the chondrosarcoma occurred in the pelvis of thirty-five-year-old man with a review of the literatures.
A male, aged 37 years, suffered from giant cell tumor of the right humeral head was treated with prosthetic arthroplasty. A tumorous part of the humerus was as completely as possible resected, after that it was replaced by artificial humeral head made from acry-resin. The musculotendinous cuff cut off in this procedure was tightly sewed in a mass on the inside of the deltoid muscle, and the simultaneously loosed long tendon of the biceps muscle was located into a tunnel of the humeral head (artificial) as well as Nicola's operation in recurrent dislocation of the shoulder joint. In six months after the operation, functional disturbance of the right shoulder joint was lightly recognized only in abduction and internal rotation.
In 1846, Dittlich reported the case of carcinoma developing in the chronic sinuses of osteomyelitis. Since then, it has been observed that the chronic sinuses and ulcer may develop malignant characteristics. In 1901, Miyata, first in Japan, reported a case of squamous-cell carcinoma developing in the chronic sinuses. Till now, about 50 cases have been reported in Japan. On the occasion of treating chronic sinuses and ulcer of skin, we must consider the possibility of developing malignant characteristics. Recently we had a case, 48 male, of squamous-cell carcinoma developing in the chronic sinuses of osteomyelitis of left tibia. Here we report this case with some referential observations.
A case of hereditary multiple exostosis with deformity of the nail of the fingers was reported. A man aged 15 had multiple exostosis in the fingers which resulted in deformities of the nails of bilateral middle, left index and right ring finger and treated by excision of the tumors and plastic operation of the nails. A housewife aged 59 had mono-osteoarthritis of MP joint of right index finger which was considered to be caused by exostosis inovolved the head of the second metacarpal bone. The mechanism of osteoarthritis in this case was discussed. Her complaint disappeared by local injection of steroid hormone and partial excision of the tumor. The authors reviewed the cases of hereditary multiple exostosis registered at the West Japan Bone Tumor Registry Center and suggested higher frequency of exostosis in the hand than that reported up-to-date, if the cases of multiple exostosis would be examined carefully.
Metastatic bone cancer are most frequently seen in vertebrae, pelvis, rib, skull and femur etc, but rarely seen in the peripheral bones below the elbow or the knee joint. 381 cases of metastatic bone cancer were diagnosed radiologically from March 23rd. 1962 to January 31th. 1968, at the National Cancer Center Hospital. Among them, 7 cases were diagnosed to have bone metastasis in hand and foot bone. Three cases which were very interesting in diagnosis and clinical course were presented. Case 1. A man, fifty-six years old; bone metastasis of the finger. Case 2. A woman, seventy-three years old; wide-spread bone metastases of the hand. Case 3. A woman, fifty years old; metastases of the metatarsal bones. In case 3, open biopsy was not done, but aspiration needle biopsy was done for the exact diagnosis of the metastatic bone cancer and cancer cells could be seen in the May-Giemsa stained specimen. Moreover, the cancer cells were recognized from the neighbouring bone which showed Sudeck's bone atrophy-like shadow and were very difficult to be diagnosed as bone metastases. Therefore, bone metastases of all metatarsal bone were diagnosed very quickly and easily, and early radiation therapy was successfully performed.
We quantified Acid Mucopolysaccharides (A. M. P.) in synovial fluids of human knees and bovine foreleg and examined the relation between A. M. P. and joint diseases. The materials were aspirated from knee joints of arthritis. Total No. 82. Rheumatoid Arthritis. (R. A.) -35. Osteoarthritis. (O. A.) -26. Other diseases. -21. They were experimented with Kushida-Kira method. (J. Jap. Orthop. Ass. 41. 1. 1967). Results.; From all synovial fluids, Hyaluronic Acid (H. A.) and Chondroitin Sulfate (Ch. S.) were separated by electrophoresis and paper chromatography. We classified these joint diseases to three groups and observed the relation between A. M. P, of each groups and age, pH, and amount of synovial fluids. (1) H. A. tends to decrease with aging but has no relation with pH and volume in R. A. and O. A. In the other, it decreases with increase of volume but has no relation with aging and pH. (2) Ch. S. tends to decrease with aging in R. A. and increase in O. A. but has no relation in the other. It has no relation with pH in three groups and with volume in R. A. and O. A. But in the other, it increases in proportion to volume. Average values of A. M. P. are most in the other, next R. A. and last O. A. In each groups, 2: 1 is most at the ratio of Ch. S./H. A. R. A. was classified to stage (by Steinbrocker) and class (by A. R. A.). The average values of both H. A. and Ch. S. decrease with advance of stage and class.
It is well known that tetracycline (TC) and TC derivatives accumulate in the mineralizing tissues particularly in the newly formed bone tissue. This effect has been utilized as tetracycline labelling of the osseous tissue. However, those drugs cause the disagreeable yellow pigmentation of the bone and teeth in clinically administered doses for the young patients as antibiotics. In the present study, we examined the deposition in vivo of TC to bone, and the fixation in vitro with calcium phosphate and the human bone powder. The binding ability of each TC was compared. In comparison of the macroscopic staining, macroscopic fluorescence and histological labelling, less staining abilitty was confirmed in young rats given intraperitoneally deoxy-oxytetracycline than those receiving an equivalent dosage of oxytetracycline and demethylchlortetracycline. To check whether there might be the difference also in vitro, after shaking each TC with tribasic calcium phosphate and the bone powder, the residual TC in supernatant and the adsorbed TC in precipitate were measured by ultraviolet resorption at wave length of 370 to 380mμ and fluorometry at 510mμ. The results were consistent with the observation in vivo; the percentage of TC fixed to calcium phosphate and the bone powder were lower in deoxy-oxytetracycline than the others. It seems to show a primary importance of calcium salt in TC-bone complex that TC uptake of the bone powder decalcified by ethylendiaminetetraacetate decraesed remarkably.
An examination of the fine structure of proximal tibia-epiphyseal cartilage (3-5 weeks-old rabbit) has ravealed the following information. 1) Chondrocytes of epiphyseal cartilage contain numerous cytoplasmic processes, and in their cytoplasm many vacuoles. The so called cartilage lacuna, like a halo, which gradually proceeds to the cartilageons matrix is seen around the cell to a certain extent. 2) The matrix appears to be irregularly intricated, possessing a felt-like structure, with fibre and then small fibres appear, without demonstrable periodicity, on the longitudinal septa. It is assumed that these fibres develop from the granules in the cartilage lacuna, in the cytoplasmic vacuoles. 3) Chondrocytes involve changes in cytoplasmic hydration rather than changes in the organelles. After maximum hydration, chondrocytes undergo death and degeneration. 4) Calcification initiates on the longitudinal matrix with relative electron-dense granules, gradually, forming itself into islets and granular specks. As they increase in number and volume, they fuse with each others to complete the formation of calcified cartilage.
The results of investigation on the radiographic density in distal end of the human radius from the young up to the old the previous reports made on the lumbar vertebrae, the femoral neck and especially on cases of its fracture (the femoral neck: 23 cases, compression fracture: 59 cases) were comparatively examined. The subjects studied were 215 cases of healthy persons ranging from 18 to 89 years of age (Male 89, Female 126), and 27 cases of Colles' fracture were also comparatively examined. It seems almost to agree with the results of measurement reported before that with advancing years the density becomes higher regardless of sex, and that the female tends to show suddenly a relatively high density from her fifties. A comparative study of the degree of density by age group in each region mentioned above and of that between the fractured and non-fractured groups revealed that in both cases of fracture and non-fracture, both sexes show a high density with increasing age in order of the forearm, the femoral neck and the lumbar vertebrae, and that in females this tendency is conspicuous. In cases of over fifty years of age, the fractured group presents a considerably high density. On the other hand, since fracture occures in the majority of cases of over fifty years of age showing an abrupt increase in density, that is, in 96 out of 109 cases (87.2%), the density in cases of non-fracture, fracture and a combined fracture of the forearm and other regions developed within year after fracture was examined. As the result it was found that the fractured group presented a high density in both sexes in order of the forearm, the femoral neck and the lumbar vertebrae. A statistic investigation on the significant difference in the case of fracture and a combined fracture disclosed that in the forearm there is a significant difference with a risk of 1 per cent and in the femoral neck and the lumbar vertebrae with a risk of 5 per cent.
Experimental studies were made of rabbits in the vertebral bodies with regard to bone circulation by means of radiation clearance method. These resul.s were obtained. In the normal vertebral bodies, circulation was more increased than in the gastrocnemius but decreased than in the tibial shaft. Under the pharmacological influence (noradrenalin, cedilanid, and kallikurein), bone circulation in the vertebral bodies were accelerated. Passive exercises in the upper or lower extremities and electric stimulation into the sciatic nerve brought out the increased circulation in the vertebral bodies. When the neck and trunk were immobilized in a plaster cast, bone circulation was decreased but markedly improved by the exercises of the lower limbs. Passive exercise in the lower extremities brought out more greater influence than in the upper extremities on the vertebral circulation. These results mean that general or local stimulation into the four extremities has some influences on the vertebral circulation.
Lately, the importance of very early treatment has been emphasized by Bobath, B., Bobath, K. and Köng, E.. We report on early examination and early treatment that we have tried. As well as incidents with regard to cause, abnormal signs which mother finds out first are very useful for early finding. Neurological examination was made under chart that we organized. Treatment was carried out according to Bobaths' method. As each case has factors of different kinds, the result can not be related equally, but it is sure that beginning of treatment is the more early, training is the more easy and effective.
In treatment of cerebral paralysis rehabilitation is essential, but surgical methods are also considerably useful as supplementary procedure. There are many reports concerning improving-operation of kneeflexions occur in cerebral paralysis. We tried a modified method of Eggers operation transplants medial hamstring only to femoral condylus in 28 legs of 16 patients, consisted of 14 cases with spastic type and 2 cases with athetoid type, and 24 among 28 legs improved remarkably in knee-flexion and 12 among 15 legs with internal rotation at the hip improved remarkably in internal rotation. Consequently, up to present, on patient showed genu recurvatum due to over correction and a trend of recurrence. It is necessary to make long-term observation to valuate operation effect of our method. Operation of muscle and tendon seems to be held possibility of recurrence easier than operation of bone and joint, but has an advantage to be enable secondary operation if necessary. In these viewpoint, we expect rather earlier effect of rehabilitation in combination of our method to cautiously selected materials.
1. Showed you the measuring on their physical condition, physical strength and muscular endurance. 2. Biochemical test of blood and urine or in liver function. 3. To prevent bedsores of the wheel-chair workers, examined continually the skin in buttocks for 2 hours and measured the skin temperature by electric thermometer. The goal in rehabilitation is that the handicapped demonstrate their remaining function and get the productive job as a good member of the society. For these reasons, in october, 1965, we founded “The Taiyo no Ie” The Japan Sun Industries, aiming at employing the serious handicapped as possible as we can. We should promote the employment of the disabled under the basic work-medical study. We made these handicapped work in the wooden work shop as the object of our study.
Two hundred and sixty eight patients had blood transfusions during surgical operation in our orthopedic clinic, from September 1, 1962 to April 30, 1968. Five of them were attacked by serum hepatitis before leaving hospital. Bone union was followed in four of these five patients, two of them had sustained fracture of the femur, one subtrochanteric osteotomy, one spondylodesis posterior, (another patient had Love's operation). Bone union in one of two patients of femur fracture was seemed to be normal. Though his transaminase levels were relative low (GOT 600 unit GPT 500 unit) and reduce quickly, six weeks after the onset GOT and GPT elevated again 240 unit and 200 unit. That of other three patients was apparently delayed, in spite of slightly disturbed nutrition and good immobilization by Küntsche's intramedullary nail or plaster cast. Their highest transaminase levels were GOT 1260 unit GPT 680 unit, GOT 3060 unit GPT 2280 unit and GOT 140 unit GPT 370 unit respectively.
A 20-years young man suffered from the fractures of the both femurs, of the right lower leg and of the right patella. He was given blood-, fructose and aminoacid transfusion. The abnormality of the physiochemical examination in blood and in urine except for anemia was not evident for 5 days. However, symptome of uremia has appeared since the eighth day, with increasing levels of blood urea or non protein and oliguria, and he died of uremia on the fourteenth day. At autopsy, the kidneys became grossly, as large, swollen, and edematous (right 178gr, left 190gr.). Microscopically, the marked hydropic swelling of the epithelium in the proximal portion of the nephron and slight degeneration and necrotic changes of the epithelium in the distal portion of the nephron with the presence of heme cast were found The former is “osmotic nephrosis” and the latter is “lower nephron nephrosis”. No changes were observed in the glomeruli. Therefore it is suggested that slight lower nephron nephrosis resulted from the multiple fractures, marked osmotic nephrosis followed from a large quantity of fructose transfusion and functional disturbance of the kidneys has been produced by them.
A new type of K-U compression plate which was devised in our clinic has the characteristic hole having oblique groove to compression for osteosynthesis. The use of this plate needs not other apparatus for compression between the fractured fragments, and the osteosynthesis with compression is satisfactory by turning the screw only. On K-U compression plate we report the physical and mechanical study which has been done in our clinic, and discuss how to use this plate. This plate was made with 18-8-Mo stainless steel, and showed the hardness of 23° HRC in cold working and the surface of circular arc in cross section. One side of this plate has few round holes for fixing screw, and other side has one or two silding grooves and an oval hole for compressing the screw. Another plate has few round holes for fixing screw and two or three sliding grooves for compression. The sliding groove of this plate shows a gentle slope, and an angle of the inclined plane is about 12-15 degrees. The attention to use K-U compression plate is as follows; 1) The plate is made to curve along the curvature of bone. 2) Sliding groove of this plate is fixed on thickened side of cortex. 3) An oval hole prevents separating between the plate and the fractured fragment. 4) Screw are inserted at a right angle to the plate.
Clinical and roentgenographical evaluations were made on 75 extracapsular fractues elapsed more than one year after treatment, of which 41 cases were re-examined and the remainders were checked by questionaires. The years of age at injury were 61 on an average and the sex ratio was nearly equal. Twenty one cases were treated conservatively and 53 by internal fixation. An average follow-up period was 4 years and 11 months. The functional results were good in 96% of the total cases. Although no non-union and only one deformity of the femoral head were observed in the 41 cases re-examined, in about 45% of them walking pain, limping and/or disturbance of sitting were detected, which were so slight as not to be felt difficulties in their daily lives. The handicaps were considered to be closely connetced with varus deformity of the femoral neck, and the factors causing varus deformity were discussed with case reports.
The authors report a case of severe gouty arthritis which had passed into deteriorations of his general condition and the articular contractures due to chronicity of juvenile gouty arthritis and renal disturbance. Bed-ridden period of three years was followed by possible weight-bearing with effect of the medicamental and rehabilitations therapies.
The purpose of treatment in Legg-Calvé-Perthes disease is the reduction of the deformity of the capital femoral epiphysis. For this aim, the lower limbs are enclosed from the groins to the toes in a plaster cylinder, and abduction sufficient to introduce the entire epiphysis within the acetabulum and some degree of internal rotation are provided by a wooden bar between the legs. Children in the abduction cast have unrestricted use of the flexion-extension range of hip motion. Weight-bearing is forbidden, but surprising range of activities are rapidly developed and enjoyed. The cases, which were treated in abduction cast for 12 months or more were studied using the measurement technique of Heyman and Herndon. The result are as follows: 1. For the cases with sclerosing, flattening and fragmentation, abduction cast was effective, if femoral epiphysis was entirely put within acetabulum. 2. For the cases in which healing process had already begun, abduction cast was not effective. 3. For the deformity of the femoral neck, not effective.
In 1822, v. Recklinghausen made public his opinion that the disease which is characterized by multiple nodules and pigmentation of skin and tumor of nerve trunk is neurofibromatosis. Since then, this disease has been known to have extremely varied clinical features as skeletal deformity and spinal paralysis. Recently, we have encountered a case of neurofibromatosis with spinal paralysis. The patient, a boy, 6-year-old, has pigmentation all over the body, a plexiform tumor mass of the left plexus brachialis, slight deformities of the cervical vertebrae and spinal paralysis. Recently, He had difficulty in walking, but no bladder or bowel disturbance. After admitting to our Department, laminectomy (C4-7) were perfomed. The large tumor involving the left eighth cervical nerve root was completely removed. This tumor was diagnosed as neurofibroma by pathologic examination. The roentgenograms made four months after operation showed stationary deformity of cervical vertebrae. He has no difficulty in walking.
Charcot like change in leprosy appears only on foot and ankle but not another joint. We found 3 cases of the destruction all over the tarsus, 23 cases on ankle joint, 8 cases on Chopart joint, 4 cases on Lisfranc joint and 7 cases on subtalar joint of 45 joints in totals. Charcot like change in tarsal bone and ankle joint may be caused by repeated distorsion. Clinical finding shows lateral instability. The sclerosis and deformity of the tarsal bone and the loose bodies in ankle joint are reviewed roentgenologically, but there is rare the proliferation of bone. In Chopart joint, Lisfranc joint and subtalar joint, a warm swollen ankle is developed without existing cause, and the stability of foot is good. There are the destruction of the navicular, cuneiforme and calcaneal bones roentgenologically, and these findings show the feature of the leprous osteous osteomyelitis in early stages.
Clinical and experimental studies of peripheral nerve injuries had been reported by many investigators. The authors summarized investigations of 218 patients (245 nerves) with peripheral nerve injuries for five years from 1963 to 1967 and studied about the cause of injuries and prognosis after conservative or surgical treatment. In the distribution of the age, the younger generation and manhood have a majority in the number. One hundred and fifteen cases of the injured nerve were found in the upper extremities, and especially the injuries of radial and ulnar nerve are conspicuous. The majority of the injuries has caused by the trauma. In these cases, oppresion, contusion fracture and sleep are remarkable. The authors concluded as following. 1) We found that surgical treatment had to be performed for some cases of Bell's palsy. 2) The value of the King's operation for the delayed ulnar palsy is remarkable. 3) The diagnostic value of neurography after nerve suture was found.
The authors attempted to summarize results of neurovascular island flap in the thumb treated in our section from 1964 to 1967. The neurovascular flap provided an excellent durable tactile surface with sensation useful for gross grips. Although primitive sensibility was repaired, complete tactile gnosis and reorientation of stimuli can not be obtained. Hyperesthesia occured in all 5 cases for varying periods of time and degrees. It nullified the functional benefits of the operation. For these reasons, if can be applied, local flap (rotation, transposition and advancement flap) is preferred to neurovascular flap, such as small pulp loss.
Both clinical and electromyographical studies were made in 8 cases in which anterior transposition of ulnar nerve had been performed. Period for following up varied from seven months to two years and ten months after operation. The following conclusion were obtained. 1) In seven of the eight cases there were cubitus valgus in more 20 degrees which was followed old fracture of the elbow. 2) The motor improvement was observated in five cases of seven cases, but sensory recovery was noted by three cases of eight. No cases regained normal sensation. 3) The patient in whom the neuroma was noted to be of firm consistence at operation. 4) In electromyographical observation, high amp. NMU voltage were found in most of the muscles examined. 5) In evoked electromyographical studies, there was in nearly all cases a decrease in m. c. v., amplitude and increase in threshold.
Case 1: The 14 year old girl was admitted to our clinic with spastic gait and spastic weakness of the extremities on September, 1963. Although the first diagnosis was the tumor of upper cervical cord, the X-ray pictures revealed the odontoid process to be high and project into the foramen magnum. The narrowing of spinal cavity was found at the part of foramen magnum by myelography. Theese findings suggested that basilar impression caused her neurological signs. Case 2: The 40 year old female had sufferd from unsteady gait for 7 years. Numerous examinations could not explain the cause of her complaints befor she was admitted to our clinic. However, the diagnosis could be readily made by proving the odontoid process to project above Chamberlain's line and MacRae's line. Case 3: The 16 year old male revealed wry neck without tension of the sterno-mastoid muscle. In the lateral view of his cervical spine, the posterior arch of atlas was completely fused with occipital bone. The assymmetry of the atlanto-axial articulation was observed with the high position of the odontoid process. It is obvious that his wry neck is due to the rotation and the malformation of the atlantoaxial articulation. Although basilar impression has been mainly dealt by neurosurgeon, it should be given attention in the field of orthopedic surgery because it associates with malformation of atlas and axis and reveals the signs of cervical cord tumor.
Pain and stiffness of the neck are not uncommonly seen in the patient with rheumatoid arthritis. The x-ray of those patients shows various degree of subluxations of the cervical spine. In our cases the subluxation is most often situated at the atlanto-axial level, but is also less often observed below the second cervical level. One patient reveals the vertical subluxation of odontoid and other shows the posterior displacement of the third cervical spine. Those two patients developed the tetraparesis due to the probable damage of the spinal cord. The degree of the cervical subluxation are closely related to the duration of disease, rheumatoid involvement of the peripheral joint, and the adequacy of the glucocorticoid therapy.
In studying the distribution of the stresses in compression of the cord which are obtained by the photo-elastic experimental analysis of the cross section models of the cervical cord made of polyurethane rubber, we suggest that the characteristic cord lesions being the basis of myelopathy in cervical spondylosis may be formed for the ischemia precipitated by the stresses applied to the vessels within the cord. According to the severity of the cord lesions, myelopathy in cervical spondylosis can be conveniently devided into 3 types. That is, type I shows the symptoms due to the cord lesion in the central area, type 2 in the posterolateral area in addition to the symptoms of type I and type 3 in the anterolateral area in addition to the symptoms of type 2. Of the 47 cases diagnosed precisely as myelopathy in cervical spondylosis, 6 cases were included in type I, 9 cases in type 2 and 32 cases in type 3. Consequently, it becomes apparent that type 3 including advanced cases disturbed severely the gray matter and the anterior part of the posterior columns in the central area and the pyramidal tract in the posterolateral area, and slightly the spinothalamic tract in the anterolateral area, is the distinctive picture of myelopathy in cervical spondylosis. It is concluded that these experimental types coincide with the clinical types of cervical myelopathy from the neurological analysis of the symptoms. The classification of the neurologic symptoms into these clinical types is useful to differentiate myelopathy in cervical spondylosis from the other diseases similar to it.
A series of 32 cases with cervical disc lesions has been studied and followed for 6 months to 4 years after anterior cervical fusion according to the technique of Robinson-Smith or Cloward. The series has been divided into four categories depending on whether the lesion was a soft deplaced disc or hard arthritic spur and whether the presenting complaint was of segmental origin or spinal cord embarrassment. It has been found that results of surgery for the segmental syndromes originating from herniating soft disc are very good. Of patients with spinal compression syndromes originating from arthritic spur 11% have satisfactory results. The results are generally unsatisfactory in the following cases: severe spastic paralysis in the lower extremities, and the severe cervical spondylosis in many vertebral bodies. Cloward's method has failed to correct the anterior angulation of the cervical spine in 7 cases but has induced the remodeling of bony spurs in 2 cases. The severe change of the upper disc of the fused vertebral body are found in one case who gave a history of trauma. We suggest that anterior interbody fusion should be used only in those cases with a clncally and radiologically localized process without severe cervical spondylosis in many vertebrae.
In the foreign liturature, any previous reports of the posterior longitidunal ligament ossification can not be found, but in Japan, several cases are found. Since Tsukimoto and his mates have reported it for the first time in Japan, 1960, a same thing was reported ten-odd times. Only one autopsy case reported by Terayama in 1964. Whereas mecanism of the ossification remain to be discussed. Our autopsy case was man, whose age was 51. First symptome rapidly became serious. Fourteen days after having been ill in bed, laminectomy was done. On the second day following operation, respiration paralysis was suddenly occurred and he died. By macroscopical findings the posterior longitudinal ligment was rising between the second and the fourth cervical vertebra and in it's central part a protuberance was found, and that it pressed extremely the anterior part of the spinal cord. By microscopical findings, the ossification was in advanced stage. We tried to confirm the mechanism of the ossification and it's relation with the clinical figure. Then, from this case, we think the important parts of the ossification is played by the prolapse of the cervical nucleus pulposus, and it's effects on the clinical figure is caused not only by direct pressure, but also the spinal cord by circulation disorder of the anterior spinal atery.
The lumbar spines of 1055 children and young peoples under the age of 20 years, of which males were 601 and females 454, were examined by the anteroposterior, lateral and oblique X-ray. Out of the total, spondylolysis was found in 55 persons (5.2%), being 37 males (6.2%) and 18 females (3.0%). The youngest was a 7-year-old female. According to the age group, no spondylolysis was found in the group under the age of 4 years, and 10 (3.1%) in the group from 5 to 9 years, 25 (5.3%) in the group from 10 to 14 and 20 (10.8%) in the group from 15 to 20 years.
A case of the multiple neurinoma arising from the cauda equina was reported. A man, age of 24, had the low back pain and the radiating pain to the left lower extremity. In Jan. 1968, he admitted with the left sciatica and numbness on his hip. Myelogram revealed intradural tumor. Two cystic tumors were removed and proved the neurinoma histologically.